Patients with Limited English Proficiency are a protected class under the Civil Rights Act. However, clinical trials continue to remain largely inaccessible to this population. This article lays out the scientific, legal, and ethical rationales for the inclusion of LEP subjects in clinical research.

Imagine that you possess an indicator for a disease or illness that has nothing to do with your body. It is not a genetic predisposition to acquire cancer or a vice that raises the probability of contracting some dread disease, though estimates of its health risks have placed it on par with having diabetes. It has nothing to do with the environmental pollutants you are exposed to or whether you can afford health care. It is not a physical susceptibility that (...) renders you more easily reachable by the clutches of pathology. No, this indicator of health hinges on certain learned abilities and skills, and it is a barrier to health that is totally within the health field's power and resources to lift.The condition hinted at above is the inability to speak English proficiently in the United States. Today, more than one-sixth of the United States population speaks a language other than English at home, and this number is increasing rapidly. (shrink)

The case of Mrs. J is interesting not only because of the difficult questions that the clinical ethicist must confront but also because of the intriguing way in which such cases make Western clinicians and ethicists confront their own oft-unspoken cultural ethical norms and presuppositions.

The first of the following two narratives is a personal reflection by the instructor of “Narrative Approaches to Bioethics,” an elective in the PhD program at the Albert Gnaegi Center for Health Care Ethics at Saint Louis University. The author argues that perhaps the primary goal of medical ethics education should be to show how to construct plausible and defensible interpretations of human experience and sensibly resolve the problems that these happenings occasion. To that end, the author engaged the sympathetic (...) reading capacities of his students by “thwarting” their expectations for medicalized case studies to “dissect” and instead chose works that invited careful readings of morally-complex literary works. One such reading was Huckleberry Finn, which the class read on the book’s 100th anniversary. Huckleberry Finn chronicles Huck’s search for truth, goodness and justice on the Mississippi River–a location the class explored on a field trip. The second narrative is the personal reflection of one of the students in this class and attests to the moral pedagogical power of Huck Finn. He relates the insights gleaned from a particular passage where Huck confronts moralistic dogmas. (shrink)