When it comes to inclusion of social support as a criterion for kidney transplantation, there is lack of standardization and understanding of what it truly means to staff, clinicians, even patients and their families. Despite the variability in what “social support” means to many kidney transplant teams and centers, studies (mostly through survey studies) have shown that inadequate social support serves as an exclusion for patients awaiting kidney transplantation. With inadequate social support serving as an exclusion criterion and without it being properly addressed, inequities currently present in the kidney transplant considerations may be perpetuated. This thesis aims to tangibly define this social support criterion within an urban setting – North Philadelphia. Through REDCap survey administration to practitioners and support staff that handle candidacy for kidney transplantation, we will get a sense of how social support defined by wealth, marriage relationship and parental relationship affect views on the ethics of kidney transplant considerations. Discussions will also be applied to pediatric settings. This thesis will be a commentary on whether the current transplant system fulfills the standards of urban bioethics principles. This will present a framework for social support referrals to be implemented as a necessary resource if a patient on the transplant list presents with inadequate social support. I will argue support of the urban bioethical principles of social justice and solidarity for the purpose of helping healthcare systems, government and insurance understand that such resources should be funded by them to support candidates who truly need it. / 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

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

This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery. / 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.

Hepatitis C virus (HCV) is a major public health concern with significant morbidity and mortality. New HCV infection is primarily associated with intravenous drug use. With the ongoing opioid crisis, the incidence of injection drug use and new HCV infection has risen. From 2010 to 2019, the number of estimated infections increased by 387% which is largely attributed to the opioid epidemic and injection drug use (CDC Viral Hepatitis 2019). In 2011 the treatment of HCV was revolutionized with the introduction of direct acting agents which revolutionized the treatment of HCV. Despite guidelines recommending treatment for PWID infected with chronic HCV there are a number of reasons this population is not commonly offered treatment. A growing body of literature has shown that PWID can be successfully treated and attain SVR even in the presence of ongoing drug use. This thesis was prepared by search of pertinent literature to analysis and arguments and evidence for and against the treatment of HCV in those with active injection drug use. / Urban Bioethics

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