Black Lives in a Pandemic: Implications of Systemic Injustice for End‐of‐Life Care

• Published in: The Hastings Center report Vol. 50; no. 3; pp. 58 - 60
• Main Author: Elbaum, Alan
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.05.2020; John Wiley and Sons Inc
• Subjects: African Americans; Betacoronavirus; Black Lives Matter; Black or African American; Brief reflections on lessons and questions posed by Covid‐19 for health, medicine, and bioethics; Coronavirus Infections - epidemiology; COVID-19; Health Care Rationing - ethics; health disparities; Healthcare Disparities - ethics; Healthcare Disparities - ethnology; Humans; palliative care; Palliative Care - ethics; Palliative Care - organization & administration; Pandemics; Pneumonia, Viral - epidemiology; Racism; rationing; SARS-CoV-2; Social Determinants of Health - ethics; Social Determinants of Health - ethnology; Social Justice; structural racism; Systemic racism; Terminal Care - ethics; Terminal Care - organization & administration; Trust; United States - epidemiology; United States; structural racism; health disparities; Black Lives Matter; rationing; palliative care
• ISSN: 0093-0334; 1552-146X; 1552-146X
• DOI: 10.1002/hast.1135

In recent months, Covid‐19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long‐standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end‐of‐life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision‐making. In the midst of the Covid‐19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race‐neutral algorithms sacrifice black lives. Is there such thing as a “good” or “dignified” death when African Americans are dying not merely of Covid‐19 but of structural racism?