Addressing racism in the healthcare encounter: The role of clinical ethics consultants

Abstract

Justice is a core principle in bioethics, and a fair opportunity to achieve health is central to this principle. Racism and other forms of prejudice, discrimination, or bias directed against people on the basis of their membership in a particular racial or ethnic group are known contributors to health inequity, defined as unjust differences in health or access to care. Though hospital-based ethics committees and consultation services routinely address issues of justice that arise in the course of patient care, there is variability in whether and how racism and other causes of health inequities are addressed. In this paper, we describe a novel structure and process for addressing health equity within clinical ethics consultation. In addition, we discuss the barriers and challenges to its success, many of which are rooted in the identities, norms and assumptions that underlie traditional clinical ethics consultation. We offer pragmatic recommendations and conclude with unresolved questions that remain as we work to adapt the structure of a clinical ethics consultation service to improve attention to issues of health equity and promote anti-racism in patient care and institutional policy.

Clinical ethics consultations: a scoping review of reported outcomes

“…In particular, evidence pertaining to racist practices and policies, conscious and unconscious bias, and the outright discrimination and inequities in access to care experienced by racialized and marginalized groups [ 99 , 100 ]. As a field, bioethics, and by extension those who practice CEC, are also impacted by conscious and unconscious bias and must grapple with how best to combat racism and other forms of oppression in the provision of our services and in health care more generally [ 101 – 103 ]. Historically, the field has responded to racism or issues related to racial oppression with a view towards ‘neutrality’ or the “idea that ideal [ethical] deliberation would ignore race and hence prevent bias” [ 104 ].…”

“…In particular, evidence pertaining to racist practices and policies, conscious and unconscious bias, and the outright discrimination and inequities in access to care experienced by racialized and marginalized groups [99,100]. As a field, bioethics, and by extension those who practice CEC, are also impacted by conscious and unconscious Proactive group patients who died had 16% reduction in average charges compared to baseline and 33% reduction compared with control patients; but was NOT statistically significant [60] bias and must grapple with best to combat racism and other forms of oppression in the provision of our services and in health care more generally [101][102][103].…”

Intersectionality as a tool for clinical ethics consultation in mental healthcare

“…(How) may the conflict be related to structural discrimination? If possible, these questions may be considered together with the user, for example, with tools such as the Structural Vulnerability Assessment Tool , a tool recommended by MacDuffie and colleagues [ 59 ]. This assessment tool includes questions to assess the user’s financial security, residence, risk environments, food access, social network, legal status, education and previous experiences of discrimination.…”

“…In order to open space to discuss the influence of racism in clinical practices, clinical ethics consultants should further use their moderation skills to unpack biases sometimes hidden in euphemisms and clinical technical terms, which should be omitted altogether to ensure that all participants can follow [ 76 ]. Moreover, clinical ethics consultants should make sure complaints about structural discrimination and racism are given appropriate uptake, and experiences are not questioned, trivialized or invalidated [ 59 ]. This involves identifying stereotypical assumptions, biases and microaggressions [ 77 ], i.e., short communicative interactions that convey a derogatory meaning and target members of marginalized social groups, during CEC.…”

“…If instances of racism are dismissed in the CEC with M.O., the ethics consultant should emphasize the importance of recognizing that racism is prevalent in the clinical setting. They should highlight that individuals who are not directly impacted by racism may find it challenging to identify such experiences, and therefore, any complaints about racism should be treated seriously [ 59 ].…”