• Ethics

The widely accepted understanding in contemporary discourse is that race and ethnicity fundamentally arose as social constructs devoid of inherent biological or scientific significance.1 Despite this consensus, discussions abound, including in this journal,2 regarding the extent and manner in which racial and ethnic categorisations should influence the landscape of medical research, practice and policy.

In an ideal paradigm, medicine should exude an unwavering commitment to impartiality, extending care and treatment to every individual, unfettered by considerations of their racial or ethnic background—an approach that can be described as ‘colour blind.’ Yet, a cursory examination of medicine’s historical trajectory and the enduring realities of human prejudices unravels a precarious tension. This tension resides at the intersection of two seemingly conflicting imperatives: one, the ethical mandate for medicine to operate as a colour-blind entity, and the other, the ethical duty to candidly acknowledge, confront and rectify the historical and contemporary shortcomings woven into the fabric of our healthcare systems.

Navigating this precarious balance demands a nuanced and introspective approach, one that aspires to forge a path towards a more equitable healthcare landscape while remaining steadfastly committed to the principles of honesty, accountability and the pursuit of a just and inclusive future.

Scientific journals are confronted with the intricate dilemma of addressing racist scientific records.3 The question at hand pertains to whether content tainted by racism, devoid of any scientific merit, should persist within the annals of history, where it holds the potential to perpetuate offence and harm. This preservation dilemma raises concerns about inadvertently bestowing tacit endorsement on such content, thereby conflicting with the imperative to take a resolute stand against racism.

However, the prospect of censorship introduces its own set of complexities. The act of excising these records from the historical narrative runs the risk of failing to acknowledge the grievous errors of the past and the valuable lessons they proffer. Learning from these historical missteps is essential for informing present-day and future scientific practices, promoting accountability, and fortifying our commitment to eradicating racism from scientific discourse.

In medical research, the utilisation of racial and ethnic categories as data collection tools carry inherent imprecision, potentially failing to accurately encapsulate an individual’s identity or cultural heritage. Consequently, this imprecision can engender misclassification, underreporting, or oversimplification, thereby laying the foundation for research findings that may lack precision and accuracy.⁴

Moreover, there exists a lurking potential for racial and ethnic data to inadvertently bolster stereotypes, thereby fostering stigmatisation and discrimination. Misuse or misinterpretation of such data can inadvertently perpetuate detrimental biases, ultimately contributing to discriminatory practices across the domains of prevention, diagnosis and treatment.⁵

Adding to the complexity, historical injustices and ethically dubious practices, such as racial profiling or coerced data collection, loom as dark shadows over the collection of racial and ethnic data.⁶

Conversely, empirical evidence gleaned from numerous studies underscores a troubling reality: individuals belonging to racial and ethnic minority groups often encounter suboptimal care within healthcare systems, leading to compromised health outcomes. These disparities manifest across multiple dimensions, spanning from unequal access to healthcare services to disparities in treatment decisions and outcomes.7 Consequently, racial and ethnic data emerge as critical tools for illuminating these entrenched healthcare disparities, ultimately serving as a cornerstone for comprehending and redressing systemic inequalities.

When wielded judiciously, these data serve a dual purpose. First, they act as a diagnostic lens, facilitating the identification of healthcare disparities among marginalised communities. Second, they enable policy-makers and researchers to craft precisely tailored interventions aimed at addressing the specific needs of these communities. Through such targeted measures, the potential for the creation of more effective, equitable policies and programmes materialises, thereby advancing the cause of social justice and health equity.

In the realm of clinical practice, implicit bias and racism manifest as attitudes and stereotypes that exert a significant influence on an individual’s actions and decision-making processes. These deeply ingrained behaviours have the potential to precipitate disparities across various facets of healthcare, including diagnosis, treatment and the dynamics within the patient–doctor relationship.

Illustratively, research has unveiled a disconcerting pattern wherein healthcare providers, sometimes unwittingly, administer inadequate pain management to black patients as compared with their white counterparts.8 This distressing oversight can translate into extended periods of suffering and, regrettably, result in compromised health outcomes for these patients.

Additionally, implicit biases and racism may be implicated in the persistent racial disparities evident in maternal mortality rates in both the USA and the UK. For instance, within the USA, statistics reveal that black women face a startling three to fourfold higher risk of succumbing to pregnancy-related complications in comparison to their white counterparts.9 These unsettling disparities underscore the critical need for a healthcare paradigm that transcends the biases inherent in societal norms, advocating for a medical practice that is characterised by an unwavering commitment to impartiality—where healthcare providers strive to rise above the prejudices that may permeate their own perspectives.

This paradigm calls for healthcare professionals to participate in extensive education and training initiatives that surpass the mere transmission of medical knowledge. These programmes should prioritise the development of cultural competence, ethical consciousness, anti-racist medicine and the capability to discern implicit biases. Such training should endeavour to nurture self-awareness among healthcare providers, while simultaneously arming them with the essential skills to not only identify but also adeptly address their own biases.

While the ethical imperative for medicine to embrace colour blindness is evident, it necessitates careful consideration of certain challenges. One potential concern revolves around the risk that completely ignoring race and ethnicity may inadvertently result in blindness10 to crucial health disparities and racism. Striking a delicate equilibrium between colour blindness and acknowledging the stark reality of healthcare inequalities based on race and ethnicity is imperative.

The path towards achieving a colour-blind medical paradigm cannot begin until the completion of robust research and policy endeavours that identify and fully address such disparities. Additionally, the development of policies that champion equity in healthcare becomes paramount. These policies may encompass measures designed to alleviate socioeconomic disparities, enhance healthcare accessibility and provide comprehensive antiracism training for healthcare professionals.

A pressing imperative emerges in the realm of medical education and training. It becomes crucial to equip the physicians of tomorrow with the knowledge and skills necessary to recognise, navigate and thoughtfully address these complex tensions. This preparation will empower them to deliver healthcare that is distinguished by its quality, equity and patient centeredness, for individuals from all racial and ethnic backgrounds.