As one of our core values is collaboration, we have endeavoured to work with established organisations in UK bioethics to promote anti-racism. We were therefore delighted when, through my role as both a trustee of UKCEN and a member of the UKCEN 2023 organising committee, we were able to contribute to the organisation of the UKCEN 2023 pre-conference workshop. The theme – “addressing inequity in and through clinical ethics” – follows on from my growing interest in how clinical ethics support services (CESS) can also work to address healthcare disparities.
The discussions during the workshop revolved around two fictionalised cases, where “best interests” decisions needed to be made, in keeping with the UKCEN 2023 conference theme. The first case discussion, on the care of a pregnant patient, was led by Dr Louise Austin (Lecturer in Law, Cardiff University and Member, University Hospital of Wales Clinical Ethics Committee) and Dr Aisha Davies (GP and Co-Founder, Black Mothers Matter). This case focused specifically on access to care during pregnancy and considered the potential inequity that may (not) be evident through current methods of case consultation. In the case, a pregnant person’s capacity was being called into question as a result of perceived mental health issues. Amongst the issues discussed were whether and how to hear directly from patients during case consultation and how far CESS’ role in advocacy should extend. We also explored whether the patient actually lacked capacity, if the referral to the CESS was meant to serve the patient or the healthcare team, and whether the proposed treatment decision was being made in the patient’s best interests or in the healthcare team’s best interests. The case discussion ended with a reflection on how the composition of CESS (e.g., by gender, professional background, ethnicity) might affect ethical deliberation, and why it might be important to include social factors (e.g., ethnicity, migrant status) in referrals to CESS, so that socially sensitive and contextualised advice may be offered.
The second case explored the challenges posed by caring for so-called “difficult” patients, and how CESS can and should respond to requests for advice in these scenarios. Here, the fictional patient at the centre of the referral undoubtedly lacked capacity – but the question was around whether patients, who lack capacity, can be blamed for their racist actions or behaviour. This led to a dialogue on the risk of harm to both healthcare staff and patients when racial abuse is encountered, and whether racially-based reassignment of staff is appropriate. The discussion, led by Ms Kumeri Bandara (PhD Candidate, University of Oxford) and Ms Rakeb Yoseph (Medical Student and Race and Ethnicity Advocate, Bristol Medical School EDI Forum), closed with reflections on how the advice offered by CESS is perceived externally. Though CESS are not decision-making bodies, it was suggested that clinical decision-makers are unlikely to go against the advice or recommendations offered by a body of ‘ethical experts’.
I had a number of goals as I planned this session. First, I wanted the speakers to come from a range of backgrounds, recognising that expertise comes from people with lived experience and does not always fit into typical academic hierarchies. Second, I wanted the workshop to be primarily case-based, as members of CESS are in their element when discussing challenging cases. Though these cases were fictional, they were based on the real-world experiences (through research, lived experience, clinical work, or CESS involvement) of each of the speakers. Third, I wanted to challenge members of CESS, to address their own unconscious biases in a way that was non-confrontational. Finally, I wanted the environment to feel safe, so participants could engage fully in what can be perceived as difficult or awkward topics of discussion. The afternoon was well received, and the feedback suggested that these goals were met. Indeed, the conversations around how CESS can and should address inequity continued into the evening drinks reception.
In addition to the four speakers, we would like to thank Dr Jo Hartland (Senior Lecturer, Bristol Medical School), for their contribution in planning the workshop. Following Dr Hartland’s guidance, we provided participants with a broad range of resources, to continue engaging with anti-racist ideas and principles after the workshop. This list of resources is provided below. We are also grateful to Professor Richard Huxtable, as co-chair of the UKCEN 2023 organising committee, for providing Black and Brown in Bioethics with the opportunity to run this workshop.
Further Resources
- Wellcome Anti-Racist Principles and Toolkit (2022)
- Netflix – “When They See Us”, “13th”
- YouTube – Wellcome talk on “Decolonising Healthcare with Dr Annabel Sowemimo”
- Podcasts – “Revisionist History” (Gladwell) “Invisible Women” (Criado-Perez), “Intersectionality Matters!” (Crenshaw)
- Reading – “How to be an antiracist” (Ibram X. Kendi), “Why I’m no longer talking to white people about race” (Reni Eddo-Lodge)