Hastings Cent Rep. 2018 Nov;48 Suppl 4:S77-S80. doi: 10.1002/hast.963.
For nearly five years, bioethicists and neurologists debated whether Jahi McMath, an African American teenager, was alive or dead. While Jahi's condition provides a compelling study for analyzing brain death, circumscribing her life status to a question of brain death fails to acknowledge and respond to a chronic, if uncomfortable, bioethics problem in American health care-namely, racial bias and unequal treatment, both real and perceived. Bioethicists should examine the underlying, arguably broader social implications of what Jahi's medical treatment and experience represented. On any given day, disparities in the quality of health care and health outcomes for people of color in comparison to whites are evidenced in American hospitals and clinics. These disparities are not entirely explained by differences in patient education, insurance status, employment, income, expressed preference for treatments, and severity of disease. Instead, research indicates that, even for African Americans able to gain access to health care services and navigate institutional nuances, disparities persist across a broad range of services, including diagnostic screening and general medical care, mental health diagnosis and treatment, pain management, HIV-related care, and treatments for cancer, heart disease, diabetes, and kidney disease.
近五年来，生物伦理学家和神经学家一直在争论非裔美国青少年 Jahi McMath 是否存活。虽然 Jahi 的情况为分析脑死亡提供了一个引人注目的研究案例，但将她的生命状态限定为脑死亡问题，并不能承认和回应美国医疗保健中一个长期存在的、令人不安的生物伦理学问题，即种族偏见和不平等对待，这是真实存在的，也是人们普遍感知到的。生物伦理学家应该研究 Jahi 的医疗治疗和经历所代表的潜在的、更广泛的社会影响。在任何一天，美国的医院和诊所都可以看到，与白人相比，有色人种在医疗质量和健康结果方面存在差异。这些差异不能完全用患者教育、保险状况、就业、收入、治疗偏好和疾病严重程度的差异来解释。相反，研究表明，即使对于能够获得医疗保健服务并能够应对机构细微差别的非裔美国人来说，在广泛的服务领域，包括诊断筛查和一般医疗保健、心理健康诊断和治疗、疼痛管理、与艾滋病毒相关的护理以及癌症、心脏病、糖尿病和肾病的治疗，仍然存在差异。
