Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label health equity. Show all posts
Showing posts with label health equity. Show all posts

Saturday, March 18, 2023

Black Bioethics in the Age of Black Lives Matter

Ray, K., Fletcher, F.E., Martschenko, D.O. et al. 
J Med Humanit (2023).
https://doi.org/10.1007/s10912-023-09783-4

Here are two excerpts:

Lessons Black Bioethics can take from BLM

BLM showed that telling Black people’s stories or giving them a space to tell their own stories is viewed as an inherently political act simply because Black people’s existence is viewed as political. At the same time, it taught us that we absolutely must take on this task because, if we do not tell our stories, other people will tell them for us and use our stories to deny us our rightful moral status and all the rights it entitles us.

BLM let Black people’s stories fuel its social justice initiatives. It used stories to put Black people at the forefront of protests and social inclusion efforts to show the extent to which Black people had been excluded from our collective social consciousness. Stories allowed us to see the total impact of anti-Black racism and the ways it infiltrates all parts of Black life. And for those who were far removed from the experience of being Black, BLM used stories to make us care about racial injustice and be so moved that we were unable to turn our backs on Black people’s suffering. In this way, stories are an act of rebellion, a way to force people to reckon with BLM’s demands that Black people ought to be treated like the full and complex human beings we are.

Black Bioethics is also a rebellion. It is a rebellion against the status quo in bioethics—a rebellion against Black people’s lives being an afterthought, particularly in issues of justice. Stories aid in this rebellion. Just as stories helped BLM show the full range of Black people’s humanity and the ways that individuals and institutions deny Black people that humanity, stories help Black Bioethics demonstrate just how our institutions contribute to Black people’s poor health and prevent them from living full lives. In Black Bioethics, stories can create the same emotional stirring that they did for BLM supporters since they share many of the same challenges and goals. And just as it would be imprudent to underestimate the role of stories in social justice, it would be imprudent of us to underestimate what stories can do for our sense of health justice for Black people.

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Toward an intersectional bioethics

Bioethics is well-positioned to foster antiracism in scholarship, training, and advocacy (Danis et al. 2016). Although the field focuses on ethical issues in biomedical research and clinical care specifically, Danis et al. (2016) point out that many ethical dilemmas that impact health and well-being lie outside of healthcare settings. For instance, there are significant ethical dilemmas posed by the social determinants of health and complex disease. Social factors such as poverty, unequal access to healthcare, lack of education, stigma, and racism are underlying and contributing factors to health inequalities. These inequalities, in turn, generate the ethical dilemmas that bioethics grapples with (Danis et al. 2016). If the field genuinely values the just conduct of biomedical research and the just provision of clinical care, then it will need to draw upon intersectionality to understand and effectively analyze the many interlocking complexities in our world and in human experiences. Social activist movements like BLM and their use of intersectionality offer several lessons to those in the field working to secure justice in biomedicine, clinical care, and society.

First, as an analytic tool, intersectionality recognizes and understands that different social forces conjoin to produce and maintain privilege and marginalization. Therefore, intersectionality clarifies instances in which real lives and experiences are being erased. Bioethics cannot afford to “neglect entire ways of being in the world,” though it has and continues to do so (Wallace 2022, S79). Social activist movements like BLM are drawing attention to ways of being that are unjust yet largely ignored by mainstream hegemonic interests. For instance, BLM directly acknowledges within its movement “those who have been marginalized within [other] Black liberation movements” (Black Lives Matter n.d.). Using intersectionality, BLM heightens awareness of the ways in which Black queer and trans individuals, undocumented individuals, and people with disabilities have different experiences with White supremacy and advance colonialism. In doing so, it centers rather than erases real lives and experiences. Learning from this movement, bioethical scholarship grounded in the principle of justice will need to find ways to center the experiences of Black-identifying individuals without treating the Black community as a homogenous entity.

Tuesday, January 31, 2023

Why VIP Services Are Ethically Indefensible in Health Care

Denisse Rojas Marquez and Hazel Lever
AMA J Ethics. 2023;25(1):E66-71.
doi: 10.1001/amajethics.2023.66.

Abstract

Many health care centers make so-called VIP services available to “very important persons” who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates “trickle down” economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians’ conceptions of what patients deserve from them in health care settings.

Insurance and Influence

It is common practice for health care centers to make “very important person” (VIP) services available to patients because of their status, wealth, or influence. Some delivery models justify the practice of VIP health care as a means to help offset the cost of less profitable sectors of care, which often involve patients who have low income, are uninsured, and are from historically marginalized communities.1 In this article, we explore the justification of VIP health care as helping finance services for patients with low income and consider if this “trickle down” rationale is valid and whether it should be regarded as acceptable. We then discuss clinicians’ ethical responsibilities when taking part in this system of care.

We use the term VIP health care to refer to services that exceed those offered or available to a general patient population through typical health insurance. These services can include concierge primary care (also called boutique or retainer-based medicine) available to those who pay out of pocket, stays on exclusive hospital floors with luxury accommodations, or other premium-level health care services.1 Take the example of a patient who receives treatment on the “VIP floor” of a hospital, where she receives a private room, chef-prepared food, and attending physician-only services. In the outpatient setting, the hallmarks of VIP service are short waiting times, prompt referrals, and round-the-clock staffing.

While this model of “paying for more” is well accepted in other industries, health care is a unique commodity, with different distributional consequences than markets for other goods (eg, accessing it can be a matter of life or death and it is deemed a human right under the Alma-Ata Declaration2). The existence of VIP health care creates several dilemmas: (1) the reinforcement of existing social inequities, particularly racism and classism, through unequal tiers of care; (2) the maldistribution of resources in a resource-limited setting; (3) the fallacy of financing care of the underserved with care of the overserved in a profit-motivated system.

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Conclusion

VIP health care, while potentially more profitable than traditional health care delivery, has not been shown to produce better health outcomes and may distribute resources away from patients with low incomes and patients of color. A system in which wealthy patients are perceived to be the financial engine for the care of patients with low incomes can fuel distorted ideas of who deserves care, who will provide care, and how expeditiously care will be provided. To allow VIP health care to exist condones the notion that some people—namely, wealthy White people—deserve more care sooner and that their well-being matters more. When health institutions allow VIP care to flourish, they go against the ideal of providing equitable care to all, a value often named in organizational mission statements.22 At a time when pervasive distrust in the medical system has fueled negative consequences for communities of color, it is our responsibility as practitioners to restore and build trust with the most vulnerable in our health care system. When evaluating how VIP care fits into our health care system, we should let health equity be a moral compass for creating a more ethical system.