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.
Sadly, Professor Strand’s commentary, is so confounded by confirmation bias – and perhaps cultural prejudices – that this piece needs editing and explanation. For example, why does he/she/they use hyperbolic, figurative rhetoric? and so imprecisely? For example in the pivotal quote “racism is baked into our systems, institutions, laws, and policies”. Sometimes we see the figuration of CRT in another but similarly imprecise and deceptive way:”racism is the DNA of American history'” or some such used of ‘DNA’. Both figurations are to imply that race and racist/racialist ideologies are somehow essential. Of course, they are not. Technologists can do wonders with DNA, and bakers can de-construct a pie to make something entirely different of the components. Professor surely does not believe that race is essential (contrary to biological and other science!); and does not believe that racist/racialist ideologies are essential (since she/he/the is arguing against them). So, clearly the rhetoric is hyperbolic and confounding. This is likely because of the political partisanship of the argument: “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.” And? NOT promoting race or sex stereotyping or scapegoating, and NOT inculcating such views, should – on the face – be consider GOOD and/or USEFUL behavior guides! Shouldn’t they, Professor? Do these behavior guides become horrible when prefaced with the pejorative term “issues by former President Trump”? This rhetorical device – transmogrifying behaviors that are good and useful to society, supportive of ethical inquiry, and indicative of moral care – is shamefully deployed, as is seems, as purely political or ideological partisanship. Or is Professor Strand arguing that sometimes we should consider race essential – as many practitioners of CRT do when they require in trainings, workshops, etc that all ‘White’ bodied people be called racist, sometimes shouted at, sometimes physically harassed in the workshop, etc. – which, objectively, we should call a racist/racialist ideology, and a violent one at that? Professor should please respond. In summary, by observation, many people have contacted their electeds (school boards, legislators, etc) to complain about what they have observed done and heard said by many CRT theorists and practitioners. There is no reason why electeds should not respond to their constituents when they are abused in their schools, workplaces, communities. There is no reason why university or health system administrators should not require to preview and approve, any and all CRT (sometimes called ‘anti-racist’) training, workshops, forums and programs, by a responsible and responsive public process, so that the school of hospital can be ethically, morally, and legally accountable for any harms experienced by those in the training, workshop, forum or program. Or does Professor believe that harms are due to some people? That would be an interesting discussion. Some theorists, and apparently many practitioners of CRT, believe that harms are due to ‘White’ bodied people. Professor should clarify that point, please. All ‘White’ bodied people? or some? which? how? when? to what degree? why? Thank you.
This is an extremely poorly researched article, and I hope it does not represent the typical quality produced by Hastings Center. Right off the bat, the author states that this ” war on CRT” began with President Trump issued that order, however the president was responding to Voice by many people over several years, stretching back long before he ran for president. This oversight demonstrates a profound lack of education in the subject and set the tone for the rest of the article.
I also find it telling that the author neglects to address previously studied ethical concerns regarding CRT training, namely the diminished empathy for downtrodden groups (see https://doi.org/10.1037/xge0000605). These unintended side effects should be right up any bioethicists alley, yet for this author they appear to have received no consideration whatsoever.
Post-Election Day, I have been reflecting on the ongoing discourse on Critical Race Theory, The doctrine that is not reflected in K-12 education, but has become a rallying cry for the political right. A common theme is predicated on the parental right to shape one’s child and what that means for the public citizens they will become. The controversy is a proxy for the right to insulate against principles that might not represent the values, however good or bad they may be, that are promoted within the home. The Hastings center post on the subject in terms of bioethics, grounds this discourse in troubling terms. Though CRT has become deeply politicized and personalized, it is a universal struggle to define our nation’s history that if successful, becomes a history we will repeat. But I ask, jaded and suspicious, is that not the point? Moreover, what should be done if it is?
The forum post, which is at its core a call to action, underscores recent high-profile instances that highlight the growing urge to ignore an unflattering history of ethnic and racial marginalization that spans from individual acts of hate to national policies and programs that are, today, sources of shame. Though the writer calls upon her colleagues to resist the institutional effort to kowtow to CRT critics, the continued work to advance bioethics, medicine, law, and policy to address racial disparity, health inequity and bias are of even greater concern.
What does it matter if there is a faction of the population that disagrees? A democracy such as this functions on the will of majority. As we noted on election day, low turnout meant the majority could not be bothered or agreed. Which is worse? A neutrality bordering on malaise or actual desire for erasure? Nonetheless, bioethics must also decide whether resistance is a sufficient response.