A raw, unflinching ethical investigation into covert racism in end-of-life care.

In 2011-2012, Rev. Dr. Jeff Hood, then a doctoral student and chaplain-in-training, conducted an in-depth practicum at Sanctuary Hospice House in Tupelo, Mississippi-a nonprofit facility founded on Christian compassion and a mission to serve all, regardless of ability to pay. What began as a study of racial disparity quickly exposed a deeper, more insidious reality: a white-dominated environment riddled with cultural incompetence, racially insensitive language, and systemic barriers that marginalized Black patients, families, and staff.

Through anonymous surveys (where 50% of employees admitted the hospice was not a racially sensitive workplace), focus groups, and candid personal interviews, Hood documented disturbing patterns: casual use of slurs like "colored" and the N-word, resistance to minority outreach, marketing geared almost exclusively toward white communities, and a lack of diverse leadership and cultural awareness. Black employees described feeling unheard and unsafe, while statistics revealed stark underrepresentation-only ~11% of patients were Black in a region where the population was nearly 37% Black.

Blending bioethics training from Creighton University, theological reflection, and on-the-ground activism, Hood proposes concrete solutions: mandatory cultural competency training to eradicate insensitive language and practices, and the creation of a dedicated minority outreach director to build trust, expand marketing, and recruit diverse board members and patients.

Though written nearly a decade ago (with data from 2011-2012), Hood notes in his 2020 foreword that the issues remain painfully relevant. His views have since radicalized, calling for even stronger accountability-but this foundational report stands as a prophetic challenge to hospices, healthcare institutions, and society: racism does not spare the dying. It is our moral imperative to confront and eradicate it.