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Where someone lives, how much education they have, their income, all are recognized as social determinants of health, and as being of greater importance in their overall health status and outcomes than are their doctors and medicines. But all of these are affected by times in which they have lived. These encompass the physical world, the social forms, institutions, economic activities, material goods, the customs, beliefs, morals, laws, norms, and arts of the world in which we move, and all change over time. The experiences of a body moving through time alter that body in direct and indirect ways, to create change that is persistent through time. A patient might reasonably say "to understand me you need to understand the times in which I have lived." Similarly the health of a population can only be fully understood if the history of that population is considered. A case study of an individual within a specific population is used to illustrate these points. / Urban Bioethics

Lifetime incarceration within the United States has an incidence of 6.6%, thehighest globally. Within the United States, individuals experiencing incarceration are among the few citizens who have a protected right to healthcare, as outlined by the Eighth Amendment of the United States Constitution. Yet, despite the promise for adequate care, patients who are currently incarcerated or have previously experienced incarceration continue to be included in the most vulnerable and underserved populations. When bioethical principles, specifically autonomy and agency, are considered, it becomes clear that there is a convoluted relationship between the healthcare system, the correctional system, and the patient who must traverse both sides. Incarceration itself is often associated with poor short- and long-term health outcomes, and patients who currently or previously experienced incarceration can face bias when attempting to navigate the healthcare system. It is imperitive to evaluate healthcare provided in the prison systems as well as the associated outcomes because of the significant proportion of the U.S. population affected by incarceration. This thesis explores the current status of healthcare provided to individuals who are currently or previously incarcerated. In addition, this thesis aims to identify disparities that exist within the provision of this care. Lastly, it suggests potential solutions that would result in more ethical and humanistic care provided to this vulnerable population. / Urban Bioethics

Vaccines are a scientifically proven method of preventing disease. Immunization has eradicated and continues to protect individuals from life-threatening and fatal diseases. However, as a public health measure, trust in efficacy and safety of vaccines has not been unanimous since their inception. Historically, acceptance of vaccination as a method for disease prevention has been debated since development of the smallpox vaccine. Vaccine hesitancy exists on a spectrum with the advent of each new vaccine but has been amplified in the present day COVID-19 pandemic across the United States. Higher vaccination rates have been associated with lower COVID-19 caseload, a miracle for special populations such as pregnant, pediatric, and older patients at higher risk for COVID-19 complications. This thesis seeks to explore, through a bioethical lens, the factors that contribute to the growth of today’s vaccine hesitancy movement. I highlight previous vaccine hesitancy movements and hesitancy today by examining multiple themes present in literature. I argue that describing a patient as an “Anti-Vaxxer” further ostracizes them from the healthcare institution, politicizes a healthcare issue, and generates inequitable healthcare. I use the example of Philadelphia’s own COVID-19 vaccination response through interviews with involved individuals. In terms of solutions, I propose open and persistent conversation between healthcare institutions and community, public education, and structural reform. The key concern of this thesis is to explore how to navigate a complex healthcare ecosystem regarding vaccination and strategies to ensure patient safety while maintaining the bioethical principles of autonomy and agency. / Urban Bioethics

Immigrants and refugees in the U.S. tend to face many significant difficulties in obtaining good health care. In this analysis, I review what is known and unique about the health of Middle Eastern immigrants/refugees in the U.S., with a particular focus on Iraqis, and identify the barriers to healthcare that they commonly face. The most significant obstacles noted include cultural and religious differences, poverty, discrimination and distrust, and language barriers. In the process of discussing these factors, I reveal how this population understands health in the context of their religion and of their migration status. I also extrapolate how the barriers they face are likely to be exacerbated due to the COVID-19 pandemic and postulate solutions to these issues. / Urban Bioethics

Amyotrophic Lateral Sclerosis is a neurodegenerative disease affecting adults with disease onset averaging between 50-60 years of age. As neurons die, patients experience rapid physical and cognitive decline with death typically following 3-5 years after diagnosis. As there is currently no cure for disease and no treatment to prolong life expectancy, medical management is focused on quality of life. In addition to traditional medical treatments, medical professionals must also consider maximizing autonomy as a way to increase quality of life with a focus on relational and psychological factors. For patients in low-income urban neighborhoods, inequalities affecting agency should be evaluated as part of medical care to increase both autonomy and overall quality of life. / Urban Bioethics

This body of work aspires to explore the avenues by which medical professionals can leverage adolescents' current and historic high social media usage to increase their health literacy. In order to accomplish this, several types of health literacy and the ethical implications of inadequate health literacy are discussed, specifically with adolescents in mind. Next, trends in media and social media usage by adolescents and its effects on this population are determined, and examples of interventions using these means in the literature are analyzed. Finally, the work discusses my personal experience using social media to disseminate health information, challenges our collaborative faces, and future directions for our project. / Urban Bioethics

As the opioid epidemic continues in Philadelphia, buprenorphine clinics are becoming a necessary mainstay in treatment of these patients. HIV and HCV rates are rising throughout the city due to injection drug use, and buprenorphine clinics could be a bridge to therapy for these conditions as well. This thesis explores the current data about HIV and HCV rates, their connection to injection drug use, and how these overlapping epidemics might be addressed in a comprehensive manner. Historical data, current trends, and first person reflections from clinicians in the TRUST buprenorphine clinic are used to inform our understanding of barriers to integrated screening and treatment. The thesis concludes with a discussion of a better integrated model of care.

Stigma in the healthcare system is widely documented. A significant medium through which stigmatizing thoughts, opinions, and attitudes are propagated is language. Stigmatizing language can create barriers to care, while inclusive non-stigmatizing language has the ability to highlight a patient’s strengths, humanity, and potential for recovery. While several institutions have implemented campaigns and interventions aimed at reducing stigma in healthcare, research examining the impact of these interventions is limited. Specifically, no studies have examined the effects of language-focused campaigns on patient outcomes. This paper reviews the current literature on stigma and stigmatizing language in healthcare and proposes a hypothetical study designed to assess the effects of a clinician-facing training that emphasizes the use of non-stigmatizing language on opioid abstinence in patients newly diagnosed with opioid use disorder. Potential limitations in study design and data analysis, along with possible implications of study results, are discussed. / Urban Bioethics

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