Introduction
Racism, rather than race, is a social determinant of health. Black and Latino populations are disproportionately affected by some diseases due to inequities in factors such as income, housing, and education that are sometimes driven by racism. Additionally, the beliefs held by healthcare professionals regarding race could be the reason why one person receives quality healthcare and another does not receive care at all. This paper explores the ethicality of racism in healthcare from various ethical theories and bioethical principles. It also explicates how the nursing profession and the law address this concern. Racism in healthcare is unethical because it denies equitable care to some populations.
Ethical Theories and Principles
The issue of racism in healthcare can be evaluated from various ethical theories, including utilitarianism and virtue ethics. According to the utilitarian ethical theory, an action is ethical if it brings happiness and maximizes utility for the greatest number of people (Häyry, 2020). The theory would be concerned about the ethicality of racism in healthcare because discrimination adversely affects some people’s health. For example, racism denies some people access to services and leads to poor health outcomes. The virtue ethics theory holds that an action is ethical if it reflects moral values such as honesty, empathy, kindness, integrity, and fairness. The theory would question whether racism in healthcare is ethical and whether it facilitates the provision of care in a manner that is centered on values such as compassion, fairness, and integrity.
Racism in healthcare can also be considered from the perspective of ethical principles. The bioethical principle of beneficence requires medical professionals to take actions with the intention of promoting the wellbeing of their patients (Avant & Swetz, 2020). Racist healthcare providers do not take actions that benefit their patients. For example, failing to prescribe necessary painkillers to a Black person because of the belief that Black people are more susceptible to painkiller addiction goes against the principle of beneficence.
Another bioethical principle is non-maleficence, which is a call for medical professionals to do no harm to their patients. Racism harms people in the form of late or no diagnosis, lower life expectancy, and harmful stereotypes. The principle of non-maleficence would argue against racism in healthcare. On the other hand, some people would argue that healthcare professionals do not intentionally harm their patients. For instance, many incidences of medical racism stem from implicit bias (Iheduru-Anderson et al., 2021). However, ignorance is not an excuse for harming a patient because nurses and other professionals have a duty not to harm their patients. Therefore, it is their responsibility to unlearn such unconscious bias that result in racism in healthcare.
Nursing Codes
The nursing profession, through various codes, advises nurses how to approach ethical concerns arising from racism in healthcare. The CNO consists of six main principles by which nurses should abide (College of Nurses of Ontario, 2019). The first principle requires nurses to treat patients with dignity. They should treat them with care, compassion, and respect for their identity. They should also disburse care that is free from judgment and discrimination. Additionally, nurses are advised not to impose their personal biases and beliefs on patients. Racism in healthcare goes against the first CNO principle because it defies all these values. The second principle promotes collaboration among nurses to address gaps in healthcare that impact health outcomes and patient care (College of Nurses of Ontario, 2019). Addressing racism in healthcare is one way nurses can put this principle into practice. Other principles require nurses to provide safe and competent care to gain and maintain patient trust. By dispensing equitable care regardless of a person’s race, nurses will increase trust in the healthcare system.
The Canadian Nurses Association (CNA) echoes the values and principles contained in the CNO. For instance, it emphasizes the importance of safe, competent, compassionate, and ethical care (Canadian Nurses Association, 2017). When nurses strive to provide this quality of care, they ensure that their practices are free from racism. Additionally, the Code advocates for justice in the provision of care (Canadian Nurses Association, 2017). Racism in healthcare denies due justice to people of certain races, such as Black and Latino people. Finally, the Code advocates for transparency and accountability in nursing practices. This means that nurses are responsible for unlearning implicit biases about race. The various codes that guide the nursing profession have principles that help nurses navigate ethical concerns concerning medical racism.
Social Justice and Legal Considerations
Social justice is a concept which asserts that people should have equal access to economic, political, and social services and opportunities. More precisely, “Social justice includes full and equal participation of individuals in all social institutions; fair, equitable distribution of material and nonmaterial goods” (Abbott, 2014). Racism is a social justice issue because it denies people fair and equitable access to a nonmaterial good, that is, healthcare. Healthcare is a social service, and in an ideal world, people should have fair access to it regardless of their race. When race is a factor that influences the quality of care a person receives, it goes against the concept of social justice.
There are many laws and statutes that pertain to racism in healthcare. For instance, one of the human rights according to the United Nations Universal Declaration of Human Rights is the right to no discrimination. Every person is entitled to their rights and freedoms without consideration for factors such as race, sex, color, religion, or political opinion (Tisdale & Symenuk¸ 2020). This implies that racism in healthcare violates the human right to fair treatment. Additionally, all persons have the right to social service, which includes basic necessities such as food, housing, clothing, security, and medical care. When people are provided with poor quality care or none at all, it violates their right to social services. Additionally, all provinces in Canada have human rights commissions that have codes that forbid discrimination (Tisdale & Symenuk¸ 2020). One such example is the Ontario’s Human Rights Code that provides for equal opportunities and protection from discrimination. The Nursing Act and the Regulated Health Professions Act, which regulate nursing in Ontario, do not have information regarding racism in nursing.
My Values, Values, and Religion
My practice as a nurse is based in values such as compassion, quality care, and justice. I aim to provide high-quality care to patients regardless of factors such as age, sex, or race. This means that racism in healthcare goes against my beliefs. I also believe in extending myself when providing care. This means that I go above and beyond to ensure patients are contented with the care they receive. If I were to treat patients differently based on their race, some patients would not be happy with my services. Additionally, in my culture, sick people are taken care of by the community until they feel better. Everyone is considered a valuable member of society who must be nursed back to health when they are sick. Therefore, racism in the provision of healthcare goes against my core values, beliefs, and culture.
Ethical Framework
To make a decision regarding my ethical concern, I would use the Oberle and Raffin model. First, I would assess the situation as well as relationships, beliefs, goals, and values (Canadian Nurses Association, 2017). Second, I would then evaluate potential actions. One option is to provide care to a patient without regard for their race while the other is to differentiate patients based on their race. Third, I would select an ethical action that maximizes good. The first option would ensure everyone receives equitable care and is the action that would maximize good. Fourth, I would evaluate whether I am acting ethically by analyzing whether my decision is according to the Code and professional standards. Finally, I would reflect on my action by considering whether I reported it through the appropriate channels. I would also assess how people were affected by my decision, whether I could have done anything differently, and whether the outcomes of my decision are acceptable.
Conclusion
Medical racism results in healthcare inequality that negatively impacts the health of certain populations. It leads to these people having poorer health outcomes and experiencing differential treatment due to stereotypes. From the perspectives of ethical theories such as utilitarianism and virtue ethics, racism in healthcare is unethical. It also goes against the bioethical principles of non-maleficence and beneficence. Consequently, there are nursing codes that have guidelines on this ethical concern. There are also laws and legislation against discrimination of persons. Aside from the professional codes and legal mandates, my personal beliefs and values are against providing subpar treatment to a person because they are of a certain race. Racism in healthcare is an ethical concern that all healthcare professionals should strive to eradicate.
References
Abbott, K. (2014) Social justice. In Michalos A.C. (ed) Encyclopedia of quality of life and well-being research. Springer, Dordrecht.
Avant, L. C., & Swetz, K. M. (2020). Revisiting beneficence: What is a ‘benefit’, and by what criteria?The American Journal of Bioethics, 20(3), 75-77.
Canadian Nurses Association. (2017). Code of Ethics for registered nurses. Canadian Nurses Association. Web.
College of Nurses of Ontario. (2019). Practice standard: Code of conduct.
Häyry, M. (2021). Just better utilitarianism. Cambridge Quarterly of Healthcare Ethics, 30(2), 343-367.
Iheduru-Anderson, K., Shingles, R. R., & Akanegbu, C. (2021). Discourse of race and racism in nursing: An integrative review of literature.Public Health Nursing, 38(1), 115-130.
Tisdale, D., & Symenuk, P. M. (2020). Human rights and nursing codes of ethics in Canada 1953–2017. Nursing Ethics, 27(4), 1077-1088.