‘Race consciousness’ in clinical practice guidelines as a tool to address institutional discrimination?

Abstract Clinical practice guidelines (CPGs) are an important instrument of evidence-based medicine. They structure medical care on the organizational level and can help standardize care and implement best practice standards. However, if their implementation leads to systematic group-specific disadvantages, CPGs may reproduce institutional discrimination. Therefore, considering the effects of CPGs on healthcare for marginalized groups is crucial. While racism is recognized as an important social determinant of health that explains health inequities across groups marked through racialization, it is unclear how racialization should be considered in CPGs. Different approaches are currently discussed. ‘Race’-based medicine is still prevalent in clinical practice. ‘Race’-based medicine treats ‘race’ as a proxy for assumed underlying biological differences and involves considering a person’s ‘race’ in clinical algorithms. ‘Race’-based medicine is criticized as ontologically flawed because it is based on ‘racial population naturalism’. Additionally, it is criticized for its consequences in clinical practice, because it redirects resources away from groups affected by racism, reifies ‘race’ as a biological category and may reinforce biases in clinical practice. Based on the criticism of ‘race’-based approaches, ‘race’-conscious medicine has been developed. ‘Race consciousness’ understands ‘race’ as a social construct rooted in racism, which can explain and address treatment disadvantages for patients affected by racism. In this article, we discuss the potential and limitations of ‘race’- conscious as compared to ‘race’- based guidelines as a tool to mitigate the risk of institutional discrimination in healthcare. Eventually, we consider specific challenges to the implementation of ‘race’-conscious approaches in the German context.