Structural Racism as Characterized by Ethics Consultation Patterns in a Safety-Net Hospital
Saturday, October 14, 2023
7:30 AM – 8:45 AM ET
Location: Laurel AB (Fourth Floor)
Structural racism can be defined as the cumulative and compounded effects of public policies, institutional practices, and cultural representations that perpetuate racial inequity. Safety-net hospitals serve the most demographically underserved and underinsured patient populations in their region, often managing the manifestation of cumulative inequities in the form of acute and chronic diseases. We hypothesized that consequences of structural racism would be at greater likelihood to arise in our safety-net hospital as moral conflicts regarding the direction of clinical care for black patients. Ethics consultation service provides an invaluable tool to care teams across healthcare institutions and is a primary avenue for collaborative delineation when clinical decisions reach an impasse. To examine this, we interrogated our database of ethics consultations from 2014 to 2022 and analyzed the association of race with several key ethics consultation metrics. We found a disproportionately greater number of consults for black patients as compared to white patients normalizing by the distribution of race for the entire hospital population. Among all consults the most frequently occurring code for all patients was “concern about decision-maker choices” (27%). The next most common codes involved end-of-life care: “moral distress” (24%), “decisions to withhold or withdraw life-sustaining treatment” (19%), and “futility, inappropriate or non-beneficial treatment” (18%). Analysis of the distribution of these most common codes revealed a disproportionate weighting of these issues in the ethics consults of black patients. Ultimately, ethics consultation patterns have the potential power to reveal as well as address critical issues of structural racism in healthcare.
Michael Ieong, MD – Assistant Professor of Medicine, Pulmonary and Critical Care Medicine, Boston University Chobanian & Avedisian School of Medicine