Typescript. Includes vita and abstract. Includes bibliographical references (leaves 54-55). Also available online.

Short-term volunteer mission trips account for an important aspect of global health care. The demand and desire to attend a mission trip has grown over the past decade. Self-fulfillment, altruism and philanthropy are said to be the motivating factors behind mission trips. In the present study, the motivation behind abroad short-term volunteer mission trips will be further researched and reported on. Mission trips to third-world countries, providing volunteer healthcare and oral health education have gained much popularity across the United States since their start in the 1980s. These trips are seen as selfless yet self-fulfilling opportunities. The benefits of these short-term volunteer mission trips will be evaluated in this thesis.Some characteristics that make mission trips valuable include the benefits experienced by patients, who would normally not have access to care and also by volunteer participants, who are able to give back to marginalized populations. More recently, the roles of physicians (and dentists) have been studied. Along with studying clinician’s roles on the trips, students’ educational experiences have been examined. Information on various perspectives have been written and are accompanied by a considerable amount of supporting information. Of these arguable points, many consist of discussing the enlargement of educational opportunities. By being a part of these mission’s trips, students can gain valuable skills for their future careers. Cross-cultural experiences during the trips are another alluring aspect for students. As supported by evidence, cultural awareness in the medical and dental field has had a great impact on volunteers. So much so that access to clinical experiences while abroad balances out the needs for the community while serving as a unique educational opportunity to students. The increasing popularity of volunteer trips providing third-world countries with access to healthcare has come with both advantages and disadvantages. The pitfalls and risks of volunteering abroad will be discussed including the drawbacks that include ethical dilemmas. In addition, issues with the infrastructure and framework of the visited country’s health care system are considered. This literature review takes a comprehensive look at medical/dental mission trips of all healthcare fields and proceeds to evaluate associated studies in which patients’ benefits, cross-cultural experiences and providers’ and students’ roles are affected by them.

The coronavirus pandemic has highlighted the inequities in Black communities and magnified existing disparities in health care access and treatment. By examining the role of Black communities during the 1918 influenza and 2019 Covid pandemic, we understand the resilience and leadership these communities had in promoting black health. Shifting from the context of the pandemic to strategies of community engagement, this paper frames a discussion of Black community response as a strategy for overcoming barriers to health and offers a blueprint for approaching effective community engagement in Black community health post the COVID-19 crisis.Highlighted throughout are the Bioethics principles, non-maleficence, social justice, and solidarity. / Urban Bioethics

Food insecurity affects 1 in 7 households with children and has worsened due to the COVID-19 pandemic. Food insecurity disproportionately impacts marginalized populations including households with children with a single parent (usually the mother), families with low socioeconomic status, and Black and Latinx families. Amartya Sen, an economist and philosopher, was a pioneer in viewing food insecurity as a social phenomenon rather than a natural phenomenon. Furthermore, he highlighted the role that economics, politics, and social norms play in creating and perpetuating the problem. Therefore, to address food insecurity, we must address the root causes, which include poverty, structural racism, and lack of social cohesion among others. Urban bioethics provides a lens to examine food insecurity through agency, solidarity, social justice, community collaboration, and structural competency. In this thesis, I will explore the history of food insecurity in the United States, disparities in who is affected, the impact on children's health, and how government, community, and healthcare programs currently address the issue. Urban bioethics offers more than just a perspective for understanding an issue; it provides guidance on how to address this multifaceted problem in an ethical manner. Therefore, I will also demonstrate that there is an ethical responsibility as a healthcare provider and system to address the issue and explore potential solutions and strategies that align with urban bioethical principles. / Urban Bioethics

Historically, mass incarceration has proven to be more dangerous and deadly than Covid. This statement is not meant to downplay the severity of Covid or disrespect those who have lost their lives due to the virus, as it has affected many in my own family. Instead, it sheds light on the detrimental impact that Mass Incarceration has had on communities across America. Given its deadly consequences, I propose that Mass Incarceration be addressed with the same level of urgency and intensity as Covid. It is time to acknowledge mass incarceration as a cancer in our society and take immediate action to address it. It violates the core principles of Bioethics and will not pass any ethical inspection upon closer scrutiny. The principles of autonomy, beneficence, non-maleficence, and justice are not adhered to with the epidemic of Mass Incarceration. When the principles of agency, social justice, and solidarity are added as Urban Bioethical Principles, how unethical mass incarceration is becomes even more evident. I propose a multidisciplinary approach, highlighting the use of credible messengers, as a means to reintegrate incarcerated people into society as well as reduce the rate of incarceration by addressing the specific causes. / Urban Bioethics

Primary care providers in the United States face many challenges that complicatecare delivery and contribute to burnout, including heavy administrative burden, large patient panels,, and relatively low compensation when compared to other medical specialties (Carlasare 2018). In response to these problems, alternate models of primary care delivery have emerged. Direct primary care (DPC) is one alternate model of primary care delivery that some think could provide a solution to problems affecting primary care. DPC is a model of primary care delivery in which insurance is not charged for services provided by a practice. Instead, patients pay a recurring membership fee in exchange for access to services provided by the practice (Eskew and Klink 2015; DPC Frontier 2020). While DPC may decrease physician burnout and provide a viable source of primary care for some patients, there is the potential for DPC to contribute to already existing health inequities. This thesis will explore characteristics of DPC practices in the United States to identify qualities that could impact the delivery of ethical, equitable health care. These qualities will then be examined through a bioethical lens using the principles of equity, agency, and distributive justice to guide future directions for DPC and primary care delivery as a whole with the goal of establishing a care system that serves patients of all backgrounds and socioeconomic classes. / Urban Bioethics

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is common and yet remains perplexing for physicians and patients alike. Symptoms can be ambiguous, and understanding of this disorder has been limited, in part, by blunt diagnostic tools. Ironically, the lack of sophisticated scientific approaches itself has contributed to the perception that IBS is a less objective diagnosis. A syndrome that rests among intricate and poorly delineated relationships between biologic, psychologic, and social domains, IBS does not always lend itself well to traditional clinical discussions. Here, I offer narrative ethics as a potential tool to carry the nuances of this diagnosis. Invocations of narrative demand interrogation of stories and how they operate, and I argue stories work particularly potently for IBS patients. Finally, I consider how lay narratives about IBS may contribute to care disparities among different groups. Through these three sections, I seek to explore the ethical considerations of ambiguity within medical spaces and the traps that exist when dealing with illness that lies just beyond the margin of contemporary scientific understanding. / Urban Bioethics

Since the early nineteenth century, physicians have been offering the tracheostomy as a second chance at life. This procedure both saves and inextricably changes lives. Medical providers have barely scratched the surface of understanding the complexities of offering this technology. Ethically, however, we have an obligation to improve the process. We must support the patients and their caregivers and utilize everything at our disposal to ensure that we are safeguarding their quality of life. / Urban Bioethics

As COVID-19 spread across the United States, the bioethics community encountered challenges both familiar and unknown. Practitioners prepared to consult and advise clinicians, compiling lists of the anticipated bioethical issues, the dimensions of which were nuanced and multifaceted. However, a closer look at the discussion that developed around a single critical question, the ethics of ventilator allocation protocols, revealed that standard formulas and metrics had unintended consequences. The received wisdom of the ethical principles applied to the allocation of this scarce resource was questioned and found wanting as critics pointed out protocols that disadvantaged minorities, the disabled, and the elderly. New voices entered old debates. The practice of modern American bioethics, shaped at a time when patient autonomy was the prevailing value, was narrow in purview. The fundamental inequities of heath and healthcare experienced by racial and ethnic minorities and the poor, concerns of justice, were not central to the practice. The bioethics community had failed to sufficiently broaden its scope as the concepts of the social determinates of health were revealed by research and confirmed by lived experience. Prompted by the racial unrest of spring and summer 2020, one element of the bioethics community, represented by Association of Bioethics Program Directors, has recast its focus. / Urban Bioethics

In the city of Philadelphia there were over 4,000 opioid over-doses in 2018. There were many lives affected by over-prescribed medication and the dire need to have better policies and practices in place when delivering care is crucial. Better practices lead to shorter hospital stays, fewer readmissions and is cost efficient to all involved. Prescribed medications need to be better evaluated prior to dispensing for a non-acute pain. It is the pharmaceutical companies and healthcare provider’s obligation to be more educated when delivering care for the community that it serves. It is imperative to build better relationships between patients, physicians, and community leaders to alleviate this current opioid epidemic. The concerns within our current health care system are based on biased beliefs. These beliefs can lead to barriers of healthcare and give inadequate care for those who deserves the best quality of healthcare. / Urban Bioethics