Director’s Statement on Race, Trust, and Biomedical Ethics

The lethal violence inflicted on George Floyd by members of the Minneapolis police force has shocked the conscience of the nation and has spurred widespread protests about the pernicious persistence of racism in our society. As the Acting Director of the Kennedy Institute of Ethics, writing on my own but with the urging of many of our faculty, staff, and students, I join the voices that condemn police brutality and repudiate racism in all its forms, particularly as these affect the Black community.

Having lived six years at a church in Harlem, I witnessed close-up the toll that everyday acts of racism had on my community. While I can only imagine, and never fully experience, my neighbors’ pain, I remember the dismay I felt whenever I was denied a taxi ride home because of my address. I knew full well that it was not me, but those among whom I lived, who were the real targets.

The pain that racism inflicts is deep and real. The public reaction to the death of George Floyd bears witness to that pain and impels us all to look at our own attitudes, practices, and unconscious biases. The tragedy of his death might be an historic moment in which we can reflect together on how to build a better society. While the faculty and staff of The Kennedy Institute of Ethics have broad interests and expertise encompassing many areas in the field of ethics, our particular focus has been on biomedical ethics, and so I focus here on race and biomedicine.

I do so in particular because a recent poll by AP-NORC has shown that only 25% of Blacks would be likely to consent to a COVID-19 vaccine, less than half as likely as Whites and Latinx respondents. Especially in light of the differential impact that COVID-19 has had on the Black community, such a statistic is telling. It represents a deep distrust of the health care system.

That distrust is fully understandable. The legacy of abuse of the Tuskegee Syphilis study remains etched in African-American memory. Hospital wards in this country remained segregated longer than schools. Blacks continue to have less access to health care and worse health care outcomes than whites—facts made abundantly evident in the wake of Covid-19. Health care professionals have a moral obligation to understand the roots of such distrust and commit themselves to becoming worthy of the trust of all their patients.

We need a more just health care system, certainly, but justice is built on trust. And trust is eroded by bias. We need to listen.  We need to reflect on our institutional biases, and also on our own individual biases as educators, investigators, and health care professionals, and to take the corrective actions needed to become trustworthy. We need to commit ourselves to respecting the dignity of all our patients. Martin Luther King, Jr. said that he learned about dignity from his grandmother, who told him, “Martin, don’t let anyone ever tell you you’re not a somebody.” Respect for the dignity of our patients means treating every patient as a somebody. Bias clouds our ability to see the somebodiness of others, and makes us unworthy of their trust. George Floyd was a somebody, but he was treated as a nobody. We need a health care system free of the biases that discount the somebodiness of some of our patients. Only then will we be able to earn the trust of those who are not only sick, but also marginalized before they enter the exam room. Only by regaining trust can we begin the hard work of building a just system of health care.

Some of our faculty and staff have already begun to examine their own teaching and research for biases, especially racial biases, and to explore how they can be corrected. We all must do our share, incorporating concerns of social justice more explicitly into our writing and research, naming, examining, and speaking out against racism and other injustices that threaten the dignity of all. It will be important to engage in active listening and constructive change, in a spirit of reconciliation, and not just condemnation, lest the moment slip from our hands.

The foundation of medical treatment and research is trust; likewise, the foundation of a just society is trust. We must acknowledge that we have forfeited that trust among members of the Black community as well as other marginalized groups. We need to take steps to earn that trust if we are to build a more just society and provide nondiscriminatory health care for all.

Daniel P. Sulmasy
Acting Director, Kennedy Institute of Ethics