Greenwall-funded Bioethics Research Addresses Injustices in Health and Healthcare

Racial and gender bias against healthcare providers. Unequal access to vaccines. Poor health outcomes in communities of color. Bioethics can help us confront and address these and other longstanding injustices in health and healthcare. 

Recent CDC data show that individuals from racial and ethnic minority groups are less likely to have fair opportunities for economic, physical, and emotional health. A range of factors are to blame, including discrimination, lack of adequate access to healthcare and education, and large gaps in wealth. Over the past year, these inequalities have been laid bare. The CDC’s findings are among the overwhelming evidence that COVID-19 has disproportionately affected racial and ethnic minorities. COVID-19 will subside, but biases and disparities in health and healthcare were with us long before the lockdowns and will not disappear once the pandemic is gone.

The Greenwall Foundation has been an early and leading funder of bioethics research aimed at combatting these inequalities. Across many disciplines, Faculty Scholars and Foundation grant recipients are studying the social and ethical underpinnings affecting how individuals are cared for—and they are finding solutions, such as shared decision-making, that improve health outcomes.

Since its inception in 2013, the Foundation’s Making a Difference grant program has incorporated a priority area focused on bioethics issues in underrepresented communities, or racism, bias, and discrimination in clinical care.

A number of Making a Difference grants explore ethical questions in these areas. Here are a few examples:

• When people demean medical workers based on race, ethnicity, or sexual orientation, it not only undermines the relationship between the patient and healthcare provider, but it can compromise the quality of care for the patient and may violate the rights of the medical workers as employees. Making a Difference grantee Alicia Fernandez, MD, is tackling this problem by studying the range of demeaning remarks and behaviors by patients and recommending institutional policies and protocols that balance respect for the patient with meeting medical needs and maintaining dignity for the healthcare workers. Dr. Fernandez co-authored paper in JAMA Internal Medicine exploring how physicians and trainees deal with situations of biased patient behavior.
• Rural areas frequently struggle to adequately fill their hospitals with doctors and other qualified medical staff. One of the ways rural communities combat the lack of local medical professionals is to bring in international medical graduates to serve the population. However, increasing anti-immigrant sentiment can make it difficult to recruit and hire them. Making a Difference grantee Kata Chillag, PhD, is focusing on justice issues and international medical graduates, asking questions about our collective obligations to ensure access to adequate health care services, and whether immigration policies impede our ability to meet those obligations. In March 2020, Prof. Chillag and Elizabeth Fenton, PhD, co-authored an essay in The Hastings Center Bioethics Forum addressing the needs of underserved communities in the wake of COVID-19. They concluded, “We need international medical graduates to help fight COVID-19. Immigration policies keep them away.”
• When it comes to end-of-life care, policies regarding “futile” or “medically inappropriate” interventions have been developed without the perspectives of patient groups who may be disproportionately affected. A number of factors suggest that African Americans are more likely than whites to find themselves in conflicts that trigger the use of futility policies, with outcomes that most often uphold clinicians’ assessments of futile care. Making a Difference grantee Kimberly S. Johnson, MD, explored the perspectives of African Americans on managing these conflicts, and sought to develop recommendations for policies that accommodate the concerns of African Americans surrounding the use of life-sustaining technologies. Data from Dr. Johnson’s Greenwall-funded study led to two subsequently funded grants to improve outcomes for racial and ethnic minorities by addressing the importance of early advance care planning, and studying interventions that reduce bias in the clinical encounter.

The Foundation also recently funded an important effort to help build diverse voices and perspectives in bioethics. In 2019, Faculty Scholar Alum Leslie E. Wolf, JD, MPH, and her colleagues developed a new undergraduate course at Georgia State University with a Foundation-initiated grant, Engaging Diversity: Pathways to Bioethics for Minority Students. Prof. Wolf’s course helps students understand bioethics problems relevant in their communities and highlights how minority physicians and biomedical researchers are addressing these problems in real-world projects. “Having that space to come together and hear from somebody who really gets you and your experiences and learn from each other has been invaluable,” she said. “Each time we bring in a new class, we’re adding to that community and those connections and support system. We’re providing both professional and intellectual development.”

Explore more work from our community on health disparities, the role of race in research, and bias and discrimination in clinical care here, and learn about the history of discrimination as reflected in past pandemics from Keith Wailoo, PhD, in the Foundation’s 2020 William C. Stubing Memorial Lecture.