Black Lives in a Pandemic: Implications of Systemic Injustice for End-of-Life Care
Black Lives in a Pandemic: Implications of Systemic Injustice for End-of-Life Care
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DOI：
10.1002/hast.1135
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发表时间：
2020-05-01
影响因子：
3.3
通讯作者：
Elbaum, Alan
中科院分区：
文献类型：
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作者：
Elbaum, Alan
近几个月来，Covid-19 摧毁了全国各地的非裔美国人社区，明尼阿波利斯的一名警察谋杀了乔治·弗洛伊德。死亡的媒介可能是新奇的，但长期流行的黑人过早死亡和警察暴力现象却并非如此。本文认为，植根于系统性不公正的种族健康和医疗保健差异在临床伦理学中应该比一般情况更重要。这篇文章特别探讨了非裔美国人的姑息治疗和临终关怀，强调了美国医学和美国社会一样违反信任的方式。根据许多非裔美国患者与绝症作斗争的经历，医疗保健提供者剥夺了他们对自己的医疗决策的发言权。在Covid-19大流行期间，非裔美国人在呼吸机等稀缺医疗资源的配给问题上再次被剥夺了发言权，因为占主导地位且表面上种族中立的算法牺牲了黑人的生命。当非裔美国人不仅死于 Covid-19，而且死于结构性种族主义时，是否存在“美好”或“有尊严”的死亡？
In recent months, Covid-19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long-standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end-of-life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision-making. In the midst of the Covid-19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race-neutral algorithms sacrifice black lives. Is there such thing as a "good" or "dignified" death when African Americans are dying not merely of Covid-19 but of structural racism?