February 25, 2021

(HOUSTON, TX) - Assistant Professor Quenette Walton has co-authored a research article titled "How Ancestral Trauma Informs Patients’ Health Decision Making" in the American Medical Association Journal of Ethics. 

The article considers intergenerational trauma by drawing on the experience of a 37-year-old Black woman whose great-grandfather died as a result of involuntary involvement in the U.S. Public Health Service Syphilis Study at Tuskegee and contextualizes her experiences in light of past medical abuse and microethics.

We asked Dr. Quenette Walton to reflect on the findings of her research and to expand upon why it is imperative for those within the medical industry to better serve Black people and people of color.

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Name: Quenette Walton
Current Position: Assistant Professor
Pronouns: she/her

Why was it important for you and your co-authors to explore the idea of how intergenerational trauma can impact decisions made by people of color?

It was important for my co-authors and me to explore how intergenerational trauma can impact decisions made by people of color for a couple of reasons. First, there is significant research that highlights how trauma leaves a scar on a person's genes and changes the DNA that is passed down to future generations. Second, given the trauma (slavery, anti-Black racism, etc.) Black people and many other people of color have experienced we know that over generations their DNA has changed. So, we examine how intergenerational trauma can impact decision making for two reasons: (1) it can cost Black people and people of color their lives when they are deciding between seeking care or staying home, and (2) context matters and it must be included in all aspects of people's care.

The focus of the article is centered on T. T is a 37-year-old Black woman who is the great-grandchild of a man that died during his involvement in the U.S. Public Health Service Syphilis Study at Tuskegee. The traumatic experience looms large over his descendants’ interactions and perceptions of medical providers to this day. How does this ingrained sense of mistrust and history of abuse contribute to the growing health disparities faced by people of color today?

The mistrust and the history of abuse contribute to the growing health disparities faced by people of color today in many ways, but one way, in particular, is around access to care. Depending on where Black people and other people of color live, they may not have access to or may not be able to afford "the best" doctors for the care that they may need. Further, many Black people and people of color may delay seeking treatment for their ailments because of their mistrust. So, we have to ask different questions to effectively address the growing health disparities faced by Black people and people of color today.

What sort of advice would you give to those who work in the medical industry who are seeking to better serve their patients who are Black or people of color?

I think it is vitally important for those who work in the medical industry to be aware of the varied and unique lived experiences Black people and people of color have in the U.S. Black people and people of color experiences are intersectional. Further, their experiences are influenced by their social, political, historical, and cultural contexts. Thus, I think it would be helpful for people in the medical industry to have to do the following: (1) start having different discussions about how and why there is mistrust of the medical field among Black people and people of color; (2) examine how the mistrust can lead to health disparities; (3) investigate how views and practices within the industry may contribute to the mistrust Black people and people of color have; (4) explore how Black people and people of color's unique histories influence their current behaviors when seeking medical care; and (5) develop culturally appropriate solutions to address the mistrust by working "with" not just "in" Black and other communities of color.

Listen to Black people and people of color! When we discuss our concerns with you do not respond with more medicine or more medical treatment take the time to answer our questions and to understand our hesitation. It's not because we want to die, it's because we want to live that we are hesitant. Our hesitation is grounded in the larger social, political, historical, and cultural contexts of our lives that we are seeing continuing to play out in the present day. So, instead of saying a patient is not compliant or being aggressive or being combative, ask what happened or how can I help or is there something I explained that I can provide further clarification about for your care. Take the time to listen. Asking different questions can change the course of someone's care.

In the article, there is a section that explores the idea of microethics. What is microethics and why is it a critical tool in combatting systemic racism within the U.S. Health Care System?

Microethics is the clinical use of ethical principles in everyday practice and interactions between physicians and their patients. It is a critical tool in combatting systemic racism with the U.S. healthcare system because it pushes us to think about how people's experiences in the world are shaped by the events that preceded them and their family members. It also pushes to have to name what those events were and how those events, such as the Tuskegee Sphyllis Study, impact Black people now. Those events were traumatic. Those events were racist. So, we have to name the problem so that we may develop a solution. We also have to recognize and acknowledge Black people's trauma and pain so that we may better serve them on their path towards healing and getting better. Thus, microethics is like a mini code of ethics that physicians abide by in their day-to-day interactions with their patients to establish trust, respect, and honesty within their practice so their patients can be seen, heard, respected, and valued while seeking care and in the decision-making process.

What was one of the biggest takeaways from this research?

Although we know so much there is still much more to learn about Black people and people of color's experiences within healthcare. We are still operating in antiquated healthcare systems that intentionally and unintentionally marginalize and harm many Black people and people of color. T's story tells us that Black people and people of color are owed better and deserve better when they are seeking medical treatment. T's story also tells us that it's not just about training but about structural practices and policies that need to change so that Black people and people of color can feel safe in a system that has a history of experimenting on them.

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The article was published in the February 2021 edition of the American Medical Association Journal of Ethics.