Bioethics and Medical Ethics Commons^™

Consequences Of Artificial Intelligence In Health Insurance: Lawsuits, Policy, And Ethics, Alyssa N. Roberts

Honors Undergraduate Theses

In recent years, the healthcare system has been burdened by a multitude of obstacles that hinder the ability to provide effective, affordable, and timely care. Among these, one of the most significant challenges is the role that health insurance plays in shaping the quality of care. Health insurance companies are designed to decrease financial strain on patients, but they have introduced inefficiencies through delayed coverage approvals, increased denials, and administrative costs. Artificial intelligence (AI) has started to play an integral role in resolving these issues for the health insurance industry. Through its quick automated claim processing, fraud screening, and reduced …

Acute Hepatitis B Infection In A Patient With Confirmed Immunity On Long-Acting Cabotegravir/Rilpivirine, William K B Boateng, Neil Carlin, Etan Spira, Maria E Szabela, Kosisochukwu J Ezeh

Faculty and Staff Publications

Long-acting injectable formulation of cabotegravir/rilpivirine (CAB/RPV) is a promising novel maintenance therapy for HIV infection. However, coinfection with active hepatitis B virus (HBV) infection is a contraindication to initiating this therapy. Despite guidelines, patients with HBV immunity can still contract acute HBV infection. We report a case of a 30-year-old man with HIV who transitioned from antiretroviral therapy to CAB/RPV and had confirmed HBV immunity. The patient, though asymptomatic, showed significantly elevated liver function tests (LFTs) before his monthly CAB/RPV injection. He was hospitalized and diagnosed with acute HBV infection. His LFTs improved, and he was taken off CAB/RPV and …

Confidentiality In Addiction Treatment: Navigating 42 Cfr Part 2 Within Human Services, Chaniece Winfield, Jessica Huffman

Counseling & Human Services Faculty Publications

Recent federal legislation, including the Mental Health Parity and Addiction Equity Act (MHPAE) and the Comprehensive Addiction and Recovery Act (CARA), has placed greater emphasis on quality integrated health care, with a focus on access, treatment options, and evidence-based practices. Changes to Federal 42 CFR privacy protections also impact individuals seeking substance use disorder treatment, either as a primary diagnosis or comorbidity. Human service professionals, as generalists in the behavioral health field, provide vital treatment, recovery, and prevention services for individuals with substance use and addictive disorders. This paper explores the implications of these legislative changes, particularly regarding privacy protections …

“Nothing Is Going To Replace An In-Person Visit”: Canadian Long-Term Care Providers’ And Recipients’ Perspectives On When Telehealth For Physician Visits Is Not Appropriate, Tyler R Cole, Valorie A Crooks, Janice Sorensen, Sherin Jamal, Akber Mithani, Lillian Hung, Jeremy Snyder, Catherine Youngren

Faculty and Staff Publications

Background: Within long-term care (LTC) homes, telehealth use has been found to reduce unnecessary emergency department transfers, support the care needs of rural and underserved communities, and supplement in-person physician care. Despite these benefits, it is not well understood when telehealth is not an appropriate medium for providing physician care to residents with complex health needs. This knowledge gap must be addressed given the recent rise in telehealth use in LTC homes in many health systems following the COVID-19 pandemic, when virtual care use increased in many health care sectors to limit travel and in-person exposure risks, that is expected …

Whether To Offer Interventions At The End Of Life: What Physicians Consider And How Clinical Ethicists Can Help, Joelle Robertson-Preidler, Mikaela Kim, Sophia Fantus, Janet Malek

Faculty and Staff Publications

Background: Advances in life-prolonging technologies increasingly create dilemmas for physicians who must decide whether to offer various interventions to patients nearing the end of life. Clinical ethicists are often consulted to support physicians in making these complex decisions and can do so most effectively if they understand physicians' reasons for making recommendations in this context.

Methods: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding the considerations they have used to make decisions about offering interventions for patients nearing the end of life. Interview transcripts were thematically analyzed.

Results: We identified six types of considerations physicians …

A Randomized Controlled Trial Of A Compassion-Centered Spiritual Health Intervention To Improve Hospital Inpatient Outcomes, Jennifer S Mascaro, Patricia K Palmer, Marcia J Ash, Marianne P Florian, Deanna M Kaplan, Roman Palitsky, Steven P Cole, Maureen Shelton, Charles L Raison, George H Grant

Faculty and Staff Publications

Background: Inpatient medical settings lack evidence-based spiritually integrated interventions to address patient care needs within a pluralistic religious landscape. To address this gap, CCSH™ (Compassion-Centered Spiritual Health) was developed to leverage the skillsets of healthcare chaplains to improve patient outcomes through spiritual consultation. Here, we report the results of a randomized, wait-list controlled, pre-registered (NCT03529812) study that evaluated the impact of CCSH on patient-reported depression and explored putative mediators of CCSH's effects.

Method: Chaplain residents were randomized to be trained in CCSH as part of their clinical pastoral education (CPE) residency in the fall (n = 8) or …

Public Perceptions Of Neurotechnologies Used To Target Mood, Memory, And Motor Symptoms, Rémy A. Furrer, Amanda R. Merner, Ian Stevens, Peter Zuk, Theresa Williamson, Francis X. Shen, Gabriel Lázaro-Muñoz

Articles

Public attitudes toward four neurotechnologies for treating three types of brain disorders (mood, motor, and memory) vary on a range of metrics, such as perceived risk, invasiveness, and likelihood of use. In a survey of 1,052 US participants, deep brain stimulation (DBS) was seen as the most invasive and risky among the surveyed methods, involving the greatest perceived change to the person and the least likely to be used personally. Non-surgical options like transcranial magnetic stimulation (TMS) and pills were viewed as more acceptable. Devices targeting motor symptoms were rated as more beneficial and acceptable than those for mood or …

Standardization And Accuracy Of Race And Ethnicity Data: Equity Implications For Medical Ai, Alexandra Tsalidis, Lakshmi Bharadwaj, Francis X. Shen

Articles

Abstract

The rapid integration of artificial intelligence (AI) into healthcare has raised many concerns about race bias in AI models. Yet, overlooked in this dialogue is the lack of quality control for the accuracy of patient race and ethnicity (r/e) data in electronic health records (EHR). This article critically examines the factors driving inaccurate and unrepresentative r/e datasets. These include conceptual uncertainties about how to categorize races and ethnicity, shortcomings in data collection practices, EHR standards, and the misclassification of patients’ race or ethnicity. To address these challenges, we propose a two-pronged action plan. First, we present a set of …

Revoluntionizing Brain Research Using Portable Mri In Field Settings: Public Perspectives On The Ethical And Legal Challenges, Molly K. Madzelan, Frances Lawrenz, Susan Wolf, Francis X. Shen

Articles

Introduction

New, highly portable MRI (pMRI) technology promises to revolutionize brain research by facilitating field-based studies that can expand research to new settings beyond the traditional MRI suite in a medical center. At this early stage of development, understanding public knowledge and attitudes about pMRI research is crucial.

Objective In this article we present the first empirical study of the general public’s willingness to participate in pMRI research, and their perceptions of expected benefits and concerns.

Methods & Results

We conducted a nationally representative online survey (N = 2,001) administered Aug. 15-31, 2022. We found that respondents were overwhelmingly willing …

A Bioethical Analysis On The Allowance Of Physician-Assisted Death In Cases Of Mentally Declined Patients, Megan Nelson

Schultz-Werth Award Papers

As advancements are continually made in science, there is an increase in ethical issues that the world needs to address. When deciding where the law should fall on these new issues, it is important to use different ethical theories to view the issues from all sides. This is where the growing field of bioethics comes into play. “Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research” (Resnik, 2023). One of these bioethical issues that has become increasingly prevalent in society is physician-assisted death, which is sometimes referred to as euthanasia. This paper …

Implementation Of Robotics And Artificial Intelligence To Oncological Surgery, Ian Ngo

Nursing | Senior Theses

Background/ significance: Introduced in the late 20th century, robotic systems have enhanced surgeons’ capabilities by providing accurate and precise control of instruments. These systems helped minimize invasiveness in surgical procedures, providing greater precision, and gave flexibility to difficult-to-access areas of the body. Tools powered by AI help surgeons accurately identify and remove cancerous tissues, which can lead to better surgical outcomes and fewer complications. Purpose: The purpose of this study is to focus on evaluating how Robotic-Assisted Systems (RAS) and Artificial Intelligence (AI) impact surgical precision, patient recovery, and to address economic efficiencies. associated with integrating said systems into the …

Toward A More Accountable And Inclusive Vision Of Health Ethics: Navigating Complexity In Contemporary Clinical Practice, Peter A. Depergola Ii

Journal of Health Ethics

Editor's introduction to Vol. 21, No. 1 of the Journal of Health Ethics.

The Ethics Of Student Attrition In Healthcare Education Programs, Kent Haina Jr, Peter A. Depergola Ii

Journal of Health Ethics

Student attrition is a problem in healthcare education programs, but there is little in the literature regarding the organizational ethics of lowering it. Some argue that lowering attrition is unethical, because it would lower academic and professional standards, potentially impacting patient care. Others say students deserve to make decisions about when to leave a course of study. However, these arguments ignore inequities in attrition, as well as the conflicts of interest in, and moral obligations of colleges and universities. Lowering attrition rates in healthcare education programs is inherently ethical because it levels the playing field for underrepresented minorities that disproportionately …

The Ethical Impermissibility Of Implanting Embryos That Carry The Genetic Markers For Deafness, Cat Mastalerz

Journal of Health Ethics

Preimplantation genetic diagnosis is a reproductive procedure that involves testing embryos conceived by in vitro fertilization for genetic conditions, including cystic fibrosis, Duchenne’s muscular dystrophy, and controversially deafness. This paper examines the ethical dilemma surrounding parents using this technology to select for and choose to implant an embryo that carries the genetic markers for deafness. Disability and impairment are discussed, followed by an in-depth analysis of the role of Deaf culture, including the perspective of hearing children of deaf adults. The effect of deafness on life opportunities is then viewed through the lens of the child’s right to an open …

Investigating The Impact Of Phthalate Exposures From Personal Care Products On Uterine Fibroid Incidence And Prevalence In Us-Born Black Women, Ella Brissett

CMC Senior Theses

Uterine fibroids are benign tumors composed of smooth muscle cells and connective tissue that develop within or on the walls of the uterus. Despite being non-cancerous, they can severely affect quality of life by causing heavy bleeding, chronic pain, and reproductive complications. Fibroids are typically found in women of reproductive age, but they disproportionately affect Black women, who experience higher incidence and severity. The underlying causes of this disparity is poorly understood; however, an emerging body of research is highlighting the role of phthalates, endocrine-disrupting chemicals found in many personal care products, in exacerbating fibroid development. Through a critical analysis …

The Ethical Imperative Of Leadership In Dentistry, Mike Graham, Toni M. Roucka Rn, Dds, Ma, Facd

Journal of the American College of Dentists

Leadership is one of the four pillars of the American College of Dentists, taking its place alongside excellence, ethics, and professionalism. Leadership in dentistry carries an inherent ethical responsibility to uphold the trust and well-being of those who depend on us—our patients, our teams, and the community. When leaders in our field exercise their influence, they wield significant power over patient outcomes, industry standards, and public health policy. With this influence comes an imperative to act ethically, to ensure that decisions are guided by a commitment to care, integrity, and the best interests of those we serve. At the heart …

The Nohs 2024 Code Of Ethics Update, Kevin C. Snow, Christian Williams, Ed Neukrug, Kristin Barker, Kristin Ballard, Braxton A. Morrison, Leslie C.M. Mcclane, Meghan N. Morgan, Stephanie Collins

Counseling & Human Services Faculty Publications

The NOHS Ethics committee engaged in a revision of the Ethical Standards for Human Services Professionals (2024). This update focused on significant changes in the field of human services as they relate to a broad group of human services professionals. The article explores interviews with key members of the revision committee sharing their thoughts on the necessity for the current revision and the ever-present importance for human service professionals to understand and engage with the NOHS ethics code as an essential living document for the benefit of client well-being, to promote the integrity of the human services profession, and to …

Recognizing And Responding To Moral Distress: Using Transformational Leadership To Increase Nurse Leader Thriving, Miriam Dowling-Schmitt

DNP Scholarly Projects

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High …

An In-Depth Review Of Euthanasia-Related Practices, Arguments For/Against Them, And Proposed Solutions For Their Most Glaring Legal/Ethical Problems, Macon Plecha

Williams Honors College, Honors Research Projects

This paper’s goal is to cover the topic of euthanasia-related practices at great length. Terminology, history, and current programs around the world are discussed first, with the last point covering a wide geographical range: Colombia, Japan, Israel, and Africa, to name a few outside of the Western world standard. Arguments for and against euthanasia-related practices are explored. Within these arguments, several pressing legal and ethical issues arise, and the most severe of these are expanded on through the offering of potential solutions: how to handle stand-alone psychiatric cases, how to improve advanced directives and poor reporting rates, and how to …

Dialing In Or Dialing Out? The Relationships Between State Telemedicine Law And Access To Buprenorphine, Stacey A. Tovino

Faculty Articles

This Article begins by reporting the results of a comprehensive 50-state survey assessing state laws and other state sources governing the telemedicine induction (“tele-induction”) and subsequent telemedicine prescription (“tele-prescription”) of buprenorphine for the treatment of opioid use disorder (“OUD”) following the expiration of the COVID-19 public health emergency (“PHE”). Original, concrete findings include: (1) the glaring patchwork of state law governing the tele-induction and subsequent tele-prescription of buprenorphine for the treatment of OUD in the United States; (2) the variety of primary authorities and secondary sources that house relevant permissions, prohibitions, and affiliated requirements; (3) the number of primary authorities …