The magazine’s Ethicist columnist on what forms our identity and the importance of informed consent to medical procedures.
By Kwame Anthony Appiah
I am the parent of a child who was conceived via in vitro fertilization and surrogacy using the sperm of a Caucasian man and a donor egg from someone who is half Colombian and half Central American. My spouse and I are professionals and both Caucasian, so (knock on wood) our son will most likely not encounter financial hardships. May we in good conscience check “Latino/Hispanic” on his college application?
We don’t need to decide this for many years, but it has been a topic of discussion, and we would love to hear your reasoning. Name Withheld
Identities have histories, and one story about the emergence of “Hispanic” as an overarching, transethnic identity in this country was told in detail by the Berkeley sociologist G. Cristina Mora in her classic 2014 study, “Making Hispanics.” It involved a convergence of activists, media executives and U.S. civil servants in the 1970s, resulting in the promulgation of a demographic category that included Cuban-Americans, Mexican-Americans, Puerto Ricans and a great many others. “Latino” (and its variants), following suit, has gained in usage partly because it more easily accommodates people from Brazil (who speak Portuguese). Telling this story doesn’t mean the identity is unreal; it explains how it became real.
Being Latino, clearly, is not a matter of genetics. It’s a matter both of how you identify yourself and of how others identify you. Appearances could play a role here, to be sure. The experience your son would have if he were blond and blue-eyed could differ from certain experiences he might have if he were brown. People from Colombia and Central America come in a range of hues.
So your son may or may not identify as Hispanic/Latino when the time comes, depending on a host of factors, from peer groups to pigmentation. If he does, it won’t be wrong to say so. Where your connection to an identity is a matter of identification with your ancestors, the subjective personal element looms large. I’d predict too that questions about identity are likely to shift in significance over the next couple of decades, as they have over the past couple of decades.
You’re presumably thinking that, in college applications, being identified as Hispanic/Latino will give him some advantage, and that if he hasn’t experienced discrimination or borne the burdens of the identity (perhaps because he’s not readily identifiable as Latino), this might be unfair. In that situation, he’d certainly be getting advantages designed for people with a different set of experiences than his. Deliberately engineering such an outcome would be wrong. The brute fact of ancestry doesn’t suffice to make your child Latino. On the other hand, if he does come to identify as Latino and to be accepted by others as such, the special opportunities he might be offered would serve one of their functions, which is to have people of Latino identity in a wide range of positions in our society.
I went to an orthopedist to treat an acute joint problem. The doctor gave me a shot of cortisone, which helped. However, I wasn’t given a heads-up or an explicit choice about it. I didn’t question what the doctor was doing, but I thought that we should have had a discussion beforehand, so that he might explain the pros and cons and seek my consent. The doctor is affiliated with a hospital, which has asked me to fill out a survey. Should I explain my concerns there? Or should I raise them directly with the doctor at my next visit? I am satisfied with the doctor’s care and don’t want to get him in trouble, but I would like him to change the way he goes about things. Name Withheld
Informed consent to medical procedures is at the heart of a proper relationship between health care professionals and their patients. Your doctor should be reminded of this. Of the two options you’re considering, sharing your concerns with him directly, at your next visit, would be more respectful; it would also allow him to discuss with you exactly how you thought his treatment of you could have been better. What’s more, once you’ve entered the information in the survey, it could be used in ways you don’t agree with — which may not sit well with you, given your just concern with consent.
I work for a company that holds itself to be highly ethical. Recently, a senior-level consultant joined the team and on at least one occasion recorded closed meetings without consent. I want to speak up, but I fear retaliation. What is the right thing to do? Name Withheld
What’s being recorded here isn’t a private conversation but a work meeting, and this lands us in a gray zone. Different employees may have different expectations, and a reputable consultant will have agreed to keep nonpublic information confidential. You could quietly inform management, or the consultant, that you find this practice troubling. But if you really think you’ll be adversely affected by raising the issue officially, you can simply let your colleagues know what you’ve learned. That won’t stop the recordings; it will stop people from being recorded unawares.
My partner is a psychiatrist who, as a resident, treated a patient with severe mental-health disabilities. The doctor-patient relationship was severed after the residency was completed, and the patient was inherited by a subsequent resident. The patient is a talented visual artist, and my partner encouraged the patient to create art as part of a therapy regimen. Is it ethically acceptable for my partner to contact the former patient in the capacity of an art collector? The patient occasionally posts work on social media and has expressed the desire to sell it but isn’t good at self-promotion. As a result, the artwork remains largely unseen. It has been more than a year since my partner and the patient ended their clinical relationship, but I can see how an issue of doctor-patient boundaries might arise. I have found no guidance on this question, so I humbly submit it to you. Name Withheld
Like you, I don’t know of any statement of clinical ethics that deals directly with this situation. What’s plain is that there are different schools of thought here. Some hew to the motto “Once a client, always a client” or hold that any post-therapy contact should be initiated by the client. But the American Counseling Association, which prohibits sexual or romantic relationships with former clients for a period of five years post-therapy, says only that practitioners should avoid entering nonprofessional relationships with former clients “when the interaction is potentially harmful to the client.” And though the American Psychiatric Association has cautions about a “dual relationship” with clients, it offers no clear rules about nonsexual interactions with former patients.
We’ll do better to proceed from principles, rather than rules. Will this contact be confusing or upsetting to the former patient? Will this person be particularly vulnerable (out of transference or simply gratitude) to the doctor? Exploiting a therapeutic relationship for personal gain would obviously be wrong, and so would complicating whatever current clinical relationship the artist might have.
But there are reassuring features of this situation. The therapy wasn’t terminated in some problematic way; the treatment began and ended when your partner cycled in and out of the residency program. Since then, you note, more than a year has elapsed. What’s being sought now is more of a transaction than a relationship. And examples of the art that your partner admires are publicly visible: What your partner has learned within the context of therapeutic privilege need not come into play.
It’s easier to see the potential upside to the former patient — that, if your partner displays the work, it could spark interest among others — than the downside. Professional associations are rightly concerned with maintaining the integrity of the clinical relationship. But in a world where talent so easily goes unrecognized, other considerations, too, deserve weight where a patient’s welfare is concerned.
Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to [email protected]; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)