Bioethics and Medical Ethics Commons^™

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 …

Use Of Clinical Competency Examinations For Dental Hygiene Licensure, Jocelyn D. Weinhagen, Tara L. Newcomb, Brenda T. Bradshaw

Dental Hygiene Faculty Publications

Dental hygiene licensure with a clinical competency examination (CCE) using a live patient has been required by state licensing boards since 1929. Clinical competency examinations were initially used when dental training was poorly developed, non-standardized, and largely based on the apprenticeship model. Currently, Canada and the state of California have removed the requirement of passing a CCE for dental hygiene licensure, provided certain requirements have been met. Dentistry is the last health care profession to mandate that graduates pass a CCE. The vast majority of dental licensing boards continue to require that third party testing agencies validate the clinical skills …

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 …

Exploring Lgbtq+ Competency In Healthcare, Jordan Whiteman

Honors College Theses

Marginalized groups such as the LGBTQ+ community are known to face healthcare disparities that negatively affect their process of navigating healthcare systems. This project explores the perceived lack of representation and understanding of the LGBTQ+ community within healthcare settings, exposing the deficits in knowledge for unique challenges and inequalities these patients may face. By viewing the literature, a myriad of complications faced by LGBTQ+ people in clinical settings can be identified. They possess a generalized feeling of mistrust towards the healthcare system. Healthcare staff overall describe low confidence with caring for this demographic. Heteronormativity’s presence in the field of healthcare …

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 …

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 …

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 …

Effects Of Round-Up On The Environment, Sandra J. Marcu

Journal of Earth and Life Science

Many people around the world have used and still currently use Roundup but are unaware of the effects it has on the environment. Roundup is a spray on application weedkiller that is widely used around the world today both residentially and commercially. It enables its user to grow a garden or a field of crops with a no-tilling approach to eliminate weeds. It is a well-known and popular choice for killing weeds that has been around since the mid 1970’s (Oca, 2017). John Franz, a Monsanto scientist discovered that glyphosate (main ingredient in Roundup) was an herbicide or weedkiller, and …

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 …

“Regression To The Mean”: The Confluence Of Eugenics And Statistics In The 19th And 20th Centuries, Emrys G. King

Pomona Senior Theses

The work of this thesis is twofold — first, qualitatively characterizing the confluence between the British eugenics and statistics movements in the late 19th and early 20th centuries, and second, quantitatively analyzing the effect of this foundation on pedagogical materials in the growing field of statistics between 1880 and 1970. Towards the first goal, the history of the method of least squares, state statistics, and positive and negative eugenics are outlined, followed by a close reading of the foundational texts authored by Francis Galton and Karl Pearson that introduced linear regression. Towards the latter goal, English-language statistics textbooks published between …

The Excessive Cost Of Health: An Analysis Of Pharmaceutical Accessibility Issues In The United States, Henry Woodman Curtis

Electronic Theses & Dissertations (2024 - present)

Compared to the rest of the world, the United States has one of the worst-performing health care systems. While this is influenced by our hospital systems and clinical care in certain contexts, one of the biggest culprits for our poor ratings is the cost and availability of prescription medications. We pay more than any comparable country for the exact same medications and have a harder time actually accessing them. In this dissertation, I aim to analyze how individuals, companies, and governmental agencies have responded to various instances of high-cost or low-availability prescription medications. To begin, I examine pharmaceutical patenting practices …

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 …