Book Review

African American Bioethics: Culture, Race, and Identity

N Engl J Med 2008; 358:206-207January 10, 2008

Article

African American Bioethics: Culture, Race, and Identity
Edited by Lawrence Prograis, Jr., and Edmund D. Pellegrino. 169 pp. Washington, DC, Georgetown University Press, 2007. $44.95 (cloth); $26.95 (paper). ISBN: 978-1-58901-163-2 (cloth); 978-1-58901-164-9 (paper).

In this collection of essays, the contributions are written by practitioners, researchers, and theorists. Each was challenged to provide his or her “epistemic stance” and “internal perspective” in answering the question, “Is there a distinctive African-American cultural perspective on bioethics?” This topic is not new — the current book arose from an attempt that was made 16 years ago to lay an empirical foundation for African-American bioethics through a conference and book entitled African-American Perspectives on Biomedical Ethics (H.E. Flack and E.D. Pellegrino, eds. Washington, DC: Georgetown University Press, 1992). The dialogue is continued here in an attempt to determine whether the changing sociodemographic landscape has moved perspectives on culture, race, identity, and bioethics.

The essays vary in their focus, ranging from grounded clinical practice to the heights of the philosophical tower, but common themes emerge. Do people of differing ethnic backgrounds, cultures, and races view medicine and bioethics differently? That black Americans mistrust the medical community is now a given. Should they? There is a growing body of evidence that such fears have a valid historical foundation.

As various authors point out in this book, distrust of medicine by black Americans has consequences for treatment-seeking and health care use. Much work has been done to examine events (e.g., the Tuskegee syphilis study) that have contributed to this phenomenon, and a sophisticated bioethics discipline keeps watch on current medical practices. The issue of mistrust is generally handled well in the book, which shows that the treatment of black Americans by physicians can be set broadly in a context of unbalanced power that has tended — and to a certain extent continues — to systematically put black patients at a disadvantage. But the authors do not point out that physicians and clinicians are not solely to blame for this phenomenon. Attention must be called not only to ethical shortcomings of the past, but also to the structural contexts of those events and to the contributions and responsibilities of a variety of academic disciplines, and even to the popular media in the production of often mythic knowledge.

The theme of the effect of culture on beliefs and practices related to health is addressed throughout the book. The authors give a broad view of what culture is, its relevance, and how it correlates with health care and ethical decision making. Are we sensitive to the effect of culture on beliefs about health and behavior that relates to health? Although there is growing attention to these areas of inquiry, the measurement of these beliefs and behavior remains an elusive endeavor. The authors of this book call for better scientific and empirical descriptions of what black Americans actually believe and practice.

Are health care providers and researchers taking socioenvironmental perspectives into account when they deal with patients? If so, are they doing it effectively and properly? The problem of health disparities and the interaction of ethics with health care technology in medical practice need further debate. The issue of the ethics of technology is raised in this book in the context of genetics and medical research. As the field of genomics evolves, many ethical questions will continue to arise. Can it be inferred that current genetic research contains the same moral pitfalls as the eugenics of the progressive and postwar era? Proponents of both have stated the broad goal of benefiting the human race. It is argued in this book that racial categories are at best not very useful for medical research. Current eugenic rhetoric may go far in hindering treatment-seeking among black Americans and perpetuating their distrust of medicine. Because real health consequences can result from a distrust of medicine — such as the avoidance of treatment or inadequate self-treatment — practitioners, academics, and even members of the popular media must recognize their bioethical obligations.

As for the unifying question of this collection — whether there is a distinctive African-American cultural perspective on bioethics — the book's authors answer with a unanimous yes. As a whole, the contributors provide a compelling case for locating an African-American framework for bioethics. Practitioners, researchers, and theorists will find this book worth reading. There is no compendium on the subject like it.

Jeffrey Michael Clair, Ph.D.
University of Alabama at Birmingham, Birmingham, AL 35294
jclair@uab.edu

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