Questions of Race in Bioethics: Deceit, Disregard, Disparity, and the Work of Decentering

Abstract

Philosophers working in bioethics often hope to identify abstract principles and universal values to guide professional practice, relying on ideals of objectivity and impartiality, and on the power of rational (individual, autonomous) deliberation. Such a focus has made it difficult to address issues arising from group‐based, sociohistorical differences like race and ethnicity. This essay offers a survey of some of the major issues concerning race in the field of bioethics. These issues include a long history of racialized abuse in medical and scientific research, reproductive injustice and abuse against women of color, and persistent racial and ethnic disparities in U.S. health and health care. The essay also argues that the field of bioethics as a whole would be improved by taking the experience of racial minorities into account in all its theorizing. Philosophers can aid in this task by expanding their theoretical focus beyond questions of individual rights to questions of social justice, beyond informed consent to community collaboration, and beyond cultural competency to both structural competency and cultural humility.

Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review

“…In conducting the review, we were aware that interventions to reduce implicit biases were not sufficient to reduce prejudice in the public in general and in professionals in different fields on the long-term. These interventions should only form part of a bigger picture that addresses structural issues, social biases and may include more intensive training that aims to change the culture and society outside institutions in addition to within them [54]. Programmes in education to address the formation of stereotypes from much earlier on would be one way to effect longer term changes.…”

Cultural Gaslighting

“…. also represent the downstream implications of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructure, medicalization, or even about the very definitions of illness and health” (Metzl 2012, 216, cited in Russell 2016, 52).…”

“…Since reproducing conditions of psychic exhaustion is part of the design of settler social structures, the trap set up is to respond by giving up on all empirical work and applied research, particularly on research that gives socially legitimate legal measure and cultural weight to communal impacts of trafficking, battery, femicide, rape, and associated gender-based violences. The fact remains that we need lawyers who won't advocate against our interests through cultural incompetence and doctors who won't get us killed while doing nothing legally recognized as negligent, doctors who have “structural competence” (Russell 2016). We need structural competence across the board: policies that address regulatory lacunae and public servants who call racist policies and practices to task, even under a settler governance structure that on the long view skews advantage toward white settler populations and their descendants.…”

Lead Essay—Institutional Racism, Whiteness, and the Role of Critical Bioethics

“…Bioethics has the potential to make important contributions to anti-racist programmes and strategies addressing institutional racism, yet as scholars have argued, the “whiteness” of bioethics undermines its capacity to attend to institutionalized forms of racism (Mayes 2020 ; Russell 2016 ; Danis, Wilson, and White 2016 ). Catherine Myser argues that bioethics depends on social and ethical theories that normalize whiteness and that “we risk repeatedly re-inscribing white privilege—white supremacy even—into the very theoretical structures and methods we create as tools to identify and manage ethical issues in biomedicine” (Myser 2003 , 2).…”