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22 Am. J. Bioethics 1 (2022)

handle is hein.journals/ajbio22 and id is 1 raw text is: THE AMERICAN JOURNAL OF BIOETHICS 2022, VOL. 22, NO. 1, 1-2 https://doi.org/10.1080/15265161.2022.2009700 2 Taylor & Francis Taylor &Francis Group GUEST EDITORIAL K Che~kfpr upd~tes Put Your Money Where Your Mouth Is: How Bioethics Can Learn from Organized Medicine Elizabeth P. Claybornea and Marcella Nunez-Smithb aUniversity of Maryland; bYale University As physicians, the supreme importance of health and its integral role in any individual's pursuit of life, lib- erty and happiness is exhibited on a daily basis. It is abundantly clear that without health one cannot focus on any other facet of life and therefore health serves as the foundation on which wellness is grounded. It has also become clear that social determinants of health have a significant influence on health status and remain paradoxically the most malleable and yet the most challenging paradigm through which we can improve the lives of human beings. This clarity, importantly, has only crystallized because of recent strides in public health and medical research examin- ing, characterizing and linking health outcomes to multiple social factors including racism (Williams, Lawrence, and Davis 2019). Without this data and published research on health disparities, many of the sequela of racism in the United States would remain underreported, denied and downplayed. We find it interesting that the field of bioethics has failed to be an early adopter and leader in addressing inequities and social justice issues given its roots in the study of biology, ecology, medicine, and human values (Goldim 2009). To the contrary, bioethics has struggled to respond to institutional racism because, similar to medicine, it is founded in a history of whiteness (Danis, Wilson, and White 2016). Fabi and Goldberg (2022) have poignantly raised important questions regarding funding priorities in bioethics research and how this perpetuates injustice. We argue that while organized medicine still has significant shortcomings in addressing health inequities, it has provided some practical approaches to addressing social justice that can be adopted and modeled in bio- ethics. The most effective of which is increasing the number of black and minority members and outlining clear paths to leadership and influence in the field. As defined by the Centers for Disease Control and Prevention, social determinants of health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality outcomes. The United States government began investi- gating healthcare disparities and increased mortality in minoritized groups in the Heckler Report of 1985 (Heckler 1985). Healthcare disparities continue today and range from cardiac and cancer care, neonatal and obstetric mortality, access to healthcare and most recently admission rates and mortality associated with the COVID-19 pandemic (CDC, COVID-19 Racial and Ethnic Health Disparities 2020). Health disparities existed long before research began to document the details linking SDOH and health metrics but it was only after this data became widely available and discussed in organized medicine that demands for change were acknowledged and addressed. For decades, organized medicine was restricted to the limited and biased mem- bership of white men who dominated its positions of leadership and left little room for the participation, per- spective or influence of women or people of color. This laid a foundation in medicine that operated from a center with whiteness as the norm. To decenter whiteness, we must hold our professional and educational institutions accountable and encourage a multipronged approach in which social justice is pursued through broadening research, understanding bias and increasing diversity. Fabi and Goldberg (2022) argue that a central facet of this approach will require allocation of funding streams in bioethics to support scholarship, research, and training to address social determinants of health and population level bioethics. It is true both in prac- tical life as well as academics one must put one's money where one's mouth is. It is not enough to proclaim that social justice is important and that health inequities should be addressed. Bioethics must CONTACT Elizabeth P. Clayborne, MD elizabeth.p.clayborne@gmail.com MA Bioethics, Adjunct Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine. C 2022 Taylor & Francis Group, LLC