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Where you are born, the school you attend, your highest level of education, your race, age, and sex, these are all things that can directly, or indirectly impact your health. The social determinants of health is a phrase that can better be used to sum them all up. It refers to the social situation you exist in, and how that affects your ability to purchase healthy foods or obtain the medical care you need, and so much more. When it comes to certain measurements of health, people who fall within certain groups or populations, for example, minorities, or people of lower socio-economic statuses (SES), tend to have worse results than their white, or higher SES counterparts. These differences in health outcomes are referred to as disparities. As social scientists, healthcare professionals, and anyone with the means to address these disparities, we are ethically obligated to do so. There are already several initiatives aimed at addressing the social determinants of health. Through these initiatives, those in need are provided with things such as food vouchers, ride vouchers, and health education. What is missing, are organized studies with specific goals and appropriate sample sizes to address the efficacy of these initiatives. Once we have more such studies to provide us with data that supports the efficacy of these interventions, we can then advocate for policies that will make these resources widely available and encourage health equity. / Urban Bioethics

A thoughtful survey of the history of psychiatry sheds light on a rich and intricate story of our evolving understanding, experience, and treatment of mental illness through time. These chronicles are at once a show of human curiosity for the mind-body connection, and an experiment in cruel and unusual treatment of illnesses that have proven difficult to quantify through both ancient and modern scientific means. It is the latter that makes an ethical study of the past so vital in a concerted effort to write a more just future for all patients. This paper provides a survey of the history of mental health and psychiatry from ancient Egypt to modern-day America, highlighting the injustices suffered by patients with mental illness throughout all times with a particular focus on the burden shouldered by vulnerable and underprivileged persons, minorities, and urban populations. Through an analysis of landmark American cases, it examines the establishment of civil rights for psychiatric patients in the areas of: the right to treatment, right to refuse treatment, and civil commitment. Drawing upon these precedents and historical contexts, this paper explores how the principles of bioethics can be applied to the future of psychiatry with respect to emerging trends like the use of social media, telehealth, gene editing, and AI/VR in medicine. By thoughtfully reflecting on the past and applying the lessons we have gleaned to the future, this thesis aims to promote a more ethical and equitable approach to mental healthcare, one that protects and actively fosters the empowerment of all patients, regardless of background, mental status, or socioeconomic status. / Urban Bioethics

Global surgery describes the systematic way to reduce health disparities and realize accessibility and sustainability in surgical care. Nearly five billion individuals lack access to adequate and necessary surgical and peri-surgical care. The contemporary model of global surgery is that of short-term surgical trips, which have origins in European and North American colonialism. The current state of global surgery in the surgical subspecialty of otolaryngology and head & neck surgery (OHNS) care fails to meet an adequate ethical threshold based on traditional bioethical principles. In order to improve the system of global OHNS care to promote sustainability and long-term impact, global OHNS care needs to shift away from providing direct clinical care. This work presents an ethical framework composed of four primary domains—(1) preparation and understanding the local context, (2) education, (3) partnership and exchange, (4) research and evaluation. This model can be used to shephard a future with stronger ethical global OHNS care. / Urban Bioethics

This thesis is a pilot analysis of five Afghan physicians who recently evacuated Afghanistan and are hoping to reenter the medical field in the United States. To this investigator’s knowledge, there has not been a study focusing on physicians who were part of the 2021 evacuation from Afghanistan. Through participant interviews, this thesis aims to illuminate the opportunities and challenges facing these physicians. Additionally, a board member of the Afghan Medical Professionals Association of America was interviewed to better understand the resources provided to newly arrived Afghan physicians. We found that socioeconomic status, lack of social support and guidance, United States Medical Licensing Exams, and limited English proficiency were barriers to reentering the medical field for these physicians. Policy recommendations include allotting residency spots for forcibly displaced physicians and enabling opportunities for physicians to work in other positions in the medical field. / Urban Bioethics

Opioid overdose deaths in the United States have been steadily increasing for decades. Initially, these deaths were driven by overdoses from prescription opioids. Strict limits were placed on opioid prescriptions to decrease the supply of available opioids. Instead, this prompted a shift toward the illicit opioid market, causing an increase in heroin-related overdoses. Fentanyl, a synthetic opioid that is more potent than heroin, has become commonplace in the illicit supply of opioids. The illicit opioid market is unregulated and unpredictable, and there is no way to know exactly what is in a bag sold as heroin or “dope”. Illicit drug use has been historically dealt with as a crime rather than a public health issue in the United States. Recently, harm reduction has been offered as an alternative to this punitive approach. Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Naloxone distribution and syringe service programs are examples of currently utilized harm reduction strategies in the United States. While these programs are necessary to improve the quality of life of people who use illicit drugs, the rates of death from overdose are continuing to increase. These strategies do not protect people from the toxic and unpredictable drug supply. Safe supply is a relatively new concept, but there have been some small-scale implementations of this practice in Canada. Safe supply refers to a legal and regulated supply of drugs with mind and body-altering properties that traditionally have been accessible only through the illicit drug market. This is a necessary strategy to combat the alarming rise in overdose mortality. In this paper, I will analyze the ethics of this strategy using a principalism approach. This analysis concludes that safe supply is ethically sound, and it should be a part of our approach to the overdose epidemic. Safe supply promotes autonomy, prevents harms, advances well-being, and upholds justice for people who use drugs. / Urban Bioethics

Artificial Intelligence (AI) is rapidly advancing and is poised to transform healthcare. This thesis explores the current and future role of AI in medicine, radiology, and mammography, as well as the bioethical considerations surrounding its use. The introduction provides an overview of AI and its applications in medicine, followed by a discussion of how AI is being used in clinical care including its potential for improving patient outcomes and reducing healthcare costs. The thesis then delves into AI in radiology, specifically its use in image interpretation, diagnosis, triaging, and treatment planning. The role of AI in mammography is also explored, focusing on its potential for improving the accuracy of breast cancer detection and diagnosis, as well as the aspect of patient communication and education. The future of AI in healthcare is also discussed including potential challenges such as the need for high quality unbiased data and the ethical considerations surrounding AI’s use. The bioethical considerations surrounding AI in healthcare are explored including issues related to privacy, autonomy, and bias. Finally, the thesis concludes with a discussion of what can be expected from the future of AI in medicine and the implications for healthcare professionals, patients, and society. In summary, this thesis provides a comprehensive overview of the current and future role of AI in medicine, radiology, mammography, and patient care while highlighting the importance of addressing bioethical considerations as this technology continues to evolve and make its way into our lives. / Urban Bioethics

The following thesis will set out to argue that misinformation, disinformation, and conspiracies, in tandem with today’s advanced communication technology, pose a dire threat to the future of public health, biotechnological advancement, safe medical procedures, and ethical evidence-based legislation and policy. Each chapter will explore different points in public health and medicine that misinformation, disinformation, and conspiracies have already begun to shift or disrupt in ways that are eroding safe and effective care. Misinformation, disinformation, and conspiracy theories should be seen more broadly outside of the spheres of Big Tech and First Amendment discourse, and instead understood as a public health concern of which there are ways to inoculate, treat, and mitigate public spread. Much as we have come to understand that gun violence requires more than a judicial approach, so too must we come to understand misinformation, disinformation, and conspiracy theories as an indicator of failing health in a population. / Urban Bioethics

With racism driving perinatal health disparities, antiracist tools and trainings are necessary for WIC nutrition professionals who serve as frontline providers for Black and Indigenous families of color. Black families, in particular, are the most likely to experience harms from discrimination in health care and health services, even from well-intentioned providers in caring professions. This thesis investigates the role of racism, both interpersonal and structural, and how it may influence WIC enrollment, participation and culture of care. After providing a basic overview about WIC including recent participation and demographic statistics and trends, I share my own ethnographic observations and reflections on my positionality in the WIC clinic setting. I review research on the most commonly identified barriers to and benefits from WIC participation, including how those benefits intersect with contributing factors in the crisis in Black perinatal health in the United States, and make the case for including experiences of bias and racism as an overlooked barrier. With a focus on improving the client experience, I use an urban bioethics lens to inform strategies (including antiracism training for WIC staff) to increase and sustain WIC participation and the concomitant benefits participation can incur, particularly for Black mothers and birthing people and their families. I review the literature that informed our training, describe key components of the training, and summarize the findings from the evaluation and assessment of the WIC nutrition professionals who attended. Lastly, I posit how the convergence of COVID-19 and the racial justice uprisings of 2020, both accelerated the acceptance of the need for innovations in how WIC is implemented, and created the conditions to facilitate rapid changes towards more equitable policies and procedures at both the local and federal level. Many of these changes were previously thought to be desirable but unattainable, and I reflect on the need to seize this opportunity to intentionally build upon that progress by applying a racial equity framework to envision a post-pandemic WIC. / Urban Bioethics