The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments.

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice.

When Black Health, Intersectionality, and Health Equity Meet a Pandemic.

Using the example of Black people's inequitable COVID-19 outcomes and their health outcomes prior to the pandemic, I argue that the pandemic has forever changed how we should think about the conceptual and practical nature of health equity. From here on, we can no longer think of health equity without the concept of intersectionality. In particular, we must acknowledge that discrimination (e.g. sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed for health from people who themselves have intersecting identities that make them vulnerable to the effects of discrimination. To ignore intersectionality in our work on health equity would mean ignoring a great injustice imposed on some of the most overlooked people in our communities, which would also be a great disserve to bioethics' professional longevity.

What does Juneteenth mean in STEMM?

Juneteenth commemorates the freeing of the last large group of enslaved people in 1865 at the end of the American Civil War. We asked several Black scientists what Juneteenth means to them in the context of science, technology, engineering, mathematics, and medicine (STEMM)? Their answers run the emotional gamut.

The hidden impact of orthopedic surgeries: Examining the psychological consequences.

Orthopedic surgery is commonly considered "quality of life care," as most orthopedic procedures have been shown to provide excellent pain relief and successful surgical outcomes for patients. Although orthopedic surgeries continue to improve patients' functional outcomes through modern surgical techniques and preoperative psychological screening, variation in patient function persists in current studies. Sub-optimal function in patients has been shown to be associated with emotional health burdens, such as anxiety and depression. Previous research has found that preoperative psychological conditions could negatively affect patients' functional outcomes. However, these studies were limited in that they did not examine novel psychological repercussions in emotionally healthy patients following surgery. To address this gap in knowledge, a narrative review was conducted to differentiate specific orthopedic surgeries that have psychological consequences on patients and to determine the current psychological support available for these patients. Data was collected from the Medical Humanities sector of the Texas Medical Center Library and the National Library of Medicine. Studies were included that examined novel psychological effects on patients after undergoing orthopedic surgery. A total of 38 articles were identified, and the majority focused on orthopedic trauma surgery while the rest examined total joint arthroplasty and orthopedic sports procedures. A key finding was that orthopedic trauma surgeries, alone and compared to total joint arthroplasty, result in a greater risk of negative psychological effects, while there was limited data on the psychological effects of orthopedic sports procedures. This narrative review suggests a need to integrate psychosocial support for patients with traumatic orthopedic intervention, regardless of the patient's preoperative psychological state. Furthermore, more research examining the mental well-being of patients following elective orthopedic surgeries is necessary to determine if these operations would benefit from postoperative psychological support as well.

Narrating the Black Body in "Under the Skin".

Poor health is not inherently a part of Black Americans' bodies; poor health is not in our DNA. But as Linda Villarosa says in Under the Skin "something about being Black has led to the documented poor health of Black Americans."1 Like many other scholars of Black health have said, Villarosa proposes, and evidence supports, that "the something is racism."2 Villarosa attributes Black people's generally inferior health outcomes in areas like pregnancy and birth, pain care, and cardiology to racism and not a lack of social resources such as money, education, and access to healthcare. Although not always explicitly stated in her text, the stories Villarosa uses to illustrate racism's effects on health also demonstrate racism's influence on who has access to the social resources that are needed to maintain health and treat illnesses. Villarosa is right that more education and more income cannot de facto give Black people better health. At the same time, we cannot ignore that although racism is the force, education, money, housing, and access to healthcare are the means by which racism adversely affects health. Education and other social goods only fail to confer better health to Black people because racism serves as a roadblock.

Citation bias, diversity, and ethics.

How often a researcher is cited usually plays a decisive role in that person's career advancement, because academic institutions often use citation metrics, either explicitly or implicitly, to estimate research impact and productivity. Research has shown, however, that citation patterns and practices are affected by various biases, including the prestige of the authors being cited and their gender, race, and nationality, whether self-attested or perceived. Some commentators have proposed that researchers can address biases related to social identity or position by including a Citation Diversity Statement in a manuscript submitted for publication. A Citation Diversity Statement is a paragraph placed before the reference section of a manuscript in which the authors address the diversity and equitability of their references in terms of gender, race, ethnicity, or other factors and affirm a commitment to promoting equity and diversity in sources and references. The present commentary considers arguments in favor of Citation Diversity Statements, and some practical and ethical issues that these statements raise.

Clinicians' Racial Biases as Pathways to Iatrogenic Harms for Black People.

Access to care is a health determinant because health care resources, interventions, and personnel help maintain health and well-being. In addition to social determinants' roles in health inequity, clinicians' racial bias undermines the quality of Black persons' health care experiences and is a pathway to iatrogenic harm. This article considers pain management and limb amputation outcomes as examples of how clinicians' racial biases exacerbate inequitable access to health care for Black people in the United States.

Addressing Anti-Black Racism in Bioethics: Responding to the Call.

As a field concerned with ethical issues in health and health care, particularly how structures, policies, and practices unfairly advantage some and disadvantage others, bioethics has a moral obligation to address the long-standing challenges that racism has posed to the overall health and well-being of Black, Indigenous, and Latinx people and other people of color. Arguably, the premature death and disease disproportionately affecting Black Americans and the well-documented association of such death and illness with racism are issues that have not gained due attention in bioethics. This multiauthored report highlights the intergenerational work of mostly Black scholars and aims to create an agenda for bioethics that addresses anti-Black racism and the ways in which this form of racism threatens the actualization of justice in health and health care, not only for Black people and other minoritized groups but also for all people. This special report contains five major sections representing different approaches to scholarship, including theoretical, empirical, and narrative forms. The first section features two target articles focused on anti-Black racism and health care settings, with each article accompanied by two commentaries. The second section includes four essays thematically centered around anti-Black racism and health equity research and practice. Section three features four essays that explore anti-Black racism and bioethics. The next section consists of four essays framing a braver, bolder, and broader bioethics. We conclude with a powerful tribute to the late Marian Gray Secundy, a bioethics luminary, friend, colleague, role model, and mentor, and a tie that binds together many bioethics scholars who prioritize social justice in their scholarship and praxis.

Holding Them Accountable: Organizational Commitments to Ending Systemic Anti-Black Racism in Medicine and Public Health.

In this essay, I detail commitments that some of the major health organizations-the American Medical Association, the American Public Health Association, and the Centers for Disease Control and Prevention-have made to addressing anti-Black racism and discuss their policies meant to curtail racism's effects on health equity. Although these organizations' historical lack of action has contributed to a culture of anti-Black racism in health care and public health and many Black people have suffered because of it, progress has to begin somewhere, and outlining their future actions is a good start. Now, bioethicists, with our expertise in how historic policies connect to contemporary disparate health outcomes and access to health care, are in a position to hold these organizations accountable for fulfilling their commitments.

Should a Healthcare System Facilitate Racially Concordant Care for Black Patients?

Addressing racial disparities in health outcomes is an urgent priority for many health care organizations, leading health care managers to explore the potential for organization-level interventions to yield substantive health gains. In recent literature, it is suggested that Black patients who are treated by Black physicians may achieve superior health outcomes in some settings. In this case discussion, we consider a case in which a medical director considers implementing a voluntary program to promote racially concordant care for Black patients. Commentators consider the precedent for such a program, both in current informal care networks and 20th century medical history, as well as the burden such a program may place on Black physicians and the risks of reducing patients' intersectional identities to be solely about race. A subset of commentators suggest that these risks are mitigated by the voluntary nature of the program, whereas others offer caution about relying solely on Black physicians to remedy health disparities. Others view multiple paths as morally defensible but emphasize the need for managers to take proactive steps to communicate and evaluate their choices in the face of such a complex social challenge.

In the Name of Racial Justice: Why Bioethics Should Care about Environmental Toxins.

Facilities that emit hazardous toxins, such as toxic landfills, oil refineries, and chemical plants, are disproportionately located in predominantly Black, Latinx, and Indigenous neighborhoods. Environmental injustices like these threaten just distribution of health itself, including access to health that is not dependent on having the right skin color, living in the right neighborhood, or making the right amount of money. Facilities that emit environmental toxins wrongly make people's race, ethnicity, income, and neighborhood essential to who is allowed to breathe clean air and drink clean water, and thus, who is allowed to be healthy. This can be seen in the environmental crises in Louisiana; Mississippi; Houston, Texas; and Flint, Michigan. Since bioethics purports to concern itself with the principle of justice as applied to individuals and increasingly to populations, the field ought to concern itself more with environmental injustice.

Going Beyond the Data: Using Testimonies to Humanize Pedagogy on Black Health.

When health professions learners' primary pedagogical experience of Black people and how they become patients is through statistics, it becomes very easy for learners to think of Black people as data points rather than as individuals whose health is often at the mercy of racist institutions. When the human dimension of Black people's health is ignored, specifically the ways that poor health affects individual wellbeing, one of the barriers to proper health for Black patients is how to be seen and considered as a part of a larger problem of systemic racism and institutional injustices as well as individuals whose personal lives are affected by such larger problems. I propose an approach to health professions pedagogy-the experiential race testimonies (ERT) approach-that can change the way health professions learners understand and treat Black patients, thus changing the future of Black health. The ERT approach pairs population data analysis with analysis of personal testimonies and the experiences they convey.