Boston hospital launches priority medical service to coloreds, whites to wait.
That's in addition to cash payouts as reparations, among other things.
An Antiracist Agenda for Medicine
https://bostonreview.net/science-nat...genda-medicine
Colorblind solutions have failed to achieve racial equity in health care. We need both federal reparations and real institutional accountability.
Bram Wispelwey, Michelle Morse
<snip, I'll save you the sodomite's ramblings who wrote this and cut to the chase, the program being started this year at one of the biggest hospitals in the country>
For both of these reasons, we believe antiracist institutional change is essential to supplement federal reparations. If we are serious about achieving equity—both now and after federal reparations are paid—we must also pursue institutional action. Crucial to this work is a pragmatic orientation to what philosopher Naomi Zack calls “applicative justice”—“applying justice to those who don’t now receive it”—as opposed to more idealistic conceptions of justice, whether derived from John Rawls or John Locke, on which some arguments for reparations are based.
This is exactly what we have tried to achieve in the design our new pilot initiative at Brigham and Women’s Hospital set to launch later this spring. Adapting Darity’s reparations framework of acknowledgment, redress, and closure (ARC) to an institutional level, we have designed a program—we call it a Healing ARC—with initiatives for all three components. Each centers Black and Latinx patients and community members: those most impacted by unjust heart failure management and under whose direction appropriate restitution can begin to take shape.
Acknowledgment
As Darity explains it, acknowledgment “involves recognition and admission of the wrong by the perpetrators or beneficiaries of the injustice.” In our case, we take acknowledgment to entail informing patients about our heart failure findings at our hospital, claiming responsibility, and incorporating community ideas for redress. To this end, we are assembling focus groups from five priority communities, the neighborhoods with some of the highest populations of Black and Latinx residents in the city of Boston, to explain our findings, listen to responses and suggestions, and offer a space to discuss a just path forward. These focus groups will ensure that community oversight is an integral component of the program. We are also recruiting heart failure patients, who are intimately familiar with the hospital’s admission process and the intricacies of inpatient and outpatient care, to participate as co-collaborators. Providers will acknowledge our heart failure inequities at relevant points of entry into care, ensuring patients are aware of this history and what is being done to address it.
Redress
Redress is simultaneously the most substantial and the most unprecedented component of our Healing ARC. In general, institutional redress should involve not just a direct solution to monitor and end health inequities but to offer restitution for past and present injustices.
Redress could take multiple forms, from cash transfers and discounted or free care to taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes (such as preferentially admitting patients historically denied access to certain forms of medical care).
Crucial to this work is a pragmatic orientation to what philosopher Naomi Zack calls “applicative justice”—“applying justice to those who don’t now receive it.”
The case for redress is particularly urgent for academic medical centers such as our hospital. Because they receive enormous amounts of public funding through federal grants, non-profit tax-exempt status, and Medicare and Medicaid payments, among others, legal scholars have convincingly argued they have a special legal obligation to ensure equitable outcomes under Title VI of the Civil Rights Act of 1964. Even as academic medical centers increasingly attempt to bring their rhetoric and “antiracist” declarations in line with that of racial justice activists, their business plans pivot away from the material reckoning that is necessary to address racial health inequities.
Shawn Johnson and Ayotomiwa Ojo offer a sharp analysis that zeroes in on some of the racist business practices of academic medical centers that Bell would surely recognize as “so-called neutral standards to continue exclusionary practices.” Through aggressive profit-seeking, these institutions prioritize high-profit margin and privately insured patients, contributing to the de facto segregation that lands 50 percent of elderly Black patients in just 5 percent of all hospitals. In 2008 a Bronx coalition filed a civil rights complaint against three academic medical centers in New York as a result of this medical apartheid, although no remedial action resulted, and the problem persists largely unchallenged.
Sensitive to these injustices, we have taken redress in our particular initiative to mean providing precisely what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service. The Healing ARC will include a flag in our electronic medical record and admissions system suggesting that providers admit Black and Latinx heart failure patients to cardiology, rather than rely on provider discretion or patient self-advocacy to determine whether they should go to cardiology or general medicine. We will be analyzing the approach closely for the first year to see how well it works in generating equitable admissions. If it does, there will be good reason to continue the practice as a proven implementation measure to achieve equity.
Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law. But given the ample current evidence that our health, judicial, and other systems already unfairly preference people who are white, we believe—following the ethical framework of Zack and others—that our approach is corrective and therefore mandated. We encourage other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders.
Closure
To complete the Healing ARC with closure, community and patient stakeholders and institutional representatives must agree that the institutional debt has been paid and that a new system is in place to ensure that the problem will not reemerge. The point at which restitution is adequate for the debt incurred will be determined in conversation with community groups. But ensuring the inequity does not recur will require regular data monitoring and community updates. We believe this transparency is essential to establish institutional trustworthiness.
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Originally Posted by Swordsmyth
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