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The Journal of Healthcare Ethics & Administration (JHEA) is an international open-access online journal that reflects the issues on medicine and healthcare administration. The JHEA welcomes original researches, review articles and case studies by scholars, medical and law professionals, and healthcare administrators who desire to share knowledge through the dissemination of published works. Each published article in the journal is approved by an international editorial board before publication using a double-blind, peer-review process.
Current Issue Vol.12 No.1 (Winter 2026)
Pages: 1-27
Pertussis, also known as whooping cough, is an infection of the respiratory system, characterized by inflammation of the lungs and airways, and is caused by Bordetella pertussis. Studies suggest that pertussis is highly contagious, affecting around 90% of individuals exposed to the pathogen in the household and 50-80% of individuals exposed to it in schoolrooms. In 1934, the United States (U.S.) reported around 265,000 pertussis cases, which decreased to about 7,000 cases in 2023; however, the U.S. witnessed a five-fold increase in reported pertussis cases in 2024. Therefore, this paper outlines possible factors contributing to the surge in pertussis cases, lays out evidence-based effective approaches and preventive measures to curtail future pertussis and, possibly, other air-borne disease outbreaks, and provides ethical arguments for adopting the initiatives/changes recommended herein.
Pages: 28-38
Introduction: Biomarkers of cellular aging (e.g., telomere length) reflect biological aging and are influenced by environmental and social factors. Veterans often face health disparities, and understanding telomere dynamics could inform personalized approaches to improve their health outcomes.
Methods: Using data from the National Health and Nutrition Examination Survey, we analyzed telomere length among 929 U.S. male veterans aged 20-84 years, examining associations with socioeconomic status, health conditions, and lifestyle factors through survey-weighted linear regression models.
Results: Veterans exhibited significantly shorter telomeres compared to civilians, with an average reduction of approximately 229.61 base pairs (bp) (p < .0001). Factors such as poverty, obesity, and COPD were independently associated with greater telomere shortening; for example, veterans living below the poverty line had about 261 bp less telomere length, and those with COPD showed a reduction of approximately 182 bp. Obese veterans had about 152 bp shorter telomeres, and the combination of poverty and obesity resulted in a cumulative shortening of approximately 424 bp, indicating a synergistic effect on cellular aging. These associations persisted after adjusting for age and other confounders, emphasizing the impact of socioeconomic and health-related factors on biological aging among veterans.
Conclusion: These findings are associated with shorter telomeres and may inform risk stratification and targeted prevention.
Pages: 39-46
Emergency department (ED) crowding and patient boarding have emerged as critical threats to patient safety, healthcare quality, and provider well-being. Crowding occurs when the demand for emergency services exceeds available resources, leading to prolonged wait times, delayed care, and treatment in non-traditional spaces. Boarding, the retention of admitted patients in the ED due to lack of inpatient capacity, is the most significant driver of ED crowding and is associated with increased morbidity, mortality, adverse events, and staff burnout. Legal implications are substantial: malpractice data reveal significant financial losses, with boarding cases twice as likely to close with indemnity payments and nearly half involving patient death. Regulatory bodies such as The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) have proposed measures to mitigate boarding, recognizing its impact on patient outcomes. Ethically, boarding undermines the principles of beneficence, nonmaleficence, autonomy, and justice by delaying treatment, eroding privacy and dignity, and exacerbating health inequities. It also contributes to moral distress and violence against healthcare workers. Addressing this crisis requires systemic, multidisciplinary reforms. Strategies include optimizing weekend discharges, harmonizing elective admissions, creating admission-hold units, expanding staffing, and implementing full capacity protocols. ED-level interventions, such as fast track models, observation units, and telemedicine, can improve throughput, while policy action is needed to mandate maximum boarding times and to restructure reimbursement models that incentivize efficiency. Ultimately, ED crowding and boarding represent an ethically unacceptable and legally dangerous consequence of systemic capacity failures. Comprehensive institutional and policy reforms are essential to safeguard patient welfare, reduce liability, and preserve the ED’s role as the healthcare safety net.
Issue Vol.11 No. 4 (Fall 2025)
Pages: 1-21
Since the 1960s, bioethics has emerged as a field to address the increasingly prevalent clinical ethical dilemmas that accompany advancements in medical capabilities. Nowadays, over 97% of U.S. hospitals benefit from healthcare ethics services, with evidence suggesting that bioethics education correlates with enhanced physician knowledge, attitude, and practice. However, medical school ethics curricula are not standardized, and credit hour requirements vary across institutions. Although there is a need for expanding bioethics education in medical schools, there should also be emphasis on pre-health professionals gaining exposure to medical ethics during undergraduate years; this way, aspiring healthcare workers would gain better insights into the clinical difficulties of their desired careers. As such, the Institute of Clinical Bioethics (ICB) at Saint Joseph’s University instituted its Undergraduate Research Fellowship Program (URFP) in 2006, offering undergraduates clinical ethics exposure and bioethics research experience. This article sheds light on the importance of pre-health professionals acquiring early exposure to clinical ethics and provides readers with the ICB’s URFP outline, which is made available for undergraduate bioethics centers to incorporate into their programs.
Pages: 22-37
Water fluoridation is a population –level public health intervention widely endorsed by health authorities; it’s ethical justification remains contested. Water fluoridation is considered scientifically safe and effective by the proponents of water fluoridation. However, the opponents of water fluoridation regularly raise concerns about efficacy and ethics of water fluoridation which culminates in a debate.
This paper is an attempt to elucidate on the key issues of the ethical considerations of water fluoridation, based on the principles of bioethics. In particular, it raises questions about which of the competing values of the health authorities, the community, and the individual values; one must uphold in the consideration of fluoridation of the water.
This paper provides a perspective on the key principles of bioethics regarding the pros and cons of water fluoridation, highlighting the considerations of non-maleficence, beneficence, autonomy and justice. The justificatory and the stewardship model are two types of ethical frameworks used to evaluate public health interventions. The application of ethical frameworks in the evaluation of water fluoridation in a particular place, are discussed in this paper.
An intervention such as water fluoridation explicates the benefits of equity and justice as it ensures that the opportunity to be free from caries and dental morbidity is distributed equally among all members of society. This paper concludes that continuing the practice of water fluoridation for the prevention of caries and dental morbidity, can be ethically justifiable, and provided a balanced and progressive approach is applied, underpinned by strong scientific evidence.
Pages: 38-47
This article explores the growing role of Artificial Intelligence (AI) in medicine, with a special focus on the surgical field, and analyzes the profound bioethical dilemmas that its implementation raises. While AI offers significant advances, such as high-precision robotic surgery, standardized evaluation of professional performance, and optimization of clinical processes, its adoption requires critical reflection to avoid the dehumanization of medical practice.
The text addresses several key aspects:
Medical Training: It examines the paradigm shift in surgical education, where AI, through the analysis of surgical videos, can offer immediate feedback that is less variable than some human ratings, in contrast to the traditional model of human mentorship. Although this technology is efficient, it raises the question of what is lost by replacing the inspiring figure of the human mentor who transmits values, empathy, and emotional support.
Surveillance and Autonomy: The use of AI-based video surveillance systems in operating rooms raises questions about professional privacy and autonomy. The article warns about the “Hawthorne effect,” where constant monitoring could increase stress and pressure on professionals, rather than fostering an environment of continuous improvement.
Justice and Equity: It discusses the inequalities that AI can exacerbate. The asymmetrical access to these technologies between countries and between the public and private sectors, coupled with algorithmic biases trained on data from specific populations, could deepen healthcare gaps.
Governance and Responsibility: Finally, the article concludes that the implementation of medical AI is not a neutral process. It advocates for shared and transparent ethical governance, where clear responsibilities are defined between humans and machines. It proposes an “anticipatory bioethics” that, instead of reacting to problems, prevents them by integrating ethical principles from the design phase of the technology. The ultimate goal is to use AI as an ally of care, not as a substitute for the human dimension of medicine, ensuring that technological advancement is oriented toward social well-being and human dignity.
Pages:48-58
Blockchain technology offers secure, decentralized solutions for managing mental health records and identity verification; however, its ethical implications necessitate rigorous scrutiny. This paper evaluates four blockchain ethical design frameworks—Beeck Center’s Blockchain Ethical Design Framework, The Institute of Electrical and Electronics Engineers (IEEE) 7000 Value-Based Engineering Model Process, Value-Sensitive Design (VSD), and Ishmaev’s (2025) ethical risk analysis—with the National Association of Social Workers (NASW) and Louisiana State Board of Social Work Examiners (LABSWE) Rules, Standards, and Procedures by identifying and defining key ethical principles, analyzing their alignment, and exploring practical implications for trauma-informed, client-centered mental health practice. To foster and guide ethical blockchain integration, we must ensure alignment with social work values of dignity, equity, and autonomy.
Pages:59-82
While advancements in neurodiversity initiatives in the workplace are notable, a persistent gap remains in effectively addressing the high unemployment and turnover rates among individuals with autism. Objective: This literature review focuses on the main challenges faced by autistic employees in the workplace and solutions either proposed or enacted. Methods: Multiple databases were searched within the date range of January 1st, 2010 and May 1st, 2025 using the keywords listed. This initial search yielded 886 publications. Following a screening process, 187 publications met the inclusion criteria for further analysis. Results: Communication issues were the most common barrier to workplace success cited by the autistic employee, coworkers, and management. Educating coworkers and management about autism was associated with reducing this barrier and others associated with it. A strong support circle consisting of HRM, job coaches, and a direct manager with autistic employee experience were able to decrease turnover and increase morale. The direct manager is especially important in ensuring a harmonious workplace and preventing burnout in the autistic employee. The work environment, consisting of both workflow and physical factors, could also be improved to ensure success. Bullying was best handled with a zero-tolerance policy which many organizations already have but nothing specific to autistic or neurodivergent employees who are more prone to such behavior. Masking was the most common technique autistic employees used to fit in but was found to be both exhausting and a contributor to burnout if used at high levels. Disclosure of autistic status, especially in hopes of obtaining accommodations, was found to have mixed results. Conclusion: An organization that prepares a work environment for an autistic employee before their employment has a far better chance of success. This included education of the staff, ensuring the direct manager has additional education and skills regarding autism, and altering the workflow and physical environment of the workplace to better suit the autistic employee. Evaluating current leadership and their devotion to diversity and inclusion deserves evaluation, as those in charge ultimately determine the success or failure of these policies.
To ensure minimum levels of quality of care in CMS (Centers for Medicare and Medicaid Services) long term care facilities (LTC), Life Safety Code (LSC) surveys and Health Care Facilities Code (HCFC) surveys are required to be conducted on a 9–15-month cycle. The purpose of this study was to evaluate if LSC and HCFC occurring simultaneously is associated with the number of deficiencies cited in Alabama skilled nursing homes. The theoretical framework was grounded Donabedian’s quality theory for examining health services and evaluating quality of health care through structure, process, and outcomes (Donabedian, 1988). This study included two research questions evaluating if there was a correlation between LCS deficiencies and HCFC deficiencies occurring at the same time and if the number of HCFC deficiencies was lower due to LCS surveys occurring at the same time as HCFC surveys in Alabama long term care facilities. A quantitative correlation research design was used with non-probability sampling to include Alabama nursing homes that had LCS surveys at the same time as HCFC surveys using secondary data from CMS updated July 1, 2025, and released on July 30, 2025. A Pearson Correlation Coefficient Calculator determined a significant positive correlation between the independent variables LCS deficiencies and dependent variables HCFC deficiencies. The Mann-Whitney U test determined there was a statistically significant difference between the two groups LSC deficiencies and HCFC deficiencies. The potential impact of this study on positive social change is at the individual, organizational, and policy levels. Individual patients and nursing home facilities can benefit from the recognition of the association the timing of LSC surveys affects the number of HCFC deficiencies.
Issue Vol.11 No. 3 (Summer 2025)
Pages: 1-13
Society’s deep divisions, fueled by individualism, competition, consumerism, rigid ideologies, and limited dialogue, have impacted health care, leading to weakened connections between providers and patients. In the U.S., heavy reliance on medical technology and the rise of AI have further eroded these intersubjective bonds, reducing empathetic engagement in care. To address this challenge, the paper explores insights from Christian mystics Saint Teresa of Avila and Edith Stein. Teresa’s teachings on self-examination and humility, despite her life as a cloistered nun, influenced both her religious order and the broader Church. Meanwhile, Stein’s phenomenological approach emphasized empathy and “suffering with” others, viewing compassion as essential for genuine connections. Both mystics offer profound examples of intersubjectivity, fostering bonds of love and care with oneself, others, and the divine. Their insights provide healthcare professionals with a framework for creating intersubjective spaces that honor each patient’s unique experience. In a polarized society, insights from these mystics can help bridge divides, encouraging healthcare relationships grounded in empathy and compassion. This paper will argue that healthcare providers can benefit from the mystic approach in creating intersubjective spaces that facilitate the caregiving process in a society marked by profound divisions.
Pages: 14-24
As healthcare organizations navigate escalating financial pressures, technological advances, and shifting societal expectations, the imperative to foster authentic ethical cultures has never been greater. This paper critically examines the integration of ethics into hospital systems’ structural and operational fabric, arguing that ethical culture must be intentionally cultivated rather than passively assumed. Drawing from a rich historical analysis of bioethics and corporate social responsibility, and leveraging instructive case studies, including the collapse of Steward Health Care and the cultural rehabilitation of HCA Healthcare, his work interrogates the persistent challenges of resource allocation, psychological safety, and the tension between compliance and genuine moral leadership. Through a synthesis of empirical research and best-practice frameworks, the paper delineates actionable approaches for embedding ethical principles across leadership development, organizational metrics, transparent financial stewardship, and inclusive stakeholder engagement. The analysis highlights that the establishment of a robust ethical infrastructure yields tangible benefits: enhancing organizational credibility, supporting workforce resilience, and strengthening trust among patients and communities. Healthcare executives and administrators will find practical guidance and strategic insights for transforming ethics from a policy aspiration into a dynamic driver of excellence, accountability, and sustainable organizational success.
Pages: 25-36
Background: South Asians in the U.S. are a diverse group, with significant health disparities, particularly in cardiovascular disease and diabetes. While much of the existing research focuses on Asian Indians, there is a lack of studies specifically targeting Bangladeshi immigrants. Addressing these gaps in health literacy is essential to improve health outcomes in this population.
Methods: We conducted a pilot study using an exploratory design to assess diabetes health literacy (DaHL) among Bangladeshi immigrants in the U.S. We developed a 44-item questionnaire, validated through expert consultation and pilot testing. The survey was distributed via social media, utilizing virtual snowball sampling to reach participants. Data were analyzed using descriptive statistics and Cronbach’s alpha for reliability.
Results: More than half of the participants were categorized as overweight or obese according to Asian BMI standards. Nearly 28% had been told they were at risk for diabetes, and 16% had been diagnosed with high blood glucose or impaired fasting glucose. Physical activity levels were low, with 35% engaging in exercise less than once a week. Awareness of diabetes risk factors was moderate, with 84% identifying family history as a risk factor. However, there were knowledge gaps, particularly regarding hypertension and pregnancy as additional risks. Culturally specific barriers were also noted, such as 23% citing a lack of culturally appropriate exercise clothing and 15% resisting modifications to traditional diets. Additionally, only 40% of participants reported receiving diabetes information from healthcare providers, while 20% preferred health materials in their native language.
Conclusion: This pilot highlights significant gaps in diabetes health literacy among Bangladeshi immigrants and the need for culturally tailored interventions.
Keywords: diabetes, health literacy, Bangladeshi immigrants, South Asian health, chronic disease disparities
Issue Vol.11 No. 2 (Spring/Summer 2025)
Pages: 1-7
In this paper, I delve into the moral challenges facing the American healthcare system, recently highlighted by the tragic murder of UnitedHealthcare CEO Brian Thompson. Through the lens of moral economy, I discuss how the profit-driven nature of healthcare organizations often overshadows the fundamental purpose of patient care, sparking public outrage and demands for change. Recognizing the need for a shift, this paper emphasizes how healthcare management education (healthcare administration education, interchangeably) can play a pivotal role in shaping future leaders. By integrating moral economy principles into curricula, we can better prepare students to navigate the complex healthcare landscape with integrity and compassion. I propose several approachable teaching strategies, such as using real-world case studies to illustrate ethical dilemmas, fostering empathy through community partnerships, and encouraging open discussions about corporate responsibilities in healthcare. By adopting these practices, educators can inspire students to advocate for a healthcare system that prioritizes compassion, fairness, and accountability. Ultimately, this paper calls for a renewed commitment within healthcare management education to uphold the moral obligations intrinsic to the profession. By doing so, we can reinforce the commitment to healing and service that lies at the heart of the commonwealth, empowering the next generation of healthcare leaders to effect meaningful change.
- Harshil Patel, Fredy J. Abboud, Peter A. Clark, Shikha Patel, Kreena Patel, Jeremy Muhr, Benjamin Gabrieliants, Andren Chen, Dominic Zaffino, Jose Dubon
Pages: 8-21
For more than a decade, cities struck with substance-use disorder have experienced the brunt of clandestinely adulterated drugs circulating the streets, culminating in the tragic death of over 107,000 individuals by drug-overdose in the United States in 2022. Recently, those cities, particularly Philadelphia, have witnessed a new “wave” of drug-adulterants entering the illicit drug supply. In May 2024, medetomidine, a non-opioid sedative employed in veterinary medicine, was identified as a new drug-contaminant in Philadelphia, with most identified medetomidine being co-detected with either fentanyl or xylazine. Medetomidine’s long-term effects on humans remain unknown, as concerns of a worsening illicit substance-use epidemic grow. Given such fears, this article serves to briefly educate readers on the current pharmacological and medical knowledge of medetomidine and its possible ramifications on the illicit substance-use epidemic, to offer recommendations to combat the early spread of the drug, and to ground our recommendations in ethics.
Issue Vol.11 No.1 (Spring 2025)
- Brenda Ayala
Address correspondence to: Brenda Ayala. MSHA Student. VCU College of Health Professions. Richmond, VA 23298. Email: Brayala@vcu.edu
Pages: 1-6
The chronic shortage of healthcare workers presents significant ethical and legal challenges, particularly regarding the quality of patient care and safety. This paper explores the implications of healthcare worker shortages, focusing on their impact on labor cost, compromised patient care, increased medical errors, and rising malpractice claims. Healthcare institutions face legal risks when they fail to meet mandated staffing ratios, which can result in penalties, fines, and lawsuits. Furthermore, overworked staff, often subject to extended hours and excessive workloads, raise concerns about labor law violations, including non-compliance with mandatory rest periods and fair overtime compensation. The increased reliance on contract workers to fill staffing gaps also introduces legal challenges related to contract disputes, working conditions, and patient safety. Addressing these shortages is critical to preventing further harm to patients and mitigating legal liabilities for healthcare systems. This paper proposes a set of solutions, including legal mandates for minimum staffing ratios in critical care areas and incentives for recruitment and retention in underserved regions. These measures aim to reduce turnover, protect patient safety, and minimize legal risks. A holistic approach to workforce planning and policy reform is necessary to sustain safe staffing levels and ensure ethical standards of care are maintained across the healthcare system. Ultimately, addressing healthcare worker shortages is both a legal requirement and an ethical imperative to safeguard the future of patient care and the well-being of healthcare professionals.
