Anti-Black Racism as a Chronic Condition

Nneka Sederstrom and Tamika Lasege, 

In A Critical Moment in Bioethics: Reckoning 

with Anti-Black Racism through Intergenerational 

Dialogue,  ed.  Faith  E.  Fletcher  et  al., 

Special  Report, Hastings Center Report 52, no. 2 

(2022):  S24-S29.

Abstract

Because America has a foundation of anti-Black racism, being born Black in this nation yields an identity that breeds the consequences of a chronic condition. This article highlights several ways in which medicine and clinical ethics, despite the former's emphasis on doing no harm and the latter's emphasis on nonmaleficence, fail to address or acknowledge some of the key ways in which physicians can—and do—harm patients of color. To understand harm in a way that can provide real substance for ethical standards in the practice of medicine, physicians need to think about how treatment decisions are constrained by a patient's race. The color of one's skin can and does negatively affect the quality of a person's diagnosis, promoted care plan, and prognosis. Yet racism in medicine and bioethics persist—because a racist system serves the interests of the dominant caste, White people. As correctives to this system, the authors propose several antiracist commitments physicians or ethicists can make.

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Here are some commitments to add to a newly revised Hippocratic oath: We shall stop denying that racism exists in medicine. We shall face the reality that we fail to train and equip our clinicians with the ability to effectively make informed clinical decisions using the reality of how race impacts health outcomes. We shall address the lack of the declaration of racism as a bioethics priority and work to train ethicists on how to engage in antiracism work. We shall own the effects of racism at every level in health care and the academy. Attempting to talk about everything except racism is another form of denial, privilege, and power that sustains racism. We will not have conversations about disproportionally high rates of “minority” housing insecurity, food scarcity, noncompliance with treatment plans, “drug-seeking behavior,” complex social needs, or “disruptive behavior” or rely on any other terms that are disguised proxies for racism without explicitly naming racism. As ethicists, we will not engage in conversations around goal setting, value judgments, benefits and risks of interventions, autonomy and capacity, or any other elements around the care of patients without naming racism.

So where do we go from here? How do we address the need to decolonize medicine and bioethics? When do we stop being inactive and start being proactive? It starts upstream with improving the medical education and bioethics curricula to accurately and thoroughly inform students on the social and biological sciences of human beings who are not White in America. Then, and only then, will we breed a generation of race-conscious clinicians and ethicists who can understand and interpret the historic inequities in our system and ultimately be capable of providing medical care and ethical analysis that reflect the diversity of our country. Clinical ethics program development must include antiracism training to develop clinical ethicists who have the skills to recognize and address racism at the bedside in clinical ethics consultation. It requires changing the faces in the field and addressing the extreme lack of racial diversity in bioethics. Increasing the number of clinicians of color in all professions within medicine, but especially the numbers of physicians, advance practice providers, and clinical ethicists, is imperative to the goal of improving patient outcomes for Black and brown populations.

The info is here.

Should Robots Have Rights? Four Perspectives

John Danaher
Philosophical Disquisitions
Originally published October 31. 2017

Here is an excerpt:

The Four Positions on Robot Rights

Before I get into the four perspectives that Gunkel reviews, I’m going to start by asking a question that he does not raise (in this paper), namely: what would it mean to say that a robot has a ‘right’ to something? This is an inquiry into the nature of rights in the first place. I think it is important to start with this question because it is worth having some sense of the practical meaning of robot rights before we consider their entitlement to them.

I’m not going to say anything particularly ground-breaking. I’m going to follow the standard Hohfeldian account of rights — one that has been used for over 100 years. According to this account, rights claims — e.g. the claim that you have a right to privacy — can be broken down into a set of four possible ‘incidents’: (i) a privilege; (ii) a claim; (iii) a power; and (iv) an immunity. So, in the case of a right to privacy, you could be claiming one or more of the following four things:

• Privilege: That you have a liberty or privilege to do as you please within a certain zone of privacy.


• Claim: That others have a duty not to encroach upon you in that zone of privacy.


• Power: That you have the power to waive your claim-right not to be interfered with in that zone of privacy.


• Immunity: That you are legally protected against others trying to waive your claim-right on your behalf

As you can see, these four incidents are logically related to one another. Saying that you have a privilege to do X typically entails that you have a claim-right against others to stop them from interfering with that privilege. That said, you don’t need all four incidents in every case.

The blog post is here.

Is Healthcare a Right? A Privilege? Something Entirely Different?

Brian Joondeph
The Health Care Blog
Originally published April 8, 2017

Here is an excerpt:

Most developed countries have parallel public and private healthcare systems. A public option covering everyone, with minimal or no out-of-pocket expense to patients, but with long wait times for care and limited treatment options. And a private option allowing individuals to purchase the healthcare or insurance they want and need, paying for it themselves, without subsidies, tax breaks or any government assistance. One option a right, the other a privilege.

For an analogy, think of K-12 schools. A public option available without cost to students. For most, a good and more than adequate education. And a free-market private school option for those who desire and have the means. Shop around, pay as much as you want, or default to the public option.

Each system has its pros and cons, but they are separate and distinct. Instead we are trying to combine both into a single scheme — Obamacare, Ryancare or whatever finally emerges from Congress. We get the worst of both systems – bureaucracy and high cost. And the best of neither – no universal coverage and limited freedom of choice.

The blog post is here.

On Privilege and Luck, or Why Success Breeds Success

By Ed Yong
The National Geographic
Originally published May 28, 2014

Ask successful people about the secrets of their success, and you’ll probably answers like passion, hard work, skill, focus, and having great ideas. Very few people, if any, would reply with “privilege and luck”. We’re often blind to these factors and they make for less inspiring stories. But time and again, we see that the advantages that give us a head-start and the accidents that ease our path can make or break a career.

In 1968, sociologist Robert Merton noted that in several areas of science, advantage accumulates. Well-known scientists, for example, are more likely to get further recognition than equally productive peers of lesser renown. Merton called this the Matthew effect after a biblical verse that says “For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”

The entire story is here.

A Chance to Walk the Talk at the Ethics Educators Conference

By Jeff Sternlieb, PhD
The Pennsylvania Psychologist
June 2012

During the 2011 annual PPA Ethics Educators Conference, an exchange occurred that could, met with the right attitude, guide our organization in creating safe learning spaces. Here’s what happened:

The exchange

The chair of the Ethics Committee began by identifying the content of the program for the day and then introduced the “luminaries” present: past presidents of PPA and significant contributors to ethics education. He ended with a specific request to be respectful of each other in our exchange of ideas and then introduced the morning’s presenters.

When the first pair of presenters described their roles, the second made a comment about being a longtime sidekick – Robin to the first one’s Batman. Immediately, someone in the audience remarked, “Oh, I guess that means you’re gay,” chuckling as though it were a joke. A ripple of laughter from the audience quickly subsided as the presenters moved on without any comment about the “joke,” even though it occurred minutes after the Ethics chair requested sensitivity.

My thoughts

Immediately I struggled. I wondered whether anyone would respond to the remark. I believed we were all, through our silence, colluding with the “joke” and placing in an unfair position anyone who was gay or simply cognizant of the impact of such comments on any minority member.

I shared my concern with a colleague next to me, who did not seem to consider it nearly as significant. I was considering what I should do, but doing or saying nothing was not an option. Two choices occurred to me: say something to the entire group, potentially embarrassing the person who made the remark, or say something to him at the break. The former had the potential to interfere with the ethics program; the latter might determine the speaker’s awareness of the remark’s impact and intent to address it in the larger group. I chose the latter.

The conversation

When I asked the quipster whether he was aware of the possible impact of his comment, he indicated that not only was he aware, but that he had already addressed it during a small-group discussion. He said he regretted it the minute it came out of his mouth, and that he worked with a number of gay clients in a setting in which his comment would have been heard differently. It struck me as a justification rather than an understanding of its potentially negative impact in the current context. He said he appreciated that I brought the concern to him but made no offer to discuss it with the larger group. He had not heard the term “microaggression” when I used it. Included in his small discussion group had been the Ethics chair, who approached while we were talking and asked whether I would be willing to share my experience with the larger group. I agreed.

The organic process

After the morning break, one psychologist, new to the Ethics Educators Conference, questioned how the earlier comment had impacted the learning, sharing environment. This opened the opportunity to share these issues in a natural way, and the Ethics chair publicly invited me to share what we discussed during break. This person’s independent concern supported my belief that such comments have an impact. Save for those who speak out, we cannot know how many others have been affected.

I shared my reaction, thought process, and conversation. I then invited the quipster to share his perspective, and he did, explaining that he worked with a largely gay clientele, apologizing to anyone he might have offended, and repeating that he had regretted his remark immediately after making it.

Audience reactions

Some participants thanked the new attendee for her courage in raising this issue, while others commended the quipster for his apology. One asked what the fuss was about, saying she did not recall hearing any offensive remarks. One person rejected the idea that he was collusive, having heard the remark less negatively. Another asked how this had become Jeff Sternlieb’s issue. Others expressed discomfort at censoring comments that might be seen as offensive to any one person, resisting “political correctness.” One participant noted a significant bias toward calling on male participants to the exclusion of women.

Analysis

All comments struck me as introductory and reactive. No one sought clarification. We did not converse. While no time was scheduled to explore these issues, I was surprised at the lack of informal discussion during lunch or break. These issues seemed too hot to handle and we seemed too uncomfortable to talk about them. Though the exchange introduced the opportunity to learn, our inability to talk effectively stopped us from naming our experience and the concepts involved, including:

·         Privilege. Those of us with privilege – especially we who are white, male, heterosexual, and relatively financially secure ­– tend to minimize the perspectives of those who are marginalized. While none of us want an environment in which we cannot talk about race, sexual orientation, or gender because we are afraid of offending others, we seem to do the opposite: fail to take others seriously when insensitivity is identified. Just because clients or friends are gay does not give us the freedom to make jokes about being gay, particularly among those we may not know well. When any group is singled out, it impacts all groups who have been marginalized.

·         Collusion can be active or passive. Active collusion involves direct participation in the offense, and might involve adding to an initial insult or joke, thus amplifying the impact. This “joining in” sanctions the remark, making it easier for others to “pile on” with similar comments and more difficult for anyone to object. Passive collusion consists of saying or doing nothing, thereby lending tacit support to an unacceptable statement. To object may be seen as a personal affront, discomfiting, or unnecessarily confrontational.

·         Microaggressions are comments that may seem innocent, harmless, or even complimentary but contain demeaning implications or hidden messages. They “...are the brief and everyday slights, insults, indignities and denigrating messages” sent to minorities in subtle, unintended discrimination (Sue, 2010). Sue describes three types: micro-assaults, micro-insults, and micro-invalidations. A useful website, http://microaggressions.com, lists many examples of such comments.

·         Political correctness. The primary reason we should not joke about people’s race, gender, or sexual orientation is that these characteristics are personal. In the context of a professional exploration of issues, a reference might not be microaggressive, but a joke about a minority made as an aside is a personal affront, and to not recognize it as such IS to collude.

·         Misapplication of Golden Rule. The Golden Rule, “Do unto others as you would have others do unto you,” does not address individual and group preferences; we cannot assume that because a remark might not offend us that it won’t offend others. An alternate rule, the “Platinum Rule,” can be helpful: “Treat others as they want to be treated,” which would require asking rather than assuming.

The fact that one seemingly simple comment raises so many questions, issues, and reactions suggests we in PPA have a lot more to learn. Having a Committee on Multiculturalism and a host of resources (including a CE program) is not a guarantee of progress. Having this experience in vivo can teach more than any didactic exercise.

The comment one person made could have been made by any of us. The real challenge, in my view, is how we respond.

Reference

Sue, D. W. (2010). Microaggressions in everyday life:  Race, gender and sexual orientation. New York, NY: John Wiley and Sons.