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Posted on July 20, 2021 at 11:55 AM

by Keisha Ray, PhD

Originally presented at “Race and Bioethics: Amplifying Diverse Voices,” sponsored by Columbia University Bioethics. See it here: link

My co-panelists and I have been tasked with thinking about the ways that bioethics does, or in most cases, does not consider issues of race, including racism, and systemic health inequities. Although I am very happy to have this opportunity to speak about bioethics because it is something very dear to me, and I couldn’t see myself doing anything else, this opportunity feels like another moment where a bioethicist of color has to defend her work, her place in bioethics, and hope that White bioethicists see the value of her work and the value of Black bioethicists.

We know that most of bioethicists are White and arguable because of this much of the academic work we produce centers whiteness, White privilege, and a misunderstanding of the far reaching effects of racism on health. But now that bioethicists of color are starting to challenge the ways we research, write about, and teach bioethics, now bioethicists are putting the burden on bioethicists of color to prove that what we do is bioethics, essentially prove that we belong. But as I discuss gaps in how bioethics addresses race, or the perspectives that Black bioethicists and other bioethicists of color can bring to the field, I challenge you all to keep in mind that the value of our work does not depend on how well our work is received by White bioethicists. The value of our work does not depend on well we fit the guidelines of what is considered bioethics. Many Black bioethicists like myself, are bucking the traditions of bioethics that don’t serve us or populations of color. Instead, we are creating lanes in bioethics that allow us to do the work that we set out to do, to study and serve marginalized populations, to bring our perspectives to all of the typical topics studied in bioethics, and challenge the typical ethical and legal frameworks we have often so lazily come to rely upon. Bioethics can only hope to remain a relevant field of study if it opens the door to these new lanes, these new ways of doing bioethics, and thus embrace the diversity in thought bioethicists of color bring to the proverbial table.  

First, bioethicists are a principled bunch. Most of our theoretical and practical frameworks to some degree, rely on principles like justice. I think most bioethics believe justice in health care and justice in terms of health equity are important. Where we differ is what justice means, how it can be achieved, and for whom justice ought to be prioritized. This is one area where diverse voices can add to the field and keep it constantly evolving. We already talk about how justice may mean different things for different people but what we have given less attention to is what racial justice may mean in the different topics we study.

For instance, I’ve done some work on racial justice in cognitive enhancement, such as using stimulants and other drugs for a cognitive edge. Typically it is a White-washed field in that it begins from an ideal place, an ideal world where racism, inequality, and white supremacy don’t exist. For example, on the topic of using cognitive enhancing drugs to get a leg up on the competition for jobs ignores that there is racism in hiring. Therefore, Latinx and Black people may not support using cognitive enhancement for these career purposes because these drugs become another disadvantage on top of the ones they already have like systemic and personal racism.

The point I tried to make with this work is that racism touches all parts of POC lives and it can’t be ignored in research, especially research that intends to reflect the real world and people’s lived experiences. Without diverse people involved in all parts of research including publishing, peer-reviewing, editing, and presenting at lectures and conferences this kind of research that ignores diverse experiences gets ignored and left out of the profession.  And in a time when the public is demanding that science, literature, and other disciplines produce information that takes into account their diverse experiences, bioethics cannot afford to leave out diverse voices.

This also highlights another issue for bioethicists who study race and that is often our work is seen as siloed, or that our work in race should always be its own separate bioethical topic. But all topics in bioethics study the ethical, legal, and social realm of our lives, the lived experience, the health sciences, in other words the real world, and therefore intersect with race, racism, and racial justice. There is no topic in bioethics that can ignore race and racism. From how we are born, to how we die, and everything in between is a matter of race. Psychedelics, environmental justice, euthanasia, resource allocation, clinical trials, pediatric care, all of it intersects with race and racism because our institutions are racist, the people involved in the institutions and practices we study are racist and there are people whose lives are constantly affected by conscious and subconscious racism. Segregating race studies from all of these other topics in bioethics is misguided and shows an ignorance for how a lot of POC live their lives.

For diverse voices to enrich bioethics we have to make it possible for POC scholars to participate in the profession. We have to support and fund diverse graduate students. We have to hire diverse bioethicists and remove roadblocks. One roadblock that I have encountered that I know is common is the “what you do is not bioethics” roadblock. I have encountered this roadblock many times in the bioethics job market. I’ve had to defend my work beyond the normal academic criticism and defend the necessity of my work, that it belongs in bioethics, and that it is not better suited in public health or sociology, or another discipline. I have had to prove that I have something worthwhile to say that is beneficial to the profession

Calling work at the intersection of race and health, “not bioethics” is a not so subtle method of keeping bioethicists of color out of bioethics. If they can degrade our work and question its relevance then they can push us out and maintain bioethics racial homogeneity.

Secondly, along with supporting and funding graduate students, and viewing our work in race as work that makes us hirable, we also have to call upon journal editors to reshape acceptable practices in publishing and peer review.

During this time of racial awakening, namely because of Covid-19 and the racial inequities it revealed to people who were not paying attention before the pandemic, I have been reviewing many articles on race, racism, and health. I’m happy that these articles made it to the point in the process where the articles reached peer reviewers, but so much of it is bad because they

  1. Don’t engage any scholars of color who have already written on these topics (and yes, there are many) and
  2. Don’t call out racism–neither systemic nor interpersonal–and instead focus solely on race

I critique the articles and call out the authors for these problems and then a few months later I see the articles in a journal when they should have never been published.

Editors have a lot of power in our profession, in which we all must publish to sustain our careers. They have the power to facilitate making race more mainstream in bioethics and including more diverse voices in bioethics. They can demand that articles engage properly with literature on race and racism and that peer reviewers check for these things while reviewing.

This would be an institutional endeavor to address diversity in bioethics that also does not put the burden on POC bioethicists.

Diverse voices in bioethics are absolutely necessary for the relevance and longevity of bioethics. But we have to go beyond tokenism, beyond lip service and make changes to the ways we practice bioethics and make it an environment that diverse bioethicists want to be a part of. If we don’t then bioethics won’t survive the changing world.

But again, to recall what I said at the opening, POC bioethicists are not here to save bioethics. We are here to do the work we are passionate about and if bioethicists don’t see the value in that then we’ll keep doing what I’ve seen lately-that is creating separate journals, POC bioethicists giving other POC bioethicists job opportunities, hosting webinars and lectures on race and racism led by POC bioethicists, or even choosing to leave bioethics for other more welcoming fields or creating separate bioethics frameworks and practices such as Black bioethics, which I myself have written on and support. But it does not have to be this way. Bioethics can be more unified but that requires leaders in the field, center directors, department chairs and grant giving institutions to change the way they think about bioethics and bioethicists of color. But again, bioethicists of color are not going to wait for bioethics to get its act together.

Bioethicists of color who work on race are not here to prove themselves; instead I think it is bioethics who should prove that it is a place where we can thrive. Support our work and we will support bioethics.

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