Acknowledging the Burdens of 'Blackness'

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Nneka O Sederstrom1, Jada Wiggleton-Little2

  • 1Hennepin Healthcare System, 730 S. 8th Street, Minneapolis, MN, 55415, USA. NnekaSederstrom@gmail.com.

HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
|March 6, 2021
PubMed

Insights

Racial inequities in healthcare were highlighted by the COVID-19 pandemic. A "most lives saved" approach in crisis standards of care is inequitable, disproportionately harming Black Americans due to systemic racism.

Area of Science:

  • Public Health
  • Medical Ethics
  • Health Equity

Background:

  • The COVID-19 pandemic revealed significant racial disparities within the U.S. healthcare system.
  • Ethical considerations arose regarding crisis standards of care (CSC) and triage protocols, focusing on the principle of 'most lives saved'.

Purpose of the Study:

  • To analyze the inherent inequities of a colorblind, race-neutral approach to 'most lives saved' in CSC.
  • To examine how CSC, as currently implemented, may function as racist policies disproportionately affecting Black Americans.
  • To explore the use of modified Sequential Organ Failure Assessment (mSOFA) scores within a systemically racist healthcare framework.

Main Methods:

  • Critical analysis of existing crisis standards of care (CSC) policies.
  • Examination of the ethical principle of 'most lives saved' in the context of racial inequity.
  • Discussion of the modified Sequential Organ Failure Assessment (mSOFA) as a metric within systemic racism.

Main Results:

  • A race-neutral approach to 'most lives saved' is inherently inequitable, masking 'whiteness' and ignoring the burdens of 'Blackness'.
  • Existing CSC policies can perpetuate historical mistreatment of Black Americans, functioning as racist policies.
  • The application of objective measures like mSOFA in a racist system poses potential dangers for Black Americans with COVID-19.

Conclusions:

  • Idealized fairness in CSC is undermined by systemic racism.
  • The uncritical application of CSC and mSOFA scores can exacerbate health disparities for Black Americans.
  • Urgent re-evaluation of CSC is needed to address and dismantle systemic racism in healthcare.

Keywords:
COVID-1619COVID-19ColorblindCrisis standards of careIdeal and nonidealRacismSOFA score

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