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07/13/2016

Where’s the Social Justice?

by Craig Klugman, Ph.D.

Picking up a newspaper or clicking to your favorite news site could lead one to believe that the U.S. is entering a civil war along racial divides. For 6 days in a row in Chicago, protestors have marched against police brutality—specifically police shooting young, black men. Then a former soldier tried to kill white cops in Dallas. And a shooting inside of a gay club in Orlando takes many LGBT and allies lives. The news media has drawn this debate as a racial one—cops targeting minorities; minorities targeting minorities; and the disaffected targeting law and order. At the heart of all this violence is social injustice—poverty, stigmatization, and a growing acceptability of uncivil discourse.

So where are the voices in bioethics arguing for social justice? Where are the OpEds and special journal issues looking at gun control, improving schools, destigmatizing social conditions? Where is the support for urging Congress to remove the federal ban on gun research or declaring violence a public health issue? Instead we write letters urging the IOC to cancel the Olympics based on concern about Zika (a move that financially and politically is unlikely to happen. Although this makes great press, it does not really change lives. And to be transparent, I did sign that letter). I do not read all of the literature, but as a scholarly group that has a strong public presence, we have been remarkably silent on these issues. This lack of interest in larger social issues has even led some individuals to resign from ASBH.

Derek Ayeh, a masters student at Columbia University has asked this question in his column at Voices in Bioethics. Specifically, Ayeh asks why there is such silence on cases that are specifically about medical care: Freddie Gray and Eric Garner. Kayhan Parsi recently wrote about how our society through social media seems to encourage and endorse anger without moral outrage, meaning we yell at one another but nothing really changes. John Hoberman in the spring issue of the Hastings Center Report asks this same question, why hasn’t bioethics engaged the issue of racism in medicine. He comes to two conclusions: (1) We tend to “other” racism in medicine, viewing it as something from the past or a result of colonialism; (2) only discuss race through fiction. Lisa Parker has written about bioethics origins in advocacy and how it now suffers from a privileged perspective. Keisha Ray writes about being a minority in bioethics and how she is interviewed simply for the way she looks or is expected to write about certain issues because of the color of her skin.

Bioethics writes a lot about the latest technological device. Consider a glance at the topics of bioethics issues on the newsstand now: turning off implantable devices, IRB in the military, advance care planning, relating to the disability movement, Kaci Hickox, views of professionals in clinical ethics, organizational ethics as part of clinical ethics, medical curriculum, fitness to practice, measuring quality in consults, among others. Yes, a few deal with larger social issues: quarantine, race among those requesting consults, and how disability influences health care. But on the whole, it is a small part of the dialogue.

One example of an engaged bioethics comes from Loyola Medical School where the bioethics group has undertaken medical dreamers, supporting undocumented students with a passion for medicine to be able to pursue those dreams.

To be sure, some critics of a call for a more social oriented agenda argue that the problem with bioethics is that it has become too interested in applied ideas and has drifted too far from stricter philosophy. Thus, there is concern that we have abandoned a rigorous philosophical foundation (perhaps a concern that philosophy does not dominate as it once did).

As bioethics has matured, we may have become a victim of our success. Having started as a revolutionary force—asking hard questions, looking at power imbalances, and advocating for patient’s right—we have been lulled by our (sometimes grudging) acceptance into the medical canon. Bioethics has been criticized for being American-centric, white, male, and financially privileged. What we lack are diverse voices from racial and ethnic minorities, from differently-abled communities, and from global perspectives. It is time to turn our critical lens to ourselves and ask what can we do to make the world a better place through our work.

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