For doctors, ethical questions often become questions of responsibility. Traditionally that responsibility has been framed in relation to an individual doctor’s obligations to an individual patient.
But when it comes to racism and the structural effects of racism on health, an individual’s ethics might not be enough.
What are the responsibilities of doctors if we understand racism to be a fundamental determinant of health as Williams and Mohammed argue:
“…racism is one of several fundamental or basic determinants of health and it gives emphasis to institutional and cultural racism. The model emphasizes the importance of distinguishing basic causes from surface or intervening causes (proximal pathways). While changes in fundamental causes lead to changes in outcomes, interventions in the intermediate or proximal pathways, without corresponding changes in fundamental causes, are unlikely to produce long-term improvements in population health.”
If racism is a fundamental cause of disease, then what is the responsibility of the doctor outside of the examination room? This is the question Mary T Bassett M.D., M.P.H, Commissioner, New York City Department of Health and Mental Hygiene, asks in a recent piece in the NEJM the #BlackLivesMatter — A Challenge to the Medical and Public Health Communities
“Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism — both institutional and interpersonal — that contributes to poor health in the first place? Should we work harder to ensure that black lives matter?”
For Doctors Council this quickly becomes another question: how do Doctors effectively organize to win these fights? Health Professionals in general and doctors in particular often feel alienated and powerless to address the most basic issues at their institutions. If we are going to fight, we need effective sustainable strategies.
On the most basic level we believe these fights for equity in health care must be collective struggles, in which health professionals, including doctors, organize to serve their patients and communities.
Dr. Bassett is surely correct when she says that “Rightfully or not, medical professionals often have a societal status that gives our voices greater credibility.” How do we as a union, and doctors as a profession, use that voice effectively?