An African-American
Ethical Perspective in Health Care
Senior Seminar
Donnell Harris
April 30, 1999
Senior Seminar
Donnell Harris
When I was a doctoral student in Health
Care and Pharmacy Administration, one of the questions raised in a health care
ethics class was, “Is health care was a right or a privilege?. I was
immediately thrown into a quandary. I had practiced pharmacy for many years and
practiced mainly in economically and socially deprived areas. I was confronted daily with situations that
involved providing a type of care that was beyond the scope of textbook
pharmacy care. As I often sent to middle and upper class neighborhoods by a
large retail chain pharmacy, the dynamics of the practice were quite different.
In inner city pharmacies, there is a significantly larger number of patients
who receive Medicaid. These patients and the elderly are often very poor and
need extra care and understanding in that they present a unique set of problems
that warrant special considerations.
As I developed wonderful
pharmacist-patient relationships with most of the patients, I was displeased
with the health care that had been provided that believed to be inadequate in
many situations. From all information in health care documented from the
government and with approximately 40 million people without health care, one
can make an argument that health care is
a privilege in terms of the person's ability to pay for services. Adequate
health care is extremely lacking for many persons in this country. It is
unthinkable that all of the citizens in this country do not have at least
primary care health care, even if it is at a minimal cost. Primary health care
addresses those basic health needs that some believe Americans are entitled to
receive and in some cases protected by law. The health of a nation, being one
of the criteria for the health of a nation, we make sure that our children
receive all the inoculations for polio, measles, mump, etc. As we necessitate
childhood vaccinations and inoculations, clean water and clean air as public
health concerns, we know that these are necessary health interventions in order
to prevent epidemics and widespread diseases that would somehow disengage the
country if permitted to exist. Hospitals are legally required to treat anyone
who comes to the emergency room even if there is only a perception of illness.
Many persons use the emergency room for their primary health care concerns and
this has dramatically increased the cost of health care in this country.
However, this is the only option for many patients.
The notion of perception is very
important and I would like to cite a very recent incident that my mother had in
the emergency room of a community hospital. She went to the ER on her own at 3:00 a.m. without informing her family
that she was going. She had chest pains and was coughing at a disturbing level.
The primary care physician dismissed her complaints without an X-ray, ,chest
auscultation, sputum sample and any other diagnostic measurement. He sent my
mother back home in the same condition. The physicians, nurses and pharmacists in the family were inflamed and
confronted the hospital, the ER, chief of medicine, chief of emergency medical
services and all other pertinent staff. We had to re-inform them that our
mother's perception of illness was an adequate reason for treatment.
Illnesses such as the cough and
common cold,
allergies, minor pains, and
irritations are considered primary illnesses and treatment for these are
available to almost anyone. One can go to a local pharmacy, ask the pharmacist
pertinent questions and buy remedies across the counter without ever seeing a
physician. Sometimes people don't even have the finances or the wherewithal to
afford such remedies, which may be at a nominal cost. Secondary care might
involve treatment of a laceration, abdominal pain that is persistent, severe
headache, eye infection and similar conditions. Surgery of any type may be
classified as tertiary care and quaternary care would involve organ
transplants. Organ transplants often reach the heart of ethical concerns in the
availability of organs and who receives them. There is a tremendous waiting
list and people often wait insurmountable periods of time to even get on a
waiting list. Those Americans who have money, prestige and power have a
distinct advantage (privilege) in going to the top of the list, e.g. Mickey
Mantle. A lottery seems fair game, but may not be operative at this time.
Persons who have valuable and high premium health insurance policies also have
distinct privilege and receive quality health. The word quality health care
offers some problems in that defining such a construct entails many opinions,
thoughts and values as to what quality is. Perhaps a more meaningful term would
be adequate health care.
Health care as a right or privilege
is only one starting point to engage ethical concerns for the subject matter.
There are certainly other vantage points that one might want to engage
depending on his social location, culture and education and the demographic
variables that would circumscribe the dialogue. After many years of experience
in the health care industry as a provider of health care- services, it became
almost imperative-for me that I should contemplate the issue of an
African-American ethical perspective in health care from the point of view of a
practicing professional and a member of a minority group. On contemplating this
issue, I found it to be thoroughly engaging and challenging. Why not a valid
African-American ethical perspective in health care? We seem to think very
differently and react very culturally
and ethnically to most other
situations that confront us that is distinctly different from the majority
culture.
I have been sternly warned by the
noted historian, Professor Higginbotham, that engaging a single perspective is dangerous,
even though superficially it affirms one group's right to have an idea and
philosophy of life. It is plausible that there is not just a single
African-American ethical perspective in health care or for that matter in any,
other arena of life as well, simply because we are not a monolithic group of
persons. We differ in thoughts, values, expectations, education, economics and
the entire gamut of demographics that would define any group or race of
persons. As a health care provider who is educated and distinctly middle class,
I relinquish my notion of a single African-American perspective in that a
non-educated, poor, jobless, unhealthy inner city black would, could, or should
think differently than I. Parallel classes that are educationally, economically
and socially similar seem to transcend the issue of race in terms of being able
to engage the health care system to one's advantage. As one escalates the
social ladder of economic and social success as professionals and educated
persons, perhaps the notions of a single perspective becomes even fuzzier. For
instance, an African-American who works in the health care insurance sector of
the industry may ascribe to some of the values of the organization simply
through association and assimilation. Many people in this country, including
all ethnic groups, have very serious concerns about the power and control that
insurance companies have over their lives when it comes to the treatment that
they need and not covered by their policy.
For those persons who believe in
the sanctity of the person and that each person is humanly equal before God,
notions of fairness and justice complicate the matter and translates into civil
rights affairs. Fortunately, there are many civic and legal ramifications that
protect all of us from otherwise unethical situations that would nullify our
lives and behavior when we confront the health care system.
From a social science point of
view, one could possibly gauge a unique ethical perspective by means of a
random survey of. persons, groups or groups of persons based on race, sex,
nationality or any other demographic. There are many ways that one could
standardize and validate a questionnaire that would tap into the ethical
concerns of the population being discerned. Of course, there is always a
problem with these statistical matters in the sense of
interpretation and generalizations
to the (a) larger population. This notion of a random survey may be a little
too advanced for this time in history, simply because there is a multiplicity
and diversity of ideas and values concerning health care. However, it would be
a clear scientific project that would yield some needed data, and much valuable
information that may not otherwise be collected.
I entertained the notion of health
care as a right or a privilege before entering the divinity school. As a matter
of fact, it was because of these concerns that I thought a theological
education would permit me to think more fundamentally about issues that caused
me great pain as a practicing health care professional and as an
African-American. A very fundamental question for me for the past several years
is determining or studying the intellectual consistency in the way that all
ethnic groups contemplate the moral life, in as much as we are all a part of
the human race and perhaps equal in the sight of God. I wonder if the great
thinkers of antiquity, such as Socrates, Plato and Aristotle, when
contemplating the moral life, found relevancy for culturally, racially and
ethnically different groups. Or should this have been a matter of concern? I'm
not even sure if modern thinkers such as Kant, Mills and thinkers of the
eighteenth and nineteenth centuries, when discussing the rational man, even
considered that cultural and racial lives may be different in spite of a
considered rational norm. These ideas pose difficult questions for me and
introduce intellectual, emotional and perhaps scholarly ideas that may have
gone unchallenged and historically omitted from the discussion.
At this point, I need to say that
even though, I speak of an African-American ethical perspective in health care,
it is because it is my social location as a health care provider that I may
offer a unique experience in discussing this matter. However, I believe that an
ethical perspective possessed by any person, group or race of persons within a
particular social strata would be consistent for any other life matter., be it
education, business, finances,
lifestyle, recreation and all those
values that define that or those particular lives.
The Reverend Dr. Martin Luther King
Jr. as anethicist, philosopher and theologian tremendously impresses me. For
me, he was just not an ordinary preacher who was able to raise the emotional
gut feelings of a disenfranchised group of persons but he was a moral teacher
of the first order. Not only was he a teacher, but he was an exemplary
character in the twentieth century who was able to convert an entire nation
into a system of beliefs and practices, even if the changes were enforced by
the mandates of the law. He preached an ethic of love, non-violence and hope
for a better life that resonated throughout the world and especially in the
Black community. Little Black boys and girls in inner city neighborhoods and
ghettos cheered Martin for being the messiah and understood everything that he
was saying. We agreed with him on almost everything and wondered why many
Whites provided obstacles for what we deemed were no more than human rights. I
know this because I was one of those children. It was if my entire school,
neighborhood and community were in total agreement with all of his ethical
concerns about our moral lives. Because of this consensus that I felt in the
Black community during this time in my life that I was drawn ,o the notion that
there may be a singular African-American ethical perspective. Perhaps, desire
and ambition for a united race of people in values and morals to continue to
confront a racist society that had prevented me from full participation even at
a young life drove me. The kind of ethical perspective that resonated with me
from Martin was one that included, but yet transcended health care. It included
everything else about life and just the idea of being in the world. Martin
•confronted the ethics of life fundamentally from a theological perspective.
Many are not so convinced that this is the best way to achieve parity in a
world with so many options
As a doctorate in a health care
discipline, I am concerned that there is a lack of adequate and published
research on minority groups and women and especially African-Americans. When I
first took my Hippocratic oath and began to practice, I was concerned just
about being the best possible practitioner that I could be. It was after a few
short years of practice that I found great. disparity among many cultural and
ethnic groups in health care and similar disparities that I knew to exist in
other areas of life. If one were to do a literary search for health care data
that included serious demographics, outcome studies and cost and effectiveness
studies for minority groups, one would find a dearth of relevant information
that would be useful for decision making and policies. Ironically, there is no
disagreement among government personnel, research think tanks, large
corporations, professional associations and community interest groups that such
disparities exist in the American society and especially among minority. groups
such as African-Americans. Many cultural groups have unique ways, traditions
and sources of healing that may not be mainstream or totally western.
Acupuncture is now only threading an entrée into official medicine. However, to
use it often means relinquishing the support of Western medicine. This is to
say nothing about the merits, science and validity of voodoo medicine that many
people have believed saved their lives. One would never find mainstream
research in these areas of health care.
Retrospectively, when I think of my
interest in ethics, I have come to appreciate many of the doctrines that are a
part of mainstream thinking about morality, even though I curiously wonder
about the pragmatic values of many of the ideas in relation to what's happening
in the real world. I am thoroughly impressed with dialogues that engage the
sufficient, necessary and universalizability of moral action-guides; That is,
moral actions apply universally to everyone alike and never exclusively to
certain groups. This has a certain ring of theological and natural law truth,
but perhaps in the world of political economies we are faced with other
realities. The entire notion of diversity has a key role in understanding the
world of ethics, which doesn't necessarily mean cultural diversity in the
smaller sense of the word. Historians, cultural anthropologists, sociologists,
psychologists, theologians, educators, politicians, businessmen, mothers, and
all persons have contributions to make that would be beneficial and only bring
to life many of the ideas shared by those in antiquity, modern philosophy and
the likes of. Dr. Martin Luther King.
In searching the literature for
data and information on ethics, health care and African-Americans, I was
disappointed and somewhat surprised that there was so little written for, by
and about African-Americans. It was during the early sixties that ethics became
a very important part of the curriculum of medical schools and shortly
thereafter, nursing schools took up the banner. Physicians and nurses offer
primary care to patients and become intimately involved in the person's life
making attempts to understand the wholeness of the person and not just a
particular isolated infection or illness. The idea of wholeness has taken a
serious root in modern medicine and now we treat the whole person. We take into
consideration, not only the particular illness, but also the person's
psychological, emotional, social, economic and intellectual state. We also.
consider very deeply what the person feels, which are more directly related to
his ethics, values and attitudes about his life, illness and treatment. The
patriarchal mode of health care treatment for the most part, no longer exists
in this country. Patients are taking more control of their lives, their health
and have tremendous input into their therapies. They question the physicians,
nurses and other health care practitioners to the fullest demanding information
to make informed choices. In relation to this, litigation. procedures are big
business in this country with the number of malpractice suits that are now on
the dockets of the court system. The relationship of the patients to his
provider, family, health care system and the community is a very important
consideration and no one takes this lightly any longer. In addition to rights
and privileges, I now invoke the concept of choice. Persons entering into the health
care arena now have a multiplicity of options, treatment plans, availability of
second opinions and other utilities or commodities that would make their lives
more healthy and meaningful. Ronald Reagan is to be given thanks for opening up
the market for a freer competition among major businesses and corporations in
this country. Health is big business. Perhaps, I should say that health care is
big business and the bottom line, unfortunately, is profit, with optimal health
care being an additive. Insurance companies that now rule and govern HMO's,
hospitals, physician practices and other health care services guarantee profits
for the companies and not good health care. If a person receives good health
care, it is because he assertively demands this from the physician or other
health care provider and in turn the physician may interact with the insurance
company in such a way to make sure payment is paid or the procedure is covered.
There are lists and lists of forms that delineate the thousands of diseases and
illnesses that the physician can check off and if he is willing to overlook the
insurance company or decidedly wants to do something for the patient can manipulate the form. Of course there are many
patients in this country who have finances, means, and wherewithal to pay up
front for whatever services they want and may often go out of the country to
receive health care services and/or drugs that may not be approved by the Food
and Drug Administration. Non-traditional health care services are on the rise
in this country because of the matter of choice and many people believe that
the health care-system in this country is often prohibitive. Many grass root
organizations and special interest groups have been very instrumental
in-pressuring the FDA to approve certain drugs that would take long periods of
time before reaching the market. It is estimated that it takes between 50-100
million dollars and sometimes more to put a new drug on the market. The
clinical trials that prove the safety and efficacy of the drugs are the longest
part of the trial. One must, however, give credit to the FDA for being the best
regulatory health care agency in the world. The tragedies of thalidomide and
similar drugs have been under complete advisement, scrutiny of the FDA to protect
American citizens from further malfunctions of an already over loaded system.
In searching the health science
library for literature via med-line and social science abstracts, I found very
little in retrieving articles that dealt with African-Americans, health care
and ethics in a single topic. It was through a course with Professor Arthur
Dyck that I found a most wonderful book on the topic, African-American
Perspectives on Biomedical Ethics, edited by Harley E. Flack and Edmund D.
Pellegrino (1992). The book was a result of an enterprise undertaken by Harvard
and Georgetown Universities
- Are there African-American
perspectives on biomedical ethics, an African-American perspective, or the
African-American Perspective: Cultural Relativism and Normative Issues:
What are they?
- What are the moral foundations of
African and African-American cultures?
- What is the African-American
concept of personhood?
- What is the nature of wellness
from African‑ American perspectives, and what are the roles of
- healers and patients in African
and African‑American cultures?
The first writer addresses my
intellect and I am quite pleased because this is perhaps my first instinct, if
not my gut reaction. Herman Branson (1992) speaks of a universal ethic that
unites all beings. That this major ethic (singular) is that of trained
intelligence. Virtue is wonderful, and utilitarian and duty based theories have
their proper places within our moral reasoning, but it is through this medium,
i.e., trained intelligence, that we are more likely to solve our problems,
achieve our goals and understand our outcomes. An anthropologist has raised the
question of his definition of intelligence. Is it American academic training,
Asian mediation, mind control technique, Native American spirituality or mind
enhancement? This is certainly a good question. Perhaps, this underscores human
relationships, interactions and communities. Branson reiterates that this
should be our main concern, not discounting an ethnic perspective. I would
surmise that the universal ethic (or any universal ethic) supports the notion
that there is something essentially fundamental and basic about human nature
that it transcends cultural differences.
The comment by Branson is certainly
an insightful- one that trained intelligence is a necessary tool for the
continuing evolution of mankind. This statement of the trained intelligence is
without regard for, or may not necessarily be incompatible with cultural
differences. But is this the answer that we seek or the best possible answer?
Is the trained intellect in direct correlation with an African-American ethical
perspective, and for that matter, any other ethnic perspective, including that
of the mainstream? In other words, if we conducted a correlational study to
determine the relationship between the trained intellect and ethics (including
an ethical perspective, standards, etc.), would the correlation be a strongly
positive one? If this were true, it would have to follow that the relationship
between the untrained intellect and immorality would also be a positive one.
Empirical evidence does not support this-thesis.
Branson's first statement of a
universal ethic is very appealing to me in that is has theological
ramifications. It speaks of natural law and the oneness of the human race. It
speaks of a similarity in spite of all of our differences and diversities. It
compels us to come to the table and as the prophet encouraged us to come and now
let us reason together. It is quite interesting that the eagle-eyed prophet,
Isaiah, introduces a rational mode for behavior that we are not just physical,
emotional and spiritual beings, but in fact we are beings of reason.
Could it be possible that the philosophers
of the Age of Enlightenment spoke of the rational human being and the priority
of reason as an innate capability, but yet they were not speaking for all human
beings. It never occurred to me that these scholars could be speaking from a
contextual framework. What I mean by this is that they represent a specific
time in history with all of the cultural, societal and traditional
acculturation's. Branson wonders if our need to grasp and reflect on some of
the mitigating conditions in our society is directly related to there being an
African-American perspective. Here, I grasp for breath. For me, this is
existential. At this time in my academic, personal and spiritual development, I
don't see any other way. My life is my cultural history, experiences,
tragedies, happiness and perceptions. I believe that this is true for all other
groups as well. The point is that our cultural histories, experiences and
perceptions may be different, even though at time we share some of the same
life tragedies. In fact, there is great disparity between ethnic groups and the
majority culture in almost all aspects of appropriating and accessing the
American mainstream culture.
At this point, I address another
conflict in my thinking that may also be bothersome to others. The disparities
that exist between certain ethnic groups in this country have been
systematically and staged historically. The greatest example is chattel
slavery, which I will discuss later. If it is true that there is a universal
ethic that is innate to all human beings, it is not respected and at least not
pragmatic for our lives. It is my opinion that this is the cause for the great
American cultural and societal disturbances. I further, believe, that if
reconciliation is an objective or goal, a disenfranchised people must develop
an ethic for existing that counters the prevailing ethic that placed them in
the original position.
Cultural anthropologists question
the compatibility of a universal ethic for all human beings and bring to mind
those sociological, cultural, economic and anthropological factors that
influence the traditions and development of certain groups. Could this be one
of the foundations for any particular ethnic perspective? Does this notion
address cultural diversity? Are minority groups, in fact, different from
mainstream? For me, these questions pose the greatest challenge. However, I am
in full concert with Aristotle when he contemplates the good life and the
pursuit of happiness. What is the good life and happiness is different for all
of us, but perhaps the means for achieving such abstract goals need to be
exercised with greater diligence.
Another noted speaker, William
Banner (1992), corroborates with Branson on the idea of a universal ethic for
different reasons. He doesn't particularly agree with how the word perspective
is being used in this context. He believes that a perspective refers to the
realm of sensory awareness or sense perception. These sensory experiences refer
to images, dreams, illusory experiences and similar notions. For Banner,
sensory knowledge is quite different from cognitive thinking. This is where he
draws the line with Branson who speaks definitively about the intellect as the
guiding force. Banner believes that there is one moral and medical community that
addresses itself to the alleviation of physical, mental discomfort, disease,
the responsibility of good judgment, justice and compassion. It is here that he
prompts the notion of universality. Medical concerns are a universally
unlimited concern and the ethical responsibility would also be a universally
unlimited responsibility. These three statements sum up the position of Banner:
The realm of moral inquiry involves an
extramental and extrapersonal order of things. (this is very native American)
The
concept of perspective has no appropriate application within such a realm.
Human
beings constitute a single moral and. rational community, membership in which
affords them all a
single rational and humane perspective on moral issues.
It appears to me that Banner shares
a main idea with Branson with regard to the trained intellect and that it is
reason that guides us. It is the utilization of the trained intellect that
guides moral inquiry and provides a single rational humane perspective. Banner
believes that we mistakenly believe that an ethnic perspective is being
confused with a trivialized response to a universal problem with a particular
social framework. The problem is the ignoring of certain other or different
viewpoints.
He is guided by the belief that
each person is a member of several communities ranging from the family to the
state. There is one moral community of greater or lesser social units with
greater or lesser extensity. The . difference is that every social unit has
practices or customs that are governed by an ethos, only on the level of
sociology or social anthropology, but not on the level of ethics or moral
philosophy.
The term, perspective, gives us
great debate. With due consideration to the problem of language and
linguistics, this could present a major obstacle in the moral argument.
Whatever we mean by the word, we have to agree on how the term is being used
and defined in order to move from the foundational point. In my learning, this
is always the case. We all mean something different and don't agree on a
conformable definition for many of the abstract notions in life that cause us
problems. Nevertheless, Webster defines perspective as the relationship aspects
of a subject to each other and to a whole, or, subjective evaluation of
relative significance, or a point of view or the ability to perceive things in
their actual interrelations or comparative importance.
I appreciate a universal ethic and
trained intellect purported by Branson and the rejection of a perspective for
the one moral community by Banner,' but I remain partial to cultural relativism
and an ethnic perspective for the time being. Jose Garcia announces his reasons
for believing the latter in three theses:
- a relativity thesis, holding that
some moral judgments are somehow relative to the codes or lifestyles of
cultural group.
- A diversity thesis, holding that
these codes or lifestyles are not entirely identical in what they commend,
enjoins, and so on.'
- A nonrankability thesis,
restricting the extent to which different codes, can be ordered as better
or worse.
He asserts that these three theses
represent judgment, depth and strength, respectively, in determining how a
relativist moral view can vary and that cultural relativists understand
perspective to mean a standpoint from within some group and that it is a
pervasive and inescapable feature of a moral judgment. I now raise the
question, however, with Garcia, given this multiplicity of perspectives, can
there be no perspective?
Branson, Banner and Garcia (1992) seem
to capture the essence of the question. Branson with his trained intellect,
Banner with his sense perceptions, theories of classification and error of
redundancy theory and Garcia with his cultural relativity. All three raise a
composite of further questions:
- what is the object of thought and
action in dealing with problems from a racial or ethnic perspective?
- Should the medical concern for
the physical and mental well-being of persons be a universally unlimited
concern?
- Is the ethical responsibility for
good judgment and justice in human affairs a universally unlimited
responsibility?
- How does one avoid the broadest
field of view in such matters?
- Why shouldn't medical disability
be universally regarded as a human disability?
- Should the conduct of science of
medicine or the conduct of science of ethics be compatible with anything
called the ethnic perspective?
- Is the science of medicine and
ethics an affair of critical intelligence?
- Is the universality of science
and ethics the answer to racism, prejudice and insensitivity?
Questions 3 and 8 have the most
relevance for me for they tend to achieve a gut reaction. The well being of
persons is respondent to natural law and the essence, existence of life and
just Being in the world. As human beings, there are rights accorded to us by
natural law that transcend societal laws that are ordained by nature or God.
However, with rights come responsibility and this responsibility is not just a
community endeavor but can be seen as a universally unlimited concern. It is
also my deepest belief that racism, prejudice, sexism, classism and all the
other "isms" tamper tremendously with our ability and innate desire
to transcend our differences.
Professor Arthur Dyck (1994)
responds fervently to the notion of responsibility juxtaposed to the notions of
rights. He affirms that you can not have one without the other. Let me
interject here that Professor Dyck, in my estimation, is a truest of ethicist.
This does not mean that I agree with him on all of his locutions, because we
have had our moments, but his case for responsibility in the society hits a gut
nerve with me and I agree with him wholeheartedly on this issue. In his book,
Rights and Responsibilities, he states that ethics has to presuppose that
people generally can and wish to learn more about and act upon what they
perceive is right, that the screen of philosophical ideas sometimes prevents
the building of human communities through moral and spiritual development and
that human rights are knowable regardless of age, race, gender, class,
ethnicity, culture, nationality or religious affiliation. This is certainly a
plea for the universality of ethics in the human community. Dyck seems to
encompass and yet transcend all of the ideas of Branson, Banner and Garcia in this
one statement.
Cheryl Sanders (1992), a noted
theologian in her discussion of an ethnic perspective, grounds her beliefs
within a theological framework. She believes that Black Theology and
African-American Ethics have the same problems and limitations, but they both
have an appropriate starting point. She emphasizes that all theological
reflection is grounded in the particularities of race, class, gender, etc. It
would be interesting to note that perhaps she is saying that all rational,
scholarly and theological thinking takes place within a contextual framework.
If this is true, why not consider that ethical reflection on the part of those
scholars who participated in this endeavor (book) also were doing such within a
particular framework. I am told that this is a common anthropological point and
is vigorously upheld in the field of anthropology. Anthropology of this era and
partly at Harvard reversed this universalist trend in the basic tenet that
unless we come to grips with the extensiveness and pervasiveness of difference
in every thought, word or deed, we cannot transcend without harming large
segments of the world population.Womanist theologians such as Sanders and Katie
Cannon share many of the same ideas as they relate to an African-American ethic.
The ideas of Katie Cannon will form a more significant part of this paper
further on, but Sanders
cites reasons for the emergence of
the Black church during slavery and the courage that was demonstrated by the
slaves to address issues of theodicy, pain, suffering and all of the negative
persona and social situations that they were made to tolerate. She addresses
the notion that scholars must be able to transcend their particularities in
thinking at some point in order to bring critical commentary to bear on the
society at large. And furthermore, African-Americans have always participated
in biomedical discourses on a daily basis.
She states that an ethnic
perspective, may in fact, be a difference in an ethos possessed by
African-Americans. Webster defines ethos as the disposition, character, or
fundamental values particular to a specific person, people, culture or
movement. There is a difference in the Euro-American Ethos and the
African-American Ethos. She maintains that the differences are categorical and
I list them below because her categorizations are interesting and very clear.
The Euro-American Ethos is dualistic, the African-American Ethos is holistic,
the Euro, exclusive, the Afro, inclusive, the Euro, individualistic, the Afro,
communalistic, the Euro, secular, the Afro, spiritual, the Euro, atheistic, the
Afro theistic, the Euro, inflexible, the Afro, improvisational and the Euro,
materialistic,. the Afro, humanistic. This essentializing done by Sanders is
currently being resisted by Native Americans at Harvard because they believe
that White Anthropologists have come up with a similar, but longer list and
Native Americans want their own list or no list at all.
Essentializing seems an idea that
many minority groups resist because it further places them in categories that
may not appropriate and sometimes this categorization is racist based and only
add further to an already degraded human value. However, there is something
that resonates with me again with this listing that Cheryl does in that I believe
it is true. In my experience as an African-American male, professional,
teacher, friend and associate, I have observed with great patience behaviors,
attitudes and values of many groups. One thing that I know for sure is that
many times our perceptions are greatly different from others. It was my
doctoral mentor who once told me in a difficult time of my studies that what I
was perceiving as negative occurrences in the academy may just be true. He ended
the thought with, "perceptions are many times realities". Personally
speaking, I attest to Cheryl that I am somehow naturally holistic, inclusive,
communalistic, theistic, improvisational and humanistic. I own these
characteristics in my personality and character and find them sometimes
non-operative in an indifferent world. I am attracted to her statement of an
African-American ethos. For me this says more than ethics and morality. It is
the real day to day living with all of the attributes of life that attend our
existence. In fact, African-Americans tend to life in sometimes very different
ways than the main stream. The things that we talk about at dinner, the way we
relax and party, the problems we experience at work that may be racist related,
the relationships with our family and friends, the disgust, anger and ire that
we feel on a daily basis, our hopes, dreams and desire speak of an ethos that
is culturally related.
Kwasi Wiredu (1992), a Ghanaian,
agrees, in thought with Sanders with the African moral conception being
humanistic. That is, moral upbringing begins at home by the parents that
continues through moral correction in adulthood. All stages of moral
development are grounded in conceptual and empirical considerations about human
well being. He also bases much of what he has to say on anthropological studies
of African Culture and more relevantly to the Akans of Ghana. Most Ghanians
understand the saying, onipa na ohia, to mean that it is a human being that has
value, that all value derives from human interest and that fellowship is the most
important of human needs. It is by internal constitution that a human being is
part of a social community and not because he is a member of a community that
defines the human being as a social being. According to Wiredu, in Akan
culture, morality is independent of religion. What is good promotes human
interest and God is good in the highest. In that there is no institutional
religion in Akan culture defines a more fundamental basis for ethical
conception. Procedural ethics may rely heavily on utilitarian notions to tap
the resources of the world.
The Akans have a remarkable
understanding of personhood as it differs from being a human being. The first
prerequisite of personhood is marriage and procreation. Further, personhood
entails supporting the household in concrete and material ways. The person,
being of a higher level than a human being is of a sound body and has a
reasonably strong and consistent motivation seasoned with a good sense of human
sympathy. The conditions of personhood
are, correlated with rights and
privileges. A person, therefore, must carry his weight in the family and the
community. By definition, this precludes infants, children and irresponsible
adults. He offers no reasons why these categories of persons are absolved of
responsibility. I am further told that this is just one perspective of a
Ghanaian ethic belief. Everyone does not achieve personhood, but nevertheless,
all Akans are human beings and never less than that. Because there is a divine
element in the nature of all human beings, every one is entitled to a minimum
respect, dignity and a full complement of human rights.
The notion of personhood is very
important in any ethical discussion. What is a person? Of what does a person
consist? What are his limitations and expectations? Gilbert Meilander, (1995)
(Arthur Dyck appreciates him), in Body, Soul, and Bioethics, gives an
interesting and different discussion on the concept of personhood. His major
thesis is that the person has been separated from his soul and body, but there
is a connection between the person and natural trajectory of bodily life.
Meilander begins his discussion with the religious thinking of Augustine,
Origen, Saint Thomas
and Farrer. These scholars question the nature of the human body in concept and
how one conceives of it in the resurrection. What about babies who die early,
the physically impaired and handicapped? How will they and in what form will
they be resurrected? It appears that Meilander has deep theological
considerations here. However, he does base his argument on the following
propositions about personhood:
- does the person have a timeless
form?
- What is the continuum of
development and decline in the person?
- Is our person simply our personal
history, a history that is inseparable from the growth, development and
decline of our body? (pp.42)
Meilander believes that in
contemporary ethical thinking, personhood is quite divorced from our biological
nature or the history of our embodied self. He cites Fletcher who believes that
apart from cortical functioning, the person is non-existent. In summary, he
believes that to have a life is to have a natural history. Biological life
without the possibility of biography can be of no value to us. He re-emphasizes
that to have life is to be terra animata, or animated earth as Saint Augustine describe the human being,
"personhood, only a part of the organismic
trajectory, is connected to its
earlier and later phases by a complex of factors, physical, social,
psychological that constitutes part of a single history", (pp.58).
Here, we have two points of view of
how personhood can be conceived. Could this possibly be a starting point for
the discussion on how one perceives personhood or the human being? Are the
differences that are reflected in these points of view based on a different
notion of being in the world or are they truly differences based on perception?
Let us pause for a moment. Up to
this point, I have led a discussion in ethics and the case for an
African-American perception of ethics. I have mentioned very little about
health care. I would like to emphasize, here, that the paper is more about
ethics than health care. Health care is just the object in this case. The paper
could very well have been Ethics, African-Americans and Doctorate Education,
which also poses many disturbing questions. I have been investigating meanings,
perceptions, definitions and possibilities of an African-American ethical
perception. Later in the paper, I shall discuss some issues in African-American
health care that have affected me personally and others who may have
experienced some difficulties in understanding the mechanics of health care in
this country.
One of the big problems of the
paper is that of the methodology. How does one present the problem and on what
basis, scientific evidence and authority does one make claims. I have a gut
feeling for the evidence and the authority, but feel slightly awkward in
presenting the case. In my doctoral research, I looked at a problem that
African-Americans were having in health care with ethical implications. The
study involved a random sample of pharmacy students, a questionnaire,
standardized tests, grade-point averages and an inquisition into values,
attitudes, perseverance, sense of coherence and other related attribute. The
study was fairly easy because it was quantitative. Every attribute or variable
had a number or value to be calculated. After having gathered all of the data,
one could easily do statistical testing and make inferences and some
generalizations to a larger population. The historical scientific method
provided all of the tools and a valid and reliable methodology to research the
project in a very sound scientific manner.
In this paper, the problem is
somewhat different, even though I am looking at attributes in a larger sense.
However, there are no assigned values to any of the ethical issues discussed.
Though I always knew what I wanted today, the question was where to start. I
conferred with Professor Higginbotham who was discussed earlier in the paper
and also with Professor Callahan. Professor Callahan, at first, believed in the
idea of the paper as valuable information to discuss. He proceeded to talk
about a methodology that would include several ideas that should be presented
in an organized fashion. The first idea is that of chattel slavery, the unique
American experiment that has had and still having devastating effects on
African-Americans and the entire country as well. From where did the idea of
slavery to exist in America
come? Who supported it? What were the ideologies, values and attitudes of the
slave-owners and slaves. Just a discussion of this has taken up libraries.
During that time, what was the Christian value? Did Christianity support
slavery? What was the slave experience and the slave's station in life that was
man made? Did it survive God's judgment? Slave masters and slaves had a
peculiar relationship and interaction with the scripture, but the difference
was within an experiential context. Those slaves who could read, read the same
bible as the slave owners, but what was the impact of the evangelical tradition
on the country during the arrival in America by slave owners and slaves?
What was the gospel message? Did the slaves feel that they were doing God's
service in being subjected to another race of people or did they resist? How
was an African-American ethic appropriated to confront slavery and all of the
manifestations of a racist system?
For this paper, one of the current
manifestations of such a system would be an inadequate health care system in
which African-Americans participate and the ethics that may be involved. The
inadequacy of the system affects my ethical sensibilities and incurs my hatred
for inequality and unfairness. In fact, what I have experienced in the
profession has made me very angry to the point of having the shakes. Why? For
me, there is a real concern for weak persons, many of whom are
African-Americans. There is an inherent dignity of all persons that seems to
be.disregarded in many minority situations. The fact that many . people don't
have insurance plans and/or money to afford appropriate health care bugs the
hell out of me and a disproportionate number of these persons is
African-Americans. The question of ethics should deal with what is and what
ought to be in health care for African-Americans and others as well. Professor
Callahan provided me with a basis for understanding qualitative research and
what one methodology could be. When I first thought about this paper and its
ideas I was very radical in thinking about an African-American ethical
perspective because my historical consciousness, bouts with racism and bigotry
and my development of a moral code that was sometimes in opposition to
mainstream funded my need to do a paper of this sort. It was Professor Higginbotham
that truly spurned my thoughts with the statement, that African-Americans are
not a monolithic group of persons. Maybe, I could find this unity of ideas and
thoughts in a Muslim culture or Near East Country, but never in the United States
among any race of people and that includes African-Americans. I now respect the
dialogue that should exist and understand that we may never come to any
meaningful conclusions in terms of an ethical perspective that is truly shared
by a11-African-Americans and there will always be a level of truer
dissatisfaction with the ideas, values and morals that are being exhibited and
manifested in the country and every sector of the society. Perhaps the Harvard
education that I have received has made me an intelligent participant with,
foremost, an experience, education and more than desire and will, a love from a
higher source that convicts me to be concerned for not just only
African-Americans, but any disenfranchised group of persons. In the hood, we
would call these persons the underdogs.
Shall I use part of the methodology
proposed by Professor Callahan? I'm sure throughout the remainder of this
paper, there will be sparks of his influence, but it is Ms. Katie Cannon (1995)
who has called me to attention with a sound methodology that I embrace, love
and preach. The moment I first read her works, I was totally mesmerized by her
prophetic voice, critiques, essays, testimonies, witnesses, analyses,
experiences, perceptions,
provocations, rage and irreverence.
In other words, I live and thrive on her scholarship. My African-American
existential angst is defined by her history of ideas. My God, is she ever
womanist. This means also that in her womanist analysis of life and
experiences, I play a major part as an African-American male and I appreciate.
that. My mother, grandmother, sisters and aunts, nieces and female friends are
all womanist. If I re-taught junior high school for any reason and any subject
matter, we would read together the first three chapters of her book, Katie's
Canon. Her account of surviving the blight, slave ideology and biblical
interpretation is so historical and so very keenly acute in its detail, that is
a must for every African-American to read who desires to know anything about
chattel slavery.
I am so impressed with her
methodology, that I have adopted it for this paper. From this point on, my
ideas will be a reflection of what I feel and think and what Katie so
poignantly demonstrates in words. If I didn't know any better, I would think
that we had the same kindergarten teacher.
Katie is very much in tune with
W.E.B.Dubois when she restates that the problem of the twentieth-first century
is the color line, gender line, and the class line. Katie is a student of slave
narratives and has primary sources to make her case. Racial slavery in the U.S. was the
cruelest of institutions. As early as 1660, Africans and their descendants were
treated as objects, things, possessions, commodities and accumulations. The
acquisition of slaves through the middle passage was the most traumatizing mass
human migration in modern history. Close to 50 million people were seized from Africa . The treatment was so harsh, that one out of every
eight Africans died in route. The status of the slaves was that of chattel-mere
propertystock-permanent-hereditary-and strictly racial. Not considered human,
the value of the slave was that of an animal or real estate property. The slave
was not considered human beings legally, culturally, socially or politically.
African women were considered as "brood sows and breeders" and their
children as "increase". The White slaveholders had virtually
unlimited power in every dimension including life and death. The conditions of
slavery said that the slave was movable property, without the legal status of
marriage and could be robbed of familiar social ties. The exploitation of slave
workers was an infliction of torture, brute force, coercion, horse whips, cow
straps, scalding, burning, rape, castration, gouged eyes, slit tongues,
dismembered limbs and many other threats deemed necessary to make slaves
perform required tasks.
Katie states that it was during the
night time hours to daybreak that the slaves were able to foster, sustain and
transmit fragments of their culture. The slaves had their own peculiar
folklore, spirituals, religious practices, tales, songs and prayers. These
activities were completely different from what the slave masters were trying to
teach. Might I say that it was at this point, in all probability, that the
slaves began to develop an ethos, ethics and/or morality that was distinctly
theirs and
completely different from the slave
holders, the majority culture.
It is my contention that the
enslavement of African people and harsh realities of their lives left them no
alternative but to develop an ethics of their own in order to survive. They had
a culture, values, ideas, religions and ethics before they came to America . But it
was in this country that an African-American perspective was developed. The
American perspective was one of rejection, denial, and hatred of what life was
as a slave. These emotions, feelings, thoughts, activities and rebellions are
directly related to the development of a positive way to survive and deal with
life on a daily basis and how to deal effectively with the slaveholders. Is
this not ethics in its crudest form, if no more than, can I say, a negative
ethics? If I may the authority was one directly related to just plain old
survival with input from God and a belief that He would deliver.
Katie states that there are three
ideological processes that undergird the mythologizing of enslavement. The
first myth by Christian slave apologists was that of Black inferiority. Black
were not members of the human race. To further justify their enslavement, Black
people had to be completely stripped of every privilege of humanity. Their
dignity and value as human beings born with natural rights had to be denied.
"Black Americans were divested so far as possible of all intellectual,
cultural and moral attributes. They had no socially recognized personhood. The
institution of chattel slavery and its corollary, White supremacy and racial
bigotry, excluded Black people from every normal human consideration_ The
humanity of Black people had to be denied, or the evil of the slave system
would be evident", (pp.39-40).
In addition to the mythologizing of
Black inferiority, there is the mythologizing of enslavement. This was an
ideological process that involved the re-construction of history and the divine
action. "God sent slavers to the wilds of Africa, a so-called deprave,
savage, heathen world, in order to free Africans of ignorance, superstition,
and corruption", (pp.41). Africans by nature were subjects of cannibalism,
fetish worship, and licentiousness by nature and were framed and designed for
subjection and obedience.
The third ideological myth needed
to legitimize the hermeneutical circle of Christian slave apologists was the
understanding that the law of God and the law of the land gave them an
extraordinary right to deprive Black people of liberty and to offer Blacks for
sale in the market like any other articles of merchandise".
Slave apologists were successful in
stripping the slaves of their human dignity, value and worth. At this
particular point with virtually nothing, the slave held on to something that
was innate. In order to defend my position of an African-American ethical
perspective, I propose the question, where and how did (do) this group of
dehumanized beings, reclaim our life-affirming moral thoughts and beliefs. Was
this innateness from which the slaves survived and lived abstractly moral and
theological. It appears that the value of human life is always there, in spite
of those circumstances and situations that would otherwise strip us. Perhaps this
is natural law. Or is this God who in his infinite wisdom in the creative
process endowed all human beings in is likeness and image always faithful to
his creation? It would be unwise to think that the slaves did not bring to the New World a moral and religious heritage.
Cheryl corroborates with Katie when
she says that there is a different ethos that exists among Euro-Americans and
African-Americans. One would be hard pressed to state that the slave apologists
and all those persons who supported the institution of chattel slavery were not
religious, for in fact they believed that they were very religious and ethical.
It still baffles me that they were able to conscientiously do the kinds of
things that they did to Africans without any remorse or after thought. Even if
they did have remorse or after thought, it was of no avail. The categorization
that Cheryl makes for the ethos of Euro-Americans seems to be very clear here.
They were very exclusive in that they very decidedly not include Africans into
society or any other part of life that represented humanity. They were very
materialistic. They only thought of gain and Africans were no more than
property to be bought and sold in order to make more money and property to add
to the wealth of the slaveholder. Even though they claimed to be religious,,
they were fiery secular in that they did not recognize the spiritual value of
all human beings. And they were very inflexible. This needs no justification or
explanation.
These statements only support a
systematic method of treating people through institutions, beliefs and values
and in no way affirms that all Euro-Americans are racist, or supported (would
support) such a doctrine. As Cheryl describes African-Americans as holistic,
inclusive, communalistic, spiritualistic, improvisational, and humanistic, it
only confirms that African-Americans developed their own system of ethics and
morality in face of chattel slavery, racism, great danger, total rejection as
human beings and complete denial of the rights of humanity.
It is the methodology of Katie
Cannon that I support my idea that African-Americans developed an ethical
perspective that is uniquely theirs as a result of many historical and cultural
affairs forced upon their lives. We had every right to give up and die. But
instead we fought and we are still fighting to survive with an ethos and ethics
that sometimes confound the oppressor. The ethical perspective that I have
tried to describe is not directly and only related to health care, but to all
life's objects that we as human beings deem as necessary for a full life. This
includes education, religion, work, play, happiness, fulfillment, joy,
marriage, friendship and an entire complement of variables.
The paper shall now examine to some
extent our current health care system and perhaps draw some inferences as to
how the system does or does not work for African-Americans and how the system
affects how we feel, think and interact with it.
Perhaps, it would be relevant to
discuss the Clinton Administration's Proposed Health Care System. Dan Brock and
Norman Daniels (1994) of Brown
University U.S. ?
My question for them is how do African-Americans fit into the system and is
there complete accessibility for everyone. The authors discuss fourteen
principles and values that underlie Clinton 's
health care system reform proposal. These principles and values are:
- fundamental importance of health
care
- universal access
- comprehensive benefits
- equal benefits
- fair burdens
- generational solidarity
- wise allocation
- effective treatment
- quality care
- efficient management
- individual choice
- personal responsibility
- professional integrity
- fair procedure
The first principle is the nature
of the fundamental importance health care. The authors state that health care
is fundamentally important because health care protects our opportunity to
pursue life goals, reduces our pain and suffering, prevents premature loss of
life and provides. information needed to plan our lives.
Principles and values 2-6 are
founded upon the ethical theory of equality, representing the general theme of
caring for all. These five principles are founded on the notion that all
individuals deserve equal treatment to pursue their chosen goals in life. The
argument is made that certain negative aspects about health care hinder
opportunity. These notions are pain,, suffering, disability, and limitation of
function and premature loss of life. African-Americans, as a result of the
losses due to slavery and racism, fit squarely into the above mentioned
notions. The second set of principles and values, 7-10, are related to making
the system work and based upon an ethical theory of justice. African-Americans
complain everyday of their lives of system that is not just, not only in health
care, but also in every other aspect of their lives.
In summary, it appears that the
authors believe that all of the principles and values that undergird the Clinton proposal are
founded upon the three ethical theories of equality, justice and liberty. These
three theories are funded by the philosophy of the social contract. However, it
was the Rev. Dr. Martin Luther King Jr. who said that America did not
live up to the true meaning of the contract and the founding documents as they
related to African-Americans.
Andrew Nichols (1981), in his
article, Ethics and of the Distribution of Health Care, focuses on the
distinction between the right to health care, the right to health and the
concept of justice. The ethic of distributive justice in health care receives
impetus from one of the major documents of the World Health Organization. The
preface of the document opens with, "considering that health is a basic
right..." As Who defines health as a state of complete physical, mental,
and social well being, it is' perhaps an understatement that medicine and
especially the government cannot deliver health in spite of all of the
technological advances that have
been made in the discipline. It appears to me that this definition is
operationally very difficult.
Opposing the theory of medical care
as a right, Ray McIntyre, M.D. (1998), in his opinion article, Right or
Privilege to Medical Care, believes that the concept of human rights in
American is founded on the Declaration of Independence and the United States
Constitution. These rights are individual self-determination, life, liberty and
the pursuit of happiness. Additionally, there is a right to freedom from
aggressive interference from government or other citizens. He believes that the
documents did not establish a right to other people's services. He emphasizes
that access to health care is a noble agenda, but properly performed medical
care is a creative act by persons and cannot be bought, even though it may be
compensated. He further believes that medical care can never be a right for it
is a personal service performed by another free human being. For this opinion
holder, benevolence is the virtue in the dispensing of health care to the
disadvantaged and equality, justice and liberty do not figure into the
distribution of this service.
Annette Dula (1992), another
contributing ethicist in the book, believes emphatically that there are African-American
Perspectives in Health Care. She believes that we have a distinctive worldview.
She suggests that that it is our health status and philosophy that shape an
African-American bioethics. She gives an incisive depiction of African-American
health that is so sharp that I will quote her. "That there are differences
in the health of African-Americans and European-Americans is well documented.
African-Americans receive less health care than Caucasians. More than twice as
many African-Americans as whites are born with low birth weight. Our babies die
at almost twice the rate as white babies. We do not live as long as whites do.
For whites, the average age span is 74 years; for African-Americans it is 69.
Self-reported data indicate that 50 percent more African-Americas than Whites
are likely to regard themselves in poor health. The. mortality rate for heart
disease in African-American males is twice that for white males. Recent
research has shown that African-Americans tend to get less aggressive treatment
for heart disease than do whites. Cancer in whites is most likely to be
localized; while in African-Americans, it is systemic. Therefore, more
African-Americans than whites die from cancer, except for stomach cancer".
This information appears to be true in that it is taught in health care professional
schools and especially in epidemiology courses.
She also believes that we have a
distinct African-American philosophy that differs from mainstream philosophy.
Mainstream philosophers present philosophy as a thinking enterprise and as
analytical. African-American philosophers advocate for social change and
transformation. Instead of adhering to the claims of Kant, Mill, Hume and
Nozick, we should listen to our own philosophers such as W.E.B. Dubois, Alain
Locke, William Banner, Leonard Harris, Laurence Thomas and others.
I would like to conclude this paper
with my own personal experiences as a health care provider as a registered pharmacist with a Ph.D. I received
both my pharmacy degree and Ph.D. from a historically racist university that
really did every thing to discourage Blacks from entering and even getting
through the program once allowed to enter. I would like to cite one incident
about its historical racism. The late Supreme Court Justice, Thurgood Marshall,
tried to enter the law school of this same university and they told him no,
simply because he was Black and paid him a stipend to go to the University of
Delaware or Howard University. He chose Howard and in fact, we later learn, as
well as the rejecting university, that they had rejected a most brilliant
future jurist. Later in his career as a Supreme Court Justice, the rejecting
university asked him to be the graduation speaker at one of its ceremonies. He
responded with, " a hell no". Good for him.
After a very racially difficult
pharmacy education, I graduated and passed the national board. I applied for a
job, in one of the larger chains, that was advertised in the newspaper weekly.
They refused to hire me. How dare they after all the hard work that I put into
this area of my life. I took them before the federal EEO board and made a
claim. It was because of my righteous indignation that they developed a policy
of hiring any registered pharmacy regardless of his race, nationality or creed.
Was this ethics or racism related? I think both. In any racist system, ethics
play a very important role in how people appropriate racist behavior. Even now
when I think back, as an African-American on this and even currently, I would
never deny any one an opportunity because of his race or sex or nationality.
This not a part of my ethics, ethos, way of living, upbringing or life.
Furthermore, my mother would probably still give me a true laying out of my
life if I did such. What I later learned was that it didn't matter that I was
supremely educated with a needed professional skill in this country, racism was
and still is pervasive. For example, in a large pharmacy chain, you work
wherever they send you. I worked in all areas, neighborhoods, and economically
well areas and economically deprived areas. I chose when I had the opportunity,
to work in ghetto pharmacies. Life is very real there. People say exactly what
they are feeling at any time and don't care if the language is offensive. Many
of the persons are illiterate, with no money and very rude. The problem is that
I always understood all of this and in fact, it was never a problem for me.
Many patients confided in me and if they didn't have all of the money for their
prescription drugs and I felt like being a Good Samaritan at the expense of the
corporation, I was. Many of these people have a perspective of life that is
very different from that of an upper middle class White suburban pharmacy.
Their attitude towards life, death, health and the future fit within a definite
existential framework. I have heard many of. these persons express the
sentiment that they resented White physicians, attorneys and hospitals telling
them how they needed to handled their terminal illnesses and possible life
support mechanisms, when these same people could have care less for them in the
middle of their lives. How could they possibly give them moral and ethical
guidelines now at the end of their my lives? Let us die as we choose.
My latest experience was in an HMO
that was funded by the Health Care Financing Administration (HCFA). I was the
chief pharmacist and the patient population was the elderly Black. HCFA paid
the HMO a per capita fee for each enrollee for all health care services
provided. It is the responsibility of the HMO to provide care and if they can
make a profit, good for them. Believe me that they made a huge profit and the
care to these poor Black elderly persons was indeed, poor. Being the head of
one of the major departments in the HMO, I regularly met with other
departmental chiefs, many of whom were White. To this day, I still can't
believe some of the attitudes, values and dispositions of these supposedly
caring professionals. Indeed, I had a mission and in fact, I was truly a circle
in a square peg. I had to leave. What I realized was that my ethical
perspective of health care may have been totally different from many of the
persons with whom I was working. Once again, I played very often the role of
the Good Samaritan and confided in many elderly persons who gave me many
oppositional moral codes to the mainstream thought in
health cam. My twenty years of
experience as a registered pharmacist would fill volumes.
Perhaps, my most devastating
experience in health care was when I began to do my doctoral studies. To say
that this was a challenge does not even begin to touch the real problems.
Ethically, I found the school to be very unsound and racist in its acceptance
and retention of African-American faculty (there were none), African-American
graduate students and pharmacy students. Consistently presenting this problem
to the administration, I was deemed the extreme and very irritating
troublemaker for the school.
In concluding my doctoral studies,
I would have loved to do research in public policy and drugs, cost-effective
and cost benefit measurements, physician-pharmacist-patient relationships,
compliancy measures, adverse drug reactions, drug interactions, public health
concerns and the like. It was totally inappropriate for me to do such when
there was an ethnic problem looking me squarely in the face. No
African-American faculty and very few students. There was a vote of no
confidence on the part of the administration to seriously consider
African-Americans to be a part of the institution. All of the outside
indications and statistics were that there was a great need for
African-American pharmacists and other health care providers as well. The
excuse was and still is that there is never enough qualified African-American
applicants. Well, I knew that the admission's requirement was somewhat skewed
in favor of Whites. White persons have historically always done better on
standardized tests and grade point averages. This says nothing for the
wonderful letter of recommendations that are given for these students. My
ethical contention was that it takes more than a good quality grade point
average and high-test score to make a good health care professional. And
perhaps, these were not the only variables that would predict whether someone
would do well in a pharmacy school curriculum. For myself, ,l knew that what
was very beneficial to me was a sense of coherence, perseverance, a strong
support system, desire and the need to achieve. None of these variables are
measured typically by grade point averages or standardized tests. Furthermore,
are there certain character and personality traits that would be desirable in
a. health care profession that need to be recognized. In other words, if an
applicant didn't meet all of the standardized evaluations, but had all of the above
mentioned traits and desired very earnestly to be a health care professional,
is this not worth consideration? Much to the dismay of the faculty, I composed
a doctoral dissertation that examined these conditions and the results were
very surprising to them and me.
My point here is that as an
African-American health care professional, I have distinctly different points
of views about what is and what ought to be. I am in total conflict most of the
time with the powers to be who continually tell me to chill out and live a
happy life and make money. Virtually, they are telling me to forget about
others and their miserable plight. As a Christian and the son of my God-fearing
mother, this will never be a possibility given my African-American ethical
perspective.
Perhaps when this research is
published in the near future, it will shed light on some of the inadequacies in
the health care system in educating minorities for full participation, a
participation that is fully need
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