Trigger Warning: This blog discusses sensitive and potentially distressing topics, including unethical, non-consensual, and inhumane health treatment. Reader discretion is advised.
What if I told you that social constructs such as race have been used to determine medical care? Not a
person’s health or pain levels, but race, a socially constructed category of people based on real or perceived physical differences. This sad fact was the case with the national kidney transplant list. For years, Black Americans in need of a new kidney were denied their spot on the transplant list because of an algorithm that calculated Black and non-Black patients differently. This occurred even though Blacks are three times more likely than Whites to have kidney problems. Disturbingly, similar formulations have been used to determine the treatment for heart disease, lung function, and even the delivery approach for pregnant women. How and why has “race,” a socially constructed and historically changing concept been used so egregiously? Let’s use sociology to find out.
The categories used to distinguish race in the U.S. have changed over time. In the 1970s, the U.S. Census used three racial categories to define people. The options were White, Black, and Other, which encompassed Indigenous, Asian, and Hispanic Americans. In 2024, the Census moved to seven categories, which include the following:
- White
- Hispanic or Latino
- Black or African American
- Asian
- American Indian or Alaska Native
- Middle Eastern or North African
- Native Hawaiian or Pacific Islander
But these labels don’t tell you everything there is to know about a person. They don’t tell you their culture, language, or religion, and they certainly don’t tell you their kidney function or ability to give birth vaginally after a C-section. Yet, racial category formulas were used by kidney professionals for years to determine treatment. The result was that over 14,000 Black people were wrongly kept off the kidney transplant list because of a medical formula.
It is important to realize that this discussion isn’t about the role of ancestry in genetic disease. For example, Blacks have a higher risk of Sickle Cell Disease, Ashkenazi Jews are at greater risk of Tay-Sachs disease, and Europeans are more likely to have Cystic Fibrosis. Instead, this is about people being excluded from treatment because of their race even though they would qualify if they were of a different race.
Arguably, these policies could be best explained by the concepts of institutional racism and institutional discrimination. Institutional racism is defined as societal patterns that produce negative treatment against groups of people based on their race. This is about deeply embedded beliefs, values, and norms that validate the unequal treatment of individuals and groups based on race. On the other hand, institutional discrimination is the use of social institutions to deny minority group members access to the benefits of society. Broadly speaking, discrimination is about the actions taken against someone. In this instance, it means the government, corporations, or institutions are engaging in discriminatory practices against a minority group in society. Healthcare organizations using a formula to weed out medical recipients solely based on their race surely fits the definition of institutional discrimination. Institutional racism and discrimination are often accompanied by implicit bias, unconsciously held attitudes, beliefs, and stereotypes about others. An often-researched example is that of pain treatment and management. Doctors have been found to offer their Black patients less pain management care than they offer White patients. This doesn’t mean Black patients experience pain any differently than their White counterparts, but that doctors let their bias about Black patients influence their decisions on offering pain treatment. Could this help explain why the opioid epidemic in the U.S. disproportionately impacted White Americans? Quite possibly. Research indicates that even in hospitals White patients are prescribed more opioid pain medications than Black patients.
The history of Black Americans being discriminated against by medical professionals is not new. Some of the most egregious examples include
- In the 19th century, gynecological experiments without anesthesia were performed on enslaved Black women by Dr. James Marion Sims. Sims was the founder of The American Gynecological and Obstetrical Society (AGOS) and early president of the American Medical Association (AMA).
- Starting in 1932, the Tuskegee Experiment involved Black men with the venereal disease syphilis being left untreated so the researchers could watch the progress of the disease. This experiment continued even though penicillin was discovered to cure the disease in 1943. The experiment didn’t end until 1972. In the process, some went blind, others went insane, and many men died as a result of not being treated. Some even passed the disease to their wives, who subsequently passed it to their babies because of the lack of treatment.
- Henrietta Lacks was a Black woman whose biological tissue was taken without her consent in 1951 by doctors at Johns Hopkins University. Her tissue became known as HeLa cells and had unusual properties that resulted in them being used in countless research studies around the world. Lack’s family sued and finally reached a confidential settlement in 2023.
- In 2020, it was reported that Black babies have a higher mortality rate if treated by a White doctor than if cared for by a Black one. Known as the “mortality penalty,” the survival rate under the care of Black doctors improves by as much as 58 percent.
These are just a few of the most noted examples of bias in the medical profession. But when a life is at stake, even a few examples are too many. At the start of their career, new doctors take the Hippocratic Oath, pledging to do no harm. Nowhere in either the old or new version of the oath is the race of the patient mentioned, nor should race ever. Race should never be a deciding factor in treatment or how people are treated. It looks like a lot of doctors need to be reminded of their oath.
Thompson is a co-owner of UITAC Publishing. UITAC’s mission is to provide high-quality, affordable, and socially responsible online course materials.
Images in this blog:
- “Dialysis machines“ by Irvin Calicut is licensed under CC BY-SA 3.0. This image has not been altered.
- “Hospital, Emergency room, Entrance image“ by paulbr75 is licensed on Pixabay. This image has not been altered.
- “Doctor, Medical, Medicine“ by DarkoStojanovic is licensed on Pixabay. This image has not been altered.
