Bioethics and Medical Ethics Commons^™

The Fiduciary Argument Against Conscientious Refusal In Healthcare, Michael Robinson

Philosophy Faculty Articles and Research

The question of when, if ever, healthcare professionals with conscientious objections should be accommodated by permitting them to refuse to provide medical interventions to which they morally object is a heated issue that has received significant attention in the medical ethics literature. While many professional medical associations have long held that such objections may be accommodated in a broad range of cases, a vocal and growing minority has been fervently arguing that the medical profession should cease accommodating conscientious objections and should rarely, if ever, permit clinicians to refrain from providing medical care merely because it conflicts with their conscience. …

Brief Of Public Health And Health Law Scholars As Amici Curiae Urging Affirmance In Support Of Plaintiffs-Appellees, Rachel L. Zacharias, Zeinab Bakhet, Kevin Costello, Maya Manian

Amicus Briefs & Court Filings

INTRODUCTION: Physicians’ use of their judgment and expertise to prescribe drugs and devices for purposes other than those approved by the Food and Drug Administration (“FDA”)—colloquially known as off-label use—is an indispensable feature of modern medicine. The FDA approves drugs as “safe and effective for specific indications.” Christopher M. Wittich, Christopher M. Burkle & William L. Lanier, Ten Common Questions (and Their Answers) About OffLabel Drug Use, 87 Mayo Clinic Procs. 982, 982 (2012). Federal law then generally leaves prescribing decisions, including off-label use of FDA-approved drugs and devices for a patient’s particular indication, to physicians acting under state law …

A Treatise On Tool Development: The Arthroscope’S Cultural, Technological, And Metascientific Translation, Montgomery F. Waterer

Honors Theses

The arthroscope was a revolutionary development in the fields of medicine, engineering, and ethics. There are many valuable lessons to be learned from the story of its development and translation that are relevant to the future of medicine and society. Beginning with a brief description of the tool’s design, this paper will examine a period within the history of the arthroscope. This window contains multiple innovators and ends with the life and work of Dr. Robert Jackson. In examining the relevant historical facts of its development, this paper will then briefly address the importance of sports medicine in the development …

Statistical Inference Is Not Moral Reasoning: The Case Against Ai On Hospital Ethics Boards, Elan J. Haronian

Seaver College Research And Scholarly Achievement Symposium

As generative AI becomes more integrated in healthcare, it seems inevitable that AI will eventually be used on hospital ethics committees. However, before implementation, their roles need careful consideration. Although AI promises to reduce costs, increase efficiency, and reduce human workloads, there are important ways in which it is limited, especially when human emotion and connection are crucial, as in clinical ethics boards.

In this paper, I highlight several problems preventing AI from being useful on hospital ethics boards. These include issues of opaque reasoning (the “black box” problem), liability, transparency, privacy, and consent. While there are proposed frameworks for …

Justice, Autonomy, Beneficence, And Non-Maleficence: The Global Failure To Heed Ethical Mandates In Birth Spaces, Julia Dees

Richard T. Schellhase Essay Prize in Ethics

Respectful and safe care in all birthing spaces has long been an ideal that global communities fail to meet. Birthing people are disrespected, physically or emotionally harmed, or left to completely fend for themselves during a period of extreme emotional and medical vulnerability. Historically, autonomy especially has been ignored in birthing spaces with medical trends like the twilight sleep, where women were drugged into a state of unconsciousness during birth (Taylor, 2023), demonstrating the desire of western medicine, in particular, to reduce birthing people to bystanders in their own birth. While birth trends and medical treatments have changed throughout time, …

The History Of Dr. Suess And European Dentists From The Past: Relevant Lessons In Bioethics For Today, Howard A. Israel Dds, Facd

Journal of the American College of Dentists

The works of the author-illustrator Dr. Seuss evoke images of children’s books with moral themes, such as Yertle the Turtle and Horton Hears a Who. The life story of another Dr. Suess has remained relatively unknown. Walter Suess was an extremely talented dentist and musician in Austria. Brilliant and courageous, he became a victim of a morally depraved authoritarian regime and the absence of biomedical ethics during the reign of the Third Reich. The serendipitous discovery of the true story of Dr. Seuss and European dentists from this era offers lessons in bioethics relevant to today.

Capacity Over Cognition: A Case Of High-Risk Disease And Homelessness, Mikalah E. Maury, Avery M. Duncan, Rebecca A. Taylor, Mary Ann Beil, Maulikkumar A. Patel

HCA Healthcare Journal of Medicine

Background

Medical decision-making in indigent patients with baseline cognitive deficits and lack of supportive resources is a difficult problem that reveals many ethical issues. Performing high-level medical procedures (eg, invasive surgery, chemotherapy, radiation therapy) on these patients without supportive resources brings into question the efficacy and necessity of treatment if it places the patient at higher risk of additional complications and mortality.

Case Presentation

In this article, we present a case of a 62-year-old indigent man with a long history of encephalopathy secondary to alcohol abuse, presenting with an aggressive head and neck cancer impacting his quality of life.

Conclusion …

Ethics Committees In Outpatient Medical Practice: A Scoping Review, Milan Arya, Tyler Cholankeril, Marlowe Bogino, Meghan Crnic, Niharika Sathe, Isha M. Di Bartolo

Cooper Rowan Medical Journal

Introduction: This scoping review consolidates existing research on outpatient ethics committees (OECs). While inpatient or hospital ethics committees are well-researched and established, OECs are scarce in number and have received less attention from scholars, ethicists, and physicians, despite the increase in outpatient care utilization over the past two decades.

Methods: We conducted a scoping review following the JBI Manual for Evidence Synthesis. Key information sources included MEDLINE PubMed, Embase, and Academic Search Complete. Gray literature searching was conducted through Web of Science Database, keyword searching in Google Scholar, and backward citation searching was utilized. Relevant articles were screened …

Inside The Mad Mind: Medical Ethics In 19th Century Fiction, Danielle Dentremont

College Honors Program

The professionalization of medicine in mid-to-late 19th century America and Britain corresponded with heightened critical scrutiny of the ethics of doctor-patient relationships in contemporary fiction. With ethics frameworks of the century focused primarily on good fellowship between practitioners, it was difficult to charge practitioners with bad ethics. Yet, the broader debates of vivisection and women’s rights brought to light power imbalances between men and women that novelists began to suggest were present in medicine as well. Wilkie Collins’ Heart and Science weighs in on the danger of the doctor-scientist encroaching on women’s rights with the suggestion that women will be …

Who Should Be Held Accountable In Technology-Induced Medical Errors? Evaluating The Roles Of Healthcare Providers, Technology Developers, And Hospital Systems, Eleanor Roy, Amir Arshia Emam Jomeh

Journal of Health Ethics

The integration of technologies such as artificial intelligence, electronic health records, and automated diagnostic systems has significantly altered clinical practice. While these tools enhance efficiency and diagnostic accuracy, they have also introduced new forms of medical error, raising complex questions about responsibility. This article examines the ethical dimensions of accountability in technology-induced harm by evaluating the roles of healthcare providers, technology developers, and hospital systems. Drawing on the four pillars of medical ethics; autonomy, beneficence, non-maleficence, and justice, it explores the overlapping responsibilities of each stakeholder and the challenges that arise when harm occurs. Through analysis of the Therac-25 radiation …

The Impact Of Medical Ethics On Healthcare Professionals And Patient Outcomes In Resource-Poor Settings: A Focus On Ethical Challenges And Solutions, Amir Arshia Emam Jomeh, Eleanor Roy

Journal of Health Ethics

Background: Developing countries face major challenges to their healthcare system such as resource scarcity and reduced patient autonomy amongst women. The strained healthcare system often leads doctors to compromise ethical protocols and reduce their standard of care.

Aims: To explain why medical ethics are important for healthcare professionals in the context of resource-poor countries.

Findings: Many healthcare professionals lack adequate knowledge of medical ethics in developing countries. In addition, doctors make difficult decisions such as patient prioritization and resource allocation without clear ethical guidance or protocols. Women also face diminished patient autonomy in developing countries, which has been linked to …

Should Medical Assisted Suicide Be Legalised Worldwide? A Critical Examination Of Ethical Justifications And Challenges In Contemporary Healthcare, Eleanor Roy, Amir Arshia Emam Jomeh

Journal of Health Ethics

The legalisation of medical assisted suicide (MAS) is a complex ethical issue at the intersection of autonomy, non-maleficence, and justice. This paper critically examines whether MAS should be legalised worldwide, evaluating ethical justifications, regulatory challenges, and societal risks. A primary argument in favour of MAS is patient autonomy, allowing individuals to make informed end-of-life decisions, particularly in cases of terminal illness and intractable suffering. MAS is also framed as a harm-reduction strategy, preventing patients from resorting to unsafe methods of suicide.

However, ethical concerns regarding coercion, socioeconomic disparities, and the "slippery slope" effect present significant opposition. Case studies from jurisdictions …

Brief Videos During Informed Consent May Be Helpful For Participants' Understanding Of Study Information, Abby L. Braitman, Rachel Ayala Guzman, Kristin E. Heron

Psychology Faculty Publications

Although an informed consent process is required for all research, it is not clear how well study participants read informed consent forms and understand their content. A systematic review of medical clinical trials revealed participants had only a 50% rate of understanding for concepts of the consent process, including voluntary participation, blinding, and freedom to withdraw, with lower rates for randomization, risks, and safety issues (Pietrzykowski & Smilowska, 2021). This issue may be more pronounced for online research, with a recent study indicating half of participants report not reading informed consent forms at all (Perrault & Keating, 2017). Although increasing …

Incorporating An Analytical Approach To Ethical Reasoning Into An Ethics Case Conference For Residents, Holland Kaplan, Alyssa Kahl, Jonathan Lim

Center for Medical Ethics and Health Policy Staff Publications

Educating residents to apply ethical principles in clinical practice is critical in achieving standards in professionalism. We implemented biweekly ethics morning report case conferences incorporating a validated analytical tool in medical ethics, the Four-Box Method, from July 2022 to June 2023 in our internal medicine residency program. In 24 ethics morning reports, over 73% of participants reported that the intervention helped them achieve each of three learning objectives in ethics education. Ninety-two percent of cases addressed > 1 ethical issue. Our intervention may be easily integrated into the morning report conference structure as an educational tool in medical ethics across internal …

Medical Practice As Rhetorical Art Functional Medicine’S Therapeutic Partnership, Cristina Elena De León-Menjivar

English Theses & Dissertations

The current rates of provider burnout are at an all-time high, and our healthcare system is currently seeing numerous providers leave the system. The U.S. Surgeon General has deemed burnout rates at crisis levels, creating an exigency for research and work to help ameliorate this issue. One main issue at the heart of provider burnout is the idea of meaning and purpose in one’s professional life, and Functional Medicine methodology argues that it provides the means by which it can mitigate burnout while improving professional fulfillment and joy through deeper connections with patients. Their methodology is rooted in a concept …

Bioethics And A Theology Of Vulnerability, Carrie Oneil-Smith

Obsculta

This essay looks at how a theology of vulnerability can contribute to ethical decision-making in an increasingly secular society. Relationality, power dynamics and scriptural justifications are considered, as well as early contributions made to this nascent field of Christian thought. This essay was written for a class on Health Care Ethics taught by Dr. Mary Ann Kish.

Early Onset Colorectal Cancer: Research, Trends & Challenges, Sarah E. Smith

Capstone Showcase

Early onset colorectal cancer (EOCRC) incidence and mortality are rising in a global trend, contrasting with improvements seen in late-onset colorectal cancer (LOCRC). EOCRC appears to differ in presentation, histology, and pathology from LOCRC painting concerns of a more aggressive tumor profile. With incidence steadily climbing, there is still lacking awareness and guidance on screening for EOCRC. This article aims to provide background on EOCRC including epidemiology, risk factors, and traits, as well as to explore methods for adjusting provider screening criteria to combat this concerning trend.

“But My Mom Still Blinks When I Talk To Her” Understanding The Concept Of Social Death To Avoid Bias And Improve Goals-Of-Care Discussions At The End Of Life, Joelle Robertson-Preidler, Holland Kaplan

Faculty and Staff Publications

No abstract provided.

Ambivalence At 10 000 Feet, Marc Perlman

HCA Healthcare Journal of Medicine

The transition from medical neophyte to seasoned physician is a gradual process spanning the course of many years. However, there are various milestones throughout the experience that capture increases in decision-making capacity and responsibility, such as the switch from pre-clinical to clinical medical education. Medical students in their clinical years are endowed with an abundance of knowledge from their pre-clinical years and are just beginning to synthesize and apply that information to patient care. “Ambivalence at 10 000 Feet” captures a reflection of a third-year medical student on the theoretical decision to provide emergency medical care in the absence of …

At The End Of Life: Conceptualizing Human Dignity And Assisted Suicide Debates In Contemporary Germany, Edith-Marie Green

Honors Theses

As medicine improves and breakthroughs on cures for illnesses formerly thought deadly continue to develop, the global population continues to age. This has introduced new concerns about aging and end-of-life health care. One proposed end-of-life healthcare solution is assisted suicide, although the practice is not without its controversies. The case of assisted suicide in Germany is of particular interest for a variety of reasons, and the practice has not had an easy path there. A series of debates in 2015 led to the practice being banned, but that ban was overturned in 2020 by Germany’s Constitutional Court. While assisted suicide …

Ai In The Hands Of Imperfect Users, Kristin M Kostick-Quenet, Sara Gerke

Center for Medical Ethics and Health Policy Staff Publications

As the use of artificial intelligence and machine learning (AI/ML) continues to expand in healthcare, much attention has been given to mitigating bias in algorithms to ensure they are employed fairly and transparently. Less attention has fallen to addressing potential bias among AI/ML's human users or factors that influence user reliance. We argue for a systematic approach to identifying the existence and impacts of user biases while using AI/ML tools and call for the development of embedded interface design features, drawing on insights from decision science and behavioral economics, to nudge users towards more critical and reflective decision making using …

Impact Of A Multifaceted Intervention On Physicians' Knowledge, Attitudes And Practices In Relation To Pharmaceutical Incentivisation: Protocol For A Randomised Control Trial, Muhammad Naveed Noor, Mishal Khan, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Iqbal Azam, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Introduction: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
Methods and analysis: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and …

Discussing The Injustice Of The Covid-19 Vaccine Pass Imposed On Medical Consultation In Public Hospitals In Hong Kong, Fung Kei Cheng

Journal of Health Ethics

The COVID-19 pandemic has devastated public health, economy and social life all over the world, especially wherever a vaccine pass scheme has been implemented. Many countries have begun to relax schedules to return to normal activities. In contrast, Hong Kong continues to tighten the utilisation of a vaccine pass for medical services in order to boost vaccination rates. Such a practice not only significantly challenges ethical and operative concerns but also threatens health equity and social justice for healthcare decision-makers and practitioners, consequently hurting public health and community well-being. This discussion analyses the various arguments, reviews vaccine hesitancy and suggests …

Understanding The Role Of Race In American Medicine, Fariel C. A. Lamountain

Honors Theses

Long running inequity in health care and outcomes in the United States stem from failure to acknowledge the underlying role of the Transatlantic slave trade as it manifests in all facets of American society and commerce. This paper focuses specifically on the American medical system and its foundations to understand the precursors to generational trends in lack of access to healthcare and poor health for Black communities. This paper uses a three-pronged approach to understand the racist cycle of inequity, highlighting the history and origins of racism in American medicine, personal accounts and statistical evidence of inequity, and community and …

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 …

Adolescent Medical Decisionmaking Rights: Reconciling Medicine And Law, Doriane Lambelet Coleman, Philip M. Rosoff

Faculty Scholarship

Dennis Lindberg came into his aunt’s care when he was in the 4th grade because his parents struggled with drug addiction and could not provide for him. At thirteen, he was baptized in his aunt’s faith as a Jehovah’s Witness. Just days after he turned fourteen, on November 6, he was diagnosed with acute lymphoblastic leukemia.

The prognosis was that Dennis had a 75% chance of cure with standard oncology treatment. Consistent with the requirements of his new faith, however, Dennis told his doctors, “I do not want to be treated if the requirement is that I would have to …

The Bioethical Implications Of Genetic Screening Programs For Rare Diseases, Ellie Pitcher, Jeremy Mccallum

Honors Thesis

In the United States, there are currently thirty-five hereditary medical disorders that the Department of Health and Human Services recommends for newborn screening. The early diagnosis of these disorders is critical to the health and well-being of affected individuals. There are many more rare genetic diseases that would benefit from early diagnosis, but which do not symptomatically present until late in life or have low penetrance. Some of these genetic diseases are extremely dangerous, and would massively benefit from the early diagnosis that accompanies newborn screening in the United States. Here the benefits and risks associated with early screening for …

Ethical Considerations Regarding Paternalism In Medicine, Lola Holcomb

Richard T. Schellhase Essay Prize in Ethics

Paternalism and autonomy are typically conceptualized as opposing theoretical frameworks. With respect to medical ethics, autonomy is practiced by the patient when he/she has liberty and control over his/her own medical matters, and his/her opinions supersede those of the physician. Paternalism is practiced by the physician when he/she restricts the patient’s autonomy (sometimes against the patient’s will) to promote health and well-being while discouraging undesirable behaviors. This paper details and analyzes a number of cases of medical paternalism in practice, both from the past and in the present day, with the purpose of examining associated ethical considerations. Attention is given …

Case Studies In Medical Ethics In The 20th & 21st Centuries As Told Through The Perspective Of A Human Life, Madelynn Wildes

Senior Theses

This paper is an analysis of different case studies in medical ethics in the 20th and 21st century. The case studies are divided into three different categories of a human life: beginning of life, middle of life, and the end of life. Each of these chapters includes a little excerpt about a person named Jane as she goes through each stage of her life. This merely serves to humanize the topics covered a little more. The beginning of life covers topics such as abortion and eugenics and discusses court cases and ethical dilemmas surrounding them. The middle of life covers …

Disease Mongering: How Sickness Sells, Vanessa C. Iroegbulem

Augustana Center for the Study of Ethics Essay Contest

“Disease mongering” is the practice of widening diagnostic boundaries of an illness and promoting their public awareness to expand the markets for treatment and to increase profits. This tactic typically used by pharmaceutical companies, medical equipment manufacturers, insurance companies, and even some doctors and patient groups, has become a great concern. Disease mongering has since increased in parallel with “medicalization,” which attempts to label normal human conditions as medical problems, thus becoming the subject of medical study, diagnosis, prevention, or treatment. This paper first seeks to examine how an increasing amount of life’s natural conditions and ailments are being seen …