 My name is Patrick Smith. I have the pleasure of working at the Center for Bioethics at Harvard Medical School. I serve as core faculty and teach here. We have a very special guest here, Mr. Rasan Hall, who is the Director of the Racial Justice Program at the American Civil Liberties Union of Massachusetts. Before joining the ACLU of Massachusetts, Rasan was the Deputy Director of the Lawyers' Committee for Civil Rights and Economic Justice. Before then, he served as the Assistant District Attorney for the Suffolk County District Attorney's Office. Welcome, Rasan. It's good to have you back here once again with us. It's a pleasure to be here with you. When you first joined us, you joined us as a guest at our screening of the movie, The Thirteenth, just before the behind-the-bars conference that we had at the end of 2017. And during that time, the conference was really a striking semblance of how vulnerable people groups have been marginalized by mass imprisonment, those who are people of color, those who are economically disadvantaged, the undereducated and those suffering from mental illness. How do you see all of this connecting with questions of health and health care, right? Some may be a little curious as to how you're thinking, we're thinking about bioethics and some of these other kinds of issues that emerge in these spaces. Well, all of those demographic populations that you described, people of color, people with mental health issues, people who suffer from substance use disorders, black people, Latino people, poor people, disproportionately represented in the criminal legal system also come from communities where there are significant health disparities. But also, it's worth noting that people who are system-involved, people who have been incarcerated, oftentimes suffer from more strenuous health complexities once they are released. And not only them, but sometimes their families too, whether it is from the lack of adequate health care, health insurance, health coverage, or just the stressors that are a part of the system and the things that they are exposed to within those institutions, but then kind of the lifestyles and challenges that they face once they've been released. So there's a very tight correlation between health disparities, health outcomes, and people being involved in the criminal legal system. Excellent. So would you say that there is a kind of a connection between maybe bioethics and what some would consider social ethics as well? Absolutely. The questions that we are asking ourselves as a society, as parts of institutions about what are the right ways to deal with issues that people are facing, what are the appropriate analyses to bring to some of these issues are the questions that we should be asking, but they have to be asked within a full context, one that contemplates race and the history of racism in this country and the role of white supremacy, but it also has to contemplate the role of capitalism and other systems that operate in people's lives that lead to an overrepresentation of these particular groups in these systems. Yeah, yeah. I mean a lot of complex issues that you've just identified and named. And I know you do a lot of work at this intersection of policy and legislative advocacy, especially that side of the human rights conversations. What do you see as the potential solutions for some of these problems that you have identified here? Well, there's certainly no panacea. I think the more people have access to information, there's a greater likelihood that we can see some change. But I also feel like advocacy on the part of grassroots organizations and the general public is going to really help move the needle. Of course, reducing the rates of incarceration in this country are a preeminent issue. I think Massachusetts, where we are, has one of the lowest, if not the lowest, incarceration rates in the country. But if Massachusetts were its own nation, we would have the 11th highest incarceration rate. And in addition to that, we have one of the worst racial disparities in who we incarcerate. And so when you think about those racial disparities, the significant number of people that are incarcerated and the connection to health disparities and health outcomes, we would be well served to have a criminal justice system or a criminal legal system that is diverting more people away from the system, putting them into treatment, creating more opportunities for people to successfully reintegrate back into society. Because it's not just that individual who has been accused and convicted of a criminal offense, but it is also their family that they are connected to, the children that they are responsible for raising or co-parenting, the intimate partners that they are in relationship with, but also the larger community that they are a part of. So I think that is a key solution that could address some of those outcomes. Very good. I know that your organization, your chapter at the ACLU, has been doing quite a bit of work on asking the question, what difference does a DA make? Could you talk a little bit about that, how that may factor into this bigger picture here? Right. I think in the midst of this national conversation about criminal law reform, the person or the entity that is the least discussed is the district attorney. A lot of people don't know the role, the power, the influence that district attorneys have. We did some polling early on and found that four in ten Massachusetts voters did not know that the district attorney was an elected official. And so, and again, these are people who identified themselves as voters, not just residents of Massachusetts, but people who go to the polls and cast a ballot every election. And so their power over charging decisions, bail requests, sentencing recommendations, the relationship with the police, what they do with civil asset forfeiture funds, and most importantly, their influence over the legislature. These are all roles that district attorneys play, and the general public knows very little about them. And even if the legislature weren't to pass progressive legislative reforms, there are a lot of things that district attorneys can do that would limit the amount of people that are incarcerated. I think a perfect example is what we've seen in Philadelphia where Larry Krasner, a former criminal defense and civil rights attorney, was elected district attorney by an overwhelming majority. And he has put in place some sweeping policy reforms that look to change the face of the criminal legal system in the city of Philadelphia. Yeah, wow. Yeah, that's amazing. Just thinking about that, especially with the grassroots kind of organization. So not only do you need to think about making sure people are registered to vote, but voter education becomes extremely important in thinking about these issues and making an impact on the overall health of our communities. We know that you're a lawyer. You have a jurist doctorate, but you also have an MDiv. And so this question of religious ethics sometimes comes up in thinking about issues of health and how do you deal with some of the social determinants of health and so on and so forth. What role does that part of your background play in helping you think about these issues, either whether it be framing health or addressing health disparities apart from the policy and the advocacy piece that's part of your profession? I think for me, personally, it is my moral compass. It helps me discern what are or what is the appropriate approach to take to issues. Who are the appropriate people? And from my kind of theological orientation, it is the least of these. I view God as a God of the oppressed, someone or a being that is on the side of those who are without, those who suffer. And so when I think about the application of that to my vocation, I see the role as an attorney being one that I am called to serve people who are in need, people who have been put upon by society, by government and in the work experiences that I have had. I have been led to this place where criminal law reform that disproportionately impacts poor people, people of color and specifically black people is an area that is in the greatest need for reform and the greatest space for impactful advocacy. And so I think that's how I'm governed by it. But I also think there are larger truths that come from my own faith but also other religious communities, principles of faith and the ideas of fairness and the principles of caring for people. Those are some of the things that should guide people through the work that they're doing. Yeah, in one of the classes we teach here, we're really wrestling with issues of social justice and concepts of justice and how they may inform the work of bioethics. And it's fascinating some of the folks we've read who are religious at this talk about notions and ideas of justice as not only should we think about justice as states of affairs but also that we should strive to be just persons who can exercise justice in our interactions and dealings with each other and making sure that notions of justice extend beyond just how we distribute goods or burdens and benefits but to these larger kind of social dynamics that govern how we do life together. It sounds quite a bit like what you are describing in terms of how a particular religious ethic may inform the advocacy work that you're doing in some respects. Yeah, absolutely. And for as much as people profess this to be a Christian nation, the ACLU we were very clear about the separation of church and state. But there is still this ethos that permeates civil society, that there are bedrock principles to who we believe we are as a nation, that whether or not people embrace it are rooted in religious values that are tied to Christianity but I think also transcend across other belief systems and so I think to the extent that that is a part of our makeup as a nation. We have an obligation to investigate and examine those things and see how they play out for us in the society. Many states in the union, some of them are called commonwealths. We are the commonwealth of Massachusetts and so the things that we do should be in furtherance of the commonwealth. When you think about the context of the Center for Bioethics and the kind of folks that we are working with and training to wrestle with these issues that you have described here, what would be some next steps that you would recommend for folks who are working in either healthcare spaces, whether it be nurses, social workers, doctors, right? Some may be listening to our conversation here thinking, well, that's all well and good. I'm not a lawyer. I'm not a legal scholar. I'm not a political advocate. So what can I do to help address some of these issues of healthcare, healthcare disparities and so on and so forth? What would you say to someone in that situation? Right. So one of the things that I like to tell folks is, one, do the knowledge. There is an abundance of information out there that people can self-educate. But I think one of the things that is particularly important for people in this space is to understand that racial disparities are a very real thing. But they did not come to exist just by happenstance. They are an outgrowth of systemic oppression. They are the result of years of disinvestment in communities and overt oppression in certain communities. And I think the better able people are to understand the historical context and how it is tied to what they're seeing in the communities and the populations they serve now. It helps somebody to have a different level of empathy or understanding and also can help folks begin to identify what might be the things that are the sources of some of the disparities. So, you know, doing the knowledge and then, you know, kind of getting active beyond just the people being in their lane and doing their job. But what are the kind of auxiliary groups, whether it is related to your field of practice or if it's completely unrelated to your field of practice, but it raises up an issue that touches on these things? For instance, there are, whenever I give speeches or public presentations about racial justice or racial disparities in America, without fail there are white people who will come to me and say, well, what should I do? And where should I go for this information? And there are a ton of resources out there that are available online. But by way of example, there's a group called SURGE showing up for racial justice. You know, and so this kind of leads to, you know, my last, you know, suggestion or point, which is get your people. Right? Because there's a certain burden that is placed on the shoulders and backs of the oppressed to help solve the problem of their oppression when they were never responsible for creating it in the first place. And so in addition to educating oneself and knowing what the issues are and how they connect to the problems and the disparities that we see today, but getting involved and engaged with the organizations that are addressing that work, whether it is related to your field of practice or if it is something completely collateral and is related to just kind of larger social justice movements. And then finally, being in the space with the people that you are most like and sharing that information and pushing back on the false narratives that come up to kind of disabuse people of some of the notions that they have about certain groups of people. Very good. And, you know, we've discussed a little bit at the conference about this relationship of violence and the trauma that's experienced by that. And many people are pushing and advocating to reframe that as a public health issue. Would you talk a little bit about that in terms of what the benefits of that kind of reframing stuff, kind of, you know, overly criminalizing these issues of reframing as a public health issue? What are the benefits of something like that? Sure. You know, when we talk about, you know, dealing with something as a public health issue, I'm reminded of the war on drugs and particularly the war on crack, which by many has been viewed as the war on black people. Because there was a significant influx of federal and state dollars targeted at dealing with the issue of substance abuse in communities of color as a criminal issue. As opposed to the public health issue that it was, people had a sickness, people had a disease, the disease of addiction. People were self-medicating for lack of resources or whatever the case may be. And it was dealt with as a criminal issue. Now we look at the opioid crisis in America that is destroying communities and families and tearing apart lives. And to a person, politician, law enforcement officials say, we need to treat this as a public health issue. And what that has meant is that the public health issue framing on the opioid crisis means we're looking at new ways of dealing with opioid addiction that are different from the ways that they were dealt with in the past when it related to crack use and heroin in communities of color. That's in my perspective largely in part due to who are the victims of opioid disproportionately so. And it's large numbers of white people in middle class communities. And so now there's this desire to deal with it as a public health issue. And so we see the benefits of trying to find more federal funding to create more treatment beds and to get more education about the dangers of opioids. And so when we think about violence in communities of color, certainly there is a criminal aspect to it because laws have been broken, lives have been taken. But when we deal with it as an epidemic or a health crisis, there is a different way to approach understanding why it's happening, what are the potential remedies or solutions to address it, and then funding the research to understand it and to find other alternatives to intervene in the lives of the people who are caught up in it. But then also to deal with the people who have been the victims of that violence given the trauma that they face and are exposed to. Yeah, this issue that you're getting at here, there are these notions of kind of restorative justice that many folks are talking about. And I think myself included, I believe that this is a very important way of thinking about these questions. For those who may not be fully aware of what restorative justice is and how it may kind of play out in some of these issues, could you share a little bit about how that? Sure, restorative justice practices have been around for centuries, generations. It is a practice that is very well known among Native American or First Nation peoples communities. But essentially it's an accountability measure because you can put someone in prison and that is indeed punishment. And it is also a form of restraint because while they are incarcerated they are not out committing other crimes. But who is that person when they are released, when there is no programming, there is no treatment, there is no self-reflection or evaluation that prepares them to reenter society as an effective functioning whole human being. And so you have punishment but you don't have accountability. What the restorative justice process does is holds that person to account within community. And so on a very practical level what that looks like sometimes is a circle of people that include the offender as well as the person who has been victimized or wronged by the person and members of the community, the law enforcement officials, but also people who were impacted by the particular act. And in addition to the offender hearing from the victim or the person who was victimized by them what the impact of their act has had on their lives. How it may have derailed their lives or how it may have caused great harm and pain and then also what are the ripple effects of that to the larger community. The individual offender is now responsible to explore for themselves what even led them to a place where they would create that type of harm. And so that is the process of being accountable. You know a lot of people dismiss it by just saying oh it's like it's a hug of thug. But in reality we have to look at this system where we are living in a society where so many people particularly young people have not been hugged. They have not been hugged by the educational system. They have not been hugged by the employment opportunities in their community. They have not been hugged by the law enforcement that overpoliced their community. And so the person that they end up being is a function of a neighborhood or community that has been deprived of resources overpoliced and oppressed in many different ways and are in need of that type of hug. For the betterment not just of themselves but for the larger community. You've given us a lot to think about and we all collectively have a lot of work to do. Thanks so much for being here and sharing with us in our audience and we look forward to the next go round. Wonderful. Thank you for the opportunity. Thank you so much. Thank you so much for being with us today. For those of you who want to explore these issues and topics further please check out the Harvard Medical School Bioethics Journal. There you can find a number of other essays and video clips that deal with these issues.