Recommendations for Bioethics Programs on Racial Equity, Diversity, Inclusion
By Stacey Kusterbeck
Bioethics programs are recognizing the need to prioritize racial equity, diversity, and inclusion (REDI).1-3 However, some struggle with the best way to make progress. Ethicists now can inform their efforts based on specific recommendations from the Association of Bioethics Program Directors (ABPD)’s REDI Task Force.4 According to Sandra Soo-Jin Lee, PhD, president of the ABPD and leader of the REDI Task Force, and chief of the division of ethics at Columbia University, bioethicists can drive progress toward REDI at their institutions in the following ways:
- Promote research and scholarship that includes diverse perspectives. “This involves prioritizing the voices and lived experiences of historically marginalized communities within bioethics scholarship, ensuring that these perspectives are not sidelined but, instead, shape the core of ethical inquiry and practice,” says Lee.
- Integrate anti-racism frameworks into the curriculum, making these concepts fundamental to the education of students across healthcare-related fields. “This integration should go beyond elective courses, embedding REDI principles into the core coursework for students in medicine, public health, nursing, and allied health disciplines,” Lee advises.
- Support emerging scholars who focus on REDI through structured mentorship and leadership development programs. “Such initiatives can help retain these scholars within the field and promote their advancement. This creates a pipeline of future leaders who are committed to equity and inclusion,” says Lee.
- Implement sustainable funding models specifically designed to support REDI initiatives — and the scholars who focus on them. “By securing dedicated financial resources, these programs can lift up work on anti-racism and community-engaged research,” says Lee.
- Build long-term partnerships with historically marginalized communities through sustained engagement. This ensures that community voices are heard and valued in bioethics research and practice.
“Despite the urgency of advancing REDI goals, there are significant obstacles that can hinder progress,” warns Lee. One of the primary barriers is the lack of stable financial support for scholars and initiatives focused on REDI. “This lack of support limits the capacity of these scholars to pursue their work. It also creates economic instability that can deter them from entering or remaining in the field,” says Lee.
Structural barriers within academic institutions include biases in tenure and promotion processes. This creates further challenges for scholars whose work centers on equity. “These systemic issues are compounded by institutional resistance to change. Established norms and practices may not prioritize or even recognize the importance of REDI efforts. Overcoming these barriers will require a concerted effort to reform funding models, review institutional policies, and cultivate a culture that genuinely values diversity and inclusion,” says Lee.
Bioethicists at hospitals and healthcare systems can play a critical role in advancing REDI goals. In fact, they are uniquely positioned to do so, says Lee: “Ethicists can advocate for changes in institutional policies that address disparities in patient care. This ensures that ethical guidance is not only focused on abstract principles, but also on the real-world impacts of systemic racism in healthcare delivery.”
Lee says that hospital-based ethicists can challenge the status quo by identifying instances where institutional practices may perpetuate inequities. Additionally, ethicists can contribute to ongoing training and education on anti-racism for healthcare professionals. This fosters an environment where addressing bias is seen as an integral part of ethical patient care. In this way, bioethicists can leverage their expertise to drive meaningful change in healthcare institutions.
“Bias and discrimination owing to racism, sexism, classism, ableism, or antisemitism can exacerbate or be the cause of our patients’ health-related problems. An awareness of these factors is essential to addressing them,” says Ann Munro Heesters, MA, PhD, senior director in the Department of Clinical and Organizational Ethics at University Health Network and a member of the Joint Centre for Bioethics at University of Toronto.
Clinicians, patients, and families expect ethicists to bring perspectives to the table that others do not — and to reflect on the ethical dimensions of healthcare at their institutions. “This work requires that we be worthy of the trust that these parties place in us. It’s hard to be trustworthy, and to be seen as such, if the field isn’t committed to ongoing efforts to be self-critical and to welcome engagement with perspectives that we have been missing,” says Heesters.
Hospital-based ethicists typically need to have terminal degrees in their disciplines, followed by fellowships in healthcare settings that offer mentorship and practical training. “It takes a long time to be job-ready, and it’s expensive. This means that the field has a disproportionate number of people from backgrounds that are far more privileged than those of their patients. We miss out on opportunities to attract people from so-called non-traditional backgrounds,” says Heesters.
To address this, education and training in the ethics field needs to become more affordable and accessible. “Our pipeline is not just leaky — it’s almost entirely blocked. Fellowship programs don’t have the funding to invest in robust diversification efforts,” says Heesters. This includes salaries for clinical ethics fellows, protected time to create training resources, and funds for participation in conferences or other continuous learning opportunities.
Compensation is another significant obstacle. Practicing healthcare ethicists often are poorly compensated for what they do, relative to healthcare professionals with comparable skills and educational attainments. “It’s hard to see why promising, committed, younger people would take up the work,” acknowledges Heesters. It is especially difficult for first-generation university students who need to make a good living to allow them to recover from the financial investment they made in their education. Prospective ethicists also need to see themselves in the bioethics role. “If the field doesn’t contain people who look like them, or are sufficiently welcoming to them, they won’t consider this a career that they might pursue,” says Heesters.
Academic medicine has been conscious of the need to attract trainees that reflect the diversity of the patients they serve, through mentorship and sponsorship, for some time. In contrast, bioethics is only beginning to have this conversation. “Critics of the field, both within and without, are calling for greater awareness of the lack of diversity in the field,” says Heesters. “It’s a good thing that we are getting there. But it’s difficult to see this gaining sufficient traction when our bioethics programs are so often in funding crises.”
Clinical ethics fellows require salary support. Those who train them need protected time for training them and for developing rigorous curricula. “It’s a struggle to do this without the generosity of benefactors who are willing to make this a priority. I am aware of few programs that are fortunate enough to have such support,” says Heesters.
References
1. Liang T, Barned C, Heesters AM, Bell JA. Inclusion not conformity: A response to a call for diversity based on a recent survey of American bioethicists. Am J Bioeth. 2024;24(9):40-42.
2. Dougherty R, Hossain F, Mukherjee D. Anti-racism in clinical ethics fellowships: Rising to the occasion. Am J Bioeth. 2024;24(10):48-50.
3. Ray K, Blumenthal-Barby J, Parsi K, Magnus D. The future of bioethics: Striving for a more diverse and inclusive bioethics. Am J Bioeth. 2024;24(9):1-2.
4. Lee SS, Walker A, Callier SL, et al. Racial equity, diversity and inclusion in bioethics: Recommendations from the Association of Bioethics Program Directors Presidential Task Force. Am J Bioeth. 2024;24(10):3-14.
Bioethics programs are recognizing the need to prioritize racial equity, diversity, and inclusion. However, some struggle with the best way to make progress.
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