Definition of the problem Medical ethics is increasingly faced with issues that result from power asymmetries and epistemic injustice. However, medical ethics lacks the epistemic lenses for analyzing these social context factors of clinical practice. A theoretical and conceptual reconfiguration is necessary in order to be able to address these issues. Arguments This paper discusses the foundations of critical medical ethics, which takes perspectives and epistemic categories from critical theories. This includes the Critical Theory of the Frankfurt School as well (...) as those approaches from social sciences and cultural studies that reflect on power asymmetries. By drawing on these theories, the epistemic spectrum of medical ethics could be broadened in order to better include real power relations into normative analyses. The paper starts by outlining the contribution of social sciences to empirical medical ethics. This shows that an empirical approach as such cannot bridge the epistemic gap. In a further step, epistemic lenses and concepts from critical theories are discussed, such as Critical Theory of the Frankfurt School, feminist approaches, postcolonial approaches, queer theory, gender studies, and science and technology studies (STS). The conclusion sums up the foundations of critical medical ethics and discusses its limitations. Conclusion Critical medical ethics possesses the epistemic categories and broader social perspective needed to address issues in medicine that result from power asymmetries and epistemic injustice in society. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

It is urgent that we address the causes and harmful effects of racism in health care. We propose that building diversity competence in the way we deliver health care services is key to this effort....

“Hypertension in Blacks is a salt disease,” Dr. Anderson1 explained. “Too much salt overloads their renin-angiotensin system and their kidneys can’t handle it. It’s just the way their bodies work....

The three target articles constitute a powerful and persuasive call for actively anti-racist bioethics and biomedicine. All three articles reject race as a biological category. Nevertheless, they share a common commitment to racial classification. At one point, Ruqaiijah Yearby writes that “social race, like biological race, is an illusion created to establish racial hierarchy,” but mostly she writes about “races” as though they were not an illusion, but a reality. In this commentary I critique the racial realism of the target (...) articles. I argue that the biomedical fight against racism is best served by a form of anti-realist reconstructionism about race, which says that there are no races, only racialized groups—groups misunderstood to be races. Note that I do not defend the color blindness that Clarence H. Braddock (2020) persuasively rejects. Because of the role of skin color in racialization and racism, color blindness is a misguided goal. One can reject color blindness, though, without accepting racial realism... (shrink)

Black women and their babies matter. In this commentary, we explore the current challenges that Black women face when pregnant and what is needed to ensure an anti-racist approach to prenatal and p...

In their target article, Zamina Mithani, Jane Cooper, and J. Wesley Boyd make a compelling case for the importance of “counter storytelling” in bioethics. They obse...

As the twin pandemics of COVID-19 and state violence against Black Americans dominated our national landscape in the spring of 2020, many in medicine, nursing, and public health made renewed calls...

In this commentary, we take up Yearby’s call for racism-sensitive research and apply this to the discourse regarding race and diversity in COVID vaccine research. We consider whether efforts...

Events in the US in 2020 have laid bare the reality that racism and its effects continue to take a heavy toll on the lives of Black Americans. The three articles in this issue of AJOB each provide...

Liao and Carbonell explore how oppressive medical technologies constitute materiality insofar as they reflect past oppression, embody oppression in the present day, and carry oppression into the fu...

In this article, I begin by describing what I call this Black Lives Matter moment in the US. I then offer three reasons for considering racism as a bioethical issue, the least discussed of which is the way in which racism acts as a barrier to the creation of better healthcare systems. Next, I argue that the concept of race itself constitutes a bioethical issue in a way that is not fully reducible to racism. Finally, I discuss how we, both (...) bioethicists and health care professionals, might meet this moment by identifying individual points of responsibility (beyond liability) for structural injustice. (shrink)

Research into epistemic injustice, the practice of discrediting people as knowers based on their social identity, has gained broad popularity in ethics. Racism in medicine often mani...

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

“Ignorance,” Jim Hudson, the art dealer, declares shortly before the climactic scene in the 2017 film, Get Out. “They mean well, but they have no idea what real people will go through”...

This commentary discusses how racism can be perpetuated in two of the areas discussed in Sabatello et al: research for identifying remedies and contact tracing. Racism is a social system where the...

Bioethicists in healthcare institutions have the skills and insights and can and must facilitate and promote measures that address deeply ingrained structural issues that exacerbate health inequity...

Earp et al. provide a robust justification for the decriminalization of drugs based on the systemic racism that fuels the “war on drugs” and the ongoing harms of drug policies to individuals...

In a plenary presentation on structural racism at the 2019 American Society of Bioethics and Humanities Annual Meeting, invited speaker Mary T. Bassett asserted that there is no solidarity without...

Racial inequities in medicine are the consequence of intersecting, multidimensional factors. As detailed in the articles by Braddock, Mithani, Cooper, and Boyd, and Yearby, the...

There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes, provider bi...