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Holt Bioethics Essay Award for Medical Students

Call for Submissions: Essays due to humanities@uthscsa.edu by 8:00 a.m. April 22, 2019

Monetary Awards: 1st Place- $1,000; 2nd Place- $300; 3rd Place- $200 

This prestigious annual award includes a cash prize recognizing the best essay by a UT Health San Antonio medical student on a bioethics topic. The essay topic will be chosen by the medical student, and all submitted essays will be assessed by a panel of health care ethicists and knowledgeable physicians. All medical students are eligible, and the prompts are provided merely to stimulate ideas. No special preference will be given to essays that follow these prompts as opposed to a completely original topic.

First, a definition is in order:  What is Bioethics? Bioethics is a branch of applied ethics that studies the philosophical, social and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being.

In the course of practicing medicine, physicians often encounter tension between their duties to individual patients and to society (e.g., concern for public health or public/professional norms).

Select one of the following prompts or your own original topic and write an essay that identifies and illuminates – through examples, data, case studies, and informed moral reasoning – how physicians should discharge their ethical responsibilities to both the individual patient and to society.

Prompts you may consider:

  • Given current knowledge about the impact of call schedules on trainee satisfaction as well as patient outcomes, considering that medical error is the third-leading cause of death in U.S. hospitals, and bearing in mind that suicide is one of the leading causes of death during residency training, propose an ethically sound study to generate evidence for a financially sustainable and educationally effective residency training program model in which patient safety outcomes and resident wellness are optimized. Please consult and reference the two accompanying source documents as well as related literature on medical error, patient safety, physician wellness, and projected health care workforce needs.

    • Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Desai SV et al. N Engl J Med 2018 Mar 20 McMahon GT. N Engl J Med 2018 Mar 20

    • Yaghmour, N. A., Brigham, T. P., Richter, T., Miller, R. S., Philibert, I., Baldwin, D. C., & Nasca, T. J. (2017). Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Academic medicine : journal of the Association of American Medical Colleges92(7), 976–983. doi:10.1097/ACM.0000000000001736

  • Advocates of physician-assisted death (PAD) say it promotes autonomy and mercy. Yet, PAD does not have the united support of the medical profession. From an ethical perspective, should the medical professional embrace PAD as an option for patients with terminal or irreversible illness?  Include an assessment of possible consequences of legalizing PAD; the duties physicians have toward individuals, patients, and society at large; and the possible role of the principle of double effect in cases of PAD. Reference at least one publication by leading analysts of this practice such as Ezekiel Emanuel, M.D., Ph.D.; Timothy Quill, M.D.; Margaret Battin, M.F.A., Ph.D.; and/or Daniel Sulmasy, M.D., Ph.D., as well as the recent American College of Physicians position statement on PAD.

  • Maternal mortality is high in Texas, and has been rising in most of the U.S. for several years. Peer countries, such as those in Western Europe and North America, have significantly better maternal outcomes. What forces might explain these outcomes, and what is the role of physicians in understanding and responding to health disparities across vulnerable populations? What are the ethical considerations that should inform policymaking about maternal health at the state level?

  • Genetic ancestry testing can reveal connections to the past that help individuals define who they are and where they come from. Testing can also yield unexpected connections to historical communities and practices. For example, individuals seeking to understand their family’s ancestry might discover they are related to enslaved persons in America. Consider the pros and cons of genetic ancestry testing through an ethical lens. Should genetic ancestry test results be used by society or institutions to make reparations to individuals—or communities or even classes of people—who are descendants of enslaved persons or Holocaust victims? If so, how could this intervention be justly implemented? Or, consider how some sort of ethical reconciliation could be achieved. Describe a framework that would be socially and culturally compatible with American values and sound ethical principles.

  • A human genome editing technique using CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats) was recently employed by a Chinese scientist to modify the genes of two human twins born to a couple where the father had “lost hope in life” due to his own HIV infection. The genetic modification of the twins was reportedly an effort to make them resistant to HIV infection. Is it ethical to create gene-edited babies who could never provide informed consent to participate in such a procedure? How seriously should scientists and clinicians weigh the possibility of unintended consequences when faced with the potential to prevent serious illness? What are the ethical considerations regarding genome editing for serious health conditions versus genome editing for human enhancement? How can the medical community and society determine when bias in gene editing is ethically acceptable or not?

  • Every day over 130 people in the U.S. die from an opioid overdose. About 20 percent of patients who are prescribed opioids misuse them and about 10 persent develop a use disorder. About 5 percent of patients who misuse opioids will try heroin, and about 80 percent of people who use heroin first misused opioids. If the so-called opioid epidemic is demonstrably connected to the prescribing practices of physicians, then what are the ethical obligations of physicians to evaluate and change their practices? Consider the ethical obligations borne of compassion and mercy that cause physicians to treat pain with opioids. And consider how intense pain—and other symptoms—can be for patients with various acute, chronic, and malignant conditions. How can physicians balance their duties to care for individual patients safely and effectively with their responsibilities to society as a whole? Taking into account available evidence about prescription monitoring, relationships between pain and addiction, and physician education and training, what innovative policies and practices might help physicians to stem the tide of opioid misuse and overdose?

The essays will be judged on the following rubric:

Criterion

Possible Points

Applicability of topic/Educational value to health care professionals

Identification of ethical issues in topic

15

Shows how topic relates to health care

15

SUBTOTAL

30

Quality of writing

Uses proper grammar & spelling

7

Writes clearly

7

Cites resources

6

SUBTOTAL

20

Comprehension of issues

Demonstrates knowledge of chosen topic

8

Provides evidence to support thesis & arguments

8

Draws appropriately on external resources

7

Demonstrates original thought (rather than just restating what others have said)

7

SUBTOTAL

30

Clarity of discussion & conclusions

Shows a clear logical flow of argumentation (e.g. thesis; arguments; supporting evidence)

7

Stays on topic

6

Makes a logical conclusion for action, thought, or research

7

SUBTOTAL

20

TOTAL

100