Representative Student Work

Integrative Inquiry and Critical connections across course concepts

Assignment Context

Critical Connections assignments ask students to identify and explore meaningful relationships between two or more course concepts that are not typically examined together. The task is not to summarize content or argue toward a solution, but to engage in disciplined inquiry: to surface tensions, expose hidden assumptions, and ask questions of real ethical and system-level significance.

Strong submissions demonstrate synthesis rather than accumulation. They move beyond describing concepts independently and instead examine what becomes visible when those concepts are held together. Students are encouraged to tolerate uncertainty, resist premature closure, and treat disagreement, ambiguity, and discomfort as informative rather than problematic.

The excerpts below are anonymized exemplars. They are presented because they demonstrate conceptual integration, ethical restraint, and the ability to generate questions that matter.

When Permanence Meets Trust: Death Determination and Public Meaning

HTHSCI 3DT3 student, 2024

“The principle of permanence in death determination is often discussed as a technical safeguard, but this framing overlooks its relational function. Permanence is not only about physiology; it is about preserving trust in a system that asks families to accept irreversible decisions.

When I connect the permanence principle to donor family testimony, it becomes clear that ambiguity does not simply generate confusion; it generates moral distress. Families are not asking clinicians to eliminate uncertainty. They are asking them to be explicit about it. In this sense, permanence operates as an ethical boundary rather than a biological one.

This reframing suggests that disagreements about death determination are less about misunderstanding criteria and more about whose interpretation of risk and meaning is prioritized. Addressing conflict therefore requires attention not only to protocols, but to the narratives through which those protocols are explained and justified.”

Comment
This excerpt demonstrates disciplined synthesis across ethics, clinical practice, and lived experience. The student reframes permanence as both a biological safeguard and a trust-preserving commitment.

Equity Is Not Neutral: Organ Allocation and the Myth of Objectivity

HTHSCI 3DT3 student, 2025

“Allocation systems are often defended as neutral because they rely on algorithms and standardized criteria. However, neutrality assumes that all patients enter the system with comparable access, health literacy, and social stability, an assumption that is not supported by evidence.

By connecting socioeconomic barriers to post-transplant outcomes, it becomes clear that allocation criteria may inadvertently reward privilege rather than medical urgency alone. What appears objective at the level of policy becomes uneven at the level of lived experience.

This does not mean allocation systems are unethical, but it does mean they are value-laden. Recognizing this forces us to ask a different question: not whether the system is fair in theory, but whether it is fair in practice, and to whom.”

Comment
This reflection shows strong systems-level reasoning without collapsing into moral certainty. The student surfaces embedded values while maintaining analytical restraint.

Consent as Process, Not Event

HTHSCI 3DT3 student, 2024

“Consent is often treated as a discrete moment, a signature or verbal agreement, yet the guest speaker reflections reveal consent as an evolving process shaped by timing, trust, and emotional readiness.

When consent is rushed or overly procedural, families may technically agree while feeling morally unsettled. This disconnect matters because it influences how families later interpret the donation experience, including whether it is remembered as meaningful or extractive.

Reframing consent as relational challenges systems designed for efficiency. It also exposes tension between institutional timelines and human processing of loss, a tension that cannot be resolved through better forms alone.”

Comment
This excerpt demonstrates conceptual reframing. The student uses lived experience to interrogate the limits of policy language and procedural certainty.

Living Donation, Autonomy, and the Limits of Choice

HTHSCI 3DT3 student, 2025

“Living donation is often celebrated as the purest expression of autonomy, yet this framing overlooks the social pressures that shape voluntary decisions. Family expectations, cultural narratives of sacrifice, and fear of regret all complicate the idea of free choice.

When autonomy is understood in isolation, the system risks ignoring coercive dynamics that are subtle but powerful. Protecting donors therefore requires more than informed consent; it requires attention to silence, hesitation, and relational obligation.

This analysis suggests that ethical safeguards must account for what donors feel unable to say, not only what they explicitly state.”

Comment
This reflection shows ethical nuance and diagnostic discipline. The student interrogates autonomy while preserving its importance and widening the frame to include social constraint.

When Safety Mechanisms Become Moral Signals

HTHSCI 3DT3 student, 2024

“In class, we discussed normothermic regional perfusion (NRP) primarily as a technical intervention designed to improve organ viability. Separately, we examined public trust as a fragile social construct shaped by transparency, symbolism, and historical memory. What became clear when these discussions were held together is that safety mechanisms in NRP function not only as physiological safeguards, but also as moral signals.

This raises a question not explicitly addressed in existing policy: Who is the safety mechanism for? If diversion of cerebral blood flow is designed solely to prevent neurological reperfusion, its adequacy can be assessed technically. But if it also serves to reassure families, clinicians, and the public that death remains respected and irreversible, then its design and explanation carry ethical weight beyond function.

In this sense, policy decisions about redundancy and monitoring are not merely conservative choices. They are acts of moral positioning within a contested space of death determination.”

Comment
This is an anchor exemplar. The student connects two concepts taught separately and generates a novel, high-value question, then answers it through reframing rather than solutioning.

Permanence, Process, and the Limits of Consensus

HTHSCI 3DT3 student, 2025

“Throughout the course, permanence was emphasized as a foundational principle in death determination, while disagreement was treated as an expected feature of ethical systems. What became clear when these ideas were considered together is that permanence is not simply a biological claim, but a stabilizing commitment made in the presence of disagreement.

This led me to ask whether permanence is something we establish, or something we agree to uphold. If permanence depends on shared trust in process rather than universal metaphysical agreement, then its strength lies less in consensus and more in disciplined restraint after a decision is made.

Seen this way, safeguards are not designed to convince everyone that death has occurred. They are designed to mark a boundary beyond which we collectively agree not to return, even when doubt or dissent persists.”

Comment
This excerpt demonstrates high-level synthesis and conceptual maturity. The student reframes disagreement as a condition systems must be designed to hold, not eliminate.

Summary

These Critical Connections exemplars demonstrate disciplined conceptual integration rather than argumentative closure. Students connect ethics, clinical practice, policy, and lived experience to generate better questions, surface hidden values, and reframe familiar terms such as permanence, consent, autonomy, and trust. The strongest work treats uncertainty as an essential feature of ethical life rather than a flaw to be resolved.

Please Note: Attribution and Student Recognition

All excerpts are presented anonymously to protect privacy and support intellectual risk-taking. If a student recognizes their work and would like to be credited, they are welcome to contact the course instructor directly and share the original submission. With permission, attribution can be added.

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