Standard Racism: Trying to Use “Crisis Standards of Care” in the COVID-19 Pandemic

Lowering the standard of care in a pandemic is a recipe for inferior care and discrimination. Wealthy white patients will continue to get “standard of care” medicine, while the poor and racial minorities (especially black and brown people) will get what is openly described as substandard care rationalized by the assertion that substandard care is all that we can deliver to them in a crisis. (IOM Citation2009) Paul Farmer’s experience in responding to the Ebola outbreak in West Africa is a shocking, if extreme, example of how dangerous to patients this practice is. White patients were treated with the US standard of care, including transfer to the US for treatment, black (local) patients were often given little no medical care at all (on the premise that it was too dangerous for caregivers to touch them or to place IVs to hydrate them). The standard of care for the local population, in Farmer’s words, “in many cases didn’t resemble care at all.” (Farmer Citation2020) As COVID-19 has taught us, structural racism in healthcare is not just a problem in West Africa, and does not just manifest itself in a pandemic. Modifying the standard of care downward in a pandemic is unnecessary and dangerous to patients (Schultz and Annas Citation2012). Since shortages are much more likely to affect safety net hospitals that serve poor and minority communities, lowered standards of care are also most likely to be applied to these hospitals (e.g., as witnessed in Queens and Los Angeles) and primarily adversely affect minority patients (Fink Citation2021; Rosenthal et al Citation2020). In this way, lowering care standards in a pandemic can dramatically expose structural racism in the US. (Maxmen Citation2021; Manchanda et al. Citation2020a, Citation2020b) Because it is exceedingly unlikely that minority communities would voluntarily consent to second class treatment, even in a pandemic, a core element of the “crisis standard of care” (CSC) mantra is eliminating or curtailing informed consent, including sidelining advance directives, health care agents, palliative care, and even visitor access to hospitalized patients, and replacing conversation with Sequential Organ Failure Assessment (SOFA) scores and triage teams (Annas Citation2020)

The Boston Medical Center Immigrant Task Force: An Alternative to Teaching Immigration Law to Health Care Providers

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need

Medical Evidence of Human Rights Violations against Non-Arabic-Speaking Civilians in Darfur: A Cross-Sectional Study

Alexander Tsai and colleagues review medical records from the Amel Centre, Sudan, to assess consistency between recorded medical evidence and patient reports of human rights violations by the Government of Sudan and Janjaweed forces

Title 42, asylum, and politicising public health

President Biden has continued the controversial immigration policy of the Trump era known as Title 42, which has caused harm and suffering to scores of asylum seekers under the guise of public health.1 The Centers for Disease Control and Prevention (CDC) ordered the policy in March 2020 with the stated purpose of limiting the spread of the coronavirus into the U.S.; though, CDC and public health officials have admitted this policy has no scientific basis and there is no evidence it has protected the public.2,3 Instead, the impetus behind the policy appears to be a desire to keep out or expel certain immigrants seeking protection as ports of entry remain open to other travelers.1 Over 1.2 million expulsions have occurred since the beginning of the pandemic, and those expelled are not given the opportunity to have their asylum claims heard.4 As of September 2021, only 272 were permitted to seek asylum under an extraordinarily limited exception.

Title 42, asylum, and politicising public health

President Biden has continued the controversial immigration policy of the Trump era known as Title 42, which has caused harm and suffering to scores of asylum seekers under the guise of public health.1 The Centers for Disease Control and Prevention (CDC) ordered the policy in March 2020 with the stated purpose of limiting the spread of the coronavirus into the U.S.; though, CDC and public health officials have admitted this policy has no scientific basis and there is no evidence it has protected the public.2,3 Instead, the impetus behind the policy appears to be a desire to keep out or expel certain immigrants seeking protection as ports of entry remain open to other travelers.1 Over 1.2 million expulsions have occurred since the beginning of the pandemic, and those expelled are not given the opportunity to have their asylum claims heard.4 As of September 2021, only 272 were permitted to seek asylum under an extraordinarily limited exception.

Cop to Cop: Negotiating Privacy and Security in the Examining Room

Medical examination rooms are private places where a physician and patient can participate in a doctor-patient relationship, complete with a reasonable expectation of physical and informational privacy. This is the ordinary rule, and the usual expectation. But in this issue of the Journal of Law, Medicine & Ethics, Gutierrez et al. describe the case of Mr. Doe, illustrating that there is nothing ordinary about Immigration and Customs Enforcement (ICE) or other custodial authority bringing a detainee/prisoner to a private hospital to see a physician.1 In this commentary, we outline the law governing this category of doctor-prisoner encounter, and suggest how correctional officers might be persuaded to stay out of the examining room

Cop to Cop: Negotiating Privacy and Security in the Examining Room

Medical examination rooms are private places where a physician and patient can participate in a doctor-patient relationship, complete with a reasonable expectation of physical and informational privacy. This is the ordinary rule, and the usual expectation. But in this issue of the Journal of Law, Medicine & Ethics, Gutierrez et al. describe the case of Mr. Doe, illustrating that there is nothing ordinary about Immigration and Customs Enforcement (ICE) or other custodial authority bringing a detainee/prisoner to a private hospital to see a physician.1 In this commentary, we outline the law governing this category of doctor-prisoner encounter, and suggest how correctional officers might be persuaded to stay out of the examining room

US military medical ethics in the War on Terror

Military medical ethics has been challenged by the post-11 September 2001 ‘War on Terror’. Two recurrent questions are whether military physicians are officers first or physicians first, and whether military physicians need a separate code of ethics. In this article, we focus on how the War on Terror has affected the way we have addressed these questions since 2001. Two examples frame this discussion: the use of military physicians to force-feed hunger strikers held in Guantanamo Bay prison camp, and the uncertain fate of the Department of Defense’s report on ‘Ethical Guidelines and Practices for US Military Medical Professionals’

Standard Racism: Trying to Use “Crisis Standards of Care” in the COVID-19 Pandemic

Lowering the standard of care in a pandemic is a recipe for inferior care and discrimination. Wealthy white patients will continue to get “standard of care” medicine, while the poor and racial minorities (especially black and brown people) will get what is openly described as substandard care rationalized by the assertion that substandard care is all that we can deliver to them in a crisis. (IOM Citation2009) Paul Farmer’s experience in responding to the Ebola outbreak in West Africa is a shocking, if extreme, example of how dangerous to patients this practice is. White patients were treated with the US standard of care, including transfer to the US for treatment, black (local) patients were often given little no medical care at all (on the premise that it was too dangerous for caregivers to touch them or to place IVs to hydrate them). The standard of care for the local population, in Farmer’s words, “in many cases didn’t resemble care at all.” (Farmer Citation2020) As COVID-19 has taught us, structural racism in healthcare is not just a problem in West Africa, and does not just manifest itself in a pandemic. Modifying the standard of care downward in a pandemic is unnecessary and dangerous to patients (Schultz and Annas Citation2012). Since shortages are much more likely to affect safety net hospitals that serve poor and minority communities, lowered standards of care are also most likely to be applied to these hospitals (e.g., as witnessed in Queens and Los Angeles) and primarily adversely affect minority patients (Fink Citation2021; Rosenthal et al Citation2020). In this way, lowering care standards in a pandemic can dramatically expose structural racism in the US. (Maxmen Citation2021; Manchanda et al. Citation2020a, Citation2020b) Because it is exceedingly unlikely that minority communities would voluntarily consent to second class treatment, even in a pandemic, a core element of the “crisis standard of care” (CSC) mantra is eliminating or curtailing informed consent, including sidelining advance directives, health care agents, palliative care, and even visitor access to hospitalized patients, and replacing conversation with Sequential Organ Failure Assessment (SOFA) scores and triage teams (Annas Citation2020)