400 Years Later: Exploring the Systemic Impact of Exploitation, Medical Mistrust, and Medical Racism on the Maternal Health of Black Women in the United States
- Maya Hardy
- Jul 14
- 32 min read
Updated: Aug 7
Imagine Serena Williams, a legendary athlete with 23 Grand Slam titles, facing a life threatening situation not on the tennis court, but in a hospital bed. Despite her wealth and access to the best medical care, Williams nearly died during her pregnancy due to severe complications from a blood clot in her lungs. Her desperate pleas for help were initially dismissed by her physicians, exposing the troubling reality of the existing systemic racism in medical practices that can undermine even the most privileged Black individuals. THis incident underscores that these disparities transcend socioeconomic status. This paper delves into the reasons behind such disparities, exploring the deep rooted historical practices and biases that continue to affect Black womens maternal health in the United States. Through examination of the legacy of exploitation within gynecology and ford sterilization, we uncover the ethical implications of these practices and its connection to present day implicit biases and compromised patient autonomy. The theme “Reimagining the Medical industrial Complex”' emphasizes the crucial need for quality care and trust between patients and medical professionals. However, rebuilding this trust poses challenges when we live in a society within a system that has been historically fraught with oppression that presents profound challenges. This paper will pose the question of whether or not there is an ethical obligation to rectify the historical and structural foundations, along with consequences that perpetuate disparities in Black maternal health?
Table of Contents
Abstract
Introduction
Historical Background
Maternal Healthcare in America
Ethical Analysis of Dr. James Marion Sims
Frameworks
Maternal Mortality Analysis
Conclusion
Introduction
In healthcare, we often assume systems are designed to protect and support everyone equally. However, an anonymous quote challenges this assumption: "a system cannot fail those it was never meant to protect." This statement prompts a critical examination of how healthcare systems inadvertently neglect the unique needs and challenges of vulnerable individuals. The historical roots of healthcare systems were not developed with vulnerable or marginalized communities in mind, and notably: Black Americans. Systemic racism, defined as “a form of racism that is pervasively and deeply embedded in and throughout systems, laws, written or unwritten policies, entrenched practices, and established beliefs and attitudes that produce, condone, and perpetuate widespread unfair treatment of people of color” (Braveman et al.) is embedded in medical practices in the United States, playing a key role in perpetuating the inadequate medical care people of color in the United States receive, and more specifically, Black Americans. Further, for Black women, these disparities have caused them to face harmful circumstances within maternal care. But, in what ways? In this paper, I am to dig deeper into the answers to this question and the surrounding context to grasp how historical facets of the healthcare system in the United States impact Black individuals, especially Black pregnant women, and the ethical considerations involved.
In 2022, the United States allocated over 4 trillion dollars towards healthcare expenditure (Why Are Americans Paying More for Healthcare?). Despite this substantial investment, the disparity between healthcare spending and the quality of care, particularly in addressing the maternal health crisis among Black women, remains glaringly apparent. Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021 (Hoyert). The maternal mortality rates in the United States are alarming, mirroring statistics seen in many lower-income countries such as Brazil, Mexico, Malaysia, and Uzbekistan. From 2011 to 2013, the maternal deaths for Black women were 40 per 100,000. Comparatively, for white women, it was 12.4 deaths per 100,000. In Brazil, the rate was 44 deaths per 100,000, and in Mexico, it matched the United States at 40 deaths per 100,000. These numbers are particularly notable considering that Mexico is considered less developed and economically advanced than the United States (Treers). According to an 11-year study of over 9 million deliveries in U.S. hospitals, Black women also have a 53% increased risk of dying in the hospital during childbirth, no matter their income level or type of insurance (Systemic Racism Plays Role). Furthermore, the pregnancy-related mortality rate for Black women who completed a college education or higher is 5.2 times higher than the rate for White women with the same educational attainment (Hill). This evidence shows that the mortality rate cannot be attributed to class or level of education. The causes of this can be attributed to medical racism, which can be inherent in physicians who perpetuate biases against Black women when treating them. Medical racism, defined by Eric Bronson as “the systematic and wide-spread racism against people of color within the medical system,” encompasses “both the racism in our society that makes Black people less healthy, the disparity in health coverage by race, and the biases held by healthcare workers against people of color in their care” and remains at the historical root of the American medical system (Bronson). Medical racism is ingrained in our present medical system, revealing how the impacts of the foundation of the healthcare system in the United States continues to impact Black women today.
This paper will explore historical injustices, compromised patient autonomy, and consequences echoing back to the era of slavery. Specifically, the primary focus of this paper will be to demonstrate the inherent racism within the US medical system, and the impacts of it on Black women in the present day. The aim is to establish clear connections between this historical legacy and the state of medical care for Black individuals in the US. Black women are key stakeholders, and their experiences are prominent examples of the issue of medical racism that is leading to a plethora of challenges in maternal care. Maternal care, as defined in this paper, encompasses “all aspects of antepartum, intrapartum, and postpartum care.” (Levels of Maternal Care) This encompasses healthcare for women before, during, and after giving birth.
Given this context, the pattern of inadequate care experienced by Black Americans has led to a deep distrust within the doctor patient relationship. Substandard treatment has created repeated experiences of failure by the medical care system, thus creating skepticism regarding the effectiveness of the medical system to provide quality care. This year’s theme, “Reimagining the Medical Industrial Complex'' emphasizes the foundational importance of quality of care, and stresses the importance of trust between a patient and medical professionals. However, navigating and rebuilding trust within a system that has historically oppressed Black women poses challenges. Racial bias in medicine has played a pivotal role in perpetuating disparities for Black Americans. Biases that originated during the 1800s, which falsely claimed that black people were biologically closer to apes while white people were more evolved Black Americans Are Systematically Under-Treated for Pain. Why?). This created a false and enduring narrative about of Black people's pain tolerance, arguing that they are less susceptible to pain than white people.
To fully understand the present day impact on Black women, it is essential to understand the historical background that has contributed to the impacts Black women face today. Myths and biases have played an immense role in perpetuating the disparities and lack of adequate care for Black women in maternal health. Therefore, I will consider how these factors have created obstacles in our present-day maternal healthcare landscape. Further, I will delve into the ethical considerations and challenges faced by Black women within the maternal healthcare system. The core values of justice, equality, trust, and accountability will serve as the main ethical values within my paper. I will also make my considerations through a deontological, utilitarian, and consequentialist perspective. The ethical question that I used to guide my research was: Is there an ethical obligation to address mistrust and consequences caused by the historic practices that may impact Black Maternal health in the present day?
Historical Background
To understand the full history, it is important to look at key terms and foundations for a clear historical context. Firstly, the American medical system has historically not recognized Black Americans as individuals, but only as enslaved people who were not considered people. This dates back to the forced arrival of African people in America in 1619 (Onion et al). During this time period, the term “scientific racism” was developed. Scientific racism, a pseudoscientific ideology, was initially employed to rationalize the enslavement of African people. It claimed that they possessed distinct characteristics and traits divergent from those of whites, allegedly rendering them better suited for arduous labor. The Harvard Library states that scientific racism is “a history of pseudoscientific methods “proving” white biological superiority and flawed social studies used to show “inherent” racial characteristics still influence society today.” (Harvard Library-Scientific Racism) A belief that came as a result of this was racial differences in pain perception, which was fundamental in justifying slavery and the pain that enslaved people would endure. In the nineteenth century, various physicians “sought to establish the “physical peculiarities” of Blacks that could “serve to distinguish him from the white man” (Hoffman). These statements further display the persistence of white physicians during this time period to find concrete evidence that Africans developed differently than white individuals in order to justify exploitative treatment. Further, those false notions persisted into the 20th century, as Black people became subjects for medical research “based in part on the assumption that the black body was more resistant to pain and injury” (Sabin). These fallacies, prompted by figures like Dr. James Sims, known as the “father of gynecology,” (Ojanuga) provided the justification so that they could justify experimentation, such as the exploitation of Black women in medical research. As far back as 1787, in the manual “A Treatise on Tropical Diseases; and on The Climate of the West-Indies,” British doctor Benjamin Moseley propagated the notion that Black individuals could endure surgical operations more effectively than white individuals. He asserted that what would be excruciatingly painful for a white person would be almost disregarded by a black person. Moseley even provided a chilling anecdote, stating, “I have amputated the legs of many Negroes who have held the upper part of the limb themselves" (Villarosa), reinforcing these harmful and unfounded beliefs about racial differences in pain tolerance. The idea that black people are stronger or less pervious to pain are untrue, but utilized by many in the medical world. A study by The Journal of Pain wrote that African Americans actually “have a decreased pain tolerance relative to other ethnic groups.” This was done in an article that studied the ethical differences in experimental pain perception (Burnight et al).
Moreover, historical myths from the 1800s, which assert that black individuals are biologically closer to apes and less developed than white individuals (Chisango), continue to influence perceptions of pain susceptibility. Even in our present day, alarming beliefs persist among younger generations, with 40% of first- and second-year medical students endorsing the false notion that "black people's skin is thicker than white people's," a misconception rooted in historical biases (Sabin). This is particularly concerning, as it suggests a lack of progress in dismantling harmful stereotypes. Presently, racial disparities in healthcare also persist through the fact that Black patients are 25% more likely than their white counterparts to receive only non-opioid medications, such as ibuprofen. Even after adjusting for key factors like insurance status, patient age, and region, these disparities endure. (Stathi et al) These biases were manufactured as justifications for the European and American colonial endeavor, perpetuated by the exploitation of enslaved individuals during chattel slavery, rather than being inherently caused by the forced arrival of Africans in 1619. Enslavement in the United States, often known as chattel slavery, allowed enslaved Africans to be considered legal property and to be bought, sold, and owned forever (Modern Day Abolition). The exploitation of enslaved individuals was widespread, encompassing not only the grueling physical hardships of labor, but was prevalent in other spheres, such as medicine. Physicians during this period were able to exploit enslaved individuals and experiment on their bodies for research and innovation. This is a core factor in why clear mistrust continues to permeate itself generations and generations later.
Within these conditions, the purpose of birth and maternal care for enslaved women in the United States arises as a valuable perspective for understanding the historical context of Black maternal health. During that time, the purpose of enslaved women giving birth was to grow the enslaved population (Motherhood and Children). Enslaved women were not only viewed as laborers but also as producers of future labor through childbirth. This exploitation of their reproductive capacities was encouraged and enforced to increase the enslaved population. Other phenomena like “slave breeding” were also enforced during this period, which included forced relationships between enslaved women and men and the rape of enslaved women by white men. Enslaved women had virtually no control over their reproductive choices, as their bodies were exploited to further the economic interests of their owners. This exploitative system of forced childbirth was a central part of a dehumanizing environment where Black women's autonomy was disregarded.
A poignant example of the exploitation of Black women in gynecological history is exemplified by figures like Dr. James Sims, who is coined the “father of modern gynecology.” Born in 1813 in Lancaster County, South Carolina, Dr. James Sims became renowned among wealthy white landowners in Montgomery, Alabama. Operating with an 8-person staff, he ran a hospital where he “treated” enslaved patients. His treatments were focused on healing enslaved men so they could continue working and on ensuring the reproductive capacity of enslaved women by prioritizing their ability to continue bearing children for their masters. Dr. Sims was asked to aid an enslaved woman who had sustained injuries after falling off a horse and experiencing severe back and abdominal pain. Sims determined that he would need to do an examination of the patient's vaginal region to diagnose her injuries accurately (Holland). This was a violation of the woman's body, as her injuries did not pertain to her vaginal area. Dr. Sims' actions can be deemed experimentation rather than treatment, as he examined parts of her body unrelated to the injury without her consent. Dr. Sims then proceeded by positioning the enslaved woman on all fours, and used his hands to gain visual access to do a thorough examination (James Marion Sims). This moment served as the genesis for Dr. Sims' innovation, an early iteration of the modern speculum. During the years 1845 to 1849, Dr. Sims conducted a series of experimental surgeries in Montgomery with the goal of repairing vesicovaginal fistulas (VVF) in enslaved women. VVF is a condition resulting from traumatic birthing experiences, leading to a tear between the bladder and genitals, causing urine leakage (Stamatakos). Sims subjected enslaved women such as Betsy, Lucy, and Anarcha to approximately twelve surgeries each, with minimal healing time between procedures. An 18-year old named Lucy, suffered through nearly three months of recovery due to the effects of a single operation (Urell).
Furthermore, there were other instances of experimentation on Black individuals that prioritized medical research over obtaining consent. The Tuskegee Experiment stands as a stark example of how Black people were exploited as experimental subjects for the advancement of research, contributing significantly to the mistrust that persists in our present day. In 1932, The U.S Public Health Service (USPHS) enlisted the Tuskegee Institute in Macon, Alabama, to conduct the USPHS Tuskegee Untreated Syphilis Study during an era when there was no known cure for syphilis, a sexually transmitted infection, existed The study was then called “Tuskegee Study of Untreated Syphilis in the Negro Male.” The purpose of the study was to determine whether or not penicillin could prevent, not just cure, syphilis infection. The study involved 600 Black men, 399 of whom had syphilis and 201 who did not. A majority of the participants were poor and illiterate sharecroppers who had little education. The participants were told by the researchers that they were being retained for “bad blood,” which was a vague term that was meant to describe a variety of ailments such as syphilis, anemia, and fatigue. The men were promised free medical exams, meals, and burial insurance in exchange for their participation (Public Health Service Study). To fully document the disease's progression, they were not administered an effective treatment, even as the men died, went blind or insane, or experienced adverse health complications caused by the treatment (Nix). In 1933, the researchers decided to lengthen the study. They recruited over 200 control patients without syphilis. The patients were administered ineffective treatments, such as ointments or capsules containing a placebo pill, further pushing the belief that they were receiving proper care. As time went on, the patients were continually incentivized for their continued participation, providing transportation to appointments, hot meals, and other amenities. Throughout the experiment, however, the researchers actively obstructed the treatment of syphilis (Public Health Service Study). In 1934, they provided doctors in Macon County with lists of subjects, urging them not to treat them if they were a part of the study, even if they had contracted syphilis. Similarly in 1940, they made the same request of the Alabama Health Department. Between the study’s start in 1932 and 1947, which was the year that penicillin was defined as a cure for the disease, numerous men had died. The Assistant Secretary for Health and Scientific Affairs appointed an Ad Hoc Advisory Panel consisting of nine members from various fields, such as health administration, medicine, law, religion, and education, to review the study (About the USPHS Syphilis Study).
It is evident that within history, there have been medical practices that have proven to impact Black individuals negatively. The relationship between historical actions and their ongoing impact on Black women today, particularly in contexts like maternal healthcare, reflects the troubling history of the American Medical system. This history includes instances of exploitation, abuse, and negligence that have lasting consequences. The medical experimentation on enslaved Black women, forced sterilization, and discriminatory treatment have contributed to the disparities and challenges faced by Black women in healthcare today as biases that have originated within these experiments continue to reveal themselves in less obvious ways in our present day. These injustices have led to an enduring mistrust of the medical system among Black communities and have resulted in disparities in maternal health outcomes, with Black women experiencing higher rates of maternal mortality and morbidity compared to white women. I chose to highlight the experiences of Black women to illustrate the recurring cycle of maternal deaths and complications within this demographic. It sheds light on an issue that demands greater awareness and directly relates to the internal flaws of the medical-industrial complex.
Maternal Healthcare in America
In the healthcare system, Black women find themselves navigating experiences that corrode trust. Black women entrust their well-being and the well-being of their babies to a system that contributes to adverse outcomes and jeopardizes mental health. They face unique journeys in the United States, shaped by two intersecting identities—being a woman and being Black. This intersection heightens their vulnerability to poor birth outcomes due to the stigmatization and marginalization of Black motherhood. According to the Policy Center for Maternal Health, “Black women, along with other women of color, reported higher rates of mistreatment, defined as “loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help,” during hospital births (Policy Center for Maternal Mental Health). Stigmatization surrounding black mothers as mentioned, is a key contributor to the worsening outcomes for Black pregnant women. The stigma surrounding pregnancy, specifically based on race, can exacerbate maternal and infant health disparities by heightening stress levels and limiting access to essential healthcare, services reissues, and social support networks. This stigma that is often created by physicians can result in delays in seeking medical assistance and contribute to financial and material hardships such as inadequate access to food, housing, and medical care (Mehra et al). In 2021, the maternal mortality rate among non-Hispanic Black women was 2.6 times higher than the rate among non-Hispanic White women. (Hoyert) Further, the alarming reality is that “84 percent of maternal deaths are preventable” (National Partnership of Women and Families), indicating that there is significant room for improvement in preventing these occurrences. During a study conducted in April of 2023, results showed that 30% of Black women experienced mistreatment while pregnant by medical professionals (Mohamoud). The numerous accounts of Black women succumbing to preventable pregnancy-related complications underscores the urgent need for discussion of these real-life tragedies. Women such as Sha’aisa Washington, Kira Johnson, Serena Williams, and countless others have tragically fallen victim to the biases and undervaluation perpetuated by the medical system.
The historical foundations of our medical system, including the numerous examples illustrating the exploitation of Black individuals in medical settings, highlight the enduring impact of these injustices, particularly for Black women. These issues raise important ethical considerations regarding the ethicality of Dr. James Sims’s research experiment and the Tuskegee Syphilis Study. By examining various ethical stances and perspectives, we can more fully understand this complex issue. My overarching research ethical question that persisted was whether the Medical Industrial Complex has an ethical obligation to address the mistrust and consequences caused by historical foundations that continue to perpetuate Black maternal health disparities in the present day. This question encompasses many parts of the issue, emphasizing the importance of looking at both the ethical implications of historical events and events that have occurred in our present day. It is crucial to understand the ethics of both past and current practices and policies to have a full understanding of all the complexities involved.
Ethical Analysis of Dr. James Marion Sims
The first case that was explored within the historical context was the exploitation of Black women by Dr. James Sims, which represented a broader trend of Black bodies being shamelessly experimented on for medical research, often at the expense of their autonomy and freedom. During slavery and particularly during the early 1800’s, after the United States had banned the importation of slaves into any port or place within the U.S. jurisdiction, (Reproductive Medicine Advances Linked to Slavery) medical professionals exploited Black individuals, erroneously believing myths that they were impervious to pain, thereby justifying unethical treatment.
Dr. Sims' infamous case underscores a crucial concept – the refusal to treat. During this time period, when enslaved people were considered property, they were not treated as people or given the same value that would be placed on a white individual. Whereas white individuals had the full value of people, were given respect by others, enslaved people were shrunk to a fraction. Article one, section two of the Constitution of the United States declared that “any person who was not free would be counted as three-fifths of a free individual for the purposes of determining congressional representation” (Slavery and the Making of America). Beyond the political sense, these women were considered experimental subjects rather than patients. The enslaved women that were subject to this treatment did not receive any anesthesia during the procedures, making it an extremely painful process for them. The experiments done on Lucy were unsuccessful, as she almost died of blood poisoning (Urell). A key action of Dr. Sims that displayed his lack of respect and equal treatment was that once he concluded his experimentation on Black women, he then transitioned to conducting experiments on white women. This suggests that he only began treating after he was confident in his ability to provide safe procedures to white women. This came at the expense of experimentation on Black women. The psychological and physical toll of these actions inflicted deep trauma upon these women. Stirpped of their autonomy, they were rendered incapable of adapting or themselves and providing content for the treatments. The power imbalance inherent in this experiment made it nearly impossible for them to voice any objections. The physical trauma stemming from numerous invasive procedures, often unrelated to their ailments, exemplified Dr. Sims’ disregard for the individuals connected to these bodies. This exploitation also gives rise to a violation of the principle of non-maleficence, commonly known as "do no harm." The principle includes that physicians “do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life” (Varkey). Dr. Sims' experiments inflicted more harm than benefit, causing enduring suffering and enduring consequences for the Black women involved.
In addition, the value of autonomy remains a key value to be considered within this case. Autonomy is the principle that states that an individual can make their own decisions. The enslaved women had no autonomy or control over their bodies, and beyond that, their lives. This means that they were not able to give their full consent for the treatments, and it is likely that they had no education of the various experiments that were being conducted on them. Their lives were controlled by slave masters, leaving them with no agency in having any decision-making ability. Medical procedures were also carried out without adequate explanation or understanding provided to the patients. The idea of informed consent was not yet implemented during this time period. This contributes to the power dynamics that were inherent in the institution of slavery, which allowed for the denial of autonomy. Enslaved individuals had no recourse to challenge or refuse medical procedures imposed upon them by their owners or physicians. The profound power imbalance rendered any notion of autonomous decision-making practically nonexistent.
Justice is another key value that comes into this case. In this sense, justice is a principle that is a form of fairness and believes all individuals should be treated equally. During this time, justice for enslaved individuals was unlikely. Fair treatment was not guaranteed at all, and was clearly highlighted as the patients did not receive the standard of care and respect offered by white patients. The concept of justice can also be examined by comparing the owner-enslaved relationship from the historical context of slavery and the doctor-patient relationship in modern healthcare. In the owner-enslaved relationship, owners held absolute power and authority over enslaved individuals, dictating every aspect of their lives. In the doctor-patient relationship today, doctors traditionally hold significant authority and knowledge over patients. Although the dynamics have changed with an increasing emphasis on patient autonomy and spread decision-making, the knowledge gap, in addition to the biases perpetuated by physicians today, can still create power imbalances, leading to unfair healthcare treatment. The parallel between these relationships highlights the systemic similarities evident in both the dynamics of a physician and black patient and those of an owner and enslaved individual. While not as intense, the modern physician black patient relationship, particularly for Black pregnant women, is still rigid. Black women continue to grapple with a lack of autonomy and frequently face dismissal or neglect during medical interactions.
Frameworks
Utilitarianism
Another framework that we can explore within this case is utilitarianism. Utilitarianism determines what is ethically permissible based on the impacts on the greatest good for the greatest number of people. From a utilitarian perspective, it could be argued that Dr. James Sims’ research experiments ultimately were beneficial for the greater good of society through medical innovation. The development of a surgical technique for treating vesicovaginal fistulas has had widespread positive implications for countless individuals suffering from this debilitating condition. By developing a successful medical intervention, Dr. Sim’s developments and findings about VVF through experimentation has potentially alleviated and improved the quality of life for numerous patients worldwide. While the immediate impact of Sims’s experiments may have inflicted harm on the individuals involved, the enduring legacy of his work has led to advancements in surgical techniques that have progressed the field of gynecology. But, this came at the expense of enslaved women who were exploited for the purpose of medical research. How do we weigh the consequences of both actions and determine which one had more of a positive impact on the greatest good?
Utilitarianism can often be thought of as weighing the benefits and harm both quantitatively and qualitatively. More simply, this could mean that utilitarianism focuses on the number of people that are either negatively or positively impacted, regardless to the extent that another group of people are negatively or positively impacted. While the utilitarian perspective previously mentioned reveals who the greatest good in our society today is impacted positively, it overlooks the qualitative aspects of the suffering endured by the individuals involved. Utilitarianism also focuses on the overall positive benefit that arises from the situation. In this case, the stakeholder that benefits the most are privileged individuals, as the enslaved women in this case left the situation with internal pain and suffering that had been done countless times to their bodies over the course of four years. The privileged individuals in this instance were the individuals who reaped the positive ramifications of this advancement, and were able to use this form of medical treatment to their advantage, not to the expense of their bodies. The notion that Dr. Sim’s experiments disproportionately benefited certain groups while exploiting others shows the ethical injustice inherent in his actions. While his experiments did benefit individuals, those individuals were only white individuals. Were enslaved people then able to benefit from his new innovation, or was it something that was only for those that were considered “people?” His experiments reinforced existing power dynamics based on race, gender, and social class.
In closing, utilitarianism provides a framework that highlights the overall benefits of Dr. James Sim’s medical advancement, while also raising important ethical considerations. The suffering endured by the enslaved women in his experiments is an important stakeholder that can not be overlooked. This case emphasizes the importance of balancing medical progress with ethical treatment, ensuring that individuals are treated with dignity and respect. How can we navigate the pursuit of medical advancements while upholding ethical principles and ensuring consensual treatment for the individuals involved?
Consequentialism
Consequentialism is a framework that discusses the positive and negative consequences of an action and based on the consequences, evaluates the ethicality of the actions. Consequentialism can be examined here in order to weigh what came from Dr. James Sims testing. On the one hand, the positive consequences that came from this testing was the creation of a new technological advancement that is used today. This advancement continues to be used in our modern-day medical practices and has proved to be a beneficial innovation.
In addition, his work's broader societal consequences benefited individual patients and contributed to the advancement of medical science. However, the negative consequences that are prevalent in this case is the suffering endured by the enslaved women who were subjected to his experiments. They went through severe pain, trauma, and exploitation for medical research. The consequences also extend beyond the immediate impact that it had on the enslaved women involved. The harms of these actions extend beyond the immediate physical impact on the individuals involved. Being subjected to medical experiments without consent or consideration for their well being strips them of their agency and reduces them to mere objects for scientific inquiry. This dehumanization perpetuates a dangerous narrative that such experiments are acceptable, paving the way for further exploitation of vulnerable populations in the future, showcasing why the case of Dr. Sims is just one example among many instances of unethical experimentation on Black individuals throughout history. The mistreatment of this vulnerable population has eroded trust within the medical profession and has contributed to the disconnect that Black people feel with their physicians. Further, the legacy of slavery and racial discrimination in the United States, which was exacerbated by medical experiments such as Dr. Sim’s experiment has had lasting effects on access to healthcare and health outcomes for Black individuals, both systemic impacts that are encompassed with the wrongful exploitation of Black people for the purpose of medical research. Furthermore, how do we compare the benefits of these medical advancements to the trauma and harm that it has caused? Do we weigh consequences based on the length of its impact? Do we, as a society, completely discredit his innovation?
Deontology
Finally, deontology is a duty-based framework that focuses on moral rules or duties to determine the rightness or wrongness of actions. As a doctor, Dr. Sims had several duties rooted in medical ethics and professional standards. These duties included acting in the best interest of his patients, maintaining confidentiality, obtaining informed consent, and treating all individuals with dignity and respect. However, the landscape becomes murky when considering Dr. Sim’s treatment of enslaved individuals, particularly women.Enslaved women were denied basic rights and autonomy, perceived not as patients deserving care but as subjects for experimentation. Among the various stakeholders involved, the owners of these enslaved women are crucial stakeholders from a deontological perspective, with specific duties that warrant consideration. While they had a duty to protect their slaves, their primary concern derived from economic concerns, as they wanted to make sure that their enslaved women had the ability to bear children and produce more children in order to increase their population of enslaved people. Given the time period, were they acting against societal norms by treating their enslaved people the way they did?
An important question to think about is: To what extent were Dr. Sims' medical practices influenced by the prevailing social attitudes and norms of his time? In the 19th century United States, societal attitudes towards race were deeply entrenched in racism and white supremacy. These attitudes most likely influenced or were ingrained in Dr. Sim's perception of the enslaved women he experimented on. In addition, the power dynamics that were present in the institution of slavery further influenced Dr. Sim’s medical practices. As a white male physician in a society where white supremacy and paternalism were prevalent, he held immense social and professional power over the individuals he experimented on. This also allowed him to exploit his subjects because he did so in an environment where accountability or punishment were not socially applicable.
Through these frameworks, we are able to understand the multiple facets that are enriched within the case of Dr. Marion Sims, and see the overarching theme of experimentation and lack of respect for the women involved within the treatment. It gives weight to how we measure quality of care to the advancement of medical research. Do medical developments that can aid generations of patients outweigh the harms done to the few individuals that had to suffer the pain? The concept of duty is also explored here to understand the various responsibilities of the stakeholders involved in this case and how their duties, influenced by the norms of the time period, shaped their actions.
Maternal Mortality Analysis
Throughout history, instances where black individuals have been exploited for medical advancement have cast a dark shadow over healthcare. Today, these historical injustices persist, revealing the disproportionate burden of maternal mortality on Black women. In a nation that allocates substantial resources to healthcare, the glaring disparity in maternal health outcomes raises pressing questions: Why do Black Americans, specifically Black women, lag so far behind? The answer lies in the historical foundations of exploitation and mistreatment that have created biases, which continue to be seen in present day health care practices and impact the trust between the medical professional and patient.
Trust is one of the most important values within the overarching topic of Black maternal mortality in the United States. It has been evident that trust between Black individuals and the medical system has been fraught due to the various instances of inadequate care or exploitation. The lack of trust in the healthcare system discourages Black women to seek timely and appropriate care. Fear of mistreatment, neglect, or being disbelieved by healthcare providers can lead to delays in seeking help, which can have dire consequences for maternal and infant health. That being said, it is not just the responsibility of Black women to rebuild that trust on their own. Medical professionals bear the responsibility to create an environment in which Black women do not feel unsafe, or as if their voices are not being equally valued. How do we rebuild the trust between Black individuals and doctors in order to foster better care and treatment? Is it unfair for Black individuals to still harbor the mistrust that they do as those historical events are not as pertinent, and as our nation moves towards equity?
Further, despite factors such as education, socioeconomic status, income, or insurance coverage, Black pregnant women consistently face a disconcerting reality in medical settings – a systemic undervaluation. This prompts an examination of the value of respect within the healthcare system. This issue underscores a broader concern related to the responsibilities of a doctor. Respecting individual autonomy and the imperative to genuinely hear and acknowledge patients' voices should be the most important considerations when caring for patients. The persistent lack of respect in these healthcare interactions deepens existing disparities and amplifies the erosion of trust between Black women and healthcare professionals. Black women often feel disrespected or as if their voices are not heard, and there are countless examples in which this results in the death of one of these women (Hemphill). Respecting and hearing the voices of patients is crucial to saving lives.
Deontology also emerges as an important framework to consider. Deontology is a duty based framework that determines the ethicality of an action based on the duties and the morals by focusing on obligation or consequences. Stakeholders that are most critical to consider when examining deontology are the duty of the doctors and society. Doctors are the most important stakeholder because doctors have an ethical obligation to ensure the physical well-being of their patient, and to treat them with care. Doctors should navigate their careers without bias influencing their decisions, and the patient’s voice should be prioritized. Bias can affect a doctor's duty by influencing their decision-making process and the care they provide to patients. When doctors hold biases or preconceived notions about their patients, they cannot make decisions or aid their patients in a way that prioritizes them.
However, unconscious biases within our society today also remain prevalent amongst medical professionals. Unconscious bias can happen when “the person is unaware of their evaluation” (Gopal). Unconscious biases can stem from personal experiences or upbringings that one may not have much control over. The impact of these beliefs extends to the quality of care black patients receive. But, controlling unconscious biases, inherent in all human beings, poses a significant challenge. Despite medical professionals being aware of the systemic inequalities in the medical system like biases and myths, individuals may still inadvertently contribute to these biases. How do we navigate unconscious biases that perpetuate health disparities in Black Americans? Who should be held responsible? Doctors have a responsibility and duty to care for all of their patients in the same way. Black women, who are often undervalued and ignored within the medical system, need doctors that will uplift their voices and make them feel seen.
Equity in healthcare emphasizes the importance of providing fair and equal access to medical services for all individuals, irrespective of socioeconomic status or other structural factors. In this crisis, it is hard to imagine that while equity is one of the main issues in bridging the gap between maternal mortality rates, it is not the sole factor or main contributor deepening these disparities. Even if individuals have financial resources and equitable access to healthcare, they may still face health disparities related to factors beyond just access to medical services. For Black women, systemic racism, implicit bias, and discrimination are critical factors in creating these disparities. Serena Williams is a prime example of this. She is a wealthy and educated, Black woman with access to the best medical resources. Despite Williams’ wealth, education, and fame, she suffered a harrowing ordeal with the medical system while she was pregnant. She almost died as her physicians failed to listen to her concerns, which led to her ending up in a life threatening situation (Williams). How should we navigate the pursuit of equity in black maternal health care if the current efforts, centered on healthcare provider education and enhancing quality of care for Black women are not yielding the desired results? (Working Together to Reduce Black Maternal Mortality)
To understand this, it is important to consider various stakeholders. The consequences of systemic racism profoundly affect Black women's healthcare journey. This form of discrimination leads to disparities in healthcare, significantly impacting Black women's medical well-being. Maternal mortality in the US is primarily attributed to heart disease, high blood pressure, infection, embolism, and hemorrhage (Collier et al). However, the consequences escalate when treatable conditions turn life-threatening due to implicit bias and systemic racism.
Delayed or missed diagnoses and the unjust withholding of crucial treatments show the consequences of not treating all patients with the same respect and fair treatment (Richards), and is a direct impact of a refusal to treat. Refusal to treat, exemplified in the case of Dr. Sims, underscores a critical mishap to recognize the humanity of Black women in medical contexts. In present day health care, this refusal manifests in less obvious instances, where physicians are unable to devote adequate time and attention to accurately diagnose and treat Black pregnant women, often influenced by implicit biases. While historical experimentation exhibited over exploitation and racism, contemporary bases operate more subtly, shaping physicians perspectives and clinical decision making. The imperative of approaching patient care with an unbiased perspective prompts a fundamental question: Should physicians strive to examine their patients without bias? One might argue that unbiased assessments enable physicians to diagnose and treat patients based solely on medical need, free from maternal influences. However, an alternative perspective would argue that maintaining nuanced understanding of a patient's backgrounds and experiences and the possibility of making assumptions can allow physicians to foster empathy and tailor treatment plans accordingly. Ultimately, the balance between unbiased examination and contextual awareness within the healthcare system reveals the complexity of medical practices. By navigating this balance, piscinas can mitigate the impact of biases and uphold their ethical duty to prioritize patient well being above all else.
Continued inaction to address the disparities in maternal health outcomes could widen the gap between Black women and other racial or ethnic groups. This could create a slippery slope where childbirth becomes increasingly dangerous for Black women in America. Black women may develop deep-seated fears about the prospect of having children. These fears, left unaddressed, could impact our society's social and demographic aspects. This is seen as a poll by In Our Own Voice: National Black Women’s Reproductive Justice Agenda, which reported that “40 percent of Black women of reproductive age said they feel less safe and think about the risk of death if they become pregnant” (Daniels). As giving birth becomes more dangerous and unsafe for Black women in America, Black women may develop fears of even having kids, which could later contribute to a variety of social and demographic shifts.
Lastly, the ethical question that has been thoughtfully explored throughout this paper was: Is there an ethical obligation to address mistrust and consequences caused by the historic practices that may impact Black Maternal health in the present day? The answer lies within the profound impacts of historical practices. It is evident that the historical enslavement of Black individuals has led to the creation of false biases and myths that persist, albeit in less overt ways, in our modern day society. However, addressing the mistrust and its conquest is complex. Who bears the ethical obligation to initiate their process of reconciliation and healing? Is it solely the responsibility of the medical establishment, or does society as a whole share this responsibility? Within this analysis, the exploration of multiple values and frameworks unveils the ethical considerations intertwined with the maternal health crisis for Black women in the United States. Prioritizing these values allows for a more comprehensive understanding of the various impacts on Black women, encompassing physical, mental, and societal dimensions.
Conclusion
To conclude, maternal mortality for Black women in the United States has been perpetuated by various historical foundations and present day actions such as biases and undervaluing that will impact Black women’s ability to safely have children. Within this paper, ethical issues such as the exploitation of Black individuals for medical advancement through the experiments conducted by Dr. James Sims, or through the Tuskegee Syphilis Study to show the lasting legacy of distrust within the Black community towards the medical system. The further inability of the healthcare system to recognize black women as deserving of equal treatment and respect in the present day has led to dipropionate rates of maternal mortality. This paper argued the parallels of the owner-enslaved relationship to the physician and Black patient relationship to look at the similarities that are prevalent in both cases. Furthermore, by examining a plethora of frameworks, this paper demonstrated the differing perspectives to be considered when considering the issue of Black Maternal Morbidity in the United States.
In order to move forward, it is important for healthcare professionals, healthcare institutions, hospitals, etc. to acknowledge and address the historical roots of systemic racism that permeates itself in the medical system and work to rebuild trust. Addressing unconscious biases, implementing anti-racist training, and educating the next generations on issues like maternal mortality are steps towards achieving justice and equality in maternal healthcare outcomes. In order to truly “Reimagine the Medical Industrial Complex,” it is necessary to understand how historical foundations have impacted the current healthcare system that we have today. Who is to be held accountable for the various obstacles that pregnant Black women face in the medical system? There is a need for collective responsibility when it comes to this issue.Various stakeholders such as hospitals, policy makers, healthcare institutions, physicians etc. can play large roles in dismantling these obstacles and need to be held accountable for contributing to creating them. How can we reimagine a system in which the obstacles they face do not exist? After considering this question, I have come to the conclusion that these obstacles are attributed to a larger issue at hand that has to be solved first before delving into its impacts in the healthcare system. These issues are rooted in historical and systemic racism. The obstacles are symptomatic of deeply ingrained structural inequities, including disparities in education, employment, housing, and criminal justice. It is critical to address the foundation at which these obstacles lie in order to reimagine a system where these obstacles do not exist. Hospitals, medical schools, and our government can also play a role in creating a new system in which the disparities that Black women face are lessened. Health organizations around the world are implementing and creating ways in which they can implement beneficial change to this situation.
Finally, as mentioned previously, through the examination this paper explored several historical cases, illustrating how experiments inflicted harm upon Black individuals. However, I still question the motives of these experiments and the actions of them in the context of the current time period because it is crucial to understand the prevailing ethical standards of the time. Could Dr. Sims’ actions be justified by the societal norms of his era, where such treatment of enslaved individuals was deemed acceptable? To whom is this ethically acceptable? Yet, I’m prompted to question whether societal acceptance justifies unethical or ethical behavior. One must consider revisiting the fundamental idea rooted at the center of many ethical dilemmas: “Just because we can, should we?”
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