Food insecurity affects 1 in 7 households with children and has worsened due to the COVID-19 pandemic. Food insecurity disproportionately impacts marginalized populations including households with children with a single parent (usually the mother), families with low socioeconomic status, and Black and Latinx families. Amartya Sen, an economist and philosopher, was a pioneer in viewing food insecurity as a social phenomenon rather than a natural phenomenon. Furthermore, he highlighted the role that economics, politics, and social norms play in creating and perpetuating the problem. Therefore, to address food insecurity, we must address the root causes, which include poverty, structural racism, and lack of social cohesion among others. Urban bioethics provides a lens to examine food insecurity through agency, solidarity, social justice, community collaboration, and structural competency. In this thesis, I will explore the history of food insecurity in the United States, disparities in who is affected, the impact on children's health, and how government, community, and healthcare programs currently address the issue. Urban bioethics offers more than just a perspective for understanding an issue; it provides guidance on how to address this multifaceted problem in an ethical manner. Therefore, I will also demonstrate that there is an ethical responsibility as a healthcare provider and system to address the issue and explore potential solutions and strategies that align with urban bioethical principles. / Urban Bioethics

Historically, mass incarceration has proven to be more dangerous and deadly than Covid. This statement is not meant to downplay the severity of Covid or disrespect those who have lost their lives due to the virus, as it has affected many in my own family. Instead, it sheds light on the detrimental impact that Mass Incarceration has had on communities across America. Given its deadly consequences, I propose that Mass Incarceration be addressed with the same level of urgency and intensity as Covid. It is time to acknowledge mass incarceration as a cancer in our society and take immediate action to address it. It violates the core principles of Bioethics and will not pass any ethical inspection upon closer scrutiny. The principles of autonomy, beneficence, non-maleficence, and justice are not adhered to with the epidemic of Mass Incarceration. When the principles of agency, social justice, and solidarity are added as Urban Bioethical Principles, how unethical mass incarceration is becomes even more evident. I propose a multidisciplinary approach, highlighting the use of credible messengers, as a means to reintegrate incarcerated people into society as well as reduce the rate of incarceration by addressing the specific causes. / Urban Bioethics

Primary care providers in the United States face many challenges that complicatecare delivery and contribute to burnout, including heavy administrative burden, large patient panels,, and relatively low compensation when compared to other medical specialties (Carlasare 2018). In response to these problems, alternate models of primary care delivery have emerged. Direct primary care (DPC) is one alternate model of primary care delivery that some think could provide a solution to problems affecting primary care. DPC is a model of primary care delivery in which insurance is not charged for services provided by a practice. Instead, patients pay a recurring membership fee in exchange for access to services provided by the practice (Eskew and Klink 2015; DPC Frontier 2020). While DPC may decrease physician burnout and provide a viable source of primary care for some patients, there is the potential for DPC to contribute to already existing health inequities. This thesis will explore characteristics of DPC practices in the United States to identify qualities that could impact the delivery of ethical, equitable health care. These qualities will then be examined through a bioethical lens using the principles of equity, agency, and distributive justice to guide future directions for DPC and primary care delivery as a whole with the goal of establishing a care system that serves patients of all backgrounds and socioeconomic classes. / Urban Bioethics

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is common and yet remains perplexing for physicians and patients alike. Symptoms can be ambiguous, and understanding of this disorder has been limited, in part, by blunt diagnostic tools. Ironically, the lack of sophisticated scientific approaches itself has contributed to the perception that IBS is a less objective diagnosis. A syndrome that rests among intricate and poorly delineated relationships between biologic, psychologic, and social domains, IBS does not always lend itself well to traditional clinical discussions. Here, I offer narrative ethics as a potential tool to carry the nuances of this diagnosis. Invocations of narrative demand interrogation of stories and how they operate, and I argue stories work particularly potently for IBS patients. Finally, I consider how lay narratives about IBS may contribute to care disparities among different groups. Through these three sections, I seek to explore the ethical considerations of ambiguity within medical spaces and the traps that exist when dealing with illness that lies just beyond the margin of contemporary scientific understanding. / Urban Bioethics

Since the early nineteenth century, physicians have been offering the tracheostomy as a second chance at life. This procedure both saves and inextricably changes lives. Medical providers have barely scratched the surface of understanding the complexities of offering this technology. Ethically, however, we have an obligation to improve the process. We must support the patients and their caregivers and utilize everything at our disposal to ensure that we are safeguarding their quality of life. / Urban Bioethics

As COVID-19 spread across the United States, the bioethics community encountered challenges both familiar and unknown. Practitioners prepared to consult and advise clinicians, compiling lists of the anticipated bioethical issues, the dimensions of which were nuanced and multifaceted. However, a closer look at the discussion that developed around a single critical question, the ethics of ventilator allocation protocols, revealed that standard formulas and metrics had unintended consequences. The received wisdom of the ethical principles applied to the allocation of this scarce resource was questioned and found wanting as critics pointed out protocols that disadvantaged minorities, the disabled, and the elderly. New voices entered old debates. The practice of modern American bioethics, shaped at a time when patient autonomy was the prevailing value, was narrow in purview. The fundamental inequities of heath and healthcare experienced by racial and ethnic minorities and the poor, concerns of justice, were not central to the practice. The bioethics community had failed to sufficiently broaden its scope as the concepts of the social determinates of health were revealed by research and confirmed by lived experience. Prompted by the racial unrest of spring and summer 2020, one element of the bioethics community, represented by Association of Bioethics Program Directors, has recast its focus. / Urban Bioethics

In the city of Philadelphia there were over 4,000 opioid over-doses in 2018. There were many lives affected by over-prescribed medication and the dire need to have better policies and practices in place when delivering care is crucial. Better practices lead to shorter hospital stays, fewer readmissions and is cost efficient to all involved. Prescribed medications need to be better evaluated prior to dispensing for a non-acute pain. It is the pharmaceutical companies and healthcare provider’s obligation to be more educated when delivering care for the community that it serves. It is imperative to build better relationships between patients, physicians, and community leaders to alleviate this current opioid epidemic. The concerns within our current health care system are based on biased beliefs. These beliefs can lead to barriers of healthcare and give inadequate care for those who deserves the best quality of healthcare. / Urban Bioethics

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McMaster University MASTER OF ARTS (2020) Hamilton, Ontario (Philosophy) TITLE: Funding the future? Ethical considerations for the use of research-focused crowdfunding platforms AUTHOR: Rachel Katz, B.A. (McMaster University) SUPERVISOR: Dr. Claudia Emerson NUMBER OF PAGES: xi, 106 / Crowdfunding is an online fundraising tool that allows individuals or groups to collect donations from individuals both in and beyond their immediate networks, usually facilitated by social media. While many crowdfunding platforms support a panoply of projects, there are others that cater specifically to researchers. In this thesis, I evaluate a number of ethical and social issues related to the growth in popularity of these platforms. I discuss the issues of governance, accountability and trust, and transparency. I argue that currently, these platforms cannot be said to operate in a manner that indicates strong governance, and add that crowdfunding lacks the built-in accountability mechanisms of more traditional funding avenues such as grant-based funding. As a result, crowdfunding requires the building of trust between researchers, donors, and the platforms themselves. I conclude this section by arguing that better transparency may provide a way for crowdfunding to become a more trustworthy style of funding. I also critique the claims that crowdfunding can resolve a number of social inequalities related to income, experience, and global development. I dedicate a chapter to this critique and argue that despite claims that crowdfunding is currently democratizing research, there are still a number of issues that demonstrate that crowdfunding is not currently the “great equalizer” many claim it to be. This project marks one of the first long-form efforts to critically evaluate the conduct of crowdfunding platforms that specialize in funding for research, and I present and defend the view that while potentially beneficial for individuals and institutions, crowdfunding for research cannot continue to exist as a “Wild West”. / Thesis / Master of Arts (MA) / Crowdfunding is an online fundraising tool that allows organizations to collect funds from a broad range of individuals. While many crowdfunding platforms support a panoply of projects, there are others that cater specifically to researchers. Due to the novelty of crowdfunding as a financial resource for researchers, a number of important, complex issues surrounding its use have yet to be addressed and a number of ethical questions have yet to be answered. This project marks one of the first efforts to evaluate the ethical concerns associated with the use of crowdfunding platforms to support the production of research. I highlight ethical issues that pertain to governance, trust and accountability, and transparency, along with a number of other pressing issues related to social inequalities. Crowdfunding has the potential to revolutionize how research is produced and funded, but it cannot be allowed to persist as an online space with so few rules.