Boston doctors call for racially discriminating against patients in order to promote social justice

Two doctors in Boston have called for the allocation of medical resources to be done on the basis of race. Writing in the the Boston Review, they call for the implementation of standards that would show racial preference to patients. This would be in addition to federal reparations.

Dr. Bram Wispelwey, and Dr. Michelle Morse, both of whom teach at Harvard Medical School, wrote that their mission was to "comprehensively confront structural racism." To go about this, they plan to enlist the tools of critical race theory (CRT). They slam what they call "colorblind policies," or the concept of equality for individuals of all races and ethnicities under the law, saying that it is not achieving their desired ends with enough speed.

Federal reparations, they write, are only the beginning of addressing structural racism, which they define in a medical context as: "Ability to pay," "inequities in uninsurance and insurance type," "employment status," "institutional racism," "persistent housing inequality and racial segregation," "redlining, blockbusting, and contract buying," and "wealth inequality."

For their part, and to create "antiracist institutional change," which they say "is essential to supplement federal reparations," they have created a pilot program that will undertake "institutional action." The basis for this institutional action is the concept of  "'applicative justice'—'applying justice to those who don’t now receive it.'" This, they say, is "as opposed to more idealistic conceptions of justice…"

That pilot program adopts a "...reparations framework of acknowledgment, redress, and closure…" or as they call it, "a Healing ARC—with initiatives for all three components. Each centers Black and Latinx patients and community members: those most impacted by unjust heart failure management and under whose direction appropriate restitution can begin to take shape."

They write that: "Federally paid reparations are essential, and broad adoption of Healing ARCs can build on them—directly implementing restitution across a variety of institutional contexts and for a range of marginalized BIPOC communities."

"Through our pilot initiative, we hope to provide a replicable, CRT-informed framework that can move us beyond the historic cycle of documenting racial inequities while endlessly deferring their resolution. The outstanding debt from the harm caused by our institutions, and owed to our BIPOC patients, is long overdue: now is the time to start settling it."

"Acknowledgement" is the part where the health system admits that it was racist in the first place and promises to change. At this level, there will be focus groups with those in the BIPOC communities, and voices from those communities will be integrated in informing leadership of the problems they faced accessing care.

Next up are the reparations, or as they are here termed "redress," which will be done on an institutional level. "Redress," they write, "should involve not just a direct solution to monitor and end health inequities but to offer restitution for past and present injustices. Redress could take multiple forms, from cash transfers and discounted or free care to taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes (such as preferentially admitting patients historically denied access to certain forms of medical care)."

The final step is "closure," during which "community and patient stakeholders and institutional representatives must agree that the institutional debt has been paid and that a new system is in place to ensure that the problem will not reemerge." Who will decide if there's been enough payment to address all the systemic problems? The people who will be receiving the money and benefits.

They write: "The point at which restitution is adequate for the debt incurred will be determined in conversation with community groups. But ensuring the inequity does not recur will require regular data monitoring and community updates. We believe this transparency is essential to establish institutional trustworthiness."

But what about existing laws, such as the Civil Rights Act of 1964, which bars discrimination that favors come racial groups over others? The doctors have thought that through, too. They think that those laws are not that important.

"Offering preferential care based on race or ethnicity may elicit legal challenges from our system of colorblind law," they write. "But given the ample current evidence that our health, judicial, and other systems already unfairly preference people who are white, we believe… that our approach is corrective and therefore mandated. We encourage other institutions to proceed confidently on behalf of equity and racial justice, with backing provided by recent White House executive orders."

Basically, since there was discrimination before, the only way to fix it is with discrimination now. And they believe that even President Joe Biden backs them up as his administration is reportedly considering reparations at a federal level.

The call for reparations has been heard across the US and was bolstered by an Executive Order signed by President Joe Biden nearly instantly upon taking office on January 20. Since then, Evanston, Ill. and Oakland, Calif., have created programs that directly pay money to residents who are not white. While in Evanston it is called reparations and in Oakland it is a universal basic income for families that make under about $60,000 per year and are not white. New York has created a Racial Justice and Reconciliation Commission, that will consider payouts to black New Yorkers.