 So good morning, everybody, or whatever time it is for those of you who are participating internationally. My name is Bob Trug. I'm the director of the Harvard Medical School Center for bioethics. Thank you for being with us today. Before turning the session over to the organizers and moderators for our event. I wanted to put in a word for our center. In addition to our master of bioethics program or fellowship program postdoctoral program. We do host a regular series of public forums that are open to everyone. Along with featured speakers like Professor Wilson this morning. We host for book authors each year. We're going to be doing a weekly series to celebrate black history month in February and other seminars whenever good opportunities arise. If you would like to be added to our not too frequent and hopefully non intrusive mailing list. Please email us at bioethics at hms.harvard.edu. The session today has been organized and will be moderated by several of our master of bioethics students. Sheila Calivar, Giselle Vitkoff, Izzy Hernandez, Connie Lou, and Julius Emerson Towers under the mentorship of our senior faculty member Dr. Lachlan Farrell. Next slide and let me just go over a couple of questions for those of you who are watching so we are going to be having a question and answer period at the end that will be moderated by our students. And the way to do that is you can submit questions using the q amp a feature found in the meeting controls at the bottom of your screen. Please feel free to talk about us using Twitter. And you can use the chat feature, either for comments or technical issues, but please use the q amp a feature for questions that you would like to be directed to Professor Wilson. So without any further delay let me turn this over to Sheila Calivar she is a neonatal intensive care nurse and ethicist who came to our master's program from Seattle Children's Hospital. So, she can take it away. Thank you so much for the introduction and thank you all for being here. Once again, my name is Sheikha Calivar, and I'm a student in the master's degree program here at Harvard Medical School Center for bioethics. And it is my pleasure to introduce our speaker for today, Dr. Yolanda Wilson. Yolanda Wilson is an associate professor of philosophy at Howard University. She is also a 2019 2020 fellow at the National Humanities Center, and a 2019 2020 encore public voices fellow. She holds a PhD in philosophy from the University of North Carolina at Chapel Hill. Her research interests include bioethics, social and political philosophy, race theory, and feminist philosophy. She is broadly interested in the nature and limits of the state's obligations to rectify historic and continuing injustice, particularly in the realm of health care, and is developing an account of justice that articulates specific requirements for racial justice in health care at the end of life. Once again, thank you for joining us today for changing the record, how bioethics ought to address racism and bias in health care and beyond, presented by Dr. Yolanda Wilson. So thank you. Thank you so much for that beautiful introduction. Thank you for inviting me for having me here today. I hope that we can have a fruitful conversation. I'm looking forward to it. And the presentation that I had in mind for today is, and let me get my PowerPoint situated. Can you all see the screen I hope you can see the screen is a paper that's going to appear in the journal bioethical inquiry. I wanted to do a little talking about it and do a little talking through it, because I think that some of the issues that come up in this paper are helpful as we think about what bioethics is can do moving forward to address racism. So this paper is bioethics race and contempt. I should have subtitled it maybe a bioethics takes on racist contempt, or perhaps even what is this paper have to do with bioethics because I've had that question a little bit, but it is kind of a continuation of a paper that we gave in 2016, I think that appeared in the American Journal of Bioethics with colleagues and I. So let me start my timer because otherwise I will just ramble on a bit. Okay, here we are. Barbara Dawson was having difficulty breathing and sought help at Calhoun Liberty Hospital in Bluntstown, Florida. So that's a rural area near Tallahassee and during the Q&A, I hope that we can chat a little bit about rural health and how this works through the lens of race and what some of the unique challenges are of rural health generally. That's one area that I'm interested in that I haven't actually written on but I think about it particularly now. And so I hope we can talk about that a little bit but this but this little hospital Calhoun Liberty is near Tallahassee. It's, it's like the only hospital for miles a mile so Barbara Dawson sought help there. In the examination, the emergency department physicians treated her. And once they determined she was stable discharged her. However, Miss Dawson refused to leave. She was experiencing breathing difficulty and pled to be examined further, but hospital staff responded by calling the police, who properly arrested her for trespassing and disorderly conduct. Once she collapsed outside of the arresting officers patrol vehicle, the officer assumed she was faking and can be heard on the dash cam video telling an unresponsive Dawson falling down like this laying down. That's not going to stop you from going to jail. Within hours, Miss Dawson was dead from a pulmonary embolism or blood clot in her lungs so I've written about this in some of the public scholarship that I work on and if you're interested in kind of talking about bio with some public scholarship versus or in addition to or how it complements more traditional scholarship I'm happy to have that conversation to. What happened to miss Dawson is but one example of how medical racism and the carceral state converge and end black lives. The US healthcare system has a long history of displaying what I call racist contempt toward black people from medical schools use of enslaved bodies as condavers with the blessing of local or state governments but without the consent of the black ones were used to the infamous Tuskegee syphilis experiment funded by the US public health service to the widespread hospital practice of reporting suspected drug users who seek medical help, even during labor and delivery to to the police. The institutional practices and policies that have shaped us healthcare systems as we know them cannot be minimized as unfortunate coincidence, rather the very foundations of medical discovery diagnosis and treatment are built on racist contempt for black people and have become self perpetuating. Yet, I do not believe that changes and impossibility, and I think that bioethicists have a role in making this happen. I've argued elsewhere by broadening the scope of bioethicist research and clinical attention that bioethicists can effectively address this issue. In that paper, my colleagues and I argue three offer three arguments why bioethicists specifically need to address racism. Taking seriously the social determinants of health means that bioethicists cannot ignore the reality of the role that racism plays in health status and health outcomes. The stress of living with racism has been linked to hypertension and cardiovascular disease. Additionally, black people are more likely to live near power plants and landfills and older buildings with peeling lead based paint, and in food deserts far away from grocery stores, all of which can contribute to conditions like asthma and obesity. Furthermore, the current global pandemic brought about by COVID-19 highlights the high risk low status work that black and Latinx people disproportionately do such as grocery store clerks food processing plants and custodial work that makes social distancing self-isolation nearly impossible, thereby increasing risk of exposure and also increasing the risk of serious illness or death as a result of contracting COVID-19. Two, academic medicine and public health have begun to think about how practices are informed by implicit bias and bioethicists should be in step with others in the health sciences. Now, there's much to criticize about implicit bias, including how useful it is to study implicit bias in the absence of any significant institutional change. Whether focus on implicit bias masks, what is actually explicit bias, and whether the sudden interest in implicit bias is merely window dressing. That is, there is concern about whether implicit bias merely makes white people feel good about addressing racism without actually doing much substantive work. To the extent that bioethics hasn't as a field, taking these minimal steps places bioethics behind the curve. And three, one of the core commitments of bioethics is concern for justice, and this must include concern for racial justice. So bioethicists have an obligation to work to be actively anti racist, particularly as racism leads to other healthcare disparities. But beyond the general charge to bioethics, what does this look like, and does it make a difference that I frame particular manifestations of racism within US healthcare systems as contemptuous. While some who read our 2016 paper, objected that what we proposed overstepped the appropriate domain of bioethics, we contended then and I reiterate now that bioethics does not exist in a vacuum. To the extent that at least some varieties of racism reflect contempt, and that institutions can exhibit contempt, I argued that institutions can harbor specifically racist contempt. In addition to attempting to change institutions themselves, one challenge for the bioethicist will involve navigating the appropriate response to racist contempt, especially in clinical settings. In order to do that, I first explore features of contempt before turning specifically to racist contempt. On my view, racist contempt does not necessarily involve withdrawing from the content, but may instead or in addition to involve paying too much attention to black people. Although I think specifically about you with healthcare systems as institutions, I do not think one can draw a firm line between interpersonal contempt and institutional contempt as as individuals comprise institutions. This may seem at first plush to be a fairly trivial point, but I hope to make that clearer later in the talk. Finally, I consider appropriate responses to racist contempt and how the bioethics is can respond in such a way that upends the contemptuous racism of US healthcare. Dr. Bell argues that there are four central features of contempt. One negative prezel of the status of the object of contempt to globalist emotion, that is, not only is the proper object of contempt the person as opposed to the action, but contempt takes the whole person as its object. Three comparative or reflexive, that is, a comparison between oneself and the contempt that takes the contempt to be inferior and for psychological withdrawal or disengagement from the target of contempt. For my purposes, the notion of contempt as a globalist emotion is specifically salient. The feeling contempt encompasses the whole person as its target, rather than any particular act that the person is committed or attributes of the person means that it will be difficult if not impossible to revise one's view of the contempt. To borrow from Hoskins, contempt permeates interactions with the contempt. That is, any interaction with the contempt will confirm that already disfavored view that one holds of the contempt. So even an interaction that with someone other than the contempt might be viewed positively or at least neutrally. Such an interaction with the contempt will also be viewed through the lens of the negative assessment that one holds of the contempt. Although for Bell and others, one must withdraw from the contempt. David Sussman rejects for as a necessary feature on Sussman's view, the contempt might be the target of disengagement but need not to be. Instead, Sussman claims that the contempt can also be treated as a subject of mockery, far from withdrawing from the contempt to treat the contempt as a target of mockery requires engagement through treating the contempt as something ridiculous or impotent. While I find Bell's first three features of contempt compelling, like Sussman I do not find for to be a necessary feature of contempt. While Sussman understands mocking derision to be a different form of contempt. I think that contempt can also manifest as paying too much attention to the contempt. I'll develop this idea later in the talk, but for now I will say that the extent that to the extent that contempt is an expressive emotion, right one has to do something in order to show contempt. Some instances of expressing contempt require attention to the target, and that attention must be focused and sustained in order to properly express to the target that the contempt or finds them contemptuous. Institutions can also be sites of contempt. Zachary Hoskins is argued for an account of contemptuous institutions by focusing on the institution of punishment. He argues that the institution of punishment through the use of super maximum security prisons or super max prisons treats those who have been contempt of crimes contemptuously with isolation 23 of 24 hours a day, minimal exercise and minimal super max prisons send the message to those who have been convicted of crimes and sentenced to super max facilities that they not the crimes of which they are convicted are beyond redemption. So I want to move specifically to racism is contempt and and for that I'll look at Jorge Garcia who's really cool philosopher I think so Jorge Garcia argues for a volitional account of racism. On the volitional account of racism hatred and ill will form one variety of racism and disregard and contempt form the other for Garcia contempt simply is not morally permissible. So the disregard and contempt associated with his volitional account of racism reflects a larger global moral failing. However, if one thinks as I do that at least some forms of contempt maybe sometimes morally permissible. Then one must be concerned with ensuring that the contempt is apt. In other words, to the extent that the contempt can ever be morally permissible. It can only be permissible if the target of contempt is the correct one, and the reasons for contempt are morally defensible contempt that is an act is not morally permissible. Racism would be an example of inapt contempt on this view what is bad about contemptuous racism isn't the contempt itself, but that the contempt is misplaced racist contempt depends on a belief in racial superiority white supremacy. Racism is the organizing principle that whiteness has an inherent value over and above others, and that others are disvalued perhaps even to the point of having no value. The racist desires that whiteness be recognized and esteemed at all costs, and they work to preserve the high status afforded whiteness for the white supremacist race races exist as a hierarchy with whiteness at the top and blackness at the bottom. The contemptuous racist and negatively appraises those who are not white. They regard those were not white as inferior, and this sense of negative appraisal and inferiority holds for anyone who is not white. Interestingly, on my view the contemptuous racist need not themselves be white for one could conceivably be black and also hold whiteness and high regard while negatively appraising other black people. This phenomenon is sometimes referred to as internalized racism. The contemptuous racist race based contempt is focused not just on supposed actions of members of racial groups, but on persons themselves. If you are seen as low in virtue of your race attempting to win esteem by outperforming others is unlikely to be successful. Under those conditions your successes are not likely to read down to your favor. Instead, you will likely be interpreted as the beneficiary of good luck or some other external factor. In other words, the contemptuous racist hates members of disfavored racial groups, not for what they do, but for who they are. This isn't to say that the contemptuous racist would never give behavior related reasons for the hatred of non whites. However, those reasons would not likely hold up to close scrutiny. Indeed, one of the features of contempt in general is the unwillingness to reevaluate the condemned in the face of contrary evidence. So in addition to agreeing with Sussman that mocking derision is also a form of contempt, I agree, or I argue, that contempt can also take the form of too much attention. As I've stated, I agree with Bell and Hoskins that contempt can take the form of withdrawing. In fact, an interesting feature of the institutional account of contempt that Hoskins argues for with regard to Supermax prison facilities is the prisoners report that the cold and personal nature of the treatment quote like dealing with automatons is part of what makes the experience not like living. In my own work, I've highlighted the lack of touch that black patients receive from healthcare personnel at the end of life as a manifestation of medical racism. And although in that work I don't use the language of contempt, the sense of black patients not being worthy of the dignity of touch and other human comfort care at the end of life could certainly count as contemptuous. However, there are other instances that I would identify as racist contempt that are neither mocking derision nor withdrawal. Far from regarding black people, especially as beneath notice on engagement, the contemptuous racist is at times deeply preoccupied with noticing and engaging with black people. And it is that fact, and and the intensity of the engagement that serves to send the clear message that black people are contend. Charles Mills uses the term subpersonhood to describe the status of non white people in relation to those who are white under a system of white supremacy. Similarly, Imani Perry uses the term non personhood to describe this status. Each term reflects the fact that non white sit outside the moral communities in important ways. I consider two examples of how contemptuous racism manifests as too much attention slave patrols and what creed the Mitchell terms know your place aggression. But it is first important to understand how whiteness factors into paying too much attention to non whites for the contemptuous racist. Building on the ideas of subpersonhood or non person hood, white racial identity is constitutive. That is a necessary feature of fully being a person is whiteness. So the value in whiteness lies in its presumption of person hood, just as non whiteness carries with it the stigma of sub or non person hood. While Cheryl Harris points out whiteness itself is historically a legal status. US jurisprudence is rife with cases of people suing to become legally regarded as white, and the courts attempting to determine both how to make individual judgments, and how to develop a theory of race and racial classification. The legal doctrine emerging from one class of these kinds of lawsuits is that to call a white person black is to defame. Although the converse is not true. So there are there actually are. They're very there's very kind of interesting legal cases around people suing as having been regarded as black soon for defamation. Although the privileges afforded to those who have been legally determined to be white, those who would be white, also have a vested interest in whiteness. This would be the case, regardless of whether one's grasp on whiteness is firm or tenuous. Still, the more tenuous the grasp on whiteness, the greater ones investment might be in preserving whiteness via white supremacy. Whereas whiteness retains its value as a consolation prize. It does not mean that all whites will win but simply, they will not lose if losing is defined as being on the bottom of the social and economic hierarchy, the position to which blacks have been and Monty Perry states the matter. Leslie, lower status possessors of personhood as whiteness were enlisted to maintain the boundary between personhood and non personhood, both structurally and ideologically, even as their own personhood felt fragile. The boundary formed was always porous, given those on the margins of personhood, even more reasons to jealously police it for fear of slipping under it all together. I turned to my first example slave patrols in order to show how the inextricable connection between whiteness and personhood can lead to the contemptuous races paying too much attention to black people. So during the period of US slavery municipalities often employed slave patrollers to maintain orders on to maintain order on plantations. These patrollers were generally poor white men, men whose class status rendered their own grip on whiteness a bit slippery. However, these poor white men were vested with the authority to stop torture whip, and even murder any enslaved person who was thought to be in violation of the law. Perry quote Sally Haddon's description of the authority granted to patrollers slave patrollers had full power and authority to enter any plantation and break open Negro houses or other places. When slaves were suspected of keeping arms to punish runaways or slaves found outside their plantations without a pass to whip any slave, who should affront or abuse them in the execution of their duties. Hence, the practice of white people intervening and interfering in the lives of black people was codified in the law, a practice that survives by convention, if not by statute. Slave patrollers could have been motivated by simple hatred, or perhaps they were doing their jobs. However, if I'm right about the nature of races contempt, the slave patrollers actions would certainly fit the slave patrollers use their power relative to enslave black people in order to assert the supremacy of whiteness. One might suggest that contemptuous withdrawal does not require complete physical withdrawal from the contempt. There may be instrumental reasons to engage the contempt such as when a prison guard serves food to a prisoner, and perhaps the slave patrollers merely engaging in that sort of instrumental behavior toward those who were enslaved. While I don't deny the possibility that some interaction between slave patrollers and the enslaved may have been of that variety. There's also the case that slave patrolling itself carried with it, the validation of whiteness. The right to patrol slaves was the consolation prize, the hold on the bar of whiteness under which the patroller could assure himself that he would not slip. The authority to stop torture or whip any enslaved person who was suspected of violating the law, not only upheld white supremacy, but also provided an opportunity for the patroller to assert their contempt for black people. The authority to search homes to stop people on the street to ask intrusive questions to punish perceived failures of racial deference, all require that the contemptuous racist pay significant and sustained attention to black people. Yet, the intrusion is part of the insult. Just as a snub, like refusing to shake hands with one who was held in contempt, would be part of the insults of a contender who withdraws. The contemptuous racist who intrudes into the lives of their target. Since the clear message, I can disregard boundaries afforded other persons, because you are not worthy of my moral consideration. My second case of how the contemptuous racist can show too much attention to the contempt is what Griffin Mitchell calls know your place aggression. Know your place aggression is the flexible dynamic array of forces that answer the achievements of marginalized groups, such that their success brings aggression, as often as praise. The contemptuous racist would never find cause to praise anyone non white, given the global nature of contempt, punishing the success of members of disfavored racial groups, fits the conception of racist contempt that I have sketched. While referring to her book living with lynching lynching Mitchell writes, one of the studies major lessons is that the mobs African Americans victims were most often targeted, not because they were criminals, but because they were accomplished in some way. For example, they had managed to buy land that a white person wanted to take lynching African Americans of achievement, sent a terrorizing message to survivors and their families and the larger community know your place. Thus the contemptuous racist is driven to surveil black people and communities in order to ensure that black people are not stepping out of their place, the place of moral contempt. Perhaps one of the most famous historical examples of this kind of contemptuous racism will be the Tulsa race massacre of 1921. But like the case of the slave patrollers the contemptuous racist to engage is a know your place aggression pays too much attention to black people, and this over retention similarly manifests as invasiveness surveillance and aggression. However know your place aggression is explicitly a response to black success and thriving, vandalizing black owned property, professional sabotage, and even physical violence are all examples of know your place aggression. Other than withdrawing from the member of the disfavored race, the contemptuous racist asserts themselves into the intimate personal professional and community life of their target. This form of racist contempt is an assertion of both racist is value, and of white supremacy. In her article on racist memorials bell locates the wrongness of memorials memorials to racist including building name statues etc. Not in the distress or discomfort that those who see them may feel, but in the message of the honoring itself. So Bell writes to honor someone is to regard or present her as a person who has comparatively high status, and who is especially worthy of esteem and deference. Thus, to publicly honor a racist is to reify the racist misplaced sense of relative superiority, and it is difficult for people to fully respect themselves and others in that environment. The article is focused on individual responses to Confederate and other racist memorials to the extent that contempt is at the heart of racism, and memorials themselves are manifestations of institutional power Confederate and other memorials to races can also be understood through the lens of institutional contempt. The act of memorializing public spaces is the act of making playing who and what a community values. In general, individuals do not memorialize spaces communities organizations and other institutions do. And although Bell's article is a consideration of how individuals respond to racist memorials. She arrives at the wrongness of racist memorials by holding institutions partly responsible, creating an environment that is conducive to developing and maintaining respect for the members of its community. When institutions, whether through creation of public memorials, or through practices like punishment, engage in contemptuous behavior, the message of contempt is sent by the community to the contempt. When the contempt is racist contempt, then the disvalue of non white racial groups is the message that is communicated. So let us return to Barbara Dawson and this is Barbara Dawson in the image. She was called that a physician did see Dawson, and she was deemed stable enough for discharge. However, Dawson was still having difficulty breathing, and did not feel ready to leave the hospital. Because Dawson grew increasingly more insistent in her demand to stay at the hospital and receive care. The nurse called the police who physically dragged Dawson out of the hospital despite her pleas. The nurse, who neither further assessed Dawson, nor called for a physician to examine Dawson, and the arresting officer assumed that Dawson was faking her symptoms. It is to say that the nurse and the arresting officer followed established institutional protocols. Nevertheless, protocols are not neutral, and they often allow for some discretion. Dawson was arrested, because a nurse decided that police intervention was the appropriate response to Dawson's refusal to leave the hospital in the face of what turned out to be a deadly medical emergency. So Dawson arrived on the scene concurred. The salient question for me is not solely whether the nurse, the arresting officer or other hospital personnel were racist. Rather, I'm interested in whether hospitals as institutions operate in ways through their policies and protocols that could reasonably be described as racist. The Tuskegee Syphilis experiment is probably one of the better known failures of medical ethics. The experiment was a natural history study funded by the US Public Health Service. It was conducted in Tuskegee, Alabama with the institutional partnership of historically black Tuskegee institutes now university, John A Memorial Hospital, and was active from 1932 until 1972. The US Public Health Service took advantage of the racial politics of the early 1930s, the relative isolation of Tuskegee, Alabama, and the economic vulnerability of the black men and community who were enlisted as study participants. It was clear that they were not told the aims of the study, nor were they told the diagnosis that precipitated their involvement. The men who participated in the study were instead told that they were being treated for bad blood, a catch all term that was used to refer to a variety of diseases. The study continued as a study of disease progression without informed consent of its participants, even after penicillin became the standard treatment for syphilis in 1945, with penicillin having shown promise as a treatment for syphilis as early as 1934. The study ended in 1972 in response to negative press. There's no denying the multiple ethical breaches that the Tuskegee experiment reveals. The study itself could only have occurred against a backdrop of racist contempt for black people. And this contempt was expressed institutionally through the US federal government. Aside from the lingering direct effects of the experiment, the last survivor, Ernest Herndon lived until 2004. The public message of contempt for black life, health, and well being lingers. As public institutions responsible for health care, hospitals can reinforce this message of racist contempt for black people. While the Tuskegee syphilis experiment is clearly an egregious example of medical racism, and probably one of the more famous examples, it is not the only one. Even US medical schools have a history of displaying racist contempt for black patients as the historical practice of robbing graves and black cemeteries and graveyards and other to procure cadavers for use for medical student training illustrates. Contemporary instances of refusal to treat black patients, as in the case of Barbara Dawson, and instances of failing to properly treat black patients as racial disparities and pain management and maternal fetal outcomes data reveal. I found the public message of racial contempt for black people. Even if individual hospitals are individual hospital personnel understand themselves to act without racist contempt, continuing institutional practices at minimum, reify the message of racist contempt for black patients. So I began this paper attempting to grapple with what role bioethics and the bioethicists have to play in fighting the self perpetuating racist contempt that US healthcare systems continue to exhibit to our black patients. And while I think that bioethicists should work to address racism. I also worry that bioethicists have not taken seriously enough, the ways in which the institutional contempt for black people continues to permeate US healthcare. And that important first step bioethicists will miss the fundamental role that racism plays in every aspect of black patients experience and outcome. Bioethicists cannot continue to minimize the role of racism in the US healthcare system through access care and outcomes. It is also important to recognize that racist contempt may manifest in different forms. Racist contempt may take the form of withdrawal. Racist contempt as withdrawal may look like ignoring symptom complaints or failing to offer comfort care to the dining. Derisive content may include mocking or insulting patients. And racist contempt is paying too much attention to patients may look like reporting suspected drug seeking to the police. The way that racist has to first be willing to see racist contempt within US healthcare systems for what it is. And in light of the discussion of how institutions engage in racist contempt. I should return to the three avenues that my colleagues and I presented in the earlier paper as ways for bioethicists to think about how to contribute to combating racism and offer more thoroughgoing suggestions for the role of bioethics and bioethicists in combating racism. Bioethics has to understand not only that the social determinants of health play in the status of black patients in the health status of black patients, but how things came to be the way they are. It is not accidental that black people disproportionately work in high risk jobs, or live in substandard housing, rather many of these social determinants of health are attributable to structural racism, or racism that exists as a result of the convergence of public policy, institutional practices, and broader cultural practices and customs. How black patients have been and continue to experience the effects of structural racism, and it is reified within healthcare institutions. The bioethicists who is concerned with combating racism must be intentional about first acknowledging that institutional practices within healthcare systems can function as expressions of contemptuous racism in particular. Implicit bias training can be a useful tool to address interpersonal instances of racism. However, addressing racism cannot begin and end with implicit bias training. While this training can reveal unconscious attitudes, the cumulative effect of small acts of bias, such as interrupting more or harboring negative attitudes toward black patients. In his review on the literature of implicit bias Brownson observes at present, the implicit bias literature suggests that people are often aware of the content of their implicit attitudes, largely in the form of gut feelings, but are often unaware of the effects of their implicit attitudes on their behavior. If this is the case, then one useful intervention for the bioethicist is not necessarily to dispense with talk of implicit bias altogether, but to explore how it might be a useful tool among others for fighting racism. One example grounded in the literature is to challenge the value of listening to one's gut feelings over listening to patients, because one's gut can lead one to believe that a black patient seeking relief from pain is really an addict looking for a score, for example. Third, because concern with justice is fundamental to the mission of bioethics, the bioethicist must also be concerned with the ways in which discretionary application of institutional practices and policies reflects racist contempt. In her classic work, Killing the Black Body, Dorothy Roberts argues that black women's bodies particularly with regard to issues of reproduction and motherhood are subjected to racist intervention that often goes unremarked as such. These interventions can only happen where structural racism is public policy, institutional practices and individual judgments converge. She criticizes drug policies that disproportionately punish pregnant black women who use drugs. In order to show how it is that black women seem to be ensnared in drug policies at the rates that exceed rates of actual drug use, Roberts writes. To charge drug dependent mothers with crimes, the state must be able to identify those who use drugs during pregnancy. Because indigent black women are generally under greater government supervision through their associations with public hospitals, welfare agencies and probation officers, their drug use is more likely to be detected and reported. These women are already enmeshed in social welfare structures that make them vulnerable to state monitoring of every aspect of their lives. Hospital screening practices are particularly to blame. The government's main source of information about prenatal drug use is hospitals reporting of positive infant toxicologies to child welfare or law enforcement authorities. This testing is performed almost exclusively by public hospitals that serve poor minority communities. What is important for the bioethicist in this scenario is the clear understanding that healthcare professionals have and exercise discretion with regard to not only who was tested for drug use, but also who is reported in the event of a positive result. Just as in Dawson's case, the healthcare personnel decided to involve the police rather than to address Dawson's symptoms, thereby turning a medical crisis into a police matter. Whether there was some clear hospital policy that was racially discriminatory or no formal policy, thus leaving Ms Dawson at the mercy of a hospital worker's gut. The fact remains that the call to the police was the result of someone's discretion under circumstances of racist contempt within racially contemptuous institutions to support institutional practices that themselves. I'm sorry, my time is going to support institutional practices that reveal themselves to be contemptuous of black people is to abandon the principle of justice that undergirds the raison d'etre bioethics. At this point, one might object that even if the case I make theoretically falls within the realm of matters with with which the bioethicist should be concerned. Bioethicists rarely have that kind of institutional power to intervene when circumstances arise, nor do they tend to be directly involved in creating an instituting hospital policy. While it is true that in many clinical settings bioethicists tend to arrive on the scene only when someone specifically calls for a bioethics consult, the moment of global pandemic that is disproportionately affected populations of color, and the global protest calling for racial justice, potentially provides a unique opportunity, if bioethicists have the will to truly commit to justice. Eventually industries from fashion to sports to media to municipalities are grappling with their histories of racism, and how the legacies of racism continue to shape their practices in ways that disadvantaged people of color. The crushing weight of the cobit 19 pandemic in the US has laid bare just how broken us healthcare systems are, and how black patients bear the brunt of the history of medical racism that is contributed to sick or shorter lives for black people. It is the perfect time for bioethics to formalize relationships within the organizations that had previously been informal. There may be change in the wind, especially those who are committed to racial justice can certainly make the case for the value of such expertise, but the bioethicists must also have the vision to connect the dots within the institution. The argue is I have that explicit attention to racism as the domain of the bioethicist has been met with skepticism, even from fellow bioethicists. However, if this moment doesn't reveal the importance of fighting racism, then none will. Thank you. Sorry, I just forgot to unmute myself. Thank you so much for that Yolanda that was an amazing talk. We have a ton of questions rolling in from people who really want to get your thoughts on things so I want to make sure that we have enough time to get through as many of them as possible. Thank you so much for joining me myself briefly I'm Connie and one of the MBE students and one of the co moderators of the Q&A today. So to start with, some people are wondering, how can we use these bioethics principles to highlight the concept of racist contempt within health institution accountability and quality improvement mechanisms, and what do you think is the biggest roadblock to addressing racism and bioethics. I have a question first so I think that the biggest roadblock is the will to do it. You know I have kind of flippantly said in other talks not necessarily specifically bioethics talks but another race talks like, you know we figured out Uber, we figured out how to put a man on the moon. You know, it's not an impossibility to figure this out, if there's the will to do it. And so I think that's the important step and you know what comes after that has to be kind of a serious reckoning and accountability of history and how history shapes how we think about policies and policies now so to think about applying principles of justice for example to addressing racism. I think you know you can start with, you know the justice requirement you can start with requirements and beneficence. I mean they're, you know they're all these kinds of moments where, as I've tried to pull out in the paper, their decision points. And I think that at various decision points, even if race or racism aren't explicitly mentioned. I think one way to think about applying the kind of major principles of bioethics is to think about, you know how is history, shaping what we think about as non maleficence for example. I'll stop here I know there are a lot of other questions and we can talk more and I know that there's another form after this so we can chat more so I don't want to take up time but but yeah I would think kind of a serious engagement with history, and a series kind of thinking about how history shapes the present would provide that avenue for applying the principles of bioethics to racial injustice. Hi everyone so I'm Giselle. I'm another masters of bioethics student at Harvard, and I'm going to follow up with another question. So, going off of the previous one. How might a bioethicist role in addressing racist contempt be different in rural spirit spaces compared to more urban areas. Yeah. So, you know I think sometimes, sometimes we think that rural spaces are just urban spaces with fewer people. If that makes sense, and don't really pay attention to kind of some of the unique cultural particularities, but also what it means to be in a rural space so I think sometimes in rural spaces you have fewer options, and so one is boxed to certain kinds of behavior and treatment and I think it becomes much more difficult to address these challenges right if you're somewhere that has one hospital for 50 miles. There may be different kinds of pressures in terms of how one engages and how one responds to experiences of racial discrimination, and certainly in rural areas they're less likely to have bioethicists. I mean, so what, what becomes the ethics committee if there is one at all, maybe a just kind of ad hoc, who was in the hall that day when an issue came up. And that's not to be the risk of about rural spaces I'm from, I'm from a rural area and so I think about these things very deeply, but it's just going to look different because the resources are going to be different both from the institution standpoint and from the perspective of people who are engaging institution and so that's going to constrain what they want to address is racism. Thank you for that. I'm going to pivot a little bit to current events. Some people were curious about contempt in the context of coven 19. And they're wondering if you're observing features of contempt in the context of vaccine development, or the sofa scoring system, and if there's anything that could be done or needs to be done to address this. So, coven has just been such a complicated I mean it's tragic. Where are we at 270,000 ish people did now. Um, I would say the contempt and I wouldn't just say I would say some of the subtext of the contempt is racist right. I would also say or has kind of racial undertones. I would also say that there's a kind of ageism that floats around in these discussions a kind of ableism that floats around in these discussions a kind of who cares it's just them who are dying. And you know I think that's kind of textbook contemptuous behavior although people who would make those kind of arguments I don't think would deny being contemptuous. You say oh just old people are dying oh just black people are dying oh just the cab drivers are dying. That's um, you know that's that's troubling to me and I think it reflects it reflects an attitude. I think that some of what we're seeing in in vaccine in participation in the trials or reluctance of some populations to participate in the trials is an understanding of that I mean people aren't stupid right people understand what what history is and where history lies and I think that you know I wouldn't say it's the bio what this is job to kind of stand at the forefront and say no no no we want everyone to participate in these trials maybe there is a space for that. I do think that how we think about health care generally and what we think about is the history of medicine has to engage in this kind of historical reckoning that I was talking about earlier in the q amp a, and we have to form trust and part of that trust has to be not just addressing the history but also kind of calling out the careless contemptuous language that we see floating around in who's getting sick who's dying and why it does or doesn't matter that we should reopen the economy I hate that language of reopening the economy but I'll save that for another day. Great, thank you. And then another question that was asked is in the US where racing class are so interlinked could contempt for class ever be considered separate from race based contempt. Yeah, I think so I mean so so I think I think you're absolutely right a lot of these things are interwoven so it's kind of hard sometimes to write about race for example or write about gender for example because the ways that one experiences race and gender are interwoven intersect with lots of other things. I do think that sometimes contempt for class. I mean we see it I mean even in language that's in politic language that I grew up around that I grew up around with how to describe poor white people. I think it's a very clear language that that was just in the ether so I'm from South Georgia just I kind of made references to being from a rural space of being I'm from South Georgia I'm from a little town called Albany that actually was a hotspot early on in the in the pandemic. There's definitely a way to talk about class that's disentangled from race. I also think sometimes having conversations when you use words like rural or working class. I think that those get coded as white and I think that that obscures the reality of what kind of working class looks like and what poverty looks like and and who's actually poor and how how it manifests. One of our fellow MBA students had an interesting question on the subject of health care reparations as in providing free high quality health care for all African Americans as a subset of fuller reparations. There's this idea that it might not solve the underlying or I won't solve the underlying structural racism until you know the broader issues that affect social determinants of health are addressed. Do you have any comment on the idea of health care reparations and the larger policy of full reparations. I'm for both. See that was an easy answer. No, I'm no seriously though no I am and I do think, you know, with something like health care. Right. So, here are the criticisms I hear. Well that's not going to fix everything. Right I mean, I mean I think that to the extent and it doesn't mean do this instead of continuing to address structural injustice. But I do think that, you know, at minimum health care access is important and we know that people don't have access to health care and I do think that as a, there's another Albany native on the call I just saw this I'm sorry. I'm sorry the chat distracted me for a second. I'm sorry. We'll have to talk Albany native on the call. Where was our health care reparations. Yes, so I do think that that becomes part of the story of how to address structural injustice. No it's not the only thing that one should do but it's certainly something that something that one should do. I mean I think there should be you know personal health care. So there's that I do think that African Americans have a distinct claim on health care that may look different. But that's kind of a nuance of you I don't want us to get into the weeds with five minutes left. Thank you so somebody had a question about. To what extent is contempt as you've discussed it in this talk and emotion versus a cognitive assessment or a behavior, because it seems that these are interdependent and mutually reinforcing. Yeah, so I'm, I'm thinking more of the kind of cognitive or effective varieties of contempt, however, I do think, you know so interesting to kind of talk to like cog side people or people who do moral psychology. Also, and, and there's this way that they talk about them as though they are they are these kind of distinct modes of being in the world or what are modes of experiencing the world. I think you're right I think that there's a lot of intertwined a lot intertwined and how we think about contempt so yes well I think it can be kind of I also think that our. I think it triggers whatever emotional response or that or that it can trigger this kind of emotional response and that they do become self reinforcing. Yeah. I think that's a lot, but the camera only goes here so I'm just. So, you know, on a slightly different topic. We have a question on whether or not you have separate or particular observations or comments about the treatment of black and brown patients in the mental health sphere. I've had those conversations with people I don't have a fully articulated view about that so I wouldn't want to speak kind of prematurely or speak without having a kind of a more, more thoughtful thing to say. I do. At least in the conversations I've had with people we do see disparities we do see differences in treatment. And how that. Yeah, I think I'll just leave it at that but but I would be actually interested in exploring that more just haven't done any work on mental health specifically. All right, fair enough I guess if there's anyone who has explored that topic in their own work. Please share with me, please share with me with everyone on that note we are sort of nearing the end of the session thank you for your questions everyone. I'd like to go back to she good to give quotes and comments thank you so much Yolanda for coming here and speaking with us. Thank you so much for having me. Yes. Thank you so much we are so appreciative of you being here Dr Wilson and offering your incredibly important and salient expertise. I'd like to recognize and thank Dr true and Dr for for giving us students an opportunity to organize this event. And then also thank you to all the student co planners, Izzy Hernandez, Connie Lou, Julius Ibanez towers and Giselle and also to Ashley and Angela who work diligently behind the scenes at the center to make events like this possible. And I would also like to personally invite you all here on this call today to join our community here at the center for bioethics. So please feel free to find us on social media to learn more about our educational programs and events. And as a reminder to all the students on this call that there is another post session with Yolanda beginning momentarily, and wherever you are, I hope that you all have a wonderful day. Once again, I cannot even express it was the gratitude we have toward you Dr Wilson for being here with us and providing us with all of this information. And so, with that, have a great day everybody and thank you all for being here. Thank you.