This paper argues that the concept and role of ‘institutional racism’ in contemporary discussions of race should be reconsidered. It starts by distinguishing between ‘intrinsic institutional racism’, which holds that institutions are racist in virtue of their constitutive features, and ‘extrinsic institutional racism’, which holds that institutions are racist in virtue of their negative effects. It accepts intrinsic institutional racism, but argues that a ‘disparate impact’ conception of extrinsic conception faces a number of objections, the most serious being that it (...) has no plausible account of what it is that makes extrinsically racist institutions racist. It also argues that claims about the explanatory indispensability of institutional racism are overstated (individual racism is at least as important), critiques structural approaches to racial inequality, and suggests that there is reason to doubt whether institutional reform can provide us with all that morality may require in the racial domain. (shrink)

This article discusses the adequacy of Rawls’ theory of justice as a tool for racial justice. It is argued that critics like Charles W Mills fail to appreciate both the insights and limits of the Rawlsian framework. The article has two main parts spread out over several different sections. The first is concerned with whether the Rawlsian framework suffices to prevent racial injustice. It is argued that there are reasons to doubt whether it does. The second part is concerned with (...) whether a Rawlsian framework has the resources to rectify past racial injustice. It is argued that it has more resources to do this than Mills allows. This second part of the article centers on two Rawlsian ideas: ideal theory and the fair equality of opportunity principle. It is argued that ideal theory is essential for the kind of rectificatory work that Mills wants nonideal theory to do, and that where there is a socioeconomic legacy of past injustice, it is hard to see how FEO could be implemented if it did no rectificatory work, a result which means that there is less need to turn to nonideal theory at all. (shrink)

Current thinking and talk about race uses ‘racist’ for virtually everything that goes wrong in the domain of race. This paper examines the relationship between racial justice, racial discrimination and racism to argue for a more pluralistic approach to race-related ills. Such an approach provides the tools we need to understand an important if relatively neglected source of racial injustice, and does much to illuminate some race-related disputes. It starts by arguing that racial justice is a surprisingly limited ideal, and (...) then suggests understanding ‘racial discrimination’ in a minimal way. From there it is argued that while racial discrimination is necessary for racial injustice, the same is not true for racism. (shrink)

In this paper I respond to Robert Taylor's argument that a Rawlsian framework does not support strong affirmative action programs. The paper makes three main arguments. The first disputes Taylor's claim that strong AA would not be needed in ideal conditions. Private racial discrimination, I suggest, might still exist in such conditions, so strong AA might be needed there. The second challenges Taylor's claims that pure procedural justice constrains Rawlsian nonideal theory. I argue that this rests on a fetishizing of (...) pure procedural justice that is absent from Rawls's work. I also show that a revised formulation of Taylor's concern here also fails. My third argument makes a positive Rawlsian case for strong AA in nonideal conditions that builds on a Taylor concession. Taylor suggests that the goal of nonideal theory is to create a world in which ideal theory can be applied. My argument begins by showing that another permissible goal of Rawlsian nonideal theory is to ameliorate injustice. I then argue that Rawls's contractualist framework supports the strongest forms of AA when category 3 interventions are blocked. (shrink)

Across the country, legal and health care professionals who understand that health outcomes are most influenced by social and environmental conditions have improved patient health by adopting the interdisciplinary MLP health care delivery model. However, the MLP field cannot advance population health, let alone long-term health equity, until it addresses the structural determinants of health inequity that are rooted in discrimination, segregation, and other forms of racial and ethnic subordination.

In recent work in political philosophy there has been much discussion of two approaches to theorizing about justice that have come to be called ‘ideal theory’ and ‘non-ideal theory’. The distinction was originally articulated by Rawls, who defended his focus on ideal theory in terms of a supposed ‘priority’ of the latter over non-ideal theory. Many critics have rejected this claim of priority and in general have questioned the usefulness of ideal theory. In diagnosing the problem with ideal theory, they (...) have frequently fingered for blame the idealization it involves. In this paper I focus on one particular, much-discussed idealization—full compliance—in order to defend it. Focusing on the assumption, I argue that Rawls’s work is not ideal in the way that it is usually thought to be, is less ideal than is widely recognized, and became less ideal over time. I also argue that critics who in effect claim that it is not realistic enough simply fail to understand Rawls’s central motivation. Finally, I defend the assumption by arguing that there is an important sense in which all theories of justice must assume full compliance. Such an assumption, I argue, is needed if we are to have a plausible basis on which to judge the normative attractiveness of a theory. (shrink)

Patients belonging to ethnic, racial, and religious minorities have been all but excluded from the legal academy's on-going conversation about informed consent. This article repairs that egregious omission. It begins by observing the narrowing of ethical justifications that underlie our informed consent law, tracing the ethical literature from the ancients to modern formulations of autonomy-centered models. Next, this article reviews the vast body of empirical data available in social science literature, that demonstrates how distinct from the autonomy model the broad (...) range of values and priorities held by patients from racial, ethnic, and religious minority groups is. The conclusion that informed consent's focus on the western notion of autonomy affirmatively harms minority patients is inescapable. The article concludes by offering a fiduciary model of informed consent law that could improve the quality of health care for more than 100 million minority patients, potentially at risk under current law while also regulating the informed consent procedure and practice in a way that will bring balance and justice to all American patients and providers. (shrink)

Patients belonging to ethnic, racial, and religious minorities have been all but excluded from the legal academy’s ongoing conversation about informed consent. Perhaps this is just as well, since the conversation appears to have concluded that the doctrine has failed to serve as a meaningful regulation of clinical relationships. Informed consent does not operate in practice the way it was intended in theory. More than a decade ago, Peter Schuck noted the “informed consent gap” that distinguishes the “proper” law of (...) informed consent “on the books” from the actual consent law in action, and called for a more contextualized approach to informed consent. Susan Wolf later called for a systemic approach to informed consent in order to accommodate multiple decision points in the managed care setting. Some reformers have sought enhancements to expand the doctrine. (shrink)

If there is a “basic structure objection” to G.A. Cohen’s incentive critique of Rawls, then there is also a BSO to claims that private racial discrimination thwarts social justice by reducing the opportunity of its targets. In this paper, I take up the debate about the site or purview of justice and discuss it with reference to the case of race. I argue that the dispute about the site of justice has been wrongly understood as a dispute about the substantive (...) requirements of justice instead of as a dispute about where it is appropriate to apply considerations of justice. (shrink)

Among mainstream political philosophers, Charles Mills is probably best known, not as the author of The Racial Contract, but for his long-running critique of ideal theory and Rawls for his association with it. Yet the critique of ideal theory that followed the publication of The Racial Contract is prefigured in that very work, where we find in inchoate form what would be further developed later on. In the book, this early formulation of the critique occupies a small part of a (...) larger, more general argument condemning mainstream political philosophy for the way that it has ignored race. In this paper, I explore the relation of the critique to this more general argument. It might be thought that the general argument leads inevitably to the critique of ideal theory. I will argue that this is not so. I will show how Mills’ more general argument can be made without taking the further step of critiquing ideal theorizing. The blame for why mainstream political philosophy has ignored race, and continues to ignore race, I will argue, should be placed elsewhere. (shrink)

The confluence of racial unrest and Medicaid expansion in Virginia should inspire a national reimagining of how health care can contribute to health equity. Hospitals in particular can leverage their role as economic drivers in communities to equalize health and social outcomes for all. The urgent need for innovative opioid intervention presents a fertile proving ground for new ways that hospitals can act to reduce the impact of racial inequity. Inspired by the role hospitals played to achieve desegregation during the (...) Civil Rights era, this essay proposes an integrated approach to use Medicaid expansion to advance health and racial healing in America. (shrink)

“Medicalization” has been a contentious notion since its introduction centuries ago. While some scholars lamented a medical overreach into social domains, others hailed its promise for social justice advocacy. Against the backdrop of a growing commitment to health equity across the nation, this article reviews historical interpretations of medicalization, offers an application of the term to non-biologic risk factors for disease, and presents the case of housing the demonstrate the great potential of medicalizing poverty.

This article argues that blacks should reject integration on self-protective and solidarity grounds. It distinguishes two aspects of black devaluation: a ‘stigmatization’ aspect that has to do with the fact that blacks are subject to various forms of discrimination, and an aesthetic aspect (‘phenotypic devaluation’) that concerns the aesthetic devaluation of characteristically black phenotypic traits. It identifies four self-worth harms that integration may inflict, and suggests that these may outweigh the benefits of integration. Further, it argues that, while the integrating (...) process may reduce stigmatization, there is less reason to think that it can do the same for phenotypic devaluation. (shrink)

In “Racial Integration and the Problem of Relational Devaluation,” I argue that blacks should reject racial integration on self-protective and solidarity grounds. Integration will intensify the self-worth harms of stigmatization and phenotypic devaluation by leading blacks to more fully internalize their devaluation, and while the integrating process itself might reduce the former, it may well leave in place the latter. In this paper, I reply to the challenges to these arguments presented by Sharon Stanley, Andrew Valls, Elvira Basevich, Michael Merry, (...) and Ronald Sundstrom. (shrink)

In counterfactual cases of discrimination, an agent would have treated someone worse had circumstances been different such that instead of being a member of her actual group, she was a member of some other group. The case for considering such cases to be genuine cases of discrimination is bolstered by the fact that we are inclined to say that cases where an agent would have treated someone better had she been a member of another group are discriminatory. But I argue (...) that the cases are relevantly different: in one kind of case, but not the other, a person is harmed. I then consider and reject a number of objections to this suggestion. (shrink)

According to Michael Smith, in his book The Moral Problem, the following internalist claim is true: ‘‘If an agent judges it right to do something in certain circumstances, then the agent is either motivated to do that thing in the circumstances or is practically irrational.’’ He calls this claim the ‘‘practicality requirement on moral judgment,’’ and in his book tries to defend it against the amoralist challenge presented by David Brink. Brink famously argues against internalism on the grounds that it (...) ‘‘makes the amoralist conceptually impossible.’’ Amoralists are people who genuinely make moral judgments, remain unmoved with respect to their motivation, and yet do not suffer the relevant kinds of practical irrationality. They may judge, say, that it is right to donate one's old clothes to the Red Cross, but they not only fail to do so when the time comes, they are not motivated at all to do so when the time comes. Defenders of the practicality requirement, in contrast, claim that it is a ‘‘conceptual truth’’ that ‘‘agents who make moral judgments are motivated accordingly, at least absent weakness of will and the like.’’ Brink thinks amoralists are possible, and that since internalists deny the possibility, we should reject internalism in favor of externalism, which makes the moral motivation of judgers a matter of a contingent fact about them. -/- Smith's argument in The Moral Problem in defending the practicality requirement, then, is in essence to show that ‘‘it is impossible for there to be any amoralists.’’ In the argument to be considered here, he argues that externalists cannot offer an acceptable explanation for why the moral motivation of good people reliably follow their moral judgments. But we will see that Smith's defense of the practicality requirement loses its appeal once we see that it turns on an ambiguity in his use of the expression ‘‘good people.’’ Furthermore, easy examples show that, contrary what Smith says, people whose motivations reliably follow their moral judgments sometimes care only derivatively about that which they judge. Smith's later presentations of his argument also fail, for externalists need not offer a single explanation of the moral motivation of all whose motivation reliably follow their moral judgments. (shrink)