Hastings Center Report
Patient Narratives as Testimonies to Structural Inequity
Abstract: As of this year, 2026, medical schools are no longer explicitly required to teach structural competency in order to be accredited by the Liaison Committee on Medical Education. This change marks a significant shift in the priorities that guide medical education in the United States. Structural competency provides a framework for understanding how social, economic, political, and institutional forces shape health outcomes, health care experiences, and opportunities for well-being. Drawing on research encounters with medically underserved populations, particularly Black women living with HIV, this commentary argues that patient narratives are a powerful tool for helping learners in the health professions understand the lived realities that influence health and health care. As ethics educators, we have a moral obligation to help learners recognize the full humanity of the patients they serve so that these future health professionals are better able to provide respectful, compassionate, holistic, and person-centered care. In the current political climate, fulfilling this obligation may require moral courage.
