By: Caroline Nickerson
On Friday, October 11, the UF-VA UNESCO Bioethics Unit met for presentations commemorating World Bioethics Day. UNESCO has over 220 units of this particular program, and our unit was set up four years ago with the help of Dr. Russel D’Souza, chair of UN Bioethics Day in Haifa. The Unit meets quarterly and meetings are open to members of the UF campus community.
Director of the UF-VA UNESCO Bioethics Unit, Joseph Thornton, MD, gave welcoming remarks about the Unit and introduced Maryam Rahman, MD, one of the morning’s featured speakers.
Dr. Rahman, an assistant professor in the UF Department of Neurosurgery, returned for a second year to speak about “Culturally Competent Care and Care of the Muslim Patient.” She quoted a National Academies report: “Racial and ethnic minorities tend to receive lower quality of healthcare than non-minorities, even when access related factors, such as a patient’s insurance status and income are controlled” (Smedley et al. Nat’l Acad Press 2002).
Noting that “stereotyping, biases, and uncertainty on the part of care providers contributes to unequal treatment,” Dr. Rahman advised care providers to develop cultural competency to increase understanding, offered strategies to increase competence (like taking a complete social history and asking questions instead of making assumptions), and shared a case study with the group to spark discussion.
After Dr. Rahman’s talk, the group engaged in discussion about their different interactions with bioethics across the UF campus, with Brian Ray, PhD, Director of the Poe Business Ethics Center and a Senior Lecturer of Leadership and Ethics, contributing to the discussion with the Business Ethics Ambassadors. The group reflected on the interdisciplinary nature of bioethics, spanning business, health, religion, cultural practices, and beyond.
Beatriz Elena de Bruna, from Serenity Mindfulness Center, led the group through a 20 minute mindfulness meditation and discussion. Ms. de Bruna is one of the Department of Psychiatry’s Mindful Relaxation Minutes instructors, a weekly program offered to faculty, staff, and residents to promote self-care. The mindfulness session was followed by Dr. Thornton’s talk on “Activist Ethics.”
Dr. Thornton began by meditating on his ethical heroes and how they are an example for him to follow. Distinguishing between ethics (distilling right from wrong), bioethics (ethics related to living things), and healthcare ethics (ethics related to human health), he spoke about both organizational codes of ethics and his own individual code: S-A-V-E. Save lives, Alleviate suffering, Value [responsible] autonomy, Engage in therapeutic community.
Throughout the talk, Dr. Thornton advised attendees to reflect on ethical principles ahead of time to prepare for emergencies when they inevitably arrive, and among other acronyms, offered P-E-A-C-E: Pause and reflect on yourself as a person, Examine beliefs and practices of medicine, Acquire more knowledge on systems of ethics, Challenge assumptions, Engage in ethical development. He closed by inviting attendees to take a survey on the Universal Declaration on Bioethics and Human Rights, adding that no familiarity with the Declaration is needed to take the survey and learn something. If you’re reading this, please consider filling out the survey.
After he completed his talk, Dr. Thornton introduced Andres Pumariega, MD, the featured grand rounds speaker. Dr. Pumariega is a UF Psychiatry Professor and the Chief of the Division of Child and Adolescent Psychiatry. In a presentation entitled “Mental Healthcare for Child Detainees,” Dr. Pumariega gave a historical overview of immigration to the United States as it relates to undocumented immigrants and refugees, as well as specifically discussed the impact on children of separation from their families.
Dr. Pumariega spoke about traumatization and the development of psychiatric symptoms and disorders relating to immigration, as well as the specific stressors for undocumented immigrants and the multi-generational aspects of this phenomenon. He gave an overview of the current multi-agency system in the United States and the child separations at the border since June 2018, framing it with an international and historic scope. He described a general approach for mental healthcare for child detainees, and offered recommendations going forward, including that the Department of Homeland Security should “discontinue the general use of family detention, reserving it for rare cases when necessary.” He described the “xenophobic environment in the U.S.” as “contributing to violations of human rights and international law,” stating that the current dentition process is “not humane” for “refugee children and their parents and has an adverse impact on mental health.” He also cited “ethical dilemmas for physicians serving ICE (Immigration and Customs Enforcement) or DHS facilities when not allowed to followed standards of care.”
Described by attendees as “moving,” “powerful,” and “impactful,” this is a presentation you will want to watch for yourself. (Check the Psychiatry Online CME page for upcoming link)
Resident case discussions followed the Grand Rounds presentation. Aptly described by Dr. Thornton as “lively” and led by Jessica Khan, MD, PGY-4 and Chief Resident, a group of Psychiatry residents and faculty discussed cases and other issues in ethics in the last session of the day.
At the conclusion of World Bioethics Day, Dr. Thornton reflected that he “enjoyed having folks from other parts of the campus” in attendance at World Bioethics Day this year, adding that it really added to the morning discussions. He also found the Grand Rounds presentation “incredibly impactful.”
“World Bioethics Day at UF gets better and better every year,” Dr. Thornton said.
Want to get involved with the UF-VA UNESCO Bioethics Unit? Email cnickerson@ufl.edu for more info.