Critical race feminist bioethics: telling stories in law school and medical school in pursuit of "cultural competency".

• Author: Washington, Deleso Alford
• Position: SYMPOSIUM: DEFINING RACE

A SISTERSONG BALLAD (1) I know Sisters. I know Sisters who lived lives full enough to be stories- "Her-stories" untold, Carried through the heartbeat of mother's wit.., all the time being "othered" by legal fictions that turn humans to chattel property; Allowing her and "her-story" to be created, bought and sold. I know Sisters. Sister Anarcha got a story for all to take heed. Her-story cuts so deep, make you bear down, close your eyes and legs... Once you hear how her private was made public, With fine silver wires sewn together without anesthesia, Just like she was broke and needed fixin' in order to breed. I know Sisters. Sister Betsey got a story make your head spin around twice. Her-story led to the development of the urinary catheter, Yet another invention--pulled on and sewn up Perfected on her "othered" existence, Amounting to a historically accepted, but marginalized vice. I know Sisters. Sister Lucy got a story that laid the foundation for the medical specialty of gynecology, Her-story gave meaning to a pewter spoon, Both ends bent and inserted to open "the way" To see fistulas evidencing the truth About 'property' bearing human crop, Resulting in a prototype for both you and me. I know Sisters. I know Sisters who know Sisters who lived lives full and deep enough to be stories- "Her- stories" Seeing the light of day, heard through lyrics in her song All the time being centered by her-storical accuracies; Allowing Sisters to tell "her-story" In her rhythm and blues, soulful gospel, Jazzed up by the hip-hop, caught up in the rap-ture... As only a Sister can, in her own words, in her own way. I know Sisters. I know Sisters who write their own sister song ballads, As reproductive wrongs twist and shout, To revere the lives lived of Sisters past, and lives to be lived of Sisters present And for the life of every Sister yet to come; Whose lives together compose the "Her-stories" Worthy to be song about. INTRODUCTION

This article examines how slavery (2) and the concept of race (3) intersect with gender (4) to construct a distinct notion of science and technology that has been historically marginalized at best. The particular aspect of "science" that I explore is the development of the medical specialty of gynecology (5) in the United States. I specifically look at "technology," historically referred to as Sims's (6) instruments, Sims's gynecological innovations (7), and Sims's inventions, (8) circa 1845-1849, which are still used today. I argue that the particularized and unique experiences of enslaved Black women have been traditionally viewed as extracting assets from her body in the form of a "crop of human labor" (9) in the historically referred to role as a so-called "breeder." (10) The focal point of this article is to explore a means to address the impact of continuing to tell the narrative on the development of the medical specialty of gynecology in the United States without the benefit of a "herstorical" lens. The reproductive and surgical exploitation meted upon three enslaved women, Anarcha, Betsey, and Lucy, among other un-named enslaved Black women, "othered" (11) their skin based upon a construction of "race," yet "samed" their bodies for purposes of extracting reproductive knowledge, surgical inventions, and innovations to benefit all women. (12) The story of Anarcha, Betsey, and Lucy is the marginalized story of how the laws of enslavement sanctioned medical experimentation and exploitation upon the bodies of Black women. I posit that the telling of Anarcha, Betsey, and Lucy's narrative (13) in medical schools will aid current efforts to attain cultural competency. (14)

The bioethics (15) principle of truth-telling (16) is traditionally viewed from the doctor-patient relationship, however, existing racial and ethnic reproductive health care disparities mandate culturally competent training from a critical race feminist (17) perspective that suggest historical truth-telling in medical schools to students through the use of narrative (18) as a modality. I propose in this article, what I refer to as Critical Race Feminist (CRF) Bioethics as a tool which focuses on the realities of women of color with aspects of an approach that pays attention to the point of view of women of color bodies (19) and experiences with interfacing with the healthcare system of the past and present.

This article argues that CRF Bioethics enhances the ability of medical practitioners to humanize present interactions with diverse populations based on knowledge of a historically marginalized past narrative involving medical technology, specifically the specialty of gynecology and the advancement of this specialty through the laws of enslavement.

Part I explores the use of storytelling and narrative analysis in legal and medical educational settings as a viable approach to enhance learning as well as benefit ultimate professional interactions. This part focuses on the individual experiences of Anarcha, Betsey, and Lucy, oftentimes over-looked in medical history, who were forced by the laws of enslavement to lay at the intersection of gender, race, and class in pursuit of science and technological advancement.

Part II examines the historical development of the field of Bioethics and offers a new approach to address the specific needs of women of color and reproductive health.

Part III focuses on the current needs of medical education to attain cultural competency. I place particular emphasis on the development of the medical specialty of gynecology in the United States as a modality to address the need for historical truth-telling in medical schools.

Finally, Part IV concludes that CRF Bioethics should be explored to adequately address the necessity of telling the "her-storical" narratives of Anarcha, Betsey, and Lucy in order to center the so-called "objects" of experimentation in medical history and reclaim their humanity to achieve cultural competency presently.

1. NARRATIVE IN LAW AND NARRATIVE IN MEDICINE

   The relationship between the vestiges of enslavement, race, and social constructions of race, and their impact on the quality of healthcare of diverse populations, particularly as to African Americans, is well documented. (20) However, the use of storytelling and narrative jurisprudence as a teaching modality in law (21) and, most recently, in medicine (22) lays the foundation for giving voice to the historically silenced, existing in the background but never center stage, no matter how integral to the ultimate story. (23)

   The evolving discourse on the notion of "applied legal storytelling," (24) "legal archaeology," (25) and the role of narrative in law (26) provides both lawyers and law professors with an opportunity to explore the ultimate goals (27) for telling the story and enhancing the ability of the storyteller "to see law as narrative or storytelling." (28) The proponents of utilizing narrative and storytelling to develop legal skills and lawyering often begin with an extrapolation of the traditional terms of art associated with storytelling, such as the "character, conflict, resolution, organization, point-of-view," and, perhaps, setting. (29) I argue that the notion of "traditional" must be viewed through a "her-storical" lens in order to see the marginalization of "raced and gendered race" (30) characters in the story being retold. Narratives and stories energize legal theory (31) due to their ability to hear a multiplicity of voices emanating from the storyteller and moving the story listener.

   The illusive "other voice" that is being searched for can be found in the acknowledgement of a "multiple consciousness" (32) capable of speaking in many voices. In the tradition of Critical Race Feminist (33) theorists, the notion of storytelling and narrative analysis serves as a "bridge toward understanding the legal status of women of color and the ways in which women of color face multiple discrimination on the basis of factors, including but not limited to race, gender, class, able-bodiedness, and sexuality"(34) by hearing the multiple voices of those "characters" marginalized in history and at present.

   Professor Margaret Montoya sent out a call to action in her moving article, Defending The Future Voices Of Critical Race Feminism, (35) when she concluded that "[t]he fusion of CRF from law schools with linguistic and cultural competence from medical schools is an idea worth pursuing." (36) The laws of enslavement and the resulting "slave health deficit" (37) present complex narratives that have yet to be adequately examined in light of current day health disparities among Blacks. Byrd and Clayton found that "African Americans have always been aware of the United States' health system's race and class problems through their traditional interface with the system." (38)It is this history that must be acknowledged and discussed, because, as Toni Morrison put it, "in spite of its implicit and explicit acknowledgment, 'race' is still a virtually unspeakable thing."(39) A CRF analysis of medical advancements in gynecology, which embodies the laws of enslavement, is a story worth being told. Professor Pamela Bridgewater correctly argues that "[s]lavery was not just about chains and forced labor as the traditional story suggests- [sic] it was about the gendered forms of bondage which had particular consequences in the lives of women. Female slaves had a slavery all their own- [sic] specifically designed to exploit what the institution valued in their bodies." (40) This article focuses on telling the story of medical value and gynecological advancement resulting from the reproductive and sexual exploitation of Black women during enslavement as a step toward cultural competency.

   A. Narrative in Medicine

   Dr. Rita Charon has led the exploration of narrative analysis in medicine. Dr. Charon posits that "[t]he rise of narrative medicine may signify fundamental changes in the experience of disease or of...