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From page 722... ... Racial and Ethnic Disparities in Healthcare: An Ethical Analysis of When and How They Matter Madison Powers and Ruth Faden The Kennedy Institute of Ethics Georgetown University INTRODUCTION Recent health services research literature has called attention to the existence of a variety of disparities in the health services received by racial and ethnic minorities. As well, racial and ethnic disparities in health outcomes from various health services, including screening, diagnosis, and treatment for specific diseases or medical conditions have also been noted. Read the entire page →
From page 723... ... 723 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER The bulk of this paper will focus on the foundations of the theses, their relation to competing accounts of justice, and the considerations relevant to their moral analysis. In Section II, we articulate the moral foundations for the neutrality and anti-discrimination theses, and in Section III, we examine some potentially morally relevant considerations that inform the conclusions from the perspectives of alternative theoretical frameworks. Read the entire page →
From page 724... ... 724 UNEQUAL TREATMENT egories," understood here as analogous to legally suspect categories in equal protection law. Under the anti-discrimination thesis, either type of disparity -- alone or in combination -- is treated as morally problematic as long as the disparity disfavors a morally suspect group. Read the entire page →
From page 725... ... 725 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER justice. The degree of agreement across theories of justice on the matters under discussion in this paper is, therefore, surprising. Read the entire page →
From page 726... ... 726 UNEQUAL TREATMENT to as agent-relative obligations. Some libertarians have argued that because of the existence of these agent-relative obligations, which in their view form the core of our moral requirements, coercive state action is morally condemnable. Read the entire page →
From page 727... ... 727 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER be entitled first to an equal bundle of civil liberties (e.g., political and voting rights, freedom of religion, freedom of expression, etc.) , which shall not be abridged even for the sake of the greater welfare of society overall. Read the entire page →
From page 728... ... 728 UNEQUAL TREATMENT sible, then even disparities in services received (as well as disparities in health outcomes) based on racial and ethnic categories warrant some moral scrutiny. Read the entire page →
From page 729... ... 729 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER for social cooperation, will seek an overlapping consensus on some evaluative questions. That consensus will necessarily include a commitment to the view of each person as a free and equal citizen. Read the entire page →
From page 730... ... 730 UNEQUAL TREATMENT investigate identified disparities, at least with respect to morally suspect groups, there is far less agreement about how to interpret the moral significance of the results of such an investigation. The moral significance of causality is a difficult sticking point in moral philosophy. Read the entire page →
From page 731... ... 731 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER tional history that causally contributes to present patterns of inequality are in and of themselves unjust, perhaps the result of past intentional harms whose adverse consequences remain today, then present patterns of inequality may be judged as unjust, and not merely a matter of moral failing of individuals or non-governmental institutions. There is nothing intrinsic to the libertarian view that makes it hostile to such historical claims regarding the legacy of racism, the intentional harms based on racial or ethnic prejudice, or the moral taint on the advantages obtained from such practices. Read the entire page →
From page 732... ... 732 UNEQUAL TREATMENT health outcomes worse, or as a deliberate assault on their dignity, these denials of services would count as intentional harms. In this narrow range of cases, the libertarian has no choice but to support the anti-discrimination thesis and conclude that the moral failings involved are injustices. Read the entire page →
From page 733... ... 733 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER differences and natural disasters. The focus is on the way social structures contribute to inequalities, and more specifically on the way that unjust social structures influence the creation of inequalities that reduce the life prospects of some people relative to others. Read the entire page →
From page 734... ... 734 UNEQUAL TREATMENT considerations can be brought to bear. Because the social structural view requires a causal story linking the social structure to health outcomes disparities, the case for injustice when disparities involve majority racial and ethnic patient groups would be more difficult to make than it would be for racial and ethnic groups who also experience broader social disadvantages. Read the entire page →
From page 735... ... 735 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER tionate burdens that are an artifact of the social structure. This is the insight captured by the claim of injustice attaching to the inequalities coming under scrutiny by the anti-discrimination thesis. Read the entire page →
From page 736... ... 736 UNEQUAL TREATMENT Libertarian theories of justice, as well as most forms of egalitarianism, are mute on whether preferences must be taken at their face value. Many brute luck theorists believe that some preferences are beyond voluntary control and are instances of brute bad luck for which there is a duty to remedy (Cohen, 1993) Read the entire page →
From page 737... ... 737 ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER Implications for Physicians, Nurses and Other Providers of Health Care Services From the perspective of the health professional, the bottom line of this analysis can be summarized as follows. All the theories that we have reviewed have reasons to morally condemn disparities in health services and health outcomes involving racial and ethnic minorities. Read the entire page →
From page 738... ... 738 UNEQUAL TREATMENT Ethical arguments can justify the need for social action, but knowing precisely how to effectively intervene requires an integration of ethics with facts. REFERENCES American Nurses Association. Read the entire page →

From page 722...

... Racial and Ethnic Disparities in Healthcare: An Ethical Analysis of When and How They Matter Madison Powers and Ruth Faden The Kennedy Institute of Ethics Georgetown University INTRODUCTION Recent health services research literature has called attention to the existence of a variety of disparities in the health services received by racial and ethnic minorities. As well, racial and ethnic disparities in health outcomes from various health services, including screening, diagnosis, and treatment for specific diseases or medical conditions have also been noted.