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Racial and ethnic minorities in the United States experience health disparities and poor health outcomes at a disproportionate rate in comparison to other groups. One of the many social determinants of health that contributes to these poor health outcomes is mistrust in the medical community. Mistrust is a consequence of a too-long history of unethical experimentation in African American and Latino communities, and has resulted in decreased use of preventive services and screening tools, lack of adherence to medical treatments, and minimal participation in clinical trials. These patterns of minimal utilization of healthcare services have resulted in poor outcomes for numerous health conditions, poor understanding of different diseases and their impact on minority groups, as well as a lack of evidence-based treatments which will benefit these populations. The purpose of this thesis is first to address the historical origins and contemporary consequences of mistrust in medicine within the African American and Latino communities. Second, I address the ameliorating impact that patient-physician racial and language concordance has on both trust and clinical outcomes. Throughout, I reference the ethical principles which warrant the need for greater patient-physician race and language concordance, and I present pipeline programs as a tool to increase the diversity in the medical field, all with the ultimate goal of improving health outcomes in the African American and Latino community. / Urban Bioethics

The Healthy People 2020 initiative recognizes how the physical, emotional and mental toll of incarceration causes poorer health outcomes because of the health risks and exposures individuals face in the prison environment. However, incarceration in the urban setting is more than the social determinant of health. The social, political, and economic consequences of mass incarceration have disproportionately affected urban communities. By reviewing the research on the health and socio-economic status of incarcerated population prior, during and after imprisonment, I make the argument that prisoners have a predisposition to be incarcerated due the negative social determinants of health present in their natal neighborhoods. I illustrate how the evolution of mass incarceration is in part due to the United States (US) government imprisonment of many non-violent offenders by criminalizing drug abuse in part due to racial discrimination towards men of color, primarily African-American men. I examine how drug abuse as a mental illness has been disregarded by the US Criminal Justice System, and how racism has contributed to this factor. Furthermore, as the drugs policies have disproportionately affected these communities, additional consideration should be given to how the criminalization and demonization of drug abuse and addiction has impinged on the bioethical rights of the members of urban communities. I explain how mass incarceration in the urban setting violates each bioethical principle and how the racial disparities in mass incarceration is a reflection and is an extension of the problems of racism inherent to the US. Ultimately, I conclude that any new legislation passed to end mass incarceration should include policies that help to rehabilitate and to rebuild lives of those affected most by mass incarceration. / Urban Bioethics

In 1999, the Lewis Katz School of Medicine (LKSOM) established the standardized patient (SP) program, focusing on training healthcare professional students in patient interviewing and examination skills. Originating in 1963, SP programs have proliferated in American medical schools and abroad as a means to instruct and evaluate students without potential harm to real vulnerable patients. However, research indicates potential biases in SP evaluations, particularly with respect to subjective assessments such as the doctor-patient interaction (DPI). This study aims to explore attitudes towards the SP program from the perspective of both medical students and SPs to identify areas of bias and general concerns. In total, 14 medical students, nine SPs and 1 administrative faculty member were interviewed. Interviews were transcribed, coded and analyzed for major themes. Overall, students and SPs generally agreed to the importance of the SP program in medical education. However, attitudes diverged with regards to bias and standardization, with students noting multiple instances of interSP variability. A handful of solutions to concerns raised by study participants are outlined in this paper and concludes by highlighting the school’s duty to mitigate bias and ultimately foster equity, equality, and justice within the program. / Urban Bioethics

Thesis (Psy. D.)--Wheaton College Graduate School, 2005. / Abstract. Includes bibliographical references (leaves 46-48).

Thesis (Psy. D.)--Wheaton College Graduate School, 2005. / Abstract. Includes bibliographical references (leaves 46-48).

In classical antiquity there were no restrictions on who could practise medicine. There were no enforceable professional standards. The physician sold his services at his own discretion to those who asked and paid for treatment; he exercised his art as he wished. In the early Christian centuries Christian charity and moral principles effected some significant changes in the perception of medical ethics and suggested a responsibility to exercise compassion and extend charity. Yet it is not until the late Middle Ages that we can speak of the development of a clearly-defined medical deontology and professional ethics resulting from two factors» 1) The development of licensure requirements (whether imposed by external authority or obtained by medical guilds) which reflects a fundamental change in the very basis for the practice of medicine from a right to a privilege, with specific obligations attached to that privilege. 2) The clear definition and expression by casuists of the moral responsibilities of physicians. During the late Middle Ages some physicians wrote treatises on medical etiquette and ethics. When the contents of these treatises are supplemented by guild and university ethics and the moral expectations of the casuists, as well as by the evidence of physicians' conscientious response to the various outbreaks of pestilential disease in the late Middle Ages, the picture that emerges is of relatively high ethical standards circumscribed by, and in part the result of, clearly-delineated expectations of ecclesiastical authority and the secular community. / Arts, Faculty of / History, Department of / Graduate

Social determinants of health have become a bit of a buzzword in today’s discussion of healthcare inequities. Social determinants of health are broadly defined as conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes. These factors almost always include education access and quality, health care access and quality, neighborhood and built environment, economic stability and social and community context. All of these factors play a role in how individuals and communities maintain their health. Social determinants of health plays into the black experience within healthcare, which is a factor in the increase in black maternal morbidity and mortality. An important note to highlight in the increase in black maternal morbidity and mortality is the growing public knowledge of the racial history within Obstetrics and Gynecology. We have these disparities and more and more Americans are learning about this health disparity, yet there are not many articles that highlight the ways to save black women from being just another statistic. I propose that if we focus on improving the public intellectualism of our country through social media, we are then all fighting for the survival of black women throughout pregnancy and post-partum. / Urban Bioethics

<p>Hunger strikes are used as a method of protest to call attention to grievances or political positions and galvanize support for a cause. Historical examples from pre-Christian Europe through Guantanamo Bay have demonstrated various motives, interventions, and outcomes to this unique form of protest. Starvation causes life-threatening damage to the body, and to intervene on an unwilling subject involves invasive medical procedures. As scholars have debated how to approach this medical-ethical dilemma, a tug-of-war exists between autonomy, beneficence, and social justice with regard to the rights of prisoners of war (POWs) and detainees. International documents, legislation, and case law demonstrate vast support for and place precedence on the prisoners right to make their own autonomous, informed medical decisions, and many in the international community lean towards abstaining from intervention on hunger strikes on the basis of patient autonomy. However, there are notable arguments both for and against force-feeding that have been well documented. Despite the vast international dialogue, there is a key component that seems to have been forgotten&mdash;the environment within which the prisoner or detainee resides is immersed with coercive and manipulative activity and interrogation on a regular basis. This environment may impede the ability for the POW or detainee to make an autonomous decision and then leads to the refusal of life-saving, medical intervention on the basis of a decision that is markedly coerced or manipulated. It is therefore noted that a different lens must be used to analyze hunger strike situations for this specific population. </p>

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