By Sharon Kelly-West –
As a registered nurse, I am also a clinical ethicist.
When we think or hear of ethics, we tend to think of how one ought to behave, or how we judge the actions of others. We hear or make such statements as, “What she (he) said or did was unethical.”
We also tend to use the terms “morality” and “ethics” interchangeably when the actual context is different. Morality focuses more on personal values, beliefs, standards—and how one might apply those values to judge others’ behavior. When we hear someone say, “That violates my moral compass,” what they mean is that your behavior violates those things I hold to be true. It violates my standard.
Why am I speaking about this? I have been pondering the best approach to this topic of medical ethics since first hearing of Coronavirus/COVID-19 making its mark on US soil, and learning from the dreaded news reports of global restrictions and protections that are in place.
As best approaches to prevention and eradication are being written and re-written moment by moment, I must admit, I cannot help but think of those whose history with medical institutions—inclusive of the public health sectors—have not been exactly heartwarming.
The fiasco of Katrina and other such catastrophic encounters left remnants that in many cases, are still present today in most minority communities. I remember the sluggish responses to restore services in those communities, compared with the speed of restoration in non-minority communities. I reflect on the similar pace of restoration in Puerto Rico following Hurricane Maria, versus the rebuilding of non-Hispanic communities on the mainland. We should also not forget the historic Tuskegee Study and the medical deception that targeted an African American community years ago.
The threat of this happening again continues to weigh heavily in the collective consciousness of African Americans today.
That threat is crystallized in the proverb, “What we learn from history is that we don’t learn from history.”
The historical context makes clear that certain communities will be viewed as “the least of these,” will be deemed to have little value to the nation based on race, ethnicity, income, or zip codes. What we witness today—an entire cultural and institutional structure that devalues such communities—is the direct result of behavior that has long become ingrained as standard policy and practice. That structure invariably directs the course of action in the next crisis—including the one we face today.
Therefore I am concerned. During this time of pandemic frenzy, who will be the first to be eliminated as not being eligible—or worthy—to access the limited supply of resources, including intensive care resources? Who is writing the criteria that will prioritize those who will receive needed resources? Who will monitor institutional behavior to ensure there is “fair” and compassionate distribution of resources?
Remember, minor community groups (minorities) are not starting from a point of advantage. At a time when rationing of resources may come into play more dramatically, medical professionals will look at those folks with the highest chance of therapeutic success (those who could survive and recover fully). With a documented history of premature deaths due to diabetes, lung disease, heart disease, and many more diagnoses that plague the black community, will there be compassionate and fair distribution?
African Americans are 60% more likely to be diagnosed with Type II Diabetes than non-Hispanic white adults. Hypertension is diagnosed more frequently in African Americans than non-Hispanic whites, and the treatments tend to not be as effective in African Americans. (This disparity is not due to myths that black people respond differently to treatments, but black people and other minor community folk are valued differently when it comes to treatment options. The culprits tend to be provider bias, patient bias, and the influence of societal implicit/explicit bias.) Lung disease, including lung cancer, tends to be diagnosed later in African Americans than in non-Hispanic whites, limiting treatment options; therefore mortality is more likely.
When folks become chronically ill sooner in life than their white counterparts and die at a younger age due to stress from bias, prejudice, behaviors, and racism, can we be optimistic that somehow, this time, the system will work in our favor to receive fair and compassionate care?
Who will speak for us? Who is at the table as this moving target continues on its journey? Who is advocating for the voiceless? Who is triaging and tracking data of those who are actually getting tested? What does the data capture other than age, gender, location? Does it capture race and ethnicity data?
Who is ensuring that information is reaching all our communities? Who is checking to ensure the information is received timely? What if there is no transportation to access resources? Is there a plan, or does a person just miss out because they have no transportation? With the limited number of test kits available, are test locations intentionally accessible within or near communities of color?
Perhaps this is our moment—a wakeup call that it is time for us to be Buncombe Strong.
Think of those who are considered the least, the least likely, and the lesser than. Those without a voice to be heard and a presence around the table must not be ignored as decisions are made. Let us not assume equity is being demonstrated across the board. Ask questions of those who have the power to ensure compassionate and fair access in our community. Even if you are not a member of that ethnic and racial community—especially if you are not!—ask questions that will remind those who are making the decisions that we are Buncombe Strong. It starts with us.
Mother Teresa states: “Live beyond yourself.” I say: “Care beyond yourself.”