When the COVID-19 pandemic erupted in early 2020, many of the first known clusters were in jails and prisons. With poor ability to socially distance, inadequate access to prophylactic and preventative supplies, and a populace with more comorbidities than the general population, prisons and jails quickly transformed into incubation centers for the most virulent novel antigen of the last century. The United States faced a particularly daunting challenge in that despite making up just 4.2% of the global population, the correctional system houses 25% of the world’s incarcerated population. With public health experts sounding the alarm regarding the dangers to the incarcerated and surrounding communities, bold strategies were needed to prevent the spread of COVID-19. Reducing population, it was argued, by either temporarily or permanently releasing inmates who were deemed the most medically vulnerable and least threatening to public safety, was largely viewed as the most effective strategy nationwide. Instead of heeding these recommendations, administrators and legislators at both the federal and local level opted instead to try to combat the virus in prison and jails primarily with quarantines and lockdowns, draconian violations of human rights that 18 months after the pandemic’s beginning would result in an infection rate for the incarcerated population 5.5 times higher than the general population and a mortality rate 3 times that of the general population. By looking at a timeline of the pandemic in the US with a particular focus on Pennsylvania and Philadelphia County more specifically, we are able to confront the missteps that led to this humanitarian crisis. Using contemporary data and research we establish the bioethical violations that occurred due to the abdication of population reduction policies and provide data corroborating the efficacy of decarceration as a preventative tool. Furthermore, acknowledging that this public health crisis is both ongoing and likely to occur again, we argue that there is a bioethical imperative for broad decarceration measures that are inclusive of the majority of inmates in the United States. Recognizing the failures of lengthy sentencing policies to deter crime, the exorbitant costs associated with high per capita incarceration, and the obsolete and racist policies that led to these high incarceration rates in this country, we argue that our elderly and ill incarcerated population poses a negligible risk to public safety, and it is essential we reduce the number of individuals in our nation’s jails and prisons immediately. By reassessing the role of our corrections system we can not only prevent the next humanitarian crisis but recalibrate our correctional system within a rehabilitative rather than punitive paradigm. / Urban Bioethics

The Asian American and Pacific Islander (AAPI) community has seen increased adverse mental health outcomes secondary to the stresses of the COVID-19 pandemic. This includes growing literature that shows that AAPIs are at higher risk of experiencing symptoms of posttraumatic stress. Many studies allude to how these disparities in mental health outcomes may be secondary to how the world has responded to the COVID-19 pandemic. This thesis will explore this mental health inequity by organizing literature into three major groups using the biopsychosocial model, which is a holistic model classically used in mental health to model how biological, psychological, and social stressors can be the cause of mental illness. This thesis will look at how the COVID-19 pandemic has adversely affected many people who identify as AAPI and how they have been disproportionately affected compared to their White counterparts. / Urban Bioethics

Disgust is a part of medical education. Whether in the anatomy lab, the operating room, or the hospital wards, medical school is often the first time that future doctors see human suffering manifested in bodies that elicit embarrassment, disgust and fear. Over the course of training, seeing such bodies goes from exceptional to commonplace as doctors learn to witness and empathize with suffering without becoming overwhelmed by it. In this thesis, I examine students’ first encounters with abject bodies in the anatomy lab, their later encounters with such bodies in their clinical years, and the educational programming shapes students’ gaze towards these bodies as they develop from laypeople into professionals. I argue that while medical humanities curricula implemented into gross anatomy help students manage challenging personal feelings elicited by the corpse, taboos and silences during the clinical years prevent students from thinking deeply about how patients experience having bodies that elicit disgust. The dearth of reflection on feelings of disgust during clinical training leaves doctors in training ill-equipped to promote and maintain patient dignity during medical care, particularly at the end of life. / Urban Bioethics

The mature minor doctrine legally allows minors with the maturity of an adult to make decisions about their medical treatment, sometimes without the knowledge of their parent or guardian. However, the mature minor doctrine does not live up to its expectations; there are no guidelines for determining if a minor is mature or if the minor has the capacity to consent. The court system’s reluctance to allow minors to refuse treatment, the focus on stereotypical adolescent behavior, and the possibility of penalization of the family also serve as drawbacks to minors exercising their right to bodily autonomy through the mature minor doctrine. Standardization can solve these issues, revolutionizing the mature minor doctrine so that minors’ preferences about their care, particularly in the setting of life-threatening illness, can be honored. / Urban Bioethics

Race-based medicine is the belief that people of different races have different biological characteristics that affect the diseases they are prone to, and the types of treatments and procedures that should be used. This belief is reflected in medical education, clinical practice, and research. Race-based medicine was born from slavery. Notions of biological difference between races were used to justify slavery, and the structural racism that was a product of the slavery era gave rise to race-based medicine. Despite the common belief that medicine is evidence-based and objective, science and medicine reflect society, and thus are also flawed and biased. Medicine and medical education cannot be separated from the views of the dominant culture. The belief of today dictates the lens through which physicians and researchers look at patients, procedures, and treatments. Despite more and more evidence that there is no biological basis to our social construction of race, race-based medicine is still being taught in medical schools. Medical vignettes and the United States Medical Licensing Examination (USMLE) display questions that encourage the normalcy of whiteness, reinforce stereotypes, and emphasize that diseases are race-specific. Race-based medicine is dangerous; not only is the concept unscientific and based in, the belief is also a source of trauma for minority students and residents. How does one cope with the daily assault of information that your race is a risk factor for many diseases, a justification for treating you differently, or that your fellow physicians are being trained to believe that the amount of melanin in your skin is enough information upon which to base assumptions? Instead of desperately searching for innate racial differences, society needs to change their focus to social determinants of health. We are chasing the rabbit hole of biological racial differences, but ignoring social determinants and structural racism, which distracts us from achieving health equity. / Urban Bioethics

The purpose of this thesis is to examine the patriarchal undertones and overt sexism that informs and takes place within undergraduate medical education (medical school). Using a feminist analysis, I will expose some of the ways in which sexism occurs. This includes at the levels of who is given authority to teach medical students, the biomedical research we are using as our primary knowledge source, what material is chosen to be prioritized vs what is left out of the curriculum, how this material is taught and interpreted, and what the larger cultural and value system is that medical education is embedded in. I will demonstrate how the patriarchal values of masculinity, objectivity, heroism, competition, technicality/procedurality, objectivity, rationality, and so on pervade each of these levels, devalue femininity and non-biomedical sources of knowledge, exclude women, and cause harm to all trainees and future patients. / Urban Bioethics

Congenital heart disease (CHD) is the most common birth defect and often resultsin neurodevelopmental impairments and psychological problems which impede educational and occupational attainment and decrease overall quality of life into adulthood. While morbidity and mortality outcomes have improved over the last several decades, non-Hispanic black and Hispanic children continue to experience a disproportionate burden of CHD. An urban bioethics approach to disparities in cardiac neurodevelopmental outcomes necessitates an examination of the context, setting, and structures in which CHD care is delivered. This thesis proposes a model through which access to and quality of cardiac care impact disparities in neurodevelopmental outcomes. The thesis describes an initial evaluation of the proposed model conducted through retrospective record review. Though research funding and hospital resources have historically flowed toward optimizing surgical and other clinical care techniques, results indicate that factors such as poverty and other social determinants of health have a greater impact on many CHD outcomes. An urban bioethics framework asks us to additionally consider the ways in which cardiac care teams act as barriers to high quality care. Findings are discussed in terms of next steps and a proposed qualitative study to further evaluate results. / Urban Bioethics

Addressing childhood trauma is increasingly being recognized as a priority in public health, healthcare and health policy sectors. As evidence mounts that the effects of trauma are both graded and dose responsive, stakeholders in healthcare are turning more attention to preventing and addressing experiences of trauma in childhood, commonly referred to as adverse childhood experiences (ACEs). Trauma Informed Care (TIC), is a promising clinical approach attuned to the specific needs of traumatized patients that is still in its infancy with regards to training and evaluation of practitioner skills. Although physicians of all specialties will encounter patients who have experienced trauma, few undergraduate medical education curriculums provide formal training in TIC. Additionally, the approach to TIC in clinical settings has largely been biomedical and individual, with a focus on screening and treatment. This model ignores the role that communities play in both propagating trauma and generating resiliency. Urban academic medical centers, often geographically located in highly traumatized communities, must take a specific interest in developing TIC research, theory and praxis that includes and empowers communities. Service learning, a form of experiential education that cultivates self-awareness in students while simultaneously meeting community objectives, is a pedagogy that aligns with a community driven TIC framework. This thesis outlines the implementation of a community driven, bi-directional TIC learning model designed to serve the needs of medical students and low income K-8th grade students living in the geographic catchment of an urban, academic medical center. / Urban Bioethics

Teenage childbearing is considered a societal ill, despite the evidence failing to demonstrate a causative link between teenage childbearing and negative consequences for teens or their children. This thesis argues that the strongly held assertion that teenage childbearing is detrimental to teens and society is rooted in racist eugenics theories and histories of reproductive coercion. Today, social scientists, health care providers, and public health professionals develop and celebrate programs that reduce rates of teen pregnancy, particularly programs that provide Long Acting Reversible Contraceptives (LARCs) to teens in marginalized communities. While these efforts are well-intentioned, they fail to recognize their perpetuation of histories of reproductive coercion of young women of color. This paper recommends ways in which the medical community can be better informed and respect reproductive autonomy in caring for teens from marginalized communities. / Urban Bioethics

In the current healthcare landscape, parents generally make decisions regarding whether or not their children are allowed to take part in clinical research, with the general assumption being that parents know what is best for children. Investigations have been conducted regarding what is likely to lead parents to consent or not consent to their child’s participation in a trial, but research plans seldom incorporate the consideration that not all parents come into the consent process with equal social, academic, and economic footing. Since the burden of the ultimate decision lies primarily on the parents, it is supremely important that they are capable of making a well-informed and thoughtful choice. Bioethical understanding of the influence of parental decisions in clinical research must consider demographic variables and how they may affect parents’ decisions to allow or disallow their child to participate in a clinical trial. Those differences could affect the consent process and have ramifications for the research findings, as research results are affected in numerous ways by which children do, and do not, participate in studies. This paper looks specifically at parents in the process of informed consent for pediatric research, taking into account several social determinants of health and how they affect who participates in research and how that affects research as a whole. / Urban Bioethics