Master of Arts in Urban Bioethics Spring 2022 Presentation of Graduates by MA Urban Bioethics

Master of Arts in Urban Bioethics Presentation of Graduates

Spring 2022

Message from the Director and Chair The Center for Urban Bioethics was established in 2012 with a vision to see health equity across all urban communities. ‘Urban’ refers to spaces characterized by density, diversity, and disparities. ‘Bioethics’ helps us describe what minoritized populations experience as we shine a spotlight on the health inequities to which society has become desensitized. When considered together, ‘Urban Bioethics’ reflects the Center’s belief that health disparities are, at their core, fundamentally unethical. Despite an abundance of academic medical centers, Philadelphia remains a city where health disparities persist at levels surpassing national averages. In our North Philadelphia community, a disproportionately high number of residents suffer from preventable and treatable health conditions. Our mission is to eliminate health inequity by identifying barriers to health and addressing disparities in health and access through community partnerships, education and research, and implementation of locally focused solutions that foster our community's capacity for health. Our team of physicians, clinicians, juris doctorates, social workers, anthropologists, community health workers, credible community messengers, and more have contributed to the classroom and community-based learning of our students. The interests of our students are similarly diverse and wide-ranging, but all of them are united by the shared desire to see communities where health inequities do not exist. Each member of this year's graduating class will make their unique impact felt in a wide array of spaces—whether our newest alumni's next steps find them working in hospitals and other clinical settings, serving on research teams or ethics committees, learning or teaching in new educational endeavors, or thinking differently as members in their own communities, we are confident in their abilities to think, act, and advocate ethically and I am inspired by their passion and grateful for their commitment to health equity and justice. Dr. Kathy Reeves Professor, Pediatrics Director, Center for Urban Bioethics Chair, Department of Urban Health and Population Sciences

Our vision is to see health equity across all urban communities. ‘Urban’ refers to spaces characterized by density, diversity, and disparities. ‘Bioethics’ helps us describe what minoritized populations experience as we shine a spotlight on the health inequities to which society has become desensitized. When considered together, ‘Urban Bioethics’ reflects the Center’s belief that health disparities are, at their core, fundamentally unethical. 1

The MA in Urban Bioethics The Master of Arts in Urban Bioethics is the nation’s only bioethics degree explicitly focused on health equity. The program provides a solid foundation in traditional bioethics along with practical training and resources for understanding and analyzing the ethics, values, and value conflicts that exist in spaces that are dense, diverse, and laden with disparities. MA Urban Bioethics students are an interdisciplinary and intergeneration collection of individuals seeking to foster health equity in their work – in clinical care, research, administration, policy realms, public health, and more. Health equity work is necessarily vast and the skills from this degree can lead students in anti-racism work, health policy advocacy, research inclusion, and ethical community engagement impacting spheres from the interpersonal to the national and global stages.

Message to Graduates As an anthropologist working in bioethics, I am fortunate to work with students who are able to integrate the social and cultural aspects of health and health care delivery with their chosen field. It has been a tremendous privilege to get to know each of you in class through the firstyear seminar series, and whether you took the introductory seminar series with me years ago when in person learning was the norm or we met in a virtual classroom, it has been such a pleasure watching each of you make conceptual connections, examine familiar problems through a new lens, and chart your own path through your degree. Each of you dedicated time and energy to learn practical strategies and develop your own ideas of how to build a healthier, more equitable world. Moreover, you persisted against the backdrop of a pandemic and ongoing calls for social justice and racial equity in the United States. I hope you see the critical importance of the work you have undertaken and the need for more ethically informed critical thinkers and problem solvers like you. I am heartened by the thoughtfulness, passion, and determination each of you has demonstrated throughout your time in our program and inspired by the possibilities for your future in and beyond bioethics. Dr. Nora Jones Director, MAUB Program Associate Director, Center for Urban Bioethics

The Urban Bioethics Principles Autonomy → Agency No one will say that autonomy should be kept off of the principles list. It should not, however, be placed first, for autonomy without context is too philosophically abstract, and if placed at the center of our deliberations can lead us to unintentionally behave unethically. All of us (adults with capacity, to be more specific) have autonomy—we all have the right to determine what happens to our bodies and are free to make independent and uncoerced choices. None of us, however, is fully unconstrained by limits on our agency. Agency here refers first to our ability to see a complete range of options possible in a given situation, and second, to our capacity to carry out a particular choice. Our agency, the choices we are able to envision and make are dependent on the experiences we have had—and this applies to every one of us. And those experiences are influenced by our gender, sexual orientation, skin color, class background, educational experiences, schools attended— in other words, by our context. And if we act only in a way that respects a patient’s abstract autonomy, but doesn’t account for their particular agency, we are doing a disservice to that patient: We are setting them up for failure if they cannot actually take our advice, we are wasting resources when they are readmitted for preventable recurrences of illness, and we are contributing to our own burnout by making the same mistakes again and again.

Justice → Social Justice

Solidarity

Social justice as a principle requires us to consider contextual and structural inequities when allocating resources. The common equality versus equity meme reflects the underlying concern with the fact that we should be thinking about allocating resources so that everyone has the capacity for health. A social justice framework asks us to rethink the factors that contribute to our health. Health behaviors — smoking, exercise, alcohol consumption — should not be considered to be purely individual. Our behaviors are socially influenced, for example, by our access to healthy food and ability to exercise safely on our streets. The impact of our physical environment — air and water quality, for example — differs by where we are able to live, which is primarily socially determined. Social justice demands not simply that we provide proper advice to all patients regardless of context, but rather, that we tailor our advice to patients depending on their context. The advice to “eat a healthy and balanced diet” looks different in a community with a high median income and a local grocery store that carries fresh vegetables than it does in a community marked by poverty where the only accessible food is from corner stores and fast food restaurants.

Solidarity is an important addition to the bioethics toolbox of principles. As a principle it binds two or more stakeholders together; it does not separate them into disconnected corners. It is a principle that requires us to acknowledge that the social forces that led some of us to be particularly advantaged and set up for success are the same forces that have made it much more difficult for others. It is a principle that reinforces the fundamental healing bond between provider and patient, a bond that affirms that, as Levias said, we each exist for the other. It reminds us that, in the words of activist Lilla Watson, “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.”

Students & Alumni Define Urban Bioethics “Urban Bioethics provides an opportunity to look beyond the classroom into the community. As a medical student, I am learning a lot about the human body, and studying urban bioethics wonderfully complements the medical school curriculum by allowing me to explore humanity more broadly. I think that understanding how the density, diversity, and disparity of urban settings impacts patient health outcomes will be invaluable as a future physician." “Urban Bioethics means conscientiously training your mind to think in solution-driven ways that help the most marginalized in a society. Urban Bioethicists use science-driven data and first-person narratives of those individuals that have experienced hardships to create more sustainable ways to narrow the divide between haves and have-nots. Urban Bioethicists work in many platforms to close the gaps and center an underserved group of people. We work in medicine, policy change, study design, public health and more.” “Urban Bioethics means a taking up of the cause of medical or biological civil rights for vulnerable populations due to issues unique to the urban setting.” “Urban Bioethics to me is an intellectual space to better understand the societal disparities in an urban setting. This is done through the lens of better understanding ethics and morals. It also provides a platform in thinking through ways in which we can create a more just society by re-evaluating ethics and norms.” “To me, Urban Bioethics encompasses the ethical context in which urban communities exist. It gives us a unique lens as we explore the different aspects of our communities and think about ways in which we can facilitate positive change.” “Urban Bioethics to me means an opportunity to assess how bodies, systemically labeled within a social context, are affected by the environmental landscape and medical institutions tasked with ensuring the health and quality of health of those bodies (residents).” “The Urban Bioethics toolkit deepens my medical knowledge, empowers me to advocate for Temple’s patients and the wider North Philadelphia community, provides language for issues I have long struggled to understand and reminds me why I chose medicine. When I face a challenging issue in the emergency department or in my non-clinical work, I reflect on the principles I’ve learned in the program and the way forward is made clear. I’m deeply grateful for the opportunity to be a student at CUB."

Presentation of Graduates

Master of Arts August 2021

Miyuki Fukui COVID-19 and Its Impact on Asian American and Pacific Islander Mental Health

Morganne Dougherty The Intersection of Ableism and Pediatric Palliative Care

Mykal Gerald An Ethical Recovery from Breast Cancer: An Examination of Disparities in Breast Reconstruction and a Discussion About Rectifying These Disparities

Sara Goff The Ethical Considerations in the Treatment of Hepatitis C Virus in People Who Inject Drugs

Pablo Gutierrez

December 2021

Unsafe, Inhumane, and Preventable: The COVID19 Pandemic in U.S. Prisons and Jails and Decarceration as a Bioethical Imperative

Maria E. Hood-Prosser The Medicine Cabinet

Zachary Louie

Erin Hall

Class Bias in the Therapeutic Relationship: A Call to Bioethicists

The Mature Minor Doctrine: The Ethical Dilemma of Respecting Adolescents' Right to Refuse Care

Joan F. Steiner

Nubaira Khan

Bioethics, Covid-19 and Racism – The Beginning of the Aftermath

The Panopticon as a Potential Thought Experiment: An Exploration of Centralized Power Structures

May 2022

Sarah K. Mooar How Provider Stigma Towards Patients with Mental Illness and Substance Use Disorders Influences Health Outcomes

Chinaemelum Akpunonu The Intersection Between Race, Clinical Research, and Medical Education with Examples on Strategies and Policies to Understand, Identify, and Mitigate the Effects of Race-Based Medicine / Racism in Medical Institutions

Alison Richard Our Words Matter: A Proposed Study to Examine the Effects of Clinician Language Training on Patient Opioid Abstinence

Becky Anthony

Sharmaine Gabrielle Ross

Climate Change and Mental Health - Past and Future Social Justice Considerations

Patient Perspectives of Police Presence in the Emergency Room: A Trauma Informed Study

Brianne Luz Cook

Hannah Sagin

Envisioning a Feminist Medical Education

Learners' and Patients' Experiences of Disgust in Academic Medicine

Eva Cutler Creation of Life After Death: An Exploration of the Ethical Considerations of Posthumous Assisted Reproduction

Angeline Sandor Consequences of the Conflation of 'Sex' and 'Gender' on Trans Healthcare

Sonie-Lynn François

Jennifer C. Schadt

Community-Based Health Interventions: An Ethical Approach to Bringing Healthcare to the Marginalized

The Ethical Imperative of Narrative Care: The Necessity of Applying Narrative Skills to Clinical & Bioethical Practice 6

Race-based medicine is the belief that people of different races have different biological characteristics that affect the diseases they are prone to, and the types of treatments and procedures that should be used. This belief is reflected in medical education, clinical practice, and research. Race-based medicine was born from slavery. Notions of biological difference between races were used to justify slavery, and the structural racism that was a product of the slavery era gave rise to race-based medicine. Despite the common belief that medicine is evidence-based and objective, science and medicine reflect society, and thus are also flawed and biased. Medicine and medical education cannot be separated from the views of the dominant culture. The belief of today dictates the lens through which physicians and researchers look at patients, procedures, and treatments. Despite more and more evidence that there is no biological basis to our social construction of race, race-based medicine is still being taught in medical schools. Medical vignettes and the United States Medical Licensing Examination (USMLE) display questions that encourage the normalcy of whiteness, reinforce stereotypes, and emphasize that diseases are race-specific. Race-based medicine is dangerous; not only is the concept unscientific and based in, the belief is also a source of trauma for minority students and residents. How does one cope with the daily assault of information that your race is a risk factor for many diseases, a justification for treating you differently, or that your fellow physicians are being trained to believe that the amount of melanin in your skin is enough information upon which to base assumptions? Instead of desperately searching for innate racial differences, society needs to change their focus to social determinants of health. We are chasing the rabbit hole of biological racial differences, but ignoring social determinants and structural racism, which distracts us from achieving health equity. Chinaemelum Chidinma Akpunonu is a fourthyear medical student with a B.S in Biology – Vertebrae Physiology Option from The Pennsylvania State University. Some of her research interests include gathering strategies to mitigate the race-based medicine in medical institutions and clinical settings, exploring the impact of food deserts/food insecurity on wound healing in burn patients, and examining the disproportional effect of Covid-19 on communities of color. She was inducted into the Alpha Omega Alpha Honor Society and Golden Humanism Society in the Spring of 2022. Chinaemelum will start her General Surgery residency in June at the The Ohio State University.

Becky Anthony Climate Change and Mental Health - Past and Future Social Justice Considerations Thesis Advisor: Dr. Nora Jones

Evidence continues to mount regarding the impact of climate change on the ecosystems of the world with increasingly dire predictions about the need for global action to slow warming and its downstream effects. Human beings are not immune to changes in their environment. Growing research demonstrates the impact of climate change on cardiovascular, pulmonary, psychiatric, neurologic and renal diseases, as well as its disruption of overall health through malnutrition, infectious disease, and pregnancy and developmental complications. Stress is known to precipitate, worsen, and maintain chronic disease. Social and community factors are known to impact individual and community mental health. The psychological stress of loss of goods, identity, and social support through weather events brought about by climate change has the potential to worsen the health and wellbeing of populations. Climate change does not impact communities equally. Populations historically and currently disadvantaged by inequitable policies may live in environments more at-risk to natural disaster, and have access to fewer financial, governmental, social, and healthcare resources to respond to climate events. Limitation of individual and community ability to respond to stressors reduces resilience and perpetuates chronic stress. The aim of this thesis is to examine the intersection of mental health and climate change with a particular focus on how social injustice has shaped the capability of populations, particularly those in urban settings, to respond to environmental changes with Philadelphia as a particular example.

Becky Anthony is a PGY-4 resident in psychiatry at Temple University Hospital. She previously completed her undergraduate and medical education at The Ohio State University. Her academic interests include reproductive and Women's mental health and bioethical considerations in psychiatric treatment. Next year she will complete a fellowship in Consultation-Liaison Psychiatry at Oregon Health and Sciences University.

Brianne Luz Cook Envisioning a Feminist Medical Education Thesis Advisor: Prof. Providenza Loera Rocco

The purpose of this thesis is to examine the patriarchal undertones and overt sexism that informs and takes place within undergraduate medical education (medical school). Using a feminist analysis, I will expose some of the ways in which sexism occurs. This includes at the levels of who is given authority to teach biomedical sciences to medical students, the biomedical research we are using as our primary knowledge source, what material is chosen to be prioritized vs what is left out of the curriculum, how is this material taught and interpreted, and what is the larger cultural and value system that medical education is embedded in. It will be discussed how the patriarchal values of masculinity, objectivity, heroism, competition, technicality/procedurality, objectivity, rationality, and so on pervade each of these levels, devalue femininity and non-biomedical sources of knowledge, exclude women, and cause harm to all trainees and future patients.

Brianne attended Skidmore College (2014-18) and majored in neuroscience while taking on additional liberal arts courses and extracurriculars around topics of reproductive justice. She decided to go to Temple (LKSOM) for medical school where she could continue her interdisciplinary interests by getting an MD and MA in Urban Bioethics and join a community that also valued advocacy work. During this time, she stayed active with the Latin Medical Student Association, Medical Students for Choice and the Women’s Medical Fund and additionally won the Women’s Health Advocacy Award. She is currently completing both degrees as an MS4 and will soon be starting a residency in Psychiatry at Zucker Hillside Hospital where she hopes to specialize in women’s mental health.

Eva Cutler Creation of Life After Death: An Exploration of the Ethical Considerations of Posthumous Assisted Reproduction Thesis Advisor: Prof. Providenza Loera Rocco

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.

Eva Cutler is a fourth-year medical student who will be joining the Diagnostic Radiology Residency Program at Temple University Hospital in 2022.

Morganne Dougherty The Intersectionality of Ableism and Pediatric Palliative Care Thesis Advisor: Dr. Nora Jones

Since the early nineteenth century, physicians have been offering the tracheostomy as a second chance at life. This procedure both saves and inextricably changes lives. Medical providers have barely scratched the surface of understanding the complexities of offering this technology. Ethically, however, we have an obligation to improve the process. We must support the patients and their caregivers and utilize everything at our disposal to ensure that we are safeguarding their quality of life.

Morganne is a certified pediatric nurse at the Children’s Hospital of Philadelphia. Morganne provides care to technology dependent patients. Morganne has recently become a caregiver educator and provides caregivers with the critical knowledge they require to safely care for their technology dependent child in their home. Morganne has been recognized professionally as an innovator and she recently presented at a conference highlighting her work. Morganne collaborated to ensure CHOP offers skin and hair care products to better serve the BIPOC identifying patients at her hospital. Her next steps include pursuing a post-Master's teaching certificate and/or a certificate in disability studies.

Sonie-Lynn François Community-Based Health Interventions: An Ethical Approach to Bringing Healthcare to the Marginalized Thesis Advisor: Prof. Providenza Loera Rocco

Covid-19 shed a light on how disparities, based on institution racism and social determinants of health, led to negative healthcare outcomes. This inspired community organizations such as the Black Doctor’s COVID-19 Consortium to take matters into their own hands and play their part in meeting the needs of the community. With evident gaps in healthcare for marginalized communities, I believe that community-based health initiatives are an ethical approach to ensure care for marginalized communities. To ensure that a proper initiative is being crafted for these communities, it is important to define what community-based means. This paper explores four models for categorizing community based: community as setting, target, resource, and agent. While traditional research focuses on the voice of the academic, using Community Based Participatory Research amplifies and recenters the voice of the community, while providing a means to increase their capacity, fostering agency, and promoting solidarity. This paper explores local community-based health initiatives in North Philadelphia and emphasizes partnering with the community to determine their needs before creating an intervention. Using community-based interventions to increase access to healthcare for marginalized communities in tandem with existing models of healthcare, follows a utilitarian approach to ensure that the greatest number of individuals can benefit. Community-based health interventions are the most ethical approach to bringing healthcare to marginalized communities.

Sonie-Lynn is a fourth-year medical student here at Lewis Katz School of Medicine. She is a proud graduate of The University of South Florida, where she obtained a Bachelor of Science in Biomedical Sciences. During her time at LKSOM, Sonie was nominated by her peers to be inducted into the Gold Humanism Honor Society. Sonie's love for community and advocacy led her to the field of Family Medicine. Her interests include community medicine, health equity, and improving the pipeline of underrepresented students in medicine. For residency, she will be attending The University of Miami to further her training in Family Medicine. In the future, she hopes to provide compassionate fullspectrum care to the underserved, and be an agent of change in her community.

Miyuki Fukui COVID-19 and Its Impact on Asian American and Pacific Islander Mental Health Thesis Advisors: Prof. Providenza Loera Rocco, Dr. Seetha Chandrasekhara

The Asian American and Pacific Islander (AAPI) community has seen increased adverse mental health outcomes secondary to the stresses of the COVID-19 pandemic. This includes growing literature that shows that AAPIs are at higher risk of experiencing symptoms of posttraumatic stress. Many studies allude to how these disparities in mental health outcomes may be secondary to how the world has responded to the COVID-19 pandemic. This thesis will explore this mental health inequity by organizing literature into three major groups using the biopsychosocial model, which is a holistic model classically used in mental health to model how biological, psychological, and social stressors can be the cause of mental illness. This thesis will look at how the COVID-19 pandemic has adversely affected many people who identify as AAPI and how they have been disproportionately affected compared to their White counterparts.

Dr. Miyuki Fukui received an MD degree from Drexel University College of Medicine in Philadelphia. She is currently finishing her residency in Psychiatry at Temple University where she currently serves as Chief Resident. She is interested in Consultation and Liaison Psychiatry and Addiction Medicine. Outside of field of Psychiatry her interests include Asian American and Pacific Islander health, ethics, resident wellness and mentorship. She will be completing a fellowship in Consultation and Liaison Psychiatry at University of Southern California after graduation from residency.

Mykal Gerald An Ethical Recovery from Breast Cancer: An Examination of Disparities in Breast Reconstruction and a Discussion About Rectifying These Disparities Thesis Advisor: Prof. Providenza Loera Rocco

Black women, and other minority women, are among groups who have the highest rates of mastectomies, yet the lowest receipt of reconstruction in comparison to white women. (Dookeran et al. 2015; Offodile et al. 2015) Sadly, this means that Black women are stripped of their agency and as a result sacrifice a full and free, autonomous life for mere survival. This disparity persists today, and without surgeons to stand in solidarity with their patients - effectively acting in a socially just manner - this disparity will continue to exist. Written by a Black woman and future plastic and reconstructive surgeon, this thesis aims to answer the question, "Why do Black women, and other women of color, have the lowest rate of breast reconstruction in America?" By utilizing literature that addresses disparities in breast reconstruction and interviewing breast and plastic and reconstructive surgeons as well as patients who have experience with breast cancer and breast reconstruction, this thesis answers that question. In addition to providing an answer to the "why," the literature, surgeons and patients will also assist in addressing the "how," as this thesis is also purposed to provide solutions to mitigating this difference experienced by largely by marginalized women of color, and particularly, Black women.

Mykal Gerald is an M.D./M.A. in Urban Bioethics Candidate in her fourth year at Lewis Katz School of Medicine at Temple University. She is from Westchester County, New York by way of Ewing, New Jersey. In 2018, Mykal graduated cum laude from Villanova University, receiving a Bachelor of Science degree in Biochemistry. Later that year, she matriculated to the Lewis Katz School of Medicine and joined the Masters in Urban Bioethics program. At Temple, she occupies many roles, including Student Government Association’s (SGA) Executive Community Service Representative, Co-Chair of SGA’s Community Service Board, and the Student Diversity Council member. She applied to Plastic and Reconstructive Surgery residency programs, and her research interests involves understanding and mitigating disparities within this field. Her interest in Plastic and Reconstructive surgery stems from her research interests and the vast surgical opportunities and social impact that the field presents.

Sara Goff The Ethical Considerations in the Treatment of Hepatitis C Virus in People Who Inject Drugs Thesis Advisor: Dr. Nora Jones

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.

Sara is a Chief Resident at Temple University Hospital's Internal Medicine Residency Program and a graduate of Jacobs School of Medicine SUNY at Buffalo. Sara's professional interests include Gastroenterology, Medical Education, Social Determinants of Health, and Health Care Disparities. Sara will begin a Fellowship in Gastroenterology at Temple University Hospital in July 2022.

Pablo Gutierrez Unsafe, Inhumane, and Preventable: The COVID-19 Pandemic in U.S. Prisons and Jails and Decarceration as a Bioethical Imperative Thesis Advisor: Dr. Nora Jones

When the COVID-19 pandemic erupted in early 2020, many of the first known clusters were in jails and prisons. With poor ability to socially distance, inadequate access to prophylactic and preventative supplies, the United States faced a particularly daunting challenge in that despite making up just 4.2% of the global population, the correctional system houses 25% of the world’s incarcerated population. With public health experts sounding the alarm regarding the dangers to the incarcerated, bold strategies were needed to prevent the spread of COVID-19. Reducing population by releasing inmates who were deemed the most medically vulnerable and least threatening to public safety, was largely viewed as the most effective strategy nationwide. Administrators and legislators at both the federal and local level opted instead to try to combat the virus in prison and jails primarily with quarantines and lockdowns, draconian violations of human rights that 18 months after the pandemic’s beginning would result in an infection rate for the incarcerated population 5.5 times higher than the general population and a mortality rate 3 times that of the general population. By looking at a timeline of the pandemic in the US with a particular focus on Pennsylvania and Philadelphia County more specifically, we are able to confront the missteps that led to this humanitarian crisis. Using contemporary data and research we establish the bioethical violations that occurred due to the abdication of population reduction policies and present data corroborating the efficacy of decarceration as a preventative tool. Furthermore, we argue that there is a bioethical imperative for broad decarceration measures in the United States to not only prevent the next humanitarian crisis but also to ethically recalibrate our correctional system within a rehabilitative rather than punitive paradigm.

Pablo is a 4th year medical student from California. He's interested primarily in people and their individual and collective stories and how they inform both our culture and our own experiences. During medical school he volunteered with the Pennsylvania Prison Society as an Official Prison Visitor advocating on behalf of incarcerated Pennsylvanians and their families--work which led him to focusing his thesis on the experiences of the incarcerated during the COVID-19 pandemic. After graduating, he will be driving cross country and starting residency in Emergency Medicine at USC + LA County.

Erin Hall The Mature Minor Doctrine: The Ethical Dilemma of Respecting Adolescents’ Right to Refuse Care Thesis Advisor: Prof. Providenza Loera Rocco

The mature minor doctrine legally allows minors with the maturity of an adult to make decisions about their medical treatment, sometimes without the knowledge of their parent or guardian. However, the mature minor doctrine does not live up to its expectations; there are no guidelines for determining if a minor is mature or if the minor has the capacity to consent. The court system’s reluctance to allow minors to refuse treatment, the focus on stereotypical adolescent behavior, and the possibility of penalization of the family also serve as drawbacks to minors exercising their right to bodily autonomy through the mature minor doctrine. Standardization can solve these issues, revolutionizing the mature minor doctrine so that minors’ preferences about their care, particularly in the setting of life-threatening illness, can be honored.

Erin is currently a fourth-year medical student at Lewis Katz School of Medicine; she previously attended Washington University in St. Louis, where she earned a Bachelor's of Arts in Biochemistry and Women, Gender, and Sexuality Studies. Her research interests include end of life decision-making in pediatrics, decision-making for children with medically complex needs, stigmas surrounding pediatric palliative care, and trauma informed care. She is a member of the Gold Humanism Society. Erin will continue her training as a pediatric resident at University of Washington/Seattle Children's starting this summer.

Maria E. Hood-Prosser The Medicine Cabinet Thesis Advisor: Dr. Nora Jones

In the city of Philadelphia there were over 4,000 opioid over-doses in 2018. There were many lives affected by over-prescribed medication and the dire need to have better policies and practices in place when delivering care is crucial. Better practices lead to shorter hospital stays, fewer readmissions and is cost efficient to all involved. Prescribed medications need to be better evaluated prior to dispensing for a nonacute pain. It is the pharmaceutical companies and healthcare provider’s obligation to be more educated when delivering care for the community that it serves. It is imperative to build better relationships between patients, physicians, and community leaders to alleviate this current opioid epidemic. The concerns within our current health care system are based on biased beliefs. These beliefs can lead to barriers of healthcare and give inadequate care for those who deserves the best quality of healthcare.

A long-time North Philadelphia resident, Maria Hood-Prosser has been at Temple since 2001 and she currently serves as a Business and Systems Manager at Temple University Hospital. Her academic interests in urban bioethics began with her research into Managed Care Organizations while earning her bachelor's degree. Causes close to her heart include children's health, education, the environment, and human rights.

Nubaira Khan The Panopticon as a Potential Thought Experiment: An Exploration of Centralized Power Structures Thesis Advisor: Dr. Nora Jones

Jeremy Bentham’s panopticon is a theoretical prison that was developed in 1787 as a way to punish people convicted of crimes and deter future criminal behavior. 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 to 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 these systems are exploited to the point of dysfunction.

Nubaira is a graduate of the Urban Bioethics Master's program and holds a B.S. in Neuroscience. She has worked previously on potential therapeutic targets in neuronal pathways of patients with tuberous sclerosis, health care delivery and efficacy in remote rural areas of Bangladesh, and vaccine hesitancy in North Philadelphia. Her current work focuses on social constructs of power, systems thinking, and organizational behavior. She plans to continue her research in the field of bioethics and get her PhD.

Zachary Louie Class Bias in the Therapeutic Relationship: A Call to Bioethicists Thesis Advisor: Dr. Nora Jones

Bioethicists have made great strides in identifying and addressing biases that can negatively impact healthcare outcomes. However, the scope of these efforts has rarely included mental healthcare, such as psychotherapy. Discussion of healthcare biases also does not address socio-economic class as adequately as it should. In what follows, I argue that class related biases may be detrimental to the effectiveness of mental health treatment. Unconscious class biases may harm the relationship between a psychologist and patient in ways that are not adequately understood or appreciated. I also examine ways in which class bias may be incorporated into current anti-bias education and training practices.

Zachary is currently a medical records operations analyst. Previously completed a master's in Information Systems, focused on the moral and social implications of emerging technologies. Future research interests include moral psychology and its implications for normative ethics.

Sarah K. Mooar How Provider Stigma Towards Patients with Mental Illness and Substance Use Disorders Influences Health Outcomes Thesis Advisor: Dr. Nora Jones

Nearly 50% of Americans will meet the diagnostic criteria of some form of mental illness in their lifetime (Mehta & Edwards, 2018). However, only 40% of these individuals will seek treatment for them. Patients with mental illness have a lifespan that is, on average, 25 years shorter than individuals without mental illness and are at 2-3 times the risk of diabetes, heart, and lung disease than the average population but do not receive adequate treatment at a proportionate rate. As a country, there are very negative stereotypes held towards individuals struggling with mental illness and substance use disorders even though they are among the most common conditions in the population. This stigma against mental illness often prevents individuals from seeking care for their symptoms and causes medical providers to treat patients with mental illness differently than those without them. Stigma can be seen in the way providers speak about patients with mental illness, the way the medical record labels patients with mental illness, and even how health care providers themselves fail to seek treatment when suffering from mental illness themselves. This thesis examines the types of stigmas that exist describes how it interferes with clinical care and causes adverse clinical outcomes for patients with mental illness and substance use disorders and provides recommendations for improving the treatment of individuals with mental illness and the importance of normalizing talking about mental illness. Sarah Mooar is a 4th-year medical student at Lewis Katz School of Medicine at Temple University. In June 2022, she will be starting her psychiatry residency at Christiana Care in Delaware. Her interests include mental health, serious mental illness, addiction medicine, trauma-informed care, and the social determinants of health. She previously attended Denison University, class of 2011, where she majored in Psychology. She then worked at the Philadelphia VA in the Behavioral Health Lab for several years prior to completing a postbaccalaureate program at Temple University.

Alison Richard Our Words Matter: A Proposed Study to Examine the Effects of Clinician Language Training on Patient Opioid Abstinence Thesis Advisor: Dr. Nora Jones

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 nonstigmatizing language has the potential 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. My 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.

Alison Richard is a fourth-year medical student going into family medicine. Alison has special interests in addiction medicine, palliative care, and medical education. Alison hopes to one day pursue a fellowship in addiction medicine and practice patient-centered primary care at a Federally Qualified Health Center.

Sharmaine Gabrielle Ross Patient Perspectives of Police Presence in the Emergency Room: A Trauma Informed Study Thesis Advisor: Prof. Providenza Loera Rocco

Structural racism has been identified as a major source of medical vulnerability for urban populations. Police brutality is a consequence of structural racism and a critical social determinant of urban health that is associated with both physical and psychological injury. However, the presence of law enforcement agents is common in the healthcare setting, especially in the emergency department. The emergency department occupies a critical social role as a major source of healthcare for vulnerable urban populations, yet very little is known about patients’ opinions regarding police activity in the ED. This study contributes to the growing body of literature on the pathogenic effects of structural racism by designing trauma informed methodology to investigate patient perceptions of police presence in the emergency room.

Sharmaine Ross is a fourth-year medical student from Mays Landing, NJ. She received her Bachelor of Arts in Neuroscience from Johns Hopkins University and her Master of Science in Neuroscience and Education from Teachers College Columbia University. As a medical student, Sharmaine served as a mentor for the SNMA MAPS Program and Sherry Doctoring college, a community service representative for Sherry Doctoring college, a volunteer at Zion Cares, and a student representative of the Admissions Committee. She also completed a yearlong internship at the Center for Bioethics, Urban Health, and Policy. She is a member of AOA and was the recipient of multiple academic scholarships. Sharmaine will be continuing her medical training and research endeavors as a general surgery resident at Rutgers-NJMS.

Hannah Sagin Learners' and Patients' Experiences of Disgust in Academic Medicine Thesis Advisor: Dr. Nora Jones

Disgust is a part of medical education. Whether in the anatomy lab, the operating room, or the hospital wards, medical school is often the first time that future doctors see human suffering manifested in bodies that elicit embarrassment, disgust and fear. Over the course of training, seeing such bodies goes from exceptional to commonplace as doctors learn to witness and empathize with suffering without becoming overwhelmed by it. In this thesis, I examine students’ first encounters with abject bodies in the anatomy lab, their later encounters with such bodies in their clinical years, and the educational programming shapes students’ gaze towards these bodies as they develop from laypeople into professionals. I argue that while medical humanities curricula implemented into gross anatomy help students manage challenging personal feelings elicited by the corpse, taboos and silences during the clinical years prevent students from thinking deeply about how patients experience having bodies that elicit disgust. The dearth of reflection on feelings of disgust during clinical training leaves doctors in training ill-equipped to promote and maintain patient dignity during medical care, particularly at the end of life.

Hannah Sagin is a fourth-year medical student at LKSOM and rising first year Internal Medicine resident at Tulane University School of Medicine. Their professional interests include critical care medicine, chronic illness, aging and end of life care.

Angeline Sandor Consequences of the Conflation of 'Sex' and 'Gender' on Trans Healthcare Thesis Advisor: Prof. Nicolle Strand

The goal of this paper is to illustrate the real effects of maintaining an inaccurate and conflated view of the relationship between ‘sex’ and ‘gender,’ and to provide possible solutions to this quandary by analyzing the sources in both philosophy and the social sciences. The views and values embodied by the medical sciences will inevitably play an important part in how medicine is administered as well as the quality of care that particularly vulnerable patients (such as trans, intersex, and non-binary individuals) receive. The terms ‘sex’ and ‘gender’ are often ripe with misunderstanding in the scientific and medical community, as well as in common usage. Ultimately, conflation of the terms within the scientific/medical community and beyond leads to various harms, particularly to trans, intersex, and non-binary individuals. The philosophical contribution I forward aims to provide a pluralistic, contextual understanding of both sex and gender as well as a clearer understanding of biological sex as an equally socially informed concept that should be adopted to prevent possible harms as well as missuses of either term. Additionally, the social sciences and Urban Bioethics will illuminate how medical literature as well as medical school education perpetuates the conflation and stigma against trans people, and further provide us with possible solutions that go beyond cultural competency training for physicians, and instead suggest a total change in not only the literature but the structure of medical education on the whole. Angeline is a 3rd year dual degree Master's student in both Philosophy and Urban Bioethics. She received her Bachelor's of Science in Biology and Philosophy from Old Dominion University in Spring 2019. She has spent the last two years as a graduate teaching assistant in the College of Liberal Arts and has taught two different General Education Courses here at Temple. Her research interests lay primarily in Philosophy of Science, Medical Ethics, and philosophical pragmatism. She is interested in the intersection of race, gender, and science, and her current research is focused on how health inequities are perpetuated for trans/intersex people.

Jennifer C. Schadt The Ethical Imperative of Narrative Care: The Necessity of Applying Narrative Skills to Clinical & Bioethical Practice Thesis Advisor: Prof. Providenza Loera Rocco

Medicine and bioethics today are though as fields of pure logic, reasoning, and science, with physicians and ethicists trained to approach patients with an attitude of detached rationality. In reality, neither medical care nor ethics can be practiced well without an acknowledgement for their deeply emotional, relational, and narrative qualities. Medical care and bioethics must both be practiced through a narrative lens in order to truly meet the humanity of both patients and practitioners. There are practical methods to integrate narrative skills into clinical practice, as well as tangible benefits to doing so. Practically, this is performed through narrative medicine: an approach to medical care that recognizes the stories as a critical component to healthcare; as well as narrative ethics: an awareness of the essential role of narrative in moral understanding. Using narrative as a tool to understanding illness and moral grounds the more abstract and universal aspects of both in practical, individual reality. There are many practical aspects of narratives when applied to bioethics, such as acquiring narrative skills, what happens when stories are shared, recognizing how narratives are built, how they convey knowledge, organize life, and provide meaning. Illness creates an isolation – for both patient and practitioner – and stories allow each to express their experience and be supported though the stories of others. Stories help bridge the gap in experiences of illness between practitioner and patient while helping practitioners to maintain their empathy in the face of continual suffering. Narrative skills are also useful for practitioners to bring awareness to the power dynamics that influence patient stories, such as the power of practitioner as co-creator, whose voice is given credibility, external and internal influences on a story, who determines the meaning of a story, and how the patient is characterized within the story. Narrative permeates every aspect of human life, including medical and ethical situations, and approaching both through a narrative lens is imperative for the development of true understanding, empathy, and compassion. Cultivating a narrative framework towards illness allows both practitioners and patients to be cared for while also caring for the other, thus creating deep, meaningful connections.

Jennifer Schadt is a graduate of the MD/MAUB program 2022. She completed a Bachelor's of Science degree in Chemical Biology prior to attending medical school. During her time at LKSOM, Jennifer participated in many activities involving narrative medicine, international medicine, and community involvement, interested which she hopes to continue integrating into her career. She is entering a general surgery residency at the University of Tennessee Health Science Center in Memphis, Tennessee.

Joan F. Steiner Bioethics, Covid-19 and Racism – The Beginning of the Aftermath Thesis Advisor: Dr. Nora Jones

As COVID-19 spread across the United States, the bioethics community encountered challenges both familiar and unknown. Practitioners prepared to consult and advise clinicians, compiling lists of the anticipated bioethical issues, the dimensions of which were nuanced and multifaceted. However, a closer look at the discussion that developed around a single critical question, the ethics of ventilator allocation protocols, revealed that standard formulas and metrics had unintended consequences. The received wisdom of the ethical principles applied to the allocation of this scarce resource was questioned and found wanting as critics pointed out protocols that disadvantaged minorities, the disabled, and the elderly. New voices entered old debates. The practice of modern American bioethics, shaped at a time when patient autonomy was the prevailing value, was narrow in purview. The fundamental inequities of heath and healthcare experienced by racial and ethnic minorities and the poor, concerns of justice, were not central to the practice. The bioethics community had failed to sufficiently broaden its scope as the concepts of the social determinates of health were revealed by research and confirmed by lived experience. Prompted by the racial unrest of spring and summer 2020, one element of the bioethics community, represented by Association of Bioethics Program Directors, has recast its focus.

Joan is the current director of prospect research for the department of Institutional Advancement at Temple University. She has worked in advancement and the non-profit sector for 40 years, following several years at the Smithsonian Institution. She holds an MA in American Studies/Material Culture from George Washington University.

Congratulations, Graduates! Our best wishes toward your continued success in advancing health equity in communities and building a more ethical and socially just society.