Bioethical Silence & Black Lives

by Derek Ayeh 

When confirmation was released that researchers from China had genetically modified human embryos for the first time ever, there was a sudden explosion of activity on the web from the bioethics community. Physicians, academics, and anyone else who could claim some affiliation to the field wrote articles for magazines discussing the ethical dimensions of the issue. After all, human enhancement and genetic modification are staples of bioethical discourse. Who wouldn’t want to add their two cents and take part in such an important discussion?

Conversely, when the news of Freddie Gray’s death became public, I was greeted by a surprising but familiar bioethical silence. Surprising because I thought that the relationship between Freddie Gray’s death and bioethics was rather obvious: here was a man who requested healthcare numerous times but was refused it—the justification being that he was a criminal and either faking his pain or self-inflicting it. While there are likely numerous reasons why Freddie Gray died, do bystanders have moral responsibilities when they witness an injured person? There’s often debate about whether a bystander has a moral responsibility to intervene. However, as public servants, police officers surely have some ethical responsibility to ensure that even criminals receive medical treatment when badly injured.

It is ethically troubling that individuals charged with protecting the public ignored a man who was begging for and needed immediate medical treatment.[1] The dimensions of the situation also intrigued me: even incarcerated individuals are entitled to receive “adequate” healthcare, so on what moral grounds does a police officer stand when he/she ignores the cries for treatment of someone who has been seriously injured? While other aspects of the case concern me, these were questions I was able to ask purely as a student of bioethics— questions I thought bioethicists should have opinions about and be interested in discussing. Yet, while bioethicists have had no issue condemning genetic experimentation they seem to sew their mouths shut on the matter of black lives.

The lack of any analysis or statement from bioethicists on Freddie Gray’s case is familiar. Just last year, I was greeted by a similar silence from my field in response to Eric Garner. It is even easier to claim his case is within the realms of bioethical inquiry—those squeamish about discussing race could ask: Why was Garner refused CPR, the standard of care? While some claimed that Garner was still breathing (despite his now famous last words, “I can’t breathe”), the union president for EMTs and paramedics, Israel Miranda, was quoted widely as saying that the emergency medical team that arrived at the scene ignored the state protocol of supplying oxygen to an individual having difficulty breathing.[2] The ethics of the case are fairly easy— the standard of care exists for a reason, and the refusal to uphold it should have been condemned.

Even the recent death of Sandra Bland overlaps with bioethical inquiry. Though there is currently dispute over whether her death was a suicide, let’s assume that everything that Waller County Jail has told the public is true. Her intake forms indicate that she attempted suicide in the previous year.[3] There is a standard of medical care for inmates who may be actively suicidal or have exhibited past suicidal behavior. Waller County Jail failed to remove the plastic bag from her cell as a potential tool of self-harm and did not keep her under close surveillance.[4] If it was truly a suicide, Sandra Bland’s death was the result of the jail withholding the standard of care. As bioethicists we know that disregarding the principle of justice is akin to asking for a healthcare scandal. We learn about the Tuskegee syphilis study so we can recognize how racism, inequality, and poverty can affect what type of healthcare an individual receives. Denouncing medical injustice doesn’t end because the victim isn’t a patient and the crime scene isn’t a hospital.

Why hasn’t bioethics spoken up about the “Black Lives Matter” movement, especially when the health profession at large has contributed widely to the discussion? Medical students have hosted “white coat die-ins” to show that they stand in solidarity with the protesters in Ferguson and Baltimore. Public health officials like Dr. Mary Bassett, New York City’s health commissioner, have taken this opportunity to try and educate the public about the connections between health and racism. The health professions have been entrenched in our nation’s conversation over the value of black lives and the problems that persons of color face when they come into contact with the criminal justice system. These professionals didn’t wait for an invitation to speak their minds on these issues, as there was never any question that the health professions belong in this conversation. Still, bioethics shies away.

Leigh Turner, Associate Professor for the Center for Bioethics at the University of Minnesota, has criticized bioethics for exactly this tendency. He believes that the field is obsessed with the “cutting-edge.”[5] Anytime a new technology or innovation that impacts human health springs up, so do the bioethicists. We are even drawn to ethical issues that are still decades away, while questions of race or inequality fall just outside of our purview. With just a quick search hundreds of papers come up covering human enhancement and cloning. However, bioethics often overlooks poverty, unemployment, and gun violence, leaving them for other healthcare professionals. The academics in our field are fixated on high technology and, as Turner points out, it paints a picture of bioethical inquiry as only being useful for addressing the concerns of the upper and middle classes. He likely sees us as the epitome of elitist scholars commenting on the world from our ivory tower.

However, I see our field’s silence as a problem for a very different reason than Turner’s. The late Adrienne Asch once wrote “Bioethics is at its best when people don’t merely ask each other what their views are, but really take the time to find out what is behind those views.”[6] She believed that bioethical inquiry was a profound tool that could transcend the drudgery of political polarization and get at the foundations of why people believe what they believe. The ideal bioethicist not only articulates his or her own views but also understands what perceptions and life experiences shape those views and can see what values lie behind the views of others. To Asch, bioethicists are capable of thinking far beyond simply identifying with the political “left” or “right,” probing further to find out why people think differently in order to stimulate reasonable discourse.

I want to believe that Adrienne Asch is right and that I study bioethics because of its potential to find resolutions through reasonable discourse. Her vision of bioethics is truly striking and certainly not what the field always is, but what it should constantly aspire to be. Most importantly, it is Asch’s bioethics that would be truly useful in our country’s current debate over racism and black lives. It’s hard to even call it a debate—we constantly spend our time talking over one another and raising our voices louder in hopes that someone will hear our views. Our country is completely divided on this issue. Where some see criminals and rioters others see disenfranchised individuals and suffering communities.

I am not saying that a handful of bioethicists writing about these issues will correct the gap between our perceptions, nor do I think that the field should stop talking about technological advancements. Nevertheless, I do believe that we have a place in this important conversation and hope that those in the field with far more experience than I will seize the opportunity to make bioethics more than it is today.
 

References

[1] Payne, Ed. “We failed to get Freddie Gray timely medical care after arrest,” CNN, April 24th, 2015. http://www.cnn.com/2015/04/24/us/baltimore-freddie-gray-death/.

[2] Mueller, Benjamin. “Medical Workers Face Scrutiny After Man’s Death in Police Custody,” The New York Times, July 21, 2014. http://www.nytimes.com/2014/07/22/nyregion/medical-workers-face-scrutiny-after-mans-death-in-police-custody.html?_r=0.

[3] Mathis-Lilley, Ben. “Sandra Bland Reportedly Told Jail Staff She’d Previously Attempted Suicide,” Slate, July 22, 2015. http://www.slate.com/blogs/the_slatest/2015/07/22/sandra_bland_previous_suicide_attempt_jail_intake_form_disclosed_attempt.html.

[4] Liebelson, Dana. “A Texas Jail Failed Sandra Bland, Even If It’s Telling The Truth About Her Death,” Huffington Post, July 21, 2015. http://www.huffingtonpost.com/entry/sandra-bland-jail-death_55ae9f12e4b07af29d569875.

[5] Turner, Leigh. “Bioethics, social class, and the sociological imagination.” Cambridge Quarterly of Healthcare Ethics, (2005): pgs. 374-378.

[6] Asch, A. “Big tent bioethics: Toward an inclusive and reasonable bioethics.” Hastings Center Report, (2005): pgs. 11-12.

6 comments

  1. To the statement that the officers ignored Freddie Gray’s pleas for medical help while he may seriously injured, not only did the police have no reason to suspect Gray was injured but he started calling for help long before even the prosecution says he was hurt. This leaves officers to validate for themselves whether a suspect or arrestee is in the need for medical attention reguardless if the person asks for it or not. If you watch any police show, be it cops, America’s Most Wanted, Wildest Police Chases, North Woods Law, Southern Justice, Rocky Mountain (Justice or Law), or any other show detailing the everyday workings of a police officer you know criminals make up complaints to either try to get lienancy or to go to a hospital instead of jail, even for a little bit. Police officers have to weigh whether the person is telling the truth about the injury, whether it effects them enough for medical attention, and once that is established whether the person needs an ER or would the nurse at the jail be able to handle it. Nine times out of ten the person is either faking it or doesn’t need medical attention, that leaves 10% of people claiming to be injured that truley need a nurse or an ER. Typically if there is no blood or an obvious injury they are faking it as a vast majority of injuries have some indicator such as deformity, swelling, open wound, bruising, or anything else you can check visually or by palpitations. So once you claim your injured the officer is going to give you a once over, as even with no medical training one can see if something doesn’t look right. If they see an abnormality they err on the side of caution and call an ambulance, unless it is a scrape or paper cut. If they don’t see anything they have to decide, are you faking it or is it that bad. This is not based off of medical training, it’s more of a personal history kind of thing. Officer A had lots of broken bones and injuries growing up. Officer B has taken a lot of people to the ER when they claimed injuries. Officer C is a rookie who was hardly hurt at all as a kid. Officer A and B will be less likely to take a person to the ER as Officer C. A because he has delt with lots of pain growing up and since he doesn’t think it is anything major as there isn’t any outside evidence of an injury figures a grown man can handle it until a nurse can check them out. Officer B has taken almost all of the people he has arrested to the ER and while more than half were faking, another 25% were treated with a band-aid and released, another 15% required pain medication like asprin, and only 10% needed to have been there in the first place. Every time an officer takes a person to the ER, they have to stay with them the entire time. So not only are they taking up to three hours a person from their shift, but also charging the city overtime after his shift is over. Officer C errs on the side of caution… This time. However, if he keeps it up his higher ups will start lecturing him about how the more people he takes to the hospital the more money he is taking away from police work and tax payers. They tell him he has to start making tough decisions that he will be wrong a few times, but that it isn’t worth his time or the cities money to take every joe blow to the ER for any old thing. If he has a bone sticking out of his skin, he probably needs to go. While the officer wants to err on the side of caution, the city leadership wants him to err on the side of money. Not only is the city paying the officer to babysit, but they have to pay the ER bill too if the perp doesn’t have insurance.

    So yes, we do want cops to help anyone who is injured. Telling who is and who needs an ambulance is a lot harder than it sounds. Take Freddie Gray, there was not outward sign that he needed medical attention. You can say that his breathing and sounding out of breath is one, but most suspects are after they run from the cops. He wasn’t moving much, he was handcuffed and shackled, if I was hog tied like him I wouldn’t be moving much either… If at all , if for no other reason so they don’t think I’m still trying to resist. He didn’t answer when police asked him if he was ok, a lot of prisoners don’t answer when they’re pissed off that they got caught. Even if they suspected he was injured, how badly? Was it bad enough to where he couldn’t see the nurse when they got to jail? At some point they agreed that he needed to be checked out by an ambulance, they could either wait there until one showed up or they could drive the last few miles to the jail and have one meet them there. Without having an exact address to go to, the jail was the better option. With ambulances being an average of 20 minutes out it would be a waste of time to wait there when you could get to the station, unload your other prisoner, fill out paperwork, and do anything else they needed to do while waiting on the ambulance or while they checked out Gray. So now they get to the station and the ambulance is still 15+ minutes out, the cops can’t make the bus be there earlier. They could have called earlier but they most likely weren’t convinced they needed one yet. In total I think it was 30 some odd minutes, maybe more before the ambulance shows up to find an unresponsive Gray. So in fact, the drivers choice to meet the ambulance at the jail could have saved Gray as he was able to get medical attention from a nurse before the ambulance would have gotten to the other location.

    Is it a good idea to call an ambulance every time it is requested? Depends who you ask, the criminals vote yes, for sure. Police officers would be a slight majority no, and the higher you go up the food chain the more percentage of no votes you will get. Why? It costs time and money every time, so the police are assigned the impossible task of deciphering who is lying, who is hurt, and who is injured. If you don’t know the difference between hurt and injured find someone who played a sport, they will explain it to you.

    • Ok, so there are some typos in there, like while he LAY seriously injured. I didn’t proof read it, I was typing fast on a phone so there is no telling what other mistakes I made. I have never been a cop, although I have family members who are, I have served as a firefighter, on an ambulance and in an ER as an EMT.

    • Hey there, I’m actually the writer of this piece (and really, don’t worry about the typos. I’m bound to make a few of my own). When I wrote “the justification being that he was a criminal and either faking his pain or self-inflicting it” it’s quite clear that my bias is that officers are wrong for not taking criminals seriously. However, what you’ve outlined is a reasonable reality. Neither of us can be sure if that was the reality that took place in Freddie Grey’s situation (and I’m likely more doubtful than you), however your comment sheds light on the real world concerns that officers do face.

      I take your comment to heart (though, it doesn’t fully convince me, just as my analysis of the Gray case doesn’t fully convince you and it’s alright that we partially disagree). I do wonder about your feelings on my analysis of Sandra Bland and Eric Garner though. My view of Freddie Gray’s death, for better or worse, is also influenced by what I saw in these other cases. It’s also influenced by Michael Brown’s case, where he was left on the sidewalk after the shooting for multiple hours. While I’m doubtful that even immediate medical assistance would have revived him that doesn’t stop me from questioning why medical assistance wasn’t called. Leaving his body unattended for four hours after a shooting displays to me a lack of concern with the young man’s right to healthcare (individuals who receive fatal gunshot wounds via gang violence are often rushed to trauma care centers, despite the likelihood that they will die before reaching the hospital or in it).

      Perhaps we can reasonably disagree with the Freddie Gray case (and if your comments are only aimed at that bit of my paper, that’s entirely fine) but the pattern of blatantly disrespecting the standard of care holds in several other cases. I think that pattern reinforces my concerns that Gray fits the mold, even if the case has the added dimension of police having to make tough choices when arrested individuals ask for healthcare. But I’d love to hear your response.

  2. This is an important issue that deserves more attention. It is indeed the “…pattern of blatantly disrespecting the standard of care..” no only by law enforcement but more importantly the EMS and other first responders caught on video. I am ashamed by the behavior I witness. I know there may well be “facts” unseen and unknown, but the visuals should give us all cause for serious concern.

    Stephen

  3. I too noticed that there has been a lack of outrage in the bioethics community at the deaths of unarmed black men and women while in police custody. I wrote about Gray and the Baltimore protests at bioethics.net. Glad you wrote this very necessary article.

    Keisha

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