M2 Bias and Intersectionality

bias

A subjective opinion, preference, prejudice, or inclination, often formed without reasonable justification, which influences the ability of an individuals or group to evaluate a particular situation objectively or accurately.

• Conscious and Unconscious Bias

conscious bias

refers to attitudes, beliefs, or stereotypes that a person is aware of and intentionally expresses

unconscious bias

refers to automatic assumptions or stereotypes that influence thoughts and behaviour without a person fully realizing it

reasonable apprehension of bias

A legal term used to determine whether or not the decision of a judge may have been influenced by bias. The test is whether a reasonable person properly informed would apprehend that there was conscious or unconscious bias on the part of the judge.

racism

Racism is a belief that one group is superior to others performed through any individual action, or institutional practice which treats people differently because of their colour or ethnicity. This distinction is often used to justify discrimination.

• There are three types of racism: Institutional, Systemic, and Individual.

individual racism

The beliefs, attitudes, or actions of a person that discriminate against someone because of race or ethnicity.

institutional racism

When the policies, rules, or practices within an institution create unfair outcomes for certain racial groups

systemic racism

larger, society-wide pattern where multiple institutions and historical factors work together to produce racial inequality over time

sexism

Prejudice or discrimination based on sex, usually though not necessarily against women; behaviours, conditions or attitudes that foster stereotypes of social roles based on sex.

• Sexism may be conscious or unconscious, and may be embedded in institutions, systems or the broader culture of a society.

discrimination

The denial of equal treatment and opportunity to individuals or groups because of personal characteristics and membership in specific groups, with respect to education, accommodation, health care, employment, access to services, goods, and facilities

• This behaviour results from distinguishing people on that basis without regard to individual merit, resulting in unequal outcomes for persons who are perceived as different. Differential treatment that may occur on the basis of any of the protected grounds enumerated in human rights law.

ableism

A system that sees persons with disabilities as being less worthy of respect and consideration, less able to contribute and participate, or of less inherent value than others. Ableism may be conscious or unconscious, and may be embedded in institutions, systems or the broader culture of a society. It can limit the opportunities of persons with disabilities and reduce their inclusion in the life of their communities.

source of bias

Social Learning Theory

stereotypes

dominant media

Social Learning Theory

A psychological theory that explains how people learn behaviours, attitudes, and social norms by observing others

• For example: If aggressive behaviour in sports is rewarded with praise or success, athletes may learn that aggression is acceptable.

• Leads to bias

Stereotypes

Stereotypes can propagate in society

• e.g. immigrants taking jobs, stereotypes against Black/South Asian Communities

• Leads to bias

Dominant Media

Manufactures consent/knowledge from government/politicians

Bias and Impact in Biomedical Ethics

HCPs may hold biases based on lived/professional experiences and social/cultural understanding

• These biases affect treatment and decision-making

Bias in Biomedical Ethics Examples

For example:

1. HCPs prioritizing “patient autonomy” in Western contexts may conflict with family-centric dynamics in non-Western cultures (e.g. Norwegian case of child removal from South Asian mother)

2. Historical and ongoing biases against Indigenous people in healthcare (e.g. Kudiste joins Eka Kuan being ignored?)

Critique of Principilism

Laws and principles are formulated by those in power, reflecting their contexts, potentially leading to contested and narrow applications

• (e.g. colonial pass marks in South Asia, lowering pass marks to around 30% as colonizers assumed that South Asians were less smart than them)

DKEM Model

Expands on traditional biomedical ethics (autonomy, beneficence, non-maleficence, justice)

• Adds vulnerability, social justice, and context and relationship

• Gives more weight to social justice

DKEM Critique of Kinesiology

1. Educational structure favours gendered and white ideals

2. Historically, physical education (sports) used in colonial periods for military involvement, labour control, and instilling values like stoicism and discipline

• This created standards that excluded certain groups (e.g. military recruitment based on body type, assimilation of Indigenous children in Canada)

Social Justice

Beyond immediate justice; incorporates intergenerational and historical marginalization

• Explores how historically marginalized groups can become oppressors (e.g. Irish/Italian immigrants initially discriminated against, later gaining privilege)

• Expands the understanding of ethics and power in kinesiology

Vulnerability

Not adequately present in traditional biomedical principles

• Requires holistic assessment: patient’s health, cultural, social, and familial aspects

• Also considers the positionality of practitioners (e.g. racialized faculty/nurses facing systemic pressures)

• Addresses historical targeting of marginalized communities for unethical health experiments

Example: Underrepresentation of racialized faculty/students in KPE affects trust and participation

Equality

The idea that everyone is given the same things, resources, or access

• “Provides the same starting line”

Equity

Everyone gets what they require to be placed on an equal footing, or to achieve the same outcome

• Focuses on addressing specific needs and abilities

Equality vs Equity

Which is better? It’s context-dependent, but equity is generally better for achieving fairness and removing barriers

• e.g. we need gender equality (e.g. same salary paid to both men and women) whereas we need equity with Indigenous groups (addressing specific needs of Indigenous peoples)

Gender Neutral Washrooms

Question: Should all public schools in Canada be required to have gender-neutral washrooms?

Arguments for: Equity, accessibility, inclusivity for transgender/non-binary students, choice

Concerns: Privacy and comfort for other individuals (autonomy

Optimal Solution: Provide all 3 options (male, female, gender-neutral) to ensure inclusivity w/o exclusion

Hassan Rassouli (Life Support Withdrawal)

Case: Canadian man in persistent vegetative state. Doctors wanted to withdraw life support, family objected

Supreme Court Ruling: Doctors cannot withdraw life-sustaining treatment without consent of the patient or their substitute decision-maker

Discussion:

• Disregarded patient autonomy, cultural/religious definitions of “harm”, questions fundamental human right to life, raises considerations about resource allocation (e.g. hospital bed space)

Historical Parallel: decision to drop atomic bombs on Japan, weighing lives (American soldiers vs Japanese population) from an “administrative efficiency” perspective

Baby Joseph

Case: Canadian infant with rare, fatal neurological disease. Parents wanted experimental treatment in the U.S.; Canadian doctors argued it would not be effective and only prolong suffering

Supreme Court Ruling: Ruled in favour of the doctors, allowing them to withhold life-sustaining treatment, and Baby Joseph died naturally

• Canadian legal rulings in this case established a firm boundary: Autonomy does not give a patient or family the right to demand any treatment they want, especially if that treatment is medically futile. From the doctors' perspective, forcing a surgical procedure (cutting into a dying infant’s neck) that will not alter the fatal progression of Leigh Syndrome isn't practicing medicine—it is committing an act of physical harm. The courts agreed that the state has a duty to protect a vulnerable child from suffering, even if that suffering is being caused by well-meaning, deeply grieving parents.

Decolonization

Requires transforming thinking and moving away from current systems that are often built on Western/Eurocentric knowledge

Decolonization Critique of Universalist System

Western theories/ideas established as universally applicable, ignoring diverse cultural traditions, food cultures, social practices, weather conditions, and available resources

Forward Looking Society

Western societies (forward-looking) focus on youth, often marginalizing elderly who are typically in old homes or cared for by non-family members

Backward Looking Society

Asian/South Asian countries (often termed “backward” but not in a negative sense)

• Elderly cared for by family, their wisdom is valued for future generations

Examples of Decolonization

• Indigenous games and physical activities (created by and for Indigenous populations)

• Nunavut Kamatsiaqit Helpline: 24-hour mental health helpline for Inuit, developed due to Indigenous mistrust in Canadian healthcare system and lack of resources in remote areas

• Addresses systemic racism and health disparities by providing culturally relevant support

Impact: Prioritizing diverse perspectives leads to transformational change and expanded understanding of societal issues

Race

Social category that gained prominence during the colonial period to control/dominate societies by creating hierarchies based on skin colour and “purity”

Types of Racism

1. Scientific Racism

2. Institutional Racism

3. Systemic Racism

4. Individual Racism

Scientific Racism

Racism “justified” by science

• Used to establish white dominance (e.g. by measuring physical attributes like skulls “proving whites are more intelligent”)

Institutional Racism

Policies, practices, and institutions that perpetuate racial inequalities (e.g. residential schools)

Systemic Racism

Social structures that sustain inequality, often using neutral language but disproportionately excluding certain groups (covert)

Individual Racism

Overt discriminatory actions and attitudes

Racism in PE

Embedded in masculine/colonial narratives

• PE introduced to produce soldiers, instill discipline, hard work, and control over mind/bodies

Colonial Legacy in Sports

Modern sports affected by these masculine/colonial legacies

• Ice hockey (colonial game) vs lacrosse (Indigenous game appropriated by settlers, with Indigenous exclusion)

• Soccer introduced by colonizers in various parts of the world for “civilizing missions”

White Supremacy

Both a belief system and institutional system of oppression where white dominance is maintained to control other races and demonstrate superiority

White Supremacist

A person who holds this mentality (white supremacy)

Covert Forms of White Supremacy

Socially acceptable language with racial connotations (e.g. “Make America Great Again,” “You don’t sound black”)

• Perpetuates marginalization through colloquialisms

Prevalence in KPE

Curriculum: Heavily Eurocentric, lacking courses on race, theories, and methodologies from the Global South

Research: Racial bias in studies

Health Industry Underrepresentation:

• Only 2.9% of identified health professionals are Indigenous

• Only 7.5% of PTs in Canada are racialized

• This means decision-makers and ethical principles used are predominantly Eurocentric and non-racialized, lacking diverse representation in critical health decision processes

Call to Action: There’s a need to critically assess the principles that sustain this system