Bioethics and Medical Ethics Commons^™

Conceptualization Of Effective Surrogate Decision Making, Zachary Armstrong, Michael Bourgoin, Abram Brummett, Jason Wasserman, Mark C. Navin, Stephanie Swanberg

Posters

Surrogate decision making is a key component in the hierarchy of medical decisions, whereby an assigned individual makes choices on behalf of a patient incapable of making the decision themselves. Although this is common in healthcare, there are still many questions about best surrogate practices and ethical credibility. This capstone project aspires to map these concepts and discuss issues related to the current landscape of surrogate decision making with regards to medical ethics through the use of a systematic literature review.

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 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 …

Self-Triage Among Patients Who Are Homeless, Jimmy Clemmens, Jason Wasserman

Posters

People who are homeless present to urban emergency departments at a higher rate per 1000 people than those who are housed.1 With those added difficulties, people who are homeless frequently turn to Emergency Departments for primary, rather than only emergency, health care treatment.2,3 There is great need for investigation into the thought process for the self-triage of the patient who is homeless. This study was undertaken to survey adults at HOPE adult shelter about their ability to determine the most appropriate place to seek treatment for different common conditions of varying acuity, as well as to evaluate the efficacy of …

Outbreak Risks At Religious Schools: Prevalence Of Nonmedical Vaccination Exemptions Among Michigan Kindergartens, Flora Martz, Patrick Karabon, Mark C. Navin

Posters

Religious community membership is relevant to immunization policy, as in the case of 2019 US measles outbreaks clustered in Orthodox Jewish communities. US immunization policy focuses on school enrollment requirements, which apply both to public and private (usually religiously-affiliated) schools. Most US states exempt students from these requirements for nonmedical reasons, including religious reasons, though some states, including New York, California, and Maine, have recently eliminated nonmedical exemptions. This study uses 2017-18 data from the state of Michigan to illuminate relationships between nonmedical exemption (NME) rates and attendance at religious schools with the aim of providing information about high-value targets …

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 …

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.

Medical Student Knowledge Of Physician Involvement In The Holocaust And The Importance Of Incorporating Holocaust Studies And Ethics Into Medical School Curricula, Megan Bricely, Jason Wasserman

Posters

A 2019 Claims Conference study demonstrated an alarming lack of knowledge about the Holocaust in the United States general population. There is currently no specific data on medical student knowledge of the Holocaust and the role that the medical community played. The goal of this study was to gather baseline data on medical student knowledge of the Holocaust and medicine’s involvement to demonstrate the need for Holocaust teaching in medical school.

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 …

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 …

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 …

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 …

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 …

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 …