Jeremy Bentham’s panopticon is a theoretical prison that was developed in 1787 as a way to punish and reform people convicted of crime. It involved a circular building with a central guard tower, from which an omnipresent and omniscient warden would constantly surveille the inmates who were kept in solitary confinement. Although the prison was never physically constructed, elements of the panopticon are present in many aspects of our social structure and power systems. This paper explores Bentham’s original work, the post-modern responses to it, and present day manifestations of the panopticon through a bioethics lens in order to develop a metaphorical tool that can be used examine and explain how power is systematized and functionalized by those who control it, the effects on those who are subject to it, and how the systems are exploited to the point of dysfunction. / Urban Bioethics

Importance – The homeless face higher rates of morbidity and mortality than the general population, and have lower rates of end-of-life care planning. An effective and sustainable intervention, to provide living wills and durable power of attorney, is required to protect the autonomy of a vulnerable population. Objective – To determine if medical student-led 1:1 counseling is as effective as social worker-led counseling as reported in the literature, determined by rate of advanced directive completion. Design – A focus groups and educational sessions on EOL care and ADs were conducted at 2 shelters, after which participants were offered the opportunity to sign up for a 1:1 counseling session with a medical student volunteer. Rates of sign-ups and completion were recorded. Setting – 2 North Philadelphia homeless shelters, requiring either an Axis I or current substance abuse diagnosis for residence. Participants – A convenience sample of 20 homeless men were approached; 10 enrolled in the study. Interventions – Educational sessions, focus groups, and 1:1 AD completion counseling sessions Main Outcomes – Interest in and completion of an advanced directive. Results – 9 participants signed up to complete ADs after an informational session. At the conclusion of the study, 8 of them (88.8%) completed ADs. 40% of the total participants completed an AD. Conclusions – Similar rates of advanced directive completion were achieved with the student-led intervention compared to a previous intervention in the literature. Further study with a larger sample including homeless women should be conducted to provide a generalized conclusion. / Urban Bioethics

Background: The childbearing years place socioeconomically disadvantaged African American women at increased risk for poor diet quality, excess weight gain, and cardiometabolic complications. Little is known about the attitudes, beliefs, values, and contextual constraints that shape these high risk mothers’ dietary and physical activity behaviors. Objective: The purpose of this study was to examine health perceptions of diet quality and physical activity among low-income African American women in the early postpartum period, and how these perceptions manifest as barriers or facilitators to health. Additionally, we examined how they may differ by known predictors of health, such as education, age, parity, and BMI. Methods: We conducted semi-structured, individual interviews with 20 women who were between 3-6 months postpartum. Mothers were approached and recruited in the waiting room of a university-affiliated, outpatient prenatal care clinic in Philadelphia, PA. Enrollment in the study was restricted to women who self-identified as African American, were at least 18 years old, and met the federal income guidelines to qualify for assistance (Medicaid, WIC). Individual interviews were audio recorded and transcribed verbatim, with transcripts verified by research staff. Thematic coding and content analysis were performed by 3 researchers using NVivo 10 software to assist with data management. Results: Barriers and facilitators of healthy eating and physical activity after childbirth fell into 4 major themes of mothers’ lives: 1) new structural reality in the postpartum period; 2) physiologic changes after delivery; 3) correct/incorrect perceptions of healthy eating and activity; and 4) social determinants influencing behaviors. Mothers described the transition from pregnancy to the early postpartum period as having a significant negative impact on their eating and activity behaviors due to heightened fatigue, time constraints, and the monotony of daily life with a newborn. We found more than double the number of perceived barriers to engaging in healthy eating than facilitators with regard to fluctuations in food supply, cost of food, and the built environment. Mothers with obesity and less education were more likely to have misperceptions; these misperceptions additionally served as strong barriers to making healthy lifestyle choices. Changes in mothers’ physical symptoms and health status (e.g., developing diabetes, hypertension), on the other hand, facilitated healthy behaviors. Conclusion: This research deepens our understanding of the primary drivers of health behaviors among low-income African American women in the postpartum period. We identified barriers which limit and facilitators which support these mothers’ ability to engage in healthy behaviors, though there were far fewer facilitators of healthy eating and physical activity. Interventions designed to overcome these barriers and capitalize on these facilitators have the potential to improve health outcomes for this population. / Urban Bioethics

The current fragmented delivery of health care has contributed to unplanned hospital readmissions as a leading problem in the United States. Reducing readmissions to urban teaching hospitals is difficult. Many patients living in urban communities face social, economic, language, and transportation barriers to maintaining their health. Both the patient and the medical center experience the burden of readmission and are challenged with addressing SDoH and social injustices at several levels. Medicare views hospital readmissions as a marker representing lower quality of health care delivery to penalize hospitals providing care to the poor. This thesis addresses multiple social and economic factors associated with hospital readmissions, explores the interrelated components of readmissions at the personal and hospital system level, and delves into the interactions of bioethical principles associated with urban living. Hospital readmissions remain a serious issue nationwide and in order to reduce the rates of re-hospitalization the social and economic inequalities contributing to hospital readmissions are significant and must be addressed. / Urban Bioethics

Low health literacy is highly prevalent in the United States and can significantly impact health outcomes for patients. Prior research has shown that communication is a major mediator between health literacy and health outcomes. However, there has been limited investigation into the quality of communication of patients who attend clinics staffed by medical residents. The patient population attending the resident clinic at Temple University Hospital is made up mostly of African Americans from lower-income neighborhoods of North Philadelphia. This investigation aims to gather data regarding the relationship between health literacy and communication in this previously under-studied patient population. Using a rapidly self-administered health literacy screening tool, the quantitative data reveals a high prevalence of low health literacy in this patient population. Additionally, using a semi-structured interview with a two-staged coding process, the qualitative data describes several ways in which limited health literacy can diminish optimal patient-provider communication. The patients in this study population express a high desire for information about their health status, as incomplete communication was a potential source of anxiety. Suggestions from patients in this population focus on increasing active participation in clinic visits. Study subjects agreed that interventions targeted towards medical residents would help to improve communication with low health literacy patients. Novel approaches to educating medical trainees about health literacy should be investigated in the future. / Urban Bioethics

Childhood trauma greatly impacts the lives of patients and their future health outcomes. Since the discovery of the utility of the Adverse Childhood Experiences (ACEs) screening tool in the 1990s, many providers have attempted to screen and intervene on these past experiences of trauma with mixed results. ACEs have an outsized impact on adult health. There is considerable literature documenting the changing state of screening for ACEs in adult populations, and the compelling rationales for doing so. There are also a number of interventions available currently, but providers face challenges to use them. Ethical considerations and issues with the current state of screening for ACEs exist, due to some of these challenges and differential availability of interventions between populations. Here, I use the principles of urban bioethics to explain the ethical obligation of screening for ACEs despite these challenges and to dispute previous discussions on this topic. This article will show that there are general strategies that providers can take to implement ACEs screening in an ethical manner and specifically discusses trauma-informed care’s utility to help achieve these strategies. Through this discussion, I hope to encourage providers to reconsider ACEs screening and give them strategies to do so. / Urban Bioethics

Understanding gender, sex, and sexuality is required in order to be a competent, patient-centered physician, and, therefore, inclusion of these topics in undergraduate medical education is essential. Current medical education is not producing physicians equipped to manage the complaints and issues that face their patients in these areas. LGBTQ populations are most affected by the inadequacy of training related to these topics. LGBTQ patients face unique issues in healthcare in terms of their normal development, pathology, social determinants of health, and healthcare system practices. Additionally, LGBTQ people and those who engage in behaviors that parallel these identities are prevalent in the general population. The addition of a gender, sex, and sexuality curriculum would simultaneously address LGBTQ disparities as well as the need for improved sexual health education that would benefit all patients. Currently, undergraduate medical curricula have limited, non-standardized education on gender, sex, and sexuality. A few American institutions have published both qualitative and quantitative studies that indicate medical students’ attitudes are malleable and their clinical skills can be improved in these areas. Further, numerous national medical societies have created curriculum guidelines and recommendations in order to aid medical schools looking to bolster their gender, sex, and sexuality related curricula. This paper will synthesize research and these guidelines to propose a robust gender, sex, and sexuality curriculum that is tailored to the environment found at the Lewis Katz School of Medicine at Temple University. / Urban Bioethics

The physician-patient dichotomy is reinforced continuously in medical education and medical practice. The physician possesses knowledge that will be used to help the patient in some way. However, as human beings, physicians are subject to the illnesses and diseases that affect their patients. Physicians moved by this role-reversal may feel compelled to record their experiences, leading to an accumulation of “physician-as-patient literature.” Five examples of “physician-as-patient” literature illustrate five fundamental lessons that can be adapted by physicians: relating to patient vulnerability, fostering hope for patients, mobilizing support systems, recognizing physical consequences of disease, and appreciating patient quality of life. By generalizing these individual stories, it is not necessary for physicians to experience the exact disease or illness they treat. Rather, they can draw from their unique life experiences to practice empathy. The concept of empathetic medicine can be introduced in medical school training by integrating empathy education into scientific curriculum. Current practitioners can benefit from narrative exercises, reflection and physician self-disclosure in efforts to promote empathy. Medical practice requires solid relationships between human beings, physicians and patients. This basic principle is further emphasized in “physician-as-patient” literature and concerted efforts by institutions and individual physicians can lead to a foundation for a culture of empathy. / Urban Bioethics

The United States has the highest incarceration rate in the world. The millions of people in prison across the country experience numerous health disparities and injustices despite having a constitutional right to health care. In chapter 1, the issues surrounding health inequity in prison are highlighted through two case studies on patient autonomy. From a bioethical standpoint, patient autonomy is integral to a person’s health, yet it is frequently violated in prison in multiple ways, including a lack of informed consent and the censorship of health literature. Greater awareness and advocacy efforts are needed to safeguard patient health within the carceral system.Chapter 2 highlights the importance of incorporating prison health into medical education, where currently few opportunities exist. In recent years, medical school curricula have placed increasing emphasis on the social determinants of health, which include prison health. Service-learning offers a potential means for incorporating prison health education into medical school curricula, as it represents an experiential learning modality that facilitates the formation of relationships between medical students and the surrounding community. The Lewis Katz School of Medicine’s prison health service-learning program was established in collaboration with Prison Health News and serves as one example for how students can learn about the social determinants of health and play a direct role in advocating for marginalized patient populations. / Urban Bioethics

The field of bioethics relies on the voices of nonexperts when finding solutions for bioethical issues. However, there are many factors that influence an individual’s capacity to participate in bioethics. These include one’s understanding of bioethics or the relevant jargon, one’s awareness of an issue, one’s ability to relate to an issue, and one’s desire to participate with an issue. Therefore, it is imperative that bioethicists communicate directly with nonexperts to minimize these barriers. After all, if discussions surrounding bioethical issues only include people with high ethical literacy, our solutions will be tainted by sampling bias.There are currently few strategies aimed at communicating bioethics directly to nonexperts. I propose that musical narratives might serve as a useful communication tool. Narratives are relatable, inspiring, and easier to understand than logical-scientific language. By adding music, it is possible that these narratives will evoke deeper emotions, and improve retention of the topic being discussed. Musical narratives could be a powerful tool for presenting bioethical issues in plain language, in a way that increases awareness, inspires reflection, and encourages productive discussions. / Urban Bioethics / Accompanied by two .mp3 audio files: 1) Compassionate Care Release.mp3 2) Harm Reduction.mp3