JBI Dialogues: Episode 5

JBI Dialogues: Episode 5

Institutional Racism, Whiteness, and Bioethics – Christopher Mayes

In this episode of JBI Dialogues, Dr Christopher Mayes talks about the journal’s new symposium Institutional Racism, Whiteness, and Bioethics. Chris is a Research Fellow in the Alfred Deakin Institute at Deakin University and a Research-Affiliate in Sydney Health Ethics at the University of Sydney. He is an interdisciplinary scholar with disciplinary backgrounds in sociology and philosophy. He co-edited the Institutional Racism, Whiteness, and Bioethics symposium with Professor Yin Paradies and Dr Amanuel Elias. Yin is Professor of Race Relations and Amanual is a Research Fellow, also in the Alfred Deakin Institute at Deakin University, Australia.

Institutional racism can be defined as differential access to power, resources, and opportunities by race that further entrenches privilege and oppression (Paradies 2016). Along with similar concepts such as systemic, structural, cultural, and societal racism, this form of racism profoundly shapes almost all aspects of our lives, including health and healthcare (Williams, Lawrence, and Davis 2019). Yet, racism more broadly and institutional racism in particular has been a neglected subject in bioethical discourse and scholarship (Danis, Wilson, and White 2016). Bioethics has the potential to make important contributions to anti-racist programmes and strategies addressing institutional racism, yet as scholars have argued, the “whiteness” of bioethics undermines its capacity to attend to institutionalized forms of racism (Mayes 2020; Russell 2016; Danis, Wilson, and White 2016). Catherine Myser argues that bioethics depends on social and ethical theories that normalize whiteness and that “we risk repeatedly re-inscribing white privilege—white supremacy even—into the very theoretical structures and methods we create as tools to identify and manage ethical issues in biomedicine” (Myser 2003, 2). As such, whiteness not only contributes to bioethical problems such as discriminatory patient care, but it shapes the reality of what is considered an ethical problem and the way bioethicists think ethically about such problems. To address institutional racism, and the compounding problem of whiteness, we need a bioethics that is reflexive and critical of whiteness and its relationship with institutional racism. This symposium brings together scholars and researchers from a variety of disciplines to examine how racism has been institutionalized in healthcare, how whiteness manifests in healthcare, and what bioethics can contribute towards anti-racism. In October 2019, we invited researchers to consider the following questions:

  • What are the historical and material processes that contributed to the institutionalization of racism in medicine and healthcare settings?
  • What role can Indigenous knowledges play in de-centering whiteness and addressing racism?
  • Does bioethics have a role in addressing racism or is it too entangled with histories of racism and whiteness?

The articles in this issue respond to these questions and articulate the affective dimension of race in clinical spaces, the economic and social costs of racialized health inequalities, the continuing effects of colonialism and complicity of bioethics in institutional racism.

Links Transcript

Edwina: Hello, and welcome to JBI Dialogues, presented by the Journal of Bioethical Inquiry as a multidisciplinary space to connect academic, professional and community voices in conversation. Today, we welcome Dr Christopher Mayes, one of the co-editors of the Journal’s new symposium, Institutional Racism, Whiteness and Bioethics. Chris is a research fellow at the Alfred Deakin Institute at Deakin University and a research affiliate at Sydney Health Ethics at the University of Sydney. He’s an interdisciplinary scholar with disciplinary backgrounds in sociology and philosophy. He co-edited the symposium with Yin Paradies and Amanuel Elias and joins us today to talk about that work. Chris, thank you for joining us.
[00:00:55] Chris: [00:00:55] Thanks a lot Edwina, nice to be here.
[00:00:57] Edwina: [00:00:57] Congratulations on the symposium to you and the co-editors, a nice feeling when that comes out and to share with everybody. I’ve wondered if you could take us back to the beginning though of the process and tell us about where the project emerged from. What were you and your co-editors aiming to do?
[00:01:15] Chris: [00:01:15] Yeah. So, I suppose, another area of my research interest is history. And sometimes when I’m asked questions of when things start, I have a tendency to go too far back, so I’ll try not to go too far back. I mean, for me, it, I guess one of the points that started for me was at the Australasian Association for Bioethics and Health Law conference at Townsville. I was asked to give a keynote presentation there. And I was sort of, you know, in thinking about what was I going to write on then I, in relation to some other work I’ve been thinking about race in the context of food and agriculture, and then started to think more about sort of race in the context of health and bioethics, and gave a paper on the whiteness of bioethics and, and was thinking about that.
[00:02:06] And, and the way, thinking about the way that a lot of the, I guess, moral philosophy that bioethics draws on comes from the liberal philosophical tradition. And I was reading Charles Mills work and critique of racial, what he took on terms of racial liberalism, and seeing the way that that is infused I think in a lot of bioethical reasoning. So the very sort of reality in which ethical theories, so not only what is an ethical problem, but the way and the ethics that we draw on, is shaped by a racial, social and political reality. That’s what Charles Mills was arguing. So I was looking at the way that that was occurring in the context of bioethics.
[00:02:49] And I wrote a paper which actually then didn’t get published in the special issue, but it’s, to give a plug to that, White Medicine, White Ethics, and that’s in the journal of Australian Studies. And around this time I was moving from, I think I had think I’d just moved from Sydney University to Deakin University and, and I was on a panel with Yin around, I think it was Close the Gap, and he was talking about institutional racism, which is an area of work that he’s done a lot on from a variety of perspectives, both in the context of health, but the economy. And so we talked about that after the panel and we’re just talking about similar interests and similar areas work. And he had been doing some work with Amanuel Elias, also at Deakin, on this, in the context of institutional racism and its economic costs in Australian society. So then we had a conversation about the possibility of putting together a special issue that would bring in both institutional racism and whiteness to the context of bioethics and the role of bioethics to address these things.
[00:03:58] So I think there had been a number of articles in different literatures about the need for institutional racism in medicine [to be addressed], so the way that racism is actually embedded in particular hospital or healthcare providing institutions, and how do we address this? And there were some people suggesting bioethics had a role. And then I was wondering, well, if bioethics itself is implicated in these sort of racist institutions, can it, what kind of role can it have? And so I guess seeing that, we’re sort of looking at our whole range of questions that go beyond our particular expertise and disciplinary expertise, wanting to call on other authors to contribute to a discussion about this. So that’s sort of, I guess, where the origins of the symposium came about.
[00:04:49] Edwina: [00:04:49] Great. That leads me to the next question, which is, as you say, you reached out to various people to be part of this. In your lead essay, you talk about posing some specific questions to those contributors. I wonder if you could tell us a bit about those?
[00:05:02] Chris: [00:05:02] Yeah, I should also add just, in terms of something that has been interesting and maybe this is will come up in one of your other questions, but in looking at, say, like at the moment, bioethics seems to be addressing these issues a lot more profoundly and in a lot more forums, largely due to the Black Lives Matter movement and also COVID exposing and exacerbating a lot of racial inequalities, both in society, but also in healthcare provision. And so it’s interesting, looking at the literature that in the early 2000s, there were a couple of key articles about racism and bioethics, and then nothing really much for a little while. And then in the late 2000s, there were a couple more articles. And, you know, I hope that this isn’t now just another blip in 2021: there’ll be a whole bunch, and then, nothing for another decade. So, you know, I guess the hope with the symposium is that it can be part of this broader conversation and, and lead to some, I guess, more substantive changes within the field.
[00:06:12] So the questions that we were asking people to respond to, but of course they weren’t limited to these questions, but things like how the effects of whiteness and institutional racism are differentially experienced by Indigenous peoples and non-Indigenous peoples of color. So I guess, you know, a lot of the North American literature focuses on the experiences of the Black community and the Black population, not exclusively, but that’s a sort of dominant focus, whereas Australia, we’re particularly, and we have a number of great contributions from New Zealand, wanting to sort of bring to the fore, the settler colonial context and the experience of Indigenous peoples in, particularly, I guess, you know, all the authors working in all the, all the co-editors working in Australian institutions, the experience of Indigenous peoples in medical and related areas. So that was, that was one question. What are the historical and material processes that institutionalize racism in medical institutions? What are the economic costs of institutional racism in health care? Cultural safety programs and continuing medical education able to address the effects of institutional racism. So these are cultural safety programs are something that are often put forward universities, hospitals, and elsewhere as a way to address these things. I mean, in Australian parliament at the moment, they’re talking about empathy training as a way to help some male members of parliament to relate to women. So yeah, looking at whether these sorts of training programs are effective. What role can Indigenous knowledges play in de-centering whiteness and addressing racism? And, does bioethics have a role or is it entangled with the histories of racism and whiteness? Some of the broad questions.
[00:08:02] Edwina: [00:08:02] Right. Rich. I mean, it’s, it’s difficult to ask you to focus in on an individual article, given the wonderful diversity of the contributions. But I wonder when you’ve sort of told us about where you sort of started it and posed those questions, as you say, not limited to those, but as, as they, as the contribution started to come together and as you’ve edited it together, where do you feel it’s landed in some of those spaces?
[00:08:28] Chris: [00:08:28] Yeah. I mean, you’re right in saying that it’s hard to single anything, any individual papers out. I think, I think we have been pleased in a way that there is, many of these themes have been addressed, sometimes in different ways. And sometimes in, I wouldn’t say, ways that clash or contradict each other, but certainly in ways that provide a certain generative friction, could be a way of putting it, that I think that these aren’t sort of simple and straightforward problems to be with simple and straightforward solutions. And nor are there, I think the other thing that was, you know, having contributions from New Zealand, Australia, North America, I think that was it. That’s always dangerous when you start sort of singling out these locales. I apologize if I’ve forgotten anyone. But it was, it’s interesting to see, you know, there was some papers talking about the New Zealand context and the importance or the role of the Treaty of Waitangi in New Zealand as a sort of basis and a reference point from which Indigenous and settler relations can be discussed and addressed. And in the Australian context where there is no treaty and discussions of a treaty, you know, just thinking about, Oh, how does that play out differently here in here in Australia?
[00:09:54] And then likewise, some really, powerful, articles sort of critiquing the premise of some of the questions and some of the symposium, which, which is always nice, you know, it’s, it’s nice to receive it and something that we weren’t expecting as well, I guess in not wanting to limit it to the, the terms and conditions that we put on the questions, but to, to have people have the opportunity to reframe questions and reframe the issues as they saw fit and important to particular context that they wanted to address. Yeah. So I think, yeah, we’ve been very pleased with the way the symposium has come together, and disciplinarily, I guess I should also mention that, you know, there’s not really many authors on here would be, would consider themselves or be considered sort of straight up bioethicists, whoever they are. I don’t know. They need to step forward because I’m always confused as to who’s a straight up bioethicist. And so bring in sort of disciplinary insights, which have been really fascinating and important to read as well. So, you know, health, law, constitutional law, philosophy, medical humanities, health economics, a whole range of perspectives, sociology. Yeah. So that was, that was quite pleasing as well.
[00:11:20] Edwina: [00:11:20] You’ve touched on this already, but I’m curious to sort of put in the context, I suppose, what you’re hoping a reader will get out of this. And you’ve talked about, I suppose, some of the things that you were seeking to address, and particularly I’m curious without there being a spoiler alert for anybody, but that the idea of the role of bioethics in this, things, I wondered was what are you hoping people get out of it? And also did you adjust your thinking on some of those topics or did you land on any sort of conclusions?
[00:11:47] Chris: [00:11:47] Yeah, I guess I hope that people get out of it a sense that there is this live and ongoing conversation that needs to be had, both within the university. I think importantly for people in university institutions that can be a tendency for us to look at other institutions and look at the problems there and how people are so socialized in those institutions, rather than looking at our own disciplines or fields of inquiry and, and being, you know, oblivious to the way that we ourselves are participating in racialized spaces and in environments and contributing to those. So in that sense, in the context of, I guess, bioethics thinking, I hope that, you know, people working in that space get some encouragement from these, these conversations and, and certainly challenged by them and you know, on the whole that we can be challenged to do better in the way that we think and in the way that we act. Particularly in paying greater attention to the, so to use Charles Mills terms, about the sort of social reality of race and the way it operates in institutions and medical spaces, but also the way that it operates in ethical theories, you know, what subject experiences get centered. As, you know, from this particular subject position, we then are devising our ethical theories and infrastructures. And I think, particularly in, I guess, where there are specific discussions, so that there are a number of articles addressing Aboriginal deaths in custody in Australia, and the role of health care professionals in that, and I guess the entanglement of the carceral and the medical institutions, I think is something that is obviously, there’s a huge discussion going on about this. And this is something that the bioethicist are part of, whether they or we like it or not. And I think that there is, I guess, encouragement to see the, the role of bioethics in contributing in contributing to these kinds of discussions and cases. I think, I think a number of important cases are brought forward through the articles that are perhaps not often discussed at all or centered in bioethics curricula.
[00:14:28] Edwina: [00:14:28] What kind of cases?
[00:14:30] Chris: [00:14:30] Well, I think for, for example, you know, and again, I guess speaking from an Australian context, I know the JBI is an international journal, but, you know, I think that in Australia, a lot of people know about the Tuskegee syphilis trial, for example, and you know, the horrendous trial and obviously, you know, very troubling in, in the racial dimension to that trial and the history of that. And I’m not suggesting that it shouldn’t be taught or shouldn’t be known, but then in Australia, I don’t think many people going through say a bioethics undergraduate course or a medical ethics course in medical school are taught things about either Australian research experimentation involving indigenous peoples or, or people in our region that Australian medical researchers in the past have been working on or with. And as well, the situation of deaths in custody here in Australia and the role of healthcare workers and the medical institutions, you know, the majority of those deaths in custody did have some at some point prior to the death and interaction with a healthcare professional
[00:15:49] Edwina: [00:15:49] Of course. Yeah.
[00:15:49] Chris: [00:15:49] And there’s, you know, documented coronial evidence of systematic sort of failings and what’s often talked about as sort of racial bias and those sorts of things. So I think the articles, some of the articles provide different kinds of case studies and not just case studies, but the lives of people who have been abused and let down by not just individual medical practitioners, but a whole system of which healthcare ethics, or bioethics, is part of.
[00:16:25] Edwina: [00:16:25] Absolutely. As you say, fundamentally important for bioethics, not to just look at every everything else, but to look at itself.
[00:16:33] Chris: [00:16:33] Yep. I would say, you know, to that as well, I guess something that we tried to do with this symposium, but then I think needs to be done much more than this is, the centering of Indigenous and Black scholars, voices and experiences. So I guess in, in this issue in particular, an article led by Chelsea Bond calls for that and talks about, you know, Black bioethics, which is quite provocative and I think a really, really interesting and important thing to think about. And then the work of Camisha Russell, who has a, a short piece in this, but her work in general sort of talks about the importance of racial justice being centered in bioethics. And so I think that’s something else that I guess I would hope that the symposium as a whole can partly contribute to.
[00:17:33] Edwina: [00:17:33] You’ve partially answered what I was going to ask you to, just to really wrap it up, which is what comes next? And I know you’ve said you don’t want this just to be a blip in the, the latest blip in the bioethics literature, but you’re also touching on some more systemic type of implications from having these discussions and putting these issues out there. What comes next?
[00:17:55] Chris: [00:17:55] Well, I don’t, I don’t know. I think we would ,I mean, another thing, yeah, i think it would be good to have some kinds of more, such that we can in the context of COVID, sort of public meetings and discussions, symposia, I think. You know I think there has been conversations within the JBI and then the Australasian Association of Bioethics and Health Law about the degree to which bioethics can or should be political in terms of its statements and activism. I think. So I would hope that there can be a greater role for bioethicistS and, well, not so much bioethicist. I have a problem with that as a descriptor, but people concerned with issues relating to bioethics and to see these as bioethical issues that require, thought and action.
[00:18:55] So I don’t have sort of a specific project on the horizon about this. But yeah, I think these conversations aren’t going to be going away and yeah, there’s, I would say what comes next is looking at the work that the, like the looking at the work of the contributors and what they’re doing is, should be yeah highlighted. And that, I suppose makes me encouraged and excited to see the kinds of work that they’re doing. I don’t want to sort of single people out, but, you know, I hope people who read the issue look at, look up the bios, look up these people, the contributors, and see the work that they’re doing because that, you know, many of them, as we acknowledged in the lead essay were sort of, you know, it was an interesting and difficult time of writing these papers, especially, you know, trying to stick to what some would say is arbitrary deadlines, although people maybe on the other side of the, the editorial office might not have thought so. But you know, in the context of COVID and Black Lives Matter, and many people working with communities and part of communities affected by and needing to organize in response to these, you know, it’s quite incredible.
[00:20:22] Edwina: [00:20:22] Absolutely. I think all we can really say now is encourage people to, so it’s available now and encourage people to dive in and read, listen to these interesting voices and these important ideas, and hopefully continue that conversation you’re contributing to.
[00:20:39] [music] Thank you for joining us for JBI dialogues. That was Chris Mayes. One of the co-editors of the Journal’s new symposium, Institutional Racism, Whiteness and Bioethics. My name is Edwina Light and I’m the digital content editor at the JBI. A transcript of this audio resource is available on our website, bioethicalinquiry.com, where you’ll also find links to the articles discussed today, as well as other JBI articles and issues. For updates, subscribe on the website to our email newsletter or follow us on Twitter at @bioethicinquiry. The Journal of Bioethical Inquiry is the official journal of the Australasian Association of Bioethics and Health Law and the University of Otago’s Bioethics Centre. It’s published by Springer Nature.

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