Ethics

Institutional racism is defined by Shirley Jean Better in her book entitled Institutional Racism A Primer on Theory and Strategies for Social Change as those patterns, procedures, practices, and policies that operate within social institutions so as to consistently penalize, disadvantage, and exploit individuals who are members of non-white racial  ethnic groups or the dominantpowerful majority in a certain population (11).  Two important actors are affected in the process of inequality that is happening in institutions and these actors are the dominant and powerful, and the disadvantage groups. The dominant powerful group usually consists of the majority group in a certain country, community, or population, which has the authority in respective institutions that allow them to have an advantageous position in the society. On the other hand, the disadvantaged group is commonly the minority population in a country or community that does not have the necessary power in institutions and in the society, which makes them more prone to abuses and exploitation by the dominant group.
In line with this, institutional racism is one of the most pressing issues in the American society, especially since the country is inhabited by people coming from different racial background. In addition, the controversial and highly-debated issue of health care is also linked to the concept of institutional racism because there are instances wherein the minority group does not have the same access to health care as compared with the dominant group. Institutional racism adversely affects justice and fairness in the society because inequality persists in the different institutions. That being the case, it is necessary that institutional racism be further studied, especially in the context of ethics.
Ethics is recognized as a branch of philosophy that deals with questions and issues about morality, which assesses whether a situation is good or bad, right or wrong. In relation to this, Michael Slote in his book entitled The Ethics of Care and Empathy, points out that ethics also gives importance to the observance of justice, and values in the society (96). Two of the most notable ethical systems are Immanuel Kants Categorical Imperative and John Rawls Theory of Justice. Kant and Rawls ethical systems will be applied to the institutional racism that is happening in the American health care system in order to critically analyze which its ethical implications.

Institutional Racism in American Health Care
Ridley explained in his book, Overcoming Unintentional Racism in Counselling and Therapy, that institutional racism is pervasive and deeply woven in the United States health care system (158). Racial discrimination generally compounds the institutional racism in the American health care, which greatly affects the minority groups access to health care and the quality of the health care received. Although there have been efforts in the past years to eradicate discrimination and address racial segregation, only limited changes took place when it came to quality and access to health care for many minority groups. Based on the United States Commission on Civil Rights,
Despite the existence of civil rights legislation equal treatment and equal access are not a reality for racial  ethnic minorities and women in the current climate of the health care industry many barriers limit both the quality of health care and utilization for these groups, including discrimination (Randall n.p.).

The issue of racial discrimination in the American health care in terms of delivery, financing, and research still persist and the racial barriers to quality health care are represented in different ways.

The lack of economic access to health care is one of the implications of institutional racism in the United States. An estimate of more than 38.4 million Americans is uninsured and lacks the necessary economic access to health care. In relation to this, the disproportionate number of uninsured Americans is racial minorities. The access to health care insurance is usually related to employment. However, according to Vernellia Randall, a Harvard law professor, the economy is racially stratified, which is why different forms of discrimination are observable that caused the concentration of minority groups in low-income jobs with no health insurance benefits (n.p.).

Vernellia Randall discussed in her work entitled Institutional Racism in U.S. Health Care that institutional racism in the health care system is also seen in different areas. The creation, establishment, and implementation of policies that restrict the admission of minority groups contribute to institutional racism. In line with this, the closure, relocation, privatization of hospitals and health care centers that primarily serve people that are coming from minority communities is also an example of institutional racism. Moreover, the continuous transfer of unwanted patients, who are usually from minority groups, fosters institutional racism to continue (Randall n.p.). In line with this, communities that are heavily populated by minority groups experience shortage in the number of physicians and other health care providers that serve them. A good example is the minimal number of White physicians that practice their profession in minority communities. Another key challenge is the lack of clear health care standards that give importance to cultural differences in health care, especially when it comes to language barriers. Physicians and other health care providers have difficulty in addressing the health care needs of minority groups because they cannot properly understand their complaints and predicaments due to the difference in language. Moreover, gender discrimination is also a problem in the United States health care system because the health experience of African-American women are not given due importance in the health care policy of the United States (Randall n.p).

Immanuel Kant
The categorical imperative is the central argument in the moral philosophy of Immanuel Kant. Based on the philosophy of Kant, human beings have a special part in creation wherein their morality is dependent upon one ultimate reason or imperative, which all duties and responsibilities are defined. The definition of imperative in the perspective of Kant is any proposition which makes an action or inaction necessary. According to the book of James White, Contemporary Moral Problems, categorical imperative pertains to the unconditional requirement which is applicable in all circumstances because it is regarded as both required and justified as an end in itself (White 47).

John Rawls
The Theory of Justice is a book, political philosophy, and ethical system that were established by John Rawls. Rawls created the book in order to try addressing the problem of distributive justice by means of using the social contract. The Theory of Justice asserts the principles of liberty and equality. Equality entails that fair choice should be observed in a situation by all parties. Based on the work of anthropologist-researcher, John Cottingham, the primary purpose of the principle of justice is to guide the decisions and actions of the parties in order for them to pursue their interest through cooperation with other people by means of mutually accepted terms, which exemplify justice (411).

The veil of ignorance is also a part of the ethical philosophy of John Rawls. The veil of ignorance can be used in order to determine the morality of specific issues. The principle of the veil of ignorance asserts that an individual can only really and truthfully consider the morality of an issue by means of being ignorant of the societal roles and social distribution. When an individual is ignorant of his or her position in the society like social status, assets, abilities, intelligence, and strength, he or she can be able to think of an issue in the society from the perspective of all members. According to Gordon Graham in his book Eight Theories of Ethics, an individual can be able to properly assess an ethical issue without any personal biases (167).

Analysis
The ethical philosophies of Immanuel Kant and John Rawls clearly show that institutional racism in the United States health care system is immoral and unethical. The categorical imperative is under the deontology ethics that gives importance to the duty and responsibility of an individual. Immanuel Kants categorical imperative argues that an action can only be ethical if it follows maxim, which can be regarded as a universal law. In the case of the United States health care system, the main responsibility or duty of the government, as well as health care professionals, is to address the medical needs of the people regardless of their social or economic status in the society. However, the duty of the government and health care professionals are not being done properly because of the presence of institutional racism. Moreover, the unequal access and quality of health care go against the principle of categorical imperative because the policies such as limited health care for those with no insurance and the transfer of unwanted patients, which are being applied by the American health care system cannot be recognized as a universal law.  

In the same manner, the ethical philosophy of John Rawls also exemplifies the unethical characteristics of the United States health care system. Rawls Theory of Justice emphasizes the importance of equality and justice. The ethical argument of Rawls was grounded on the idea that the principle of justice should be acceptable to all people from a fair position. In addition, the Rawls also introduce the veil of ignorance that can only understand an issue if he or she can see it without the impediments of social class and other factors that will affect his or her judgment. In the case of the United States health care system, the minority group does not have an equal access to quality health care, which clearly goes against Rawls principle of justice. Moreover, the sense of justice is not realized in the American health care system because there are people who are in advantageous situations because of the suffering of others. Furthermore, the veil of ignorance of Rawls also helps in objectively assessing the social issue of institutional racism wherein an individual from the dominant group who would practice the principle of the veil of ignorance will realized that being a member of the minority group is difficult because unfair treatment is experience when it comes to the access of quality health care.