Medical Ethics & Humanities Resources

Abstract
Despite 20% of its population living with a disability, the United States continues to produce physicians who are inadequately trained in delivering equitable healthcare to disabled patients (United States Census Bureau, 2012; Wen, 2014). With patients and healthcare providers alike acknowledging this discrepancy, the medical education system ought to integrate the lived disability experience into existing medical curricula and establish standardized training requirements and competencies for trainees (Santoro et al, 2017). As a solution, I propose a disability-focused medical curriculum. Centered around the theory of care ethics, this longitudinal curriculum redefines “care” as a mutual exchange amongst team members, with the patient as the expert of his or her body, experiences, and community (Kittay, 2011). Both medical students and residents are exposed to didactics and practical experience- based learning that provide a strong understanding of (1) this theory of care ethics, (2) the combination of the positive elements of the medical and social models of disability, and (3) intersectionality. Upon successful implementation of this curriculum, trainees will acknowledge and affirm the patient’s lived experience, heal patients in accordance with their personal values, desires, and goals, and work towards the alleviation of any extra burdens endured by patients who exist at multiple intersections of marginalization (Reynolds, 2018). As medical students and residents master these competencies, they will build a medical community that humanizes their patients rather than reinforcing the cycle of misconceptions fashioned by their predecessors.
Committee
Julie Aultman, PhD (Advisor)
Rachel Bracken, PhD (Advisor)

Abstract
Mental illness continues to rise within the United States. With the recent COVID-19 pandemic, adequate access to mental health services is becoming even more important. Despite this need, children facing mental health disorders are suffering from the lack of child and adolescent psychiatrists available. This shortage has been prevalent for decades with no permanent solution proposed. In hopes of providing care during this difficult time, pediatricians have been expected to take on responsibility for mental health disorder patients. However, research shows that pediatricians are unprepared and not confident in their abilities to take on this role. Therefore, they continue to provide inadequate care for these patients because of the ever-growing wait times on referrals and obligation to provide help to patients in need. This paper will explore the shortage of child and adolescent psychiatrists and the consequences of this shortage. In a case analysis, the patient, provider and systemic levels will be evaluated through different ethical frameworks including duty ethics, care ethics and justice. Changes will be proposed at the resident, attending physician and national level, in hopes of improving mental health care for children and creating a more accessible system.
Committee
Menefee Elizabeth, M.D (Advisor)
Aultman Julie, Ph.D (Advisor)

Abstract
Despite the Anti-Drug Abuse Act of 1986 that declared a “war on drugs”, criminalized substance abuse, and opened up treatment programs specific to pregnant women, the number of pregnant women using opioids increased five-fold from 2000 to 2009, skyrocketing the related costs for state Medicaid programs (Patrick et al., 2012). Unfortunately, this law has had a pervasive effect on the public’s attitudes and clinicians’ treatment toward opioid use disorder (OUD) in pregnancy. My analysis according to the principles of biomedical ethics has outlined several ethical dilemmas that have been created by criminalization of substance abuse, mandatory reporting laws, stigma toward OUD and its treatments, and little understanding of the social determinants of health. This ethical framework alone does not emphasize the relational aspect of pregnancy, support patient-centered care, or address the intersectionality of this patient population. I will argue how using a care and justice ethics approach to treatment of women with OUD who would like to carry a fetus to birth is the preferable ethical approach to guide physician and public health treatment of this issue. I will discuss how this framework revives the idea of using Ulysses contracts for this patient population and how Ohio has successfully implemented caring structures already. Finally, I will envision how Ohio can continue to expand its wraparound services and fight stigma against OUD in pregnancy, which stymies clinicians’ potential to form caring relationships.
Committee
Rebecca Fischbein (Advisor)
Julie Aultman (Committee Member)

Abstract
The US military medical system has come under scrutiny for severe breaches of ethics during the war on terror. Physicians assisted in the creation of waterboarding techniques to be used on prisoners (SSCI, 2014, p. 87). These failures of the ethical infrastructure of the US military have led to a reevaluation of military medical ethics, and a call for a specific code for military medical ethics (DHB, 2015). The current medical ethics of military physicians is impaired through the reliance on two competing deontological strictures from the professions of soldiering and medicine–duties to the patient and duties to orders. This thesis employs a framework of using Aristotelian virtue ethics and identity theory to navigate the intersection created by these competing duties. This framework is demonstrated in a case of Medical Rules of Eligibility (MEDRoE), where only certain individuals may receive care from military health units. It is further applied to a case of potential whistleblowing, whereby one military physician is aware of another who is impaired during a mission. The application of this framework to these two cases showcases its plausibility as an adjuvant for the deontological and teleological structure which currently dominates military medical ethics. This framework improves upon the current military medical ethics system through focus on building of moral character of military physicians.
Committee
Deborah Barnbaum, PhD (Advisor)
Julie Aultman, PhD (Advisor)

Abstract
Twenty percent of American citizens reside in a rural community and are, as a result, subject to a large healthcare disadvantage (U.S. Census Bureau, 2012). This paper outlines the current research detailing distinctions of rural communities from others, adverse health outcomes associated with rural status, the current state of rural healthcare access, with an emphasis on lack of radiology care and the ethical implications these imaging services have on rural patient populations. A mixed methods survey study was conducted, demonstrating the concerns among family medicine physicians and radiologists regarding their patients’ ability to obtain necessary radiology services, including lack of insurance and ability to pay for services; lack of local access to care and subsequent travel barriers; and collaborative efforts between physician specialties. Current enacted solutions include point of care imaging, mobile diagnostic units, teleradiology, RAD-AID efforts and increasing awareness. However, access to services, as evidenced by survey results, remains a concern for many. Addressing these issues requires the need for further detailed research, delving into many of the concerns detailed by a small population of surveyed physicians, along with increasing advocacy and recruitment efforts to increase specialized medicine access for rural communities.
Committee
Julie Aultman (Advisor)
Marcus Julius (Advisor)
Brian Harrell (Advisor)

Abstract
Mental illness has been a subject of fictional film since the early 20th century and continues to be a popular trope in mainstream movies. Portrayals of affected individuals in movies tend to be inaccurate and largely stigmatizing, negatively influencing public perception of mental illness. Recent research suggests that gender stereotypes and mental illness intersect, such that some mental illnesses are perceived as “masculine” and others as “feminine.” This notion may further stigmatize such disorders in individuals, as well as falsely inflate observed gender disparities in certain mental illnesses. Since gendered mental illness is a newly identified concept, little research has been performed exploring the way stereotypical gendered mental illness is depicted in mainstream film. This paper analyzes the movie What About Bob? to show that comedic film perpetuates stigma surrounding feminine mental illness in men and identifies the need for further study of gendered mental illness in movies to ascertain the effect such depictions have on the observed gender disparities in prevalence of certain mental disorders, as well as offers a proposal for coursework for film and medical students.
Committee
Julie Aultman, Ph.D. (Advisor)
Rachel Bracken, Ph.D. (Committee Member)
Brian Harrell (Committee Member)