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 thesis explores the role of formal bioethics instruction in preparing medical students to face ethical issues pertinent to diverse populations in clinical practice. The importance of bioethics education has been widely recognized and as a result, it is formally required in all medical schools. However, with little standardization on the actual logistics, ethics education in medical schools is extremely variable, producing students who are naïve and/or inconsistently capable of managing ethically complex situations. During medical school I pursued a Masters of Arts in Urban Bioethics (MAUB), which heavily focused on the social determinants of health and how they manifest in health care settings. I acquired new skills that gave me perspective and awareness into ethical issues that urban populations face, and during my clerkships I found I was better equipped and more comfortable navigating my patients’ non-medical complexities than my non-MAUB peers. Using three personal patient encounters as examples, I illustrate how a comprehensive urban bioethics education can positively impact patient care. Finally, I suggest improvements to medical schools’ bioethics curricula that will likely influence and mold each student’s thought processes to be more ethically-aware and culturally-sensitive. The goal of reforming bioethics education is to give students a set of real-world skills rather than a theoretical book of knowledge. Without a comprehensive and multifaceted approach to bioethics, students will likely lack the cultural sensitivity, awareness, and perspective necessary to treat a diverse patient population. / Urban Bioethics

Though there is ample evidence in existing literature demonstrating racial inequity in end-of-life care, there is minimal examination of how the culturally mainstream values of hospice contribute to inequity and reduced access for nonwhite populations. This paper reviews participatory action research, interviews and chart reviews of nonwhite populations including African Americans, Latinx, Asians and Native Americans to determine what end-of-life values these groups report and how they differ from the values of hospice and western biomedicine. All of these groups reported unmet cultural needs with respect to hospice access ranging from differing communication style preferences to different religious beliefs to different ideas about what they dying process should look like. Contributing to these barriers was practitioner ignorance about cultural variance in end-of-life preferences, demonstrated by studies of physicians to identify barriers to effectively providing end-of-life care. To help foster better knowledge and understanding between practitioners and nonwhite patients whose cultural needs are not being met, I have created a value-assessment tool to add to the standard structure of end-of-life conversations. Using this tool with patients in end-of-life conversations could improve physician confidence in understanding the needs of patients and provide patients an opportunity to freely communicate their needs and therefore increase access to the hospice services that can meet those needs. / 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

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

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

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