Do no harm: the dangers of racialized medicine

Opinion

Photo by Hush Naidoo Jade Photography on Unsplash

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First, do no harm.

This is probably the most famous line in medicine. Commonly associated with the Hippocratic Oath, an oath of medical ethics taken by Western physicians since its origin in ancient Greece, this noble phrase has faced many challenges over the years. Medical professionals have grappled with the morality of performing abortions and dispensing birth control, treating wounded enemy soldiers and prisoners of war, and the legacy of atrocities such as the famous Tuskegee Experiment—which led to the research ethics processes, or Institutional Review Boards (IRB), that all of us who work in academia are so familiar with today. Recently, however, the maxim of “do no harm” has come into conflict with the now-popular prospect of rationing critical medical care according to race.

At least one major U.S. state, New York, has published guidelines for dispensing life-saving COVID-19 treatments, like the oral anti-viral Paxlovid and all monoclonal antibodies, which appear to send sick white folks to the back of the metaphorical bus. According to an official directive from the New York State Department of Health—bearing the virtual signatures of Governor Kathy Hochul, Acting Commissioner Mary T. Bassett MD, MPH, and Executive Deputy Commissioner Kristin M. Proud—the list of “medical condition(s) or other factors” that qualify patients to receive these scarce life-saving drugs include such factors as being over 12 years of age, having COVID-19, being healthy enough to start treatment, and being a “non-white race or [of] Hispanic/Latino ethnicity.” The latter, it is claimed, should be considered a medical risk factor akin to having a disability, since, according to the New York State Department of Health, “long-standing systemic health and social inequalities” allegedly make people of color more likely to get sick and die from COVID-19.

New York’s policy on monoclonals is not the state’s only venture into race-based health care. The New York Post reports that New York City also appears to be prioritizing race in the distribution of COVID-19 testing resources. A series of leaked emails from the NYC Department of Health and Mental Hygiene reveal that the city is explicitly prioritizing neighborhoods flagged by a city task-force on “Racial Inequality and Equity” when it comes to establishing COVID-19 testing centers and pop-up clinics.

This is not some theoretical, abstract process: the task force has so far identified 31 “underserved” neighborhoods to receive priority attention from the city. These neighborhoods seem to have been designated as “underserved” based entirely on their racial makeup, rather than social class or demonstrated need; the Post article notes that Staten Island’s famously white and working-class South Shore is curiously not one of the prioritized neighborhoods, despite having one of the highest rates of COVID-19 infection in the city. While the borough of Staten Island was assigned a total of 13 COVID-19 testing sites, all were located on the more racially diverse North Side of the island. Similarly, Robert Hold, Councilman for Queens, has noted separately that his entire district is “still without a city testing site.”

All of this is emblematic of the increasingly common flip-side of “white privilege.” In a widely read recent piece, again for the heterodox Post, young minority writer Rav Arora points out that “minority privilege” is now far from uncommon in American upper-middle class life. Arora highlights the almost universal prevalence of affirmative action in the business world. He notes that Facebook, for example, has committed to hire 50 percent of all employees—presumably across tech and non-tech positions—from “unrepresented” black, Hispanic, and Native American communities by 2023. Best Buy plans to hire “one person of color for every three new hires” during at least the next five years. United Airlines, not to be outdone, has declared in writing that half of all new pilots will be minorities (including women) for the next decade. And so on.

These ideas are founded in a long history of progressive academic theory. For the past several decades, many prominent progressive thinkers have claimed that literally all discrepancies in performance among large groups reflect racism or some similar bias, with this idea growing so prevalent that Thomas Sowell felt compelled to write a best-selling book debunking it. Most notably, Boston College Historian and MacArthur genius Ibram X. Kendi has argued that any significant group performance gap has to indicate bias—because the only other potential explanation is, in his view, that the under-performing group is somehow innately inferior to the other groups.

This assumption leads directly to sweeping logical conclusions. Kendi openly argues that “the only remedy for past discrimination is present discrimination, and the only remedy for present discrimination is future discrimination,” and calls for a Federal Department of Anti-Racism to ensure proportional representation of all racial groups across all fields. You can find his dead-serious proposal here.

To someone who has swallowed modern Wokist philosophy hook, line, and sinker, Facebook’s hiring plan and New York’s COVID-19 policy might seem like the only logical and moral options. However, there are obvious factual and ethical problems with these unabashedly discriminatory proposals which the vast majority of Americans intuitively understand. 

First, the core of these arguments is empirically false. As Sowell, June O’Neill, Amy Chua, Glenn Loury, Walter Williams, John Ogbu, Heather Mac Donald, and little ol’ me have pointed out for years, there are dozens of easily trackable variables other than “racism” and “genes” that affect the performance of groups, such as median age, culture, and geography. Many minority groups out-earn white Americans for exactly these reasons, something many social justice activists find almost impossible to explain, yet quantitative social scientists accept as a commonplace.

In fact, the list of these successful minority groups includes more than a few of the East Asian, South Asian, “MENA,” and black immigrant groups that would be prioritized over all whites for COVID-19 care by the state of New York. It is both illogical and unethical to prioritize non-white folks for access to life-saving medical treatment when they are doing better than their Caucasian country-men. Even among those groups that currently are doing a bit worse, targeting care at the poor and/or elderly persons in general would make more sense in any scenario than focusing on the largely irrelevant characteristic of race per se.

All that said, it would still not make sense to use race as a basis for individual patient-care decisions even if Kendi was right that some form of past bias or very subtle current bias (in favor of Koreans?) really did explain all human group performances. In reality, membership in 100 different categories—being a woman instead of a man, gay instead of straight, poor instead of rich, Italian or Cajun or Jewish instead of a 6’4” blonde WASP—makes one more likely to have a tough and challenging life. But it would be completely untenable, not to mention morally wrong, for a critical care doctor to prioritize gay guys over straight guys, or even women over men, within a line of patients waiting for a blood transfusion. In fact, in at least the second scenario, the law would forbid the doctor from doing so. The U.S. Civil Rights Act specifically prohibits any denial of rights or service on the basis of race, sex, gender identity, sexuality, ethnicity or nationality, and religion.

That is why FAIR is suing New York City to challenge its current unconstitutional COVID-19 policy. FAIR asserts that it is bad—and illegal—to ration access to essential medical care on the basis of race and ethnicity. The lawsuit is also based on the idea that open discrimination is always wrong, whether it is against white people or people of color. We can perhaps debate potential exceptions-to-the-rule like private sector affirmative action, and we can certainly utilize programs focused on helping the poor in America (who are disproportionately “POC”) in an attempt to remedy the residual harms of our country’s past racism. But, it is simply absurd to argue that guiltless citizens today should accept old-school racial discrimination in an attempt to compensate for theoretical or even proven bias in the distant past. 

The solution to “discrimination then” simply cannot be “discrimination forever.”

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The opinions expressed here do not necessarily reflect those of the Foundation Against Intolerance & Racism or its employees.

In keeping with our mission to promote a common culture of fairness, understanding, and humanity, we are committed to including a diversity of voices and encouraging compassionate and good-faith discourse.

We are actively seeking other perspectives on this topic and others. If you’d like to join the conversation, please send drafts to submissions@fairforall.org.

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