Although clinical ethics scholarship and practice has largely avoided assuming an activist stance, the many health care crises of the last eighteen months motivated a distinct change: On listserves, in blog postings, and in published essays, activist language has permeated conversations over such issues as the impact of triage policies on persons with disabilities and of color, and how the health care system has historically failed African Americans. In this paper, I defend this turn, arguing that clinical ethicists should embrace (...) activism—generally, and with particular emphasis on institutional, mesolevel concerns. Ethicists are often uniquely situated to understand the structural factors that regularly motivate clinical ethics cases, and they are often in a privileged position to be effective change agents. In making this case, I also stress the need not to overstep one's skills and to be acutely cognizant of the political risks associated with such work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha RayChioma Dibia (bio)Black Health: The Social, Political, and Cultural Determinants of Black People's Health by Keisha Ray New York: Oxford University Press, 2023Prior to the COVID-19 pandemic, bioethics had engaged only sparingly with the concept of racism. In 2016, Danis and colleagues published an article exhorting bioethicists to engage more meaningfully with the concept (...) of racism—given its impact on health and well being—and to consider strategies for combating it within and outside clinical settings (Danis et al. 2016, 5). While this paper generated considerable debate regarding how far bioethics ought to go in its engagement with racism (Baker 2016, 16; Weddle 2016, 32; Fuller 2016, 29), the focus of the field of bioethics quickly turned to more traditional subjects of bioethical inquiry, including ethical issues arising in doctor-patient relationships and new reproductive technologies. However, since the COVID-19 pandemic and the murder of George Floyd during that time, racism has received greater attention in the bioethics literature and Keisha Ray's Black Health arrives just in time to urge us to ensure that the current focus on the impact of racism on the health of racially minoritized people is not short-lived (Ray 2023, 21; BBC News 2020).The overarching argument in Ray's Black Health is that Black people's poor health does not arise from innate biological deficiencies but stems from their experience of racism at the structural, institutional, and interpersonal levels. Ray stresses that far from being solely a feature of America's past, racism [End Page 105] continues to taint Black people's relationship with the healthcare system and other societal institutions. In each chapter, Ray focuses on a specific racial disparity in health to illustrate how racism limits Black people's access to the social determinants of health and thereby contributes to their poor health. To set the context for this discussion, Ray provides an introductory chapter where she unpacks key terms including "racism," "racial disparities," and "the social determinants of health." In this chapter, Ray also clearly outlines the structure of the text and provides a summary of each chapter. This chapter provides the blueprint for the rest of the book, as in it, Ray provides a clear statement of the style, content, and purpose of Black Health.The first racial disparity that Ray considers is Black birthing mortality, and in chapter 1, Ray traces this to the history of slavery and eugenic policies which have shaped the relationship between physicians and Black women. As Ray explains, since Black people were forcibly brought to the United States, the government has sought to control Black women's reproductive lives and has often relied on physicians to effect control. She demonstrates how harmful stereotypes about Black women, including their so-called hardiness, originated in medical literature and have been used to deny pregnant Black women humane care. According to Ray, "[c]linicians' attitude and behaviors towards Black pregnant people still reflect an enslaved and slave-owner mentality, and this has great consequences for the survival of Black pregnant people." (32) By highlighting the birthing experiences of Serena Williams and Shalon Irving, Ray dispels the assumption that wealth or academic qualifications are a panacea for Black birthing mortality and shows how racism can be deadly for all Black pregnant women, irrespective of socioeconomic status. Ray also considers how income and housing inequities affect Black pregnant women and the cumulative effect of weathering on their health as well as that of their unborn children. This chapter most clearly shows how interpersonal, institutional, and structural racism operate and intersect to render pregnancy and childbirth a potentially dangerous experience for Black women.Next, Ray turns to racial disparities in clinical pain management and continues to explore the impact of historically racist beliefs and false stereotypes on the care of Black people. However, in this second chapter, Ray delves more deeply into the role of medical literature—both historical and contemporary sources—in perpetuating false assumptions about the Black body. She demonstrates how the historical portrayal of the Black body as not only less than human... (shrink)

Events in 2020 have sparked a reimagination of how both individuals and institutions should consider race, power, health, and marginalization in society. In a response to these developments, we exa...

February is Black History Month and so healthcare practitioners will soon rummage history books for information about famous African Americans, like Onesimus, the African slave who...