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.
