PHI413V GCU Fetal Abnormality: Moral Status of the Fetus case study Based on “Case Study: Fetal Abnormality” and other required topic study materials, writ | Homework Answers

PHI413V GCU Fetal Abnormality: Moral Status of the Fetus case study Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
How does the theory determine or influence each of their recommendations for action?
What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

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Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. ? COMMUNITY-ORIENTED PRIMARY CARE ?
Community-Oriented Primary Care:
A Path to Community Development
Although community development and social change are
not explicit goals of community-oriented primary care
(COPC), they are implicit in
COPC’s emphasis on community organization and local participation with health professionals in the assessment of
health problems. These goals
are also implicit in the shared
understanding of health problems’ social, physical, and economic causes and in the design of COPC interventions.
In the mid-1960s, a community health center in the
Mississippi Delta created programs designed to move beyond narrowly focused disease-specific interventions
and address some of the root
causes of community morbidity and mortality.
Drawing on the skills of the
community itself, a selfsustaining process of healthrelated social change was initiated. A key program involved
the provision of educational
opportunities. (Am J Public
Health. 2002;92:1713–1716)
| H. Jack Geiger, MD, MSciHyg
EARLY IN HIS CAREER, THE
distinguished social epidemiologist John Cassel worked for a
time as clinical director of the
Pholela Health Center, the pioneering South African program
at which Sidney and Emily Kark
and their colleagues first created and implemented community-oriented primary care
(COPC). Their work transformed the health status of an
impoverished rural Zulu population and, ultimately, served as a
worldwide model for the integration of clinical medicine and
public health approaches to individuals and communities.1–4
During a window of opportunity
that opened in the 1950s,
Pholela’s center and a network
of other South African health
centers elaborated the core
goals of COPC: epidemiological
assessment of demographically
defined communities, prioritization, planned interventions, and
evaluation.5 By decade’s end,
however, these centers had all
been shut down by a rigidly
racist apartheid government.
A few years later, Dr Cassel—
by then a professor at the University of North Carolina School
of Public Health—made a return
visit to a Pholela that was even
more deeply impoverished. After
conducting a thoroughly informal
and anecdotal survey, he saw no
signs that the earlier improvements in health status had persisted. But he was struck by the
target population’s unusually
high levels of educational aspiration and educational achievement. (Indeed, one of the health
November 2002, Vol 92, No. 11 | American Journal of Public Health
center’s pediatric patients later
went on to become a physician, a
leader of the African National
Congress in exile, and—after liberation—Nelson Mandela’s first
minister of health.6)
Cassel’s observation illustrates
a goal of COPC—community development—that the Karks, fully
aware that social, economic, and
environmental circumstances are
the most powerful determinants
of population health status, understood very well. Although
only occasionally specified in
their publications, it was implicit
in their programs focusing on
community organization and involvement, training and development of local residents as staff
members, employment of Zulu
nurses as role models, intensive
A health center nurse makes a home visit to a stroke-disabled
patient living in a plantation shack near Shelby in Bolivar County,
Mississippi, in 1967. Most such housing is less substantial than
this. (Photo by Dan Bernstein.)
Geiger | Peer Reviewed | Community-Oriented Primary Care | 1713
? COMMUNITY-ORIENTED PRIMARY CARE ?
health education, and environmental improvements. Even in
the constrained social and political circumstances of apartheidera South Africa, such efforts
apparently had a lasting educational effect.
In the mid-1960s, half a world
away, another—and much bigger—window of opportunity
opened in the United States. The
“war on poverty” and its federal
implementing agency, the Office
of Economic Opportunity (OEO),
proposed in principle to address
the root causes of deprivation
and inequality. The OEO’s
largest arm, the Community Action Program, was committed to
ideas of community involvement
and program participation. Of
equal importance, the flourishing
civil rights movement embodied
bedrock principles of community
empowerment and political and
economic equity. When health
services—and, specifically, COPCbased health centers—were
added to this rich mix, the stage
was set for an experimental test
of the idea that a health program,
in addition to its traditional curative and preventive roles, could
be deliberately fashioned as an
instrument of community development and as a lever for social
change.
This experiment was conducted, in the late 1960s and
early 1970s, when Tufts Medical
School proposed the community
health center model to OEO.
The Tufts-Delta Health Center
was the first in what is now a national network of more than 900
federally qualified health centers.
Closely modeled on the Pholela
experience,7 it was designed to
serve a primarily African American population of 14 000 persons residing in a deeply impoverished 500-square-mile area of
northern Bolivar County in the
A typical plantation shack near Alligator, Mississippi, in 1968. A
whole generation is often missing from the home, as parents—
displaced by mechanical cotton-harvesting—leave children with
grandparents while they search for other work in northern cities.
(Photo by Dan Bernstein.)
Mississippi Delta. As was the case
with many other areas of the cotton-growing delta, this was a
population of sharecroppers increasingly displaced by mechanization and living in crumbling
wooden shacks with no protected
water supplies, untouched by
food stamps or commodity surplus foods. These families had a
median income of less than
$900 per year, had a median
level of education of 5 years
(and were exposed to segregated
and inferior schools), and were
suffering the inevitable consequences of malnutrition, infant
1714 | Community-Oriented Primary Care | Peer Reviewed | Geiger
mortality, infectious and chronic
diseases, and adult morbidity
and mortality.
Detailed descriptions of the
Tufts-Delta Health Center’s personal medical service programs,
outreach services, health education efforts, and environmental
and other interventions involving
housing, water supplies and sanitation, and other public health
approaches have been published
elsewhere.8,9 What is of interest
here is the center’s community
empowerment program.
With the guidance of Dr John
Hatch, the head of the center’s
community organization department, 10 local health associations were formed and began to
survey and assess local needs,
nominate people for employment at the center, and plan
satellite centers. Each association
elected a representative to an
overarching organization, the
North Bolivar County Health
Council. The council served as
the health center’s required community advisory board but was
deliberately chartered as a nonprofit community development
corporation to broaden the
scope of its work.
Its first effort was to end the
local racist banking custom that
denied mortgages to Black applicants altogether, demanded a
White cosigner, or charged exorbitant (and illegal) under-thetable interest rates. Members of
the health council visited all of
the local banks and informed
them that the center’s milliondollar annual funding and cash
flow would be deposited in
whichever bank opened a branch
in a Black community, hired residents as tellers instead of janitors, and engaged in fair mortgage loan practices.
After successful completion of
this process, the local health associations obtained mortgages to
buy buildings for satellite centers, rented them to the health
center during the day, used the
rental income to cover the loan
payments, and used the buildings
as community centers at night.
Local health center staff members obtained mortgages to build
modest new homes. Next, because there was no public transportation and few people had
cars, the health council—on contract from the health center—established a bus transportation
system that linked the satellites
to the health center (and pro-
American Journal of Public Health | November 2002, Vol 92, No. 11
? COMMUNITY-ORIENTED PRIMARY CARE ?
vided economic mobility for
workers and shoppers).
This was just the beginning.
Subsequently, the council developed a pre–Head Start early
childhood enrichment program
and a nutritional and recreational program for isolated elderly rural residents. In addition,
the council hired a part-time
lawyer to ensure that federal
and state agencies (which had
often ignored Black communities) provided equitable assistance in housing development,
recreational facilities, water systems, and other elements of
physical infrastructure.
Also, by means of a federal
grant and its own budget, the
health council developed a supplemental food program. And
when staff of the health center
suggested that local residents
grow vegetable gardens, the
council had a better idea: with a
foundation grant and help from
the Federation of Southern Cooperatives, it spun off a new nonprofit organization, the North Bolivar County Farm Co-op, in
which a thousand families pooled
their labor to operate a 600-acre
vegetable farm and share in the
crops. This unique enterprise—
nutritional sharecropping—built
on the agricultural skills people
already possessed.
What made all of this possible? One of the principal factors
was ending the isolation that had
kept members of poor rural minority communities cut off from
knowledge of, or help from, such
traditional sources of support as
government agencies, philanthropic foundations, and universities and professional schools. By
1970, for example, the health
council and health center had
ties to 7 universities, a medical
school, and numerous foundations and agencies. In addition, in
At a 1968 meeting of the North Bolivar County Health Council at the Delta Health Center, Mound Bayou,
Mississippi, William Finch announces the arrival of a Ford Foundation check that will launch a farming
cooperative to grow vegetables for a malnourished population. (Photo by Dan Bernstein.)
the summer of 1970 alone, the
programs were host to Black and
White student interns from 8
medical schools, 2 nursing
schools, 3 schools of social work,
2 public health schools, and 3
environmental health programs.
As was the case at Pholela,
however, the most important impact was educational, in this instance in the form of a structured
and multifaceted program. The
health center established an office of education, seeking out
bright and aspiring local high
school and college graduates, assisting them with college and
professional school applications,
and providing scholarship information and university contacts.
At night, health center staff
taught high school equivalency
and college preparatory courses,
both accredited by a local Black
junior college. In the first decade
in which it was in place, this effort produced 7 MDs, 5 PhDs in
health-related disciplines, 3 envi-
November 2002, Vol 92, No. 11 | American Journal of Public Health
ronmental engineers, 2 psychologists, substantial numbers of registered nurses and social workers, and the first 10 registered
Black sanitarians in Mississippi
history.
One of the physicians returned to become the center’s
clinical director, and another returned as a staff pediatrician. A
sharecropper’s daughter acquired a doctorate in social work
and a certificate in health care
management and returned as
the center’s executive director.
(Her successor 8 years later, similarly well credentialed, had once
been a student in the college
preparatory program.) Other
center staff members completed
short-term intensive training as
medical records librarians, physical therapists, and laboratory
technicians.
Moreover, as John Cassel’s observation at Pholela suggested,
this process has proved to be
self-perpetuating. Today, the
number of Black northern Bolivar County residents and their
next-generation family members
working in health-related disciplines, at every level from technician to professional, is well over
100. There is anecdotal evidence
to suggest that other health centers, even without special programs of this sort, may have a
similar effect. Local residents
who become center staff members tend to invest their increased earnings in two areas:
better housing and college education for their children.
The effect is more than economic, however. Building community-based institutions and replacing the race- and class-based
isolation of poor and minority
communities with ties to other
institutions in the larger society
may create a new kind of social
capital that facilitates social
change. This in turn enlarges the
health effects of the traditional
clinical and public health inter-
Geiger | Peer Reviewed | Community-Oriented Primary Care | 1715
? COMMUNITY-ORIENTED PRIMARY CARE ?
ventions that are the core of
COPC. Other community health
centers established in the first
wave of the OEO’s Office of
Health Affairs program similarly
invested vigorously in community organization, environmental
change, and (in urban areas with
more existing resources) links
with other organizations to create multisectoral interventions.
There are two important lessons to be gained from the Mississippi Delta experience. The
first is that communities of the
poor, all too often described
only in terms of pathology, are
in fact rich in potential and
amply supplied with bright and
creative people. The second is
that health services, which have
sanction from the larger society
and salience to the communities
they serve, have the capacity to
attack the root causes of ill
health through community development and the social change
it engenders.
As at Pholela, after too few
years the window that was open
to expanded programs and community development began to
close. This happened in part because of program costs and in
larger measure because conservative national administrations
were (to put it mildly) not overly
interested in community empowerment and social change. As a
result, health center programs
were squeezed back toward
more traditional roles of delivering personal medical services
and more limited public health
interventions.
Good ideas, however, may be
rediscovered, and the potential is
still there. The North Bolivar
County Health Council, no
longer in need of university
sponsorship, now owns and operates the freestanding Delta
Health Center, with branches in
2 additional counties, and most
other federally qualified health
centers have analogous community control and practice elements of COPC. Over the next
few years, the number of community health centers will double. The recent and growing national interest in community–
campus partnerships, including
but not limited to health services,
may be a first step in the rediscovery of community development as a legitimate goal of
health care interventions.
About the Author
H. Jack Geiger is with the Department of
Community Health and Social Medicine,
City University of New York Medical
School.
Requests for reprints should be sent to
H. Jack Geiger, MD, MSciHyg, City University of New York Medical School, City
College of New York, 138th St at Convent
Avenue, New York, NY 10031 (e-mail:
jgeiger@igc.org).
This commentary was accepted June 4,
2002.
References
1. Kark SL, Cassel J. The Pholela
Health Centre: a progress report. S Afr
Med J. 1952;26:101–104, 131–136.
2. Uach D, Tollman SM. Public health
initiatives in South Africa in the 1940s
and 1950s: lessons for a post-apartheid
era. Am J Public Health. 1993;83:
1043–1050.
3. Susser M. A South African odyssey
in community health: a memoir of the
impact of the teachings of Sidney Kark.
Am J Public Health.1993;83:
1039–1042.
4. Philips HT. The 1945 Gluckman
report and the establishment of South
Africa’s health centers. Am J Public
Health. 1993;83:1037–1039.
5. Kark SL, Steuart G, eds. A Practice
of Social Medicine. Edinburgh, Scotland:
E & S Livingstone Ltd; 1962.
6. Geiger HJ. A piece of my mind.
The road out. JAMA. 1994;272:1152.
7. Geiger HJ. Community-oriented
primary care: the legacy of Sidney Kark.
Am J Public Health.1993;83:946–947.
Care. Washington, DC: National Academy Press; 1982:73–114.
9. Geiger HJ. A health center in Mississippi: a case study in social medicine.
In: Corey L, Saltman SE, Epstein MF,
eds. Medicine in a Changing Society. St.
Louis, Mo: CV Mosby Co; 1972:
157–167.
2nd Edition
CommunityOriented Primary Care:
Health Care for the 21st Century
Edited by Robert Rhyne, MD, Richard
Bogue, PhD, Gary Kukulka, PhD, and
Hugh Fulmer, MD
This book will give insight into:
• How medicine, health systems, community leaders, and social services
can be supportive as America’s public health practice continues to be
restructured and redefined
• New models of community-oriented
primary care
• Methods and interventions on population-derived health needs
• Health promotion and disease prevention as part of the overall reorganization of health services
• Understanding how communityoriented primary care can complement managed care and community
benefit programs
This book teaches skills and techniques
for implementing a community-oriented
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ISBN 0-87553-236-5
1998 ? 228 pages ? Softcover
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8. Geiger HJ. The meaning of community-oriented primary care in the
American context. In: Connor E, Mullan
F, eds. Community Oriented Primary
1716 | Community-Oriented Primary Care | Peer Reviewed | Geiger
American Journal of Public Health | November 2002, Vol 92, No. 11
HW #2: Out in the Rural Worksheet
Name and Section:
Instructions: This week please take the time to watch the 22 minute 1966 documentary, Out in the Rural, and
complete this worksheet. Also read the accompanying article, Community-Oriented Primary Care: A Path to
Community Development, by Dr. Jack Geiger (4 pages). You will need to watch the movie and read the article
to complete the homework and come up with 5-7 issues that came up in the documentary and which actions
were taken to address the issue. Finally, you will have to assess which social-ecological level or levels the
action falls into. The homework is due in Canvas by Friday, February 15th by 11:59pm.
What were the issues in Bolivar County, Mississippi, in the early 1960’s?
What did they do to address these issues?
Issue
Action Taken
Socio-ecological Level
(Individual, Interpersonal,
Organizational,
Community, Policy)
HW #2: Out in the Rural Worksheet
Issue
Action Taken
Name and Section:
Socio-ecological Level
(Individual, Interpersonal,
Organizational,
Community, Policy)

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