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07/24/2017 - 11:04pm

By Miles Brundage (FHI, Oxford University) and John Danaher (NUI Galway)

07/24/2017 - 11:04pm
James Hughes (Institute for Ethics and Emerging Technologies, UMass Boston) and Regina Rini (reginarini.net, NYU Center for Bioethics)
07/24/2017 - 4:06pm

By Peter Young

 

In April of this year, the Berman Institute and Johns Hopkins Hospital Ethics Committee held its monthly Ethics for Lunch case presentation focusing on how to manage patients who make racist, sexist, and otherwise offensive comments. The discussion, moderated by Dr. Joseph Carrese, featured panelists who have experienced racism/sexism in the clinic, and it allowed audience to gain insight from their perspectives.

 

During the discussion, there was mention that minority patients in an in-patient setting cannot choose their own doctor based solely on race, because Hopkins’ practice is to pair the best doctor with a patient’s medical needs. I was a bit confused how minority patients not being able to choose race-based concordance in an in-patient setting fits into the larger, nation-wide conversation of minority groups wanting safe spaces. For example, some argue the race of the physician affects the quality of care, and when the provider and patient’s race align, the provider can speak better to certain beliefs, religious practices, nutritional knowledge, and cultural norms. Also, there may be even subtler, yet equally important benefits of having your provider look like you, especially in our current political climate. This includes patient-compliance as well as the potential for less polarizing power dynamics in the provider-patient relationship.

 

Scholars like Dr. Dayna Bowen Matthew, author of Just Medicine and professor at University of Colorado, might argue that if a white, middle-class person tells an intercity, minority person to take their medication, that patient may be less likely to adhere. Other research suggests minorities may be more likely to trust a provider that looks like them, and this can contribute to patient compliance and better outcomes. When the patient/provider relationship is good, or patient feels more comfortable with the provider, it’s possible to improve health outcomes.

 

If this is the case, why can’t minority patients be offered an option for race-based concordance in an in-patient setting at Hopkins Hospital?

 

Someone against race-based concordance may argue that not assigning the best physician for each job poses a safety risk. Currently, Hopkins pairs the best available physician based on skill to attend to a patient’s medical needs. To be clear, skill-based concordance includes language proficiency, cultural consciousness, and dietary considerations (these are not attributes physicians are born with, but skills they develop throughout their lives and career). In some specialties, such as dermatology, physicians with a darker skin pigment can provide skilled information to patients with dark skin, therefore, this type of accommodation is acceptable. Assigning a physician to a patient for no other reason than skin color, however, is a consideration not based on skill and could pose a risk to the patient.

 

Suppose, for example, a mother in labor and her baby entered the hospital in critical condition. Two care teams come in, one for the mother and the other for her baby. The father and husband then enters the delivery room and states, ‘I don’t want any African Americans in here with my wife or child.’ This request is not based on anything pertaining to skill, but only skin color. If that attending physician were to accommodate the father’s request, the resulting situation could create a safety risk for the mother and child since those two care teams work together regularly and know each other’s rhythm and working style—they would be at a disadvantage by sending black clinicians out of the room. Furthermore, and more obvious, accommodating the father’s request would enable racism and could potentially cause trauma to those clinicians who are victimized by this type of action. While that harm is problematic in itself, it could also affect team dynamics and the quality of care provided in the future.

 

There could be other unforeseen problems by accommodating patients’ preferences for race. There are, for example, people in the US who may look white, but know more about the Latino culture than someone who was born in Latin American and who looks Latino. Just because someone was born into a culture and looks a certain way does not mean they can work as a provider with respect to that culture.

 

Additionally, assigning physicians to a patient solely because of skin color or gender could set a risky legal precedent since it promotes discrimination. In a paradigm where patients can choose the race or sex of their provider, there are possible discriminatory actions against women and minority providers. Take for example a patient who doesn’t want a female physician because they don’t have confidence in their skills. Other patients may only want a white male physician because those patients have more confidence in their skills, although this would be unfounded. Wrapped around all of this are issues surrounding Title IX, which Hopkins must adhere to since it’s a teaching institution.

 

Putting the legal risk aside and keeping to the conversation about ethics, the question still stands: could providing minority patients an option for race-based concordance as a policy while denying other requests for race-based preference be permissible? I ask particularly because of a history of racism in the United States, which has led some minorities to feel unsafe in certain white-dominated institutions. If race-concordance among minorities could help promote better health outcomes, then could such a policy could be seen as a legitimate way forward?

 

As a possible solution, one can consider the work of Dr. Kimani Paul-Emile, who gave a Berman Institute seminar in late 2016 titled “Dealing with Racist Patients.” Dr. Paul-Emile cites scholarship in her New England Journal of Medicine piece, which argues, “patients who are members of racial or ethnic minority groups may request concordant physicians because of a history of discrimination or other negative experiences with the health care system that have resulted in mistrust.” So a physician who practices by this philosophy would never accommodate a request for race-concordance based on bigotry. Patients can, however, be accommodated with race-based concordance if it pairs them with physicians who can understand their experiences, show them respect, and whom they can trust more.

07/24/2017 - 3:19pm

A Wisconsin company is about to become the first in the U.S. to offer microchip implants to its employees. "It's the next thing that's inevitably going to happen, and we want to be a part of it," Three Square Market Chief Executive Officer Todd Westby said

07/24/2017 - 12:58pm

ASBH has announced the following awards for the October 2017 annual meeting.  

Lifetime Achievement Awards...

07/24/2017 - 12:58pm

ASBH has announced the following awards for the October 2017 annual meeting.  

Lifetime Achievement Awards

ASBH announces two Lifetime Achievement Awards for longstanding achievement by an individual in bioethics and/or the medical humanities. Both recipients will make remarks at the 2017 ASBH Members' Meeting and Award Presentations, Friday, October 30, 3:45 pm in Kansas City, MO.

Myra Christopher is recognized as the first leader of the Center for Practical Bioethics (CPB), an applied, real-world bioethics organization emphasizing ethics and action informed by thoughtful reflection, guided by academic discipline. Christopher’s work has changed how shared decision making among families helps to match the care a loved one receives with his or her wishes, how hospital ethics committees respect and advocate for the rights of patients, and how communities care for those with terminal illness.

Steven Miles, MD is honored for three and a half decades of research and education. He has published 6 books and over 160 articles and chapters on a breathtaking array of issues, an extraordinary contribution to bioethics scholarship. His career is also distinguished by the impact of his work beyond academia and his devotion to the reform needed to alleviate suffering, especially in contexts affecting the most vulnerable members of our global society.

Cornerstone Awards

ASBH announces two Cornerstone Awards for enduring contributions by an institution to the fields of bioethics and/or the medical humanities. These awards will be presented at the 2017 ASBH Members’ Meeting and Award Presentations.

For over 25 years, The ANA Center for Ethics and Human Rights has advocated for social justice and the protection of human rights and tirelessly provided ethical guidance, both theoretical and practical, at the state, national, and international levels.

The Center for Literature & Medicine at Hiram College is the birthplace of the first undergraduate health humanities program in the country. The Center has been a pioneer in the development of interdisciplinary programs in which health care professionals, artists, educators, medical students, and scholars of literature examine critical health care and ethical issues from multiple perspectives, with application in clinical settings, academic medicine, health policy, and the liberal arts environment. 

Schedule, Speakers, Abstracts

Check out the schedule, speakers, and abstracts for the 2017 ASBH Annual Meeting. With over 200 sessions to choose from, it is not too early to plan. Have you booked your hotel room and confirmed your registration for the most important bioethics and humanities meeting of the year?

07/24/2017 - 11:11am

Helix will sequence your genes for $80 and lure app developers to sell you access to different parts of it

07/24/2017 - 10:42am

by Keisha Ray, Ph.D.

Last week Lexi Carter, a black woman from Tennessee had an experience that so many other black people have had, a racially charged visit with a doctor. When Carter walked into her doctor’s office, Dr. James Turner greeted her with “Hi Aunt Jemima.” During the visit, he proceeded to call her Aunt Jemima more than once. Carter’s encounter with Dr. Turner is problematic for many reasons: 1. The term “Aunt Jemima,” which is the name of a popular syrup and pancake mix whose packaging depicts the face of a black woman, has a long history of racism dating back to the late 1800s; 2.…

07/24/2017 - 10:26am

The approval of gene therapy for leukemia, expected in the next few months, will open the door to a radically new class of cancer treatments

07/24/2017 - 10:09am

Below is our weekly review of news and publications related to housing law and equity. This week — July 17-23, 2017 — included news about zoning, segregation and lead poisoning: Dr. Herbert L. Needleman died on July 18. Dr. Needleman … Continue reading →