Author’s note on language: Many different terms are used to describe people from Latin America or with Latin American heritage. I prefer “Latine,” and I use this term throughout unless I am referring to someone else’s work or chosen term.
The first time someone referred to me as her “Latina friend” (with the subtext that I was her only Latina friend), my immediate thought was, “You need more friends.” How could I possibly be her only Latine friend? Yet, underrepresentation is common in bioethics. One study found that about 3% of ethics consultants are Hispanic while 90% are white non-Hispanic. Underrepresentation raises concerns about whether the people affected by a decision are involved in the decision-making. The dominance of white voices risks cultural imperialism and marginalization of minority ethnicities. This underrepresentation is especially concerning given the broad heterogeneity of Latines.
Variety of Experiences
When my friend made the remark about me being her Latina friend, I worried about what assumptions she was making about Latines in general based on her interactions with me. When I’m the only Latine in the room and the subject of ethnicity comes up, I am aware that I cannot speak on behalf of many of my fellow Latines. As a light-skinned person with a British name and mixed Mexican and European heritage, my experiences are different than some of my other family members who have darker skin and/or Spanish or indigenous names. My experiences are even more different than other Latines who have a primary language other than English, are immigrants, are from another country with different culture and politics, and have different religious beliefs.
Unfortunately, it is common to lump Latines into a group and make assumptions. Recently, I’ve seen a nurse assume a patient needed an interpreter based on their Spanish name, an administrator assume a patient receives Medicaid based on their Spanish name, and a physician assume a non-English speaking Guatemalan patient needed a Spanish interpreter (she spoke some Spanish, but primarily spoke an Indigenous language). While all well-intentioned, each of these assumptions was incorrect, exacerbated bias, and impeded appropriate culturally congruent care.
Reclaiming Latine Narratives
Joanne Suarez outlines the need for Latinx-centered bioethics and calls on Latines to reclaim our narratives and bioethicists to amplify marginalized voices. This is a critical call to a field that is founded on Western philosophy and is predominantly made up of people who are categorized as white non-Hispanic. Bioethicists cannot amplify Latine voices if Latines are not included or don’t feel they belong in the conversation. Inadequate or unheard voices risk ongoing marginalization and tokenism. Identities are complex. People do not fit neatly into boxes, especially socially constructed boxes. Over 70 years ago, the Supreme Court case of Texas v. Hernandez highlighted the need to include ethnicity in discussions of equity and discrimination. Yet, categorizing ethnic and racial identity remains challenging. Researchers and data collectors continue to grapple with how to capture ethnic and racial demographics accurately and have had mixed results. A recent survey showed that about half of United States adults overall felt the U.S. Census questions reflected their identity “very well.” This number dropped by 7% when looking at the subgroup self-categorized as “Hispanic.” Many Latines push back on the term “Hispanic” because they don’t speak Spanish or because it calls to mind Spanish colonization that negatively impacted the Indigenous people living in Latin America.
Attending to Justice
In clinical ethics, the core principle of justice calls us to address racism and racial and ethnic disparities, and research demonstrates that race and racism are attended to in clinical ethics consultations. One study found that patients who identified as Black, Hispanic, and/or use Spanish as their primary language were more likely to have an ethics consultation regarding their care, though the researchers could not make conclusions about the reasons for these disparities or whether ethics consultations mitigated racial and ethnic disparities. Another study, though, did show that ethics consultations may mitigate gender and racial disparities. Mitigation of disparities is more successful when clinical ethicists are intentional in this work. Recent bioethics scholarship focuses on practical ways of addressing racism and inequity through clinical ethics such as a recent proposal to expand the traditional four-box method of clinical ethics consultation to address racism and a new model for addressing health equity in clinical ethics consultation.
Latine Heterogeneity
Other recent work has spread awareness and understanding of Latine heterogeneity. For example, multiple recent articles debunk the myth of the “Latino vote,” demonstrating that voting preferences among Latines depended on additional factors beyond ethnicity, such as country of origin and immigration experiences. A growing body of research more deeply examines diversity and intersectionality within Latine populations. It demonstrates that disaggregation of data shows significant differences related to additional factors such as race, socioeconomic status, environment, geography, language, and more.
Increased awareness of Latine heterogeneity is a good initial step towards inclusion. Bioethicists must understand the broad spectrum of Latine voices to be inclusive of Latines. To do this, bioethics needs more Latine voices. Let’s acknowledge our inherent diversity. Let’s ask questions about how someone’s multiple facets of their identity and the context of their lives intersect and inform who they are as a whole person.
Apply Clinical Ethics Skills
Bioethics recognizes that most things are not black and white. In clinical ethics, our work is grounded in the understanding that we need multiple perspectives to fully appreciate the issue or problem and arrive at the most ethically appropriate next steps. Ethics programs and committees often tout the diversity of their membership, though they don’t necessarily explain what they mean by diversity. Clinical ethics ought to have a broad definition of diversity. Clinical ethicists also ought to acknowledge our limits, asking ourselves where we have the knowledge and expertise to speak on a perspective and where we need to pull in those with a deeper understanding of a needed perspective.
Potential Solutions
To move forward with this work, I offer two practical solutions. First, clinical ethics education programs and clinical ethics committees ought to seek to have their participants better represent the community they serve. Program and committee leaders should actively seek out participants from currently underrepresented groups. Second, clinical ethicists and clinical ethics committees ought to actively work to hear and understand the voices of the subgroups they serve. This may be done through formal and informal educational offerings, partnering with their institutional diversity, equity, and inclusion colleagues, and connecting with local community groups.
As bioethicists, we must seek to become more inclusive of diverse voices and work to create a sense of belonging for Latine people. This involves creating space in the bioethics community for Latine voices and listening for diverse narratives and perspectives to inform our work in bioethics. We can work towards broader justice and flourishing by fostering a culture of belonging.
Acknowledgement: The authors thanks Joanne Suarez, Tatiana Pasewark, and Marianita Manolis for recent conversations on Latine identity and representation.
Pageen Manolis Small, MS, BSN, RN, HEC-C (she/her/ella) is a Clinical Ethicist at Unity Point Health – Meriter and a Regional Services RN Coordinator at UW Health.