The first section of The Immortal Life of Henrietta Lacks contains real instances in which many of the topics we have discussed about ethical problems in medical practice arise. One instance where many dilemmas were extremely clear to me was discussed at the beginning of chapter eight when Henrietta felt that the cancer was metastasizing in her body. Lacks repeatedly told doctors that she was not doing well, first feeling discomfort and then pain but they continually examined her and reported that she was fine. A few weeks after the first complaint however, doctors discovered an inoperable mass on Henrietta’s pelvic wall causing her so much pain and ceasing her ability to urinate and walk. Skloot, the author, reminds readers that benevolent deception was extremely common during this time particularly for black patients being treated at public wards. While there is no way to ensure that the financial and class relations that arose for Henrietta at Johns Hopkins played a role in her treatment (or lack thereof), research has demonstrated that black patients were hospitalized later, received less pain medication, and had higher mortality rates than white patients of her time.
At the time Henrietta sought treatment, doctors may very well have been practicing paternalism by not relaying to her the terminal status of her cancer. However, I would argue against the plausible beneficence enacted. While I understand at the time it was common practice to not inform patients of illness because of the fear they may become desolate during the limited time they will live, in this instance patient autonomy should have definitely been a priority. If Henrietta knew that she only had a limited amount of time left, she may have spent more time with her family or put aside things for her children to remember her with. Also, the topic of healthcare injustice is extremely pertinent in this situation and is likely the true reason for why Lacks was not treated promptly, not merely doctors practicing an outdated custom of beneficence regarding terminal illnesses. Referring back to Daniel’s position on healthcare as a right to normal functioning, Henrietta was not able to go visit another hospital because of the discriminatory rules against black people seeking treatment at most hospitals. The opportunities Lacks had throughout her life were not equal due to the prevailing racism of her day, and unfortunately those inequities manifested in her ability to seek medical care for cancer.
Brilliantly cognizant of the subtexts of racial inequity and systemic marginalization described in Skloot’s The Immortal Life of Henrietta Lacks, Kaeli analyzes the various moral and ethical questions within the text, while also posing salient arguments regarding the ethical parameters of paternalism, beneficence, autonomy, and healthcare injustice in the realm of normal functioning that are central to the text’s message.
First, Kaeli underlines the deceptive beneficence practiced by the physicians involved with the case, who were apathetic about her complaints and prognosis, by addressing the status quo of that era, in which patients of color were treated with less care and had higher mortality rates. Her argument is extremely compelling because she also acknowledges a counterpoint: the exact level to which Henrietta’s racial and socioeconomic station impacted her medical care is not entirely quantifiable. However, in order to further substantiate her claim and refute this criticism, Kaeli points to the research that Skloot lays out in the text that shows this trend towards delayed hospitalization and higher rates of mortality for patients of color.
Kaeli moves on to another salient argument of her analysis: the notion that a strong strain of paternalism was practiced by these physicians in not revealing to Henrietta the terminal status of her condition, and that that the plausible beneficence was not sufficient enough to justify such action. Kaeli’s argument is logically consistent because she once again recognizes the counterpoint in critiquing the physicians’ actions. While she acknowledges that these doctors may have been motivated by fear that informed consent would make their patient desolate, she lays out key refutations: Henrietta, having known about her condition, would have prioritized her family. Essentially, Kaeli’s argument is inherently strong for this reason, and it essentially boils down to the notion that individuals should have that freedom to make those decisions of priority and value-ordering in their life. They should not be disenfranchised of that freedom for practically any reason.
Finally, Kaeli addresses the issue of healthcare injustice, and argues that a systemic culture of racism in healthcare of that era led to the medical disenfranchisement and diminished medical condition of Henrietta Lacks during that time. Her argument is vastly reinforced by her allusions to Daniels’ ideas of normal functioning, because Henrietta was prevented from seeking medical care at other institutions due to Jim Crow. I vastly agree with this specific notion of her analysis, and after reading Kaeli’s post, I began to ponder the remnants of this morally corrupt system in today’s healthcare industry. I began to wonder if patients of color, on a systemic and quantifiable scale, still face these same challenges. I notice the proportional discrepancies in healthcare costs and mortality rates between white and minority communities, which begs the question: how can systemic inequities in healthcare be solved. I believe the answer lies in examining the ethical ramifications from Kantian ethics about the power that pharmaceutical companies and the insurance agencies have as a result of that system, in that “goodwill” is the only way to ensure a more positive outcome. I also believe the answer may lie in examining how Aristotelian virtue ethics may impact implicit biases and implicit bias training: recognizing that habits, experience, and environments have effects on actions and character.
I agree that the treatment of Henrietta Lacks provides numerous examples of violations of the moral theories we have discussed. One example you provide is her doctors continuously ignoring her complaints of pain until it was incredibly severe. Additionally, you bring up Skloot’s point that there is no way we can confirm that the doctors’ mistreatment of Lacks was tied directly to her race and gender as many of the doctors’ behaviors, including benevolent deception, were a common practice at the time. However, I feel that it is not wrong to infer that Henrietta’s mistreatment was partially, if not largely, due to the racism and sexism of the time. Racism and sexism can be seen plainly throughout medical history, violating impartiality, a key principle in many moral theories.
Much of this racism and sexism still exists in our current healthcare system. Many black women have mistrust in the medical profession because their reports of pain are ignored, similarly to Lacks’ case. This mistrust is entirely valid as shown by statistics that highlight black women’s increased likelihood of dying in child-birth regardless of factors other than race. Lacks was also stripped of her autonomy when she was not fully informed of the likelihood of her cancer treatment making her infertile. A clear disregard for black women’s right to make their own decisions about their fertility is shown through a continuing history of compelled and forced sterilization of black women and women of color in the US. It is true, we cannot give concrete proof that Lacks’ mistreatment was a result of racism but by looking at history and context, it can be considered a valid argument.