I recently read “Black Lives in a Pandemic: Implications of Systemic Injustice for End-of-Life Care”, and I want to briefly reflect on the article. In this piece, Alan Elbaum analyzes palliative care in the light of systemic injustice. Elbaum contextualizes his analysis with the fact that the COVID-19 pandemic has disproportionately affected African Americans compared to other races due to systemic injustice. He then discusses how this has had an impact on palliative care.
Elbaum explains how the medical decisions patients make in palliative care vary between white Americans and black Americans. For instance, several repeated studies have found that “relative to white Americans, African Americans more often choose therapies such as prolonged ventilation and feeding tubes, less often elect to receive hospice care, and less often engage in advance care planning” (Elbaum, 2). In other words, African Americans feel that accepting to not undergo aggressive treatment on their deathbed gives the doctors the green light to give up on their lives. This belief is evidently rooted in systemic injustice.
Another point that Elbaum touches on is the fact that African Americans were unjustly and disproportionately affected by the COVID-19 pandemic. They have less access to healthcare and the economic ability to self-isolation. African Americans across the US face negative social and structural determinants of health. Evidently, the system is effectively working against them.
In analyzing this phenomenon, journals like the Journal of the American Medical Association create “colorblind” rationing, despite the fact that the pandemic has clearly disproportionately affected African Americans. This is part of the greater issue of trying to create equality over equity, when one group is more blatantly struggling from oppression.
After reading this article, one question that came to mind was how can medical professionals actively work against racism and create trusting, meaningful relationships with their African American patients? After so many years of systemic injustice, how can physicians and other healthcare providers create strong relationships with their African Americans patients in a way that allows them to trust their providers with their end-of-life decisions?
Reference:
Elbaum, A. (2020). Black lives in a pandemic: Implications of systemic injustice for end‐of‐life care. Hastings Center Report, 50(3), 58-60.