After giving the name “burnout” to the experience of being overworked and undervalued and the physician and patient suffering that comes from it, many clinicians have sought to elucidate further wh...

When health professions learners’ primary pedagogical experience of Black people and how they become patients is through statistics, it becomes very easy for learners to think of Black people as data points rather than as individuals whose health is often at the mercy of racist institutions. When the human dimension of Black people’s health is ignored, specifically the ways that poor health affects individual wellbeing, one of the barriers to proper health for Black patients is how to be seen and (...) considered as a part of a larger problem of systemic racism and institutional injustices as well as individuals whose personal lives are affected by such larger problems. I propose an approach to health professions pedagogy—the experiential race testimonies approach—that can change the way health professions learners understand and treat Black patients, thus changing the future of Black health. The ERT approach pairs population data analysis with analysis of personal testimonies and the experiences they convey. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S46-S49, March‐April 2022.

Hastings Center Report, Volume 52, Issue S1, Page S3-S11, March‐April 2022.

There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes, provider bi...

Fabi and Goldberg raised important considerations regarding both research and funding priorities in the field of bioethics and, in particular, the field’s misalignment with social justice. W...

Facilities that emit hazardous toxins, such as toxic landfills, oil refineries, and chemical plants, are disproportionately located in predominantly Black, Latinx, and Indigenous neighborhoods. Environmental injustices like these threaten just distribution of health itself, including access to health that is not dependent on having the right skin color, living in the right neighborhood, or making the right amount of money. Facilities that emit environmental toxins wrongly make people's race, ethnicity, income, and neighborhood essential to who is allowed to breathe clean (...) air and drink clean water, and thus, who is allowed to be healthy. This can be seen in the environmental crises in Louisiana; Mississippi; Houston, Texas; and Flint, Michigan. Since bioethics purports to concern itself with the principle of justice as applied to individuals and increasingly to populations, the field ought to concern itself more with environmental injustice. (shrink)

Using the example of Black people’s inequitable COVID-19 outcomes and their health outcomes prior to the pandemic, I argue that the pandemic has forever changed how we should think about the conceptual and practical nature of health equity. From here on, we can no longer think of health equity without the concept of intersectionality. In particular, we must acknowledge that discrimination (e.g. sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed for health from people who (...) themselves have intersecting identities that make them vulnerable to the effects of discrimination. To ignore intersectionality in our work on health equity would mean ignoring a great injustice imposed on some of the most overlooked people in our communities, which would also be a great disserve to bioethics’ professional longevity. (shrink)

Poor health is not inherently a part of Black Americans’ bodies; poor health is not in our DNA. But as Linda Villarosa says in Under the Skin “something about being Black has led to the documented poor health of Black Americans.”1 Like many other scholars of Black health have said, Villarosa proposes, and evidence supports, that “the something is racism.”2 Villarosa attributes Black people’s generally inferior health outcomes in areas like pregnancy and birth, pain care, and cardiology to racism and (...) not a lack of social resources such as money, education, and access to healthcare. Although not always explicitly stated in her text, the stories Villarosa uses to illustrate racism’s effects on health also demonstrate racism’s influence on who has access to the social resources that are needed to maintain health and treat illnesses. Villarosa is right that more education and more income cannot de facto give Black people better health. At the same time, we cannot ignore that although racism is the force, education, money, housing, and access to healthcare are the means by which racism adversely affects health. Education and other social goods only fail to confer better health to Black people because racism serves as a roadblock. (shrink)

An argument in the cognitive enhancement literature is that using stimulants in populations of healthy but socially disadvantaged individuals mistakenly attributes pathology to nonpathological individuals who experience social inequalities. As the argument goes, using stimulants as cognitive-enhancing drugs to solve the social problem of poorly educated students in inadequate schools misattributes the problem as an individual medical problem, when it is really a collective sociopolitical problem. I challenge this argument on the grounds that not all types of enhancement have to (...) be explained in medical terms, but rather at least one conception of enhancement can be explained in social terms—opportunity maintenance. Therefore, I propose that as a moral requirement we ought to explore whether stimulants could be a means of remedying underprivileged children's experiences of social inequalities that are borne from inadequate schools for the sake of increasing their chances for opportunities and well-being. (shrink)

Torben Kjærsgaard’s argues that the term “cognitive enhancement substances” is an inappropriate term considering that stimulants do not enhance cognition, but rather only enhance motivation. Therefore, he concludes that stimulants are best described as “performance maintenance” and not “performance enhancement.” I challenge his conclusion on the grounds that both life’s ordinary, daily activities and life’s extraordinary activities are types of performances necessary for living the kinds of lives that we want to live, which can be enhanced, not just maintained, with (...) the effects of cognitive enhancing substances. “Cognitive enhancing substances” may be a misleading term, but referring to the effects of cognitive enhancing substances as “performance maintenance,” rather than “performance enhancing,” misguidedly minimizes the role that motivation plays into our self-determined lives. (shrink)

Some proponents of moral bioenhancement propose that people should utilize biomedical practices to enhance the faculties and traits that are associated with moral agency, such as empathy and a sense of justice. The hope is that doing so will improve our ability to meet the moral challenges that have emerged in our contemporary, globalized world. In this paper, we caution against this view by arguing that biomedically inducing more empathy may, in fact, diminish moral agency. We argue that this type (...) of increase in empathy would not be effective for addressing empathy’s vulnerability to the biases that can undermine moral judgment. Furthermore, doing so may undermine the important capacity to regulate empathy. We determine that if the moral enhancement project is to be a serious one, it must address these challenges. (shrink)

Black people experience lower quality and lesser quantity of sleep than white people. Researchers, however, do not believe that racial disparities in sleep sufficiency are caused by biological differences, but rather by various social differences, such as differences in sleeping environments and socioeconomic status. Racial disparities in sleep sufficiency are a matter of social justice because sleep is important to mental and physical health, meaning racial disparities in sleep sufficiency can contribute to unequal and unjust disparities in overall health. Racial (...) disparities in sleep may also be linked to other racial disparities in health that black people disproportionately experience such as hypertension and obesity. Sleep hygiene, common therapeutic advice given to help induce sleep, is often the first step to helping people sleep. Sleep hygiene, however, does not address the social, legal, cultural, and economic causes of racial disparities in sleep sufficiency. Sleep hygiene, as an ideal theory, addresses sleeplessness under ideal circumstances, only which a small group of privileged people live. Sleep hygiene ignores the unequal circumstances that contribute to some black people’s sleeplessness. Nonideal theory, however, acknowledges the less than ideal circumstances of certain groups, including people of color, and gives us a framework to develop solutions to racial disparities in sleep sufficiency. (shrink)

Why do American Black people generally have worse health than American White people? To answer this question, “Black Health” dispels any notion that Black people have inferior bodies that are inherently susceptible to disease. This is simply false racial science that has been used to abuse Black people since our African ancestors were brought to America on slave ships. A genuine investigation into the status of Black people’s health requires us to acknowledge that race has always been a powerful social (...) category. Race largely predetermines individuals’ social and political power and access to resources needed for health and wellbeing. And as a group, Black people have been intentionally denied this power and access. Systemic racism, oppression, and White supremacy in American institutions have largely been the perpetrators of differing social power and access to resources for Black people. It is these systemic inequities that create the social conditions needed for poor health outcomes for Black people to persist. An examination of social inequities reveals that it is no accident that Black people have poorer health than White people, instead in America, almost every institution has been designed to withhold what Black people need for proper health and wellbeing. Black Health provides a succinct discussion of Black people’s health, including the social, political, and at times cultural determinants of their health. This book examines the ways that Black people’s multiple identities—social, cultural, and political—intersect with anti-Black institutions, such as housing and health care to determine their poor outcomes in pregnancy, pain management, sleep, and cardiovascular disease. (shrink)

An argument in the cognitive enhancement literature is that using stimulants in populations of healthy but socially disadvantaged individuals mistakenly attributes pathology to nonpathological individuals who experience social inequalities. As the argument goes, using stimulants as cognitive-enhancing drugs to solve the social problem of poorly educated students in inadequate schools misattributes the problem as an individual medical problem, when it is really a collective sociopolitical problem. I challenge this argument on the grounds that not all types of enhancement have to (...) be explained in medical terms, but rather at least one conception of enhancement can be explained in social terms—opportunity maintenance. Therefore, I propose that as a moral requirement we ought to explore whether stimulants could be a means of remedying underprivileged children's experiences of social inequalities that are borne from inadequate schools for the sake of increasing their chances for opportunities and well-being. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha RayChioma Dibia (bio)Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha Ray New York: Oxford University Press, 2023Prior to the COVID-19 pandemic, bioethics had engaged only sparingly with the concept of racism. In 2016, Danis and colleagues published an article exhorting bioethicists to engage more meaningfully with (...) the concept of racism—given its impact on health and well being—and to consider strategies for combating it within and outside clinical settings (Danis et al. 2016, 5). While this paper generated considerable debate regarding how far bioethics ought to go in its engagement with racism (Baker 2016, 16; Weddle 2016, 32; Fuller 2016, 29), the focus of the field of bioethics quickly turned to more traditional subjects of bioethical inquiry, including ethical issues arising in doctor-patient relationships and new reproductive technologies. However, since the COVID-19 pandemic and the murder of George Floyd during that time, racism has received greater attention in the bioethics literature and Keisha Ray's Black Health arrives just in time to urge us to ensure that the current focus on the impact of racism on the health of racially minoritized people is not short-lived (Ray 2023, 21; BBC News 2020).The overarching argument in Ray's Black Health is that Black people's poor health does not arise from innate biological deficiencies but stems from their experience of racism at the structural, institutional, and interpersonal levels. Ray stresses that far from being solely a feature of America's past, racism [End Page 105] continues to taint Black people's relationship with the healthcare system and other societal institutions. In each chapter, Ray focuses on a specific racial disparity in health to illustrate how racism limits Black people's access to the social determinants of health and thereby contributes to their poor health. To set the context for this discussion, Ray provides an introductory chapter where she unpacks key terms including "racism," "racial disparities," and "the social determinants of health." In this chapter, Ray also clearly outlines the structure of the text and provides a summary of each chapter. This chapter provides the blueprint for the rest of the book, as in it, Ray provides a clear statement of the style, content, and purpose of Black Health.The first racial disparity that Ray considers is Black birthing mortality, and in chapter 1, Ray traces this to the history of slavery and eugenic policies which have shaped the relationship between physicians and Black women. As Ray explains, since Black people were forcibly brought to the United States, the government has sought to control Black women's reproductive lives and has often relied on physicians to effect control. She demonstrates how harmful stereotypes about Black women, including their so-called hardiness, originated in medical literature and have been used to deny pregnant Black women humane care. According to Ray, "[c]linicians' attitude and behaviors towards Black pregnant people still reflect an enslaved and slave-owner mentality, and this has great consequences for the survival of Black pregnant people." (32) By highlighting the birthing experiences of Serena Williams and Shalon Irving, Ray dispels the assumption that wealth or academic qualifications are a panacea for Black birthing mortality and shows how racism can be deadly for all Black pregnant women, irrespective of socioeconomic status. Ray also considers how income and housing inequities affect Black pregnant women and the cumulative effect of weathering on their health as well as that of their unborn children. This chapter most clearly shows how interpersonal, institutional, and structural racism operate and intersect to render pregnancy and childbirth a potentially dangerous experience for Black women.Next, Ray turns to racial disparities in clinical pain management and continues to explore the impact of historically racist beliefs and false stereotypes on the care of Black people. However, in this second chapter, Ray delves more deeply into the role of medical literature—both historical and contemporary sources—in perpetuating false assumptions about the Black body. She demonstrates how the historical portrayal of the Black body as not only less than human... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha RayChioma Dibia (bio)Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha Ray New York: Oxford University Press, 2023Prior to the COVID-19 pandemic, bioethics had engaged only sparingly with the concept of racism. In 2016, Danis and colleagues published an article exhorting bioethicists to engage more meaningfully with (...) the concept of racism—given its impact on health and well being—and to consider strategies for combating it within and outside clinical settings (Danis et al. 2016, 5). While this paper generated considerable debate regarding how far bioethics ought to go in its engagement with racism (Baker 2016, 16; Weddle 2016, 32; Fuller 2016, 29), the focus of the field of bioethics quickly turned to more traditional subjects of bioethical inquiry, including ethical issues arising in doctor-patient relationships and new reproductive technologies. However, since the COVID-19 pandemic and the murder of George Floyd during that time, racism has received greater attention in the bioethics literature and Keisha Ray's Black Health arrives just in time to urge us to ensure that the current focus on the impact of racism on the health of racially minoritized people is not short-lived (Ray 2023, 21; BBC News 2020).The overarching argument in Ray's Black Health is that Black people's poor health does not arise from innate biological deficiencies but stems from their experience of racism at the structural, institutional, and interpersonal levels. Ray stresses that far from being solely a feature of America's past, racism [End Page 105] continues to taint Black people's relationship with the healthcare system and other societal institutions. In each chapter, Ray focuses on a specific racial disparity in health to illustrate how racism limits Black people's access to the social determinants of health and thereby contributes to their poor health. To set the context for this discussion, Ray provides an introductory chapter where she unpacks key terms including "racism," "racial disparities," and "the social determinants of health." In this chapter, Ray also clearly outlines the structure of the text and provides a summary of each chapter. This chapter provides the blueprint for the rest of the book, as in it, Ray provides a clear statement of the style, content, and purpose of Black Health.The first racial disparity that Ray considers is Black birthing mortality, and in chapter 1, Ray traces this to the history of slavery and eugenic policies which have shaped the relationship between physicians and Black women. As Ray explains, since Black people were forcibly brought to the United States, the government has sought to control Black women's reproductive lives and has often relied on physicians to effect control. She demonstrates how harmful stereotypes about Black women, including their so-called hardiness, originated in medical literature and have been used to deny pregnant Black women humane care. According to Ray, "[c]linicians' attitude and behaviors towards Black pregnant people still reflect an enslaved and slave-owner mentality, and this has great consequences for the survival of Black pregnant people." (32) By highlighting the birthing experiences of Serena Williams and Shalon Irving, Ray dispels the assumption that wealth or academic qualifications are a panacea for Black birthing mortality and shows how racism can be deadly for all Black pregnant women, irrespective of socioeconomic status. Ray also considers how income and housing inequities affect Black pregnant women and the cumulative effect of weathering on their health as well as that of their unborn children. This chapter most clearly shows how interpersonal, institutional, and structural racism operate and intersect to render pregnancy and childbirth a potentially dangerous experience for Black women.Next, Ray turns to racial disparities in clinical pain management and continues to explore the impact of historically racist beliefs and false stereotypes on the care of Black people. However, in this second chapter, Ray delves more deeply into the role of medical literature—both historical and contemporary sources—in perpetuating false assumptions about the Black body. She demonstrates how the historical portrayal of the Black body as not only less than human... (shrink)

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations (...) and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice. (shrink)

This paper brings together the work of Nicholas Wolterstorff and William Alston in speech-act theory with the aim of providing a deeper understanding of the nature of divine speaking through the medium of Scripture. Despite the fecundity of Wolterstorff's seminal work on the philosophical theology of Scripture, aspects of his speech-act centric account are underdeveloped and would benefit from the contributions of William Alston. In particular, his account of divine speech-acts could be fruitfully expanded by incorporating the concept of ‘taking (...) responsibility’ that is central to Alston's analysis of the nature of illocutionary acts. This would elucidate both the way in which readers of Scripture encounter divine practical authority in the reading process and the nature of the response of faith that is demanded of them. (shrink)

This paper brings together the work of Nicholas Wolterstorff and William Alston in speech-act theory with the aim of providing a deeper understanding of the nature of divine speaking through the medium of Scripture. Despite the fecundity of Wolterstorff's seminal work on the philosophical theology of Scripture, aspects of his speech-act centric account are underdeveloped and would benefit from the contributions of William Alston. In particular, his account of divine speech-acts could be fruitfully expanded by incorporating the concept of ‘taking (...) responsibility’ that is central to Alston's analysis of the nature of illocutionary acts. This would elucidate both the way in which readers of Scripture encounter divine practical authority in the reading process and the nature of the response of faith that is demanded of them. (shrink)

Semantic Structures is a large-scale study of conceptual structure and its lexical and syntactic expression in English that builds on the theory of Conceptual...

This book emphasizes the role of semantics as a bridge between the theory of language and the theories of other cognitive capacities such as visual perception...

The COVID-19 pandemic is negatively impacting people’s mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women’s eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17–73 years, recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (...) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor. (shrink)

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

Bioethics, Volume 36, Issue 3, Page 233-234, March 2022.

In “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Keisha Ray and Jane Cooper (2024) assert that bioethicists have an obligation to...

This book assesses how Vatican II opened up the Catholic Church to encounter, dialogue, and engagement with other world religions. Opening with a contribution from the President of the Pontifical Council for Interreligious Dialogue, Cardinal Jean-Louis Tauran, it next explores the impact, relevance, and promise of the Declaration Nostra Aetate before turning to consider how Vatican II in general has influenced interfaith dialogue and the intellectual and comparative study of world religions in the postconciliar decades, as well as the contribution (...) of particular past and present thinkers to the formation of current interreligious and comparative theological methods. Additionally, chapters consider interreligious dialogue vis-à-vis theological anthropology in conciliar documents; openness to the spiritual practices of other faith traditions as a way of encouraging positive interreligious encounter; the role of lay and new ecclesial movements in interreligious dialogue; and the development of Monastic Interreligious Dialogue. Finally, it includes a range of perspectives on the fruits and future of Vatican’s II’s opening to particular faiths such as Judaism, Islam, Hinduism, and Buddhism. (shrink)

Mitigating response distortion in answers to sensitive questions is an important issue for business ethics researchers. Sensitive questions may be asked in surveys related to business ethics, and respondents may intend to avoid exposing sensitive aspects of their character by answering such questions dishonestly, resulting in response distortion. Previous studies have provided evidence that a surveying procedure called the randomized response technique is useful for mitigating such distortion. However, previous studies have mainly applied the RRT to individual dichotomous questions in (...) face-to-face survey settings. In this study, we focus on behavioral research examining the relationships between latent variables, which are unobserved variables measured by multiple items on Likert or bipolar scales. To demonstrate how the RRT can be applied to obtain valid answers from respondents answering a self-administered online questionnaire with Likert and bipolar scales, we build a behavioral model to study the effect of punishment severity on employees’ attitudes toward misuse of information systems resources in the workplace, which in turn influence misuse behavior. The survey findings meet our expectations. The respondents are generally more willing to disclose sensitive data about their attitudes and actual behavior related to misuse when the RRT is implemented. The RRT’s implications for causal modeling and the advantages and challenges of its use in online environments are also discussed. (shrink)

Keisha Ray and Jane Falls Cooper’s article “Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments” seeks to give environmental concerns greater p...