Rene Bowser
excerpted from: Rene Bowser, Racial Profiling in
Health Care: an Institutional Analysis of Medical Treatment Disparities
, 7 Michigan Journal of Race and Law 79-133, 79-83 (Fall 2001)(287
Footnotes)
Racial profiling is a problem in the United States, and much has been
written about the race-based, temporary detention of minorities.
Stories and incidents of Black and Latino men being stopped while
driving or walking in White neighborhoods because of skin color are so
routine that they are no longer news. In
fact, the practice of racial profiling is more commonplace than we may
realize. This Article suggests that
race-based profiling exists in health care and influences providers'
clinical judgment.
Researchers increasingly recognize that something has gone terribly
wrong in the medical treatment of minority patients. Study after study
reveals dramatic disparities in treatment decisions, and recent work
confirms that these disparities cannot be explained away by benign
factors like economic status, health insurance status, or condition upon
presentation.
Ending treatment disparities between Blacks and Whites requires, as a
first step, that we understand how those disparities arise.
Unfortunately, the health care
literature offers no satisfactory explanation. Efforts to understand the
reasons for these disparities have focused on psychological, social, and
cultural influences such as unspecified patient preferences,
overuse of medical treatment by Whites,
and unconscious racism. All of these
supposed explanations fall short of accounting for the disparities we
observe. This Article proposes to fill this gap in the legal and medical
literature by offering a more complete theoretical explanation of
observed medical treatment disparities--one that yields a variety of
specific policy recommendations. The main thesis is that medicine
attaches characteristics to particular racial and ethnic groups, and
physicians, for a variety of reasons, resort to these profiles in making
individual treatment decisions. For
example, African American patients are understood to be less likely to
survive invasive medical procedures, more likely to possess more
virulent tumors, and less likely to respond to the standard course of
treatment, because of presumed biological differences.
From a cultural perspective, African American patients are understood to
be less likely to adhere to risky and costly courses of treatment, and
less likely to understand their medical condition.
To the extent that these profiles influence diagnostic impressions and
treatment recommendations, racial disparities in clinical judgment
ensue.
The biomedical professions are largely responsible for creating, reproducing,
and legitimating these race-based expectations. Within the disciplines
of science and medicine, biomedical researchers continue the historical
practice of attempting to attribute health differences to race-based
biological and cultural differences between Black and White patients.
Whether their motives are to reverse the health disadvantages of ethnic
minority groups or curiosity about racial and ethnic differences, this
race-based research has not discovered the causes and processes of
diseases. Instead, race- based research
into health differences may paradoxically help to support
institutionalized expectations and suspicions within the medical
community that unwittingly produce the disparities in treatment that
most researchers rightly decry.
This Article links unscientific, race-based medical research to a
broader, institutionalized pattern of racial profiling of Blacks in
clinical decision- making. Far from providing a solution to the problem
of racial health disparities, this Article shows that race-based health
research fuels a collection of dubious background assumptions, creates a
negative profile of Black patients, and reinforces taken-for-granted
knowledge that leads to inferior medical treatment. This form of racial
profiling is unjust, and also causes countless unnecessary deaths in the
Black population.
This Article is divided into VI sections. Part I provides the most
recent evidence that similarly situated Black patients receive different
and inferior medical treatment. Part
II examines potentially benign explanations for this evidence, and finds
them insufficient to account for the existence of racial disparities in
medical treatment across numerous medical diagnostic categories and
health care settings.
Part III briefly discusses the central tenets of New
Institutionalism. New Institutionalism, a genre of organizational
sociology, provides the conceptual framework for this analysis. The term
"institution" has a distinct technical meaning; it refers to
self-perpetuating patterns and practices made in reliance on
taken-for-granted background knowledge.
Not all institutions are racist. New Institutionalism defines
institutional racism as those self- perpetuating patterns and practices
made in reliance on taken-for-granted background knowledge about race
that serve to lower the status of a particular racial group.
In Part IV, the Article examines the institution of racialized
research. As a preliminary matter, it demonstrates that the institution
originated within a specific, historical ideology of White supremacy.
Second, it suggests that the institution has become self-perpetuating
even though the original intent has been lost or forgotten. Third, it
suggests that the use of race as a scientific variable constructs Black
patients as deviant in relation to the White norm. Finally, it shows how
biomedical incentives and norms help to lock-in these understandings,
and reinforce the practice of looking for racial differences to explain
health differences.
Part V situates these background understandings within the context of
clinical decision-making and suggests that physicians rely on them in
deciding whether and how to treat a patient of color. Part VI presents a
proposal for reinvigorating Title VI enforcement in the area of health
care that can potentially eliminate racial profiling in health care.
The remedy this Article suggests is to require each health care
entity that receives federal funds to collect and report data on racial
disparities in the use of services, as well as the choices of diagnostic
and therapeutic alternatives. Existing "report cards" offer a
well-established system for data collection; all that is needed is to
stratify the reporting by race. This proposal has the obvious advantage
of withholding federal funds from institutions that have statistically
significant racial disparities. Equally important, it would force
institutions to think about race, racial profiling, and medical
treatment disparities. Statistics are increasingly being collected to
combat racial profiling in criminal law enforcement,
and should also be used to combat profiling in health care. It should be
emphasized here that my focus in this Article is on racial disparities
in medical treatment--the differences in services that clinically
similarly situated White and Black patients receive when seeking medical
care. While racial disparities in health status are also influenced by
factors other than racial disparities in
medical treatment, those treatment
disparities that we observe directly implicate issues of racial justice
and civil rights and therefore merit their own robust legal and policy
response. |
