White Normativity and Subsequent Critical Race Deconstruction of Bioethics

The discussion of white normativity, encompassing both white dominance and privilege in the field of bioethics requires a critical analysis of the inextricable relationship between the sociological construction of race, the role of cultural capital, and the development and schematization of white hegemonic structures. Thus, a corollary to recognizing the infusion of cultural capital in contemporary bioethics (Myser 2003) includes the critical deconstruction of white privilege and eurocentricity in bioethical policies such as organ transplantation.

"Human races are . . . social constructs—products of the human mind's indelible wont to classify phenomena into some meaningful semblance of order" and thereby reflect the dominant culture and dominant ideology (Wienker 2001, 4; Marks 1995). This subjective classification system permeates the ideology of white supremacy, thoroughly marking the other while unmarking the normative white self.

All forms of classification are an extension of how the classifiers interpret the world around them. Racial categories are not based on biological evidence but on arbitrary physical and cultural attributes such as hair texture and skin pigmentation. Given this social/subjective interpretation by the dominant culture, the role of "race" and "racial" categories is dubious in a science-based system. The privilege of "whiteness" invades social discourse, particularly a healthcare delivery system based on providing scientific (objective) services within a societal (subjec- tive)context. The "racial" and ethnic disparities in organ donations and organ transplants exist because of the so- cial construct within which the scientific system op- erates.

Reducing the role of cultural capital is integral to deconstructing white normativity in bioethics. Cultural capital encompasses elements of hierarchical, structural determinism, conceding that assimilation in certain minority groups is comparable to the duality experienced by other individuals in society who attempt to pass as the token ideal standard by maximizing their cultural capital. To benefit from cultural capital in the United States, one must be (or be perceived to be): white¹ (Pace v. Alabama, 106 U.S. 583 [1882]; Roldan v. Los Angeles, 18 P.2d 706 [1933]), male² (Davis 1981, 175), middle-class,³ heterosexual⁴ (Adams v. Howerton, 673 F.2d 1036 [1982]; Baehr v. Lewis, 852 P.2d 44 [1993]). These cultural capital assets allow the individual to be included in white normative structures, thus lending further credence to the long- enjoyed privilege of being white (Harris 1993).

These four cultural assets are more insidious than they appear. In organ transplants, "African American patients wait longer to obtain kidney and other organ transplants than white patients, and whites continue to account for most organ donations . . . [limiting] the number of organs available for minorities where immunologic matching is deemed essential." (Noah 1998, 135-36). The potential for racially biased decision making exists during both the evaluation of the organ recipients and the ranking of their medical eligibility. White physicians have long enjoyed cultural capital assets and racially preferential status. Their failure to critically recognize white normativity further contributes to minority dependence on a majoritarian value system.

Within this hierarchical structure where race is a predominant, immutable factor, organ transplantation may epitomize the white hegemony prevalent in healthcare. Hegemony is the "illusion of structure and provision of a means of control" (Nunn 2000), with particular emphasis on instrumental, coercive, and persuasive mechanisms that "[subdue] and [co-opt] dissenting voices through subtle dissemination of the dominant group's perspective as universal and natural, to the point where the dominant beliefs and practices become an intractable component of common sense" (Karsjens 2002, 79-80).

In a hegemonic regimen an unjust social arrangement is internalized and endlessly reinforced in the very institutions that have been delegated to recognize, facilitate, and empower minority voices. The disparity and inequality among minority organ recipients exemplifies an unjust social arrangement that has become accepted and reinforced by a white medical majority. Consequently, the medical profession may implicitly condone "whiteness as property" while perpetuating the subtle...