“Vulnerable” Populations—Medicine, Race, and Presumptions of Identity

“Vulnerable” Populations—Medicine, Race, and Presumptions of Identity
Virtual Mentor: American Medical Association Journal of Ethics
Volume 13, Number 2 (February 2011)
pages 124-127

Karla F. C. Holloway, Ph.D., MLS, James B. Duke Professor of English and Professor of Law
Duke University, Durham, North Carolina

At the beginning of the twentieth century, renowned sociologist William E. B. Du Bois warned that “the problem of the twentieth century” would be “the problem of the color line”. I suspect that Du Bois would not have imagined that this color line would be as enigmatic and troubling in the twenty-first century. But the fact is that today’s issues of race and identity reveal an arguably more complicated terrain. To illustrate this point, consider the background of the following patients.

  • Ms. A’s father is Nigerian and her mother is British.
  • Ms. B’s mother and father are both from Jamaica. She has lived in the United States since birth.
  • Ms. C’s parents were both born in the United States. Her father is from Detroit’s inner-city and her mother is white.
  • Ms. D’s parents were born in Ghana and South Africa.
  • Ms. E, who has curly blond hair, fair skin and green eyes, has checked the box for “black or African-American” on her medical history form. She was adopted at birth.

In fact, each of these patients has checked that same box—“black or African American”—on their patient history forms. What does this tell us?…

…The black folk whose souls Du Bois worried over in 1903 had a peculiar history of visibility and vulnerability. It is a history replete with narratives about medical care of lesser quality and exploitation sutured to institutionalized racial biases and stereotypes. When contemporary medicine takes up the category of race as a biologic rather than a social indicator, it ignores the complexity that is resident in “African American communities.” A community-based medicine or research ethic cannot escape this history of identity and vulnerability and the significant variables that accompany the experience of race. This is not an occasion when new and good intentions erase the impact of past bad acts. Language has a habit of entanglement…

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