The COVID-19 pandemic has disrupted all sectors of society including medical education. Medical schools are faced with an ethical dilemma pitting quality of medical education against student safety and delivering quality patient care. This paper identifies the different participants affected by a medical school’s decision on how to educate their students, discusses the current context of the pandemic, and analyzes the different options medical schools have. This paper defines two phases of the pandemic whereby phase two is defined as the time period the scientific community has an adequate understanding of the risks associated with COVID-19 and hospitals have adequate personal protective equipment. Phase one is simply the time before both of those criteria are met, and is the time when medical students should not be allowed on in-person clinical rotations. During phase two, students should be granted agency to make the decision for themselves. Using the analysis of the current pandemic, the paper outlines how medical schools’ decisions should change for future hypothetical pandemics. / Urban Bioethics

The United States’ response to the COVID-19 pandemic of 2020 has been shaped by the country’s pre-existing narratives around disability. The master narrative of disability presents disability as a static condition that inherently lowers a person’s quality of life. This creates bias in physicians dealing with disabled patients, since under the master narrative’s logic disability is a negative trait that must be eradicated or cured. This troubling view has wider ramifications during a global pandemic as well. The COVID-19 pandemic has reshaped everybody’s relationship with time, bringing even nondisabled people closer to the experience of disability. However, the federal government and many state governments adhered as closely as possible to able-bodied conceptions of time. This has hindered the United States’ pandemic response by misprioritizing “reopening the economy” even at the expense of people’s lives. This creates a cycle, because this mismanaged response has led the country into even greater uncertainty about the pandemic, which moves everybody even closer to disabled conceptions of time. Had the master narrative not been so powerful, perhaps the United States could have responded more effectively to the COVID-19 pandemic. / Urban Bioethics

Every year more and more families are choosing home birth over the hospital. There is a growing movement, in person and online, of parents opting-out of hospital birth, sharing their stories, and encouraging others to do the same. At the same time, the United States is reckoning with its abysmal maternal mortality rates- the majority of which are the result of poor management of dangerous pregnancy complications. How can these two phenomena exist within the same social and cultural conversation? The landscape of home birth in the United States is complex. Data on the safety of home birth is limited, but it appears to be more dangerous than hospital birth. Further complicating the picture is a fractured, private American healthcare system, but families choosing to birth at home are highly motivated to navigate through it. We present multiple theories to explain why so many birthing people are opting for the home, some of which include feminist philosophical arguments, the romanticization of birth, the contemporary all-natural movement, and a strong distrust of our racist medical system. These arguments shed light on the flaws and inadequacies of our maternal healthcare system, and as a medical community we must actively work to alleviate them. We need to nationally and locally address maternal safety and implement practices to dismantle systemic racism within our institutions. While we address maternal mortality, we must also take steps to make home birth an equally safe option for parents who choose it. / Urban Bioethics

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

Medical schools around the country are utilizing service-learning as a method of promoting cultural humility among future physicians and strengthening partnerships between academic institutions and their surrounding communities. Critical service-learning (CSL) is an approach which emphasizes the need to address the power dynamics inherent to service through guided critical self-reflection for student learners, and centers autonomy and self-determination for community stakeholders. STEM Stars is an afterschool STEM enrichment program at a community center in North Philadelphia which was piloted in the 2019-2020 academic year. It was created with a trauma-informed design to address the social and emotional needs of K-6 students at the community center and to introduce trauma-informed practices to staff at the center. STEM Stars also served as a more intensive CSL opportunity for medical student volunteers and a model for future service-learning programs at the medical school. This thesis is a gap analysis of STEM Stars: it will provide a background of the program, review the pilot year, assess its successes and shortcomings, and propose changes to be made in the coming years. / Urban Bioethics

Studies have shown that the rates of incarceration in the United States of America have skyrocketed over the course of the last several decades. Furthermore, the extremely high rate of incarceration in the United States has become a destructive force on children, families and entire communities and has disproportionately affected and targeted young men from low-income communities of color. Studies have also shown that mass incarceration is generally harmful to the health of the individuals that are imprisoned, the health of formerly incarcerated individuals, and harmful to the health of families and communities. The true cost of mass incarceration on society is estimated to be as high as over $1 trillion per year and studies indicates that more than half of those costs are ultimately levied upon families, children, and community members that are not incarcerated. This paper discusses policy reforms that have been implemented in recent years and that are currently being implemented to help mitigate the harmful impacts of mass incarceration, prevent recidivism, and reduce the population of incarcerated individuals. It also outlines higher education and positive development programs as effective strategies to further achieve these goals, lists current programs and interventions that have been effective, and discusses policies that would improve access to education for justice-involved populations as an effective tool to combat mass incarceration. / Urban Bioethics

Helping patients and their families prepare for the end of life is a privilege for physicians. Often these discussions are very sensitive; one must be able to navigate the complexities of dying while maintaining the strong, intimate relationship with a person who has entrusted the doctor with his or her final care. Many of the same principles of medical ethics still apply such as informed consent, acknowledging different degrees of health literacy, and cultural humility. With end-of-life care, physicians are responsible for providing their patients dignity in death. In doing so, it is important to decide how aggressive or intense medical treatment should be. There is evidence to suggest that early involvement of palliative care, foregoing invasive procedures or surgeries, and honest communication with families can improve the dying experience. The COVID-19 pandemic has only added more challenges to an already difficult art that physicians spend entire careers working on perfecting. Nevertheless, this provides even more reason to be proactive in determining what is most important for every individual in their final days. / Urban Bioethics

Bioethicists have made great strides in identifying and addressing biases that can negatively impact healthcare outcomes. However, the scope of these efforts has rarely included mental healthcare, such as psychotherapy. Discussion of healthcare biases also does not address socio-economic class as adequately as it should. In what follows, I argue that class related biases may be detrimental to the effectiveness of mental health treatment. Unconscious class biases may harm the relationship between a psychologist and patient in ways that are not adequately understood or appreciated. I also examine ways in which class bias may be incorporated into current anti-bias education and training practices. / Urban Bioethics

The goal of this paper is to illustrate the real effects of maintaining an inaccurate and conflated view of the relationship between ‘sex’ and ‘gender,’ and to provide possible solutions to this quandary by analyzing the sources in both philosophy and the social sciences. The terms ‘sex’ and ‘gender’ are often rife with misunderstanding in the scientific and medical community, as well as in common usage. While neither term means the same thing contextually, both are constructed socially and require refinement for their usage in and outside of the scientific community. ‘Sex’ and ‘gender’ ought to be understood as interconnected socially constructed concepts, rather than hierarchically at odds where speculations about sex are valued greater than those on gender. A pluralistic, contextual understanding of both sex and gender as well as a clearer understanding of biological sex as an equally socially informed (and thus fallible) concept should be adopted to prevent possible harms as well as missuses of either term. The conflation of the terms within the medical community has significant consequences on some of the most vulnerable identities, particularly transgender people and especially trans people of color. The eventual delivery of poor health outcomes for trans people first begins with the fundamental definitions for ‘sex’ and ‘gender’ in the medical literature, as well as the medical literature’s basic understanding of non-normative sexuality. As a result, medical school education does not provide physicians in training with the adequate tools to provide care for trans people, or anyone outside the spectrum of accepted normative sexuality (heteronormative sexuality), and in addition primes them to further perpetuate and reinforce stigma. Possible solutions to this systemic medical injustice are to incorporate a pluralistic understanding of sex and gender to revise the medical literature, as well as going beyond simple cultural competency training for physicians and instead completely innovate how sexuality and sexual identity is taught in medical school education. / Urban Bioethics

Evidence continues to mount regarding the impact of climate change on the ecosystems of the world with increasingly dire predictions about the need for global action to slow warming and its downstream effects. Human beings are not immune to changes in their environment. Growing research demonstrates the impact of climate change on cardiovascular, pulmonary, psychiatric, neurologic and renal diseases, as well as its disruption of overall health through malnutrition, infectious disease, and pregnancy and developmental complications. Stress is known to precipitate, worsen, and maintain chronic disease. Social and community factors are known to impact individual and community mental health. The psychological stress of loss of goods, identity, and social support through weather events brought about by climate change has the potential to worsen the health and wellbeing of populations. Climate change does not impact communities equally. Populations historically and currently disadvantaged by inequitable policies may live in environments more at-risk to natural disaster, and have access to fewer financial, governmental, social, and healthcare resources to respond to climate events. Limitation of individual and community ability to respond to stressors reduces resilience and perpetuates chronic stress. The aim of this thesis is to examine the intersection of mental health and climate change with a particular focus on how social injustice has shaped the capability of populations, particularly those in urban settings, to respond to environmental changes with Philadelphia as a particular example. / Urban Bioethics