Bioethics Forum Essay

Bioethics Must Resist Attacks on Critical Race Theory

There has been an onslaught of systematic attacks on the concept of critical race theory (CRT) in the United States, largely from the political right. It would be easy for bioethicists as individuals, and bioethics as a field, to ignore or dismiss this phenomenon—it is not in our wheelhouse, it is too politically charged, it is irrelevant to our work, it concerns K-12 schools rather than undergraduate and graduate education, it is not pertinent to science and medicine, it is not as dangerous as some make it out to be. Each one of these assertions is false. In fact, the attacks on CRT are squarely relevant to our work. They could have tremendous consequences in science and medicine, and although they are politically charged, that does not absolve us of our obligation to intervene and resist.

The war against CRT has gone through several stages in the past few years. It began with an executive order issued by former President Trump that prohibited federal contractors from promoting “race or sex stereotyping or scapegoating” and inculcating “such views in their employees.” Stanford University faced backlash for ordering departments to modify any ongoing diversity training efforts to meet the order’s requirements. Since then, several stage legislatures have passed laws banning CRT in public K-12 schools. And now, we are seeing further ripple effects into universities, including an email last month sent on behalf of the provost of Pittsburgh State University in Kansas requesting that each department to report which classes included any content on CRT. Nikole Hannah-Jones, the Pulitzer Prize winning author of the “1619 Project,” was initially not offered a tenured position at the University of North Carolina at Chapel Hill because, despite her eminent qualifications, a major donor to the journalism school felt that her presence would be too controversial. Hannah-Jones’s experience and the Pittsburgh State email  both demonstrate how the backlash against awareness of and education about systemic racism extends far beyond any particular statute or executive order and into the halls of academia.

Bioethics is rooted in concerns about justice, power, and agency. As a field, it is honing its senses about the nature of injustice and power differences in the cases we bioethicists often use in our teaching and our scholarship. The U.S. Public Health Service syphilis study in Tuskegee, Alabama, was not wrong simply because individual participants were not adequately informed about the research or able to give consent—it was an abuse because of the fundamental power differences between the government researchers and the largely poor Black men. The atrocious experiments conducted by Nazi doctors in Germany were wrong, as Rosamond Rhodes noted in her 2005 essay, because of the tremendous power difference between captors and their prisoners. The U.S. government intentionally infecting sex workers in Guatemala with sexually transmitted diseases to study their course was wrong, or perhaps only even possible, because of the exploitation of a vulnerable racialized and marginalized group.

Moving beyond the roots of our field, health equity is one of the most pressing bioethical issues of our time. We are engaging more and more with questions of racial, ethnic, and socioeconomic health disparities and asking why they persist. We are teaching our students about social and structural determinants of health. We are publishing blog posts and articles in the Hastings Center Report and other prominent bioethics journals about racial justice and our field’s duty to address it in medicine and in our own ranks.

As bioethicists in university settings, we often have a duty to attend to imbalances of power, especially when racism is a factor. On our hospital ethics committees, we concern ourselves with health literacy and how it impacts clinical interactions. On our IRBs we are attentive to risk and harm to marginalized communities and to diverse participation. We write and teach about concerns about who will have access to technology and advancing science and whether marginalized populations will be shut out. We write and teach about eugenics and its racist roots. We ask our students whether what happened to Henrietta Lacks is simply the result of an inadequate regulatory framework for informed consent for biobanking or whether her treatment was related to her race. 

We simply cannot have these conversations—and cannot do our jobs to push for medicine and science to be more just—if the universities where we work restrict speech related to racism. Critical race theory asks us, essentially, to understand that racism is baked into our systems, institutions, laws, and policies, and that it has become so ubiquitous as to be rendered nearly invisible. In other words, the only things we can see are the impacts of racism. But if we blind ourselves to the causes, we will inevitably slip into assuming the causes are inherent and naturally occurring features of individuals or of communities. This is incredibly dangerous.

Bioethics has had a tendency to see itself as politically neutral—or at least, as not siding with the left or the right. But though the right wants to make it so, addressing racism is not an issue of left-right politics. This is an issue of humanity. Humanity is at the center of what we do. If we allow politicization to strip humanity, we cannot do our jobs. In order to solve the great injustices of our world, we must see them clearly. We can see racial disparities in health outcomes—the empirical evidence of differences in maternal morbidity and mortality,  treatment of pain, and life expectancy. However, if we fail to recognize, discuss, teach, and write about the structural causes of those differences, we will be unable to eliminate them. The backlash to CRT, in essence, asks us to blind ourselves to the truth—about our nation’s history, the ways that racism was embedded into law and policy, from redlining to employment discrimination, and the ostensibly race-neutral ways our society is organized, like property tax-funded schools and standardized tests for college admissions.

All of this is not to even touch on the gross violations of the First Amendment and the principle of academic freedom inherent in attempting to ban a set of concepts from schools and universities. One might argue that, as bioethicists, we also owe a fierce duty to the truth and to resist suppression of ideas. When efforts to “chill” CRT come to your university, resist them. We cannot do our jobs if we cannot speak and teach and write about the truth.

Nicolle K. Strand, JD, MBE, MPH (@nicolle_strand), is an assistant professor in the Center for Urban Bioethics at the Lewis Katz School of Medicine at Temple University.