How should we set up structures and systems such that marginalized groups receive equal care?

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Women paint their bodies in red as they take part in protest against white supremacy in front of a statue of Dr. J. Marion Sims on the the upper east side of New York City.- Edwardo Munoz

 

Introductions + Link to Video!

Overview & Context 

I don’t believe I need to explain why racism is an issue. The concept of race, as controversial as it is, has been widely regarded for some time as an impractical way of categorizing humans. Biological racism, the belief that there is empirical proof of certain members of geographical locations being inferior or different to others, has been used throughout history to justify heinous acts. While we are all aware of the disturbing history of slavery and Jim Crow and so forth, it would seem that America’s history with racism is far beyond us, when truthfully, it is embodied into every existing system today. Medicine, more specifically, gynecology, is one specific world in which we can quickly identify significant inequalities. We can look to one nineteenth-century case to being to peer into what discriminatory issues Black Women continue to face today. 

Deemed “The father of gynecology” nineteenth-century gynecologist James Marion Sims developed critical tools and surgical techniques for women’s reproductive health. Within his lifetime, he was also named president of the American Medical Association and later the president of the American Gynecological Society (Holland). His legacy has been marked by innovation and success. He did not achieve any of this alone, however. Sims conducted his pioneering experiments on enslaved Black women, without the anesthesia that was made available at that time. Here, Sims exposes some of the ethical dilemmas we continue to see with BIPOC today. 

 

The main principles of bioethics can be summarized as such: autonomy (voluntary consent with adequate disclosure while competent), beneficence (intent to do good), non-maleficence (avoiding harm), and justice (fairness, equality). In his autobiography, Story of my life, he recalls negotiating with the women’s slave owners in order to use them for this experiment; therefore, none of the women were able to give their full consent. Because of the vulnerability of their position, they were not in a position where they could refuse to be a part of the experiments. Additionally, Sims does not elaborate on what experiments he was conducting, meaning that the women were not properly informed, and thus, unable to give him full consent. As far as Sims’s intent to do good, he was conscious of the traumatizing pain the women would face when he neglected to give them anesthesia. He writes in his book,” Lucy’s agony was extreme. She was much prostrated, and I thought that she was going to die. … After she had recovered entirely from the effects of this unfortunate experiment, I put her on a table, to examine.” Here, he explicitly details how he caused unnecessary injury to the women’s bodies. This counts as a gross violation of beneficence and nonmaleficence, but also one of justice. When performing similar procedures on wealthier white women, later on, he makes the decision to use anesthesia. By providing a better quality of care to those of different social statuses, his discrimination infringes the justice theories of equality, need, and responsibility.

 

So how do Sims’s unethical practices relate to women today?

With modern medicine, pregnancy-related deaths are preventable but have plagued BIPOC communities for centuries. Black women are two to three times more likely to die from pregnancy-related complications than their white counterparts. Pregnancy-related complications are defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy (CDC). 

 

 “The nursing culture is white, middle-class, and female so is largely built around that identity. Anything that doesn’t fit that identity is suspect,”

In addition to the other forms of systemic oppression that exist against BIPOC, a healthy mother is no match for neglect in health care. As a part of a story, NPR and ProPublica were able to collect stories of over 200 Black mothers, who all recall feeling neglected or mistreated during pregnancy: 

“The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB-GYNs in her seventh month, only to suffer a fatal postpartum stroke. Over and over, black women told of medical providers who equated being African American with being poor, uneducated, noncompliant and unworthy,” (Martin, Montague, 2017) 

This neglect oftentimes results in Black patients’ pain not being taken seriously or being completely ignored (Remember Sims?)…

(See minutes 10:00- 16:00, long video, but very interesting if you get the chance)

What can we do?

While it might seem difficult to imagine systematic change at this exact moment, as young people, as future doctors, policymakers, and citizens, we are capable of inciting change in our own lives. By identifying and addressing our own biases, privileges, and ignorance, we are primed to receive information that will help engage with society in a meaningful way.  Through establishing a foundation of open-mindedness and tolerance, it will become easier to find other faults in existing systems and eventually discover new solutions. As to how we can set up structures and systems so that marginalized groups receive equal care- I believe that the world of medicine will have to prioritize benefice over everything else. While it might seem as if health care does already value beneficence, I believe that it will have to do so at a deeper level so that aspects like limited resources and profit are no longer factors. I can imagine that economically, significant change will need to occur in order for there to be decent access to medical resources across the nation as well as education reform so that practitioners are able to utilize those resources properly. Because all systems are related, finding solutions to these unethical practices will be nothing less than complicated. However, I believe that as a woman of color myself, I have the opportunity to take my own experiences and reflect on the ways I can become a better ally to other communities. Personal reflection and understanding are the first steps to addressing these issues.

Let’s Get Started! 

Feedback! 

  1. Have you experienced/ witnessed neglect from a medical practitioner? 
  2. Can you name a moment when you had made an assumption about someone based on their appearance? How do you personally work on combatting harmful preconceptions? (Don’t be shy! We’ve all had these moments, it’s important to address them!) 
  3. If you took the quiz, what did you learn from the activity? Were you surprised about your results?

Works Cited

Thank you!

 

 

2 Comments

2 comments

  1. Hi Bethel! – I the topic you chose for your project. It is very unfortunate that marginalized groups don’t receive equal healthcare and it is important that we raise awareness about this issue and hopefully bring change within our society. I love how you included a quiz as it was pretty interesting especially to see the most common results.

    1. Have you experienced/ witnessed neglect from a medical practitioner?
    No, thankfully I have never experienced neglect from a medical practitioner but I have heard about neglect multiple times specifically towards black women. I have heard stories of Black women being denied service because they are “over-dramatic” or “not really in pain” which is sad because as a Black person myself this could potentially happen to me in the future.

    2. Can you name a moment when you had made an assumption about someone based on their appearance? How do you personally work on combatting harmful preconceptions? (Don’t be shy! We’ve all had these moments, it’s important to address them!)
    I definitely have made assumptions in the past but I understand why this is wrong because we can’t just look at someone for a couple of minutes and just assume that they are a bad person especially without getting to know them. You can also put yourself in their shoes, as I am sure that you wouldn’t want others to make preconceptions about you.

    3. If you took the quiz, what did you learn from the activity? Were you surprised about your results?
    My results suggest that I have no automatic preference between African Americans and European Americans. No, I was not surprised by my results. At the bottom of the page, there was a graph showing the most common responses and it said that most people preferred white people over black people. I was honestly not surprised by this but it is sad to see how people attribute one’s race to all these negative qualities.

  2. Hi Bethel, thank you so much for doing this project. This is a topic I have read about only once in class then had to research it myself. This topic NEEDS to be discussed, focused on, and changed. The US health system needs a complete re-build because, like you brought up with the father of gynecology, it is founded on terrible people and values.

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