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The Bioethics of Environmental Injustice · Health Ethics Podcast

• 0:10
  Speaker 1: Welcome to the COVID Ethics Series podcast, a conversation with
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  Speaker 1: leading experts about bioethical issues that have been exacerbated due
• 0:17
  Speaker 1: to the COVID nineteen pandemic. I'm Brian Pilkington, and I
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  Speaker 1: teach bioethics at Seatonhole University and at the Hackensack Marine
• 0:25
  Speaker 1: School of Medicine. I moderate the COVID Ethics Series in
• 0:28
  Speaker 1: cooperation with the IHS Library and IHS Student Life. This
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  Speaker 1: podcast is a spinoff collaboration with the IHS Library where
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  Speaker 1: we'll have the opportunity to go deep with the experts
• 0:40
  Speaker 1: from our series. Thanks for joining our conversation. Welcome everyone
• 0:55
  Speaker 1: to the Health Ethics Series podcast. I am Brian Pilkington,
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  Speaker 1: and it is my great pleasure to be chatting with
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  Speaker 1: Keisha Ray. Doctor Ray is the John McGovern, MD, Professor
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  Speaker 1: of Aslarian Medicine and an Associate professor at the McGovern
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  Speaker 1: Center for Humanities and Ethics at ut Health Houston, where
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  Speaker 1: she also serves as the director of the Medical Humanities
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  Speaker 1: Scholarly Concentration. She is also well known to folks in
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  Speaker 1: the bioethics world and a Hastings Center fellow to boot
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  Speaker 1: So Keisha, thanks so much for joining me. I really
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  Speaker 1: appreciate it.
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  Speaker 2: Thank you. I appreciate you having me here.
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  Speaker 1: Brian, So, I mean, you've written a ton of great stuff,
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  Speaker 1: but what I want to focus on today is considerations
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  Speaker 1: associated with climate. So in the American Journal of Bioethics,
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  Speaker 1: you recently have a thought thought provoking piece on justice
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  Speaker 1: and bioethics. The title of the pieces for folks listening
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  Speaker 1: along the bioethics of environmental and justice, ethical, legal, and
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  Speaker 1: clinical implications of unhealthy environments. And so you argue that
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  Speaker 1: bioethicists ought to pay greater attention to environmental and justices
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  Speaker 1: and the threats that such injustices pose to bioethics principles,
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  Speaker 1: health equity, and clinical care, ultimately arguing for the existence
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  Speaker 1: of an advocacy for a right to healthy environment. So,
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  Speaker 1: before we sort of jump into the details, and I
• 2:16
  Speaker 1: ask you to say a little bit more about it
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  Speaker 1: and unpack that argument. We have lots of folks from
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  Speaker 1: all over listening to the podcast, especially medical students who
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  Speaker 1: are interested in bioethics research. So what motivated you to
• 2:28
  Speaker 1: pick up this topic. Could you talk a little bit
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  Speaker 1: about that process.
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  Speaker 2: Yeah, you know, overall the topic of environmental injustice really
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  Speaker 2: started from my work embracial disparities and health care, particularly
• 2:42
  Speaker 2: those that affect Black people, and just drawing connections, but
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  Speaker 2: then also wanting to look at root causes of issues,
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  Speaker 2: root causes of why black people have poor health outcomes
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  Speaker 2: than other people, but not wanting to look at just
• 2:59
  Speaker 2: those sort of of easy or quick causes or even
• 3:03
  Speaker 2: those easy and quick solutions. And so the more that
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  Speaker 2: I started diving into, the more that I started diving
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  Speaker 2: into why Black people's health is so inferior in almost
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  Speaker 2: every outcome. We talk about cardiovascular disease, talk about respiratory diseases,
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  Speaker 2: we talk about cancer, we talk about diabetes, we talk
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  Speaker 2: about overall mortality, we talk about birthing. And so when
• 3:30
  Speaker 2: I started just connecting the dots and really saying, okay,
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  Speaker 2: what's the source of this environmental and justice just kept
• 3:37
  Speaker 2: coming up. It was inescapable. You cannot talk about black
• 3:41
  Speaker 2: people and respiratory illnesses without talking about where they live
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  Speaker 2: and how their lives and their neighborhoods, and where they work,
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  Speaker 2: and where they go to school and where they go
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  Speaker 2: to church, how it pollutes the air and the water
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  Speaker 2: that they're in And of course big instances that have
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  Speaker 2: been shown on television and in news sources like Flint,
• 4:00
  Speaker 2: Michigan in their water crisis, Jackson, Mississippi and their water crisis,
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  Speaker 2: the big BP oil spill. I remember that when I
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  Speaker 2: was a kid, and that was a very big deal.
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  Speaker 2: And so when you just keep seeing who is suffering
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  Speaker 2: the most from environmental pollutants in air and water, you
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  Speaker 2: can't help but see that if black people, Latino people,
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  Speaker 2: and indigenous people, people in the Global South, people from
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  Speaker 2: poorer incomes are the ones that are most infected by
• 4:27
  Speaker 2: environmental pollutants, and those are the same people that have
• 4:31
  Speaker 2: the worst health outcomes. You can't ignore connections. And if
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  Speaker 2: you really want to talk about the root, cause you
• 4:36
  Speaker 2: really want to talk about the source of poor health,
• 4:39
  Speaker 2: you have to talk about the places where we live
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  Speaker 2: and how we cannot be expected to be healthy in
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  Speaker 2: unhealthy environments. And so I've done some preliminary work on
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  Speaker 2: environmental injustice, and this article just seemed like the next
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  Speaker 2: necessary step, and I wrote this with my partner Jane Cooper,
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  Speaker 2: and it's really a way for us to look at
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  Speaker 2: the ethics of it, which is my specialty for her
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  Speaker 2: as a legal scholar to think about how we can
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  Speaker 2: use the law to think about environmental injustice, and how
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  Speaker 2: we can use the law to talk about a right
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  Speaker 2: to healthy environments, and how we really need to be
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  Speaker 2: using legal measures to ensure that more people have access
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  Speaker 2: to clean air and clean water. So it's really this
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  Speaker 2: sort of meshing of two different disciplines but ones that
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  Speaker 2: are equally important when we talk about why unhealthy environments
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  Speaker 2: matter so much to our lives.
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  Speaker 1: That are really helpful sort of framing. And thank you
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  Speaker 1: for mentioning your co authit because again, one of the
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  Speaker 1: reasons that the article is so powerful, I think is
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  Speaker 1: the interdisciplinary nature of it and such a nice illustration
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  Speaker 1: for medical students and everyone who's sort of interested in
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  Speaker 1: interdisciplinary approaches to bioethics. So well, I mean, I take
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  Speaker 1: it some folks who listen to the show will read
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  Speaker 1: the paper, some folks won't have read the paper. That's
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  Speaker 1: a great framing, But do you want to unpack any
• 6:06
  Speaker 1: of the specific features of the argument. Was there part
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  Speaker 1: of the argument that you found especially powerful or give
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  Speaker 1: us the quick sort of put a little meat on
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  Speaker 1: the bones as it were.
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  Speaker 2: Yeah. Absolutely, you know, when you're first, starting off your
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  Speaker 2: training as an ethicist, you always hear that age olds
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  Speaker 2: saying just because it's ethical doesn't make it legal, and
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  Speaker 2: just because it's legal doesn't make it ethical. And so
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  Speaker 2: we really wanted to dive into that and to say, okay,
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  Speaker 2: let's talk about what has been done legally to protect
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  Speaker 2: the environment, but that doesn't necessarily mean that that's where
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  Speaker 2: ethics should stop. That there are ethical implications on healthy
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  Speaker 2: environments that the law does not necessarily cover. But that
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  Speaker 2: doesn't mean also that we can't use the law to
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  Speaker 2: influence how we should ethically be thinking about the environment.
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  Speaker 2: And so we go through these sort of legal steps
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  Speaker 2: that have already been taken, a lot of them taken
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  Speaker 2: by groups that have organized because they've seen or have
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  Speaker 2: experienced environmental injustice themselves. So you have lots of groups
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  Speaker 2: of indigenous people who have suffered from environmental justice, things
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  Speaker 2: like fracking, things like pollutants in their water, places like
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  Speaker 2: Hawaii who have army and military and navy pollutants polluters
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  Speaker 2: of their water sources. And you even have a lot
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  Speaker 2: of groups that have organized by teenagers and by young
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  Speaker 2: people who sayd hey, we want a better world. When
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  Speaker 2: you all these generations are gone and we're left to
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  Speaker 2: deal with the implications of climate change, We're left to
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  Speaker 2: deal with implications of pollutants. What kind of world are
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  Speaker 2: you leaving us? So we're going to use the law
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  Speaker 2: ourselves right now to make sure that we have a
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  Speaker 2: good planet left for us. So we go through these
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  Speaker 2: sort of legal measures, but then also thinking about how
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  Speaker 2: us as bio weth it's just how we can make
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  Speaker 2: environmental injustice or central part of our work. That there's
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  Speaker 2: no area in bioethics that does not touch upon environmental
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  Speaker 2: injustice in some way, even if we talk about it,
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  Speaker 2: just at the very basic that we can't do our
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  Speaker 2: work if our planets are healthy, right, I mean just
• 8:13
  Speaker 2: the very basic. How can I study AI and healthcare?
• 8:17
  Speaker 2: How can I study disability ethics? Right, whatever your topic is,
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  Speaker 2: your area of expertise, and bioethics, just at the base level,
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  Speaker 2: we don't get to do this work that we find
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  Speaker 2: meaningful if we have to relocate because of a wildfire,
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  Speaker 2: or we're to relocate because of hurricanes, or like mee
• 8:35
  Speaker 2: in Houston, we had a very bad storm and didn't
• 8:37
  Speaker 2: have internet and water and electricity for a few weeks.
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  Speaker 2: In some places that made working very difficult to do
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  Speaker 2: those kinds of things. And so after going through these
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  Speaker 2: legal measures, we go through the ethics and how it
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  Speaker 2: can affect how environmental injustice can affect clinical care, for instance,
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  Speaker 2: and we go through the story of in Canada, this
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  Speaker 2: doctor that had a patient come in suffering from the
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  Speaker 2: effects of heat and put climate change in her charters
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  Speaker 2: as the source of why she was suffering from this ailment,
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  Speaker 2: and how we keep asking physicians to patch us up,
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  Speaker 2: but they're only patching us up because our outside worlds
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  Speaker 2: are making us unhealthy. Our environments, our physical environments are
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  Speaker 2: making us patients and then sending us in need of
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  Speaker 2: clinical care to physicians who are working and doing their best,
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  Speaker 2: but they can only do so much because the world
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  Speaker 2: we live in, they're just sending us back into an
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  Speaker 2: unhealthy world. So thinking about clinical care health equity is
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  Speaker 2: something that by what this is from all areas always
• 9:42
  Speaker 2: talk about. It's become a buzzword, especially after the COVID
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  Speaker 2: nineteen pandemic. Everyone's talking about health equity. But once you
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  Speaker 2: start seeing that not everyone suffers from environmental pollutants and
• 9:54
  Speaker 2: climate change equally, and it affects our health in inequitable ways.
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  Speaker 2: You can't talk about health equity without also talking about
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  Speaker 2: a large factor that contributes to health and equity, and
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  Speaker 2: that's our environment, our physical environments. It is a large
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  Speaker 2: contributor to why some people have what they need for
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  Speaker 2: proper health and why some people don't. So we can't
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  Speaker 2: talk about that without environmental and justice. And then by
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  Speaker 2: what this is? You know, I always like to joke
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  Speaker 2: and say, buy what this is? Our principal bunch. We
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  Speaker 2: love our principles. We hold on to them real tight.
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  Speaker 2: Sometimes we don't want to let them go. We start
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  Speaker 2: them as our major framework, even when sometimes we shouldn't.
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  Speaker 2: I myself include to have been guilty of that, but
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  Speaker 2: we can't. We have to really think about what our
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  Speaker 2: principles require of us. I always feel so heavy when
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  Speaker 2: I think about things like justice, Like I don't want
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  Speaker 2: justice to be a throwaway word. I really want the
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  Speaker 2: weight of it to sit heavy with myself and sit
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  Speaker 2: heavy with my work and for me to really think
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  Speaker 2: about what I'm required to do, where our governments are
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  Speaker 2: required to do, what those that are wealthier and have
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  Speaker 2: more resources and more privileges are required to do in
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  Speaker 2: the name of justice. And really question what are we
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  Speaker 2: willing to do in the name of justice? And environmental
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  Speaker 2: pollutants and climate change are a threat to our principles.
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  Speaker 2: We cannot say that we care about vulnerable populations or
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  Speaker 2: justice without thinking about how the very world we live
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  Speaker 2: in makes it impossible for some people to have health
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  Speaker 2: justice or makes it impossible for some people to have
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  Speaker 2: the resources that they need for proper health. So it
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  Speaker 2: is a threat to just the very nature of our profession.
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  Speaker 2: So that is why we are really calling on biowethesists
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  Speaker 2: to make environmentalism much more central to the work that
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  Speaker 2: they do.
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  Speaker 1: Yeah, I mean, that's really helpful. Let me pick up
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  Speaker 1: on some of the bioethics and bioethics professions threads. Here's
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  Speaker 1: two questions. One is about the bioethics principles. So justice
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  Speaker 1: looms large and a lot of your work, and also
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  Speaker 1: in particular in the in the age of paper, the
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  Speaker 1: age of paper, I mean, the arguments generally seem rooted
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  Speaker 1: in principalism. It is that your overall approach is that
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  Speaker 1: just what bioethics kind of do, and you can sort
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  Speaker 1: of run with justice. Are there other ethics approaches for
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  Speaker 1: folks who don't go into principalism where there might be
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  Speaker 1: common alignment around environmental justice and responses to environmental and justice.
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  Speaker 1: So that's a bunch of questions.
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  Speaker 2: That, yeah, no problems.
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  Speaker 1: How should we think about how should we think about
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  Speaker 1: principalism in light of the work that you're doing. We'll
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  Speaker 1: leave it there. Yeah.
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  Speaker 2: You know, one thing that I always advocate for bio
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  Speaker 2: what this is doing is talking to the general public
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  Speaker 2: or talking to other audiences, and doing so by speaking
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  Speaker 2: their language. When I talk to high school students about
• 12:51
  Speaker 2: racial disparities and health, I talk to them like I
• 12:53
  Speaker 2: would talk to high school students, and in a professional way,
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  Speaker 2: of course, but conveying it using their terms. And so
• 12:59
  Speaker 2: with this paper, if we're calling for BIO what this
• 13:02
  Speaker 2: is to care more about our physical environments, we felt
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  Speaker 2: like we had to talk to BIO what this is
• 13:08
  Speaker 2: in bioethics language. Bioethics speaks principles, right, and so if
• 13:12
  Speaker 2: we can say these things that you hold very central
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  Speaker 2: to the way that you do your work, here's how
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  Speaker 2: they apply here in these very clear distinct ways. And
• 13:21
  Speaker 2: here's why if you ignore our physical environments, this is
• 13:25
  Speaker 2: a threat to the very principle that you hold, dear,
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  Speaker 2: I think that that is impactful for some biowethesis, those
• 13:32
  Speaker 2: that say, oh yeah, these principles are central, they're important.
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  Speaker 2: I see the world if bioethics through this way. If
• 13:39
  Speaker 2: you're telling me, here are some very clear cut examples
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  Speaker 2: of how this is a threat to the way that
• 13:43
  Speaker 2: I do my work and the framework of my research.
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  Speaker 2: I got it, I understand it. But that does it
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  Speaker 2: mean that our commitment to the healthy environments that we
• 13:54
  Speaker 2: live in has to be seen as just a matter
• 13:57
  Speaker 2: of principles. I think that again that it's and powerful,
• 14:00
  Speaker 2: it's impactful principles. We have principles in all areas of
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  Speaker 2: our life that we hold deal to a it's a value, right.
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  Speaker 2: It says something about who we are as individuals, as people,
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  Speaker 2: as professionals, and then also in other areas of our
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  Speaker 2: lives as parents, as friends, as daughters, as sons, you
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  Speaker 2: know that kind of thing. But again, I don't think
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  Speaker 2: you have to do everything through a principle. It can
• 14:23
  Speaker 2: be simply that we value human life, and I think
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  Speaker 2: that that has to be enough and environmental injustice that
• 14:31
  Speaker 2: look at how our unhealthy environments are just a threat
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  Speaker 2: to human life, a threat to human flourishing, a threat
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  Speaker 2: to us living the kinds of lives that we deem desirable.
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  Speaker 2: It's a threat to how we connect to other humans
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  Speaker 2: and the planet and our communities. It is a threat
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  Speaker 2: to everything that we hold dear. And I think, even
• 14:50
  Speaker 2: though that's very broad, that has to also be enough, right.
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  Speaker 2: But I don't know that if we were to write
• 14:56
  Speaker 2: a paper of Jade and I and said look, it's
• 14:58
  Speaker 2: just a threat to human life, that that would have
• 15:01
  Speaker 2: been as impactful for bioethicis, especially if we're saying we
• 15:05
  Speaker 2: have to change the way that we do bioethics work.
• 15:07
  Speaker 2: So in order to make that argument, I think we
• 15:09
  Speaker 2: did have to use the language of bioethics.
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  Speaker 1: That's yeah, I mean, that's a fun point, well taken
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  Speaker 1: both with high school students, bioethicists and anyone, right, I mean,
• 15:18
  Speaker 1: the sort of benefits of clear communication. Let me stick
• 15:23
  Speaker 1: with the sort of professional bioethics community for a bit,
• 15:27
  Speaker 1: So imagine, right, a bioethicis is doing work on some
• 15:32
  Speaker 1: sort of very important but sort of more hospital based
• 15:35
  Speaker 1: ethical concerns about informed consenter so very pick any list
• 15:39
  Speaker 1: and sort of hasn't thought a lot about sort of
• 15:41
  Speaker 1: rights to health, healthy environment considerations. Reads your and Jan's piece,
• 15:45
  Speaker 1: ands is, oh, yeah, this is great. What do you
• 15:49
  Speaker 1: see as a good response from a professional bioethicist to this?
• 15:55
  Speaker 1: I mean you had mentioned before sort of c centering
• 15:59
  Speaker 1: bioethics work in a way that either includes or focuses
• 16:03
  Speaker 1: on environmental and justice and healthy environments. Could you say
• 16:08
  Speaker 1: more about that or sort of? So what is the
• 16:10
  Speaker 1: you know not at well? Yeah, what is a bioesthesist
• 16:14
  Speaker 1: who hasn't thought about this as much until really running
• 16:16
  Speaker 1: into your piece? What would they do? What should they do?
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  Speaker 2: Right? So? I think so, let's say you are a
• 16:23
  Speaker 2: researcher who studies informed consent, right, and that is that's
• 16:27
  Speaker 2: your jam, right, That's that's what you do, that's what
• 16:29
  Speaker 2: you're known for. You still have to look at the
• 16:33
  Speaker 2: people who are engaging in informed consent for medical interventions
• 16:39
  Speaker 2: as a holistic person. They are not just the person
• 16:41
  Speaker 2: that's sitting right in front of you looking at this
• 16:44
  Speaker 2: very long, sometimes too long document, sometimes a document that
• 16:47
  Speaker 2: they can understand and say, okay, I consent to ex procedure, right.
• 16:52
  Speaker 2: They are a person outside of just that medical setting.
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  Speaker 2: And so if we think about the lies that patients
• 16:59
  Speaker 2: lead before they come to us. That includes the environments
• 17:03
  Speaker 2: that they live in. That may mean they had a
• 17:05
  Speaker 2: hard time getting here because there was an unusual snowstorm
• 17:09
  Speaker 2: that day, which you know, maybe ten years ago that
• 17:11
  Speaker 2: wouldn't be the norm of that area, right. Or maybe
• 17:15
  Speaker 2: they're signing consent for some sort of reproductive health intervention
• 17:19
  Speaker 2: and it may getting the road right, the roads are
• 17:23
  Speaker 2: very difficult for them to get to for that intervention
• 17:26
  Speaker 2: because of climate change or because of some environmental disaster.
• 17:30
  Speaker 2: Those are the kinds of ways that we have to
• 17:33
  Speaker 2: think about people that we serve as by what'says, as
• 17:36
  Speaker 2: complete and wold persons, not just the person in front
• 17:40
  Speaker 2: of you. So that is why it's hard for me
• 17:42
  Speaker 2: to see why, no matter what you study in bioethics,
• 17:46
  Speaker 2: that environmentalism will touch on that in some kind of way,
• 17:50
  Speaker 2: even if it's just simple as the people that we
• 17:54
  Speaker 2: talk about, the people that we serve are entirely whole
• 17:58
  Speaker 2: individuals that are not just research participants. They're not just
• 18:02
  Speaker 2: study participants. They're not just people we are abstractly talking about.
• 18:06
  Speaker 2: They have lives, and their lives and their well being
• 18:09
  Speaker 2: and their health are affected by the world that they
• 18:12
  Speaker 2: live in. So that's how I would think about it.
• 18:14
  Speaker 2: If I were a bioticism I thought nothing that I
• 18:17
  Speaker 2: study has anything to do with the environment, I would
• 18:21
  Speaker 2: argue that, yes it does. Right, there's always a case
• 18:24
  Speaker 2: that environmentalism affects them in some kind of way.
• 18:28
  Speaker 1: The whole person conceptualization of the issue, I think is
• 18:33
  Speaker 1: really nice for a couple of reasons. One, it applies
• 18:36
  Speaker 1: both to patients or sort of persons for whom bioethicists
• 18:40
  Speaker 1: might care for contribute to the care of in some way,
• 18:43
  Speaker 1: and also to the bioethicists themselves. And so you know,
• 18:47
  Speaker 1: for everybody, but especially I have medical students in the
• 18:50
  Speaker 1: back of my head who are sort of really working
• 18:51
  Speaker 1: on their professional identity formation and thinking about professional identities.
• 18:56
  Speaker 1: This notion of the whole person both the work the
• 18:58
  Speaker 1: researcher in your example does in bioethics on informed consent, Well,
• 19:03
  Speaker 1: they're still a person. They still have to get somewhere.
• 19:05
  Speaker 1: And when they start thinking in that way about those
• 19:08
  Speaker 1: who might be signing the very very long informed consent
• 19:12
  Speaker 1: or even sort of iPhone and user agreements, right, there's
• 19:17
  Speaker 1: still people that are still impacted by the environment you
• 19:19
  Speaker 1: sort of can't get out of that. I mean, I
• 19:23
  Speaker 1: suspect they are folks smarter than me who have better
• 19:26
  Speaker 1: critiques or objections to that line. But I think that
• 19:28
  Speaker 1: would push someone into sort of bioethics in a vacuum, right,
• 19:31
  Speaker 1: or sort of brains and a v I mean, it's
• 19:34
  Speaker 1: to discount lived experiences, both of persons and of oneself
• 19:38
  Speaker 1: seems too much, you know that, That's exactly that's that's
• 19:42
  Speaker 1: really helpful.
• 19:43
  Speaker 2: Yeah, thinking about medical students too. You know, we I
• 19:49
  Speaker 2: work and teach, and the largest medical center in the world, Houston, Texas,
• 19:54
  Speaker 2: Texas Medical Center is just this massive beast, right, and
• 19:59
  Speaker 2: we have hundreds of thousands literally patients coming every day
• 20:02
  Speaker 2: to see clinicians. And we talk to students about think
• 20:06
  Speaker 2: about what it took for some of your patients to
• 20:09
  Speaker 2: get to you. Did they have a babysitter right for
• 20:13
  Speaker 2: their kids? Did they have to take off of work
• 20:15
  Speaker 2: and they work a job where they don't have pay
• 20:17
  Speaker 2: when they take off. There's no free parking here, so
• 20:20
  Speaker 2: then they're also paying the park It's amazed. Could they
• 20:23
  Speaker 2: find the building right now? It's one hundred and five
• 20:26
  Speaker 2: degrees outside, so they're also walking around outside trying to
• 20:28
  Speaker 2: find the building to find you did they have to
• 20:31
  Speaker 2: schedule care for their elderly patients, right, So thinking about
• 20:35
  Speaker 2: your patient's life outside of the clinic to think about
• 20:38
  Speaker 2: how you treat them within the clinic. That also includes
• 20:41
  Speaker 2: their environmental lives. We also are in Houston, we get
• 20:45
  Speaker 2: as much rain as the outer right, so it's also
• 20:47
  Speaker 2: rains a lot too, and then we have flooding, we
• 20:49
  Speaker 2: have hurricanes, we have storms, right, So thinking about their
• 20:52
  Speaker 2: lives outside of the clinic is something that we teach
• 20:56
  Speaker 2: to students, and that has to also include their environmental lives.
• 21:00
  Speaker 2: It's also important for our students to think about that
• 21:03
  Speaker 2: as they become well rounded clinicians.
• 21:06
  Speaker 1: Thinking about those who accept environmental impacts, but who aren't
• 21:11
  Speaker 1: persuaded that there's a right to healthy environment right. And
• 21:14
  Speaker 1: maybe they're folks who go in for rights to free
• 21:15
  Speaker 1: speech or other kinds of right, so they're not disagreeing
• 21:18
  Speaker 1: with rights language, or maybe they even sort of think
• 21:21
  Speaker 1: human rights exist, but they just don't think a right
• 21:25
  Speaker 1: to a healthy environment exists. And it might be well,
• 21:29
  Speaker 1: they're sort of geeky philosophical reasons why you might think
• 21:31
  Speaker 1: that's the case, there's sort of other practical reasons. Could
• 21:36
  Speaker 1: you sort of respond to this? I mean, why is
• 21:39
  Speaker 1: there a right to help? Huge question, so pick any
• 21:41
  Speaker 1: part of it, but why is there a right to
• 21:43
  Speaker 1: a healthy environment?
• 21:45
  Speaker 2: Right? So for me, again, it's hard for me to
• 21:51
  Speaker 2: answer or to think about environmentalism as something other than
• 21:55
  Speaker 2: essential to everything else that we do and want to do.
• 21:59
  Speaker 2: And so if I think think that we have a
• 22:01
  Speaker 2: right to life or a right to the pursuit of
• 22:05
  Speaker 2: happiness right their life, liberty and happiness right, I don't
• 22:09
  Speaker 2: know how we can pursuit or engage in the other
• 22:13
  Speaker 2: rights that we have if I don't also have some
• 22:17
  Speaker 2: sort of legal mechanism to make sure that I have
• 22:20
  Speaker 2: the environment needed to perform those other rights or to
• 22:23
  Speaker 2: engage with those other rights. And so that's how I
• 22:26
  Speaker 2: see it. If we say things and I do see
• 22:30
  Speaker 2: it along the lines of skeptics who say things like
• 22:32
  Speaker 2: do we have a right to healthcare? Right? And that's
• 22:35
  Speaker 2: a question we always talk about with students, is where
• 22:37
  Speaker 2: it get their critical skills thinking. As soon as they
• 22:41
  Speaker 2: start treating patients, we have these conversations again, like now
• 22:44
  Speaker 2: you have this clinical experience, let's talk about it. Right
• 22:47
  Speaker 2: to have right to healthcare. And I'm in one of
• 22:50
  Speaker 2: the most diverse cities in the US. We have a
• 22:52
  Speaker 2: large immigrant population. I am in Texas right so thinking
• 22:55
  Speaker 2: about right to health care for all of the people
• 22:58
  Speaker 2: that live in the state and live in the country,
• 23:03
  Speaker 2: I don't know. So I can see how a conversation
• 23:07
  Speaker 2: about rights to an environment a healthy environment can be
• 23:11
  Speaker 2: somewhat controversial, or maybe someone won't be on board in
• 23:16
  Speaker 2: the same way that someone may not be on board
• 23:18
  Speaker 2: with a right to healthcare. But I don't see how
• 23:22
  Speaker 2: I am supposed to be able to live in a
• 23:26
  Speaker 2: country like the United States, in particular, with a lot
• 23:31
  Speaker 2: of emphasis on individualism, a lot of emphasis on rights,
• 23:36
  Speaker 2: a lot of emphasis on being unencumbered, uninfringed upon right
• 23:43
  Speaker 2: like being able to live the kind of life that
• 23:45
  Speaker 2: I want to live if we don't use the government's
• 23:48
  Speaker 2: control in some kind of ways, and in particular to
• 23:53
  Speaker 2: have the environments needed for me to do things like
• 23:57
  Speaker 2: and engaging my right to a symbol, engage in my
• 24:01
  Speaker 2: right to use firearms right, or my right to not
• 24:07
  Speaker 2: be harmed by other individuals. I just don't know how
• 24:10
  Speaker 2: we do that. If I'm also worried about is my
• 24:14
  Speaker 2: water polluted? Did that storm make me put us on
• 24:19
  Speaker 2: a boil water notice which happens in houstoner every now
• 24:22
  Speaker 2: and then some water condamination. Now we have to boil water?
• 24:25
  Speaker 2: Or how can I engage my right to assembol something
• 24:29
  Speaker 2: that I think is unjust? If there is an unusual
• 24:33
  Speaker 2: storm outside right now, I can engage in that. So
• 24:36
  Speaker 2: I don't know how we engage in our other rights
• 24:39
  Speaker 2: if we don't have this overarching right. I kind of
• 24:41
  Speaker 2: see like an umbrella, like environmental right is at the top.
• 24:44
  Speaker 2: Everything else has to stem from that in order for
• 24:47
  Speaker 2: us to have those other rights.
• 24:49
  Speaker 1: That we enjoy. The sort of right to a healthy
• 24:51
  Speaker 1: environment is basic in a certain sense, and it's basic
• 24:54
  Speaker 1: in that if you don't have that, you couldn't enjoy
• 24:57
  Speaker 1: those other kinds of rights that you want. So someone
• 24:59
  Speaker 1: who says like I'm not going in for this, Keisha,
• 25:01
  Speaker 1: but you know, I really care about one of the
• 25:04
  Speaker 1: other rights you enumerated, you can point out you're not
• 25:07
  Speaker 1: gonna be able to assemble if it's constantly flooded. You're
• 25:10
  Speaker 1: not gonna be able to you know, whatever, those rights
• 25:13
  Speaker 1: are good. I mean, I'm again, there are better critics
• 25:18
  Speaker 1: than me, I'm persuaded.
• 25:19
  Speaker 2: There.
• 25:21
  Speaker 1: Suppose someone comes back and says, look, look I'm okay
• 25:24
  Speaker 1: with rights to healthcare. And I know, I mean, you're
• 25:27
  Speaker 1: you're a big deal. You've sort of have bioethical influence
• 25:29
  Speaker 1: across the globe, and I know when I've occasionally hopped
• 25:32
  Speaker 1: out of the US, the response is almost one of
• 25:35
  Speaker 1: shock from lots of folks working in bioethics. How could
• 25:38
  Speaker 1: you not have this? I mean, this is just a
• 25:40
  Speaker 1: human rights violation. So suppose someone sort of is amenable
• 25:43
  Speaker 1: to this kind of conversation and says, yeah, we're sure
• 25:48
  Speaker 1: there are rights to healthcare, but there aren't rights to
• 25:51
  Speaker 1: health so they don't take that jump. And maybe it's
• 25:55
  Speaker 1: for reasons like well, I just don't think we can
• 25:57
  Speaker 1: satisfy it, Like there's just we just again, how we
• 26:00
  Speaker 1: can satisfy rights to healthcare? We just can't satisfy. So
• 26:04
  Speaker 1: is there something for the person who's in for or
• 26:08
  Speaker 1: goes in for rights to health care but just thinks
• 26:11
  Speaker 1: a right to health is too far? Is there anything
• 26:13
  Speaker 1: any assistance you could offer to sort of make that bridge?
• 26:17
  Speaker 2: So I think the bridge there is going to be resources.
• 26:22
  Speaker 2: The reason why health care matters, So much to us
• 26:25
  Speaker 2: is because it is a resource that's needed for health.
• 26:29
  Speaker 2: There's some estimates that are healthcare only matters about twenty
• 26:33
  Speaker 2: percent of our health, but it's important because it's a
• 26:35
  Speaker 2: gatekeeper of interventions and medicines and surgeries and all these
• 26:40
  Speaker 2: expertise of these clinicians that we need. And the other
• 26:44
  Speaker 2: eighty percent about education, transportation, access to healthy foods, and
• 26:50
  Speaker 2: one of those is access to safe environments because it's
• 26:53
  Speaker 2: a resource. And so if you use that same argument
• 26:56
  Speaker 2: of okay, I can see why health care matters, but
• 26:59
  Speaker 2: not why health. We can't make all health equitable because
• 27:03
  Speaker 2: of these other factors, but we can make it equable
• 27:06
  Speaker 2: insofar as we make sure people have access to the resources. Now,
• 27:10
  Speaker 2: people have diftive biologies and genetics and all those kinds
• 27:13
  Speaker 2: of things and just different desires that then play into
• 27:16
  Speaker 2: our health. But there is one thing that I don't
• 27:19
  Speaker 2: think should be a variable, and that is access to
• 27:21
  Speaker 2: the things that we need if we can ensure them.
• 27:24
  Speaker 2: And so if we can protect environmental our physical environments,
• 27:29
  Speaker 2: if we can protect our air and our water sources,
• 27:32
  Speaker 2: if we can stop human influence on climate change, then
• 27:37
  Speaker 2: those allow us to have resources that is then needed
• 27:40
  Speaker 2: for health. So it's not necessarily about a right to health,
• 27:43
  Speaker 2: it's about a right to those resources that we need
• 27:47
  Speaker 2: to have good health.
• 27:48
  Speaker 1: Yeah, good move. So yeah, and so my question wasn't
• 27:52
  Speaker 1: it wasn't well posed or wasn't well posed enough, because
• 27:54
  Speaker 1: it's not a rate to all health. You know, your
• 27:57
  Speaker 1: position doesn't fall to the critique that we couldn't ensure
• 28:02
  Speaker 1: health for variety of kinds of reasons. It's really just
• 28:04
  Speaker 1: a healthy environment. So sort of poorly posted question on me.
• 28:07
  Speaker 1: But the resource move I think works and I appreciate it,
• 28:10
  Speaker 1: especially the sort of the empirical data around what kinds
• 28:13
  Speaker 1: of impacts certain kinds of interventions have on health. And
• 28:17
  Speaker 1: if it's only twenty percent right, if the thing we
• 28:20
  Speaker 1: care about is health, then there's the right or that's
• 28:23
  Speaker 1: the argument why it's so good. That's really helpful. And
• 28:26
  Speaker 1: you make that point well in a recent Hastings Center
• 28:30
  Speaker 1: Bioethics Forum essay which everybody who listens to this should read.
• 28:35
  Speaker 1: Ending unequal treatment requires a shift from inequitable health care
• 28:38
  Speaker 1: to social inequities. And to make some of these points
• 28:41
  Speaker 1: really well there, I'm going to use that as a
• 28:44
  Speaker 1: bridge to throw a last question at you, which is
• 28:48
  Speaker 1: about your new book, and I haven't read it yet,
• 28:52
  Speaker 1: so my apologies. But the new book out recently is
• 28:56
  Speaker 1: Black Health, The social, political, and cultural Determinants of Black
• 28:59
  Speaker 1: Peaceeople's Health. And so I was hoping in light of
• 29:02
  Speaker 1: this conversation you might just be able to speak briefly
• 29:06
  Speaker 1: to the various categories of determinants and implications for Black health.
• 29:10
  Speaker 1: I know it's a whole book, but give us, you know,
• 29:12
  Speaker 1: a sort of few lines to bridge our conversation to that,
• 29:16
  Speaker 1: and then I'll read the book and tell everybody else
• 29:18
  Speaker 1: to go get the book too.
• 29:20
  Speaker 2: Yeah, you know. I focus on cardiovascular disease, birthing, and
• 29:26
  Speaker 2: reproductive health, sleep and pain as these four main areas
• 29:31
  Speaker 2: where Black people have poor health outcomes, and then I
• 29:34
  Speaker 2: sort of trace those poor health outcomes to inequities and
• 29:37
  Speaker 2: resources and environmental health comes in in the sleep chapter,
• 29:41
  Speaker 2: and people are always a little bit surprised there. But
• 29:44
  Speaker 2: there are racial in equities and who get sleep and
• 29:46
  Speaker 2: who doesn't, and of course once again it falls home
• 29:49
  Speaker 2: racial lines and sometimes gender lines as well. But also
• 29:53
  Speaker 2: in that chapter, I push people to think about how
• 29:56
  Speaker 2: can I be expected to get adequate sleep? And adequate
• 29:59
  Speaker 2: sleep is so important. After doing that research, I will
• 30:02
  Speaker 2: not pull all nighters. I will sleep. Sleep is just
• 30:05
  Speaker 2: connected to so much of our cardiovascular health Alzheimer's deminia
• 30:10
  Speaker 2: rates right, sleep is the most important thing. I will
• 30:13
  Speaker 2: use this time to say get sleep, get sleep, get sleep,
• 30:15
  Speaker 2: but talk about how you cannot be expected to have
• 30:20
  Speaker 2: good sleep. That then translates into better health outcomes. If
• 30:24
  Speaker 2: I'm also worried about the physical environments that I live in,
• 30:27
  Speaker 2: if i am stressed, or I'm thinking about climate change
• 30:31
  Speaker 2: or water sources, or how our neighborhoods are literally making
• 30:35
  Speaker 2: us unhealthy because of the pollutants there, and then having
• 30:38
  Speaker 2: to sleep in those neighborhoods that is very difficult. And
• 30:42
  Speaker 2: we also know that pollutants make some neighborhoods more unsafe
• 30:45
  Speaker 2: than others, and those fall along racial lines. So the
• 30:48
  Speaker 2: book is really thinking about how these four main areas
• 30:51
  Speaker 2: of racial dispairs and health are affected by things like housing, environmentalism,
• 30:57
  Speaker 2: access to health care, access to education, and proper income.
• 31:01
  Speaker 2: And so that is the connecting as this A job
• 31:04
  Speaker 2: article is sort of an offshoot of the book and
• 31:07
  Speaker 2: just making it important for us to think about healthy
• 31:10
  Speaker 2: environments and particular vulnerable populations.
• 31:14
  Speaker 1: Excellent, super helpful. I look forward to reading the book
• 31:17
  Speaker 1: As someone with little kids running around a house. This
• 31:20
  Speaker 1: is a powerful argument for me. I can't stitch memories
• 31:24
  Speaker 1: of the leader. Yeah, that's I think. I'm going to
• 31:26
  Speaker 1: go home and tell the five month old it's time
• 31:28
  Speaker 1: to sleep. I'm asleep. Keisha, thank you so much. This
• 31:32
  Speaker 1: has been a thought provoking conversation everyone. I've been speaking
• 31:36
  Speaker 1: with Keisha Ray and the John McGovern, MD, Professor of
• 31:38
  Speaker 1: us Larian Medicine and Associate Professor at the McGovern's Center
• 31:41
  Speaker 1: for Humanities and Ethics at ut Health Houston. Everyone go
• 31:47
  Speaker 1: and get the book. I know I'm going to, and
• 31:49
  Speaker 1: I really look forward to reading the chapter on sleep.
• 31:51
  Speaker 1: So thank you so much, Keisha, thank you. Thank you
• 31:54
  Speaker 1: for listening to this episode of the covid Ethics series podcast.
• 31:58
  Speaker 1: Be sure to check out video versions of our episodes
• 32:01
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• 32:07
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• 32:11
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• 32:18
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• 32:22
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• 32:24
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