Racial Equity, Diversity and Inclusion in Bioethics: Recommendations from the Association of Bioethics Program Directors Presidential Task Force

Abstract

Recent calls to address racism in bioethics reflect a sense of urgency to mitigate the lethal effects of a lack of action. While the field was catalyzed largely in response to pivotal events deeply rooted in racism and other structures of oppression embedded in research and health care, it has failed to center racial justice in its scholarship, pedagogy, advocacy, and practice, and neglected to integrate anti-racism as a central consideration. Academic bioethics programs play a key role in determining the field’s norms and practices, including methodologies, funding priorities, and professional networks that bear on equity, inclusion, and epistemic justice. This article describes recommendations from the Racial Equity, Diversity, and Inclusion (REDI) Task Force commissioned by the Association of Bioethics Program Directors to prioritize and strengthen anti-racist practices in bioethics programmatic endeavors and to evaluate and develop specific goals to advance REDI.

Keywords:

• Biomedical research
• DEI
• education
• history
• race and ethnicity
• research ethics

INTRODUCTION

Over the past several years, calls to address racism both in medicine and the field of bioethics reflect a sense of urgency to mitigate the lethal effects of a lack of action by scholars and institutional leadership in the field of bioethics and in medicine more broadly (Baker 2023; Barwise et al. 2021; Bogdan-Lovis, Kelly-Blake, and Jiang 2022.; Braddock 2021; Fabi and Goldberg 2022; Fletcher et al. 2022; King and Hines 2021; Parsi and Dudzinski 2022; Ray 2021; Riaz et al. 2022). These appeals are not new; Black bioethicists have long made such calls and pushed for attention to racism in medicine (Dula 1994; Fletcher et al. 2022; Galarneau 2022; Secundy and Nixon 1998). While the field was catalyzed in response to pivotal events such as the US Public Health Service (USPHS) Untreated Syphilis Study at Tuskegee (Brandt 1978; Gamble 1997; Parsi 2016; Reverby 2009), subsequent ethical oversight focused on consent, rather than the pernicious effects of racism in biomedicine. It was only in the late 1980s and early to mid-1990s, such as in the Report of the Secretary’s Task Force on Black and Minority Health, or the Heckler Report (Heckler 1985), when inequities in health care, and racism started to be recognized in bioethics. Despite these efforts, the field has failed to center racial justice in its scholarship, pedagogy, advocacy, and practice, and neglected to integrate racism as a central consideration (Burton 2007; Danis, Wilson, and White 2016; Galarneau and Smith 2022; James 2022a; Mithani, Cooper, and Boyd 2021; Myser 2003; Ray et al. 2023; Russel et al. 2023; Wilson 2021a, 2021b). Bioethics leadership has long sidelined racism as a topic in bioethics—treating it as “unscholarly” or as the responsibility of other disciplines (Bogdan-Lovis, Kelly-Blake, and Jiang 2022; Fletcher, Lapite, and Best 2023), and leaving scholars to argue repeatedly for recognition of its importance and impact, rather than make progress toward “how to do anti-racist work in our research, teaching, and clinical activities” (James 2022a, 22). Thus, we contend that directors of bioethics programs have a moral and professional responsibility to tackle epistemic injustices, specifically the lack of racial diversity inherent in the field of bioethics (Pierson et al. 2024). These leaders must center Racial Equity, Diversity, and Inclusion (REDI) in their programmatic efforts to advance social justice in the field of bioethics.

THE ASSOCIATION OF BIOETHICS PROGRAM DIRECTORS (ABPD) PRESIDENTIAL TASK FORCE ON RACIAL EQUITY, DIVERSITY, AND INCLUSION (REDI)

Anti-racism and a robust understanding of REDI should be central to the work of existing and future bioethicists enrolled in bioethics degree-granting programs. Unfortunately, rubrics or efforts to measure and assess anti-racism in bioethics are sorely lacking. While few have systematically studied whether and how anti-racism is integrated into bioethics program requirements, Kalevor et al. (2021) found that mention of racism in the course descriptions of three well-known bioethics programs was limited and when it did appear, was overwhelmingly present in elective courses. Shifting norms in the field of bioethics to promote anti-racist work will require the work of bioethics leaders to take concrete steps toward practice that supports REDI. Recognizing bioethics programs as critical sites of intervention for anti-racism, the Association of Bioethics Program Directors (ABPD), which represents the leadership of over 100 academic bioethics programs in North America (https://www.bioethicsdirectors.net/), commissioned a two-year task force to provide guidance on addressing REDI. This followed the adoption of the ABPD statement on Violence, COVID, and Structural Racism in American Society issued in response to the killing of George Floyd by Minneapolis police in 2020 and signed by over 300 directors and faculty of bioethics programs and centers across the US and Canada to commit to focusing on racism, both individually and collectively, through concrete actions to change the field (ABPD 2020).

The REDI Task Force was commissioned by ABPD Past President Christine Mitchell in 2021 and was co-chaired by ABPD President Sandra Soo-Jin Lee and Clarence H. Braddock, and included ABPD directors and other bioethics scholars¹ invited to offer lived and professional expertise and leadership in anti-racism in bioethics. Task Force members (the authors of this article) represent scholars from a range of disciplines and fields, including anthropology, bioethics, public health, feminist studies, law, medicine, nursing, philosophy, religious studies, and sociology; and a range of career stages and ranks across twelve institutions in North America. The REDI Task Force met for over 100 hours in bi-weekly, virtual meetings from May 2021 until May 2023. Meeting minutes of the discussion and seminal resources volunteered by members were distributed to the group. In response to its charge to explore and recommend strategies for improving REDI in the field of bioethics, and how program directors could substantively advance the field toward REDI goals, the Task Force used the questions in Table 1 to guide the work:

Table 1. ABPD REDI task force guiding questions.

What is the current state of racial diversity and inequities in the field of bioethics?

What problems, causes, and consequences are associated with existing inequities and a lack of diverse perspectives and voices in bioethics?

What are individual and institutional responsibilities for improving diversity, equity, and inclusion in bioethics aimed at sustainable change and transformation in the field?

Are there indicators or assessment tools for examining REDI in bioethics programs?

What strategies, actions, and funding sources would improve diversity in bioethics research, practice, and education?

The Task Force engaged in deliberative dialogue, shared experiences, and discussed ideas about the barriers and potential facilitators to REDI in bioethics programs and the field, more generally. The Task Force also collaborated on APBD-sponsored initiatives, including the ABPD “Expanding REDI in Bioethics” workshop in Spring 2022 and a survey of efforts to address racism in bioethics training programs led by the NIH Center for Clinical Bioethics.² Through its work, the Task Force identified a set of draft recommendations and potential processes for achieving REDI goals in bioethics programs. Task Force co-chairs Braddock and Lee presented these at the annual ABPD Fall Meeting in October 2022. Task Force members led breakout group discussions to invite members’ feedback on each of the recommendations, which was considered and integrated into the final recommendations. The Presidential Task Force on Racial Equity, Diversity, and Inclusion in Bioethics Report (ABPD REDI Task Force Report) was presented and approved by the ABPD Board and distributed to members in March 2023. At the annual ABPD Spring Meeting later that month, Task Force members Shawneequa L. Callier, Jennifer E. James, Ubaka Ogbogu, and Christine Mitchell led a discussion of the REDI recommendations in a plenary panel “ABPD Leadership on REDI”.

Drawing on the ABPD REDI Task Force Report, which urges leaders in bioethics to promote REDI in the field, we argue in this article that to reckon with the failure to promote anti-racism, leaders in bioethics must recognize the field’s role in perpetuating systemic racism and create fundamental change in all aspects of bioethics. This includes ensuring that all those doing the work of bioethics should be competent in discussing racism, its expressions (interpersonal, cultural, institutional, structural), and adaptations over time, as well as arguments for its moral wrongness and effective responses to it. Meaningful change will require more than recognition; to prioritize and achieve these goals, resources (financial, time, attention) will need to be identified, allocated, and utilized. It will also require identifying responsibilities and systems of accountability. Critical to this work are meaningful collaborations and partnerships that recognize that organizations, programs, and individuals are differently positioned and have distinct, but complementary work to do in bioethics. The purpose of these recommendations is to guide bioethics scholars, program directors, and organizational leaders to strengthen anti-racist practices in bioethics and to evaluate and develop specific goals to advance REDI.

RECOMMENDATIONS FOR REDI IN BIOETHICS

Bioethics program directors, organization leaders, funders of bioethics research, and others who play key roles in influencing the field are critical to establishing practices that support research on and with diverse populations and stakeholders that is inclusive of values and worldviews, and efforts that center REDI. The following nine recommendations (Table 2) are directed to these leaders who significantly shape the development of the field and are grouped under three domains: attracting, training, and retaining REDI scholars; advocacy and community outreach; and assessment and continuous learning. Although not an exhaustive consideration of the broad range of issues that deserve attention, this article is intended to promote action on REDI commitments and to encourage the development of best practices. Each of the nine recommendations includes bulleted “essential questions” that highlight steps for realizing specific goals. The recommendations are intended to be synergistic. For example, efforts related to integrating REDI as core to bioethics teaching can build on and contribute to partnerships through community engagement. Because our Task Force identified issues of REDI related to what counts as bioethics and who is in the field, we refer to both REDI scholarship and “REDI Scholars”—the latter referring to those who bring lived experience to REDI perspectives of the field.

Table 2. Association of bioethics program directors REDI task force recommendations.

Attracting, Training, and Retaining REDI Scholars	Recommendation 1. Promote scholarship and research on and with diverse populations and stakeholders that is inclusive of a broad range of values and worldviews, and which centers REDI.	Who do you cite in your bioethics scholarship? Which works are considered required reading in your bioethics programs and why? How well does your bioethics scholarship reflect the lived experiences of people who have been minoritized as result of racism? Which frameworks in bioethics are called upon to conceptualize and address ethical problems?
	Recommendation 2. Develop funding models to sustain REDI and REDI scholars in bioethics.	What type of funding supports REDI scholarship and REDI scholars? How do funding models in bioethics differ for REDI and non-REDI scholarship and scholars? What are the mechanisms for sustainable support of REDI scholarship and REDI scholars in bioethics?
	Recommendation 3. Integrate REDI as a fundamental framework in the education of bioethics to students in a broad range of professional training, including medicine, public health, nursing, social work, and other allied health fields.	How are race and racism taught in bioethics courses? What must a bioethicist know about the history of race and the impact of racism on health and science? What REDI scholarship is required in your bioethics courses and by whom are they taught?
	Recommendation 4. Support REDI scholars through mentorship, sponsorship and leadership opportunities.	How many REDI scholars are in your program? How does your mentorship and sponsorship reflect a commitment to REDI? How is a commitment to REDI reflected in your tenure and promotion policies, processes and outcomes?
	Recommendation 5. Integrate REDI into program governance and policies to ensure equitable treatment.	How is service and specifically, REDI work (eg. DEI committees and DEI statements), distributed and compensated? Are salaries and other forms of compensation equitable across faculty and staff? How has REDI informed leadership opportunities and succession plans?
Advocacy and Community Outreach	Recommendation 6. Adopt a REDI lens in policy, advisory and consultative roles.	Do policy, advisory and research and clinical consultation recommendations consider implications for REDI as standard practice? Do the bioethics organization, editorial boards, review sections and other bodies reflect a commitment to REDI in their membership? Is ongoing training on REDI required for advisors, consultants, and reviewers you engage?
	Recommendation 7. Build equitable partnerships with communities that return concrete value to those communities.	How have you invited historically marginalized communities to participate in bioethics? What roles do these communities play in collaborations? What value do these communities derive from these partnerships? What mechanisms and approaches support sustainable relationships over time?
Assessment and Continuous Learning	Recommendation 8: Integrate REDI by committing funding and other resources to achieve REDI goals within a specific timeline.	How many REDI scholars can your program support within the next five years? What courses related to REDI need to be developed to offer students training by 2025? What mechanisms could produce accountability for REDI goals?
	Recommendation 9. Develop assessment tools and measure progress on REDI through collaboration.	What does progress mean in your local context? How would you measure change and identify facilitators and barriers? How are you learning from others who have made progress toward REDI goals?

The REDI Task Force’s focus on anti-racism is not meant to exclude other forms of oppression or minimize the realities of intersectional identity for the goals of achieving equity in bioethics. Scholars have argued for the conceptual utility of intersectionality in connection to activism (Danis, Wilson, and White 2016; Grzanka, Brian, and Shim 2016), underscoring the co-production and imbrication of marginalizing categories such as race and disability (Valentine 2022). Task force members recognize that a focus on anti-Black racism may lead to what scholars have noted as homogenizing visions of Blackness, especially in a global context (Afolabi 2021; Ogbogu and Hardcastle 2021). This global context has not been central to discussions of racism and bioethics despite scholarship from outside the US that has highlighted the particularities of racism and bioethics (e.g., in Australia, see Borell 2021; Mayes, Paradies, and Elias 2021). Confronting epistemic injustice demands examining “our cognitive biases against certain groups of people as knowers” in bioethics and medicine (Del Pozo and Rich 2021, 90). Addressing epistemological gaps requires consideration of a broader set of methodologies, and conceptual and normative frameworks, in bioethics that integrate a wider range of perspectives and stakeholders than have been included in the past.

Bioethics program directors, organization leaders, funders of bioethics research, and others who play key roles in influencing the field are critical to establishing practices that support research on and with diverse populations and stakeholders that is inclusive of values and worldviews, and efforts that center REDI. The following nine recommendations are directed to these leaders who significantly shape the development of the field and can promote action on REDI commitments.

ATTRACTING, TRAINING, AND RETAINING REDI SCHOLARS

The “broken pipeline” is often cited as the primary challenge to recruiting faculty, staff, and trainees of color into bioethics programs, and used to explain why there are so few leaders of color in the field. While building pathways into the field is critical, confronting why the overwhelming majority of bioethics programs has failed to attract and retain scholars of color must take into consideration of a range of complex dynamics. These include whether and how questions of justice and methodologies prioritized by scholars committed to centering the lived experience of minoritized populations, such as community-engaged research, are promoted and funded by the field (Ray 2020). A commitment to REDI also requires introspection on how leadership in the field welcomes and supports scholars of color who raise critical questions about equity to create an open and welcoming intellectual space for this work. Scholars of color may be more likely to be hired into departments and programs that value a critical lens and focus on power, such as feminist studies, race and ethnic studies, and public health, where questions of race are central to the field’s identity (Sharif et al. 2022) and supported through research funding.

Recommendation 1. Promote Scholarship and Research on and with Diverse Populations and Stakeholders that is Inclusive of a Broad Range of Values and Worldviews, and which Centers REDI

• Who do you cite in your bioethics scholarship? Which works are considered required reading in your bioethics programs and why?

• How well does your bioethics scholarship reflect the lived experiences of people who have been minoritized as result of racism?

• Which frameworks in bioethics are called upon to conceptualize and address ethical problems?

A fundamental challenge to REDI in bioethics is the field’s Eurocentric ideology uncritical of colonization and imperialism that informs training, scholarship and policymaking (Galarneau 2021). Scholars have emphasized the importance of analyzing and acting on the norms of bioethics that perpetuate racism and injustice. James and Iacopetti (2021), for example, have argued that choices regarding objects of study in the field have ethical implications, that “[o]mission of academic perspectives from BIPOC experts is likewise an ethical choice that amounts to erasure,” and they have encouraged bioethicists to recognize agency and “take ownership for the racism in such actions” (57). There are barriers to considering other perspectives, such as Afrocentric or Indigenous views that do not align with dominant ethical frameworks that emphasize values such as individual autonomy as well as risk and benefit with less focus on solidarity and the common good (Bogdan-Lovis, Kelly-Blake, and Jiang 2022; Kotalik and Martin 2016; Tsosie 2012). Bioethics must be open to traditions and frameworks that can provide a fulsome approach to questions of justice and inclusion of historically marginalized perspectives.

Recommendation 2. Develop Funding Models to Sustain REDI and REDI Scholars in Bioethics

• What type of funding supports REDI scholarship and REDI scholars?

• How do funding models in bioethics differ for REDI and non-REDI scholarship and scholars?

• What are the mechanisms for sustainable support of REDI scholarship and REDI scholars in bioethics?

Critically important to REDI-informed bioethics is addressing the limitations of funding models that currently support bioethics scholars and programs. Bioethics positions, predominantly in medical schools and academic centers, often rely on grant funding which introduces instability and can create economic uncertainty for professional advancement compared to “hard money” salaried positions in faculties of academic departments in the arts, humanities, social and natural sciences, and schools of law. These challenges are exacerbated for scholars focused on REDI due to well-documented racial and ethnic disparities in who receives the largest and most coveted federal grants (Ginther et al. 2011; Katz and Matter 2020; Lauer and Roychowdhury 2021; NIH Office of the Director 2022). These disparities are further entrenched by prioritizing disease-focused research over the examination of social systems and structures on health outcomes. While the National Institute of Minority Health and Health Disparities aims to address health inequities, the institute has one of the smallest budgets and lowest award rates at the NIH (Gilpin and Taffe 2021). Furthermore, studies have revealed that researchers and scholars of color are not only less likely to receive career-sustaining awards (Gibbs et al. 2022), but this gap is linked to the questions prioritized by scholars of color and the type of studies proposed, particularly community-engaged research (Hoppe et al. 2019). Even when funded, community-engaged research often requires more time and resources due to the collaborative nature of the work, which may not translate quickly into publication in high impact science journals as is required for tenure and promotion in academic medical centers. Furthermore, ongoing inequities within the research ecosystem reveal that grant funding, a critical metric for academic promotion and institutional support, is more likely to flow to highly-resourced academic research centers rather than minority-serving institutions and programs with a higher proportion of researchers and scholars of color. This model creates structural barriers that only further entrench inequities having long-term consequences for not only who advances in the field, but which questions are promoted to define the field.

New models for bioethics research and scholarship that focus on the experiences of historically minoritized racial and ethnic communities led by researchers and scholars from these communities are needed and require new pathways to intervene on these structural barriers. Efforts by NIH, such as administrative supplements for Research and Capacity Building Efforts Related to Bioethical Issues (NIH 2024b) and to Recognize Excellence in Diversity, Equity, Inclusion, and Accessibility (DEIA) Mentorship (NIH 2024a), are examples of mechanisms that can begin to build the needed expertise in the field.

Recommendation 3. Integrate REDI as a Fundamental Framework in the Education of Bioethics to Students in a Broad Range of Professional Training, including Medicine, Public Health, Nursing, Social Work, and Other Allied Health Fields

• How are race and racism taught in bioethics courses?

• What must a bioethicist know about the history of race and the impact of racism on health and science?

• What REDI scholarship is required in your bioethics courses and by whom is it taught?

Pedagogy and training are core areas for realizing the goals of REDI, necessitating an in-depth assessment of whether and how REDI is requisite in bioethics programs that are producing the next generation of bioethicists. What should researchers trained in bioethics programs know about race, racism, and racial justice, and what does it mean to integrate a REDI lens into bioethical questions?

Some bioethicists have argued that analyzing racism and health is beyond the expertise and responsibility of most bioethicists, even in cases with demonstrated health impacts such as racism and policing (Baker 2016; Reardon et al. 2023). Rather than shy away from these questions of health and justice, bioethics programs should commit to training bioethics scholars in REDI issues to achieve competency in identifying racism, its expressions (interpersonal, cultural, institutional, structural), and adaptations over time in a broad range of settings both inside and outside medicine and “traditional” sites of public health concern (Goodwin and Lynch 2022). Engagement with racism and examining how it shapes today’s narratives about the field can open new possibilities for stronger anti-racist practices (Galarneau 2022; Wilson 2022a).

Bioethics program directors and those who teach and lead bioethics training programs should review their educational offerings for REDI focus and content. This should include an inventory of current literature and references in REDI, and syllabi of courses focused on REDI topics and concerns. Particular attention should be paid to what literature is required and/or recommended for bioethics students and trainees; and what are they required to know about core concepts in REDI scholarship and how they may be applied in bioethics. Identifying the potential gaps in building REDI knowledge is a first step to building an effective bioethics workforce. Organizations such as ABPD or ASBH could be instrumental in identifying key texts and resources through their membership for bioethics programs. Such efforts could be augmented by leveraging the expertise of community groups, other organizations, and members of the public to engage in bioethics discourse as part of their training and teaching activities.

To advance these efforts, leading organizations in bioethics should create mechanisms for sharing teaching resources and best practices for teaching REDI across programs and support programs and instructors to develop course and training materials. This will be especially important in light of increasing regulatory pressures in some states to abolish coursework on racism. Bioethics organizations have a special role for leadership in demonstrating their commitment and support of REDI and should collaborate on efforts, including co-sponsoring workshops and seminars focused on teaching REDI in bioethics that feature scholars who center REDI in scholarly work.

Recommendation 4. Support REDI Scholars through Mentorship, Sponsorship and Leadership Opportunities

• How many REDI scholars are in your program?

• How does your mentorship and sponsorship reflect a commitment to REDI?

• How is a commitment to REDI reflected in your tenure and promotion policies, processes and outcomes?

Mentorship is a critical component for any emerging scholar’s success. Effective, ongoing mentorship is even more important for REDI scholars who may be unwelcome in or alienated by a field dominated by Eurocentric scholarship and historical whiteness. Integrating REDI will rely on the field’s ability to create effective mentorship between junior and senior researchers across bioethics programs. This is particularly important for scholars working in the areas of race and ethnic studies, gender studies, religious studies, and other fields that have been considered outside of the field of bioethics, yet whose work and voices are critical for integrating REDI in scholarship and teaching.

Recent decisions by the US Supreme Court on affirmative action (Students for Fair Admissions, Inc. v. President and Fellows of Harvard College; Students for Fair Admissions; Inc. v. (2023) University of North Carolina et al.), may further exacerbate the systemic failure to bring scholars into the field. Pathway programs that center diversity, equity, and inclusion, and use the language of race in their admissions process are subject to scrutiny in light of the judicial rulings. Bioethics as a field has a responsibility and opportunity to provide leadership in upholding the value of racial equity and the need for promoting anti-racism in the training of not only the next generation of bioethics leaders and scholars, but also equitable representation of scientists, researchers, and healthcare providers.

To support REDI scholars, programs should adopt goals of sponsorship which prioritizes financial support, advocacy and creating and sustaining supportive networks (Ayyala et al. 2019). Developing deep, impactful mentoring relationships is critical for the professional advancement of REDI scholars. By pursuing goals of sponsorship, bioethics programs should build a strong cohort of emerging leaders in the field committed to REDI through fellowship programs aimed at cultivating leadership skills. Such programs should offer foundational training in identifying and supporting REDI through peer mentorship. Leading bioethics organizations, such as the ABPD, could support these efforts by creating partnerships across programs that include sponsored “visits” to meet faculty and students with the aim of building professional networks and gaining practical leadership skills.

Bioethics programs should consider long-term plans for changes in leadership and cultivate the seeding of new leaders through the promotion of scholars focused on REDI. Bioethics organizations should support the fair and equitable promotion of REDI scholars for tenure and promotion by providing guidance to senior faculty on how to support the development of emerging leaders in the field that center REDI in their work. This may include resources to assist program leaders to explain the importance of REDI scholarship for bioethics in creating candidate case files and to contextualize the contribution of REDI work and REDI scholars to the development of the field. When determining positions of leadership, bioethics programs should use a REDI lens. This includes creating succession plans and the possibility of leadership term limits to allow for the promotion of faculty and staff of color.

Recommendation 5. Integrate REDI into Program Governance and Policies to Ensure Equitable Treatment

• How is service and specifically, REDI work (e.g., DEI committees and DEI statements), distributed and compensated in your program?

• Are salaries and other forms of compensation equitable across faculty and staff?

• How has REDI informed leadership opportunities and succession plans?

Institutions and programs in bioethics should develop governance policies and practices that reflect and are accountable to REDI goals; for example, mechanisms for assuring pay equity and specifically, addressing non-paid work that contributes to the “minority tax” that can lead to significant burnout. This includes distributing service and unpaid labor assignments, such as committee work, determining compensation, and providing funds for travel, etc. To ensure equity, programs should collect data on disparities in pay equity across programs and provide resources for members to use when negotiating for institutional resources.

ADVOCACY AND COMMUNITY OUTREACH

Bioethicists are often called upon to contribute their expertise to policy and advocacy. This includes stakeholder and community engagement. Incorporating REDI is essential for developing equitable and ethical relationships with public partners and communities. By integrating community-engaged and community based participatory research, bioethics can learn from communities how to address issues related to justice and think more expansively about communities as partners in REDI.

Recommendation 6. Adopt a REDI Lens in Policy, Advisory, and Consultative Roles

• Do the policy, advisory and research and clinical consultation recommendations consider implications for REDI as standard practice?

• How do bioethics organizations, editorial boards, review sections and other bodies you serve demonstrate a commitment to REDI in their membership?

• Is ongoing training in REDI required of the advisors, consultants, and reviewers you engage?

Bioethicists should address REDI issues and concerns in their roles as advisors and consultants to institutions, institutional leaders, members of state and national governments, international oversight committees, and other bodies. For many bioethicists, this will require educational programs and training on bias, systemic racism, and discrimination. By promoting best practices in REDI, bioethicists should develop REDI guidelines for serving in advisory and consultative roles, including on editorial boards, study sections, review committees, conference organizing committees, and other leadership bodies. For example, a REDI lens may require refusal to serve on committees that do not include researchers or scholars of color.

Numerous scholars have called for a more engaged practice of bioethics, both through activism (Mithani, Cooper, and Boyd 2021) and through public involvement and consultation (Viaña, Raman, and Barber 2021); they have called on bioethics organizations to do much better in political and activist engagement and have argued that bioethicists need to take a much more upstream approach to activism on social determinants of health. Leadership in the field will be important in addressing racism in clinical ethics as well; notably the importance of consultants to identify racism and to propose action rather than staying silent to perform a sense of neutrality. Bioethics organizations have an important role. Organizations such as the American Society of Bioethics and Humanities (ASBH) have developed core competencies towards “understanding of how cultural and religious diversity, as well as biases based on race, ethnicity, gender, and disability, informs the context of an ethics case consultation” (ASBH Statement 2020; Olszewski et al. 2021; Riaz et al. 2022). Integrating this type of training as essential to policy and advocacy work in bioethics will be important.

Recommendation 7. Build Equitable Partnerships with Communities Historically Impacted by Racism that Return Concrete Value to those Communities

• How have you invited historically marginalized communities to participate in bioethics?

• What roles do these communities play in collaborations?

• What value do these communities derive from these partnerships?

• What mechanisms and approaches support sustainable relationships over time?

When bioethics programs and bioethicists engage historically minoritized communities, they should adhere to an ethics of equitable engagement that is not transactional and ensures reciprocity. This includes avoiding relationships with communities that are merely instrumental or a means to an end, but rather engage communities with mutually-agreed upon goals and purpose (Ogbogu and Hardcastle 2021; Sodeke 2016). This begins with supporting communities to drive discussions of what value means to the community in these partnerships and allocating institutional resources and developing mechanisms for engaging communities. Scholars have focused on the importance of centering the lived experience of communities and to resist using community engagement as a tool to serve the needs of programs and institutions (Galarneau 2020; Wilson 2022b). Engaging community represents a commitment to understanding the priorities, needs, and values of the community through sustained, non-transactional relationships (James 2022b). This will require moving beyond seeking community feedback on a singular study or intervention and shifting to long-term, sustainable relationships that require programmatic commitment (Lee 2021). For example, when community members contribute their time, expertise, and experience, they should be acknowledged and compensated for their work, including participation in consultations, grant development, public speaking, and policy-related collaborations. Bioethics programs should develop partnerships that demonstrate the value of community-based work and advocacy when evaluating faculty and staff activities in their programs, including teaching, research, scholarship and consulting, and policy work.

ASSESSMENT AND CONTINUOUS LEARNING

Recommendation 8: Integrate REDI by Committing Funding and Other Resources to Achieve REDI Goals within a Specific Timeline

• How many REDI scholars can your program support within the next five years?

• What courses related to REDI need to be developed to offer students training by 2025?

• What mechanisms could produce accountability for REDI goals?

Policies and practices should reflect a commitment to REDI. Bioethics programs should review their practices and consider revisions to be more inclusive of scholars of color in the field. This means assessing why REDI scholars may not be well represented or feel welcomed in programs and making changes. A commitment to REDI requires concrete milestones that reflect a monetary commitment. For example, a bioethics program should identify the number of scholars it intends to recruit and/or promote with detailed timelines and dedicated financial investments to achieve programmatic goals of centering REDI. A REDI lens should be normalized and integrated into everyday practices. Importantly, reviewing, integrating, and improving approaches to recruitment and retention, sponsorship programs, community engagement, tenure and promotions, and other avenues should be routinized. Programs should regularly evaluate progress on their commitment in practices and policies to determine if REDI efforts have been impactful. Strategies incorporating REDI over time should be integrated into strategic plans. Successful practices and policies should be shared across programs to help programs improve their progress toward REDI goals.

Recommendation 9. Develop Assessment Tools and Measure Progress on REDI Through Collaboration

• What does progress toward equity mean in your local context?

• How would you measure change and identify facilitators and barriers?

• How are you learning from others who have made progress toward REDI goals?

To make sustained and meaningful change in the field, tools that assess and measure progress will be necessary. Creating systematic evaluation measures can have a significant impact on practice at the individual and institutional levels. For example, the Racial Justice Report Card (RJRC) developed by White Coats for Black Lives (WC4BL 2022), a medical trainee-run organization, is a national assessment resource that prioritizes transparency.³ The RJRC consists of metrics that evaluate an academic center’s curriculum and climate, student and faculty diversity, policing, racial integration of clinical care sites, treatment of workers, and research protocols. As a work in progress, the RJRC is an aspirational approach to encourage academic medical centers to take seriously their responsibility to enact anti-racist medical education and care. Other tools that assess organizational racial equity include Moving a Racial Justice Agenda: Organizational Assessment: Are You Ready (Westerm States Center)? Additionally, there is the Organizational Assessment Rubric (Western States Center) and the four stage process “Démos’ Racial Equity Transformation: Key Components, Process & Lessons,” (McGhee et al. 2021) which comprises foundational analysis, organizational assessment, and learning and implementation (see Table 3). Tailoring existing tools and frameworks for centering goals of REDI in bioethics can provide concrete and strategic goals.

Table 3. Tools and resources for REDI assessments of bioethics organizations.

Moving a Racial Justice Agenda: Organizational Assessment: Are You Ready? Organizational Assessment Rubric. Diversity, Equity, and Inclusion (DEU) Organizational Assessment Tools: A Resource Guide Racial Equity Tools: Organizational Assessment Tools and Resources Assessing Organizational Racism Race Forward’s Racial Equity Impact Assessment Démos’ Racial Equity Transformation: Key Components, Process & Lessons

Leading bioethics organizations have an opportunity to engage bioethics program leadership, funders, and other key stakeholders to develop and adopt REDI best practices for the field. The Hastings Center Sadler Fellows Program⁴ and the Hastings Center Summer Bioethics Program for Underrepresented Undergraduates⁵ serve as promising models. Bioethics programs and organizations should use their convening power and influence in the field to develop tools, resources and expertise to support the development of an assessment tool that can collect data on REDI and evaluate progress. This should include an evaluation of the scope of the anti-racism work that is being done in bioethics, and changes over time.

CONCLUSION

Despite the central role of racism in the atrocities that led to the founding of bioethics, the field has failed to confront its own structural racism and confront the profound impact that it has had on the constitution of the field: who is a bioethicist, what knowledge is centered in bioethics training and which questions are prioritized for scholarly work. Change will require a commitment of individual and collective action. While not exhaustive of all that can be done to center REDI in bioethics, these recommendations build on the important work by bioethicists and other scholars in charting a path toward a REDI-forward future for the field.

Camisha Russell argues for the power of self-transformation for both clinicians and bioethicists, asserting that attention to anti-racist reflection and praxis by individuals can shift broader norms of these fields (Russell 2022). Much of this work has occurred through participation in social movements and community-based organizations such as faith communities, outside of academia. Parsi and Dudzinski highlight the importance of this notion of praxis drawn from Camisha Russell, as well as the importance of moving toward actionable guidance for meeting Russell’s goal of “all hands on deck” toward anti-racism in bioethics (Parsi and Dudzinski 2022). Working across our field will require leadership from within the field and collaboration grounded in a commitment to make positive change.

To conclude, anti-racism and a robust understanding of REDI should be central to the work of existing and future bioethicists. In the context of broader political battles over teaching on race and racism and state bans on diversity, equity, and inclusion (DEI) initiatives in the US, this may present further challenges. In the face of these obstacles, bioethics has a key role to play in articulating the importance of understanding the role of race, racism and other forms of structural power that have a profound and enduring impact on health and science. Ensuring that anti-racism is fundamental to what it means to be a bioethicist begins with evaluating whether and how a commitment to anti-racism is reflected in the field.

ACKNOWLEDGEMENTS

We thank the Association of Bioethics Program Directors (ABPD) and ABPD Past President Christine Mitchell for commissioning the REDI Task Force and supporting this work. We are also grateful for the early contributions of Yolonda Wilson and Rueben C. Warren. We thank Dounya Alami-Nassif and Angelica Johnson, who provided administrative support to the REDI Task Force without which this work would not have been possible.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work of the REDI Task Force was funded by the Association of Bioethics Program Directors (ABPD) and in-kind contribution from the Division of Ethics at Columbia University.

Notes

1 Clarence H. Braddock, Shawneequa L. Callier, Faith E. Fletcher, Charlene Galarneau, Nanibaa’ Garrison, Jennifer E. James, Sandra Soo-Jin Lee, Renee McLeod-Sordjan, Christine Mitchell, Ubaka Ogbogu, Nneka Sederstrom, Patrick T. Smith, and Alexis Walker.

2 The results of the survey, administered to members of the ABPD, the Association for Practical and Professional Ethics (APPE), and selected historically black colleges and universities (HBCU) with a bioethics focus, will be forthcoming.

3 Born out of the National White Coat Die-In demonstrations that took place on December 10, 2014, the mission of WC4BL has two primary aims: 1) dismantling dominant, exploitative systems in the US, which are largely reliant on anti-Black racism, colonialism, CIS heteropatriarchy, white supremacy, and capitalism; and 2) rebuilding a future that supports the health and well-being of marginalized communities.

4 https://www.thehastingscenter.org/diversity-equity-and-inclusion-at-the-hastings-center/sadler-scholars/.

5 https://www.thehastingscenter.org/diversity-equity-and-inclusion-at-the-hastings-center/summer-bioethics-program2024/.