Whiteness as a bioethical problem

Below is a link to a pdf of my keynote at the Australasian Association for Bioethics and Health Law conference in Townsville, 22nd-25th September, 2018.

Link: Mayes_Whiteness_as_a_bioethical_problem_AABHL_2018

AABHL 2018



In March 2018 the Nursing and Midwifery Board of Australia (NMBA) released new editions of their codes of conduct, standards of practice, and code of ethics. In the glossary section, “cultural safety” was described (among other things) as providing “a de-colonising model of practice based on dialogue, communication, power sharing and negotiation, and the acknowledgment of white privilege”. Conservative media commentators reacted by claiming that white nurses were being asked to apologise for being white prior to caring for Aboriginal and Torres Strait Islander patients. Media personality Andrew Bolt called the code a new form of racism and Senator Corey Bernardi characterized the situation as a “new medical Marxism”. These responses serve to illustrate the sensitivity some sections of Australian society have to examining whiteness and white privilege in general, and health institutions in particular.

In recent years, whiteness studies has emerged as a way of examining race relations and the effects of racism by focusing on assumptions that “white” occupies a position of normalcy and neutrality. Black feminist scholars such as Audre Lourde have been significant in turning the critical focus from the racialised other to the institutions, beliefs, systems, and practices that do the work of racialising, while reinforcing white privilege. In Australia, this has meant that instead of focusing exclusively on the injustices suffered by Aboriginal and Torres Strait Islander peoples, the whiteness analytic lens allows scholars such as Irene Watson and Aileen Moreton-Robinson to draw attention to the material conditions, histories, ideas, and practices that make such racialised injustices possible, and even normal.

This paper explores the historical legacy and contemporary implications of whiteness in the provision of health care, health-related research, and bioethics itself to ask: If biomedicine and bioethics are implicated in the privileging of whiteness, is it possible to begin a process of decolonisation and move towards a postcolonial bioethics?

Is your research policy relevant? Does it matter?

Policy-relevancy is repeatedly upheld as a gold standard for quality academic research. Two recent examples of this appeared in my social media feeds.

The first came from an interesting paper testing a new tool to assess the impact of health intervention research on real world policy and practice. The second came from a LSE Blog post arguing that university professors are promoted based on publishing research in obscure journals that no one reads, rather than engaging the public debate or shaping public policy.

Both of these articles generated a lot of discussion about the role and purpose of academic research.

Reflection on what we are doing, and why, is always important. But when a number of brilliant colleagues openly doubted the value of their work because it didn’t have “real-world” implications I began to wonder if something was awry with the quest for policy-relevancy and “real-world” impacts.

Good research makes good policy, right?

Policy translation as the gold standard is particularly prevalent in the social sciences (the literal gold standard, commercialization, is less applicable). The translation of research into policy is good and appropriate for some types of research. However, it is not always appropriate or desirable. We should be cautious to expect all research to translate into public policy.

In the push towards policy relevancy there is little acknowledgment of the effect of “policy paradigms” and their influence on what research gets adopted and what research gets ignored.

The ins and outs of policy paradigms

In his highly-cited 1993 paper “Policy Paradigms, Social Learning and the State”, Peter Hall defines the “policy paradigm” as a ‘framework of ideas and standards that specifies not only the goals of policy and the kind of instruments that can be used to attain them, but also the very nature of the problems they are meant to be addressing’.

Policymakers work within this framework and it is within these frameworks that certain policies are imaginable, thinkable and implementable, and others are not.

Analogizing from Thomas Kuhn’s famous thesis about scientific paradigms and normal science, Hall argues that there is “normal” policy making that occurs within the policy paradigm.

Research that is policy relevant contributes to the normal policy making process within a paradigm. To be sure there can be adjustments to the paradigm due to research, but these adjustments do not challenge ‘the overall terms of a given policy paradigm, much like “normal science.”’ For example, research demonstrating an association between food choice and certain diet-related non-communicable disease may recommend the implementation of food labels. Although often disputed by industry, the recommendation of food labels is consumer and market orientated, which fits within the contemporary policy paradigm.

Paradigm shifts

In contrast, Michael Marmot’s recommendations to address health inequalities or the recommendations of climate scientists

via a tweet @TheDivideFilm 14 Jan 2014  See the Film http://thedividedocumentary.com/about

via a tweet @TheDivideFilm 14 Jan 2014
See the Film http://thedividedocumentary.com/about

do not readily fit within the market-orientation of the contemporary policy paradigm. The global market economy as we currently know it cannot operate in the “normal” way if policies addressing the social determinants of health inequalities or climate change are to be introduced.

By considering the influence of policy paradigms, the inability for research to be translated into policy may have less to do with the research or researchers, and more to do with the social, economic and political conditions. It is possible that the research that falls outside the policy paradigm is simply redundant, but it could also be that it is not imaginable or possible within the paradigm.

Research that falls outside the paradigm can contribute to a paradigm shift. Research that experiments with different policy ideas, points out the failure of current policies or the incommensurable relation between the policy paradigm and the sociopolitical reality can contribute to a shift in policy paradigms.

Shifting the policy paradigm is a key reason why it is dangerous to value university research solely for its ability to work within the “normal policy making” context. With stagnate policy debates over health expenditure, climate change, asylum-seekers, and housing affordability etc, perhaps we don’t need all research to neatly translate into policy. Rather we need to value and promote research that forces a shift in policy paradigms.