Bioethics and Medical Ethics Commons^™

Informed Consent: Foundations And Applications, Joanna Smolenski

Dissertations, Theses, and Capstone Projects

Since its advent in the 20th century, informed consent has become a cornerstone of ethical healthcare, and obtaining it a core obligation in medical contexts. In my dissertation, I aim to examine the theoretical underpinnings of informed consent and identify what values it is taken to protect. I will suggest that the fundamental motivation behind informed consent rests in something I’ll call bodily self-sovereignty, which I argue involves a coupling of two groups of values: autonomy and non-domination on the one hand, and self-ownership and personal integrity on the other. I will then go on to consider two 'case …

Must Consent Be Informed? Patient Rights, State Authority, And The Moral Basis Of The Physician's Duties Of Disclosure, D. Robert Macdougall

Publications and Research

Legal standards of disclosure in a variety of jurisdictions require physicians to inform patients about the likely consequences of treatment, as a condition for obtaining the patient’s consent. Such a duty to inform is special insofar as extensive disclosure of risks and potential benefits is not usually a condition for obtaining consent in non-medical transactions.

What could morally justify the physician’s special legal duty to inform? I argue that existing justifications have tried but failed to ground such special duties directly in basic and general rights, such as autonomy rights. As an alternative to such direct justifications, I develop an …

Make Your Wishes Known: Understanding The Challenges And Barriers For Providing Effective Ethics Consults To Low-Income African American Men, Ruth Nwefo

Symposium of Student Scholars

The distrust of the U.S. health care system is prevalent, especially within the African American (AA) community. This distrust is largely based on infamous cases such as the Tuskegee Syphilis Experiment and experiments conducted by James Marion Sims on slave women without anesthesia. While these experiments along with many others further advanced medicine, they severed trust between health care institutions and the African American community, bringing upon repercussions still felt today. Although many steps have been taken to rebuild trust in the health care system by establishing effective ethical guidelines, more needs to be done in terms of rebuilding the …

Opioid Abuse: Are Doctors Creating The Problem?, Nguyen Tran

Symposium of Student Scholars

Opioid abuse and overdose are serious health problems in the United States. Current research has concentrated on the treatment and prevention of opioid abuse. Using data from the Controlled Substance Utilization Review and Evaluation System (CURES) for California zip codes, my research focuses on the causes of opioid overdose by considering the relationships between the following variables within each zip code: population size, average number of prescriptions per doctor, percentage of people who receive opioid prescriptions, percentage of people receiving the same prescription drug from 3 or more doctors, average number of opioid pills per prescription and number of people …

Beneficial Effects Of The 30-Minute Door-To-Needle Time Standard For Alteplase Administration, Suja S Rajan, Marquita Decker-Palmer, Jessica Wise, Thanh Dao, Cindy Salem, Sean I Savitz

Faculty and Staff Publications

Objective: The American Heart Association recently raised the bar on the timely treatment of acute ischemic stroke (AIS) with intravenous alteplase. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times of alteplase initiation on the clinical, quality of care, and efficiency of care outcomes.

Methods: This retrospective case-control study examined 752 AIS patients treated with intravenous alteplase in a large academic health system during 2015-2018, and compared their outcomes after treatment within 30, 45, and 60 min of arrival. The outcomes compared were: (1) clinical - discharge and 90-day modified Rankin …

Future Space Missions And Human Enhancement: Medical And Ethical Challenges, Konrad Szocik, Mark Shelhamer, Martin Braddock, Francis A. Cucinotta, Chris Impey, Pete Worden, Ted Peters, Milan M. Ćirković, Kelly C. Smith, Koji Tachibana, Michael J. Reiss, Ziba Norman, Arvin M. Gouw, Gonzalo Munévar

Health Physics and Diagnostic Sciences Faculty Research

Future human space missions to Mars and beyond may be realized for different research, economic, political or survival reasons. Since space remains a hazardous environment for humans, space exploration and exploitation requires the development and deployment of effective countermeasures. In this paper, we discuss prospects for human enhancement by gene editing, synthetic biology, or implants, for the purposes of future space missions. We argue that there are good reasons to consider such options, and that ethical arguments can be made in favor of human enhancement to enable long-term space exploration.

Cross-Sectional Analysis Of Patient-Centered Language Use In Journals Publishing Research Focused On Heart Failure, Vivian Pham, Benjamin Greiner, Ryan Ottwell, Matt Vassar, Micah L. Hartwell

Journal of Patient-Centered Research and Reviews

Purpose: Detrimental effects of using non–patient-centered language (nPCL) have been reported for diabetes, mental illness, and obesity, and both the American Medical Association (AMA) and International Committee of Medical Journal Editors (ICMJE) recommend using patient-centered language in medical literature. Heart failure is a common yet stigmatized disease, and nPCL may further propagate stigma. This study analyzed current use of nPCL in journals focused on heart failure research and also examined whether the journals steer authors to adhere to AMA or ICMJE guidelines regarding nPCL.

Methods: Following systematic search of PubMed for heart failure-related articles published from May 1, 2018, to …

Preprints In Times Of Covid19: The Time Is Ripe For Agreeing On Terminology And Good Practices, Raffaella Ravinetto, Céline Caillet, Muhammad H. Zaman, Jerome Amir Singh, Philippe J. Guerin, Aasim Ahmad, Carlos E. Durán, Amar Jesani, Ana Palmero, Laura Merson

Section of Nephrology

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to "unlearn" what we …

Black And White Health Disparities: Racial Bias In American Healthcare, Yasmeen Almomani

Bridges: An Undergraduate Journal of Contemporary Connections

This paper explores the historical implications of race in American society that have led to implicit racism in the healthcare system. Racial bias in healthcare against Black people is a factor in the health disparities between Black and white people in America, such as the gap in life expectancy, infant death, and maternal mortality. Black people are more likely to report racial discrimination from healthcare providers, which is a reason for the decreased quality of care received. The past justifications of slavery, the Tuskegee syphilis study, and the medical experimentations on Black women are horrifying but were considered acceptable in …

Information Needs Of Traditional Medicine Practitioners (Tmps) In Nigeria With A Particular Reference To Alimosho Local Government Of Lagos State, Adeniran Pauline Oghenekaro Mrs.

Library Philosophy and Practice (e-journal)

Information plays a crucial role in modern society. It helps people to develop their knowledge of the world. This knowledge guides them against mistakes leading to effectiveness and efficiency in all aspects of life. This survey aimed to determine the Information needs and sources of Information of Traditional Medicine Practitioners (TMPs) in Nigeria with reference to Alimosho Local Government Area of Lagos State. The study population comprised forty (40) registered traditional medicine practitioners in Alimosho Local Government Area of Lagos State. The questionnaire instrument was used for data collection in which forty (40) copies were administered to the traditional medicine …

Black Lips Don't Turn Blue: A Womanist Critique Of Discriminatory Language In Medical Education, Alison Lawrence

Womanist Ethics

This paper examines race and gender inequities in healthcare as it pertains to the unequal presentation of descriptors of illness in medical textbooks. The author adopts a womanist perspective to criticize the use of the white male body as the standard for all patients, which causes signs and symptoms in women and people of color to be dismissed as less important. Following an analysis of normalizing language in current medical texts as well as its consequences for patients, the author calls for a system-wide shift to more inclusive, intersectional medical education that not only acknowledges differences among patient groups, but …

The Violence Of Postmodern “Gender Identity” Medicine, Heather Brunskell-Evans

Dignity: A Journal of Analysis of Exploitation and Violence

The medical “transition” of children with “gender dysphoria” is increasingly normalized in North America, Western Europe, Australia, New Zealand, and the United Kingdom. Although each country has specific national gender identity development services, the rationale for prescribing hormone treatment is broadly similar. A minority rights paradigm underpinned by postmodern theory has gained traction in the past 10 years and has been successful in influencing public policy, the education of pediatricians, endocrinologists, and mental health professionals. In this view, any response other than an affirmation of the child’s claim to be the opposite sex or “born in the wrong body” is …

Meilaender's "Bioethics: A Primer For Christians, 4th Ed." (Book Review), Carl P. Olson

The Christian Librarian

No abstract provided.

Demographics, Activities, And Environmental Factors Impact Burnout In A National Survey Of Emergency Medicine Residents, Nicole Battaglioli, Tim P. Moran, Simiao Li-Sauerwine

Journal of Wellness

Introduction: Burnout in emergency medicine and in residency training has been well-described. The impact of demographic, individual, and programmatic factors on burnout have not previously been determined in a national survey of emergency medicine residents. This study aimed to identify personal and environmental factors impacting resident burnout in a national sample of emergency medicine residents.

Methods: A prospective Emergency Medicine Resident Wellness Survey was administered in 2017. We surveyed respondents on demographic, personal, and environmental factors; each respondent also completed the Maslach Burnout Inventory - Human Services Survey. Linear regressions were used to identify variables associated with the Maslach Burnout …

A Qualitative Study On The Factors Affecting The Willingness Of 3rd Level Students To Register As Organ Donors In Ireland, Evelyn Hayes, Erika Horan, Cian Lally, Aisling Murphy

International Undergraduate Journal of Health Sciences

A wide range of factors contribute to an individual’s choice whether or not to register as an organ donor. The knowledge of the Irish population at large around the area of donation and transplantation is varied. A research survey was designed to be completed by third level students. The purpose of the research was to determine the most important factors that played a role in their decisions regarding opting-in to organ donation. A second aim of the survey was to determine the participants’ levels of knowledge and understanding on the ‘opt in’ donation system in place here in Ireland.

The …

Full Issue: The International Undergraduate Journal Of Health Sciences, Volume 1, Issue 1, June 2021, Iujhs Full Issue

International Undergraduate Journal of Health Sciences

The full June 2021 issue (Volume 1, Issue 1) of the International Undergraduate Journal of Health Sciences

Health Care Disparities Around The Globe, Brianna N. Hodak, Renee Nicholson

Mountaineer Undergraduate Research Review

In Honduras, there are only 0.8 physicians for every 1,000 citizens, creating a nearly insurmountable barrier on the ability to access health care for the impoverished lower and middle classes. Various health care models that a country adopts directly affects the quality of life of its citizens, including access to care and clean water, advocacy of preventative methods, and life expectancy. By analyzing models, such as the “Out-of-Pocket”, Beveridge, and Bismarck models, one can see that there are positive and negative aspects in every system. It can also be seen that the American Healthcare system is also in dire need …

The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber

The Review: A Journal of Undergraduate Student Research

The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …

Session 2: Access To Health And Health Services Panel - The Covid-19 Experience, Annette Clark, Wendy Chalres, Dan Laster, Anna Santos Rutschman, Madhavi Sunder, Margret Chon

SITIE Symposiums

COVID-19 has had a massive impact on the U.S. and the world regarding health care and health care access. Improving access has been the topic of scholarship for many years. It took the COVID- 19 pandemic to bring these issues to the forefront of public discussion. Inequities in public health access, not only domestically but globally, have become apparent in the light of COVID-19. This expert panel addresses the inequities of vaccines worldwide and the concept of vaccine sharing programs. It also explores the role that intellectual property plays in these equity issues and some of the risks inherent in …

Ethics & Pricing In The Pharmaceutical Industry, Ayo-Oluwa Laleye

Student Research

During the final weeks of Professor Dan Gurnon’s CHEM 343 class, students are given the opportunity to present a topic that intersects with the biochemistry knowledge learned over the course of their semester. For my presentation, I chose to explore a specific ethical and moral issue of drug pricing in the bio-pharmaceutical industry. This presentation dives deep into the metabolic functional pathways of Daraprim, a WHO essential medicine and the scandal that surrounds the pricing of the medication. The cost of Daraprim rose from $13.50 to $750 per pill, a 5455% increase for a medication that costs less than $2 …

Promoting Health Literacy To Aging Christians To Combat The Scourge Of Euthanasia Through The Church, Willie Mae Corley

Doctoral Dissertations and Projects

The many dilemmas that occur in the medical care of chronically ill seniors raise the question of whether senior populations have become the new black. The research seeks to provide an evidence-based review of limited health literacy among elderly African American Christians regarding diagnoses and medical treatments, which has resulted in unethical Christian practices becoming a norm. The researcher adapted the health literacy framework of Paasche Orlow and Wolf’s view of three distinct causes that influence health literacy: the access and utilization of health care, the patient-provider relationship, and self-care. The problem is that Victory Church members may not understand …

Exploring Social Determinants Of Covid-19 Related Sickness And Suffering In The Bronx, Hamida Chumpa

Student Theses and Dissertations

Through a positivistic and phenomenological approach, the study examines social determinants of COVID-19 related sickness and suffering in the Bronx, New York City, New York, ZIP codes 10462, 10472, 10467, 10458, 10474, and 10464. I utilize a violence paradigm (structural and everyday violence) to describe the social determinants of risk and sickness-related suffering and deploy an assemblage framework to shed light on how these determinants create negative synergies that undermine wellbeing and render certain communities vulnerable to extreme suffering. The mixed methods include 64 surveys and eight interviews. Analysis methods include a descriptive analysis of survey results and a thematic …

Biomedical Ethics In The Medical School Curriculum: Lessons Learned From The Holocaust, Emma Flanagan

College Honors Program

The Holocaust, the murder of 6 million Jews, is the only medically-santioned genocide. This thesis explores the roles of Nazi doctors in the planning, organizing, and implementation of the organized mass murder of European Jewry. Given the German medical community’s complicity, it is imperative that physicians today are well informed about their profession’s history of involvement in the Holocaust. In addition, and by way of contrast, a study of the moral challenges faced by doctors imprisoned in concentration camps or in the ghettos of Nazi-occupied Europe might serve to better prepare physicians for future ethical dilemmas. In a survey of …

Do Males With 45,X/46,Xy Mosaicism Have Turner Syndrome, Michelle Knoll

Research Days

Background: Patients with 45,X/46,XY mosaicism can have genitalia spanning the range from typical female to typical male, and the sex assigned at birth is often based on the appearance of the genitalia. According to current nomenclature, only the subgroup assigned female are diagnosed with Turner syndrome (TS) (Gravholt et al, 2017). Clinical practice guidelines recommend that girls with TS be screened for several comorbidities, including short stature, cardiac and renal anomalies, and autoimmune conditions, but there are no recommendations for screening of boys with 45,X/46,XY mosaicism.

Objectives/Goal: We sought to determine if boys with 45,X/46,XY mosaicism exhibited a similar rate …

Pediatric Intensivists' Use Of Nudging In Care Conferences, Aliza Olive

Research Days

Background: Nudging is a behavioral economics term describing a form of choice architecture that affects behavior without eliminating options. Shared decisions with families are made frequently in the PICU during care conferences, where nudging likely occurs, but has not been studied.

Objectives/Goal: We aimed to identify how pediatric intensivists use nudging to guide decision making.

Methods/Design: We conducted a retrospective analysis of 70 PICU care conference transcripts using a validated coding scheme for choice architecture. Choice frames included: saliency, gain loss or mixed frame, yes/no, two options, multiple options, open ended, default, endowment, commission, omission, recommend, expert opinion, certainty, and …

Clash Of Titans: An Ethical Framework Towards Limitations In Religious Accommodation Within Healthcare, Yoelit Lipinsky

Electronic Theses and Dissertations

In late October 2017, a young Canadian Jewish man was at the center of a storm that involved ethics, religion, law and policy He had been unconscious for a month and doctors deemed him brain dead. The Jewish community, and his family, wished to keep him on life support, since their religion did not consider brain death to be ‘death.’ This clash between medical and religious perspectives poignantly illustrates the unique and growing challenges posed by religious observance in Canada’s secular healthcare system. A similar story is found in America. In December 2019, a story was published demonstrating fears that …

Integrating Ethics And The Opioid Crisis Via Simulation: An Ethical Debriefing For Nursing Students, Raigan A. J. Shackelford

Senior Honors Projects, 2020-current

Over the past three decades, opioid medication misuse and abuse has skyrocketed. The increase in improper use has created the need for more frequent exercise of ethical reasoning skills in practice. This study was designed to determine the effect of an ethics-centered debriefing exercise following a standardized simulation scenario concerning opioid misuse/abuse on nursing students’ value of and perceived confidence in ethical reasoning skills. 18 senior level BSN students at James Madison University in Harrisonburg, VA, participated in an ethics- focused debriefing exercise following the simulated scenario. The debriefing was constructed using the ANA Code of Ethics and James Madison …

Professional Ethics For College Health Services, Dessa Mrvos

Electronic Theses and Dissertations

College health services provide a crucial resource for campus communities in the United States, substantially affecting student health, safety, and wellbeing. The impact and quality of campus clinical services impact student life through varied approaches to the delivery of services, health innovations, and business models. The role that campus health services plays in dealing with risk mitigation is essential: well-established public health principles of disease prevention, health promotion, and health education are sustained and advanced by campus clinical health services. Despite the widely recognized importance of college health services, there is very little literature on the contribution of ethics related …

An Ethical Foundation For Genetic Therapy And Gene Editing (Crispr), Nikolija Lukich

Electronic Theses and Dissertations

There are many steps involved in the process of introducing CRISPR-Cas9 into the current health care system. This dissertation provides an ethical foundation for the uses of CRISPR-Cas9 genetic therapies and editing techniques, which organizations can utilize when implementing these new technologies. Multiple components must be examined, including the practical application of the concept of autonomy, which benefits from the inclusion of personalism and care ethics as it aims to provide a more effective method upholding the right to independent decision-making. In addition to individual considerations, population-based decisions and public health tools are explored, connecting the human right to health …

Dying Well In Nursing Homes During Covid-19 And Beyond: The Need For A Relational And Familial Ethic, Jennifer Parks, Maria Howard

Philosophy: Faculty Publications and Other Works

This paper applies a relational and familial ethic to address concerns relating to nursing home deaths and advance care planning during Covid-19 and beyond. The deaths of our elderly in nursing homes during this pandemic have been made more complicated by the restriction of visitors even at the end of life, a time when families would normally be present. While we must be vigilant about preventing unnecessary deaths caused by coronavirus outbreaks in nursing homes, some deaths of our elders are inevitable. Thus, it is essential that advanced care planning occurs in a way that upholds the familial and relational …