What do ethics have to do with inclusion? And, in particular, what do ethics have to do with inclusion in healthcare?
This are questions that Hafez Ismaili M’hamdi, associate professor of ethics at Maastricht University, has spoken about on different platforms, including at the 7th Annual Meeting of Amsterdam Public Health (APH) in November 2023 and, more recently, the 11th CEC Els Borst lecture when he addressed the topic of "Unjust health inequalities in an ethical perspective". It’s also his belief in the importance of these issues that drive him in his additional roles as a council member of the council for public health and society (Raad voor Volksgezondheid en Samenleving) and the vice chair of the Dutch Centre for Ethics and Health (Centrum voor Ethiek en Gezondheid).
For Dr. M’hamdi, “Perhaps the best gauge for societal decency is the way it treats its least well-off members”. This powerful statement underpins his upcoming keynote at the 2024 ECWO conference which will see him share his vision for what inclusive healthcare in the Netherlands will look like – and, crucially, what it will take to get us there.
We spoke to Dr. M’hamdi ahead of his keynote on 15 November in Rotterdam.
Why is ethics so important – not just to researchers and academics but ordinary people in society?
For me, ethics starts not from all kinds of highbrow philosophical thoughts about the rational nature of human beings. It starts very simply from the observation that when we think that our lives matter, it's a very small step to recognising that other people's lives matter as well. We make that step very intuitively and very easily when we think about our loved ones – when we think about our children, or our families. But I like to think the evolution of morality - in the sense of ever expanding circles of moral concern – ultimately brings us to the understanding that all lives matter.
"Making people feel that they are truly seen, truly respected and truly accepted for who they are"
And, related to that, why is the topic of inclusive healthcare so pressing?
We are nearing half a century of data which shows that the area in which you are born, your neighborhood, your parents income, your own income, your parents education your own education, your parents occupation, your own occupation and so on, all these factors influence your chances to a decent life as well as your chances to attract a plethora of non-communicable diseases such as diabetes, heart disease and a number of cancers. As a society and as healthcare providers, we urgently need to correct these societal wrongs. But I would argue that inclusive healthcare goes even further – to be able offer help and care which aligns with everyone’s needs, preferences and values, making people feel that they are truly seen, truly respected and truly accepted for who they are.
There seems to be increasing activity around highlighting the need for inclusive healthcare, bringing it more into the public eye. Can you share your thoughts on this?
I think it is as a result of a lot of people like Hanneke (Prof. Hanneke Takkenberg, ECWO’s Executive Director) and other individuals and organisations actively and consistently bringing attention to this topic. The fact is, inclusive healthcare is not a “nice to have”. It is an essential precondition to make medical attention and treatments accessible to everyone who needs them. It is true that the level of care in the Netherlands is unbelievably high, if you look at it in comparison to much of the world, - and we must never obscure from sight what has already been achieved and what we have to build on. But we must also recognise that there are undesirable forms of inequality that exist, even in a country like this. Satisfying the standards of high quality care with respect to different groups in in society and believing that the system is non-discriminatory is not the same as inclusion.
"We need to rekindle that idea of solidarity; the idea that your problem is, to some extent, my problem."
Could you expand on this?
A lot of diversity and inclusion talk occurs along the lines of equity and justice. I think that's necessary, but it is not sufficient. Justice is a very cold way of approaching this because it is about rights and duties, right? The language of justice - in which you seek what you are owed - is, despite its importance, a language that is rational, argumentative, calculating, non-emotional, devoid of love and passion. But we must also remember that we are creatures of empathy, creatures of solidarity, creatures who can relate to other people through our rational mind, yes, but also – indeed especially - through our hearts, and this is vital when it comes to true inclusion. We need to rekindle that idea of solidarity; the idea that your problem is, to some extent, my problem.
As an ethicist, this idea that the heart comes into the crucial issues facing society – like health inequalities and inclusion – is powerful. Would you expand on this for our readers?
I have a strong belief in the fact that when we think about ethics in general, when we talk about things like health inequalities and inclusivity, we should make ample space for our moral sentiments. In my view these are very important drivers of human behaviour. For example, if you have a board made up of white, middle-age men, and you try to convince them, based on rational arguments, that their board should be more inclusive, but they don't feel it in their stomach, in their core being, my contention is that they will never change. And I'm willing to stake a lot on the claim that the opposite is true: that if you can make them feel – really feel - the wrongness of only having one, homogeneous group of people on their board then I think the chances for change are higher. For me, the ethical current does not take this sufficiently into consideration – the question of what the moral drivers are that make us act in one way, rather than another way. And I think that the influence of rationality is grossly exaggerated. We act on the basis of all kinds of sentiments, be it empathy, be it sympathy, be it solidarity, be it hate, be it lust. Those are very strong drivers of human behavior. An ethical system which does not, one way or another, deal with those human drivers of behaviour is, as I call it, an ethics for angels - and there are none of those on earth.
Experience as someone of Moroccan descent plays a part in thinking about gender
You were recently one of the speakers at the 11th CEC Els Borst lecture. Our Executive Director, Prof. Hanneke Takkenberg, was awarded the Els Borst Prize in 2018 for her work to improve healthcare for women, both for patients and medical staff. Does gender come into your work at all and if so, in what way?
The Dutch Network of Women Professors (LNVH) was kind enough to ask me to speak at one of their events several years ago, and that really got me interested in the topic of healthcare and gender. I have also always beeninterested in the work of female philosophers so my own curiosity had led me there previously but I would say that that experience was a turning point for me to really consider much more deeply how gender intersects with healthcare. There is no doubt that I have brought my own experience of discrimination as someone from Moroccan descent into my thinking about gender. I have confronted non-inclusivity, discrimination and racism many times. For me it comes in the guise of the views people have about Arabs, about people with my skin color, with my shape nose and eyes, my name and so forth.
So your background has played a role in shaping your thoughts about inclusivity?
Yes. At a certain point I realised that all through school – elementary and high school – and then through two study programmes , a Masters degree in Music at the Conservatory and a Masters degree in Philosophy, I never had a lesson from a single Arab teacher; from someone who looked like me. And that really does something to you. It has nothing to do with discrimination or racism. What it has to do with is identity formation. When I realised that, it was a significant lacuna. Now, when I lecture, I can see that I have this click with Arab students, and, even though I am not Turkish, with Turkish students too. There’s always this understanding of “hey, I see you and you see me”. I am so happy I can do that for those students.
You trained as a musician at the Royal Conservatory of The Hague. We would love to learn more about the importance of this aspect of your life.
I used to love playing music, but I am one of those people who made the wrong choice by making a profession out of their hobby and that didn’t bode well for me. Being a fulltime musician is really hard – you have to be your own manager, you have to be very skillful in arranging sufficient work, you have to do a lot of music teaching and you have to create a brand and be on social media. I was not very successful at any of that. But switching from music to ethics, from the music world to academia, well the difference is only superficial in my view. That is because what I look for in anything I do is a way to express my creativity. And, in fact, whether I am thinking about diversity and inclusion or about ethics regarding embryos, I am struck by the fact that what these real world problems need is creativity, which enables me to really turn these problems on their head and look at them from different angles. I would say that this is a fundamental way in which I approach the world - and there's ample room for it in music, but also very much in academia. Actually, going into ethics means I have come back to music as a listener. I live on YouTube which is full of so many amazing bootlegs and recorded concerts. It’s been a real pleasure to return to music in this way.