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Bioethics Forum Essay

Reckoning with Anti-Black Racism in Bioethics: Key Takeaways

The field of bioethics has a moral responsibility to respond to the continued racial and health inequities confronting Black, Indigenous, and other people of color. Along with several colleagues, we formed an antiracism task force to interrogate that moral responsibility, assess what bioethics has done so far, explore what bioethics can and should do, and bear witness to the longstanding health and health care injustices, including those exacerbated by the Covid-19 pandemic. Inspired by the work of the task force and an upcoming special report on anti-Black racism in bioethics which will be published next year in the Hastings Center Report, the four of us led a panel discussion at this year’s American Society for Bioethics and Humanities (ASBH) annual meeting. The session, moderated by Jennifer McCurdy, aimed to identify and discuss engagement strategies to bolster inclusivity and equity in the field of bioethics and framed a better, bolder, and braver bioethics that prioritizes social justice.

Here, we briefly describe key takeaways from this session, and we encourage readers to listen to the recorded session for more details.

Anti-Black racism is embedded and pervasive in the field of bioethics.

It is important to recognize that anti-Black racism is in bioethics and to call out instances of it. We can’t fix concerns if we don’t recognize them. Anti-Blackness is constantly reinforced in the ways that we practice bioethics. We witness the manifestations, embeddedness, and pervasiveness of anti-Black racism in multiple ways:

Employment and leadership opportunities

Tactics (e.g., non-inclusive and non-equitable institutional recruitment practices and evaluation criteria) that reduce the likelihood that scholars of color, particularly Black scholars, are hired

Consulting scholars of color for insights to enhance publications and funding opportunities, but not including them as authors or in key funded roles

Anti-racism committees that include predominately Black scholars but are headed by non-minority scholars

Lack of representation of Black scholars in other leadership roles (i.e., department chairs, center directors, organizational positions

Invited lectures

Discounting the scholarship, expertise, and contributions of Black bioethicists by not inviting Black scholars to deliver symposia, keynote lectures, seminars, and other scholarly endeavors of local, regional, and international importance

Inviting Black scholars to participate when the content pertains to “Black issues,” but not when the content involves the various other realms in which we work

The racial wage gap extends to lower (or no) honoraria payments offered to Black scholars who are invited to give lectures

Topic choice

Failing to integrate or teach the scholarship of Black bioethicists in courses and not emphasizing the role of race, class, gender, and other identities in bioethics discourse

Teaching students or publishing articles that imply that race, rather than racism, is a key driver of problems, including differential health outcomes, for Black individuals

We have become too concerned with sophisticated (i.e., academic) language when discussing racism.

Language can act as either a deterrent or an invitation to a conversation. People do not have to know all the “correct” vocabulary (e.g., “intersectionality,” “critical race theory”) to call out racism. Simply put, it boils down to what is morally right or wrong. Calling out injustice in all its forms requires moral courage, the ability to act and speak out against an injustice despite fear of the consequences. To address these problematic challenges, it is necessary to have difficult and uncomfortable conversations. Yes, we might stumble; yes, we might be uncomfortable, but we must speak up and speak out and bear witness to the wrongs that are being committed.

Buildings and institutions are not racist; the people inside of such buildings and institutions are racist.

Some contend that systems and structures are responsible for upholding racism, yet it’s crucial to remember that individuals make up systems and structures. Individuals are responsible for writing institutional policies rooted in racism and unfairly disadvantaging certain groups of people. We have witnessed this firsthand during the pandemic, with differential treatment of essential workers. These workers are expendable in the eyes of society. We have not gotten to the heart of the matter because the issue of racism lies within the hearts of individuals.

Importantly, not much has changed in the 15 years since the ASBH 9th annual meeting in Washington, DC. In fact, bioethicists are still grappling with many of the same societal issues today, including social justice issues and health care inequities. Instead of asking (as many bioethicists continue to do) why Black individuals mistrust White medical professionals, we need to be asking why White medical professionals behave in untrustworthy ways? A similar reframing is warranted for scholars: the focus should not be to create a program for Black individuals to learn to trust White scholars, but instead the focus should be on identifying and changing untrustworthy behavior in White scholars. Overall, we must ask ourselves, what has changed in the field of bioethics?

We must change the bioethics narrative: we’re asking the wrong questions.

There is a national push to recruit Black bioethicists for faculty positions and engage them in lectures, panels, and popular media. Indeed, the question “Where are all the Black bioethicists?” often arises in academic settings (e.g., departmental meetings, bioethics organizations, working groups).To move beyond situating this question as a mere intellectual exercise, colleagues developed a resource circulated via Twitter to increase accessibility and familiarity with diverse bioethicists. Although this resource and other efforts are intended to increase the visibility and amplify the voices of Black bioethicists, there is a critical need to address the structural and systemic forces that continue to perpetuate a nondiverse bioethics workforce and otherwise prevent the recognition and upward mobility of Black bioethicists. Instead of simply inquiring “Where are all the Black bioethicists?” and problematizing the lack of visibility, as a field we must grapple with the hard questions that point to the imposed invisibility and silencing of Black bioethicists as a moral and systematic failure of the profession.

The following questions are particularly worthy of deep reflection:

  1. What are the embedded and existing structures and systems that have excluded and continue to exclude the work of Black bioethicists from mainstream bioethics?
  2. What are institutions and organizations doing to develop a pipeline and an infrastructure to train and nurture the next generation of Black bioethicists?
  3. What are bioethicists doing within their institutions and organizations to make the climate and structure more equitable, inclusive, and just for Black scholars?

The ASBH panel discussion identified crucial factors within the field that continue to prevent the visibility of Black bioethicists. Until these factors are resolved, the next generation of Black bioethicists will certainly continue to face the same unique challenges that we currently face. Therefore, we concluded the session by providing our intergenerational advice to the next generation of Black bioethicists.

Do meaningful work

People will recognize meaningful work. It does not matter if you “fall” into a nice cookie-cutter category in terms of your scholarly identity or purpose; just do good work driven by passion and purpose.

Control your own narrative

Tell people who you are and what you do, rather than allowing people to label or characterize your work. The scholarship of Black scholars is often mischaracterized because people don’t understand it in its fullness, so be sure you take all opportunities to fully explain it yourself.

Find a community of Black bioethicists

Being in community with other Black bioethicists and finding Black mentors will help you push past the microaggressions and racism. Not only are these relationships important, they can also lead to collaborative scholarship production. You may have to search outside your institution for your village, especially early in your career.

Be brave and stop defending yourself

Bravery involves asking questions, leaning into your curiosity, and networking. It also requires refraining from defending yourself (which too often sounds like, “well, I am only a . . .” or “I am not, but . . .”). Questions that elicit defensive responses are not the same as curious inquiry; listen closely for that distinction. Recognize the spaces (i.e., institutions, organizations) and situations in which you are being asked to defend your value or worth. Find your community and space by seeking out those colleagues (including those outside of your institution) who understand your work and want to engage. Remember that you have a right to be here; you are here. It is critically important that you don’t sabotage yourself; the environment will try to do that for you. Resist and persist!

Do not be too insular

Try to avoid the tendency to be that “strong person” who tries to handle adversity alone and don’t be afraid to share your truth. Use your voice and scholarship to expose the burdens and instances that have caused you chronic hurt and turmoil. This helps others know they’re not alone. It also helps with your healing process, so that you can move forward. Finally, remember your worth. 

To hear more about what the panelists had to say, see links to the video and transcript. Their ideas will be more fully explored in a special report, which will be published next year in the Hastings Center Report. This report is guest edited by Faith E. Fletcher, Keisha S. Ray, Virginia A. Brown, and Patrick T. Smith and developed in collaboration with the antiracism task force.

Acknowledgements

Special thanks to Jennifer McCurdy for co-leading the Hastings anti-racism initiative. We also thank the task force for engaging in collective, reflective, and systematic inquiry to develop and move this important work forward. Antiracism Task Force: Faith E. Fletcher, PhD, MA, Center for Medical Ethics and Health Policy, Baylor College of Medicine; Jennifer McCurdy, PhD, BSN, MH, HEC-C, Michigan State University Center for Bioethics and Social Justice; Elizabeth Bogdan-Lovis, MA, Michigan State University Center for Bioethics and Social Justice (retired); Vence L. Bonham, JD, Social and Behavioral Research Branch, National Human Genome Research Institute; Claretta Y. Dupree, PhD, RN, Medical College of Wisconsin (retired); Vanessa Hiratsuka, PhD, MPH, Center for Human Development, University of Alaska Anchorage; Wendy Jiang, MPH; University of Alabama at Birmingham School of Medicine; Nneka Sederstrom, PhD, MPH, MA, FCCP, FCCM, Hennepin Healthcare; Roberto Sirvent, JD, PhD, Department of Social Sciences, Hope International University; Patrick T. Smith, PhD, MDiv, MA, Kenan Institute for Ethics at Duke University; Stephen Sodeke, PhD, MA, Center for Biomedical Research, Tuskegee University; Joanne Suarez, MBE LatinXBioethics and Boston Neighborhood Health Center; Virginia A. Brown, PhD, MA, Department of Population Health, University of Texas at Austin Dell Medical School.  

Faith E. Fletcher, PhD, MA, (@FaithEFletcher) is an assistant professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine, a senior advisor to the Hastings Center, and Hastings Center fellow. Keisha S. Ray, PhD, (@DrKeishaRay) is an assistant professor at the University of Texas McGovern Center for Humanities & Ethics and senior editor of bioethics.net, the blog of the American Journal of Bioethics. Virginia A. Brown, PhD, MA, (@VirginiaABrown) is an assistant professor at University of Texas at Austin Dell Medical School in the Department of Population Health and a courtesy assistant professor in the Department of Psychiatry and Behavioral Sciences. Claretta Y. Dupree, PhD, RN, (@ethicsnerd) is a retired registered nurse and bioethicist with a wide variety of clinical and academic experiences in both the civilian and military sectors. She is the founder of the American Society for Bioethics and Humanities RACE Affinity Group.

This essay and the panel discussion it refers to were supported by a grant from The Greenwall Foundation.

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  1. Thank you especially for the video, as it was important to me to hear you talking in greater detail and in the specific contexts involved. It was also helpful to understand that you were talking about failures in the analyses of bioethics to address the ways in which these issues—whichever they were—fell differently on POC, but talking also and more about Anti-Black Racism landing on the Black practitioners of Bioethics. In response to Dr. Dupree’s curiosity about the faces of who was watching the video I’m going to try to send her one in an email.

  2. Not being in any medical field, I found the entire article an exercise in redundancy. Maybe I read the story too fast, but I couldn’t find an example of antiblack racism, but I could see quite a few buzz words. I read that it’s important to “call out” the racism. I agree, but why weren’t the specific examples cited, given the stated importance of doing so? And what is a bioethicist? Is it a person who goes to seminars and discusses ethics in the medical industry? Is the bioethicist a person who physically performs a medical procedure, or someone who talks about it? If it’s the latter, what is the value of the bioethicist versus any employee of a medical facility, from the custodian to the chief surgeon? Could this be as simple as there is a lack of black people in the bioethicist trade, thus causing the under representation? I think what I read could be described as an answer in search of a problem.

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