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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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  Death Exposure Influence on Medical Students’ Attitudes Toward End-of-Life Care

  Sara J. Barlow, Nelia Alfonso, and Jason A. Wasserman

  Publication Date: 5-5-2022

  INTRODUCTION
  Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding end-of-life care develop during physician’s education.

  
  
  

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  Pre-Medical Student Concerns Regarding Applying to Medical School During COVID-19 Pandemic

  Rachel Connell

  Publication Date: 5-5-2022

  INTRODUCTION
  Over the last two years, the COVID-19 pandemic has altered the system processes of medical education. The primary goal of this study is to identify themes regarding the concerns of pre-medical students in the 2020-2021 application cycle through qualitative analysis of www.studentdoctor.net medical school admission forum posts in order to contribute to the limited literature available on this relatively novel topic.

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  Emergency Department Recidivism Due to Skin Lesions Among the Homeless Population

  Kylee JB Kus and Jason A. Wasserman

  Publication Date: 5-2-2022

  INTRODUCTION
  Ample research supports the correlation between homelessness and poor health generally. Individuals experiencing homelessness face a higher risk of dermatological health problems due to exposure and sanitation concerns and comprise a disproportionately large share of emergency department (ED) visits. This study assesses whether and how the interaction between homelessness and dermatological health contributes to ED recidivism.

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  The Influence of BLM and the Death of George Floyd on Medical and Pre-med Students and Their Views on Institutional Racism

  Asia Susko and Jason A. Wasserman

  Publication Date: 5-2-2022

  INTRODUCTION
  Racial inequalities present in medical education in a multitude of ways, including basing disease prevalence on majority populations and using images that disproportionately represent white patients. George Floyd’s death was not only a sentinel event of police violence, but underscored broader systemic racism, including medicine’s potential for complicity. This study highlights the perspectives of premedical and medical students in light of George Floyd’s death and the Black Lives Matter movement. Their views help elaborate ways to better support students and staff of color in medical education.

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  The divergence of medical ethics and state laws regarding life sustaining treatment

  Hannah VanDusen and Jason A. Wasserman

  Publication Date: 5-2-2022

  INTRODUCTION
  Research reveals that cardiopulmonary resuscitation (CPR) rarely leads to prolonged survival in patients with chronic illnesses in whom death is expected in the relative near-term. There is strong ethical consensus favoring a physician’s right to refuse to provide CPR when it is physiologically futile or medically inappropriate. State laws governing medical treatment, however, sometimes diverge from this guidance. This study examines laws related to life sustaining treatment, analyzing both physician and surrogate authority in decision making about resuscitation orders in the national context.