Professional Documents
Culture Documents
DOI 10.1007/s10903-008-9210-y
ORIGINAL PAPER
Abstract Race and racism has been increasingly implicated in known disparities in the health and health care of
racial, ethnic and cultural minorities groups. Despite the
obvious ethical implications of this observation, racism as
an ethical issue per se has been relatively neglected in health
care ethics discourse. In this paper consideration is given to
addressing the following questions: What is it about racism
and racial disparities in health and health care that these
command our special moral scrutiny? Why has racism per se
tended to be poorly addressed as an ethical issue in health
care ethics discourse? And why, if at all, must racism be
addressed as an ethical issue in addition to its positioning as
a social, political, cultural and legal issue? It is suggested
that unless racism is reframed and redressed as a pre-eminent ethical issue by health service providers, its otherwise
preventable harmful consequences will remain difficult to
identify, anticipate, prevent, manage, and remedy.
Keywords Racism Ethics Health care
Health services Health professionals
Introduction
Health care ethics, by its very nature, involves values,
views, and propositions that invite and provoke controversy. Ethical issues such as abortion, euthanasia/assisted
M.-J. Johnstone (&)
School of Nursing, Faculty of Health, Medicine, Nursing
and Behavioural Sciences, Deakin University, 221 Burwood
Highway, Burwood, Melbourne, VIC 3125, Australia
e-mail: megan.johnstone@deakin.edu.au
O. Kanitsaki
RMIT University, Melbourne, Australia
suicide, end-of-life decision making, reproductive technology, genetic engineering, to name some, are all familiar
subjects of debate and disagreement in the health professional literature. A less familiar topic in health care ethics,
however, is that of racism. Just why racism as an ethical
issue has been overlooked in health care ethics discourse is
a matter for consternation.
Racism is a highly charged moral issue [1]. When
allegations of racism are made, even when justified, the
people concerned tend to respond with deep moral outrage.
Racism is also emerging as a highly charged health care
issue. Racism and its counterparts xenophobia, prejudice
and discrimination are being increasingly implicated in
racial and ethnic disparities in health and health care [2],
and in disparities in the safety and quality of health care of
ethnic minority groups [37]. As Smedley et al. [2, p. 494]
observe the racial experience has been, and remains, the
most intense in discriminatory levels and differential outcomes, especially with regard to health and health care.
When suggestions are made that racism is at least
implicated in, if not casually related to, racial and ethnic
disparities in health and health care, health service providers and researchers alike have tended to reject the idea
that racism is a problem here and instead have emphasised as causal explanations:
cultural and language barriers, a lack of consumer
health literacy and knowledge about health and social
support services, the impact of geographical location
and circumstances of migration on migrants financial
circumstances, service provider cultural insensitivity
and lack of cultural competency, a lack of agreed
standards guiding the delivery of culturally and linguistically appropriate services, and a lack of
understanding among community and government
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490
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491
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492
been termed elsewhere as the health care illusion of nonracism, which is defined as an illusion that rests on the
frequently articulated belief that there is no racism here
and racism is not an issue anymore [18, p. 178]. The
basis of this illusion and the reasons for its durability are
complex. Nonetheless, we suggest that the following processes have played a significant role in maintaining this
illusion: a misguided view among health service providers
of health care being an institutional culture of no culture;
the deeply conservative nature of medicine and allied
health professional cultures; a biased tendency by some
health service providers to misperceive and overestimate
their capacity to be ethical; moral passivism; and the
implementation of Trojan horse cultural diversity policies
in health care. These processes are summarised below:
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Racism as Whistleblowing
Proposing the existence of racism and racialized practices
in health care is an inherently risky thing to do. This is
because such a proposition is a form of whistleblowing.
The risks of such whistleblowing can be far reaching.
Among other things, drawing attention to the incidence and
impact of racism in health care could result in bad publicity, complaints, and costly legal proceedings by those
affected. Meanwhile, minority racial and ethnic groups
493
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494
Conclusion
This article has argued that racism as an ethical issue per se
and its moral implications for health service providers are
neglected issues in health care ethics discourse. In an
attempt to redress this oversight, attention has been given
to briefly exploring: what it is it about racism and racial
disparities in health and health care that these command
our deepest moral scrutiny; why racism per se has tended to
be poorly addressed as an ethical issue in health care ethics
discourse; and why, if at all, racism ought to be addressed
as an ethical issue in addition to its positioning as a social,
political, cultural and legal issue. It has been suggested that
unless racism is reframed and redressed as a pre-eminent
ethical issue by health service providers, its otherwise
preventable harmful consequences will remain difficult to
identify, anticipate, prevent, manage, and remedy. Health
care professionals in turn will find themselves in a less than
ideal position from which to ensure that their clinical
encounters with others (whose cultural life ways and
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