Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand (...) their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

In this essay, I argue that exploring institutional racism also needs to examine interactions and communications between patients and providers. Exchange between bioethicists, social scientists, and life scientists should emphasize the biological effects—made evident through health disparities—of racism. I discuss this through examples of patient–provider communication in fertility clinics in South Africa and the ongoing COVID-19 pandemic to emphasize the issue of mistrust between patients and medical institutions. Health disparities and medical mistrust are interrelated problems of (...) racism in healthcare provision. (shrink)

Issues of race have traditionally been addressed in medical school curricula in a didactic manner. However, medical school curricula often lack adequate opportunity for the application of learning material relating to race and culture. When confronted with acts of racism in clinical settings, students are left unprepared to respond appropriately and effectively. Forum Theatre offers a dynamic platform by which participants are empowered to actively engage with and become part of the performance. When used in an educational (...) context, Forum Theatre can be a powerful tool for students to interact with a wide variety of social issues. This paper describes the process by which one medical school designed a workshop in the Forum Theatre style to equip students to respond to racism observed in clinical settings. Based on real student experiences, the Responding to Racism in the Clinical Setting workshop was designed to give students an opportunity to combine cultural humility, communication theory and conflict resolution skills in order to prepare for interactions in clinical stages of medical education. As a result of workshop evaluations, surveys, and written reflections, the authors propose that Forum Theatre is a novel teaching modality for incorporating issues of race and culture into medical curriculum. (shrink)

Despite legislation and public education, racism and sexism are alive and well. Though pre‐conceptive gender selection may enhance procreative liberty, this technology presents two disturbing questions. First, does sex selection represent underlying parental sexism? Second, by performing gender selection, do medical professionals perpetuate sexism? It will be maintained that pre‐conceptive sex selection is sexist as it reflects parental anticipation of stereotypical gender based behavior. Perhaps even more incriminating, sex selection forces parents to prefer one sex over another, to (...) place a value on gender. This emphasis on sex conflicts with societal goals which urge, and often legally require, individuals to ignore gender. We will assert that pre‐conceptive gender selection exemplifies sexism in its purest most blatant form as prior to conception, before parents can possibly know anything about their child, gender dominates the calculus of a child’s worth. We will also emphasize that physicians, by facilitating sex selection, legitimize the motivations of their patients and provide de facto support of sexism. In a similar vein, arguments against pre‐conceptive race selection will be made. (shrink)

Racism is a complex problem in the US that is institutionalized, personally mediated, and internalized. Within medical education the recognition and response to structural racism is be...

When we go to the doctor, he or she will not begin to treat us without taking our history – and not just our history but that of our parents and grandparents before us. The doctor will not see us u...

Precision medicine is an emerging approach to individualized care. It aims to help physicians better comprehend and predict the needs of their patients while effectively adopting in a timely manner the most suitable treatment by promoting the sharing of health data and the implementation of learning healthcare systems. Alongside its promises, PM also entails the risk of exacerbating healthcare inequalities, in particular between ethnoracial groups. One often-neglected underlying reason why this might happen is the impact of structural racism on (...) PM initiatives. Raising awareness as to how structural racism can influence PM initiatives is paramount to avoid that PM ends up reproducing the pre-existing health inequalities between different ethnoracial groups and contributing to the loss of trust in healthcare by minority groups. We analyse three nodes of a process flow where structural racism can affect PM’s implementation. These are: the collection of biased health data during the initial encounter of minority groups with the healthcare system and researchers, the integration of biased health data for minority groups in PM initiatives and the influence of structural racism on the deliverables of PM initiatives for minority groups. We underscore that underappreciation of structural racism by stakeholders involved in the PM ecosystem can be at odds with the ambition of ensuring social and racial justice. Potential specific actions related to the analysed nodes are then formulated to help ensure that PM truly adheres to the goal of leaving no one behind, as endorsed by member states of the United Nations for the 2030 Agenda for Sustainable Development. Structural racism has been entrenched in our societies for centuries and it would be naïve to believe that its impacts will not spill over in the era of PM. PM initiatives need to pay special attention to the discriminatory and harmful impacts that structural racism could have on minority groups involved in their respective projects. It is only by acknowledging and discussing the existence of implicit racial biases and trust issues in healthcare and research domains that proper interventions to remedy them can be implemented. (shrink)

The phenomenon of medical overtesting in general, and specifically in the emergency room, is well-known and regarded as harmful to both the patient and the healthcare system. Although the implications of this problem raise myriad ethical concerns, this paper explores the extent to which overtesting might mitigate race-based health inequalities. Given that medical malpractice and error greatly increase when the patients belong to a racial minority, it is no surprise that the mortality rate similarly increases in proportion to (...) white patients. For these populations, an environment that emphasizes medical overtesting may well be the desirable medical environment until care evens out among races and ethnicities; additionally, efforts to lower overtesting in conjunction with a high rate of racist medical mythology may cause harm by lower testing when it is actually warranted. Furthermore, medical overtesting may help to assuage racial distrust. This paper ultimately concludes that an environment of medical overtesting may be less pernicious than the alternative. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S29-S31, March‐April 2022.

One of the unspoken issues in public discourse in most countries is the racism of patients toward nurses who originate from a different ethnic group than theirs. The aim of the present study is to examine whether patients' racism toward nurses increases as the invasiveness of treatment rises. This study was conducted in Israel, a highly conflictual society where Jews and Arabs live together and meet in the same health facilities. Despite the tension and sometimes animosity caused by (...) the political situation, members of each group regularly encounter members of the other group during the provision of health‐care, both as patients and as medical and nursing staff. A study questionnaire which presented nine nursing treatments of diverse levels of invasiveness was filled out by Arab and Jewish participants. They were asked to convey their preference for an Arab or a Jewish nurse for each treatment. Results of Logistic Regression Analyses reveal that in both sectors, racism toward nurses increases as the treatment invasiveness rises. These findings are discussed in light of the concept of social distance, and serve as an empirical basis for several proposed practical recommendations for eradicating racism against nurses. (shrink)

ABSTRACT Darker skin correlates with reduced opportunities and negative health outcomes. Recent discoveries related to the genes associated with skin tone, and the historical use of cosmetics to conform to racist appearance standards, suggest effective skin‐lightening products may soon become available. This article examines whether medical interventions of this sort should be permitted, subsidized, or restricted, using Norman Daniels's framework for determining what justice requires in terms of protecting health. I argue that Daniels's expansive view of the requirements of (...) justice in meeting health needs offers some support for recognizing a societal obligation to provide this kind of ‘enhancement,’ in light of the strong connections between skin tone and health outcomes. On balance, however, Daniels's framework offers compelling reasons to reject insurance coverage for skin‐lightening medical interventions, including the likely ineffectiveness of such technologies in mitigating racial health disparities, and the danger that covering skin‐lightening enhancements would undermine public support for cooperative schemes that protect health. In fact, justice may require limiting access to these technologies because of their potential to exacerbate the negative effects of racism. (shrink)

Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

The following pages sketch the outlines of “a Canaanite reading” of the health system. Beginning with the Black person—African, Afro-diasporic, Aboriginal, and Torres Strait Islander—who is seen by a health professional, the functions and effects of the racializing gaze are examined. I wrestle with Al Saji’s understanding of “colonial disregard,” Whittaker’s insights into the extractive disposition of settler institutions vis-à-vis Indigenous peoples, and Saidiya Hartman and Fred Moten’s struggle with the spectacular. This leads me to conclude that the situation of (...) the Black within the health system is a tragic one. The prescription for the path out of this tragedy that I settle on, responding to Okiji’s opening call, is found in Vernon Ah Kee’s “Unwritten” series. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Reprinted with modification and permission from Kennedy Institute of Ethics Journal. The phenomenon of medical overtesting in general, and specifically in the emergency room, is well-known and regarded as harmful to both the patient and the healthcare system. Although the implications of this problem raise myriad ethical concerns, this chapter explores the extent to which overtesting might mitigate race-based health inequalities. Given that medical malpractice and error greatly increase when the patients belong to a racial minority, it is (...) no surprise that the mortality rate similarly increases in proportion to white patients. For these populations, an environment that emphasizes medical overtesting may well be the desirable medical environment until care evens out among races and ethnicities; additionally, efforts to lower overtesting in conjunction with a high rate of racist medical mythology may cause harm by lower testing when it is actually warranted. Furthermore, medical overtesting may help to assuage racial distrust. This paper ultimately concludes that an environment of medical overtesting may be less pernicious than the alternative. (shrink)

The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural (...) racism, and trajectories of racism during COVID-19. (shrink)

Machine generated contents note: -- Notes on Contributors -- Preface; R.Dallos -- Carving Nature at its Joints? DSM and the Medicalization of Everyday Life; M.Rapley, J.Moncrieff&J.Dillon -- Dualisms and the Myth of Mental Illness; P.Thomas&P.Bracken -- Making the World Go Away, and How Psychology and Psychiatry Benefit; M.Boyle -- Cultural Diversity and Racism: An Historical Perspective; S.Fernando -- The Social Context of Paranoia; D.J.Harper -- From 'Bad Character' to BPD: The Medicalization of 'Personality Disorder'; J.Bourne -- Medicalizing Masculinity; S.Timimi (...) -- Can Traumatic Events Traumatise People? Trauma, Madness and 'Psychosis'; L.Johnstone -- Children Who Witness Violence at Home; A.Vetere -- Discourses of Acceptance and Resistance: Speaking Out About Psychiatry; E.Speed -- The Personal Is the Political; J.Dillon -- 'I'm Just, You Know, Joe Bloggs': The Management of Parental Responsibility for First-Episode Psychosis; C.Coulter&M.Rapley -- The Myth of the Antidepressant: An Historical Analysis; J.Moncrieff -- Antidepressants and the Placebo Response; I.Kirsch -- Why Were Doctors so Slow to Recognise Antidepressant Discontinuation Problems?; D.Double -- Toxic Psychology; C.Newnes -- Psychotherapy: Illusion With No Future?; D.Smail -- The Psychologization of Torture; N.Patel -- What Is To Be Done?; J.Moncrieff, J.Dillon&M.Rapley -- Figure: Papers Using Term 'Antidepressant' On Medline 1957-1965 -- Index. (shrink)

Medical academics are increasingly bringing critical race theory (CRT) or its corollaries to their discourse, to their curricula, and to their analyses of health and medical treatment disparities. The author argues that this is an error. The author considers the history of CRT, its claims, and its current presence in the medical literature. He contends that CRT is inimical to usual academic modes of inquiry and has obscured rather than aided the analysis of social and medical (...) treatment disparities. Remedies for racism suggested by CRT advocates will not work and some of them will make things worse. Academic medicine should avoid the embrace of CRT and should maintain an allegiance to rigorous empirical inquiry and to treating patients not as essentialized ethnic group members but as individual human beings in need of care. (shrink)

This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial (...) minorities that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research. (shrink)

Liao and Carbonell explore how oppressive medical technologies constitute materiality insofar as they reflect past oppression, embody oppression in the present day, and carry oppression into the fu...

This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial (...) minorities that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S24-S29, March‐April 2022.

Shen-yi Liao and Vanessa Cabonell’s “Materialized Oppression in Medical Tools and Technologies,” joins the long list of groundbreaking papers whose importance is obscured by an innocuous title. Som...

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and (...) institutional-system activity; and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

In colonial states and settings, constitutional arrangements are often forged within contexts that serve to maintain structural racism against Indigenous people. In 2013 the New Zealand government initiated national conversations about the constitutional arrangements in Aotearoa. Māori leadership preceded this, initiating a comprehensive engagement process among Māori in 2010, which resulted in a report by Matike Mai Aotearoa which articulated a collective Māori vision of a written constitution congruent with te Tiriti o Waitangi by 2040.This conceptual article explores the (...) Matike Mai Aotearoa report on constitutional transformation as a novel means to address structural racism within the health system as a key domain within the constitutional sphere. Matike Mai suggests alternative conceptual structural formations through its focus on the kāwanatanga, the relational and the tino rangatiratanga sphere. This framework is informed by a range of Indigenous ethical values such as tikanga, belonging, and balance that can usefully inform the redesign of the health sector.We assert that constitutional transformation and decolonization are potentially powerful ethical sources of disruption to whiteness and structural racism. We argue that, to eliminate entrenched health disparities, change processes need to be informed by the Indigenous inspirations expressed in the Matike Mai report. (shrink)

In “Materialized Oppression in Medical Tools and Technologies”, we show how oppression can be inscribed in medical devices. We consider oximeters and spirometers, drawing heavily on the work of anthropologist Amy Moran-Thomas and historian Lundy Braun. Both devices encode racial biases: oximeters because they do not correct for race, and spirometers because they do. We zoom out from these particular devices to examine a wide range of tools and technologies, and we build a theoretical framework that covers not (...) only race but other axes of oppression: gender, ability, class, etc. -/- We are inspired by the peer commentaries and the guest editorial, and we are grateful to the contributors for engaging with our work and sharing their expertise. Their responses to our target article advance our understanding in three directions. First, a set of responses contextualize our framework within the histories of medicine, bioethics, and science and technology studies. Second, a set of responses provide additional examples of oppressive medical tools and technologies: not only material artifacts like oximeters and spirometers, but also spatial environments like inpatient psychiatric units, and cognitive niches comprised of digital technologies like electronic medical records and medical data classifications. Third, a set of responses propose countermeasures: operationalizing anti-oppressive practices for device design and testing; mapping the complex causal relationships involved in real-world problems; and repairing the harms done by materialized oppression through racism-conscious praxis. We reply to these three sets of responses—respectively, the “past, present, and future” of oppressive medical objects and spaces—in what follows. (shrink)

Elizabeth A. McGibbon and Josephine B. Etowa’s co-authored book Anti-racist Health Care Practice exposes and addresses systemic racism in the Canadian health-care system. McGibbon and Etowa directly confront racism in health provision and Canadian society, and provide a discussion of racism and related issues (gender, class) that does not hold back criticisms. The system of racial oppression and its sustenance by white privilege is presented to the reader in a clear and straightforward way, making it impossible for (...) the reader to deny or misunderstand his or her role in the power structures of Canadian (or American) society. The book is directed primarily at medical practitioners, as well as educators and policy .. (shrink)

Law and racism are intertwined, with legal tools bearing the potential to serve as instruments of oppression or equity. This Special Issue explores this dual nature of health law, with attention to policing in the context of mental health, schools, and substance use disorders; industry and the environment in the context of food advertising, tobacco regulation, worker safety, and environmental racism; health care and research in the context of infant mortality, bias in medical applications of AI, and (...) diverse inclusion in research; and anti-racist teaching and practice in the context of building an interprofessional curriculum and medical-legal partnerships. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, (...) including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans (...) feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Objective Analyze racial differences in comfort with medical research using an alternative to the traditional approach that treats white people as a raceless norm.Methods Quantitative analysis of survey responses (n = 1,570) from Black and white residents of the US to identify relationships between perceptions of research as a right or a risk, and comfort participating in medical research.Results A lower proportion of white respondents reported that medical experimentation occurred without patient consent (p < 0.001) and a (...) higher proportion of white respondents reported that it should be their right to participate in medical research (p = 0.02). Belief in one’s right to participate was significantly predictive of comfort (b = 0.37, p < 0.001). Belief in experimentation without consent was significantly predictive of comfort for white respondents but not for Black respondents in multivariable analysis.Conclusions A rights-based orientation and less concern about the risks of medical research among white respondents demonstrate comparative advantage. Efforts to diversify medical research may perpetuate structural racism if they do not (1) critically engage with whiteness and its role in comfort with participation, and (2) identify and respond specifically to the needs of Black patients. (shrink)

Berger and Miller offer a strong argument for how cultural competence in medical education reinforces the racial structures that it purports to address. As social scientists with expertise i...

In her 2018 book, What the Eyes Don’t See, Dr. Mona Hanna-Attisha wrote that it is the duty of doctors to speak out against injustice. In fact, no other physician or institution in Flint had done the research and spoken out, as a whistleblower, against the poisoning of Flint’s children by Michigan government. Why had Dr. Hannah-Attisha? Unfortunately, in the absence of a medical education system that teaches community-oriented primary health care in the tradition of the 1978 Alma Ata (...) Declaration, there is little reward in doing so. This article focuses on three movements that are challenging medical education orthodoxy: 1) primary health care 2) the medical humanities and 3) “Study Up your Town” medicine. How can we create a radical health pedagogy – one that draws the links between several pandemics raging across the planet: capitalist collapse, climate disruption, Covid-19, racism, and an emergent neoliberal fascism – to enable doctors, health professionals and citizens to see them as all of one piece? Medical educators must employ critical pedagogy to create legions of “constructive troublemakers” who challenge the social-structural obstacles that are driving millions to premature death. We have reached the “end times.” A new “planet medicine” is finally emerging. (shrink)

The negative health effects of stress are well documented in medical and psychological research, but these effects are underexplored in political philosophy. This essay evaluates these effects in relation to the explanatory and normative value of the concept that I call “being at home.” The phenomenological description of the state of being at home is the sense of feeling safe and at ease in your context, and therefore able to relax. Although it characterizes a particular state of being for (...) an individual person, its conditions are relational. I show how the normative value of being at home can guide nonideal action-guiding recommendations to respond to racism in light of the claim that one of the negative effects of racism is a steady stream of disruptions to a person’s sense of ease in the world. Racism and microaggressions create stress, which then causes further negative health effects to the minority body. Consequently, the physical harms perpetrated by racist and sexist societies on the members of oppressed identities can be as great as the effects of actions standardly understood as violence. Demonstrating that a nonideal theoretical approach to bioethics is well suited to evaluating the philosophical ramifications of the bodily damage incurred by microaggressions, I recommend selective and episodic separatism from the perpetrators of microaggressions as a health-protective response to the realities of living in an unjust world. (shrink)

When denial of medical treatment is being used as a lever to move people out of the country, ethicists and healthcare professionals should speak out.An ugly feature of political life throughout the Western world, and beyond, is the suspicion towards, and maltreatment of, migrants from poor to rich countries. People who would otherwise be horrified at being labelled racist nevertheless find it acceptable to support practices which can range from stigmatisation to confinement in brutalising conditions in “reception” and “removal” (...) centres.1–5An hour spent searching through government and NGO websites concerned with the treatment of asylum seekers and refugees in developed world countries is an hour well spent – but profoundly depressing. This is not only because of the frankly Orwellian language used by the governments of the UK and Australia , or because of the conditions and treatment meted out, but also because of the apparent support these practices have among the voting public. In the pointedly optimistic reports of Her Majesty’s Inspector of Prisons, for example, one can find praise for the fact …. (shrink)

BackgroundBioethics can play an important role in addressing diversity both in and outside of academia, setting precedents for meaningful contributions to public discourse, research, teaching, training, and policy development. However, in order to do so, these conversations also need to reflect on the issue of diversity within the field of bioethics across the globe. This study aims to examine current gender representation and diversity at medical ethics and humanities institutes in Germany, the German-speaking areas of Switzerland, and Austria.MethodsA total (...) of forty-nine medical ethics and humanities institutes from Germany (n=42), the German-speaking areas of Switzerland (n=5), and Austria (n=2) were included in the study. Institutes websites were reviewed in the first week of March 2021 and the details of each staff member listed on the website recorded.ResultsOverall, a total of 964 staff members were identified at the forty-nine German-speaking medical ethics and humanities institutes. Just over half (530/964; 55%) of all staff were female. There were significant differences between gender in some staff positions: 64.6 per cent (31/48) of directors were male (χ2(1)=4.1, P=.04); 62.7 per cent (84/134) of student assistants were female (χ2(1)=8.6, P=.003); and 83.7 per cent (77/92) of administrative staff were female (χ2(1)=41.8, P<.001). There were no significant differences between staff gender for researchers and lecturers, or associated researchers. In addition, 65.5 per cent (19/29) of researchers and lecturers who had a professor title were male, but the difference between genders was not found to be significant. However, significantly more of the researchers and lecturers who had completed a habilitation were male (75.8% (25/33); χ2(1)=8.8, P=.003). When comparing the institute director’s gender presentation with staff gender presentation, it was found that male-led institutes had 53.4 per cent (286/536) female staff overall but had 52.7 per cent (136/258) male researchers and lecturers. However, the difference between genders were not found to be significant. On the other hand, female-led institutes had significantly more female staff overall (59.9% (223/372); χ2(1)=14.7, P<.001) and also significantly more female researchers and lecturers (58.9% (119/202; χ2(1)=6.4, P=.01).ConclusionsThere has been a significant push to address gender diversity in German-speaking academia, and this study finds overall good gender parity in medical ethics and humanities institutes. However, there has not been a similar openness to discussing issues of systemic racism or how other forms of inequality affect academic diversity. Taking diversity seriously requires opening up conversations around intersectionality, including difficult conversations around race and cultural background that have long been taboo in German-speaking countries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:(P)rescription Narratives: Feminist Medical Fiction and the Failure of American Censorship. by Stephanie Peebles TaveraEtta M. MaddenStephanie Peebles Tavera. (P)rescription Narratives: Feminist Medical Fiction and the Failure of American Censorship. Edinburgh: Edinburgh University Press, 2022. Hardback, xii + 220 pp. ISBN 978-1-4744-9319-2.Utopian Studies readers first saw Stephanie Peebles Tavera’s work in print in her 2018 essay on reproductive health in Charlotte Perkins Gilman’s Herland. More recently, (...) in (P)rescription Narratives, she gives readers a view of the much broader historical scope of her scholarship in literary and cultural studies. Tavera’s analysis of what she labels “feminist medical fiction” considers not only novels and short stories but also literary reviews, dramas, and documentary films, many of which will be unfamiliar to readers of utopian and dystopian literature. Yet the book contextualizes the ways in which these works capture the “utopian possibilities” of women writers who pushed for breaking the boundaries of the dystopian strictures of embodied life. The literary works “rescript” what had been prescribed by others as “normalized behavior,” from the latter-nineteenth century through the Progressive Era (5, 37). As Tavera illustrates through her detailed analysis, these women’s narratives provide “interventions that... interrupt the dissemination of false [End Page 612] narratives of the female body” and “alter the course of cultural development toward greater inclusivity” (5).To establish the temporal boundaries for the project, Tavera emphasizes the Comstock Law, established in 1873, and the death of its author Anthony Comstock in 1915. While Comstock’s work often has been understood as restricting pornography, she explains the Comstock Law as more than merely that. Comstock sought to control what he and others saw as sexual deviation, which included birth control in any form. Tavera also bookends the project with lawsuits associated with Victoria Woodhull and Margaret Sanger, both women who advocated for abortion and birth control as means of allowing women to avoid the strictures over their bodies. Additionally, she explains, Comstock’s racism caused him to completely overlook Black women, ironically allowing a space in which Black women’s feminist medical fiction especially rescripts “normalized behavior” (37)—a topic she pursues in two parts of the book.The book follows a roughly chronological path as it examines four topics related to women’s health, brilliantly organized into “(p)rescriptions,” indicated by Rx, rather than chapters with numbers. Rx1, “Crip Medicine,” illustrates how authors such as Charlotte Perkins Gilman pointed to the socially constructed status of “hysteria” in a patriarchal culture that saw women as deviant by nature. Instead, these authors advocated for a more holistic examination of women’s health, impacted by the environments in which they lived. Drawing from Lyman Tower Sargent’s widely accepted view of utopianism as dreaming of a place “considerably better than the society in which the author lived,” she underscores “the utopian impulse underlies much of the work of feminist medical fiction” (39). In particular, writers of feminist medical fiction were “driven by failure.”Perhaps most familiar to illustrate this point is Gilman’s work, such as “The Yellow Wallpaper,” which illustrated how the culture failed certain characters. The narrator of that story suffers postpartum depression and is made worse by Dr. S. Weir Mitchell’s rest cure. Consequently, Gilman proceeded to write other works, such as Moving the Mountain (1911) and then Herland (1915), which push readers to envision “alternative societies” without such destructive patriarchal medical practices (39). But Tavera also explains how Louisa May Alcott’s Eight Cousins, or the Aunt-Hill (1875) critiques contemporary culture by providing a “domestic utopia” in the female domain of Aunt-Hill, wherein the male Dr. Alec Campbell demonstrates “a better way... of caring for the female body” (55). And another key example is Rebecca Harding [End Page 613] Davis’s Kitty’s Choice: A Story of Berrytown (1875). Berrytown is described as “the Utopia in actual laths, orchards, and bushel-measures of the advance guard of the reform party in the United States” (qtd. in Tavera 55). Through its two physicians, Dr. Muller and Dr. McCall, who represent homeopathic and allopathic practitioners, readers see that the society... (shrink)

In mental health ethics, it is generally assumed that coercive measures are sometimes justified when persons with mental illness endanger themselves or others. Coercive measures are regarded as ethically justified only when certain criteria are fulfilled: for example, the intervention must be proportional in relation to the potential harm. In this paper, we demonstrate shortcomings of this established ethical framework in cases where people with mental illness experience structural racism. By drawing on a case example from mental healthcare, we (...) first demonstrate that biases in assessing whether the coercive intervention is proportional are likely, for example, due to an overestimation of dangerousness. We then show that even if proportionality is assessed correctly, and the specific coercive intervention would thus be regarded as ethically justified according to the standard framework, coercion may still be ethically problematic. This is because the standard framework does not consider how situations in which coercive measures are applied arise. If structural racism causally contributes to such situations, the use of coercion can compound the prior injustice of racist discrimination. We conclude that the ethical analysis of coercion in mental healthcare should consider the possibility of discriminatory biases and practices and systematically take the influence of structural discrimination into account. (shrink)

Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards (...) registered with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

Liao and Carbonell discuss the role of (supposed) racial differences and racism in two medical devices: pulse oximeters and spirometers. They show that what might seem like cases of mere bias, are...

Medical-legal partnerships (MLPs) integrate knowledge and practices from law and health care in pursuit of health equity. However, the MLP movement has not reached its full potential to address racial health inequities, in part because its original framing was not explicitly race conscious.

The consideration of racial differences in the biology of disease and treatment options is a hallmark of modern medicine. However, this time-honored medical tradition has no scientific basis, and the premise itself, that is, the existence of biological differences between the commonly known races, is false inasmuch as races are only sociocultural constructions. It is time to rid medical research of the highly damaging exercise of searching for supposed racial differences in the biological manifestations of disease. The practice (...) not only condoned but required by the National Institutes of Health of utilizing racial identification as a demographic characteristic with assumed biological implications is at best badly flawed, and at worst unintentionally contributes to perpetuating the fallacy of natural differences between persons of different skin color, which has been used in the past to advance the cause of racial discrimination. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S50-S56, March‐April 2022.

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

Ideas of racial genetic determinism, though unsupported by scientific evidence and atavistic, are common and readily apparent in American medical education. These theories of biologic essentialism have documented negative effects in learners, including increased measures of racial prejudice.

I defend an empirically-oriented approach to the analysis and remediation of social injustice. My springboard for this argument is a debate—principally represented here between Tommie Shelby and Elizabeth Anderson, but with much deeper historical roots and many flowering branches—about whether racial-justice advocacy should prioritize integration (bringing different groups together) or community development (building wealth and political power within the black community). Although I incline toward something closer to Shelby’s “egalitarian pluralist” approach over Anderson’s single-minded emphasis on integration, many of Shelby’s (...) criticisms of integrationism are misguided, and his handling of the empirical literature is profoundly unbalanced. In fact, while both Shelby and Anderson defend the importance of social science to their projects, I’ll argue that each takes a decidedly unempirical approach, which ultimately obscures the full extent of our ignorance about what we can and ought to do going forward. A more authentically empirical tack would be more epistemically humble, more holistic, and less organized around what I’ll call prematurely formulated “Grand Unified Theories of Social Change.” I defend a more “diversified experimentalist” approach, which rigorously tests an array of smaller-scale interventions before trying to replicate and scale up the most promising results. (shrink)

The Dobbs decision will directly affect patients and reproductive rights; it will also impact patients indirectly in many ways, one of which will be changes in the physician workforce through its impact on graduate medical education. Current residency accreditation standards require training in all forms of contraception in addition to training in the provision of abortion. State bans on abortions may diminish access to training as approximately half of obstetrics and gynecology residency programs are in states with significant abortion (...) restrictions. The Dobbs decision creates numerous hurdles for trainees and their programs. Trainees in restrictive states will have to travel to learn in a different program in a protective state. As training opportunities diminish, potentially leading to a decline in clinical skills, knowledge, and experience in the provision of abortion, the rate of complications and maternal mortality are likely to rise. This will likely have a disproportionately negative effect on preexisting disparities in reproductive health fueled by a longstanding history of systemic racism and inequities. This work aims to both define the looming problem in abortion training created by Dobbs and propose solutions to ensure that an adequate workforce is available in the future to serve patient needs. (shrink)