Medicine often falls short of helping black, indigenous, and people of color (BIPOC). While many individuals successfully invoke medical framing to offer some assistance to address the serious burdens they face — as I explain in a recent article — such efforts have fallen short in the context of racial justice. BIPOC are either subject to hypervisibility — where their medical trait is made a defining characteristic of their existence — or medical erasure, where their medical needs are left unaddressed and ignored.
BIPOC experience medical erasure within the medical system itself. Michele Goodwin describes how the medical need of a middle-aged black woman was ignored by medical staff, who called the police and helped disconnect her oxygen mask, as she collapsed and died on the hospital steps. Kimani Paul-Emile explains how frontline healthcare workers of color face both discrimination in their workplace, and higher rates of medical need — but how those medical needs are often left unmet. Claudia Haupt describes problems with accessing health advice within a doctor-patient relationship. Wendy Epstein and co-authors explain how the move to telehealth has likely left behind BIPOC.
The medical erasure BIPOC experience can affect their entire life cycle. Courtney Anderson and Thalia Gonzalez, with co-authors, write about how the negative health effects that BIPOC experience because of housing and educational inequity respectively go unnoticed. Osagie Obasogie and Keon Gilbert explain how in the context of policing and criminal justice, the health and medical dimensions of harm wreaked on black men are left ignored.
On the flipside, BIPOC are subject to hypervisibility. Seema Mohapatra describes how Asian-Americans have been subject to medical hypervisibility as the result of COVID-19 — or, as it is referred to in some quarters, the Chinese or Wuhan virus. Matiangai Sirleaf documents how the presumed availability of BIPOC bodies renders them into “guinea pigs” for medical trials, on the account of some activists. And Courtney Campbell explains how COVID-19 has reemphasized biological narratives of race — BIPOC need to be recruited into clinical trials because of their biological difference.
To understand the way medicine operates in the context of racial oppression, it is useful to invoke the concept of the “double bind” that appears most prominently in the context of sex-discrimination jurisprudence. As the Supreme Court explains in Price Waterhouse v. Hopkins, women are often subject to a “Catch-22” in the workplace. On the one hand, if they act too “feminine,” they are assumed not to be competent to perform their jobs. On the other, if they act too “masculine,” they are considered too abrasive, and also passed over.
Scholars of race have discussed the double bind only in seeking to explain how, when BIPOC adopt certain behaviors to fit in with their white colleagues, they lose the ability to integrate fully with their other BIPOC colleagues. Arguably, this dilemma is true for all minorities — assimilate, even collaborate — or separate, and suffer greater exclusion.
But the double bind concept as discussed in Price Waterhouse imagines a situation where conflicting demands apply simultaneously in a single social context. In the context of medicine, BIPOC fall into exactly this kind of double bind. Women are subject to conflicting demands from the same audience, that pressure them to both emphasize and conceal their femininity in ways that enhance their oppression. So too are BIPOC subject to forces that both emphasize and conceal their medical vulnerability.
Such double binds further oppressive relationships. On one hand, Goodwin, Mohapatra, Obasogie, Gilbert, and others show how these medical narratives justify exclusion and denigration. On the other, Campbell, Paul-Emile, and Sirleaf show that even while being treated as second class, as the “other,” BIPOC are used for extraction, exploited for clinical trials and their labor.
Is there any way out of this Catch-22, or are BIPOC inevitably subject to oppression when medicine is invoked? There are potential solutions, as the concluding post of this symposium will investigate. But any solution will require walking the tightrope of the medical double bind.
For more, please refer to Craig Konnoth, Race and the Medical Double Bind, Colum. L. Rev. Forum (forthcoming 2020).
Craig Konnoth is an Associate Professor of Law and Director of the Health Law Certificate Program at the University of Colorado Law School. Konnoth is the guest editor of Understanding the Role of Race in Health, a Bill of Health digital symposium.
