Toward abolition medicine

April 6, 2022

Bixby members Monica Hahn and Nicholas Rubashkin contributed to the AMA Journal of Ethics issue Toward Abolition MedicineIssue editor Osagie K. Obasogie writes about the need to center equity, inclusion and belonging, and that the journal issue “provides an opportunity to continue the conversation on this important intervention and move us one step closer to making abolitionism central to what it means to practice medicine.”

Monica Hahn, along with coauthors Nhi Tran and Aminta Kouyate, uses a case study to argue that structural racism and carceral bias come out when considering how a patient has stuck to health recommendations in the past to decide if they’re eligible for current interventions. They write,

“Part of the work of decarcerating and decolonizing health care policy and practice involves an investment in the idea that people are capable of change. A carceral framework implies that people are doomed to maintain their past patterns and behaviors. Transformative justice and abolitionist frameworks maintain that change is possible and within the capacity of human agency and will. It is critical for clinicians to recognize patients’ capacity to grow and learn and be partners in their health care decision making.”

Nicholas Rubashkin writes about how the calculator used to determine whether someone can give birth vaginally after a c-section is laced with racism and compromises patient autonomy. He concludes:

"Removing race from the VBAC [Vaginal Birth After Cesarean] calculator does not fully address the ways that racism continues to cloud the issue of VBAC. In order to make fairer algorithms, we must pay attention to the explicit and implicit ways that racism structures the risk of a primary cesarean, the quality of postoperative care, and clinicians’ willingness to respect women’s care preferences. Bioethicists have recommended that we center women’s preferences in VBAC decision making. However, the VBAC calculator demonstrates how relative risk can be used to trump a woman’s preferences for VBAC. Both the new and the old VBAC calculator compromise patient autonomy and undermine the principle of informed consent."