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Posted on June 5, 2020 at 12:57 AM

by Craig Klugman, Ph.D.

“What can bioethics do to help with the racial injustice” is a refrain that I wish I heard more in bioethics. When COVID-19 entered the stage, bioethicists—myself included—tripped over each to put out special journal issues, write OpEds, work with the media, set up webinars, and advise governments at all levels. The response from the George Floyd killing and protests against racial injustice have been quieter.

Racism is a health issue. Racism is an ethics issue.

Narrative ethics seeks to understand the stories of a case. Who are the characters? Who is the antagonist and protagonist? What language is used? What is the plot? What are the symbols? What are the themes? Let’s take a case from this week when Donald Trump walked from the White House, across Lafayette Park, to St. John’s Church. His picture was taken holding a bible.

Fox News, America’s conservative information source, offered this headline, “Trump Vows To Mobilize Federal Resources In Address To Nation, Makes Surprise Trip To Church That Caught Fire”. The story then begins, “On Monday night, the president visited St. John’s, holding up a Bible and posing for a photo outside the church which caught fire Sunday night. Prior to his visit — and a mandated curfew in the city — law enforcement took steps to move protesters out of Lafayette Park.” The hero in this story is clearly Trump who is shown as a man of religious faith, visiting a damaged church before a curfew was in place. We see that “protesters” were “moved” from the park for violating the curfew. This story insinuates that the protestors brought this on themselves. “Took steps to move” is quite a passive phrasing: No mention of tear gas; no mention of weapons or combat gear; no mention of force.

MSNBC, American’s liberal information source, offers this take, “Trump visits church after police clear protesters with tear gas” and then explains, “Willie Geist recounts Monday’s timeline where police backed by the National Guard stormed into a peaceful protest outside the White House and scattered a large group of people to clear a path for a Trump photo op.” In this version Trump is the is the monarch who needed a clear path for his photo op. The insinuation is that he ordered police and the National Guard (though Barr has taken the blame for the order—someone who doesn’t have the authority to order the Guard) to “storm” a “peaceful” protest (heroes) using tear gas. The image is one of violence and an exercise of autocratic like power to move the people out of his way for a “photo op”. This term, as opposed to Fox News’s “posing for a photo”, has a negative connotation, that the whole event was a vanity project of the President.

NPR, which is often cited as the U.S.’s most fact-based reporting outlet (and considered liberal leaning by others), says this, “Peaceful Protesters Tear-Gassed To Clear Way For Trump Church Photo-Op”. They explain, “The plaza between St. John’s Church and Lafayette Park was full of people nonviolently protesting police brutality late Monday afternoon when U.S. Park Police and National Guard troops, with the use of tear gas, suddenly started pushing them away for no apparent reason. And then it became clear. President Trump wanted to walk from the White House through the park to the Episcopal church.” This story has many villains including Trump, park police, and the national guard. The victims are the “peaceful protestors”. The hero is Geist, a television personality, bravely relaying his story, like the survivor of a siege. This version uses more drama to create a heightened sense of outrage by saying protestors were “pushed away for no apparent reason”. The next very short sentence (paragraph in the original) makes the tension palpable—because Trump want it. The actions of the president are described to evoke the privilege of kings and emperors. This story also raises irony—a protest of brutality was broken up through brutality.

On Breitbart, a right-wing content agency, the event was mentioned only briefly, in reporting on a CNN commentator’s statement. The headline read, “CNN’s Sellers on Trump Using Tear Gas to Move Protesters: ‘George Wallace Is Probably Looking Up at Him with a Smile’.”  The event is made light of but mostly ignored.

One other notable observation from these comparisons is that these are all stories told by male, white reporters. Narrative ethics teaches that we have to be careful about who tells the story. When a physician tells a patient’ story, is it jointly authored, is there consent, is the physician usurping the narrative? Those with power tell the stories.

Another way to ask about this question of power is through another bioethics perspective: Feminist bioethics tells us to look at the power structures and how they are used to diminish, control, and belittle. Our current administration and members of its party have consistently worked to remove power and voice from people of color, people who live in poverty, women, and scientists. Efforts to disenfranchise voters and to spread lies and to obfuscate the truth have diminished democracy and demeaned most people in this country. What we have experienced is a continuing power grab without shame. What has filled that vacuum is divisiveness and fear. When a president uses his military might against the people of the country that he is sworn to protect, feminist bioethics tells us that power is being misused and abused. This perspective also points to the lack of engagement on issues of race in bioethics and a lack of diversity in the field.

The story of power is located in American history where suppression and discrimination of Blacks was a response to the end of slavery and fears that the more numerous former-slave population could rise up against former slave holders. The story of power is located in a federal effort to sell off extra and outdated military hardware by militarizing civilian police forces beginning in the 1990s. The story of power is urban renewal projects that displaced communities of color and built highways right through their neighborhoods separating them from more prosperous parts of cities. The story of power is one that created a war on drugs and then imprisoned black men more than any other group. The story of power is one that enacted redlining to keep blacks away from middle class and upper class white neighborhoods. The story of power is one that continues to underfund schools in black neighborhoods and where the decreased state and federal spending on education disproportionately impacts these communities where parent booster groups cannot make up the difference. This is a story of a capitalist system of medical care and fulfilling basic needs that leaves Black communities in medical and food deserts.

This is what bioethics can do. We can put aside our historic focus on high technology and one-on-one medicine for a time. We can adopt a more public health stance and learn about the social determinants of health. We can host webinars on health in minority populations. I am adding my voice to the chorus saying things have to change so that the burden of arguing for social justice is just not the work of our minority colleagues alone.

We must use our tools of analysis; of facilitation and mediation; of education; of understanding theory, law and policy; and of talking about the really hard issues to identify what is going on behind the stories; what are the values and virtues in play and how can we find ethical solutions. Although the idea of advocacy is controversial in bioethics. we should advocate for not only greater access to voting, but to register more voters. We must vote for and support political candidates who are in favor of equity, universal health care, better education, civilian oversight of police, and shared democracy. We must educate our children, our students, and our families. We must support businesses that represent these values and frequent banks that do not automatically label people of color as risky investments. We must support affordable housing initiatives, push our institutions to hire more minorities into positions of authority and seek to have more diversity in our classes and among our ranks. We must also question ourselves and our reactions (a.k.a microaggressions) to everyday encounters.

And we have to do all this while also keeping ourselves and others safe from a pandemic. The question is not “what can bioethics do” but rather “what will bioethics do?”

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