In the setting of the health care field, multiple decisions must be made on each patient’s care from a variety of viewpoints on the medical team. In these settings, Interprofessional Decision Making is becoming a tool that can incorporate shared decision making with the patients and multiple care team members’ goals in order to optimize and keep an ethical focus on clinical outcomes. By reviewing a patient case below and evaluating the body of literature at the present, it can be determined that a disassembly of the current medical hierarchical structure and the barriers to team based interaction it creates, with a move toward open and ethical interactions, collaborations, and discussions will result in shared consensus on a patients management and care. While this may be difficult to achieve, interventions such as multidisciplinary team building and medical training, prior to matriculation, may provide a foundation for improved Interprofessional Decision Making and overall collaboration. / Urban Bioethics

A modern version of the Hippocratic Oath instructs physicians that, “prevention is preferable to cure.” As healthcare providers, physicians promote healthy behaviors to prevent social issues from becoming health issues. Firearm violence is a social issue that has led to significant morbidity and mortality making firearm related-injuries and deaths a major health crisis of our time. If physicians have a role as credible messengers and advocates for firearm injury prevention, the educational institutions that form them must have a role as well. Unfortunately, firearm injury prevention education is rare in undergraduate medical education curricula. This poses an ethical dilemma. Undergraduate medical education without firearm injury prevention education misses the opportunity to equip trainees to discuss firearm violence as a health issue. As a result, physicians’ agency to advocate, educate patients, and thus fulfill ethical obligations may be limited. In this paper, physician codes of ethics are briefly presented. A case study of educational inquiry for medical students regarding firearm injury epidemiology, violence as a public health issue, the role of physicians in firearm policy, as well as clinical bedside skills related to firearm safety and injury is described. A case for firearm injury prevention education in undergraduate medical education curricula is made. / Urban Bioethics

The American medical profession has publicly pondered its roles and duties since its inception in the 18th century. Recently, that discussion has included whether or not advocacy by physicians is a responsibility of the profession. The following work is an argument and plan to support the ethical, professional imperative of physician advocacy. The historical underpinnings of the American medical profession suggest a responsibility to patients and interactions with society. In addition, there is a strong bioethical argument in favor of physician advocacy as an essential duty. Although there is a well-recognized set of barriers to physician advocacy, this article details solutions to help implement advocacy as a daily practice in the lives of all physicians. This piece will describe a way forward for physicians to take on their professional responsibility to advocate. / Urban Bioethics

Undocumented immigrants in the United States currently do not have the same access to health care as their legal and citizen counterparts. This is wrong, and both state and national governments bear responsibility in remedying this situation by expanding policies to include them to protect their rights, especially undocumented immigrant children as a special vulnerable population. In order to demonstrate this, I will discuss the historical barriers that immigrants have encountered when trying to access to health care. I will review the laws and policies that have excluded them from welfare programs and inflicted fear into discouraging them from using what is available. I will examine the ways in which children have been treated at the Southern border detention centers and show evidence that they have been historically abused and traumatized at these facilities while the government continues to promote discrimination, injustice, and hostility in the ways that immigrants are portrayed and treated. I will explore the ethical problems surrounding these issues by considering ideas of influential philosophers and bioethicists regarding health care as a right for all and question the philosophical basis for treating undocumented immigrants differently than the rest of the population. With the support of international law and bioethics I will argue that children are a vulnerable population that deserves special protection regardless of immigration laws. Finally, I will discuss the importance of intervening in this situation and describe ways in which the government, health care providers, and the general population can all contribute to promoting equality for all. / Urban Bioethics

Personalized medicine is the idea that every patient can be treated in a unique manner, tailored specifically to his or her individual needs. Traditionally the field of personalized medicine has focused on using genetic information to determine medical treatment. However, humans are not only the sum of their genetic parts. All people exist within the context of their environment, their experiences, and their relationships. While the connection between this greater context and medical treatment may not be immediately obvious, it exists. If we are to truly tailor medical care, it must occur in a holistic manner, combining both genetics and social context. A thorough understanding of the way that they interact, as well as the individual limitations of both, is the best way to offer individualized care to all patients. / Urban Bioethics

As a healthcare professional at the bedside, it has been very difficult to advocate for the patient while all parties involved cannot respect what the patient wants. Four out of five Americans do not have an advance directive. The history and court cases that have led the country to make patient’s right to make their own healthcare decisions has been decades in the making, yet still bring daily challenges within the healthcare system. When a patient’s wishes are not being honored, medical futility may lead to moral distress and compassion fatigue. Institutions provide multidisciplinary teams to address these issues, but if a patient’s capacity or competence is in question, their voice may not be heard. The toll on the healthcare provider and the patient can be permanently damaging, causing many nurses to leave the profession all together. I will attempt to determine the barriers to implementing the patient’s wishes, address the syndrome of moral distress among healthcare professionals, and attempt to offer solutions to promote well rounded, patient-centered care. / Urban Bioethics

Immigration is a highly politicized topic increasingly on the forefront of the nation’s consciousness. Though news media and academia have drawn attention to evidence of physical health needs of undocumented immigrants being compromised due to their documentation status, relatively less attention is brought to their mental health needs. The purpose of this paper is to review literature about the mental health care needs of immigrants and refugees to the United States, with a particular focus on recent adult immigrants from Latin America and their youth, who may directly or indirectly suffer trauma related to deportation, violence, family separation and/or loss. This paper serves to provide ethical arguments for increased awareness, education and resources towards trauma-informed, culturally sensitive mental health care for immigrants and refugees to the United States. The ultimate aim of this paper is to provide its readers with essential information regarding the impact of trauma and cultural identity in the mental health care (or lack thereof) of Latinx immigrants. / Urban Bioethics

BACKGROUND: While parents have central influence on children’s eating behaviors, an increasing number of grandparents participate in child feeding. The manner in which grandparents approach feeding young children as well as how that role is negotiated with parents is unclear. The purpose of the study was to explore maternal perceptions of grandparents’ influence on preschool aged children’s snacking and parental authority in child feeding. METHODS: Participants were 55 ethnically-diverse, low-income mothers of preschool children, aged 3 to 5 years. A qualitative design was employed where semi-structured interviews were used to examine mothers’ schemas around child snacks and the context of snacking. Interviews were recorded and transcribed verbatim. Analyses used NVivo 10 to identify major themes using a grounded-theory approach. Participant demographics and household food security were assessed by self-report. RESULTS: Three major themes emerged regarding mothers' perceptions of grandparents. First, many mothers described supportive or positive aspects of grandparents’ involvement in child feeding: 1) building bonds with grandchildren, 2) providing healthy foods, and 3) setting limits. Second, at the same time mother believed grandparents often to be unsupportive partners in child feeding by: 1) offering “junk foods” and 2) being permissive regarding the types, frequency, and portion sizes of snacks offered to children. Third, mothers’ authority in feeding was challenged by grandparents’ approach to feeding children snacks when at odds with the mothers’ the mothers approach. CONCLUSION: Findings suggest that grandparents may have important roles in family dynamics around feeding among low-income families with young children. / Urban Bioethics

Death is an inevitable part of life, yet many Americans fail to plan for this final part of life. Only about 1/3 of our country has an advance directive (Off White Papers, 2014). This underutilization of advance directives is reflected in our health care spending. It is estimated that 30% of all Medicare spending occurs during the last six months of a patient’s life. The numbers are even lower when broken down into sub-categories. Only 24% of older Black Americans possess an advance directive versus 44% of their older White counterparts (Huang, Neuhaus, & Chiong, 2016). Some studies found that African Americans were more likely to “express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs which conflict with the goals of palliative care, and distrust the healthcare system” (Johnson, Kuchibhatla, & Tulsky, 2008). Other studies have even concluded that Black race is an independent predictor of lack of advance directive possession (Huang et al., 2016). This paper further explores the possibility that race and ethnicity may simply be proxies for cultural values that impact advance directive possession. We’ll discuss the barriers, for both Black patients and health care providers, to advance directive possession as well as investigate culturally mindful interventions to combat the barriers. / Urban Bioethics

Death is inevitable, and research indicates that 80% of Americans wish to die at home. Does anyone know those wishes? Advance directives outline those wishes and personal decisions. Do advance directives make a significant difference in the experience of death for the patient, loved ones, and clinicians? Through interviews with loved ones of those who have died, as well as legal representative and a physician, this thesis examines the benefits and obstacles of having an advance directive, as well as the issues that have a high impact on whether and why an advance directive is written. Policy recommendations, business tactics, and community-based solutions are proposed to address these issues. It is clear that access to healthcare and the clinical professionals who can discuss end of life issues has a major impact on whether an advance directive is considered by the patient, along with health literacy skills and knowledge. / Urban Bioethics