The Case for Protected Healthcare Spaces for Undocumented Immigrants
Author: Erika Carmody, MS1
Policies governing immigration enforcement in the United States have historically designated healthcare settings as “sensitive locations” to promote safe access to essential services. However, recent policy changes have expanded enforcement activities in these spaces, raising concerns about decreased healthcare utilization among undocumented immigrants. Evidence suggests that fear of immigration enforcement is associated with reduced health- seeking behaviors and worsened health outcomes, with anecdotal reports noting declining attendance at DOCS Health Fairs and free clinics.
Guided by Beauchamp and Childress’ four principles of biomedical ethics, beneficence, nonmaleficence, autonomy, and justice, this analysis evaluates the ethical implications of immigration enforcement in healthcare settings and argues that healthcare institutions have a moral obligation to function as protected areas. Fear of enforcement may lead to avoidance of care, undermining beneficence by limiting clinicians’ ability to provide optimal treatment and advocacy. It also challenges nonmaleficence by contributing to emotional distress and delayed or foregone care, increasing the risk of harm. Autonomy is compromised when patients feel unable to make voluntary and informed healthcare decisions due to coercive external pressures, while justice is threatened as these barriers disproportionately reduce access to care among undocumented populations, exacerbating existing health disparities.
These findings suggest that healthcare institutions have an ethical obligation to function as safe and accessible environments, as failure to do so conflicts with foundational principles of medical ethics and contributes to inequities in health outcomes.
God's Command or Psychiatric Symptom? Navigating the Boundary Between Religious Belief and Mental Illness
Author: Carson Cable, MS2
The intersection of religious belief and psychiatric illness presents one of the most ethically nuanced challenges in clinical medicine. Physicians must distinguish sincere religious expression from symptoms of psychiatric disorders such as schizophrenia or obsessive-compulsive disorder. This distinction has profound consequences for patient autonomy, dignity, and safety. Errors in either direction risk serious harm. Pathologizing genuine faith violates patient autonomy, while failing to recognize psychiatric illness may allow preventable deterioration.
This poster examines this ethical challenge through a clinical case encountered during an inpatient psychiatry rotation. A middle-aged man with established diagnoses of schizophrenia and OCD was hospitalized following weeks of near-total food refusal. He attributed his fasting to a divine command, denied hallucinations, and declined antipsychotic medications, asserting that God would heal him. His presentation was consistent with a prior documented pattern of psychotic decompensation following medication nonadherence. Formal capacity assessment revealed significantly impaired judgment and insight. Following resumption of antipsychotic therapy, both the fasting behavior and medication refusal resolved, and the patient returned to baseline functioning.
While this case offered relative clinical clarity, many presentations do not. Individuals who pray for many hours daily or engage in rigid religious rituals may represent devout faith, psychiatric pathology, or something in between. The clinician's task is further complicated by their own cultural and religious background, institutional norms, and the absence of standardized clinical guidance.
This presentation applies the four principles of biomedical ethics to this diagnostic challenge and offers an evidence-based framework for distinguishing religious belief from psychiatric pathology. The goal is to equip future physicians with the ethical reasoning, cultural humility, and comfort with ambiguity essential to navigating these complex clinical encounters.
Who Decides What Is Beautiful? Ethical Implications of Artificial Intelligence in Facial Aesthetic Surgery
Author: Kierstyn Smith, MS3
Artificial intelligence (AI) is increasingly integrated into facial aesthetic surgery, with applications spanning patient education, preoperative planning, and postoperative outcome assessment. While these technologies offer improved efficiency and the potential for more standardized evaluation, they are being introduced into a field fundamentally defined by subjective perceptions of beauty and patient preference. As a result, their use raises important ethical questions regarding how aesthetic ideals are constructed and the extent to which algorithmic tools should influence clinical decision-making.
ThThis work examines the ethical implications of AI in facial aesthetic surgery, focusing on four key domains: bias and justice, autonomy and informed consent, safety and reliability, and transparency and accountability. AI systems, though often perceived as objective, are trained on human-labeled datasets that may reflect limited or culturally biased beauty standards, risking reinforcement of narrow aesthetic ideals. Additionally, AI-generated outputs, including simulated postoperative images and treatment recommendations, may influence patient expectations and decision-making, raising concerns about the integrity of informed consent and patient autonomy. The increasing accessibility and ease of AI tools may also enable individuals without appropriate medical training to generate and act on clinical recommendations, further raising concerns about patient safety and misuse. Limitations in accuracy, including hallucinations and unsafe recommendations, further highlight potential risks.
Emerging evidence suggests that while AI can approximate human perception, it may oversimplify complex aesthetic judgments by disproportionately weighting select features, reinforcing an illusion of objectivity. These concerns underscore the need for careful integration of AI into clinical practice.
To address these challenges, a framework is proposed that emphasizes bias mitigation through diverse datasets, transparency in communicating limitations, physician-led oversight, rigorous validation, and prioritization of patient-centered goals. Ultimately, AI should function as an adjunct to clinical judgment, supporting rather than redefining individualized standards of beauty in aesthetic care.
Push to Publish: A Cross-Sectional Study at a Single Academic Medical Center of Publication Volume and Scholarly Contribution Among Incoming Residents
Author: Justin T. Dreyer, MS3, Nicole R. Fraga, MS3, Jessica Herman, MS3, Zhuochen Yuan, MS2, Sergio Litewka, M.D., M.P.H.
Purpose: The residency application process increasingly emphasizes publication volume, particularly following the 2022 transition of USMLE Step 1 to pass/fail scoring. This study aimed to evaluate whether growing publication productivity among medical students is associated with differences in research quality and depth of scholarly contribution.
Methods: A cross-sectional study was conducted in 2024 among 86 incoming residents at Jackson Memorial Hospital, Miami, FL. Participants completed an anonymous REDCap survey reporting their pre-residency publications and scholarly contributions. Participants were stratified by specialty match rate (< 53.9% vs. ≥ 53.9%) and specialty-level publication volume (< 7 vs. ≥ 7 publications). Outcomes included scholarly contribution type, publication characteristics, journal impact factor, research category, and authorship-weighted publication scores.
Results: Residents in high-publication specialties reported significantly greater involvement in study design (58.3% vs. 34%, p = 0.03), manuscript writing (83.3% vs. 52%, p = 0.01), and data analysis (80.6% vs. 60%, p = 0.04) compared to low-publication counterparts, along with higher combined journal impact scores (13.4 ± 21.2 vs. 3.7 ± 4.8, p = 0.038). Residents from low match rate specialties reported significantly higher total publication counts (15.0 ± 13.2 vs. 7.7 ± 10.5, p = 0.006), driven primarily by posters and abstracts, but did not demonstrate greater involvement in substantive research activities. No significant difference in impact factor was observed between match rate groups (p = 0.055).
Conclusions: Higher publication volume alone does not reflect deeper scholarly engagement. Applicants from more competitive specialties produced greater quantities of research without demonstrating more meaningful contributions. Residency programs should consider prioritizing the quality and nature of research involvement over publication volume when evaluating applicants.
