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. (shrink)

In 2003, the South Carolina Supreme Court upheld the conviction of Regina McKnight, an African American woman who was convicted at the age of twenty‐two for committing “homicide by child abuse.” She became the first woman in the United States to be arrested, prosecuted, and convicted for experiencing a stillbirth. Rather than an outlier case in the annals of American jurisprudence that stretched law beyond reason while restraining compassion and justice, McKnight's conviction inspired similar prosecutions of other poor black women (...) and then of other women. More than one‐third of states consider pregnant women's illicit drug use a form of child abuse, resulting in unprecedented forms of criminal and civil punishment. Laws previously understood to protect pregnant women from domestic violence during pregnancy, such as fetal protection laws, now serve as the vehicles for prosecuting pregnant women. What these prosecutions and laws expose are the multitudinous ways in which the criminalization of poor pregnant women—and normalization of that criminalization, such that even doctors and nurses are expected to participate in it—serve to humiliate women, interfere with their reproductive health, and ultimately rob women of reproductive autonomy. (shrink)

In a recent essay, George Annas, the legal columnist for The New England Journal of Medicine, observed that the resuscitation of extremely premature infants, even over parental objection, is not problematic because “once the child's medical status has been determined, the parents have the legal authority to make all subsequent decisions.” Annas himself is quick to concede that treatment in a high-technology neonatal intensive care unit frequently takes on a life of its own. He also acknowledges that although bioethicists and (...) courts agree that there is no ethical or legal difference between withholding or withdrawing a respirator from a patient, parents and physicians find the withdrawal much more emotionally troubling. (shrink)

This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term “bioethics” provides a lens, language, and guideposts to the (...) study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent. (shrink)

This project places at its center the urgency for a more responsive organ transplant policy in the United States. It studies how relationships and affinity affiliations motivate intimate exchanges, including human biological markets. Specifically, the article considers whether affinity relationships might serve as a platform in the domain of organ transplantation and if so, whether the law should tolerate discriminatory behavior in the human biologics realm. In defining affinity relationships, the article speaks primarily to race, gender, and sexual orientation. Its (...) theoretical underpinnings, however, could also apply to religion. The theoretical hunch of the article is that affinity relationships could play a role in motivating transplant procurement. (shrink)

The domains of religious doctrine and practice provide ground for double bind analysis, particularly as applied to race, religion, and bioethics. In these spheres, reconciling church doctrine with social or medical practice is often challenging; the demands from each sphere are unique and sometimes irreconcilable. This chapter uses double bind theory as a framework to engage in a dialogue concerning race, religion, and bioethics. It offers a dialogue that scrutinizes conservative religious thought in what is colloquially known as the “black (...) church” regarding the challenges of medical ethics and race. (shrink)

This issue of the American Journal of Bioethics shines a light on abortion, recognizing that reproductive freedom as understood for the past fifty years no longer exists in the United States. Some...

Law and racism are intertwined, with legal tools bearing the potential to serve as instruments of oppression or equity. This Special Issue explores this dual nature of health law, with attention to policing in the context of mental health, schools, and substance use disorders; industry and the environment in the context of food advertising, tobacco regulation, worker safety, and environmental racism; health care and research in the context of infant mortality, bias in medical applications of AI, and diverse inclusion in (...) research; and anti-racist teaching and practice in the context of building an interprofessional curriculum and medical-legal partnerships. (shrink)

This essay argues that what separates poor mothers from their middle class counterparts are many factors — not simply couples' ability to plan, the power of their choices, and agency. For example, power, social clout, and access to health care influence status and parenting. Historically, for white women choice has been about abortion; for many women of color, choice is about being able to be a mother. This essay begs the question whether real parallels can be drawn on questions of (...) contraception, abortion, and ART simply by examining class and to what extent race and sexual orientation matter in research on parenting. (shrink)