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Veracity Enhancement Using Non-Invasive Brain Stimulation: A Systematic Review
Alice Hou, Shahrukh Naseer, and Abram Brummett
Publication Date: 5-2025
For decades, non-invasive brain stimulation (NIBS) techniques like Transcranial Magnetic Stimulation (TMS) and Transcranial directcurrent stimulation (tDCS) have been used in clinical settings as forms of neuromodulatory treatment for depression and other neurodivergent disorders. In recent years, there has been increased research in utilizing the non-invasive techniques to enhance cognition beyond one’s baseline, including language, memory, moral, and veracity enhancements. Due to the lack of systematic reviews in the growing field of veracity enhancement, we aim to provide a concise, summative overview of current research studying the impacts of NIBS on truthfulness, as well as its ethical dilemmas and future directions.
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A Survey of factors Affecting Students Ethical Attitude toward Medical Disobedience
Quinn Simpson and Jason Adam Wasserman
Publication Date: 5-2025
- Government regulations, particularly post-Roe v. Wade, create ethical conflicts for physicians between patient care and legal constraints.¹
- Decisions influenced by external pressures can negatively affect patient health.¹
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Prevalence of traumatic brain injury among the guests at a low-barrier homeless shelter
Nicholas Ang and Jason Wasserman
Publication Date: 5-2024
Traumatic Brain Injury (TBI) is a significant public health concern, characterized by disruption of normal brain function due to head trauma, with common causes including automobile accidents, athletic injuries, and assault. TBI accounts for a substantial portion of injury-related deaths worldwide and is a leading cause of neurological disability. However, there's considerable variability in defining and measuring TBI, complicating prevalence comparisons. Studies indicate varying rates, with a particularly high prevalence among individuals experiencing homelessness, potentially due to increased vulnerability to trauma. The cognitive impairments associated with TBI, often manifesting years later, pose challenges, especially for marginalized populations like the homeless, who may face barriers to treatment and social integration. The relationship between TBI and homelessness is complex, with evidence suggesting bidirectional causality. Despite this, research on TBI within specific homeless subpopulations, such as those utilizing low-barrier shelters, remains limited. This study aims to address this gap by examining TBI prevalence among clients of a low-barrier homeless shelter and investigating the temporal relationship between TBI and homelessness.
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Cancer Screening Guidelines in Midwest Adult Correctional Facilities
Stephen Greenwell and Jason Adam Wasserman
Publication Date: 5-2024
National cancer screening guidelines (CSGs) exist to promote early cancer detection, reducing mortality, morbidity, and cost. The incarcerated population is at increased risk for certain cancers, decreased cancer screening, and barriers to treatment. In this study we investigate how state and federal prison CSGs differ from the National Comprehensive Cancer Network’s (NCCN) CSGs.
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Impact of Housing First Supportive Housing Provision on Healthcare Accessibility and Health Status of Individuals who Previously Experienced Homelessness
Aubrey Haughn, Tiffany Loh, and Jason Adam Wasserman
Publication Date: 5-2024
- The 2020 AHAR report to Congress revealed about 580,000 people experience homelessness on a single night.
- Approximately 3 out of every 200 people have experienced homelessness.
- Individuals experiencing homelessness face higher risks of infectious diseases, injuries, mental health issues, substance abuse, and suicide.
- Individuals experiencing homelessness are 6-10 times more likely to have unmet healthcare needs compared to the general population.
- In contrast to a treatment-first approach, the housing first (HF) approach of supportive housing focuses on provision of immediate stable housing for individuals experiencing homelessness without preconditions regarding substance use.
- Avalon House Hickory Way are newly implemented HF apartments based in Ann Arbor, Michigan.
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Critical Reflection and Place Based Medical Education in Bioethics, Humanism, and Professional Identity Formation: The Impact of a Study Trip to Auschwitz
Maxwell Li, Ramona Stamatin, Hedy Wald, and Jason Wasserman
Publication Date: 5-2024
Between 1939 - 1945, unethical and often ghastly human experimentation was conducted in Nazi concentration camps. Physicians working in the camps also performed selections of prisoners for work detail or immediate death. Ultimately, there was a significant amount of physician complicity in Nazism and the Holocaust, ie. the genocide of European Jewry. At the end of WWII, war crime trials against the doctors and scientists involved helped give rise to the Nuremberg Code of Ethics.
There are increasing calls for inclusion of education on medicine during the Holocaust in medical school curricula. A study trip to Poland with pre-trip study modules for medical students was conducted examining the role of physicians during the Holocaust as an extension of medical ethics and humanities curriculum at the Oakland University William Beaumont School of Medicine (OUWB). Students were prompted about their experiences.
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Perspectives of a permanent supportive housing population on their trust in sources of health information, experiences with health care providers, and navigation of health information amidst the COVID-19 pandemic
Tiffany Loh and Jason Wasserman
Publication Date: 5-2024
Permanent supportive housing (PSH) has become the predominant housing intervention for addressing homelessness in the U.S.1 It provides o Unhoused adults with mental and substance use disorders long-term, affordable housing2 o Voluntary social support services.
Studies have found that the unhoused population experience mistreatment in health settings.3–6 o Some unhoused individuals expressed not being seen as human, feeling invisible to health providers, or treated as an experiment.
Limited research on sources of health information used by those who have experienced homelessness. o Allen et al. found that unhoused individuals refer to news media, word of mouth, the internet and social media, as their main sources of health information.7 o In a survey conducted during the COVID pandemic, respondents in homeless shelters in Detroit, MI placed most trust in vaccine information from the news.
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Catholic Hospitals Should Permit Physicians to Provide Emergency Contraception to Rape Victims as an Act of Conscientious Provision
Marlee Mason-Maready, Victoria Whiting, and Abram Brummett
Publication Date: 5-2024
Some Catholic hospitals provide emergency contraception (EC) to rape victims, but some prohibit it based on institutional conscience and that it may act as an abortifacient.
We argue that the reasonable internal disagreement on this issue can be the basis for Catholic hospitals to accommodate physicians who may feel compelled by conscience to provide EC.
U.S. legal asymmetries protect conscientious objection (CO) in health care, but not conscientious provision (CP). Catholic hospitals can sanction or even fire physicians who provide EC.1, 2.
Ramifications of barriers to EC access and potential objections to this perspective are also discussed.
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Relationships between the Number of Chaplain Visits and Patient Characteristics at a Large, Midwestern Suburban Teaching Hospital
Sarah E. Toates and Kevin D. Hickey
Publication Date: 5-2024
Hospital-based chaplaincy increases patient satisfaction and overall quality of life1 and has been shown to positively influence physical and mental health outcomes.2 Given that most inpatient chaplaincy departments operate with limited staff and resources, and that the vast majority (83%) of patients wish to discuss religion and spirituality with their health care team,3 understanding the activities of inpatient chaplains is essential to optimize the care chaplains provide to hospitalized patients. In general, the current medical literature lacks data to guide inpatient chaplains’ activities based on patient characteristics,4 thus, there is a need for an empirical evaluation of spiritual care departments’ activities in order to demonstrate value, promote quality improvement, and enhance care.
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Exploring Illness Beyond Disease: Development of a sense of identity in patients with inflammatory bowel disease (IBD)
Nicholas Totah and Jason Adam Wasserman
Publication Date: 5-2024
- Inflammatory bowel disease (IBD) poses significant challenges to an individual’s physical and emotional well-being, often reshaping their sense of self and life trajectories.
- Patient narrative can illuminate the illness experience in ways that are often unaddressed in the literature.
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What Exactly is a Patient's Best Interest
Saketh Akula, Joshua Jones, Jason Wasserman, Mark C. Navin, and Abram Brummett
Publication Date: 5-2023
In any clinical setting, the patient’s preferences are respected and valued by the medical team. As clear as that may seem, that can be tough when considering all the perspectives of what makes up a patient’s best interest (BI), especially for a minor. In the literature, there is wide disagreement about the interpretation of BI. The primary goal of this project is to unearth the perspectives that play into a pediatric patient’s best interest and delineate how and whether family interests should be considered.
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Conceptualization of Effective Surrogate Decision Making
Zachary Armstrong, Michael Bourgoin, Abram Brummett, Jason Wasserman, Mark C. Navin, and Stephanie Swanberg
Publication Date: 5-2023
Surrogate decision making is a key component in the hierarchy of medical decisions, whereby an assigned individual makes choices on behalf of a patient incapable of making the decision themselves. Although this is common in healthcare, there are still many questions about best surrogate practices and ethical credibility. This capstone project aspires to map these concepts and discuss issues related to the current landscape of surrogate decision making with regards to medical ethics through the use of a systematic literature review.
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Differences in Rational and Relational Autonomy during End-of-Life Care
Michael Balce, Mark C. Navin, Abram Brummett, and Jason Wasserman
Publication Date: 5-2023
Within biomedical ethics, the principle of autonomy focuses on a patient’s right to make choices about his or her medical decisions and care. Along these lines, patients can then make decisions based on their own beliefs, attitudes, and customs, which is referred to as rational autonomy. However, shared-decision making is often more complicated than this, and patients often desire input from their spouse, family, and other trusted individuals, which is termed relational autonomy. These two concepts of autonomy drive different approaches to an individual’s perceptions and choices regarding medical-decision making during the end of one’s life.
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Conceptualization of Evidence Used by Surrogate Decision-Makers to Determine a Patient’s Wishes
Michael Bourgoin, Zach Armstrong, Abram Brummett, Mark C. Navin, Jason Wasserman, and Stephanie Swanberg
Publication Date: 5-2023
Many modern concepts within clinical bioethics can be conceptualized in various ways. This subjectivity is demonstrated when analyzing ideas in the literature about the types of evidence that can or should be used by surrogate decision-makers to determine a patient’s wishes. This project aims to explore normative claims on this topic in order to map out the current landscape of the various understandings of this concept.
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Medical Student Knowledge of Physician Involvement in the Holocaust and the Importance of Incorporating Holocaust Studies and Ethics into Medical School Curricula
Megan Bricely and Jason Wasserman
Publication Date: 5-2023
A 2019 Claims Conference study demonstrated an alarming lack of knowledge about the Holocaust in the United States general population. There is currently no specific data on medical student knowledge of the Holocaust and the role that the medical community played. The goal of this study was to gather baseline data on medical student knowledge of the Holocaust and medicine’s involvement to demonstrate the need for Holocaust teaching in medical school.
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The Ethics of Medical Interventions Against Parental Consent
Corey Carney, Mark C. Navin, Jason Wasserman, Abram Brummett, and Kaitlyn Hanson
Publication Date: 5-2023
Between an adult patient and physician they are the only two people that have a say in the patient’s medical treatment with the patient having the final say. In pediatrics, there is a patient, parent, and physician which adds a third party that is a proxy decision maker for the child but lacks absolute authority over the child’s treatment. The goal of this study is to give a sense of the diversity of the pediatric ethics literature regarding parent/physician disagreements and to address ambiguities about pediatric interventions.
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Self-Triage Among Patients Who Are Homeless
Jimmy Clemmens and Jason Wasserman
Publication Date: 5-2023
People who are homeless present to urban emergency departments at a higher rate per 1000 people than those who are housed.1 With those added difficulties, people who are homeless frequently turn to Emergency Departments for primary, rather than only emergency, health care treatment.2,3 There is great need for investigation into the thought process for the self-triage of the patient who is homeless. This study was undertaken to survey adults at HOPE adult shelter about their ability to determine the most appropriate place to seek treatment for different common conditions of varying acuity, as well as to evaluate the efficacy of an educational resource used to help identify where appropriate medical treatment can be sought.
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Concern for Authenticity in Rational and Relational Autonomy
Joshua J. Daniel, Abram Brummett, Mark C. Navin, and Jason A. Wasserman
Publication Date: 5-2023
The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether a trend exists for the inclusion of authenticity in rational or relational autonomy. A secondary goal is to determine whether a trend exists with the use of autonomy and the highest degree of the authors.
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Conceptualization of Intervention in Pediatrics Systematic Review
Kaitlyn Hansen, Mark C. Navin, Jason Wasserman, and Stephanie Swanberg
Publication Date: 5-2023
Navigating when to intervene against parents’ wishes is a difficult task in pediatrics. Different frameworks have been proposed, but disagreements remain. One problem debated about in pediatric intervention principles often refer to different kinds of interventions (e.g. calling Child Protective Services, consulting the Ethics Committee). This project reports results of a critical scoping review of recent bioethics literature about the concept of pediatric intervention principles.
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'Best Interest' in Clinical Medicine: A Critical Scoping Review
Joshua R. Jones, Saketh Akula, Jason Wasserman, and Mark Navin
Publication Date: 5-2023
The Best Interest Standard (BIS) has been a much-debated guidance principle in clinical ethics with ambiguous definition and application. In this study we focus on the conceptions of best interests that differ according to which kinds of interests are included. While there is wide agreement that ‘best interests’ include the physiological welfare of a patient, there is still substantial disagreement about which other interests are included in wider accounts of welfare, the balancing of those other interests, and whether interests are objective or subjective.
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Compassion Fatigue Seen in EMS Workers Treating Chronic Opioid Users
Amelia Kruse and Jason Wasserman
Publication Date: 5-2023
Opioid use and misuse has been rising nationwide since 1999, as have the number of opioid-related deaths. This has not been limited to illicit drug use, but accelerated by prescribing practices that have ignored concerns about addiction. Emergency services have seen an increasingly high volume of opioid overdose and injury patients, but little additional support to respond to this crisis. This study seeks to investigate EMS workers perceptions of the opioid crisis and the barriers they face to providing adequate response.
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The Meaning of Pediatric Assent: A Critical Scoping Review
Natalie Liogas, Amelia Najor, Jason Wasserman, Stephanie Swanberg, Abram Brummett, and Naomi Levanthal
Publication Date: 5-2023
The moral obligation to include children and adolescents in medical decisions has been long recognized. Soliciting pediatric assent is a component essential to this effort. Despite the AAP characterization of assent (AAP 1995; AAP 2016), there appears to be a lack of consensus regarding the operational and conceptual meanings of pediatric assent. This this critical scoping review provides an analysis of the varied meanings of pediatric assent in the clinical context.
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Outbreak Risks at Religious Schools: Prevalence of Nonmedical Vaccination Exemptions Among Michigan Kindergartens
Flora Martz, Patrick Karabon, and Mark C. Navin
Publication Date: 5-2023
Religious community membership is relevant to immunization policy, as in the case of 2019 US measles outbreaks clustered in Orthodox Jewish communities. US immunization policy focuses on school enrollment requirements, which apply both to public and private (usually religiously-affiliated) schools. Most US states exempt students from these requirements for nonmedical reasons, including religious reasons, though some states, including New York, California, and Maine, have recently eliminated nonmedical exemptions. This study uses 2017-18 data from the state of Michigan to illuminate relationships between nonmedical exemption (NME) rates and attendance at religious schools with the aim of providing information about high-value targets for future vaccination policy to increase compliance and decrease vaccine-preventable diseases.
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Analyzing Medical Student Call To Action Letters Following 2020 Black Lives Matter Protests
Nick McMillen and Jason A. Wasserman
Publication Date: 5-2023
The Flexner Report, written in 1910, may have revolutionized medical education, but it also recommended and led to the closure of all but two Black medical schools. While recent decades have lead to increased attention to diversity and inclusion, representation of historically marginalized groups among students and faculty has been slow to materialize.
Black Lives Matter protests encouraged a national dialogue over the need for more effective DEI initiatives and increased antiracist material in medical school curricula. Organizations such as White Coats 4 Black Lives developed “Call to Action” letters to medical school administrations across the country.
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Pediatric Assent in Clinical Practice: A Critical Scoping Review on the Ethical Justifications for Assent
Amelia Najor, Natalie Liogas, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Laventhal, and Mark C. Navin
Publication Date: 5-2023
Pediatric assent is an important ethical construct, yet there is little agreement on what precisely it means, including the ethical justifications for assent. The term is used to indicate everything from acquiescence to an analogue of informed consent itself. The primary goal of this study is to assess the range of ways that pediatric assent is specified in the clinical ethics literature, as well as what different conceptions intimate about its moral value. This systematic review will summarize the normative claims about pediatric assent in recent literature. Analysis will map divergent constructs and various moral and ethical justifications for pediatric assent.
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