by Dalia M. Feltman, MD, MA and Craig Klugman, Ph.D.
Our country is polarized to a breaking point on too many issues. Black vs. white. Liberal vs. Conservative. Documented vs. undocumented. Haves vs. Have-Nots. Politics have perversely crept into all areas of life, even into matters of health and pandemic response such as wearing a mask and access to a ventilator. In public health ethics, we know that some communities have the determinants necessary to live healthy lives–safe neighborhoods and built environments, economic stability, good quality education, strong communities, and access to health–but many do not, a difference often divided on racial and ethnic lines thanks to redlining and other urban policies. In Chicago, one’s life expectancy can differ by 30 years simply based on their zip code.
In Minneapolis, a man who used a fake bill was smothered to death by a police officer taking a knee in front of people who filmed the event. The dead man was black. The police officer was white. Outrage, grief, and powerlessness are righteous and just reactions. Opportunistic rioting and looting will muddy the issues and probably make it even harder to talk about what really needs to happen.
This killing comes on top of a pandemic that has disproportionately struck people of color. Although there is limited national data, Johns Hopkins estimates Blacks account for 34% of all COVID-19-caused deaths where they are 14% of the overall population. In Chicago, Blacks are 45% of all COVID deaths and 30% of all infections (Black population in Chicago is 30.2%). People of color, especially blacks, are more likely to have a burden of chronic disease, lack of transit, food and medical deserts, live in poverty, and work in jobs that require them to be out of the house during the pandemic.
The first principle in medicine is “do no harm” and the second is “respect for persons.” People with blatant disregard for these tenets have perpetrated the tragedies we have seen in the last few days. The ex-officers responsible for George Floyd’s death (Derek Chauvin, Thomas Lane, J.A. Kueng and Tou Tho) have done great harm. Those who undermine peaceful protests (to change a broken and unjust system) for their own personal profit and to sow chaos continue to do great harm.
The ex-officer responsible for George Floyd’s death (Derek Chauvin, Thomas Lane, J.A. Kueng and Tou Tho) have done great harm. Those who undermine peaceful protests to change a broken and unjust system for their own personal profit and to sow chaos continue to do great harm.
Unfortunately, respect for persons has never been embraced by all. We struggle to apply it to dilemmas in bioethics. Individually, we struggle to incorporate it into our treatment of those in front of us and our advocacy for those we do not see. Respect for persons means all persons– all ethnicities, races, economic groups, immigration standings, abilities, orientations, and ages. There are no qualifiers or loopholes in this commitment. As bioethicists we must be vigilant and courageous to expose areas in medicine where persons are not respected. Mutual respect will allow people to actually hear each other and to address the social determinants of health to improve their well-being. Meeting educational needs will allow children to develop to their fullest potential.
As a pediatrician (DMF) and a health humanities professor (CK), we know that children are generally trusting, honest, and open to all people. They have to be taught prejudice and trained to support a system that too often leaves many behind. We implore parents, teachers, and clergy to join me in a promise: Let us commit ourselves to teaching our children to respect all persons. This requires more than thoughts and prayers. Children learn from our behaviors more than our words. They will hear how we talk about people and observe how we treat them. Discuss Georgle Floyd, the protests, and the violent looting with your children using age-appropriate language. Tell them the history of racism in this country no matter how uncomfortable that is for us adults. Ask your children what they understand, what they want to know, and what questions they have. Meet them where they are in their understanding and work from there. Answer them honestly and frankly. Decide on one thing you will do as a family to be better.
It’s too late to prevent the heartache of this past weekend or to stop these former officers from ending Floyd’s life. Changing neighborhoods, increasing quality education, and providing quality health care access to disadvantaged communities can not happen overnight. But respect for persons leaves us no choice–we must work to fix things. And we can start with one positive interaction at a time, while respecting all people and doing no harm, in our workplaces and homes.
As bioethicists, let’s come together–as white, black, or brown, Ivy-league, state school, or Jesuit school graduate, philosopher, physician or lawyer–as persons. When we engage in these discussions, with respect for persons as central, we will become agents for justice in the social determinants, ensuring opportunities for health for all.