The legislature is essential in enforcing rules, norms, and behavior in society. Without it, the chances of maintaining order and security become significantly low. However, there is always a question of the extent to which the law should interfere with people’s lives. In this context, Matthew raises the question of dealing with racial health disparities by changing existing laws. While the general idea and propositions do seem a reasonable solution to address discrimination, her particular vision of the Civil Rights Act of 1964 appears exceedingly radical.
Law in Defining Norms
The author begins her argument by highlighting the decisive role that the law plays in defining norms in doctor-patient relationships. Particularly, Matthew provides an explanation of how the law practices during different time periods in U.S. history not only enabled racism but even fostered it in various cases. During the colonial period, land grants and slave codes played a vicious role in injuring minority health since they effectively lowered the minorities’ status (Matthew, 2018). Even laws that did not directly concern health or the healthcare field created disparate health outcomes by reflecting and reinforcing discriminative tendencies.
As America’s society and economy became more complex, the laws required to maintain existing racial subordination became increasingly straightforward. Particularly, the ubiquitous segregation practices made the health of minorities another victim of an unjust environment (Matthew, 2018). In this context, the civil rights era presented a period when the relationship between the state of minority health and the law was positive and symbiotic. Namely, Title VI of the Civil Rights Act of 1964 proved its worth in dismantling segregation in healthcare (Matthew, 2018). Unfortunately, these civil rights victories managed to secure only episodic progress.
In the fourth period, antidiscrimination law in America ironically performs almost identically to colonial law in ensuring health disparities. A slight legal indifference is enough for legislatures and courts to contribute to the collapse of minority health. In particular, implicit biases producing health disparities today are the reason that destroys minorities’ health (Matthew, 2018). While modern law is capable of dealing with cases of direct discrimination, it fails to defeat the subconscious bias toward racial minorities.
Potential Legal Reforms
The author takes subconscious bias as a reference point in building her future argument. According to Matthew (2018), it requires a societal paradigm shift, or, in other words, a structural solution of great magnitude, to defeat racism at its subconscious level. She proposes several general interventions that can ease the situation surrounding bias in the healthcare field, such as counseling and education, clinical, and long-lasting protective interventions. The first topic refers to interventions conducted at the individual level (Matthew, 2018). While having a relatively small impact on a narrow scope, these interventions have the potential to provoke significant societal changes if applied universally.
The second point stands for ethical standards imposed on practitioners by healthcare organizations. Despite their genuine effort to motivate healthcare professionals to align their practice with ethically appropriate conduct, its main flaw is the non-obligatory nature (Matthew, 2018). In turn, the last point primarily concerns individuals but on a more extensive and long-term scale. The author provides an example of universal health insurance coverage – a governmental initiative to improve healthcare disparities by making services more accessible (Matthew, 2018). Unfortunately, increasing service accessibility does not address service quality issues – it still remains affected by bias.
Thus, the author makes her final proposition of making subconscious bias literally illegal. In particular, she refers to the already mentioned Title VI, emphasizing that, apart from addressing explicit discrimination, it should also address its implicit form (Matthew, 2018). The proposed reforms should hence accurately account for unconscious discrimination, promote evidence-based structural changes in healthcare practice, and leverage the role of law in the fight against discrimination.
Discussion
In my opinion, the general idea of the book is inherently genuine in its effort to foster equality and provide a solution to the long-lasting problem of racism. I mostly agree with the author’s definitions and bias classification, as well as with the claims she makes regarding societal interventions and their positive impact on the matter. However, the proposal to legally punish subconscious behavior seems rather ambivalent. On the one hand, undeniably, it will be a decision that produces the required paradigm shift in society. In short, it is a solution that impacts societal life regardless of prevailing social standards and tendencies.
On the other hand, however, punishing for the processes that occur subconsciously establishes a question of the extent to which the law can control individuals. In 1984, Orwell (2013) demonstrated a dystopian world where the government established such a degree of control over its citizens that people were afraid to think at all. While 1984 might seem a severe exaggeration regarding the current issue, it provides a vivid example of the sources for my concerns. If the government were to accept Matthew’s (2018) proposition, it could create a precedent for future law practice. Then, once the precedent is created, it could have an avalanche effect, turning even the most genuine intent of fighting racism into the greatest act of racism that ever existed. Therefore, while I agree that legal reforms can provide a solution to racism, I cannot agree with the proposition Matthew makes in her book.
Conclusion
Law can be an invaluable tool in the long-lasting battle against various forms of discrimination. Compared to America’s colonial times, the situation regarding attitudes toward minorities has dramatically improved, with the Civil Rights Act of 1964 playing a leading role in the process. Unfortunately, the outcome of Matthew’s proposition is uncertain, making its acceptance potentially dangerous. Therefore, there is a need for less radical propositions that put more thought into the overall well-being in their fight against health disparities.
References
Matthew, D. B. (2018). Just medicine: A cure for racial inequality in American health care. NYU Press.
Orwell, G. (2013). 1984. HarperCollins.