In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage.
Epistemic Oppression and Ableism in Bioethics
Disabled people face obstacles to participation in epistemic communities that would be beneficial for making sense of our experiences and are susceptible to epistemic oppression. Knowledge and skills grounded in disabled people’s experiences are treated as unintelligible within an ableist hermeneutic, specifically, the dominant conception of disability as lack. My discussion will focus on a few types of epistemic oppression—willful hermeneutical ignorance, epistemic exploitation, and epistemic imperialism—as they manifest in some bioethicists’ claims about and interactions with disabled people. One of the problems with the epistemic phenomena with which I am concerned is that they direct our skepticism regarding claims and justifications in the wrong direction. When we ought to be asking dominantly situated epistemic agents to justify their knowledge claims, our attention is instead directed toward skepticism regarding the accounts of marginally situated agents who are actually in a better position to know. I conclude by discussing disabled knowers’ responses to epistemic oppression, including articulating the epistemic harm they have undergone as well as ways of creating resistant ways of knowing.
Race Based Medicine, Colorblind Disease: How Racism in Medicine Harms Us All
The genome between socially constructed racial groups is 99.5%-99.9% identical; the 0.1%-0.5% variation between any two unrelated individuals is greatest between individuals in the same racial group; and there are no identifiable racial genomic clusters. Nevertheless, race continues to be used as a biological reality in health disparities research, medical guidelines, and standards of care reinforcing the notion that racial and ethnic minorities are inferior, while ignoring the health problems of Whites. This article discusses how the continued misuse of race in medicine and the identification of Whites as the control group, which reinforces this racial hierarchy, are examples of racism in medicine that harm all us. To address this problem, race should only be used as a factor in medicine when explicitly connected to racism or to fulfill diversity and inclusion efforts.
Intersectionality in Clinical Medicine: The Need for a Conceptual Framework
Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.
It’s Time for a Black Bioethics
There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes (Barr 2014), provider bias and racism lessening their access to quality care (Sabin et al. 2009), disproportionate police killings (DeGue, Fowler, and Calkins 2016), and white supremacy and racism which encourage poor health (Williams and Mohammed 2013). Bioethics, comprised of humanities, legal, science, and medical scholars committed to ethical reasoning is prima facie well suited to address these problems and influence solutions in the form of policy and education. Bioethics, however, so far has shown only a minimal commitment to Black racial justice.
Fish pluralities: Human-animal Relations and Sites of Engagement in Paulatuuq
This article explores human-fish relations as an under-theorized “active site of engagement” in northern Canada. It examines two case studies that demonstrate how the Inuvialuit of Paulatuuq employ “fish pluralities” (multiple ways of knowing and defining fish) to negotiate the complex and dynamic pressures faced by humans, animals, and the environment in contemporary Arctic Canada. I argue that it is instructive for all Canadians to understand the central role of humans and animals, together, as active agents in political and colonial processes in northern Canada. By examining human-fish relationships, as they have unfolded in Paulatuuq over the last 50 years, we may develop a more nuanced understanding of the dynamic strategies that northern Indigenous people, including the Paulatuuqmiut (people from Paulatuuq), use to navigate shifting environmental, political, legal, social, cultural, and economic realities in Canada’s North. This article thus places fish and people, together, as central actors in the political landscape of northern Canada. I also hypothesize a relational framework for Indigenous-State reconciliation discourses in Canada today. This framework expands southern political and philosophical horizons beyond the human and toward a broader societal acknowledgement of complex and dynamic relationships between people, fish, and the land in Paulatuuq.
“Life Comes from it”: Navajo Justice Concepts
This paper offers a comparison between Navajo conceptions of law and justice based on the community’s experiences to those of Anglo-european law and justice.
What’s Normative Got to Do with It?: Toward Indigenous Queer Relationality
This article considers the queer problem of Indigenous studies that exists in the disjunctures and disconnections that emerge when queer studies, Indigenous studies, and Indigenous feminisms are brought into conversation. Reflecting on what the material and grounded body of indigeneity could mean in the context of settler colonialism, where Indigenous women and queers are disappeared into nowhere, and in light of Indigenous insistence on land as normative, where Indigenous bodies reemerge as first and foremost political orders, this article offers queer Indigenous relationality as an additive to Indigenous feminisms. What if, this article asks, queer indigeneity were centered as an analytic method that refuses normativity even as it imagines, through relationality, a possibility for the materiality of decolonization?
Understanding Tribal Sovereignty: Definitions, Conceptualizations, and Interpretations
Forty years have passed since the Midcontinent American Studies Journal published its landmark special issue, “The Indian Today.” Since that publication, the landscape of Indian country has changed dramatically. This change has come primarily from an amazing cultural resurgence among Native Peoples in the United States — a resurgence that has manifested itself in everything from the Red Power movement to the birth of American Indian studies in the academy; to the renaissance of contemporary Native art, literature, and film; to the creation of tribal colleges, museums, and cultural centers; to the unprecedented rise in economic development; to notable gains in power in political and legal arenas.
Working Together: Crossing Color Lines at Work
Amidst signs of declining social capital, the typical workplace is a hotbed of sociability and cooperation. And in a still-segregated society, the workplace is where adults are most likely to interact across color lines. The convergence of close interaction and some racial diversity makes the workplace a crucial institution within a diverse democratic society. Paradoxically, the involuntariness of workplace associations—the compulsion of economic necessity, of managerial authority, and of law—helps to facilitate constructive interaction among diverse co-workers. Where racial diversity is a fact of organizational life (and the law can help to make it so), then employers and workers have their own powerful reasons—psychological and economic—to make those relationships constructive, even amicable. I contend here that it is where we are compelled to get along, and not where we choose to do so, that we can best advance the project of racial integration.