Bioethics and Medical Ethics Commons^™

Conceptualization Of Evidence Used By Surrogate Decision-Makers To Determine A Patient’S Wishes, Michael Bourgoin, Zach Armstrong, Abram Brummett, Mark C. Navin, Jason Wasserman, Stephanie Swanberg

Posters

Many modern concepts within clinical bioethics can be conceptualized in various ways. This subjectivity is demonstrated when analyzing ideas in the literature about the types of evidence that can or should be used by surrogate decision-makers to determine a patient’s wishes. This project aims to explore normative claims on this topic in order to map out the current landscape of the various understandings of this concept.

Concern For Authenticity In Rational And Relational Autonomy, Joshua J. Daniel, Abram Brummett, Mark C. Navin, Jason A. Wasserman

Posters

The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether …

The Meaning Of Pediatric Assent: A Critical Scoping Review, Natalie Liogas, Amelia Najor, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Levanthal

Posters

The moral obligation to include children and adolescents in medical decisions has been long recognized. Soliciting pediatric assent is a component essential to this effort. Despite the AAP characterization of assent (AAP 1995; AAP 2016), there appears to be a lack of consensus regarding the operational and conceptual meanings of pediatric assent. This this critical scoping review provides an analysis of the varied meanings of pediatric assent in the clinical context.

Pediatric Assent In Clinical Practice: A Critical Scoping Review On The Ethical Justifications For Assent, Amelia Najor, Natalie Liogas, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Laventhal, Mark C. Navin

Posters

Pediatric assent is an important ethical construct, yet there is little agreement on what precisely it means, including the ethical justifications for assent. The term is used to indicate everything from acquiescence to an analogue of informed consent itself. The primary goal of this study is to assess the range of ways that pediatric assent is specified in the clinical ethics literature, as well as what different conceptions intimate about its moral value. This systematic review will summarize the normative claims about pediatric assent in recent literature. Analysis will map divergent constructs and various moral and ethical justifications for pediatric …

Infertility: An Evaluation Of Treatment Modalities And Ethical Considerations, Elise Ferenczy

Senior Honors Theses

This thesis reviews a variety of options for treatment of infertility, along with ethical considerations for each. The basis for ethical concerns will be primarily a biblical worldview, as the goal is to support Christian couples in decisions regarding infertility treatment. The biblical worldview is outlined to provide readers with an understanding of its core principles, and the Bible is used as the primary source for ethical discussion. The most common etiologies of infertility are outlined, followed by treatment modalities grouped by category. While some modalities present very few ethical concerns, others require careful consideration in many regards. Many of …

Ethical Hazards Of Health Data Governance In The Metaverse, Kristin Kostick-Quenet, Vasiliki Rahimzadeh

Center for Medical Ethics and Health Policy Staff Publications

Metaverse-enabled healthcare is no longer hypothetical. Developers must now contend with ethical, legal and social hazards if they are to overcome the systematic inefficiencies and inequities that exist for patients who seek care in the real world.

The Human Role In Artificial Intelligence, Christopher J. Smiley Dds

The Journal of the Michigan Dental Association

The success of AI requires human involvement to ensure that it is used safely and effectively. Transparency, collaboration, and standardization are necessary.

The Ethical Dilemmas Epigenetic Editing In Utero Presents To Christians, Victoria Hendrix

Senior Honors Theses

The development of CRISPR epigenetic editing technology was initially impactful due to its potential for disease treatment. However, despite the potential benefits of epigenetic technology, there exist ethical dilemmas surrounding its use in utero. The review of the ethical dilemmas of epigenetic editing in utero from a Christian perspective showed that research in epigenetic editing is promising, yet fraught with peril. The basic ethical issues of epigenetic editing in utero stem from its inaccuracy, lack of research concerning its effects on offspring, an incomplete understanding of gene interactions, and its connection to eugenics. The ethical concerns particularly relevant to Christians …

Reflections On The Use Of Patient Records: Privacy, Ethics, And Reparations In The History Of Psychiatry, Jonathan Sadowsky

Faculty Scholarship

One of the most common questions we get asked as historians of psychiatry is “do you have access to patient records?” Why are people so fascinated with the psychiatric patient record? Do people assume they are or should be available? Does access to the patient record actually tell us anything new about the history of psychiatry? And if we did have them, what can, or should we do with them? In the push to both decolonize and personalize the history of psychiatry, as well as make some kind of account or reparation for past mistakes, how can we proceed in …

Wellness Review 2022, Part 2, Martin Huecker, Brian A. Ferguson, Jacob Shreffler

Journal of Wellness

Introduction: Similar to prior reviews, the Journal of Wellness editors searched the literature from the second half of 2022 for an interesting and impactful selection of publications on wellness in healthcare professionals.

Methods: Editors conducted a standard keyword search in Pubmed, focusing chiefly on large journals, interventional trials, and other prospective research. We included papers published between July 1, 2022 and December 31, 2022.

Literature in Review: Finding several hundred publications, we excluded editorials, reviews, and some smaller, less generalizable papers. A final 25 significant studies focusing on wellness in medical professionals were sorted into the following categories: logistics, creativity …

The Impact Of Champion Training On A Two-Clinician Indwelling Urinary Catheter Insertion Technique To Prevent Catheter Associated Urinary Tract Infection (Cauti), Punitha Stevenson

Doctoral Dissertations and Projects

Catheter-associated urinary tract infections are a most common and preventable health care associated infection. Approximately 15% to 25% of hospitalized patients receive a urinary catheter during their hospital stay. The PICOT question that guided this quality improvement project was: How does a two-clinician indwelling urinary catheter insertion technique affect the CAUTI rate over one month in one unit? To answer the question, 19 high-quality studies that met the inclusion and exclusion criteria were reviewed. These articles recommended using CAUTI bundle and champion training by the Centers for Disease Control and Prevention to reduce CAUTIs and catheter days. This evidence-based intervention …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Attitudes Toward Personal Health Data Sharing Among People Living With Sickle Cell Disorder, Exemplar For Study Of Rare Disease Populations, Rebecca Baines, Sebastian Stevens, Zainab Garba-Sani, Arunangsu Chatterjee, Daniela Austin, Simon Leigh

Journal of Patient-Centered Research and Reviews

Purpose: Rare conditions are often poorly understood, creating barriers in determining the value treatments can provide. This study explored barriers and facilitators to personal health data sharing among those with one particular group of rare hematologic disorders, ie, sickle cell disorder (SCD) and its variants.

Methods: A single online focus group among those > 18 years of age and living with SCD was conducted. Participants (N = 25) were recruited through a United Kingdom-based SCD charity. Discussions were transcribed verbatim, with data therein analyzed using inductive thematic analysis.

Results: Five primary motivators for sharing health data were identified: improving awareness; knowing …

Patients And Families As Partners In Patient-Oriented Research: How Should They Be Compensated?, Monika Novak-Pavlic, Jan Willem Gorter, Michelle P. Phoenix, Samantha K. Micsinszki, Kinga Pozniak, Lin Li, Linda Nguyen, Alice K. Soper, Elaine Yuen Ling Kwok, Jael N. Bootsma, Francine Buchanan, Hanae Davis, Sandra Abdel Malek, Karen M. Van Meeteren, Peter L. Rosenbaum

Journal of Patient-Centered Research and Reviews

Patient and family engagement has become a widely accepted approach in health care research. We recognize that research conducted in partnership with people with relevant lived experience can substantially improve the quality of that research and lead to meaningful outcomes. Despite the benefits of patient-researcher collaboration, research teams sometimes face challenges in answering the questions of how patient and family research partners should be compensated, due to the limited guidance and lack of infrastructure for acknowledging partner contributions. In this paper, we present some of the resources that might help teams to navigate conversations about compensation with their patient and …

Peer-Supervision Of Nursing Professionals: A Shield Against Burnout, Kyle Gamache, Sarah Gamache, Joseph Robillard

Journal of Wellness

Introduction: Burnout is a major risk in healthcare professions and is a significant contributor to the current nursing shortage. Strategies to combat burnout of healthcare professionals are in desperate need. The purpose of this project is to introduce the clinical peer supervision model as a method to alleviate burnout in nursing professionals.

Approach: Eight nurses from in-patient settings participated in a peer-supervision support group, modeled after existing European nursing and mental health provider-support protocols. To assess the effect of this intervention, qualitative data analysis was conducted on the transcripts of session and the results described. All participants reported statistically high …

Delivery Of The Immune System: Understanding The Development Of The Human Immune System Based On Birth Mode, Sara Abbas

Faculty Curated Undergraduate Works

The creation of the immune system starts from the womb. The expecting mother plays an immense role outside of the genetic influence in developing a neonate’s immune system. The mode of birth has a substantial impact, as the neonate’s initial moments can have lasting impacts on the making of a proper immune system. A mother should have the choice in choosing between a vaginal birth or a cesarean section and this paper looks to provide aid in the decision process by contrasting the two modes in terms of immunological impact, especially as the rate of c-sections climb (1,2). The approach …

Personal Autonomy And Self-Determination Are Crucial For Professionalism In Healthcare, Jason M. Organ, Heather F. Smith, Paul A. Trainor, Kari Allen, Joy Y. Balta, Amy C. Beresheim, Danielle Brewer-Deluce, Kirsten M. Brown, Anne M. Burrows, Kelsey T. Byers, Jessica N. Byram, Andrew S. Cale, Melissa A. Carroll, Thomas Champney, Jon Cornwall, Manisha R. Dayal, Valerie B. Deleon, Martine Dunnwald, Christopher Ferrigno, Gabrielle M. Finn, Glenn M. Fox, Pamela L. Geller, Geoffrey D. Guttmann, Noah Harper, Kelly M. Harrell, Adam Hartstone-Rose, Sabine Hildebrandt

School of Medicine Faculty Publications

No abstract provided.

Jurisgenerative Tissues: Sociotechnical Imaginaries And The Legal Secretions Of 3d Bioprinting, Roxanne Mykitiuk, Joshua Shaw

Articles & Book Chapters

Three-dimensional ‘bioprinting’ is under development, which may produce living human organs and tissues to be surgically implanted in patients. Like tissue engineering and regenerative medicine generally, the process of bioprinting potentially disrupts experience of the human body by redefining understandings of, and becoming actualised in new practices and regimes in relation to, the body. The authors consider how these novel sociotechnical imaginaries may emerge, having regard to law’s contribution to, as well as its possible transformation by, the process of 3D bioprinting. The authors draw on Gilbert Simondon and corporeal, material feminists to account for these disruptions as ‘ontogenetic,’ in …

Public Opinion And Support On Physician Assisted Suicide, Emma Gottschalk

Political Science Theses and Capstones

I investigate the connection between public opinion and physician assisted suicide, using data in the SPSS data set from 2021. The strength of support a person feels towards PAS and what influenced that view is studied, religious affiliation, age, sex, education level, income, race, and region are considered in the study. The data set was collected through surveys that willing persons over the age of 18 completed. I analyze who is more willing to support PAS and why. I find that religion has a huge impact on public support for PAS, while other factors like education, sex, age and race …

"Life Unworthy Of Life" Aktion T4: The First Nazi Genocide, Alexander M. Remington

Student Publications

Though usually viewed as a prelude to the Holocaust, the T4 euthanasia program was a distinct genocide carried out by the Third Reich’s doctors. Allowing themselves to be corrupted by eugenics and Nazi policy, the perpetrators of the Nazi euthanasia killings transformed themselves from healers to murderers. Despite public resistance led by Bishop Clemens von Galen which resulted in the cancellation of the T4 program, Nazi doctors took it upon themselves to continue euthanizing patients until the end of the war, emphasizing the legitimacy that euthanasia had acquired. The history of the T4 program, its perpetrators, and resisters is critical …

The Revolutionary Genome Editor: Crispr-Cas9 Systems, Grace Spade

Senior Honors Theses

Genetic engineering is the modification of an organism's genetic material to alter its traits through adding, deleting, or changing specific genes. CRISPR-Cas9 systems are groundbreaking tools for genetic engineering, in short utilizing a molecule called RNA to guide a protein called Cas9 to a specific location in DNA to add, delete, or replace genes. The history of how the CRISPR-Cas9 systems came into existence, how it was adapted from a natural defense system in bacteria, and its mechanism of action in both are explained. Its applications, both present and future, competing genetic modifiers, advantages and disadvantages, and the ethical dilemmas …

In Vitro Gametogenesis: A Research Timeline And Implications For The Future Of Assisted Reproductive Technology, Nicole Buckley

Senior Honors Theses

The novel reproductive technology, In Vitro Gametogenesis (IVG), includes the process of obtaining mature viable germ cells from pluripotent stem cells. To do so, embryonic stem cells and induced pluripotent stem cells are specified to primordial germ cells and differentiated to form gametes that undergo further maturation, which subsequently may undergo in vitro fertilization to form an embryo. With this capability, IVG holds the power to provide a novel treatment option for human infertility. As of now, research has been conducted on mice successfully, and with limited success in humans. Future research will likely focus on discovering the species-specific differences …

Where Do We Draw The Line? The Ethical Dilemma Involved In Genetic Engineering And Gene Therapy, Amber Schrag

Senior Honors Theses

Genetic engineering and gene therapy are greatly disputed in our time. With the advancement of technology, one has the power to manipulate genes in the body, which raises the questions: What is our role in this? Is there a limit to this power, or should there be? This paper reviews the uses of this technology and evaluates the ethics from a scientific and Biblical point of view. It is concluded that using gene therapy to help cure diseases is very beneficial in both the scientific and Biblical realm as it is restoring individuals back to health and wholeness.

Moral Injury To Inform Analysis Of Post-Traumatic Stress Disorder, Amanda Julia Manea

Senior Theses

Post-traumatic stress disorder (PTSD) is a mental health condition that almost one out of ten veterans struggle with. Although the National Center for PTSD has made extensive progress in characterizing and developing new treatments for PTSD, most veterans still experience symptoms of PTSD following treatment. Novel avenues of investigation, such as developing algorithms to review electronic health record (EHR) data and better understanding moral injury, are being pursued to address the gap that still exists when it comes to treating veterans. Moral injury is the individual evaluation of exposure to a potentially morally injurious event (PMIE) and can lead to …

The Ethical Challenges Of Newborn Screening Programs In The United States, Devin Donovan

Senior Theses

Newborn screening programs have been mandated throughout the United States since the 1960s, and technological advancements have allowed for their evolution into the essential public health entities they are today (Arnold 558). These programs screen newborns for a variety of congenital and genetic conditions in all states, but each state varies in conditions screened and policies for collecting and using samples. Residual blood spots are a key component of these programs because they are often used for secondary purposes, such as for quality assurance and public health or biomedical research (Botkin et al. 121). Ethical challenges have arisen related to …

International Society For Prenatal Diagnosis 2022 Debate 3-Fetal Genome Sequencing Should Be Offered To All Pregnant Patients, Ignatia B Van Den Veyver, Yuval Yaron, Zandra C Deans

Center for Medical Ethics and Health Policy Staff Publications

Prenatal trio exome sequencing (ES) has become integrated into the care for pregnant women when the fetus has structural anomalies. Details regarding optimizing indications for prenatal exome sequencing, its detection rates with different categories of fetal anomalies, and principles of interpretation of pathogenicity of sequence variants are still under investigation. However, there is now growing consensus about its benefits for finding the cause of fetal structural anomalies. What is not established, is whether exome or genome sequencing (GS) has a place in the care of all pregnant women. This report is a summary of the debate on this topic at …

Things That Make You Go Hmm: Myths And Misconceptions Within Cognitive-Behavioral Treatment Of Obsessive-Compulsive Disorder, Samuel D Spencer, Jordan T Stiede, Andrew D Wiese, Andrew G Guzick, Matti Cervin, Dean Mckay, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on …

Key Drivers Of Family-Level Utility Of Pediatric Genomic Sequencing: A Qualitative Analysis To Support Preference Research, Hadley Stevens Smith, Emily S Bonkowski, Raymond Belanger Deloge, Amanda M Gutierrez, Alva M Recinos, Tara A Lavelle, David L Veenstra, Amy L Mcguire, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Given that pediatric genomic sequencing (GS) may have implications for the health and well-being of both the child and family, a clearer understanding of the key drivers of the utility of GS from the family perspective is needed. The purpose of this study is to explore what is important to caregivers of pediatric patients regarding clinical GS, with a focus on family-level considerations. We conducted semi-structured interviews with caregivers (n = 41) of pediatric patients who had been recommended for or completed GS that explored the scope of factors caregivers considered when deciding whether to pursue GS for their child. …

Are Human Papillomavirus Knowledge And Vaccine Uptake Associated With Hiv Status And Social Determinants Of Health In Young Sexual Minority Men?, Trisha L Amboree, Alan G Nyitray, John Schneider, Nick Gargurevich, Jacky Kuo, Elizabeth Y Chiao, Lu-Yu Hwang, Kayo Fujimoto

Center for Medical Ethics and Health Policy Staff Publications

This brief report examines the relationship, if any, between human immunodeficiency virus (HIV) status, and individual-level and socio-sexual partner-level factors of social determinants of health (SDOH) that are associated with human papillomavirus (HPV) knowledge and vaccine uptake in young sexual minority men (YSMM). We used data from 126 YSMM recruited by network-based sampling during 2015-2016 in Houston, Texas. Descriptive statistics and regression analyses were conducted to test the association between HIV status, SDOH, and HPV knowledge and vaccine uptake. Those living with HIV had lower odds of knowledge of HPV-associated anal cancer (OR: 0.43, 95% CI: 0.18-0.97) and knowledge of …