Persistent Preventable Maleficence in Health Care: Where’s the Outrage?

Abstract: This Enrichment Hub will explore how structural racism and discrimination is a persistent cause of harm in medicine, and will question why healthcare staff and systems appear to accept the status quo. Our primary lens will be related to racism, but in the problem-solving phase we will promote consideration of all forms of discrimination. Our format will be in two parts. First, we will present background features that clarify our justifications, including:

presenting data about the persistence of bias in healthcare, including how racism violates each one of bioethics’ core “principles”. We will include contemporary examples of how systemically discriminatory institutions or systems regularly (still) fail their patients using their current mechanisms.

arguing that if a system is inequitable (and therefore unethical), the change agents should be those who least benefit from it. In health care, that responsibility belongs to those in positions of power, but also any health care professional who occupies any (or more) of the following identities: White, male, cisgender, straight, financially advantaged, or traditionally abled.

given the present political and societal landscape and its implications for deepening barriers among humans, we will balance maintaining semantic integrity – ie., calls to eliminate references to "diversity" or "inclusion" – with the value of actions and outcomes themselves, independent of their labels.

Second, we will facilitate a discussion, including small-group breakouts, to (1) provide an opportunity for self-reflection on practices and experiences and (2) construct strategies for enacting personal/professional as well as structural changes in participants’ systems or institutions.

Keywords: structural racism and discrimination, healthcare bias