Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.
Institute of the History of Medicine and Ethics in Medicine, Charité - Universitätsmedizin Berlin, Thielallee 71, 14195, Berlin, Germany.
Philos Ethics Humanit Med. 2024 May 2;19(1):6. doi: 10.1186/s13010-024-00156-w.
Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice.
生物伦理学越来越认识到基于种族、性别、性取向或能力等社会类别的歧视性做法对临床实践的影响。因此，主要的生物伦理学协会强调，确定和反对临床伦理咨询中的结构性歧视是临床伦理顾问的专业义务。然而，临床伦理顾问如何履行这一义务仍不清楚。更具体地说，临床伦理需要理论工具来分析和实践策略来解决临床伦理咨询中的结构性歧视。交叉性是黑人女性主义学术中发展起来的一个概念，在生物伦理理论中越来越受到关注。它强调了社会结构和实践如何在多个相互构成的压迫制度中决定特权和劣势的社会地位。本文旨在探讨交叉性如何有助于解决临床伦理咨询中的结构性歧视，特别是在精神保健方面。为此，我们批判性地审查了临床伦理顾问解决临床伦理咨询中结构性种族主义的现有方法，并通过交叉性考虑对其进行了扩展。我们认为，交叉性是解决临床伦理咨询中结构性歧视的合适工具，并表明它可以通过两种互补的方式实际实施：1）作为一种分析方法，2）作为一种批判性实践。
