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Being Seen by the Doctor: A Meditation on Power, Institutional Racism, and Medical Ethics

  • Symposium: Institutional Racism, Whiteness, and Bioethics
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The following pages sketch the outlines of “a Canaanite reading” of the health system. Beginning with the Black person—African, Afro-diasporic, Aboriginal, and Torres Strait Islander—who is seen by a health professional, the functions and effects of the racializing gaze are examined. I wrestle with Al Saji’s understanding of “colonial disregard,” Whittaker’s insights into the extractive disposition of settler institutions vis-à-vis Indigenous peoples, and Saidiya Hartman and Fred Moten’s struggle with the spectacular. This leads me to conclude that the situation of the Black within the health system is a tragic one. The prescription for the path out of this tragedy that I settle on, responding to Okiji’s opening call, is found in Vernon Ah Kee’s “Unwritten” series.

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  1. “The Chinese martial arts Wushu is helpful here: when one holds a stance, such as the horse stance, this is an active endeavour (that the leg muscles begin to shake in resistance after a few short moments is testament to this) … But while a horse stance can be held for the sake of training, it is also more: in the context of a form or routine, the stance serves as a foundation for transition, preparing and positioning the body for the next movement or strike. It is significant that in Chinese the word for stance, 步, can also be translated into English as ‘step.’ Holding is not only active, it also enables and prepares us for action and movement” (Ngo 2017, 40, emphasis in original).

  2. In his conversation with Wole Soyinka, Anthony Appiah delivers the following caution: “I think the concept of tragedy tends to get used in our culture very much and in a debased form and with very little sense of classical tragedy.” In response, Soyinka suggests that Appiah is only correct “if one begins by accepting the European definition of tragedy” (Appiah 1988, 782). For Soyinka, the tragic has little to do with genre or technical niceties but has to do with existence, particularly its dangers and insecurity. My use of tragedy here is in reference to that situation whereby the Black has always already fallen from “grace to grass,” as Soyinka puts it. It is an evaluation of that situation described by Fanon (2008) whereby, given the prevailing racist, colonial order, the Black, among others, arrives “too late” onto the plane of meaning making where the frameworks on which society is to function are articulated (see also Al-Saji 2013).

  3. “I have chosen not to reproduce Douglass’s account of the beating of Aunt Hester in order to call attention to the ease with which such scenes are usually reiterated, the casualness with which they are circulated, and the consequences of this routine display of the slave’s ravaged body. Rather than inciting indignation, too often they immure us to pain by virtue of their familiarity … and especially because they reinforce the spectacular character of black suffering. What interests me are the ways we are called upon to participate in such scenes. Are we witnesses who confirm the truth of what happened …? Or are we voyeurs fascinated with and repelled by exhibitions of terror and sufferance? What does the exposure of the violated body yield? … does the pain of the other merely provide us with the opportunity for self-reflection?” (Hartman 1997, 3–4, emphasis mine).

  4. With respect to the former, Frantz Fanon notes: “The upheaval reached the black man from the outside. The black man was acted upon [Le Noir a été agi]. Values that were not engendered by his actions, values not resulting from the systolic gush of his blood, whirled around him in a colorful dance” (Fanon 2008, 194).

    Regarding the later, Steve Biko writes: “Since that unfortunate date—1652—we have been experiencing the process of acculturation. It is perhaps presumptuous to call it’“acculturation’ because this term implies a fusion of different cultures. In our case the fusion has been extremely one-sided … the Anglo-Boer culture had all the trappings of a colonist culture and therefore was heavily equipped for conquest … This is where the African began to lose a grip on himself and his surroundings” (Biko 1987, 40–41, emphasis mine).

  5. As Henry Kyburg (1974) helpfully points out in the preface to his The Logical Foundations of Statistical Inference, “Everyone knows that it is easy to lie with statistics. It is important then to be able to tell a statistical lie from a valid statistical inference” (vii). These are in fact the very opening lines of the book. Let us assume that the finding that ACEM was guilty of racial discrimination was overturned on the basis of valid statistical inference. Kyburg also states the following:

    If we turn to philosophers, or to mathematical statisticians, or to probability theorists for criteria of validity in statistical inference, for the general principles that distinguish well grounded from ill grounded generalizations and laws, or for the interpretation of that probability we must, like a gambler, take as our guide in life, we find disagreement, confusion, and frustration. (vii)

    My point is simply that a favourable statistical finding is a measure of how likely a particular set of mathematic operations determine one thing to be related to another. There is therefore an unbridgeable gulf that lies between that favorable outcome and the absence of racial discrimination.

  6. This assumption is a plea for the suspension of disbelief. It asks that one put aside Chelsea Bond’s testimony: “For a long time, I had been trying to find the way to get beyond the veil—to outperform and outsmart racism. But I have resigned myself to the fact that the academy … is theirs, not ours” (Mukandi and Bond 2019, 261). It also demands that one look past Bond and David Singh’s observation: “Closing the Gap tends to focus our attention disproportionately on the behaviour of individuals, suggesting that health inequalities are a product of Indigenous lack, morally and intellectually, rather than socially determined” (Bond and Singh 2020, 1). Belief in the ability to train individuals to overturn a system similarly evades the structural while overdetermining the possibilities inherent with the individual.


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Mukandi, B. Being Seen by the Doctor: A Meditation on Power, Institutional Racism, and Medical Ethics. Bioethical Inquiry 18, 33–44 (2021).

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