Hastings Cent Rep. 2020 May;50(3):58-60. doi: 10.1002/hast.1135.
In recent months, Covid-19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long-standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end-of-life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision-making. In the midst of the Covid-19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race-neutral algorithms sacrifice black lives. Is there such thing as a "good" or "dignified" death when African Americans are dying not merely of Covid-19 but of structural racism?
近几个月来，新冠疫情肆虐全美各地的非裔美国人社区，而明尼阿波利斯市的一名警察杀害了乔治·弗洛伊德。新冠疫情和警察暴力致死这些“死亡的元凶”虽然是新出现的，但非裔美国人长期面临早逝和警察暴力的现象却由来已久。本文认为，由于种族健康和医疗保健方面的差异根源于制度不公正，因此在临床伦理中应该比以往更加重视这些差异。具体来说，本文探讨了针对非裔美国人的姑息治疗和临终关怀，强调了美国医学与美国社会一样，已经违背了信任原则。在许多与绝症作斗争的非裔美国患者的经历中，医疗服务提供者剥夺了他们在自己的医疗决策中发表意见的权利。在新冠疫情期间，由于主导性且表面上中立的算法牺牲了黑人的生命，非裔美国人在呼吸机等稀缺医疗资源的配给方面再次被剥夺了发言权。当非裔美国人不仅死于新冠病毒，还死于结构性种族主义时，还存在所谓的“善终”或“有尊严的死亡”吗？
