This editorial appears in the October 2024 issue of the American Journal of Bioethics
As a Black bioethicist whose primary area of expertise is anti-Black racism’s influence on our health, I read articles calling on bioethics to do a better job of promoting anti-racist principles and policies such as Lee’s “Racial Equity, Diversity and Inclusion in Bioethics: Recommendations from the Association of Bioethics Program Directors Presidential Task Force” with enthusiasm but with a justified dose of “What does this require of me?” As someone who has also called on the field of bioethics to do more to include principles of racial equity, I applaud Lee and colleagues for their call to bioethics program directors to prioritize a lack of racial diversity in the field. They give very clear recommendations on how program directors can be sources of racial equity, diversity, and inclusion (REDI) by targeting bioethics research, education, student recruitment, funding, and governance policies. What is missing, however, is the specific “how.”
How can program directors, particularly ones who do not have the proper anti-racist knowledge implement changes to bioethics programs that will have meaningful change for the field? How do program directors avoid implementing misguided, but well-intentioned policies, behaviors, and actions to support REDI changes? One reasonable answer to these questions is already an unfortunate staple in the field—turn to faculty, often bioethicists of color, who already specialize in REDI research and pedagogy. Therefore, the next necessary “how” question that this target article raises is “How do we not further inflict a minority tax on REDI scholars who are often bioethicists from racially (and ethnic, religious, sexual orientation, and ability) marginalized backgrounds?”
Some of the recommendations in “Racial Equity, Diversity and Inclusion in Bioethics…” seem very feasible for anyone practicing bioethics. For instance, recommendation one, which calls on bioethicists to promote scholarship on and with diverse groups may require more intentional effort from people who do not already practice diverse citations and diverse frameworks in their research, but it is doable for anyone, regardless of their area of bioethics expertise. Anyone can put in the work to make their research and scholarship more inclusive and reflective of anti-racist practices. Anyone can challenge the Eurocentric ideologies that have a stronghold over the ways we think, write, and talk about bioethical topics. To not do so is simply lazy; it’s accepting our own willful ignorance and an unsettling comfort with the exclusionary status quo. This is a recommendation that bioethics program directors, even with little knowledge of REDI scholarship can lead by example with the use of search engines and university and health organizations’ websites. It won’t be fast or easy, but it is doable without assistance from REDI scholars.
Other recommendations from the target article, however, are not so easy to implement without prior knowledge or help from experienced REDI scholars. For example, recommendation three calls on bioethicists to integrate a REDI framework into bioethics pedagogy in undergraduate, graduate, and professional training programs. If bioethics program directors want to follow this racially inclusive recommendation they must know the best practices for inclusive bioethics pedagogy. If they do not have this knowledge, then they have to rely on people who do, which are typically bioethicists who already saw the value in this work and made it a priority in their own research and teaching. They are also typically people of color and racially minoritized. It is likely that program directors will turn to bioethicists of color in their departments to accomplish this recommendation because it’s easier to use positions of power to assign tasks that you are unwilling or unable to perform yourself.
REDI scholars like myself are already often called upon by our own departments and professional organizations to do REDI work, often times without additional pay or recognition. And when we do, we are often under a watchful eye that waits for us to do something disagreeable or scapegoated when someone is unhappy with our work and sometimes even lose our jobs. REDI scholars also frequently do this work without it mattering for academic spoils like tenure and promotion; instead our REDI work is commonly done as a risk to our tenure and promotion. Additionally, we are asked to do this REDI work on top of our other research, mentoring, teaching, and service work.
The recommendations in this target article can also lead to tokenism. Not all racially marginalized bioethicists work specifically on REDI issues, yet we are sometimes asked to be the face of REDI at our institutions or asked to take the lead on REDI initiatives, despite a lack of experience other than personal knowledge of marginalization. Without answering the “how” of it all, the recommendations in this article could exacerbate the minority tax that many racially marginalized bioethicists already pay to be a bioethicist.
Recommendation four, which calls on bioethicists to mentor REDI scholars is a prime example of the existing minority tax in bioethics. Bioethics professors, including program directors at universities in the US, Canda, and Europe have called on me to mentor students in their programs who are interested in issues of racism and health because neither they, nor faculty in their departments, have the expertise to help them. Students from bioethics programs often email or direct message me on social media to ask if I will give them feedback on their scholarship, provide mentorship or career advice because they don’t have any faculty in their programs who can help foster their interest in REDI scholarship. Sometimes, they reach out to me because they have never seen a Black bioethicist before because their program does not have any. And (within reason) I do my best to help students who contact me because I want to help foster the next generation of REDI bioethicists. I know other bioethicists of color who also do this work. I also know many bioethicists who are not people of color are not asked to do this unpaid, unacknowledged work. And rather than hiring faculty who can mentor students’ growing interests in REDI work or offering adjunct or associate faculty titles, or other kinds of acknowledgements, bioethicists like myself are asked to do the REDI work that our colleagues cannot and do not want to do. This is not necessarily a reason to not follow the recommendations in the target article, but it is a reason to be cautious with how program directors implement the authors’ recommendations.
Bioethicists of color faced and continue to face discrimination just to participate in the field. They also do extra work because they believe in REDI principles and want bioethics to reckon with its non-inclusive and non-diverse past and present. But I know that this takes work. So when I read articles like “Racial Equity, Diversity and Inclusion in Bioethics…” I read it through the lens of the minority tax I’ve paid, and others paid, and continue to pay. I hope program directors take this as a call to do and learn more. What I’m afraid will happen is that they will read this article and take it as a call to ask marginalized bioethicists to do more and bare more of the burdens of our profession’s flaws and this is certainly not in the spirit of meaningful REDI work.