African American Bioethics: Culture, Race and Identity

BOOK REVIEW African American Bioethics: Culture, Race and Identity Lawrence Prograis, Jr, and Edmund D. Pellegrino, editors, Georgetown University Press, 2007, Washington, DC, 169 pages; $44.95 (cloth); $26.95 (paper). ISBN 978-1-58901164-9 (paper); ISBN 978-1-58901-163-2 (cloth). African American Bioethics: Culture, Race and Identity is a collection of essays by 8 African American scholars working in the fields of ethics, law, medicine, or theology with ‘‘Introduction’’ and ‘‘Afterword’’ written by the editors. They share their musings about ethical issues surrounding the healthcare enterprise in America at the beginning of the 21st century. Like its 1992 predecessor, this volume is the product of a symposium organized by the Center for Clinical Bioethics at Georgetown University Medical Center, with which the editors and one of the authors are affiliated. It joins a handful of other books that have attempted to examine bioethics by culture or ethnicity since the first Georgetown symposium. Rather than serving as a reference work, though it is well indexed, this slim volume may best serve as a sampler of the opinion of African American scholars on selected ethical issues. To illustrate this conclusion, I will discuss briefly an issue touched on by a number of the essayists: health disparities in the United States. The US Department of Health and Human Services first commissioned a major report on the topic in the 1980’s. In the 1990’s reducing health disparities was declared a national goal in the ‘‘Healthy People 2000’’ document. In ‘‘Healthy People 2010,’’ eliminating health disparities was elevated to an overarching goal. In the first essay, Boston College philosophy professor Jorge L. A. Garcia raises a number of cogent questions about the ethical dimensions of this problem. Are health disparities morally objectionable because they are unjust or unfair, present at all or merely too large? Are some people left below a minimum morally acceptable standard of health care? Is this a violation of human rights? Are African Americans owed compensatory justice for past wrongs? Are persistent health disparities morally desirable for social comity and shared mission in the country? Garcia suggests that a paramount question is whether disparities ‘‘.stem from the disrespect that lies at the heart of social or personal injustice?’’ In the third essay, scholar Annette Dula of the University of Colorado weighs in on what she sees as active disinformation campaigns of conservative think tanks and their

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corporate sponsors that shift blame for disparities from those who market dangerous products to minorities and situate environmental pollution sources in minority neighborhoods to minorities themselves. She concludes, ‘‘This country will not be able to achieve the humane goal of Healthy People 2010deliminating health disparitiesdunless and until we understand and fight the problem on all fronts.the political and economic dimensions of health disparities.’’ In the fourth essay, law professor Patricia King adds that the norms and values of the broader society are at fault. The essays of Veterans Affairs surgeon Reginald Peniston and bioethicists Kevin FitzGerald and Charmaine Royal question whether eliminating health disparities can be realized by 2010, if ever, and whether disparities in health are built into the American capitalist system and institutionalized medicine. For example, will even greater disparities result from the recent doubling of the budget of the National Institutes of Health over 5 years, which may result in increasingly expensive health technologies such as those of genomic medicine, with no provision made that poorer segments of the population may have access to them? Without universal health insurance, does even the possibility exist of approaching the goal of health equity and even basic primary care for the poor, among whom African Americans are disproportionately represented? Does increasing research and debate over the existence, magnitude, and origins of health disparities distract African American and other scholars, leaders, and citizens from focusing on a more important issue: the provision and funding of an equal opportunity to receive a morally mandated level of care by universal health insurance coverage? In conclusion, the essays in African American Bioethics: Culture, Race and Identity raise questions that epidemiologists, other health professionals, and society will debate for years to come, and they provide valuable insights into the thinking of several African American scholars on these issues. Richard F. Gillum, MD Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, MD

1047-2797/08/$–see front matter doi:10.1016/j.annepidem.2007.12.005