Bioethics Forum Essay
Experiencing Racism: Health Care Professionals Speak Out
“My emotions and insecurities were at an all-time high, so much so that I was no longer comfortable coming into work. Do my coworkers also joke about my culture, my skin tone? Do my patients and families feel uncomfortable with me being their nurse? These were the questions I frequently asked myself as I anxiously braced myself for my next shift. I could no longer walk the streets, sidewalks, or even the hospital lobby without believing someone was looking at me because of the color of my skin.”
This quote from Cecilia Igwe-Kalu describes her experience as a nurse confronting racism in health care. In a recent symposium dedicated to this problem, the journal Narrative Inquiry in Bioethics gives voice to what many BIPOC health care professionals already know—their work culture and environments are not diverse, equitable, inclusive, or anti-racist. Worse, they are often ignorantly or willfully hostile.
The symposium, “Experiencing Racism in Health Care: Stories from Health Care Professionals,” is a rallying cry to confront racism in health care by looking through the lens of professionals afflicted by it. There is abundant testimonial evidence of being invisible, unheard, silenced, marginalized, underestimated, undervalued, gaslit and made to feel inferior and “othered.” Calvin E. Bradley, Jr., a health care chaplain (and one of The Hastings Center’s Sadler Scholars), writes: “Many times in healthcare, I have been reminded through the actions of others that my expected role is to be seen but not heard; patronized but not validated; and present but not influential. It is not my size or skin color that most threatens or offends, but it is the ability to think freely and to be creative, to challenge and cultivate change, and most of all, to love people genuinely without return. It is that I both give respect, and demand respect from those around me. But most critically, it is that I have the ability to do all of this while being a Black man in healthcare.”
Through this enlightening and instructive symposium of first-person narratives about racism, the reader is left with the overarching question of why. With the ratification of civil rights laws and professional ethical codes of conduct many decades ago, why we are still here? The health care field, in general, is an educated community that has at its core the organizing principle of “do no harm.” One easy answer is that some traditions are hard to break. “One might think that becoming a physician alleviates Asian American racial dynamics, but the culture of medicine is not immune to microaggressions,” writes Kimbell Kornu. “As a medical student, I enjoyed rotating at the VA hospital because of the veteran population. However, immediately after I walked into a patient’s room, a veteran told me, ‘Go away. I don’t want a Jap doctor.’ Despite my gratitude for this veteran’s service to America, I was not considered American enough to be involved in his care.”
A more egregious possibility is that structural norms and individuals with power and influence condone a discriminatory culture, leveraging structural and interpersonal superiority against vulnerable and marginalized groups, thereby perpetuating a timeless resistance to view all persons with the respect and dignity that our principles and words on paper would dictate.
The symposium editor, Gloria A. Wilder, along with four expert commentary authors and the narrative contributors, speak to inequities rooted in the history of racism in the United States, which might be more accurately characterized as white supremacy. In her introduction to the symposium, Wilder states: “The closer you are to ‘Whiteness,’ the more access you have to privilege. The authors reflect upon the dogged denial of privilege and the resulting consequences of maintaining the status quo.”
Perhaps it is time our professional health care community and society at large reframe racism by focusing on those in the racial majority with power and influence who are ill-equipped or refuse to change their attitudes and beliefs. The presence and recognition of racism are denied and amorphous to the person who is privileged to be insulated from its impact. This protective cocoon cannot remain if the white majority takes seriously their role in addressing racism.
“Bioethicists have written on the field’s refusal to engage meaningfully with racism and its deleterious effects on health and well-being, arguing for the recognition of racial justice as a bioethical issue,” writes Nathalie Égalité in a commentary. The study, application, and practice of ethics provide a framework, a code of moral values, and a set of standards and virtues that we—all people–should consult as a source of guidance. Despite having persuasive data that racism is immoral, destructive, and costly, we are nonetheless stuck at a critical impasse. Reason and our bioethical stance fall short in transforming human behavior and structural traditions.
None of this seems to effectively challenge deeply held beliefs and behaviors. Author Zaiba Jetpuri describes an interview she had with a hiring physician for a scribe position. Upon meeting Jetpuri, who wears a hijab, the hiring physician explains, “We don’t allow any accessories here—no hats, no jewelry, no religious affiliations here. People aren’t allowed to wear necklaces with crosses.” But she also said, “Wearing your headscarf here would make my patients scared.”
Personal and institutional accountability is lacking, even though everyone stands to benefit, and national health outcomes will improve, without racism. In their commentary, Aletha Maybank and Fernando De Maio, of the American Medical Association, quote from a 2021 JAMA podcast in which the then-deputy editor said, “No physician is racist, so how can there be structural racism in health care?” White privilege and a lack of awareness were emblematic with the hosts of the podcast and the quote, which was widely broadcast on Twitter.
If we want to achieve an anti-racist culture and work environment, willful ignorance and the “pattern of righteous indignation,” as Wilder puts it, must be confronted with mandatory education, rigorous enforcement, and serious consequences for a failure to act ethically. Wilder states, “Racism requires complicity,” and the current culture of permissibility must be replaced with a culture of intolerance. It is no longer acceptable for people to be unaware and claim ignorance when it comes to racism, not when valued health care professionals and historically marginalized communities are suffering and sharing their painful reality with us. The 21st century failure of institutional leadership to confront and eliminate racism is a matter of choice, a choice to live in one’s privileged reality devoid of such racist experiences and the choice to discriminate against and disadvantage others for personal and/or institutional benefit.
In the historic 1965 debate, “Is the American Dream at the Expense of the American Negro?”, between author and activist James Baldwin and conservative political commentator William F. Buckley, Jr., Baldwin captured the essence of our ongoing dilemma when he said, “The certain awkwardness I feel has to do with one’s point of view, one’s sense or system of reality.” I feel a certain awkwardness in knowing that my reality of experiencing racism is easily dismissed by others who do not share the same reality. Like me, the contributors to this symposium share the unfortunate reality of experiencing racism, and it is for others who don’t experience racism to learn how to be anti-racist. For our professional community to become anti-racist, we must work toward a shared reality, one in which everyone’s sense or system of reality matters and moves closer to achieving equity, fairness, and justice for all.
Racism is categorically antithetical to the four ethical principles of autonomy, beneficence, nonmaleficence, and justice, to the concept of respect for persons, and to laws espousing all persons deserve the right to citizenship, equality, and liberty. What will it take for all of us—especially our white allies—to act now and adhere to the ethical imperative to hold each other accountable to an anti-racist and anti-white-supremacist culture? As Dr. Wilder writes, “This moment is a reckoning with who we are to each other and an aspiration of who we want to be.”
I want to see America be what she says she is
in the Declaration of Independence and the Constitution.
America, be what you proclaim yourself to be!
– Pauli Murray
Pringl Miller, MD, (@pringlmillermd) is a board-certified general surgeon and hospice and palliative medicine physician trained in clinical medical ethics. Dr. Miller is the founder and executive director of Physician Just Equity, a nonprofit organization that supports and empowers physicians and surgeons experiencing unjust workplace conflicts. (@EquityDocs)