Why racism in health care is an ethical crisis: A nursing perspective

Research shows that Black and Indigenous patients are more likely to receive inadequate pain management due to deeply ingrained biases.

For example, the research discusses how stereotypes such as the false belief that Black individuals have a higher pain threshold influence clinical decision-making, leading to under-prescription of analgesics for these populations.  

This directly contradicts the ethical requirement of health-care providers to act in the best interest of their patients. When racial bias leads to disparities in care, it causes harm.

Racism in health care isn’t just a political issue — it’s an ethical one. Although health care is built on values like justice, compassion and the duty to do no harm, systemic racism is woven into the fabric of the system, affecting both patients and health-care providers. 

If we truly believe in ethical care, dismantling racism must be a top priority. 

Systemic racism continues to create barriers to equal treatment for both patients and providers. These aren’t just unfortunate realities, they are ethical failures that demand urgent attention.

Fatal outcomes 

I recall caring for a Black woman with severe abdominal pain whose symptoms were dismissed by a physician who labeled her as drug-seeking and withheld treatment. Despite my advocacy, her condition worsened. She later coded on the unit and was found to have suffered a heart attack. She died shortly after. This experience remains a painful reminder of how racial bias can lead to fatal outcomes, and highlights the urgent need for justice and accountability in clinical care. 

Diversity equity and inclusion initiatives are designed to support marginalized communities, but have often benefited non-racialized groups, particularly through accessibility measures like ramps, elevators, remote work and accessible transportation.

However, when racialized individuals seek equitable treatment, such as fair pain management or protection from discrimination, they frequently face resistance. This disparity reveals a deeper ethical failure in society’s approach to justice and inclusivity. 

While accessibility initiatives for individuals with disabilities are generally accepted as necessary for inclusion, racial equity efforts often face opposition because they challenge entrenched power structures. The ethical obligation to ensure fair treatment should not be selective. Society values inclusivity, so it's unethical to deny it based on race. 

A diverse workforce fosters cultural competency, which improves patient outcomes and ensures more equitable treatment. When health-care institutions fail to promote inclusivity, they violate their ethical responsibility to provide competent, unbiased care. 

Ethical and inclusive workplaces 

Fostering an ethical and inclusive workplace means implementing zero-tolerance policies for discrimination, providing mentorship opportunities for racialized health-care providers, and integrating anti-racism training into health-care education.  

These steps align with the ethical obligation to promote justice and fairness within the profession. Institutions that fail to address racism undermine the ethical foundations of health care.

It’s time for health-care institutions to move beyond statements and into action. Here’s how we can align our commitment to ethical care with tangible change: 

1. Mandatory Anti-Racism Training: Health professionals must receive education on systemic racism, implicit bias and cultural competency, aligning with the ethical duty to provide equitable and informed care.
   
   
2. Policy Overhauls: Institutions must implement policies that hold staff accountable for discriminatory practices and ensure ethical hiring and leadership representation.
   
   
3. Community Engagement: Partnering with marginalized communities to understand their needs ensures ethical, patient-centered care that respects cultural differences.
   
   
4. Stronger Advocacy: More research and policy advocacy are needed to push for systemic changes, in line with the ethical obligation to challenge injustice.
   
   
5. Workplace Accountability: Safe reporting systems for racism in health-care settings must be established, with transparent follow-ups and ethical consequences for violations. 

Addressing racism in nursing and across health-care systems isn’t just a moral choice, it’s an ethical obligation. Health professionals are bound by codes of ethics that emphasize justice, equity and respect. Upholding these principles means confronting biases, amplifying marginalized voices and holding institutions accountable. 

The fight against racism in health care is far from over, but with collective effort, we can build a system that truly serves everyone with fairness and dignity.

If we claim to be ethical professionals, we must prove it by confronting and eliminating racism in all its forms. 

Views presented are the author’s personal perspectives and do not reflect the positions of any affiliated institutions.