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The medical ethics curriculum is an important part of medical education as it helps foster students to become virtuous and compassionate caretakers. The format of the curriculum is intended to expose students to ethical and moral issues early in their careers and allow them to apply their knowledge in clinical situations. However, the implementation of the curriculum is incredibly varied and fraught with challenges. This thesis explores the challenges of the current format of the medical ethics curriculum and the repercussions that will extend throughout medical school and moving into residency and beyond. It will additionally delve into potential solutions that, if implemented conscientiously, can encourage more engaged and thoughtful discussions in the classroom and the clinical setting. It is the ultimate hope that such interventions will result in students’ increased moral development and shape these future physicians into better caretakers, colleagues, and leaders. / Urban Bioethics

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—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. / Urban Bioethics

Maternal Health requires a bioethical evaluation to thoroughly address and reduce the troubling statistics and events of pregnancy-related complications and maternal mortality. Maternal mortality affects African American women three to four times more than any other race, therefore presenting race as a factor. Types of experienced racism and the overall scientific pathway are explored in relation to the health of African-American women. Race-related stress and its association with adverse maternal health outcomes is an important issue to consider when evaluating the maternal health complications. In addition, addressing the result of unethical inequalities in the healthcare system in combination with other societal contributions is essential when trying to recognize its impact on the experience of pregnancy. This thesis explores the impact of racism on maternal outcomes and health of African-American mothers, beyond the commonly understood influences of other socio-economic factors. / Urban Bioethics

This paper examines the lived experience of multiple sclerosis (MS) through the lens of stigma. Stigma is a social phenomenon through which people who are deemed outside the norm, due to either behavior or appearance, become vulnerable to being discredited or ostracized. The case of MS is interesting, because while it eventually manifests in distinct outward physical signs, individuals with the disease often live for years without outward symptoms, meaning that their stigma-inducing qualities are latent, but not yet seen. Pre-symptomatic individuals, in attempting to manage the inevitable stigma, must balance the risks and benefits of choosing whether to pass or reveal. The seismic physiologic shifts MS flares cause result in changes to both an individual’s physical and social capabilities, thus affecting individual’s roles and subsequent emotional well-being, which can be further impacted by social stigmatization. As a result of physical limitations, individuals with MS experience stigma in the form of employment discrimination, co-worker misunderstandings, and familial over or under attention to their illness. These factors only exacerbate the emotional despondence these individuals experience from a loss in their identity. By looking at the literature on stigma formation, management of invisible social identities, and the stigma of MS, an appreciation for the lived experience of MS can be gained. Such an appreciation can hopefully lead to methods to prevent the marginalization of such groups and foster supportive measures and education that helps deconstruct the stigma. / Urban Bioethics

The discourse surrounding medical error and its ethical implications has become a pivotal focus within healthcare. Thus, this thesis aims to delve into the multifaceted aspects of and influences on medical error and its disclosure, with each chapter progressively shedding light on their complexities and ethical considerations. The overarching argument posits that despite society’s general intolerance for errors and a recognized aim for perfection, error remains an unavoidable and inevitable aspect of the practice of medicine and medical training. There exists an inherent fallibility in healthcare juxtaposed against the gravity of the profession and its consequent medical and legal ramifications when something goes awry. The following ten chapters collectively highlight the intricacies of error management in healthcare through discussions on societal expectations, medical training, error analysis, accountability, systemic influences, patient-provider relationships, legal implications, and bioethical tenets. Ultimately, advocating for a cultural shift towards greater transparency, collective accountability, systemic quality improvement, and support for healthcare professionals to address errors effectively while upholding patient safety and trust. This thesis also recognizes the ethical imperative of error disclosure and the importance of fostering a balanced approach that acknowledges both the inevitability of errors in healthcare and the significant physical, emotional, and financial burdens caused by medical errors. / Urban Bioethics

Despite decades of changes in allocation policies for lung transplantation, the field is plagued by outdated and ethically problematic processes that impact candidate selection. Transplant centers screen potential organ recipients with a psychosocial evaluation in an attempt to identify potential barriers to post transplant success. Professional guidelines note the problematic nature of basing transplant candidacy on social factors. The prohibitive nature of the process in conjunction with the coercive pressures of impending demise forces individuals and their social support systems to make concessions that directly impact their individual dignities. Precluding eligible candidates based upon nonadherence does not improve clinical outcomes and thus does not benefit the net population. Psychosocial evaluation needs to be reimagined. The current practice, as it stands, fails to meet national ethical standards, but with its diverse widespread utilization, the psychosocial evaluation can become a tool to identify potential gaps and empower transplant teams to support individuals in addressing perceived deficiencies. / Urban Bioethics

As the first systematic and in-depth study in any language on the subject, this thesis makes original contributions by unravelling the relationship between Chinese healthcare state governance, health law and medical practitioners, and casting a spotlight on the ethically problematic medical practices raised by cases of SARS and others. More specifically, this thesis examines the role of state governance and regulation in China’s healthcare system and their impact on professional practices and ethics. The thesis addresses the issues from a social-legal perspective. It provides evidence from an integration of historical, empirical and theoretical approaches to explore the role of Chinese medics in their relations with healthcare state governance and law. It explores the character of power relations and the consequences of imbalance of power in these relations. Diagrammatic models are used throughout this work to illustrate the findings from the above approaches and to represent the changing nature of the author’s thinking about the dynamics at work in the relationships under scrutiny. The basic principle advocated in this thesis is that the effective formation and delivery of healthcare is facilitated by ethically-based systems of policy, rules and regulation. More particularly, it is argued that the roles of medical professionalism and patient control are central to good governance of healthcare in China. Set within this context, the thesis has three main goals. First, it aims to contribute to the development of theories about the relationship between the medical profession and the Communist state of China, examining the relatively powerless position of medical professionals in China as demonstrated by both historical and original empirical evidence generated by the research undertaken for this thesis. Secondly, the thesis examines the nature and extent of de-professionalisation among Chinese medical professionals. More particularly, it considers the consequences of challenges to Chinese medics’ professional autonomy which have occurred as a result of the Chinese healthcare power structure. Ultimately, it is argued that a re-structured model which places Chinese medical practitioners in a more professional and responsible role is urgently required.

Discussions of autonomy at the end of life in health care contexts is no new phenomenon. However, what seems to have changed in issues of autonomy is cases where patients want to refuse a treatment to cases where patients are demanding more treatment when medical professionals may not agree or be able to provide them with the medical treatment. Some key competing interests impacting patient autonomy include beneficence-doing what is in the best interests of the health or well-being of the patient- and resource limitations. Here, I will explore distributive justice theories that impact the end of life and how they constrain autonomy.

published_or_final_version / Community Medicine / Master / Master of Public Health