Acknowledging the Burdens of 'Blackness'
Nneka O Sederstrom1, Jada Wiggleton-Little2
1Hennepin Healthcare System, 730 S. 8th Street, Minneapolis, MN, 55415, USA. NnekaSederstrom@gmail.com.
Summary
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.
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