JBI Dialogues: Episode 6

JBI Dialogues: Episode 6

Racism & bioethics – contemptuous racism, medical mistrust, colonialism & biopower: Yolonda Wilson, Tessa Moll & Thalia Anthony

Please note this podcast contains references to people who have died.

In this episode of JBI Dialogues, philosopher Professor Yolonda Wilson, medical anthropologist Dr Tessa Moll, and professor of law Thalia Anthony join us to discuss their work in the journal’s latest symposium “Institutional racism, whiteness and bioethics”.

Professor Yolonda Wilson is a philosopher with interests in bioethics, social and political philosophy, race theory, and feminist philosophy. She is an Associate Professor in the Departments of Health Care Ethics, Philosophy, and African American Studies at Saint Louis University in the United States.

Dr Tessa Moll is a medical anthropologist with a focus on assisted reproductive technologies in South Africa, race, and postcolonial medical research. She is currently a Postdoctoral Research Fellow at the University of Witwatersrand in Johannesburg.

Professor Thalia Anthony is a professor of law specialising in colonial legacies and systemic racism in the penal/criminal justice system. She is a professor in the Faculty of Law at the University of Technology Sydney, in Australia.


Wilson, Y, Bioethics, Race, and Contempt: The U.S. healthcare system has a long history of displaying racist contempt toward Black people. From medical schools’ use of enslaved bodies as cadavers to the widespread hospital practice of reporting suspected drug users who seek medical help to the police, the institutional practices and policies that have shaped U.S. healthcare systems as we know them cannot be minimized as coincidence. Rather, the very foundations of medical discovery, diagnosis, and treatment are built on racist contempt for Black people and have become self-perpetuating. Yet, I argue that bioethics and bioethicists have a role in combatting racism. However, in order to do so, bioethicists have to understand the workings of contemptuous racism and how that particular form of racism manifests in U.S. healthcare institutions. Insofar as justice is part of the core mission of bioethics, then antiracism must also be part of the mission of bioethics.

Moll, T, Medical Mistrust and Enduring Racism in South Africa: In this essay, I argue that exploring institutional racism also needs to examine interactions and communications between patients and providers. Exchange between bioethicists, social scientists, and life scientists should emphasize the biological effects—made evident through health disparities—of racism. I discuss this through examples of patient–provider communication in fertility clinics in South Africa and the ongoing COVID-19 pandemic to emphasize the issue of mistrust between patients and medical institutions. Health disparities and medical mistrust are interrelated problems of racism in healthcare provision.

Anthony, T & Blagg, H, “Biopower of Colonialism in Carceral Contexts: Implications for Aboriginal Deaths in Custody“: This article argues that criminal justice and health institutions under settler colonialism collude to create and sustain “truths” about First Nations lives that often render them as “bare life,” to use the term of Giorgio Agamben (1998). First Nations peoples’ existence is stripped to its sheer biological fact of life and their humanity denied rights and dignity. First Nations people remain in a “state of exception” to the legal order and its standards of care (Agamben 1998). Zones of exception place First Nations people in a separate and diminished legal order. Medical and health agencies have been instrumental in shaping colonial “biopower,” both in and beyond carceral settings to ensure that First Nations lives are managed in accordance with the colonial settler state project. This project is able both to threaten First Nations rights to live and to maintain settler self-perceptions of decency and care. We illustrate this discussion with reference to the tragic and unnecessary deaths in custody of twenty-two-year-old Yamatji woman Ms Dhu in 2014 in South Hedland Police Station, Western Australia, and twenty-six-year-old Dunghutti man David Dungay Jnr in Long Bay jail in Sydney, NSW, in 2015. Health professionals and police demonstrated callous disregard to Ms Dhu and Mr Dungay—treating them as “bare life.”


Edwina: 0:03: [Music] Hello and welcome to another episode of JBI Dialogues presented by the Journal of Bioethical Inquiry. My name is Edwina Light and today I’m very pleased to welcome three guests philosopher, professor Yolonda Wilson, medical anthropologist, Dr Tessa Moll, and professor of law, Thalia Anthony, each of whom have authored papers in the journal’s latest symposium, Institutional Racism, Whiteness and Bioethics. Professor Yolonda Wilson is a philosopher with interests in bioethics, social and political philosophy, race thoery and feminist philosophy. She’s an associate professor in the Department of Healthcare Ethics, Philosophy, and African-American Studies at St. Louis university in the United States. Dr. Tessa Moll is a medical anthropologist with a focus on assisted reproductive technologies in South Africa, race and postcolonial medical research. She’s currently a post-doctoral research fellow at Wits University in Johannesburgand. Professor Thalia Anthony is a professor of law, specializing in colonial legacies and systemic racism in the penal and criminal justice system. She is professor and Faculty of Law at the University of Technology Sydney in Australia. And before we begin our conversation, I’d like to recognize we’re speaking together at the start of National Reconciliation Week in Australia. I work on the land of the Gadigal people of the Eora Nation and I pay my respects to their elders past present and emerging. Reconciliation Australia urges people to speak up, speak the truth, and ask the hard questions on issues affecting Aboriginal and Torres Strait Islander peoples. And in that context amongst others, our guests’ discussion today is very timely. Yolonda, Tessa, Thalia, welcome and thank you for sharing your time with us. Your excellent work in the latest issue of the journal examines amongst other topics, institutional racism, racism, contempt, medical mistrust, biopower, settler, colonialism, carceral institutions, and justice. And amidst all that, what roles bioethics might have in addressing racism. And I wondered if you could briefly tell us about your articles. I’m not sure who’d like to go first. Tessa?

Tessa: 2:13: Okay. I’ll go ahead and jump in. Uh, well, the article I wrote, I kind of contextualized was in response to Camisha Russell’s article where she, her commentary. She was speaking about the role that bioethics can play in the life sciences and, and kind of working with life scientists and how to address race in their research. And which I think was a fantastic intervention. And I want to kind of expand upon that because she really put it in this context of race science, which is decidedly, something that we still see in medical research in South Africa today, and kind of the legacies and durability of those ideas. But I wanted to kind of put it in context of the every day that people were encountering. And, and so I shared the story from my research and field work in fertility clinics in South Africa. And an experience that I decidedly thought was, had very racist undertones. And I believe that the patients that were in the context believed that as well. And, and kind of put that in context of the conversation that was happening around me at the time around why there was all these so-called conspiracy theories going around in South Africa, around the origins of COVID-19 and what, you know, the eventual, now we’re kind of looking at vaccines, um, a year later. But at the time, people were all talking about needing to educate a population that didn’t seem to “understand” and, quote unquote, and so I wanted to kind of put it in context of people had everyday experiences of racism that really shaped how they perceived healthcare as an institution. And so that was just kind of the intervention that I, yeah, wanted to make with that piece.

Edwina: 3:55: Thank you. Yolonda, Thalia, did you want to tell us a bit initially about your work?

Yolonda: 4:00: Yeah, sure. So my paper, Bioethics, Race and Contempt, it’s actually, uh, I’m actually doing a few things in this paper that I hope will make sense to the reader. I hope the reader will appreciate, uh, the way that my mind works sometimes. So part of what’s happening in this paper is a response to a 2016 paper that I co-authored, that bioethicists can and should address racism or at least contribute to addressing racism. And so I wanted to set up that paper, I wanted to set up this paper in, in light of, you know, the four or five years that have passed and the kind of mixed response that we got to that paper, my coauthors and I, including that, you know, even thinking about racism, is kind of overstepping the role of bioethics. And a lot has happened in the intervening years that I think bioethicists are at least willing to talk about what we can do as a, as a field, as professionals, as a, as a discipline, some would say we’re not a discipline we’re field, but whatever. At least in the spaces where we are, in, in terms of addressing racism, there seems to be at least a little bit more receptivity. And so, the opening of the paper, the setup of the paper is a kind of, you know, here are the things that we thought were important to 2016. Let me revisit them and see if I still think the same way as you know, my coauthors and I felt in 2016. And so one thing that I wanted to think about specifically that we didn’t talk about as much in that paper was the space for institutional racism. I took up a variety of racism that I think of as contemptuous racism and wanting to think about how that works and operates in institutions. Because I think a lot of the impulse when bioethicists do talk about racism is to think about hearts and minds, right, to borrow the famous kind of American phrase, from Bill Clinton, I believe it was in the nineties, right? How to individual people feel about people who aren’t white, particularly individual white people. And I’m wanting to think, well, there might be some other way to think about something like bad feeling or contempt, but think about it institutionally and so that it can operate apart from any one individual kind of thinking. And so I spent a bit of time kind of exploring and interrogating what that might look like in an institutional kind of space of US healthcare. And I gave a couple of examples and kind of revisited the “here’s where bioethicist could intervene”. So I’ll just stop there.

Edwina: 6:24: Thalia, could you tell us a bit about your work?

Thalia: 6:28: Yeah. So I guess I come from a bit of a different bit of a different disciplinary background, so not in healthand not philosophy directly. So my background being law, and one of its related strands of criminology means that to some extent, the discipline in which I belong I think valorizes health and healthcare, something as a positive alternative to criminalization and carceralism, and sets up health as this paradigm that is about care. You know, we shouldn’t criminalize or we shouldn’t incarcerate. We should give them health options or, or, you know, therapies, as if it’s a panacea for the evils of criminalization. And yet what I wanted to show in my article with professor Harry Blagg is that in fact health can also be implicated in some of the harms that are inflicted by the criminal justice system. And I do this through the lens of deaths in custody specifically, uh, and looking at the complicity between the carceral and health professionals, when it comes to the treatment of First Nations people in Australia and which in turn contributes to death in custody. But I also look more generally and broadly at the race politics that are embedded in health responses to First Nations Australians ever since colonization and looking at how the use of disease is very much politicized by the protectors, as they were called, of Aboriginal people. And these protectors were, um, very much colonialists who had the role of controlling the lives of Aboriginal people. And disease was set up as a, as a, I guess, justification for controlling their lives. That they were, they were deficit, they were pathologized and therefore the interventions of protectors to control everything, but very importantly, where they lived in their segregation site, which could have been on, you know, theyused islands of management of disease for First Nations people, or it could have been equally on missions or government settlements, that this was necessary because they needed to be separated from the population. So the legacy of so-called health care and it, and First Nations people, is very much alive today that they’re they’re they have much greater, you know, biological problems, that they are much more likely to die of natural causes. And that’s linked to, you know, evolutionary and Darwinist ideas and, and ideas in turn about Indigenous people dying out as it was. But this is also current today where we look at how the debts of First Nations people in custody are then explained by coroners in terms of natural causes, you know, they were going to die anyway, and it brushes off the responsibility of people, healthcare professionals, um, working with criminal justice agents in being reckless towards the lives of First Nations people in custody and showing callous indifference. And so this, this kind of natural cause justification is very much, uh, trying to point the finger at the person who dies rather than at the system. So I think it’s used in this very pernicious way that is often overlooked by, I would say, people outside of health who that the system is not to be held to account.

Edwina: 10:32: Thank you, Thalia. I mean, listening to the three of you, it just becomes more obvious that, you know, you’re coming from different disciplinary backgrounds, you’ve brought these different, brought attention to very different issues, yet there are these common themes as well. I wondered whether any of you in reading the other’s work, had some particular responses?

Thalia: 10:51: Yeah, it’s Thalia again. Um, I think I just really, I mean, I found both Tessa and Yolonda’s piece really enlightening, but I really liked that idea of contempt. I think that’s something that is a really nice framing device and it kind of traces that line between intentional harm and negligence or recklessness. Which I, which I think is very much true in terms of how we treat the lives and bodies of First Nations people in Australia within the, within the health system. And although I would say that, you know, I specifically look at, uh, the carceral system and the health, health workers within that system, I think it can be more broadly, we see discrimination within health services that enlivens that term contempt. Because what, what I think grounds that in Australia is these racist stereotypes with the lives of First Nations people, it’s not simply that they’re, they’re disregarded, but many interventions don’t occur because there are certain stereotypes that the person is drug, drug affected, or the person is of a certain demeanor that, that enables this kind of, I think, concept of contempt to be very real, because it’s been put across as a choice of the person to be like this that fuels the contempt rather than simply humanizing the person, which would be how we should be informed in all our health decisions. The contempt is, is what dehumanises them, so I really liked that as a device.

Yolonda: 12:38: Well, one thing I noticed as I was reading our papers, particularly together and in conversation with one another, first, I’m very excited about this special issue. I mean, just the thought of bringing us, us together in conversation and, and, you know, we had no contact with one another beforehand to know what one another was writing about and we just kind of intuitively all kind of honed in on, on this issue. Uh, just intellectually I was excited by that. But one thing that I found really disheartening was just the similarities globally in terms of how institutional racism manifests in these bioethics spaces. I mean, uh, in reading, you know, Tessa and Thalia’s, I thought about, I could be in the U S like having this conversation about, uh, assisted reproductive technology or, or dying in police custody. And it’s interesting that Thalia and I both uh, pointed to cases where this happened, right. In her instance, um, Ms. Dhu was already incarcerated and, you know, was taken into the hospital system. And in my instance, Ms. Dawson was in the hospital system and was, uh, you know, they were attempting to incarcerate her, was under arrest, but I, but I, you know, I found that so disheartening, just the kind of global manifestation of institutional racism. And I wonder if any of you felt that way too, where it’s just, it’s just my own sensibility.

Tessa: 14:02: Yeah, no decidedly. And I think as Thalia now is kind of contextualizing her paper a bit, particularly the way that like settler colonial legacies operate very similarly in both the Australian context and the South African context is really apparent in hearing, in hearing what she was describing as the way that, you know, the, the healthcare system was set up as part of part and parcel of separating people. Um, and that is very much the start of how apartheid, you know, it began in South Africa and the Cape Colony was under the auspices of public health because it was separating the so-called diseased African away from the white settlers. And so just seeing parallels is, yeah, I’ve had, I don’t know if I could say unfortunately, like, unfortunately not terribly surprising, but also just seeing how these, these are really, I don’t know. Yeah, the, the arms of this, like settler colonial octopus is just wide and penetrative.

Thalia: 15:05: And I think, Tessa and this is one of the things I liked about your piece. Racism is really embedded by international structural, effectively power, relationships. So power is what is at play here. And I guess it’s the reason why, in order to challenge racism, we need to also challenge this power. And I think what your article shows is that at least how I, or what I took from it is that it, uh, emanates from these historical colonial relations. So these power grabs, you know, from, from the empire to the colonies and that, you know, effects things today, like access to vaccines, with COVID. And even though, you know, it might mean that you know, deaths in custody of Ms. Dhu or David Dungay in Australia seems quite removed from, you know, the, the historical power grabs or, or the distributions of the vaccine, it all pivots on that, that, you know, one point that one, you know, center the world, the global north sees itself as more entitled to resources to land, to control of other bodies. And, and I think, I think it’s really important to locate that because it’s been able to inform how we challenge it, you know, and it’s not just about, you know, challenging individual scapegoats. Although I think it is really important to have individual accountability because it does signal a certain culture in the system that holds people to account and, and, you know, sends a message that you can’t get away with racism and that there are consequences. Well, that, that is important. I think more importantly, we have to look at the distribution of power that enables one race of people to control another race. And that, that, that comes down to, you know, how the land has been carved up and how we have effectively, I think, enabled one group of people to, to control the resources of the rest of the world. And that’s obviously with the vaccine, but it’s also with, you know, virtually all, all goods and services, absolutely healthcare, but you know, it’s part of a broader circulation of, you know, of the ownership of resources that just happened to manifest in, in certain ways in the health system to deprive the majority of people who belong to marginalized races.

Edwina: 17:47: I’m very interested in what you’re all talking about here. And it raises some questions I had that are related. I mean, there’s a few mentions across the work in the symposium about the fact that other industries and disciplines are grappling with histories of racism, but not yet bioethics. And I’m hoping we can get to that. Also that you’ve each described the, the, the breadth and reach of racism and its bioethical significance and that they’re in pockets and spaces that people might not think about all the time. Whereas there might be some more infamous instances that are spoken about and taught. I wondered if anyone could tell us a bit more about the examples that you raised in your papers and that you’ve been talking about today. You know, what work does bioethics have to do?

Tessa: 18:30: Oh, sorry. I had to take a breath there cause I was like, oh, there’s quite a lot to dig in. I think in, in this context, in the South African context around it, thinking back to historical examples where there were, I can’t even, it wouldn’t even be fair to call it just bioethical problems, but human rights violations committed either at the hands of, or with the complicity of the healthcare, the healthcare workers and professionals. I think in this context, and what I raised in the piece was the discussion around Project Coast, which was a, the chemical and biological warfare research unit during apartheid, during the 1980s. Which as far as I understand, it was intending to try to, I mean, they were researching a number of horrible atrocities, including injecting women with some sort of chemical that would render them in fertile, injecting black women with this chemical to render them fertile. Putting different chemicals in the water and they were doing research with Mandrax, which is kind of like a a sleeping pill, as far as I understand it and ecstasy and all sorts of other, I mean, it sounds kind of wild in fact, but a whole load of things in efforts to commit mass atrocities against the majority of the population. A lot of this came out in the Truth and Reconciliation Commission in 1997. And not a lot of people were held accountable, if any. And one of the most famous cases in that instance who was running this Institute, he’s actually still a working doctor in Cape Town. He’s been the Health Professionals Councils of South Africa has tried him for, uh, his name is Wouter Basson, has tried him for the atrocities that he’s committed and said that he was guilty, but they haven’t actually revoked his medical license. So he’s still a practicing cardiologist. And I think that the lack of accountability in particular is just kind of shocking in that instance, but there was definitely a more and, and which kind of echoes what Thalia was describing in her piece, a lot around the way that healthcare workers worked, alongside people who are incarcerated. And again, the most famous would probably be Steve Biko, who was tortured in prison. And the district surgeon signed off that he was fine and very fine to be traveled to Pretoria, which was 1100 kilometers away from where he was. And he ended up dying when he arrived in Pretoria shortly thereafter. So I think there’s a lot of reckoning that needs to be done. And I don’t know if I can say that the, the medical professionals in South Africa have fully reckoned with that legacy. I think that a lot of the discussion of the post-apartheid healthcare has been around redistribution of access, um, which I do think is decidedly a huge story and, and, and a process that needs to, and continues to need to go on. But I don’t think that that’s the only thing.

Thalia: 21:27: Um, Yolonda, are you okay if I jump in?

Yolonda: 21:31: Absolutely.

Thalia: 21:33: Yeah. I, I just, um, at first it was really, um, touching Tessa to hear you talk about Biko in, in that light, because I think people around the world know his story. And for you to link that to the, um, or to implicate, you know, health authorities in, in his death is just really sad to hear. I mean, I think the way it was cast was very political and not specifically, um, within that health context and, and, and it’s devastating to know, you know, how much, how much power they, they yield and, and how it can be used in those really fatal ways. And, and then bringing it back to Australia and deaths in custody. I absolutely agree that there hasn’t been the necessary accountability in some respects. I think there has been, you know, reckoning at an institutional level, but it never seems to, I guess, filter down and change anything in terms of practice on the ground. So I’m for example, currently working on, uh, a death in custody and looking at all the previous deaths in custody, you know, there’s been, since 19…, actually since 1980, there’s been at least 600 deaths in custody. And what is shocking is that the health workers continue to show the same disregard for Aboriginal lives. And there’s inquest after inquest highlighting this and making recommendations, and they’re simply ignored. And then there was a Royal Commission into Aboriginal Deaths in Custody, that, and this was in 1991, so 30 years ago, that shed light on the same issues that are causing the death of First Nations men, women, and children today. So we really haven’t had any type of awakening or shifting practice within the health profession in custody. And I, and I think, I guess one of the things I pointed out in, in my piece is that it is because Aboriginal people are seen and treated as inherently sick and to some extent that means rather than showing extra care, health workers, uh, tend to excuse any lack of assessment and, and, and treatment. But it’s also because they’re, they’re seen as offenders, which means that they are effectively responsible for their own behaviors and they don’t deserve the same level of treatment. And certainly in Australia, people in, in prisons, don’t for example, get access to Medicare, which is available universally in the community and enables people to have free access to health services. So they’re, they’re deliberately cut off from that system. But it’s. But aside from that, what was really important in there in the Royal Commission was the fact that if we’re going to have a shift in, you know, these malpractices by health professionals, there needs to be greater Aboriginal control of health services in prisons, in police custody. So there needs to be a shift away from just having, I guess, non Aboriginal workers and, and practices and towards more culturally safe practices. So really, I guess, challenging Western ways of doing medicine and thinking more broadly about cultural, emotional, and social wellbeing as underlying the approach to health, which absolutely is part of Aboriginal ways of seeing health within this context, that doesn’t just medicalize everything. And when you can take a more holistic perspective, you’re able to identify underlying issues that would otherwise be set aside because of the stereotypes imposed, particularly stereotype, like with Ms Dhu, that the person is drug affected. So you can do away with that because you’re creating a culturally safe environment, but equally you can identify how to, how do we engage the person and how to, I guess, look at underlying issues of trauma. And this is really important because a lot of health practitioners in, in psychiatry or psychology in prisons, don’t understand that someone is struggling with issues that are linked to intergenerational and current trauma arising from colonial interventions. And if they were able to see that it might prevent a lot of the, of the suicide risks in prisons. So I think it’s, it is about changing, uh, you know, the Western approach to bioethics, which on some respects is just a more humane approach. But for Aboriginal people, it’s about creating that cultural safety so their health needs can be fully addressed and they can develop that rapport. Um, and the last thing I’d say is just echoing Tessa’s view that the, the accountability, it’s not, it’s not only, um, absent, you know, in Australia in terms of there have been no prosecutions. There have actually been some disciplinary action, some consequences for health professionals, including recently for Ms Dhu. The practitioner was fined in that case in a recent professional board decision. It was, it was seen as inadequate by the family. It was about $30,000. But there was, there was, some punishment, you could say. But more, more generally, like that is quite an exception, more generally we not only see a lack of punishment, we see lack of responsibility. Uh, there was a case recently, a coronial inquest of Nathan Reynolds. And in that instance, he died in prison due to an asthma attack where there was no care plan. And when he had the asthma attack, there was no emergency in the response. And it was very clear to the family and I, and you know, I went to a lot of that inquest hearing, it was very clear that the health professionals were sorely lacking, including that the nurse did not attempt to resuscitate him, but slapped him in the face because she thought he was having some drug withdrawal, which was totally wrong and against the medical notes. But despite the medical negligence the coroner refused to hold anyone responsible because she said that they had learned from their, um, you know, from, from their wrong, they, they thought about it and it was unnecessary to send any messages of their wrong doing. And if we did that in any other context, certainly if we did that with an Aboriginal offender, it would be seen as a travesty. You know, that someone can be responsible for someone’s killing and yet they have reflected on it and it shouldn’t be rubbed in by adding that responsibility within the system. And yet we do it with health professionals because of this assumption that they dealing with people in their best interests. And I think that comes back to the key point of our articles is that there is this unconscious bias, the systemic racism that you might not see because of the words that health professionals are using, you know, they might refer to the care, they might refer to the fact that there were checks done, that there are assessments that within the best professional knowledge they made the right decision, but what is really important to us to interrogate is, what were the assumptions about that person, because they were not white, that meant that they were treated differently and they were treated with lesser care? And if you look at the inquest, if you look at the research done on deaths in custody, there are clear patterns that First Nations people do consistently receive lesser care. So there is a systemic problem there that the coronial courts and the criminal courts have not yet been able to grapple with.

Edwina: 30:19: Yolonda, I thought I’d, thank you Thalia, that I just thought I’d check in with you. I know in your paper, you talk a lot about what the potential roles could and should be for bioethics. And I suppose any responses you have to what Tessa and Thalia have talked about.

Yolonda: 30:33: Yeah. So. I think to kind of broaden out what Tessa and Thalia have already said, right. I think what’s important, and what’s coming out in different ways in, in each of our papers is this idea of understanding social determinants of health, right? Understanding that where we’re situated in society affects the kinds of care we get, the kind of access to care we get, what those interactions look like once we’re engaged, what institutions we even engage. Right? So when my instance, Ms. Dawson’s in this small rural hospital, and she’s also having this bumping up against this police presence in, within the hospital, which in the US, a lot of hospitals have a police presence situated right in the hospital. Right? So there’s not this kind of sharp distinction between, the, you know, getting medical care and somehow becoming entangled in the carceral state. So I think that that’s important. And what I say in my paper is, right, there’s this way that at least in the US bioethicists, will talk about social determinants of health, but to really think about what that looks like on the ground and what that looks like when you do occupy a position, a social position that is regarded as marginalized, for example. The other thing I’ll say just kind of quickly is again, the space of institutions and the role of institutions. So I think sometimes these instances happen, these kinds of incidents that each of us has highlighted in each of our paper will happen. And there’s this kind of investigation about what individual actors did and how they felt and is, is, is a clinician X a racist. And then there’s a lot of energy spent spent around that. And I think that right, while, while it’s certainly important to hold individual people accountable for their behavior, I also think it’s really important and the bioethicists could have a role in this and kind of thinking about how we assign responsibility, blame, and to think about what kinds of institutional practices and processes are triggered at each step of an interaction that, you know, regardless of whether a healthcare professional sees themselves as helping or just following orders or just doing their job, that, you know, that there’s this other way that we need to think about justice and accountability. And that’s in the very institutions that we, that we have and that we sustain. And there are these kind of moments of engagement, but there also happened to be moments where, and I think this has been a kind of interesting opportunity, the convergence of global pandemic and kind of global action about anti-racism I think for places that talk about it, right, it’s, it’s one thing to just talk, but I think this is an interesting moment to be serious about that and to really sit down and think about what our institutions look like and what messages we’re sending to the people who have to engage our institutions and what it really looks like to be socially situated and how your options are shaped by that.

Edwina: 33:36: Um, I’m curious on the back of what you’ve been each talking about about the responses you’ve had to the work so far and, Yolonda, I know you mentioned with some earlier work, you had some mixed responses. Yeah. It’d be interested to hear from any of you about the responses you’ve had to this recent work.

Yolonda: 33:51: Yeah. So as I mentioned in the 2016 paper, there was almost a split, right. Very few people were just kind of, meh, or middle of the road on that paper. People either, either really felt, look, you all are overstepping what the bioethicist a, has the kind of power and wherewithal to do, but also just what a bioethicist is supposed to do. Right. We imagine ourselves to be X and, and there were lots of people, overwhelmingly white people, who were telling me what a bioethicist was and what a bioethicist should be and should be concerned with. And I’m thinking, I’m a bioethicist, and this is what I’m concerned with. And I don’t think I’m overstepping. And you know, if we’re going to live in a world full of different kinds of people, then we can’t just imagine the kind of hypothetical white man who’s able-bodied and doesn’t need anyone’s assistance or doesn’t need care, and, and such that, that this precisely has to be what we care about. And then the other side of that, there were people largely marginalized bioethicists. So it’s so interesting just how, you know, not just the intellectual work, but how also kind of demographics and sensibilities and where one sits in terms of privilege versus marginalization. But, you know, and I won’t say exclusively marginalized scholars, but largely who thought it’s about time that we’re really talking about this. And I’m not suggesting that our paper was the first paper to say bioethicists should care about race and racism. It wasn’t. There were some that had come out before, but I think precisely because the American Journal of Bioethics kind of put it as a target article that invited a certain kind of commentary. And there were people who were saying, look, not only should you be talking about this, but even the things that you’re proposing are actually too modest. We wish you had gone further. And so, you know, with this current work that I’m doing, it’s, it’s interesting to hear people saying, yeah, we think this is important work. I’m getting more of that. And maybe the people who think that we’re overstepping, just don’t talk to me or don’t seek me out, but, which is what is quite possible. And I’m quite fine with that. But it, but it is interesting to see. I at least I’m seeing and feeling and sensing a shift in the, in the culture of bioethics that there’s at least a willingness to talk about it and think about it .Now, what, what it means beyond talking will be interesting to see in the next five years, but at least there’s, there’s a little bit more of an openness and a, “oh yeah maybe these things do matter”. And I do think that it matters that this pandemic and the kind of global protests that happened last year, happened at the same, you know, happened simultaneously and happened while the kind of professional class of bioethicists were able to sit at home and watch it all unfolding on television. Think those things matter.

Edwina: 36:32: Tessa or Thalia, but what about the responses you’ve had?

Thalia: 36:36: Yeah, I think the response that I’ve received notably has been from families and lawyers who are working on inquests, um, or who have lost their loved ones in custody. They have been, I think, grateful that more of this evidence and research is coming to light because there’s, the idea that there’s systemic racism in health care is fairly new within at least the inquest space and probably in Australia, it’s relatively new, at least compared to the US in, in the academy. And so there’s been, uh, a tendency to submit more of this type of evidence in inquests to show unconscious bias among health practitioners in their, in their practice towards the First Nations people who are incarcerated, that in turn contributes to their, to their death. So I think that there’s some momentum now in, in trying to conceptualize and even count the extent to which systemic racism contributes to deaths in custody. The. What, what has also been latched onto, and I think this, um, emerges in Yolonda’s paper as well, is the fact that there is, I would say particular types and degrees of systemic racism in relation to First Nations women. And, and what the research shows is that, um, women tend to have even lesser care and there’s less compliance with health guidelines when it comes to the treatment of First Nations women. And we saw this absolutely in the case of Ms. Dhu, and then also it’s evident in the, in the current inquest I’m working on, which I probably can’t mention at the moment, but which will emerge. So I think, I think the intersectionality between race and gender and, and how that overlaps with, with bioethics is, is really important to consider as well. And I think that people are paying greater attention to how we, how we respond to that, how we look at different bioethical models for, you know, working with First Nations women and responding to their health needs and, and, and enhancing their wellbeing. Because I think the, you know, the way in which, at least the Australia, colonialism was, was inflicted, was very much through a patriarchal lens as well. And so I think that that requires some reckoning if we’re going to move forward.

Edwina: 39:32: Unfortunately, we’re really running out of time and I’m, I’m loathe to cut this conversation off, but we’ll need to finish up. Before doing so I just wanted to check in with each of you, whether you had any final remarks.

Tessa: 39:43: I’ll jump in then. Um, um, there was two things that I wanted to, I guess, leave as more questions since we’re running out of time, but an article, and I’m not a bioethicist, so I kind of come at this, I guess, from a particular and somewhat unknowledgeable lens, but an article at least that I was really recently provoked by or in a good way, like I thought it was fantastic and interesting was, um, uh, Sarah Franklin, who’s also a medical anthropologist that works with assisted reproductive technologies and she spoke about how bioethics had actually moved into a more sociological lens in that it was incorporating much more community opinion and community sense of ethics and morality and how this could continued in a, maybe even in a more radical way could be, uh, an avenue for which bioethics could be situated to have a really great role in this question of institutional whiteness and institutional racism. If it, rather than of course the question of like a universal bioethics, which I think is like long gone at this point, but, but having a much more engaged community driven focus. And so that was uh, a role that I could see at least in, in kind of where bioethics could sit in this. And the other comments I just wanted to close on, cause it was it happening in recent weeks is I don’t want to kind of reiterate the idea of a, like a bad apple or that these are just different actors, but I do think that people in their institutional power, they do kind of enact, they enact this kind of power. And so it can come through in the way that people interact with each other and in the way that doctors interact with patients. And so it’s less of a, like kind of a bad apple and that, that person’s racist and we should cancel them, and then blah and then it’s done. Because I think that there’s kind of often a sense of, we just have to remove these people out and then the problem’s finished. Not so much that, but I do want to see how, like, people do kind of enact these forms of power. And I bring this up because there was the recent controversy from a different podcast, from the journal of… oh, gosh, I just know the acronym JAMA. I don’t know if anyone’s…

Yolonda: 41:51: Journal of the American Medical Association..

Tessa: 41:53: Yes. Yeah. So they had a podcast about structural racism and the whole podcast started with doctors aren’t racist and racism was outlawed in the 1960s, so how can there be structural racism? And it, it just, everyone was like, What? How, how can you make these claims? And this, these are two white men making these claims and, and coming into with like a very skeptical lack of understanding about what the issues were and then you know, pretending to have a conversation about it. Yeah. So I just, I kind of, at least, I think doctors can be racist. And I think that, I think that, completely neglecting that, or at least how they enact that, um, in these kinds of contexts is also kind of putting it into a structural realms too much, maybe, maybe not too much, but, I don’t know, placing it in kind of an abstract rather than these are, these are real things that happen to people in, in very micro ways at times. Thanks.Yolonda: 42:53

So there, so there are two quick things that I kind of wanted to point to that we didn’t quite talk about in the conversation, although Tessa’s last remark kind of hinges on, on one of the things that I wanted to say. So I’ll start with that with the JAMA part, podcast. So one thing that I’ve said elsewhere, I don’t recall if I’ve said it in print, but I’ve certainly said it in interviews is that, you know, it’s deeply troubling even in, you know, in this moment when there’s this kind of openness to think about structural racism and racism broadly, et cetera, it’s deeply troubling to me that one can be a competent physician, bioethicist, clinician, healthcare worker, otherwise without having seriously taken any kind of courses in, in race theory, in disability ethics and feminist theory. Right? So, so part of what happened in the JAMA podcast. I don’t know if these people were good faith, interlocutors, maybe they may probably, they weren’t, but possibly they were and what they were espousing, just reflected a stunning lack of information, right. It reflected a stunning ignorance because there’s, you know, a century of scholarship certainly on kind of race and racism. And if you’re thinking about the kind of contemporary thinking about race and racism and structural racism and inequality, that’s that literature goes back 40 years easily. Right? And so that they can sit there so confident in their credentials and so confident in their whiteness and maleness and, and be stunningly ill informed. And that, you know, the Journal of the American Medical Association, which is one of the most prestigious journals in the U S and probably globally could, could just kind of sit here and roll with it. You know, until there’s backlash. You know, I didn’t think that that was so unusual. I thought I’d actually just kind of reflected the state of where we are. So, you know, when people ask me to be prescriptive, that’s one thing I say, like, we have to educate people differently. That, you know, if we’re going to be, you know, even within, you know, the nations that we’re working, these are diverse spaces. And if you’re thinking about, you know, global citizenship, then there’s certainly a kind of diversity that there has to be an understanding of, of history, of race, of race theory of racism, of colonialism, of imperialism. And then, you know, to broaden that, of kind of, how are women treated differently, you know, to think about intersectionality, we can think about disability ethics, and that one can be an educated healthcare worker in the so-called first world and not have any kind of training in that, or education is a deep problem. And then kind of related to that, that I’ve also said elsewhere, I care about the intellectual genealogy of the work. And so one thing that would concern me as an academic in this moment, which, you know, people may care less about this, this particular point. It is that I’m seeing a lot of interest in the topic, but I’m not seeing a lot of work. Uh, I’m not seeing a lot of good work. And here’s what I mean by that. Um, if I were an epidemiologist, there’s a certain literature that I would have to ground my work in, there was a certain way that I would have to present myself to be informed, to think and write and pontificate on some issue in epidemiology. And I think in this moment, and while people are, people, right, so some of this may just come from just being excited and wanting to, wanting to write something, but I think, you know, we have to take seriously the work that has gone before. And what I’ve seen is a lot of scholars, particularly white scholars, who’ve never had any interest in race and racism suddenly kind of taking up this mantle, not engaging the literature and, you know, becoming the voice of how to think about racial equity, racial justice, and, you know, some of that work is kind of ill-informed and, and troubling. And so, you know, again, to kind of, kind of thinking about training, but also thinking about, you know, whose voices are amplified and what kind of intellectual work and production is respected. Even in this, even in this moment where there’s clearly an opportunity to engage the work of different kinds of scholars. So, you know, those didn’t really come up in the conversation, but I thought I’d just be an interesting food for thought to close on. So, thank you so much for having me.

Edwina: 47:05: Thank you, Yolonda, and Thalia, I’ll just check in with you, if there’s anything else you wanted to add.

Thalia: 47:10: Look, I think that’s a really great note to end on, and I just think it’s really important that, you know, the, this journal has this special edition and that these conversations are, you know, afoot and, and hopefully they’re, they’re growing in, in momentum. I do feel. In many ways that I’m both an activist and an academic. And I think that just in terms of what Yolonda’s saying in, in, in relation to doing the work, it’s, it’s really important that we not only talk critically about these things, but we, you know, look at, look at what’s happening on the ground and we try and change what’s happening on the ground. And I can absolutely also say that I work with amazing scholars in this space that are, such as Juanita Sherwood, uh, uh, a Wiradjuri academic in, in Australia, who are, you know, on the front line with health workers, promoting anti-racism as a core part of their, of their learning and their unlearning, because there’s a lot of unlearning that needs to be done to debase these assumptions that it, that it’s deeply rooted in our health system. So, so I, I think that, you know, it’s, it’s heartening that the discussions about race and anti-racism are becoming more normalized. But we also need to follow that up with, you know, doing that work that involves sacrifice, that involves questioning power, if we’re really going to see the systemic change that’s needed, that’s not just to come from individuals, but is actually going to come from a cultural change that, you know, not wanting to be too cliche, but that, you know, respect the lives in Australia of First Nations people and of, of not nonwhite people. And, and I, and I think in so many cases where First Nations people died in custody, if they’d being treated with that respect, if they’d been given basic checks, if they’d been given basic interventions, their lives would have been saved, they’d be with us today. So the work of anti-racism is substantial work, but the outcomes are absolutely necessary for our humanity.

Edwina: 49:34: Thank you, Thalia. And thank you, Tessa and Yolonda for your time today, it’s been a wonderful conversation and I would encourage listeners and readers to visit the website. You’ll be linked to the author’s papers as well as the rest of the symposium. And, uh, I commend it to you. Thank you for joining us for JBI Dialogues, a transcript of this audio resources 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 JBI updates. Subscribe on the website to our email newsletter or follow us on Twitter @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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