Ethics brief chapter 13
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University of Cincinnati, Main Campus *
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1040
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Philosophy
Date
Feb 20, 2024
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Racism is a problem that has existed since the beginning of time and is still prevalent today. Racism is the belief that a group of individuals is inferior because of their race or characteristics associated with them. There are many types of racism. Institutional racism- “unequal treatment that arises from the way organizations, institutions, and social systems operate”, Racial prejudice which is “antipathy toward a racial group based on a faulty view of that group, or implicit bias- where an individual does not intentionally display antipathy towards a race but holds a negative opinion of a group that operates subconsciously. While is it Evident that direct open individual racism- “person-to-person acts of intolerance or discrimination”- has drastically declined in the United States, there are still many institutions and settings where racism exists. One of the most prominent examples of racism in America is the health care system. Throughout history, African Americans have been openly discriminated against, denied treatment or forcibly used as test subjects in inhumane medical experiments. While today it operates more subtly, racism still affects both the quality and opportunity of care. A controversial
study identified race as a potential risk factor for certain treatments, surgeries, and other healthcare. While this study did not demonstrate any credible evidence for this finding, many hospitals and physicians nevertheless include race as a factor in determining care. An algorithm used by hospitals includes race as a risk factor and has led to discrimination against African Americans and people of color. While the algorithm itself cannot be held responsible as it is a machine, certainly the creators of the algorithm should be held partially responsible for its outcome. To ensure that racially biased algorithms stop causing unjust outcomes, race should be completely taken out of the algorithms.
As stated, it is impossible to hold the algorithm itself responsible for the harm caused, however, it is possible to hold the creators of the algorithm ethically responsible. While it is more
than likely that the creators did not intentionally create this program with racist intentions or maleficence and is not possible to know the inherent biases of the creator, the application of several ethical theories makes it clear they are still liable. Consequentialists would likely find this individual(s) responsible. For consequentialists, an action is judged ethically by its consequences or results, and motives are irrelevant. Despite the creators most likely not having racist intentions, the program led to discriminatory outcomes. Because of the negative inequitable consequences of the theory, Consequentialists would find the creators responsible for
the outcomes. Several methods could be used to prevent institutional bias in algorithms. Race should be taken out of risk calculations altogether. Our textbook clearly states that while studies have shown certain treatments and procedures produce more benefits for one race than another on average, the studies also stated that these same treatments worked very well for others of the same disadvantaged race. Utilitarian ethics would support this as they are concerned with ensuring the most good for the most amount of people. Removing race from the calculations, it would ensure a more equitable division of medical resources and access to treatment. Those who could have benefited from treatment but were denied due to race would now have access.
Others may disagree with my assessment of responsibility by citing other theories. The theory of deontology factors both outcomes and motives into the determination of blame. If the creators truly did not have racist intentions and did not foresee this algorithm having racially biased results deontologists might not hold the creators liable. The rationale for this opinion may be justified because people cannot foresee all of the consequences of their actions and if there is no reason to suspect an undesired result may occur it is unfair to place blame for that result. Additionally, others may see may potential solution as incorrect. Some may criticize removing race as a determination because it could lead to the proscribing of treatments that do negatively
impact someone because of their race. While research into racial risk factors is shaky at best, my outcome caused more harm than benefice. Furthermore, physicians may truly believe that risk is an inherent risk factor and not including this as a calculation would violate their duty to not harm.
I understand these concerns, however, I believe that creators can still be held responsible. While they likely did not intend discrimination, it did occur. And a researcher must account for all foreseeable risks. Any time race is a factor there is a potential for bias. It is reasonable to assume that the algorithm creates disadvantaged outcomes as a result. Individuals did not receive
the necessary care, and this could have resulted in greater harm and suffering to these patients. When so many people have been disadvantaged because of this algorithm, the creators should be held consequentially responsible. The creators had a duty to ensure that their program delivered an equitable division of resources and they failed. Given that so many people have been harmed, a consequentialist approach holds stronger than a deontological approach. I agree there may still be physicians that truly believe, from a nondiscriminatory view, that race is a fundamental risk factor. Another possible solution is still taking race out of the algorithms but having physicians inform the patients of their demographic risks separately and allowing the patient the ability to determine consent. Informed consent is a fundamental bioethical principle. Physicians should be required to separately inform the patient of their racial risks, and all relevant information necessary for the patient to consent. If the patient understands the risks and still chooses to proceed with treatment. Physicians would be able to satisfy their duty of no harm and patients would still have access to treatments that may not have been available; producing more good than the algorithm accomplished. Even if they experienced negative outcomes, it would still be more beneficial than denying them treatment altogether.
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Overall, I believe that based on a consequentialist perspective, the creators of the algorithm are ethically responsible for the harm caused and have a duty to correct this for future patients. One possible solution would be removing race from the algorithm's calculations and having physicians separately inform patients of their risks. This allows the patient better control and access to medical treatments and physicians to uphold their ethical responsibilities to do no more by acquiring patient consent.