Racial and Ethnic Classification in the Clinic: Is it Just?

Natalie Pino, BA - National Human Genome Research Institute

ELSIconversations - March 26, 2021

The United States has a long history of institutionally classifying people by racial and ethnic (R/E) categories. The use of this information in healthcare settings is often unexamined, leaving questions about its overall purpose. Given the sensitive nature of R/E classification and its historical abuses, we assert that a formal ethical evaluation is needed to determine whether this practice is justified for the purpose of improving the delivery of healthcare, and if so, on what grounds. Following the framework established by Childress et al. (2002), which states that a justified public health practice is Effective, Proportional, Necessary, Least infringing, and Public Justified, we conducted a scoping review in PubMed to identify articles about the delivery of health care that involve R/E classification of study subjects (N=200), to determine whether there is evidence available to make an evaluation for each of Childress’s justificatory conditions. We found that collecting R/E can serve different purposes with unique benefits and harms that must be evaluated independently. While describing health statistics was the most popular function of R/E classification in studies in our literature review (N=121), there is a lack of clarity about the efficacy, proportionality, necessity, infringement, or public understanding of the practice. Overall, we found there is little evidence in the literature on which to base a formal ethical evaluation for the use of R/E classification in clinical settings. Further inquiry is required to generate evidence that would enable a formal evaluation of whether this ubiquitous practice is justified.