This paper highlights the importance of the provision of interpreter services for patients of limited English proficiency (LEP) in primary care settings in the United States. In the United States today, over 8% of the population is of LEP, and yet no formal funding structure exists to ensure that these patients have access to interpreter services when they see their primary care provider. Research shows that without appropriate interpreter services, LEP patients not only endorse poorer subjective experiences of healthcare, but that these patients also experience objectively worse healthcare, such as less frequent visits to primary care providers, poorer management of chronic illness such as diabetes and hypertension, and higher rates of expensive testing in emergency departments, to list a few examples. This paper was inspired by firsthand experiences of a medical student learner at an urban health center witnessing frequent improper utilization of interpreter services by physicians in primary care settings. The paper traces the federal legal history addressing communication services in healthcare in the United States, reviews papers that juxtapose patient and provider opinions of interpreter services, and concludes with a discussion of potential steps forward for improving interpreter services offered to the large percentage of the US population that is currently receiving subpar care due to unsurmounted barriers to communication. / Urban Bioethics

Psychiatric illnesses take place in the context of socioeconomic circumstances. A growing body of evidences support that a multidisciplinary care system that includes not only medical management but also social and psychological care significantly improves short-term and long-term outcomes of diseases. However, at the current stage, multidisciplinary teams often function without an exact manual and would rely on traditions and previous customs that vary among centers, which can make individual professionals involved in the care to feel uncertain and ambiguous in terms of his or her roles. This can pose a serious a risk of professional frustration and sense of disempowerment, which can negatively impact team dynamic and quality of patient care. This article attempts to articulate possible challenges that can be faced by multidisciplinary team, and how such challenges can be addressed and handled. To achieve this, first, elements of multidisciplinary care model will be identified, and roles of each professional member will be delineated. Then, challenges that can be faced by a multidisciplinary team will be addressed, using a historical example of National Institute of Mental Health (1946) and a personal account from a British social worker. Then, possible solutions for the current problems will be discussed, which include implementing effective communication systems and adapting a multidisciplinary care plan to address the special needs of different age groups. In closing, I will emphasize that multidisciplinary care is both a medical and ethical imperative; not only sociobehavioral interventions will improve patient adherence, prevent relapse, and maximize the effect of the care, but also the model will facilitate patient’s recovery of agency, the ability to discern right from wrong, and autonomy, the right to make the decision that is most consistent with their beliefs and value systems. / Urban Bioethics

As a healthcare provider focused on women’s health, injustice is something that I see in my patients’ experiences daily. The reasons behind the injustice go far beyond the walls of the hospital. They are related to provider awareness and training, patient access and cultural ideals, as well as structural bias against women, specifically non-English speaking women and women of color. They exist in an entangled web, in which the compilation of multiple factors results in further bias and further distance between the actual care the patient is in need of and the care they receive. My planned future role is to be a provider in Urogynecology, and I will be starting my fellowship in July 2024. This field has a unique lens into the care of women, spanning all ages, races, ethnicities, and education levels. So many women experience incontinence and prolapse, yet so few get help and present to care. Often in the literature, there is documentation that Black and Brown women do not have these issues as frequently as White women. However, there is little acknowledgment of the role that race and culture plays in obtaining care, and how this view could be distorted given so few women feel comfortable speaking on the topic of incontinence and prolapse. This thesis investigates the possible reasons associated with either no presentation or late presentation to care for incontinence and prolapse, and questions whether the captured prevalence in the literature is the true prevalence in our population. I review the research that exists, both quantitative and qualitative, regarding care patterns, patient attitudes and cultural factors, provider knowledge and awareness, and structural factors that facilitate and hinder access to urogynecologic care. I then use an urban bioethical lens to further identify structural bias and racism within healthcare, and inform strategies that may be used to better patient knowledge and education, to allow for more comprehensive and equitable care for women within the field of urogynecology. / Urban Bioethics

Patients with opioid use disorder (OUD) are at a high risk of a patient directed discharge (PDD) from the hospital and subsequent readmission, which is a significant detriment to their health. Qualitative studies have shown that, amidst myriad other reasons, patients with OUD leave the hospital due to undertreatment of their withdrawal and pain. Current guidance for the inpatient medical management of both withdrawal and, more broadly, OUD is initiation of opioid agonist therapy in the form of methadone or buprenorphine. While both have been shown to be highly effective for maintaining remission from OUD, there exist a myriad of barriers to enacting and maintaining this therapy. One approach to address this gap is expanding the array of opioid medications available to patients in withdrawal to include long and short acting opioids. There is limited data on the patient reported outcomes and perspectives of such an approach. This thesis draws from qualitative interviews of patients with OUD about their experiences being treated with this expansive protocol in order to characterize the attributes of successful withdrawal management for this population. Being treated by an addiction medicine team has already been shown to successfully reduce premature discharge. I argue that this approach, considered unorthodox by some, centers a patient's agency in making the decisions that are best for their situation and reduces harm to patients. The current standards of care do a disservice to patients with opioid use disorder, and this is a more progressive and ethical approach to inpatient addiction medicine that should be applied to other hospitals with high volumes of patients with OUD. / Urban Bioethics

Palliative care is a specialty focused on improving the quality of life for patients with serious illnesses through symptom management and emotional/spiritual support. Despite its documented benefits, it remains largely underutilized among head and neck cancer patients, especially those in urban environments. This thesis reviews obstacles to accessing care in these environments and proposes practical solutions to enhance palliative care accessibility and effectiveness. Disparities in the access and utilization of palliative care are largely influenced by socio-economic status, cultural discrepancies, and healthcare infrastructure, with limited patient awareness further impacting its use. Addressing these challenges requires a comprehensive strategy that includes policy reform, educational outreach, and localized community interventions. Such approaches should be culturally sensitive and tailored to local needs to bridge the gap between medical services and community expectations. By working with patients to recognize palliative care as an integral part of comprehensive cancer care, rather than merely an end-of-life option, we can improve the quality of life for patients with head and neck cancer. / Urban Bioethics

Objectivity is a valued principle in western allopathic medicine, and for good reason: it has been very effective in saving lives and improving quality of life since the nineteenth century. In recent years, however, there have been many visible accounts in social and mass media describing the consequences of disbelief by physicians, particularly from women and people from marginalized communities. This paper uses an urban bioethics perspective to examine how overreliance on the principle of objectivity can lead to violations of bioethical principles that it should be in balance with.First, media and personal accounts of physician disbelief and misdiagnosis of patients are discussed. This is followed by a brief discussion of the historical roots of objectivity in medicine, an examination of the particular difficulty western medicine seems to have with medically-unexplained symptoms, and a closer look at specific diseases that encounter stigma in the clinical setting. From there, specific bioethical principles are analyzed. Nomaleficence is violated when clinicians traumatize their patients through disbelief of symptoms that cannot be confirmed through confirmatory testing and when they prematurely assume a psychogenic cause of symptoms simply because the cause cannot be found with a physical examination, laboratory test, or imaging study. Solidarity, autonomy, and agency are violated through the denial of the patient’s expertise in their own experience and the disempowerment of the patient in the doctor-patient relationship. Distributive and social justice are violated when the efficiency demanded of a medical system built upon reliance on objective findings disadvantages patients with difficult-to-diagnose conditions along with women and marginalized groups. Potential solutions to the unethical overreliance on objectivity include changes to medical education and culture to be more allowing of fallibility and humility, as well as better integration of mental and behavioral health into the primary care setting, so patients’ medical and psychosocial needs may be treated more holistically. Structural changes to the healthcare system allowing better physician reimbursement for clinical counseling will also mitigate dependency on objective findings for diagnosis and treatment. / Urban Bioethics

No description available.

The development of HIV counselling has been one of the major public policy innovations in response to the challenges posed by HIV and AIDS in Britain. This research, using a participative and qualitative methodology, examines how HIV counsellors have conceptualised their approach to the ethical issues associated with their innovatory role. The research takes an overview of two separate phases of fieldwork conducted in 1990 and 1994. The first phase concentrated on establishing the background of self-identified HIV counsellors and how they related to the wider counselling movement which had already developed a distinctive ethic founded on respect for individual autonomy. Their general identification with the wider counselling movement raised issues how this ethic could govern their work with clients affected by HIV. The second phase concentrated on the management of confidentiality within multidisciplinary teams. The results of the research are set within the wider ethical and socio-historical context of AIDS policy development in Britain and explore changes in how HIV counsellors conceptualise ethical issues in the local context of their work. The methodology is that of `descriptive ethical inquiry' accompanied by examination of how this type of inquiry relates to moral philosophy and social sciences. The method of participative research adopted is consultative and careful consideration is given to how this type of research relates to comparable procedures used in the production of professional codes of ethics.

Thesis (doctoral)--Pontificia Università gregoriana, 2005. / Includes bibliographical references (p. 337-358) and index.

Abstract When it comes to the management of non-profit organizations, our country¡¦s academic sector has always placed an emphasis on the organization¡¦s decision making nuclei or those in command, and their effects on the fulfillment of organizational goals, resources placed into operation, efficiency, satisfaction, and other such self-management analysis. Seldom did they adopt an ¡§ethically-oriented¡¨ method of management. Instead they viewed the medical industry as a for-profit business, stressing business strategies and marketing, and therefore regarded patients as customers. This Study¡¦s Characteristics: 1. Focuses on medical and religious philosophies for investigation. Unlike single-issue studies, this study uses medicine as the primary basis for its perspective, and adds religious beliefs (Buddhism) to probe each health care morality issue. Health care morality issues include: abortion, cloning, euthanasia, organ transplants, and hospice care. In addition to ethical standpoints on medicine, using the sorted investigations on religious documents, we looked deeper into the viewpoints of Buddhism. 2. Feature: Besides investigating the morality of the body and flesh of ordinary medicine, we probed further into the root of the ethics of the mind. In retrospect to ¡§Medical Ethics¡¨, and the viewpoints of eastern and western medicine, we went beyond the perceptions of ordinary medicine, and explored a deeper plane of the mind, so as to increase the depth of health care ethics. Results: Through a factor analysis, we ended up with 10 factors: (hospice care, euthanasia, surrogate mothers, cloning and genetic issues, therapeutic art, religious care, stem cells, medical ethics, and abortion issues) and analyzed them according to 3 morality decision models to identify which is the best suited. Results: efficiency model and ethics model had positive effects on hospice care and therapeutic ethics, while as liability model had negative effects; liability model and ethics model had positive effects on religious care, medical ethics, and abortion issues; all 3 models, efficiency model, ethics model, and liability model, had positive effects on genetic issues and stem cells; efficiency model had positive effects on euthanasia, while as ethics model had negative effects; liability model had positive effects on surrogate mothers; liability model had positive effects on cloning issues, while as efficiency model and ethics model had opposite effects. Did people have different attitudes towards health care ethics? Results: the general public and medical personnel had significantly different attitudes towards hospice care, genetic issues, and therapeutic ethics; medical personnel, religious personnel, and the general public had significantly different attitudes towards religious care, stem cells, and abortion issues; medical personnel, patients, religious personnel, and the general public had significantly different attitudes towards medical ethics; medical personnel and religious personnel had significantly different attitudes towards euthanasia; the opinions of the groups were unanimous towards surrogate mothers and cloning issues. As to individual orientation, the higher the person¡¦s education level, the less he or she places emphasis on health care morality issues. Perhaps since medical ethics is only beginning to be drawn attention to in our country, most people with a higher degree of education have not yet concerned themselves to this level. In summary, this is worth the attention of our current education ministry. Key words¡GMedical Ethics¡AHuman Cloning¡AHospice