Ethics of Stigma and Mistrust in Healthcare and Research

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As part of the Fordham University Center for Ethics Education’s Advancing Health and Social Justice Web Series, Dr. Alana Gunn and Dr. Nicole Overstreet led a panel on Wednesday, November 19th titled, “Ethical Implications of Stigma and Mistrust in Healthcare and Research.” moderated by Dr. Laura Specker Sullivan, Assistant Professor of Philosophy at Fordham University. Both Drs. Gunn and Overstreet are alumni of Fordham’s HIV and Drug Abuse Prevention Research Ethics Training Institute, which is directed by Dr. Celia Fisher.

Speakers:

Dr. Alana Gunn
Dr. Alana Gunn is an assistant professor of Criminology, Law, and Justice at the University of Illinois at Chicago. She is also a Faculty Partner with the Prisoner Reentry Institute (PRI) at John Jay’s School of Criminal Justice where she is examining data on the reintegration experiences of men in PRI’s (Prison-to-College Program) who are engaged in the City University of New York (CUNY) educational system. Dr. Gunn has extensive experience working with incarcerated individuals and those under correctional community-based supervision including in restorative justice programs, as well as with the agencies that support their reintegration process. Her program of research focuses on the ways that multi-level experiences of institutionalized stigmatization shapes the health and well-being of women with intersecting histories of criminal legal involvement and substance use and abuse disorders. Dr. Alana Gunn is also engaged in projects contributing to the research study of examining familial and services systems and how they shape identity change as well as the processes for women reintegrating  into the communities, post-imprisonment, and the study of exploring the ethics-specific implications of interviewing formerly incarcerated women with histories of structural and individual-level trauma and vulnerability. 

Nicole Overstreet, PhD

Dr. Nicole Overstreet 
Dr. Nicole Overstreet is an associate professor of psychology at Clark University. Her program of research examines the sociocultural factors that contribute to mental and sexual health disparities among Black women and marginalized groups in health care. Dr. Overstreet also focuses on the influence of societal stereotypes and stigmatizations around race and gender on the sexual health and well-being of marginalized groups; with a particular focus on the synergistic relationship between sexual objectification and violence against women. Her current research examines the consequences of intimate partner violence-related stigma on health outcomes on personal, interpersonal, and a structural level. She recently received funding from Fordham’s HIV and Drug Abuse Prevention Research Ethics Training Institute, which is directed by Dr. Celia Fisher. Her research will investigate the role of intersectional stigma in HIV research among HIV-infected African American women. 

Dr. Laura Specker Sullivan
Dr. Laura Specker Sullivan is an assistant professor of Psychology at Fordham University. Her research interests are in cross-cultural ethics and neuroscience. Some of her current partnerships include being a member of the Philosophy and Medicine committee for the American Philosophical Association. Dr. Sullivan serves as an abstract chair and a member of the program committee for the International Neuroethics Society and working with the Science for Monks program in India as a visiting scholar. 

Panel Discussion

Dr. Laura Specker Sullivan began the panel discussion by asking the speakers how they initially developed their research focus on mistrust and stigma of healthcare in minority groups and marginalized communities. 

Dr. Gunn gave an overview of her background explaining that in her research, in social work and public policy, she has observed and engaged with communities that have been victims of institutionalized racism and stigma in the healthcare field. She has also been involved in projects that focused on rebuilding the relationships between patients and people in the community who have been victims of policing and surveillance. Her work has focused on discussing cultures that reinforce stigma and mistrust when trying to seek medical and mental health in marginalized communities. 

Dr. Overstreet’s practice and research focus is on ethical issues and mistrust within the communities of marginalized groups. Her work focuses on the experiences of both ideological and systemic violence with a particular focus on the lived experiences of violence and trauma of Black women. Using her own lived experiences, which have influenced her research and engagement with the communities she is involved with, she navigates experiences of violence and aids communities in liberation from inequality. Dr. Overstreet also acknowledged that stigma and mistrust are the byproducts of systemic and structural oppression. Through her research she has unveiled the broken relationships between prejudice and discrimination and its affects on the self and how the perception of the self is affected in regard to systemic trauma. 

Dr. Laura Specker Sullivan then followed up with a question about the ethical issues surrounding stigma and mistrust in Black and marginalized groups. 

Dr. Gunn suggested that workers in the healthcare field and in research must come into their practice understanding that the majority of marginalized communities have been harmed by multiple systems of trauma and stigma. In understanding this, they should recognize that the issue is an ethical issue to begin with and they should change their approach in engagement with these groups. Physicians and researchers need to go into their practice acknowledging the long history of systemic trauma and harm that has affected the communities at large. The ethical dilemmas that plague their patients and surrounding communities are already affecting them before initial treatment and care. 

Dr. Overstreet reinforced what Dr. Gunn explained, and emphasized that there is a long history of  institutional obstruction and the most trusted institutions have participated in the mistreatment of  marginalized groups and communities. The expectation of these institutions are unjust and unethical due to the belief that marginalized groups should feel trustworthy when the history within that institution is not so. There is a paternalistic view of the ethical dilemmas in principles of autonomy and beneficence when in fact these communities know what they need and want, but are continuously disregarded and unheard. The focus of correcting these detrimental systems should be instead on the ways that we can structurally and systematically change and uphold and maintain positive changes in hopes of correcting the onset of institutionalized trauma indefinitely.

The panel continued to discuss misinformation that is spread within marginalized communities. Institutions and healthcare organizations need to implement spaces of open communication and comprehensive literacy when in conversation with marginalized groups and communities. Fully explained consent is critical in the patient and healthcare team relationship and would aid in the limitation of information being misconstrued. Trustworthy practices and institutions should acknowledge the expertise within the institutions and have a collective understanding of human practices and research. Creating an environment of understanding and knowledge would disrupt their oppressive systems and practices within healthcare systems and research. In doing so, it would honor the patients’ knowledge and experience and recognize that their knowledge has value. These trustworthy practices lead to appropriate measures and methods of creating a trusting relationship with the marginalized groups and physicians. 

Institutions should engage with marginalized groups on a more intimate level and provide a genuine space for discussions and emotions. This would create an environment for healing and justice to those who have been affected by negligence, policing, and surveillance. Listening to the experiences of oppression and trauma would potentially heal the relationships of the communities and healthcare institutions. At this point in the discussion, participants were encouraged to have intimate conversations in breakout rooms to further discuss methods of deconstructing stigma and mistrust in healthcare. Some of these methods include training on anti-racism and anti-bias in the healthcare system to dismantle racism within institutions. Additionally, values of compassion and cultural humanity will have to be implemented in training to fully understand factors that contribute to systematic oppression to guide the road of reformative action.  

The panel ended with a recommendation from Dr. Gunn suggests that vulnerability can be seen as a gift. Spaces of vulnerability can disrupt the spirit of power and promotes one’s health and promotes the wellbeing of the community. By bringing vulnerability into spaces of healthcare institutions and organizations within communities it can establish a firm foundation of trust, partnership, and healing. 

“Collective self determination is not about what we can give, it’s really about setting the conditions of possibility that are already known.” – Dr. Nicole Overstreet

For questions on the series, please email Steven Swartzer, Associate Director of Academic Programs at sswartzer@fordham.edu.

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