Many women at academic medical centers experience gender-based microaggressions and sexual harassment during their careers. Women in surgical specialties experience a particularly high rate of these incidents, but these incidents occur across medical fields. As a result of microaggresions and sexual harassment in the workplace, women physicians experience a higher rate of burnout and moral injury, have fewer opportunities for promotion, and experience difficulty finding mentors when compared with their male colleagues. I argue that for these and myriad other reasons, microaggressions and sexual harassment of women physicians by their physician colleagues violates the bioethical principles of beneficence and non-maleficence. I also explore the importance of mentorship of women physicians by women physicians for navigating a career in academic medicine. / Urban Bioethics

Posthumous assisted reproduction (PAR), or conception after death, is of significant ethical debate. This thesis seeks to explore and evaluate the major ethical considerations concerning PAR. Autonomy, considered the most important ethical principle, holds a majority of the weight in this evaluation; it is not the sole topic on deciding whether to permit a request for PAR. In addition to the autonomy of the deceased, the discussion focuses on stakeholders, justice, and welfare of the child in regard to PAR. Application of these ethical principles allows for a holistic review of a PAR request, and ensures the best possible outcome for each request. / Urban Bioethics

Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics

The thesis begins by examining the history of the newborn screening (NBS) process in the United States and why it is the way it is today. The next section explores why certain genetic conditions, such as Long QT Syndrome (LQTS), do not fulfill requirements for the recommended uniform screening panel (RUSP). Lastly, ethical considerations of expanded NBS in the age of genomic technology are examined by highlighting the principles of autonomy, beneficence, equity, cost-effectiveness, privacy and trust. Overall, the NBS process benefits children by identifying serious rare diseases and intervening early to prevent harm; however, a deeper ethical analysis highlights some of the concerns with expanding mandatory, universal NBS in the age of precision medicine. The focus must be on educating the public and healthcare professionals about the NBS process and using evidence-based protocols for adding new conditions to the panel. / Urban Bioethics

Correctional populations account for about 2% of persons in the United States, who have a unique right to health care guaranteed by the Constitution per court decisions. However, the quality and breadth of this care is not standardized, and incarceration itself creates risk factors for one’s health. A review of the literature was done to evaluate the health and access to care of prison populations. Prison populations are largely minorities from poor neighborhoods with low socioeconomic status who usually have limited engagement with health services prior to incarceration; there is a large amount of morbidity of chronic diseases in prisons, and prisoners are at increased risk for communicable diseases, substance abuse and mental illness. Former inmates are also at increased risk of death following release. While advances such as telemedicine help to bridge the gaps in correctional health, more research needs to be done to assess the needs of this population, and more education and linkage to care should be accomplished to do right by these populations and ensure they get the care they need. This will in turn lead to better health outcomes in this population and may have a beneficial effect on the communities from which these prisoners come. / Urban Bioethics

While death is surely inevitable, the timing and circumstances of our deaths may vary widely and are likely to be negotiable in response to the changing needs of patients and families for physical, emotional and spiritual support as their diseases and illnesses evolve. Patients and families need to become aware of specific care options and supports that are available for them so they can be accessed in order to achieve their own “good death”. The professional health care team is obliged to assist patients and families become knowledgeable about potentially appropriate resources to assist them to become more comfortable with their roles thus more effectively supporting the patient as well as each other. Through literature review and interviews with diverse stakeholders, I will explore what a good death means from the divergent perspectives of patients, families and the clinicians who provide care for hospitalized dying patients. / Urban Bioethics

Research has long shown that breastfeeding provides many concrete health benefits for both mothers and infants that other forms of infant feeding do not. As such, unsurprisingly, breastfeeding has been deemed the preferred infant feeding method by the national and global medical communities and widespread initiatives promoting breastfeeding have followed. However, despite being well-intentioned, messaging around breastfeeding has left some people who cannot or choose to not breastfeed feeling othered and inadequate. While the health benefits of breastfeeding should not be understated, there are other experiences and perspectives that deserve to be in the conversation when thinking about breastfeeding and breastfeeding promotion. This thesis seeks to analyze breastfeeding and breastfeeding promotion from a bioethical perspective, providing an alternative lens through which to think critically about the way breastfeeding recommendations and initiatives are impacting real people. In this thesis, I will discuss the history of breastfeeding in the United States, why breastfeeding has come to be the gold standard of infant feeding, and real-life experiences of breastfeeding. I will also analyze breastfeeding, breastfeeding messaging, and current breastfeeding initiatives through the four principles of bioethics: beneficence, maleficence, autonomy, and justice. Lastly, I will offer my view and recommendations on how to incorporate bioethical perspectives into breastfeeding promotional strategies to create a more effective, inclusive, and supportive breastfeeding culture at the individual, community, and national level. / Urban Bioethics

The Temple University Hospital System Ophthalmology Department implemented a telemedicine screening program for diabetic retinopathy to improve patient care and community engagement. The program screened over 1900 patients in the Philadelphia area from March 2016 to March 2020 and identified a significant number of patients who required further in-person examination and treatment. The implementation of a telemedicine screening program for diabetic retinopathy raises important ethical issues and merits discussion of the impact of social determinants of health on healthcare outcomes. In these community initiatives, the principles of agency, beneficence, non-maleficence, social justice, and solidarity in bioethics should be considered as they pertain to the specific needs of the community in which they are implemented. Overall, the COVID-19 pandemic has highlighted the importance of considering the ethical implications of healthcare practices, including diabetic retinopathy screenings. The risks and barriers to access must be taken into account, especially for vulnerable populations in urban areas. As such, promoting primary care engagement, providing accurate and culturally appropriate education and outreach, and addressing social determinants of health can help ensure that all patients have access to comprehensive and equitable care. By considering these factors, diabetic retinopathy screenings can be conducted in an ethical and effective manner. / Urban Bioethics

Distributive justice is a bioethical principle concerned with the fair distribution of resources and benefits in society. In the context of orthopaedic surgery management, distributive justice is an important consideration in ensuring that all patients have equal access to the resources and care in the treatment of their injuries. The literature well documents demographic and socioeconomic factors in the allocation of elective orthopaedic surgeries, but unfortunately a similar analysis is lacking when it comes to orthopaedic trauma surgeries. This study examines fundamental philosophical perspectives that underly healthcare delivery specifically pertaining to orthopaedic trauma. In doing so, the influence of race, socioeconomic status, insurance status and other factors on access to care and allocation of resources are described. Findings for various orthopaedic trauma surgery cases suggest decreased allotment to those of black race, lower socioeconomic, educational, and non-insurance status. Although the reason is multifactorial and complex, I suggest a shift in focus to the equity and fair distribution of surgical resources by considering the role of population health, understanding multidisciplinary interactions, improving research methodology, and community partnership. / 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