Color, Healthcare and Bioethics E-Book

Henk ten Have

• Herausgeber: Open Book Publishers
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Veröffentlichungsjahr: 2025

Beschreibung

This book explores the profound, yet often overlooked, role of color in healthcare and bioethics, arguing that color is far more than a visual or aesthetic element—it actively shapes human experience, perception, and ethical reasoning.


Traditionally regarded as secondary to objective medical observations or rational ethical debates, color has been marginalized in these fields, considered subjective and inconsequential. However, this book reveals that color is critical in diagnostic and therapeutic practices and that it subconsciously influences moral interpretations in bioethics. Through examples like the ‘blue hour’—a time of day associated with melancholy and creativity—readers are invited to consider color not just as a physical phenomenon explained by wavelengths and visual physiology, but as a medium rich with emotional and metaphorical meaning. From ‘feeling blue’ to seeing the world in ‘black and white’, color conveys complex messages that inform our perceptions of health, morality, and identity.


By bridging the gap between science, emotion, and ethics, this book illuminates how colors impact our worldviews, urging readers to consider the subtle yet significant ways that color influences our understanding of ourselves and the world around us.

Leseprobe

COLOR, HEALTHCARE AND BIOETHICS

Color, Healthcare and Bioethics

Henk ten Have

https://www.openbookpublishers.com

©2025 Henk ten Have

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). This license allows you to share, copy, distribute and transmit the text; to adapt the text for non-commercial purposes of the text providing attribution is made to the authors (but not in any way that suggests that they endorse you or your use of the work). Attribution should include the following information:

Henk ten Have, Color, Healthcare and Bioethics. Cambridge, UK: Open Book Publishers, 2025, https://doi.org/10.11647/OBP.0443

Further details about CC BY-NC licenses are available at http://creativecommons.org/licenses/by-nc/4.0/

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Digital material and resources associated with this volume are available at https://doi.org/10.11647/OBP.0443#resources

Information about any revised edition of this work will be provided at https://doi.org/10.11647/OBP.0443

ISBN Paperback 978-1-80511-482-6

ISBN Hardback 978-1-80511-483-3

ISBN PDF 978-1-80511-484-0

ISBN HTML 978-1-80511-486-4

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DOI: 10.11647/OBP.0443

Cover image: Textures & Patterns (2022), https://unsplash.com/photos/modern-multi-colored-template-with-curve-dynamic-fluid-flow-abstract-geometric-background-3d-rendering-digital-illustration-Txu4PTomSrY

Cover design: Jeevanjot Kaur Nagpal

For Cecilia N. G. Jansen,making our life so colorful

Contents

About the Author xi

List of Illustrations xiii

1. Introduction:Color, Healthcare and Bioethics 1

1.1 The Experience of Color 1

1.2 Color and Medicine 3

1.3 Color and Ethics 7

1.4 The Outline of the Book 10

1.5 The Nature of Color 10

1.6 The Power of Color 12

1.7 Color and Healthcare 15

1.8 Color and Bioethics 17

1.9 A Colorful Bioethics 21

1.10 Conclusion 24

References 25

2. The Nature of Color 29

2.1 Introduction 29

2.2 The Traditional View 31

2.3 The Scientific Revolution 31

2.4 Primary and Secondary Qualities 33

2.5 Philosophies of Color 34

2.6 Color Relationism 36

2.7 Ecological Theories 38

2.8 Color Adverbialism 40

2.9 The Phenomenological Perspective 41

2.10 Conclusion 43

References 44

3. The Power of Color 47

3.1 Introduction 47

3.2 Color Language 50

3.3 The Affective Power of Color 54

3.4 The Meaning of Color 57

3.5 Color, Emotions and Feelings 64

3.6 Color, Human Behavior and Performance 66

3.7 Practical Implications 68

3.8 Conclusion 70

References 73

4. Color and Healthcare 79

4.1 Introduction 79

4.2 Disease 81

4.3 Diagnosis 82

4.4 The Color of Medication 90

4.5 Pigments as Pharmaceuticals 92

4.6 The Pharmaceutical Revolution 96

4.7 Color Therapy 101

4.8 Healing Environments 104

4.9 Conclusion 106

References 107

5. Color and Bioethics 111

5.1 Introduction 111

5.2 Colors and Normativity 114

5.3 Color and Rationality 117

5.4 Moral Associations of Black and White 120

5.5 Color and Race 123

5.6 Skin Color 127

5.7 Color-Based Hierarchies 129

5.8 Racial Science 131

5.9 The Persistence of Race and Racism 134

5.10 Racism and Healthcare 136

5.11 Racism and Bioethics 141

5.12 The Whiteness of Bioethics 143

5.13 Conclusion 146

References 150

6. A Colorful Bioethics 159

6.1 Introduction 159

6.2 Race as Bioethical Issue 160

6.3 Race under the Bioethical Microscope 164

6.4 Racism as Bioethical Issue 172

6.5 The Color of Bioethics 178

6.7 Ethics and Aesthetics 181

6.8 Moral Imagination 190

6.9 Expansion of Bioethical Discourse 194

6.10 Conclusion 203

References 206

Index 215

About the Author

Henk ten Have has been Director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, USA (2010–2019). He studied medicine and philosophy in the Netherlands and worked as professor in the Faculty of Medicine of the Universities of Maastricht and Nijmegen. From 2003 until 2010 he has joined UNESCO in Paris as Director of the Division of Ethics of Science and Technology. Since 2019 he is Emeritus Professor, Duquesne University, Pittsburgh, USA, and since 2021 Research Professor at the Faculty of Bioethics in the Universidad Anahuac Mexico. He is editor of the International Journal of Ethics Education, and Medicine, Health Care and Philosophy.

His recent book publications are Global Bioethics; An Introduction (2016), Vulnerability: Challenging Bioethics (2016), Global Education in Bioethics (2018), Wounded Planet. How Declining Biodiversity Endangers Health and How Bioethics Can Help (2019), Dictionary of Global Bioethics (with Maria do Céu Patrão Neves, 2021), Bioethics, Healthcare and the Soul (with Renzo Pegoraro, 2022), Bizarre Bioethics—Ghosts, Monsters and Pilgrims (2022) and The Covid-19 Pandemic and Global Bioethics (2022). He has edited the Encyclopedia of Global Bioethics (2016) and Global Education in Bioethics (2018).

List of Illustrations

Fig. 1.1

Hazy blue hour in Grand Canyon, photo by Michael Gäbler (1988). Wikimedia, https://commons.wikimedia.org/wiki/File:Hazy_blue_hour_in_Grand_Canyon.JPG#/media/File:Hazy_blue_hour_in_Grand_Canyon.JPG, CC BY 3.0.

Fig. 1.2

The four humors, Tom Lemmens (2013). Wikimedia, https://commons.wikimedia.org/wiki/File:Humorism.svg#/media/File:Humorism.svg, CC0 1.0.

Fig. 1.3

Angelica Dass Retratos, Proyecto Humanae Valencia. Color labels like black, white, yellow or red are inadequate to capture this diversity. Photo by LOLAOMI (2014), Wikimedia, https://commons.wikimedia.org/wiki/File:Ang%C3%A9lica_Dass_retratos.jpg#/media/File:Ang%C3%A9lica_Dass_retratos.jpg, CC0 1.0.

Fig. 2.1

Isaac Newton’s prism experiment. Image created by Castellsferran (2020), Wikimedia, https://commons.wikimedia.org/wiki/File:Experiment_dels_primes_d’Isaac_Newton_-_Refracci%C3%B3_de_la_llum.png#/media/File:Experiment_dels_primes_d’Isaac_Newton_-_Refracci%C3%B3_de_la_llum.png, CC BY-SA 4.0.

Fig. 2.2

Color wheel wavelengths. Image created by Amousey (2023), Wikimedia, https://commons.wikimedia.org/wiki/File:Color_wheel_vector.svg#/media/File:Color_wheel_vector.svg, CC BY-SA 4.0.

Fig. 2.3

Yellow-banded poison dart frog. Photo by Holger Krisp (2013), Wikimedia, https://commons.wikimedia.org/wiki/File:Bumblebee_Poison_Frog_Dendrobates_leucomelas.jpg#/media/File:Bumblebee_Poison_Frog_Dendrobates_leucomelas.jpg, CC BY 3.0.

Fig. 3.1

Joseph Karl Stieler, Johann Wolfgang von Goethe (1828). Neue Pinakothek, Munich. Photo by Pierre André (2016), Wikimedia, https://commons.wikimedia.org/wiki/File:Joseph_Karl_Stieler_portrait_de_Johann_Wolfgang_von_Goethe.jpg#/media/File:Joseph_Karl_Stieler_portrait_de_Johann_Wolfgang_von_Goethe.jpg, CC BY-SA 4.0.

Fig. 3.2

William Turner, Light and Colour (Goethe’s Theory) (1843). Tate Britain, London. Photo by Wuselig (2020), Wikimedia, https://commons.wikimedia.org/wiki/File:Horror_und_Delight-Turner-Light_and_Colour_(Goethe%27s_Theory)_DSC2252.jpg#/media/File:Horror_und_Delight-Turner-Light_and_Colour_(Goethe’s_Theory)_DSC2252.jpg, CC0 1.0.

Fig. 3.3

Utigawa Kuniyoshi, Medical and Surgical Treatments for a Lame Princess and Others (1849/52). Wellcome Collection. Wikimedia, https://commons.wikimedia.org/wiki/File:Medical_and_surgical_treatments_for_a_lame_princess_Wellcome_L0035015.jpg#/media/File:Medical_and_surgical_treatments_for_a_lame_princess_Wellcome_L0035015.jpg, CC BY 4.0.

Fig. 3.4

Yellow emperor. Scan from Shèhuì Lìshǐ Bówùguǎn [Social History Museum]. Wikimedia, https://commons.wikimedia.org/wiki/File:Yellow_Emperor.jpg#/media/File:Yellow_Emperor.jpg, public domain.

Fig. 4.1

Johannes de Ketham, Fasciculus Medicinae (1491). Uroscopy chart relating the color of urine to bodily constitutions and ailments. Wikimedia, https://commons.wikimedia.org/wiki/File:Fasciculus_Medicinae_1491.jpg#/media/File:Fasciculus_Medicinae_1491.jpg, public domain.

Fig. 4.2

Red litmus paper reacts with hydrochloric acid in litmus test. Photo by Kanesskong (2016), Wikimedia, https://commons.wikimedia.org/wiki/File:The_result_of_red_litmus_paper.jpg#/media/File:The_result_of_red_litmus_paper.jpg, CC BY-SA 4.0.

Fig. 4.3

Microscopic image of a Gram stain of mixed Gram-positive Staphylococcus aureus (purple) and Gram-negative Escherichia coli (red). Image by Y tambe (2010), Wikimedia, https://commons.wikimedia.org/wiki/File:Gram_stain_01.jpg#/media/File:Gram_stain_01.jpg, CC BY-SA 3.0.

Fig. 4.4

Jerry Allison, William Henry Perkin—Pioneer in Synthetic Organic Dyes (1980). Science History Institute. Perkin (center) in his laboratory examines test dying of silk taffeta with mauve aniline dye. Wikimedia, https://commons.wikimedia.org/wiki/File:William_Henry_Perkin-_Pioneer_in_Synthetic_Organic_Dyes_-_DPLA_-_3acf6c4043b0ea3ee1044c835092c5ec.jpg#/media/File:William_Henry_Perkin-_Pioneer_in_Synthetic_Organic_Dyes_-_DPLA_-_3acf6c4043b0ea3ee1044c835092c5ec.jpg, CC BY 4.0.

Fig. 4.5

Paul Ehrlich, c. 1910. Photographer unknown. Wikimedia, https://commons.wikimedia.org/wiki/File:Paul_Ehrlich,_c._1910.jpg#/media/File:Paul_Ehrlich,_c._1910.jpg, public domain.

Fig. 4.6

Phototherapy of neonate for jaundice. Photo by Vtbijoy (2013), Wikimedia, https://commons.wikimedia.org/wiki/File:Phototherapy.jpg#/media/File:Phototherapy.jpg, CC BY-SA 3.0.

Fig. 5.1

Cistercian monks. Bernard of Clairvaux invests Gerwig with the robes of the Cistercian order. Fresco from 1695–1698 by Johann Jakob Steinfels in Abbey church Waldsassen. Photo by Wolfgang Sauber (2018), Wikimedia, https://commons.wikimedia.org/wiki/File:Waldsassen_Stiftsbasilika_-_Fresko_3c_Gr%C3%BCndungslegende.jpg#/media/File:Waldsassen_Stiftsbasilika_-_Fresko_3c_Gr%C3%BCndungslegende.jpg, CC BY-SA 4.0.

Fig. 5.2

Rembrandt, The Anatomy Lesson of Dr. Nicolaes Tulp (1632). Mauritshuis, The Hague. Wikimedia, https://commons.wikimedia.org/wiki/File:Rembrandt_-_The_Anatomy_Lesson_of_Dr_Nicolaes_Tulp.jpg#/media/File:Rembrandt_-_The_Anatomy_Lesson_of_Dr_Nicolaes_Tulp.jpg, public domain.

Fig. 5.3

Jean-Auguste-Dominique Ingres, Portrait of Francois Bernier (1800). Wikimedia, https://commons.wikimedia.org/wiki/File:Bernier-Ingres-1800.jpg#/media/File:Bernier-Ingres-1800.jpg, public domain.

Fig. 5.4

Johann Friedrich Blumenbach, De generis humani varietate (1795). Sequence of human skulls showing the diversity of the main types. Wellcome Collection. Wikimedia, https://commons.wikimedia.org/wiki/File:J.F._Blumenbach,_De_generis_humani_varietate_Wellcome_L0032295.jpg#/media/File:J.F._Blumenbach,_De_generis_humani_varietate_Wellcome_L0032295.jpg, CC BY 4.0.

Fig. 5.5

“Colored” water cooler in streetcar terminal in Oklahoma City (1939). Wikimedia, https://commons.wikimedia.org/wiki/File:%22Colored%22_drinking_fountain_from_mid-20th_century_with_african-american_drinking.jpg, public domain.

Fig. 6.1

Caucasian Biosphere Reserve in the vicinities of Sochi, Russian Federation. Photo by SKas (2016), Wikimedia, https://commons.wikimedia.org/wiki/File:Caucasian_Biosphere_Reserve.jpg#/media/File:Caucasian_Biosphere_Reserve.jpg, CC BY-SA 4.0.

Fig. 6.2

Alex da Silva, Slavery Monument (2013), Rotterdam. Photo by GraphyArchy (2020), Wikimedia, https://commons.wikimedia.org/wiki/File:GraphyArchy_-_Wikipedia_00706.jpg#/media/File:GraphyArchy_-_Wikipedia_00706.jpg, CC BY-SA 4.0.

Fig. 6.3

Skin-whitening product in supermarket in Sri Lanka. Photo by Adam Jones (2014), Wikimedia, https://commons.wikimedia.org/wiki/File:Fair_and_Handsome_-_Skin-Whitening_Product_in_Supermarket_-_Bandarawela_-_Hill_Country_-_Sri_Lanka_(14122094934).jpg#/media/File:Fair_and_Handsome_-_Skin-Whitening_Product_in_Supermarket_-_Bandarawela_-_Hill_Country_-_Sri_Lanka_(14122094934).jpg, CC BY-SA 2.0.

Fig. 6.4

Gaston Bachelard (1965), Dutch National Archives, The Hague. Photographer unknown, uploaded by Anefo, Wikimedia, https://commons.wikimedia.org/wiki/File:Gaston_Bachelard_(kop)_filosoof,_Bestanddeelnr_917-9599.jpg#/media/File:Gaston_Bachelard_(kop)_filosoof,_Bestanddeelnr_917-9599.jpg, CC0.

1. Introduction: Color, Healthcare and Bioethics

©2025 Henk ten Have, CC BY-NC 4.0 https://doi.org/10.11647/OBP.0443.01

1.1 The Experience of Color

In “L’heure bleue” (1970)the French artist Françoise Hardysings about the brief moment when the day has ended but the night has not yet started; an uncertain juncture where everything becomes more beautiful, softer and brighter. It is also a happy time where you wait for the person you love. Listening to this song, I was wondering why this brief period of twilight is called the “blue” hour. The usual explanation is that when the sun is sinking below the horizon, the shorter wavelengths of the visible light dominate so that the remaining light has a blue shade. The expression is not very common in the Dutch language, perhaps because the skies are often more cloudy than in the southern parts of Europe. But a related expression is “a blue Monday” referring to an extremely short period of time in which people have worked or lived in a particular place. The blue hour has inspired numerous painters, musicians and writers, not because it is a meteorological condition or a specific time of the day, but since it has manifold symbolic meanings. As the transition between light and dark, it provides the occasion to dream, and to reflect on what has ended and what will be expected. It is a melancholic experience, an awareness of loss and impermanence. The blue hour is the point of metamorphosis; it provokes not only mourning about what is over, but also longing for restoration and renewal. As an occasion of hope, it connects nostalgia and sadness with the expectation of happiness and new beginnings.

Fig. 1.1 Hazy blue hour in Grand Canyon, photo by Michael Gäbler (1988). Wikimedia, https://commons.wikimedia.org/wiki/File:Hazy_blue_hour_in_Grand_Canyon.JPG#/media/File:Hazy_blue_hour_in_Grand_Canyon.JPG, CC BY 3.0.

This example illustrates that color is a physical and physiological phenomenon which can be explained in terms of different wavelengths of light, and properties of our visual system. During the twilight period the sky is dark blue, and we can observe this color, while the sciences of physics and physiology help us to explain why this occurs. At the same time, the blue hour is an experience associated with emotions and feelings. The scientific explanation is not sufficient to comprehend the phenomenon and what it does to humans. Why has it inspired so many artists to make paintings and write novels about it? Not only do many musicians sing about the blue hour but there is also a music genre originating in the Southern part of the United States which expresses the sorrows and sadness of African Americans. Blue as a color is used as a metaphor to refer to specific emotions, a particular type of mood produced by certain circumstances and experiences. When we feel sad, we are “feeling blue.” When we have the “Monday morning blues” we feel tired when we have to get up early and back to work. Colors, it seems, apply to objects and substances (such as blue cars and blue sky) as well as concepts and ideas. They are also linguistic ways to convey messages and meanings. Even if they are not really there in the objective world, they help us to imagine and interpret our world in particular ways.

In this book the role and significance of color will be examined in two areas of human activity: healthcare and bioethics. While colors surround us, are directly experienced, and often enrich our perception of the world, they do not receive much attention in medical and care activities, and even less in ethical analyses. Usually, color is regarded as secondary and trivial—a subjective impression deemed less important than objective observations and findings. Nonetheless, as discussed in this book, color has played and continues to play an important role in healthcare, not only in diagnostic but also therapeutic endeavors. The same is true for ethics. Historically, ethics was clearly demarcated from aesthetics, with color relegated to the domain of emotions, feelings, intuitions and subjective experiences, while ethics was characterized by rational arguments and deliberation. In present-day bioethical debate, this distinction can no longer be upheld since, in practice, colors (particularly black and white) carry moral connotations and interpretations that influence ethical judgments before they are rationally articulated.

1.2 Color and Medicine

While contemporary medicine is regarded as an objective and scientific enterprise, color plays a special role in healthcare activities. For a long time, diagnostic means were limited and doctors relied on inspection and observation to clarify the ailments and complaints of patients. When the face is extremely pale and dusky, it may together with other symptoms indicate imminent death, described by Hippocrates as the facies Hippocratica. A bluish-purple coloration of the skin on the other hand is, according to Hippocrates, indicative of respiratory problems.

Even today, medical students are taught to take a medical history and perform a physical examination. This involves first of all a systematic inspection of the body of the patient, and its various parts. Colors of the body such as redness, cyanosis (blue), jaundice (yellow) and pallor may give clues for possible diagnoses. Excretions may have various colors, indicative for specific problems. Brown or orange urine may suggest liver disease, while red urine can be caused by certain foods but may also be a sign of a serious health problem (loss of blood due to kidney stones, infection or cancer). Stool may a have range of colors but black and red require medical attention. When a person’s teeth become red-brown it indicates porphyria, a very rare genetic liver disease.

Since Ancient times, medical theory was based on the primacy of colored substances for health and disease: the four humors, namely blood, black bile, yellow bile and phlegm.

Fig. 1.2 The four humors, Tom Lemmens (2013). Wikimedia, https://commons.wikimedia.org/wiki/File:Humorism.svg#/media/File:Humorism.svg, CC0 1.0.

A healthy constitution depends on the balance of these body fluids, which also determine a person’s predisposition toward disease. If the balance between them is disturbed, and one of the humors is excessive or deficient, specific diseases will develop. If black bile dominates, melancholy will be the result; if there is an excess of yellow bile, jaundice or icterus will be observed. The humoral doctrine which determined medical thinking and acting for centuries was not an isolated theory but connected to a wider cosmology, relating the basic constituents of humans to fundamental elements of the universe: air (blood), fire (yellow bile), earth (black bile) and water (phlegm). The basic fluids, furthermore, were assumed to have psychological impact since they determined different temperaments: sanguine, choleric, melancholic and phlegmatic. This ancient theoretical framework assumed a close connection between colors and the physical and psychological constitution of humans. This is noticeable for example in the naming of diseases. It also explains the linkage between pigments and medication. In the past, many pigments were used for painting and coloring objects but also as drugs for a variety of ailments. The yellow pigment gamboge, for example, first imported from South-East Asia, became in the seventeenth century a popular medicine against rheumatism, scurvy and other illnesses (St Clair 2016). The search for new synthetic dyes in the nineteenth century was a major catalyst for the emergence of the pharmaceutical industry.

In medical history some diseases are easily recognizable because of typical coloring: scarlet fever, rubella (from the Latin ruber: red), erysipelas (from the Greek erythros: red), yellow fever, albinism (from the Latin albus: white), blue baby syndrome, ochronosis (from the Greek ochros: pale yellow), leukemia (from the Greek leukos: white), melanoma (from the Greek melas: black), and glaucoma (from the Greek glaukos: gray, bluish-green) Cholera was known as the ‘blue death’ because dehydration turns the skin bluish. One of the most severe medical disasters of the past, the fourteenth-century plague, became known later as the Black Death, presumably because the infection caused black boils in the armpits, neck and groin due to internal bleeding. The plague pandemic of 1348–1353 in Western Europe was initially called the Great Pestilence, and in Latin atra mors, dismal or terrible death. Because ater also means black or dark, the expression was later mistranslated as black death (Benedictow 2004). In this interpretation the color term does not refer to the hue that is visible in patients but first of all invokes a symbolic meaning: death, earth, darkness, grief and hell. The Latin word ater is associated with black bile, a worrying and matt black, in contradistinction to niger which indicates shiny, glossy black and has positive connotations of respectability, austerity and authority (Pastoureau and Simonnet 2005).

The ‘green disease’ is identified in the sixteenth century as a specific ailment of young teenage girls, and therefore also called the virgin’s disease (Starobinski 1981). The subjects have a host of symptoms, from fatigue, lack of appetite to palpitations, paleness and absence of menstruation. The explanation is that the symptoms are caused by excess of blood since it cannot be released through menstruation. The remedy for the disease therefore is sexual activity so that the proposed cure is marriage, followed by pregnancy and children. The disease is also known as chlorosis (from the Greek term chloros, pale green). It is likely that the girls are suffering from anemia; they are in fact pale rather than green. The color evokes the traditional symbolic meanings of green: youth and love but also hope, destiny and fertility (Pastoureau 2014).

These examples show that associating colors and diseases has different functions. First of all, the color may be a sign that something is wrong with the person. The color of the body or body parts may reveal that normal functioning is disturbed or that pathology within the body is manifested at its surface. Blue skin for example is an indication that oxygen levels in the blood are low. At the same time, color conveys a specific meaning and is used as a symbol. It may or may not refer to visible hues but, above all, evokes emotional responses. Death is black because it means extinction and darkness whether or not patients have a specific coloration of parts of their bodies. A particular combination of symptoms is labeled as green disease, not because sufferers become green but because they are young, female and just entering reproductive age. Colors furthermore have a third function which is also particularly relevant in healthcare: they can act as signals used to communicate certain ideas and influence practices. Hospitals use various color codes. Code ‘blue’ means that there is a medical urgency; a patient has a cardiac arrest and immediate resuscitation is required. Code ‘red’ indicates that there is a fire or smoke in the healthcare facility. Code ‘black’ became especially relevant during the Covid-19 pandemic. It is declared when hospitals are at capacity; there are not enough beds to treat every patient who needs it. This has serious ethical implications since physicians have to choose who will be prioritized for treatment. Color codes were also used by policy-makers to indicate the threat level of the coronavirus. Red refers to the most dangerous level, and green indicates safety. However, countries implemented various colors for Covid-19 alerts. Most countries used a four-color system with amber (caution) and orange in between red and green. Some countries revised their color-coded system: the United Kingdom, for instance, moved from a five-level to a three-level system (Shendruk 2021). The European Union adopted a common color-code to coordinate travel restrictions with red, orange and green, and published a weekly color map of countries. The coronavirus dashboard launched by the World Health Organisation used red for the number of deaths, and shades of blue for the number of confirmed cases; the darker the blue, the more cases.

1.3 Color and Ethics

Since the Covid-19 pandemic, it has been argued that the color of coronavirus disease is black. This argument illustrates that color is not only used as a sign, symbol and signal but also as a means of expressing moral values. Covid-19 is associated with the color black because the disease disproportionately affects older Indigenous, Latino and Black Americans: among these populations, rates of infection, hospitalization and death due to the coronavirus are significantly higher than among White populations, with death rates approximately two to three times greater. Also, the social impact of public health measures on these racial and ethnic groups is stronger: these populations face higher rates of unemployment, reduced ability to work remotely, and are more likely to be frontline workers, who are at greater risk of exposure. Racial and ethnic populations in the United States also have higher risks of severe illness and death from the coronavirus due to pre-existing health inequalities rooted in longstanding structural racism and discrimination (Garcia et al. 2021). Describing the color of Covid-19 as black underscores that not everybody is affected by the virus in the same manner and with the same severity. The pandemic exposes and intensifies the existing inequalities in health and society; Black and Brown populations are more vulnerable because of systemic disadvantages, including lack of access to healthcare, unsafe living conditions, limited employment opportunities and environmental degradation. Labeling the disease as black serves as an outcry against structural racism, and a moral call to action to address these disparities. Ironically, the coronavirus itself has no color. Although its images are often presented in red, the virus is too small to interact with visible wavelengths of light, and therefore lacks color entirely (Siegel 2020). By presenting it in red, the meaning of this color as danger and harm is invoked.

The association of color with morality is demonstrated in multiple studies. White and black, especially, are regarded as symbols of moral purity and pollution. Black is associated with ideas of dirtiness, impurity and immorality. It is the color of the night, darkness, uncertainty and potential danger; it can also contaminate other objects. Moral connotations are also attached to other colors. Blue, which is now the preferred color in Western cultures, was for a long time not appreciated. In Ancient Rome, it is the color of barbarians, and in Ancient Greek texts blue is absent. In the Middle Ages it became a divine color, widely used in stained glass in churches and adopted by the kings of France. During the Reformation it became one of the “worthy” colors, with moral discourse promoting black, gray and blue. Colorful objects and clothing were regarded as extravagant, while blue was associated with calmness, modesty and serenity. Blue, along with black and white, was considered a more worthy and virtuous color. In addition to its historical associations, blue holds significance as a color of consensus: today, it is used in the emblems of the United Nations and the European Union (Pastoureau and Simonnet 2005).

The idea that colors have a moral significance has a long tradition. In Ancient Rome a distinction is made between good and bad colors. The first group (colores austeri: white, red, yellow and black) are honest colors because they are dignified, decent and restrained. The other group (colores floridi: vivid colors) are frivolous, false, vulgar, merely decorative and thus dishonest. According to Plinius and Seneca, these last colors are extravagant and decadent; they are usually imported from abroad, and have an exotic and oriental origin. Instead, the Romans favored simplicity and austerity, and thus traditional colors (Gage 2013). Since the Reformation, the belief that some colors are more worthy than others has remained strong. Bright colors, which attract the eye and capture attention, divert from what is virtuous (Pastoureau 2010). Clothing should be somber, simple and plain so that it expresses humility, sincerity and austerity, with priority given to black, gray and blue. Protestant chromoclasm, the effort to expel vivid colors from public life, is visible in the paintings of Rembrandt: the physicians in The Anatomy Lesson of Dr. Nicolaes Tulp (1632) and the officials in Syndics of the Drapers’ Guild (1662) are all dressed in black, like almost all militiamen in The Night Watch (1642).Some have argued that Western culture, more than other cultures, is characterized by chromophobia, leading to recurrent trends of marginalizing and devaluing color, diminishing its significance, and denying its complexity (Batchelor 2000). First of all, color is regarded as dangerous and pathological; it is seductive and can corrupt and misguide the mind because it is not directed at the intellect but at the senses. However, it cannot be avoided or ignored since the world is colorful, but rather must be contained and subordinated in order to control the emotions that it incites. Chromophobia also exists because bright colors are not refined and sophisticated; they are usually exotic and imported. Johann Wolfgang von Goethe argued that “savage” nations, uneducated people and children have a predilection for vivid colors (Batchelor 2000). Colors are therefore often defined by “otherness”: they are feminine, oriental, primitive, infantile and vulgar. This is related to the Western experience of colonization: “Color in the West became attached to colored people or their equivalents…” (Taussig 2009, 16). Most desired colors, and especially pigments, came from exotic places beyond Europe: for example, the emergence of blue in the eighteenth century as a popular color is dependent on indigo plantations in Central American and Indian colonies, and thus interconnected with slavery.

Another reason for chromophobia is that color is often regarded, especially in philosophy, as trivial. Immanuel Kant, to mention one example, argues that in painting, sculpture, architecture, and in all fine arts, the drawing, the design is essential. It is the form that pleases and that gratifies the sensation of beauty. Colors merely illuminate the outline and make it livelier; they may be charming but do not make a piece of art beautiful (Kant 2001, §14). In many philosophical treatises color is interpreted as a secondary quality of experience. They argue that the word “color” is derived from the Latin verb celare, meaning to hide, cover or conceal. Color is like a second skin, make-up, an envelope that covers beings and things, a surface rather than the substance itself. Its trivial nature is accentuated in the enduring debate of design versus color in art (Riley 1995). Design or form is rational, structured, honest, reliable and an example of moral rectitude, while color is identified with the emotional, rhapsodic, formless and even deceitful. Composition, line, subject or perspective are more important than color because color is not the creation of the human mind or the expression of an idea. For the architect Le Corbusier color is intoxication; it is suited to simple “races, peasants and savages.” He prefers white because it is no color in his view and thus represents order, purity and truth: “White is clean, clear, healthy, moral, rational, masterful…” (Batchelor 2000, 46). The distinction between color and shape is also applied practically in the Rorschach test—the psychological test of someone’s personality using abstract inkblots. A powerful response to color indicates emotional instability and impulsiveness, whereas a strong response to shape suggests control or balance between emotional and intellectual life (Riley 1995).

1.4 The Outline of the Book

Before the relevance and significance of colors within healthcare and bioethics can be examined, it is necessary to explore various ideas and theories about the nature of color. Since colors are everywhere in our surrounding world, they are immediately experienced by all human beings, except those with particular forms of colorblindness. Not only do objects and entities in the experienced world possess the property of color, but we ourselves are colored. Our bodies have different colors that can change over time and across different environments. Moreover, colors can reflect varying states of health and indicate certain diseases. We use color terms to refer to different states of mind and varying moods, to make social distinctions, and to morally judge behaviors and practices. The omnipresence of colors in everyday life has stimulated reflection since the dawn of philosophy. Following the Introduction, the second chapter will discuss ideas about what color precisely is.

1.5 The Nature of Color

Reflections on the nature of color have often oscillated between objective and subjective interpretations. Especially since the experiments of Isaac Newton in the 1660s, colors have been regarded as objective realities. Newton relates color to light, following Aristotle’s suggestion that light is the activator of color (Gage 1999). When visible light is refracted through a prism, it contains seven fundamental or spectral colors (red, orange, yellow, green, blue, indigo and violet). Each color has a specific length and frequency of electromagnetic waves. Red has the longest wavelength and violet the shortest. The surfaces of objects in the world absorb and reflect these waves so that specific colors become visible. The chemical constitution of materials determines what wavelengths are absorbed and reflected. If all wavelengths are reflected, we see white; if they are all absorbed, we see black. If the longest wavelengths are reflected, and the others absorbed, we see red. The studies of Newton have promoted physicalistic theories. Colors are physical properties of material bodies and entities, and can be measured since they are written in the language of mathematics (Romano 2020, 66). Another scientific theory of color is based on neurophysiology. It emphasizes perception: wavelengths of visible light are only colors when we see them. Colors are produced and constructed in the visual system and do not exist outside of perception. The retina has two types of photosensitive cells: rods (to distinguish between dark and light) and cones (to distinguish among colors). There are three types of cones, sensitive to short, medium or long wavelengths, and usually labeled as blue, green or red. Light waves activate the rods and cones which then send messages to the visual cortex of the brain, that interprets the physical sensation as the perception of colors, depending on what kind of cones are activated. Without cones wavelengths have no color. Neurophysiological theories thus provide an explanation of color in anatomical and physiological terms but they are subjective theories in the sense that color is not a property of objects in the outside world but completely produced within the subject’s perception.

One conclusion so far is that objective as well as subjective interpretations have the same effect: they assign a particular location to color; it is either outside in the physical world or inside in our brains (Romano 2020, 135). They reduce colors to either sensations and sense data that stimulate the human visual system or perceptions that are constructed in the visual system. Milk itself is not white; because its molecular composition reflects all wavelengths of visible light, our visual experience of milk is white. Since the wavelengths reflected by the milk activate the neuronal system, we have the perception of whiteness. In both cases the color does not exist in the outside world unless we take the physicalist view that identifies colors with wavelengths of light. Usually, colors are regarded as sensations or perceptions rather than as experiences which relate objective and subjective elements. This last view is elaborated in the theory of phenomenological realism which regards color as a relational property. It is not an intrinsic property of an object (determined by its physical characteristics) nor an idea or mental construct (determined at neuronal level), but a relational property that brings together the object and its environment as well as the perceivers. Colors have a reality in the phenomenal world which is partly independent of human perceivers, and it is also more than a private mental state in the perceivers. This relational theory is influenced by an ecological view of colors that attributes specific functions to perception. The aim of perception is to detect certain characteristics of the environment that are useful for the survival of a species, and to discriminate between beneficial and harmful objects.

Against this phenomenological backdrop, perception is not simply detection and recording of objects in the world but it structures and patterns the world into visual fields. The world in which it takes place and which it reveals is not the objective, physical or biological world but the world of immediate, lived experience. In the immediacy of the experience there is no distance between humans and world; being human is fused with the world. We exist, live and act in the life-world (le monde vécu) before we can make this world the object of scientific reflection and analysis. The cognitive relationship between knowing subject and known object is preceded by the intertwining of human beings and world, and is first of all a perceptive relationship. Perception takes place at a pre-reflective level; it brings us into contact with the world that is prior to scientific knowledge; according to Maurice Merleau-Ponty, perception, in contrast to knowing, is a living communication with the world that makes it present to us as the familiar place of our life (Merleau-Ponty 1945, 64–65). In his view, a color is felt and the body is responding before we are even aware that we see it. Colors have “signification motrice”: they are touching and moving us (Merleau-Ponty 1945, 243 ff).

1.6 The Power of Color

The third chapter explores the suggestion that colors have particular effects on human beings. Since color is a multidimensional phenomenon, it is studied from a range of perspectives: physical, physiological, neurological, medical, psychological, social, cultural, linguistic and aesthetic ones. Color is not simply a surface or ornament but it can transmit and communicate codes, prejudices and normative judgments. It influences language, behavior, imagination and sentiment (Pastoreau and Simonnet 2005). These effects of color are particularly expressed by artists. For Henri Matisse, for example, colors are powers; he uses colors in his paintings not to transcribe nature but to express emotions. According to Wassily Kandinsky, color is a power which directly influences the soul (Riley 1995, 136, 142). Color is a language without words and it can directly address our emotions and feelings (Street 2018).

That colors have an impact on emotions and feelings is shown in numerous studies. College students in the Unites States, for example, associate red with excitement, orange with distress, yellow with cheerfulness, and blue with comfort and security. Colors can evoke positive as well as negative emotional responses. Green has a retiring and relaxing effect, and gives the impression of refreshment, naturalness and quietness but it is also associated with tiredness and guilt (Kaya and Epps 2004). Cross-cultural studies describe similar patterns in a variety of countries. Blue is the most highly esteemed color; least preferred are grey and black. The strongest responses are associated with red: it is heavy or intense in feeling, and generally regarded as an active color (Adams and Osgood 1973). If colors are connected with meanings and emotions, this may have implications for psychological well-being and functioning. The color red is positively related to failure, and negatively to success, while green is positively related to success. These connotations are also expressed in ordinary language with negative references for red (“in the red,” “red tape,” “red herring”) and positive ones for green (“green light,” “green fingers,” and “greenback”) (Moller, Elliott and Maier 2009).

Human performance is the subject of a range of studies in various settings. People make more proofreading errors in interior offices which are white compared to blue and red offices, even if they mostly prefer to work in white and beige offices which are often regarded as the least distracting colors (Kwallek et al. 1996). The learning performance of students is best when the walls in their study room are blue. Red-colored walls have a negative impact on intellectual activity by impairing concentration (Al-Awash et al. 2016). The negative effect of red is also demonstrated in IQ test performance. In contexts in which an achievement is expected, perception of red impairs performance, particularly when cognitive analysis, mental manipulations and flexible processes are required (Maier, Elliott and Lichtenfeld 2008). On the other hand, blue enhances performance of a creative task. If creativity and imagination are required (for example, in the development of a new product or a brainstorming session) blue is more beneficial than red (Mehta and Zhu 2009). Effects of the color red and its associated meanings seem to depend on the context. When this is competitive, red positively influences the outcome of a contest. When the context is relational, red enhances attractiveness.

These studies of the effect of colors usually have practical implications. An illustrious example is the finding that waitresses in restaurants wearing red receive more frequent and higher tips from male (not female) customers than those wearing other colors (Guéguen and Jacob 2014). This finding indicates how waitresses may increase their income. The assumed effects of colors on human emotions and behaviors is especially examined in the marketing industry. Giving brands of products a particular color not only helps to recognize the brand but also to establish a visual identity which communicates a certain image; it creates a distinctive personality of the brand. Red associates a brand with excitement, white with sincerity, and blue with competence (Labrecque and Milne 2012). Decisions to purchase a product are not only based on brand, price and quality but also on color. Consumers ascribe a particular meaning to the color of products. The effects of colors are furthermore studied in relation to food. We immediately appraise the quality of meat, fish and fruit by their colors. Color is often the most powerful visual aspect of food packaging, intended to influence consumer decisions. Red packaging is associated with hot flavors, and green with nature and environmental friendliness (Yu et al. 2021). Another question is whether the color of food influences taste and the perception of flavor. Studies document that red food coloring has an effect on the perception of sweetness. A finding that drew substantial popular attention was that people eat less when food is served on red plates, possibly because the color red signals danger and prohibition, consequently inducing avoidance behavior (Bruno et al. 2013).

1.7 Color and Healthcare

The role of color in the context of healthcare is the subject of Chapter 4. As discussed earlier, colors are used in medicine to classify diseases and diagnose disorders. Specific color tests have been developed for diagnostic purposes. Examples are the litmus test to determine the acidity of a substance, and the gram stain to identify microorganisms. But colors also play a role in the fields of medication, therapy and care environment.

Substantial efforts have been invested in examining the effect of the color of medication on its use, popularity and efficacy. The response to medication is not only determined by its chemical composition but also by other factors. How it looks like (i.e. its preparation form, size and color) generates certain expectations concerning action and strength. Black and red capsules are perceived as more potent than orange, yellow, green and blue ones. White capsules are generally perceived as weak (Sallis and Buckalew 1984). A review of the literature concerning the color of drugs with stimulant and depressant effects concludes that red, yellow and orange are associated with a stimulant effect, blue and green with a tranquillizing effect (De Craen, Roos, De Vries and Kleijnen 1996). These associations are generally consistent across countries (Amawi and Murdoch 2022). Traditionally, medication was not colored but in the 1970s the new technology of producing soft-gel capsules made colorful drugs possible. Nowadays, capsules and tablets can have thousands of color combinations. Usually, the coloring of medication is defended with several arguments: it helps consumers to recognize medication, and for pharmaceutical companies, coloring frequently plays a role in marketing. Another argument refers to the supposed power of colors. If colors have particular meanings and raise specific expectations about their efficacy, then responsivity of patients to medication will be better when its color corresponds with its intended effects (i.e. use red for speedy relief, and blue for sleep and calmness).

While colors influence the working of medication, they can also impact patients who do not use drugs. Studies indicate that colors can affect the perception of pain. Red has a stimulating effect and can intensify pain, compared to green and blue. White is a pain-reducing color (Wiercioch-Kuzianik and Babel 2019), associated with purity, cleanliness and hygiene, and has sedative properties. The idea that colors may act as therapeutics is clearly manifested in the history of medicine, particularly in approaches to smallpox. In many cultures, red was used to offer protection against this disease (Hopkins 2002).

A belief in the healing powers of colors has promoted chromotherapy. When colors are a physical phenomenon, it can be supposed that each color has a specific wavelength, and thus vibration, which affects the body and specifically its chemical constitution. Diseases can therefore be healed by color vibrations, and for each disease a specific color can be used (Klotsche 1992). Knowing, for example, that red is stimulating, it activates digestion and the liver; blue, which is soothing, has a catabolic effect and reinforces the immune system. Advocates of chromotherapy have developed theories to specify the action of colors upon different organs and systems of the body. They argue that the advantage of chromotherapy is that it leaves no harmful residues in the body, in contrast to medication (Anderson 1990). Another therapeutic use of colors focuses on light, applying artificial light for a variety of conditions, an example being the exposure of newborns with severe jaundice to blue light (Stokowski 2011).

Another use of colors in healthcare is within the environment of patients. The rationale is that the interior design of hospitals and other healthcare facilities should contribute to the recovery process of patients and to enhance the well-being of all users of these facilities. Colors may contribute to the positive experience of these surroundings. They are, first of all, important for navigation and spatial orientation. But the assumption that colors have physiological and psychological effects has more fundamental implications. Exposure to green colors, for example, is associated with improved feelings of well-being. The most common color in hospitals used to be ‘hospital green’ or ‘spinach green.’ (Pantalony 2009). The dominance of green in hospital settings is increasingly criticized, and since the 1970s many other hues are used (Olgunturk et al. 2021).

1.8 Color and Bioethics

Chapter 5 will elaborate the connections between colors and bioethics. Colors have often been associated with normative judgments. In medieval moral theology, the seven deadly sins were each represented with a color, leading to the idea that ethics should avoid association with any of them. Pastoureau (2019) argues that the Protestant Reformation introduced a moralistic approach to colors in public life, distinguishing “worthy” from “unworthy” colors. The first group (white, black, brown, grey and blue) are the expression of certain values such as soberness, discreteness and dignity. The second group, including yellow and green, were deemed disgraceful and improper, and almost disappeared from public life in some parts of Europe. However, the idea that some colors, especially bright ones, are transgressive and morally inappropriate is much older, and already expressed in classical Antiquity. They are regarded as misleading since they attract the eye and capture attention, directing our mind to the surface of things rather than their essence. Distrust of colors is related to the idea that the human being is distinguished from other living beings since it is a rational animal, characterized by discursive thinking, explanation and argument. Color is relegated to the domain of emotions and subjective impressions. In this view, the vibrant hues of the surrounding world obscure a more fundamental reality which can only be discovered and analyzed by the mind. Therefore, colors are subtle deception; they are merely external, ornamental and decorative. This value judgment about colors was regularly connected to another one: that colors are extravagant and decadent. Using many colors is not a matter of refined taste and civilization. It indicates that the moral values of a society are declining, and that traditional values such as simplicity and honesty are no longer cherished. This association is partly explained by the historical reliance on exotic and costly pigments, which were imported from abroad, reinforcing the idea of color as foreign and indulgent.

That colors have a moral value is clear in the hierarchy which many societies apply to them. Batchelor (2000) argues that cultures often oppose colors with white, regarded as colorless. White is associated with innocence and purity (Pastoureau and Simonnet 2005). It is a guarantee of cleanliness and hygiene. The moral value of colors is furthermore evident in their use to articulate social divisions and distinctions. In the past, numerous societies had color codes and stringent regulations for the application of color in public life (Pastoureau 2017). Social classes are indicated by the colors that they are allowed to use for their clothing. But this moral value of colors has become problematic when it is applied to people themselves. While in the past, different groups of humans have often been identified by the color of their skin, the classification of the German physician and anthropologist Johann Blumenbach in the 1770s became highly influential. He distinguished five varieties of the human species (“races”) according to skin color: Ethiopian (black), Caucasian (white), Mongolian (yellow), Malaysian (brown) and Amerindian (red). Colors were understood to vary due to geographical factors, such as climate. Blumenbach argued that the differences between these varieties are so small and gradual that it is almost impossible to make sharp distinctions. At the same time, he strongly opposed any hierarchy among the varieties, rejecting the suggestion that some are superior and others inferior (Pastoureau 2019). Nonetheless, this is exactly how his ideas were interpreted and elaborated in theories of scientific racism. In classifications of people, skin color was associated with character and moral worth. Particularly, black was connected to evil and negativity, while white was believed to be superior (Jablonski 2012).

The pervasiveness of moral associations of white and black has now become a major topic of concern in ethical debates. The Covid-19 pandemic—which disproportionately affected populations of people of color—and the Black Lives Matter movement have placed racism, structural injustice, discrimination and vulnerability more center stage in bioethics (Russell 2022). It is recognized that racism is a barrier to health and healthcare of non-White people. Since it is an imperative in healthcare ethics to prevent harm to patients, racism and the concept of race should be the focus of bioethics. That requires an analysis of the contextual and structural dimensions of health and diseases, and also, as Russell (2022) points out, an awareness that all subjects of bioethical inquiry are racialized. She suggests that bioethics itself, as it has emerged as a new discipline since the 1970s, is based on an underlying principle of White supremacy, i.e. the idea that white lives are of greater value than those of people of color. The theoretical framework of bioethics, with its focus on autonomy, consent, transparency and risk assessment, presupposes individual citizens who are independent and free to make decisions. However, this framework largely ignores non-White people who are disadvantaged and vulnerable because of social, economic and environmental conditions. In these analyses, whiteness is often rendered invisible as a racial category, and White people are seen as a neutral social group. As a result, race is primarily applied to non-White people, while whiteness becomes the normative standard from which deviations are assessed. White is then equated with being human, and the embodiment of universality (Dyer 2017). This is reflected in the practice of “race norming”, i.e. the adjustment of test scores to account for the race of people who are tested. The assumption is that the physiology of white bodies is the norm and that outcomes for people of color need to be corrected because their physiological capacities are considered inferior (Braun 2014). While race norming was prohibited by law in the United States in 1991, similar criticisms are now directed at the use of algorithms in healthcare, which often disadvantage communities of color (Ledford 2019).

Current debates about race and racism are shifting the focus of attention from black to white. Whiteness itself has become problematic with criticisms of White superiority and White privilege. Movements as ‘wokeism’ are motivated by resistance to the power of White men (Weyns 2023). The great replacement theory, popular among conspiracy thinkers, regards White people as an endangered species; White populations are systematically replaced through mass immigration of people of color, and intermingling between Whites and people of color (Rose 2022). White has become a metaphor for a world that is disappearing while for anti-racists it is a symbol of power and privilege. The obsession with whiteness, however, shares the same prejudices as the pejorative connotations of blackness, attributing moral qualities of superiority and specialness to a specific color. They reflect anxieties and fears about a world which is changing due to demography, immigration, wars, climate, disparities and structural violence. Both keep alive the ideology of colorism: discriminatory treatment of individuals based on skin color. They forget that colors have power to condition our behavior and way of thinking, but that the colors themselves are ambiguous and can induce various associations. For example, in some cultures white is the color of death and mourning while in Western culture black is also the color of elegance and seriousness. Furthermore, colors present themselves in a range with varying hues and intensities. White people are not really white, unless they are ill (anemia and tuberculosis). The same goes for dark colors which present themselves also in a huge diversity. This is directly visible in the project of Angélica Dass, who made 4,000 photographic portraits in order to document the uniqueness and diversity of the color tone of faces (Dass 2023).

Fig. 1.3 Angelica Dass Retratos, Proyecto Humanae Valencia. Color labels like black, white, yellow or red are inadequate to capture this diversity. Photo by LOLAOMI (2014), Wikimedia, https://commons.wikimedia.org/wiki/File:Ang%C3%A9lica_Dass_retratos.jpg#/media/File:Ang%C3%A9lica_Dass_retratos.jpg, CC0 1.0.

Additionally, the moral use of the contrasting colors white and black is criticized from an evolutionary point of view. Skin colors vary because different amounts and kinds of the pigment melanin are produced to protect skin against damaging solar radiation. Initially, all humans were dark skinned. When homo sapiens moved out of sub-Saharan Africa at least 60,000 years ago, gradually their skin became lighter in the process of adaptation to life in the northern regions of the globe (Jablonski 2012). DNA studies show that the hunter-gatherers in Western Europe had a dark skin that only slowly lightened in order to facilitate the production of vitamin D (Posth et al. 2023). The moral problem lies not in the color itself, but in the associations it evokes—especially the tendency to rank people and attribute specific character and moral worth based on color. This is further evident in historical examples, such as the way the British once viewed the Irish as black (Dyer 2017). Also, in US immigration policy, stringent laws were first drafted to counter the influx of Chinese and Japanese immigrants, and later to restrict immigrants from Central and Southern Europe. These laws were fueled by fears that non-White immigrants were going to replace White Americans (Jones 2021).

1.9 A Colorful Bioethics

Recognition that colors are associated with moral appreciations and that these associations need critical analysis has implications for the subjects addressed in bioethics. This recognition not only requires that certain topics such as racism, structural violence and discrimination should be higher on the agenda of contemporary bioethics, but also demands the expansion of the field of ethical inquiry. The relevance of color demands that bioethicists are aware of racism and colorism as determinants of well-being and disease but also, as the example of Covid-19 demonstrates, that they focus attention on the underlying mechanisms that disadvantage people of color. It is therefore important not only to expand the agenda of bioethics with the addition of more relevant topics but also to broaden its approach. Ethical examination should be reorientated towards contextual and structural conditions rather than focus on the individual perspective of rational and autonomous persons. This means that a broader framework of ethical approaches and principles must be employed than is currently applied. Commonly used ethical principles such as respect for individual autonomy and non-maleficence are engaged as universally applicable, assuming that they are equally appropriate for all human beings regardless of their situation and predicament. Contemporary bioethics perceives itself as colorblind. It assumes that when colors are not ‘seen’ or simply regarded as irrelevant or trivial particularities, differences in reality, and especially differences among people, no longer exist. Erasing color as a relevant ethical consideration removes the possibility of exploring why disadvantages and injustices prevail, and analyzing why people are affected and treated differently (Mesman 2021). Acknowledging that color is a relevant consideration in health and disease, and that its power necessitates critical analysis that goes beyond the usual ethical principles of respect for individual autonomy and non-maleficence, results in a conception of bioethics that is genuinely global, i.e. relevant for all peoples, ethnicities and cultures around the world.

Furthermore, consideration of color and its relevancy in healthcare ethics focuses attention on the relationship between ethics and aesthetics. Though traditionally connected in Western philosophy, they are nowadays mostly separated. Ethics is concerned with what is good and right; it aims to determine what ought to be done, and it uses general principles to guide rational arguments and deliberations. Aesthetics is concerned with beauty; it involves the senses, particularly seeing, when colors are concerned. Because the senses are considered as less reliable than reason, aesthetics is regarded as a matter of affection and intuition, thus personal taste. The term ‘aesthetics’ is derived from the Greek aisthánomai which means perceiving, feeling and sensing. Aesthetic judgments are based on human sensitivity, imagination and intuition and as such assumed to be sources of error. It seems that the traditional distinction between the profound and the superficial is at work here: ethics is the search of goodness, proceeding from rational arguments and deliberation, and focused on identifying reasons for and against acts and decisions. In contrast, aesthetics is driven by emotion and intuition, focusing on subjective experiences of what appears to be attractive or beautiful.

The common view of bioethics as an abstract system of moral principles and rules, working on the basis of arguments and rational reflection and with clear procedures for decision-making is nowadays increasingly criticized. It is argued that principles require continuous interpretation and cannot directly be applied to moral dilemmas in order to provide clear-cut answers. It is also argued that ethical decision-making takes place within concrete contexts and practices and is therefore not abstract but drawing on the moral experiences of the persons involved. Moreover, moral judgments and decisions are not merely rational but influenced by values and emotions which determine what is relevant and significant. These criticisms have articulated the crucial role of moral perception in ethical discourse. Before a moral judgment can be delivered and before moral reasoning and rational deliberation can take place, particular situations must be perceived as morally significant. Such perception requires moral sensitivity and experience but is also facilitated by the imagination that expands our perspective and situates ourselves in the circumstances of other people. Rehabilitating the role of perception in ethics re-establishes its connection to aesthetics as the science of sensory perception (Macneill 2017). This connection is furthermore reinforced with the new appreciation of emotions and feelings in moral reasoning and deliberation. Though usually discarded and considered as obstacles to rational decision-making, cognitive psychologists nowadays argue that most moral judgments are made through an intuitive process based on emotions and feelings, which operates more quickly than reasoning. A conscious reasoning process, such as that used in moral analysis and deliberation, is employed after a moral judgment is made to justify this judgment (Haidt 2001).

When it is concluded that ethical reflection and moral deliberation are not entirely rationalistic processes but connected to intuitions and emotions, the relevance of color for ethics must be reconsidered. It is not a trivial side issue in our dealings with the surrounding world but it presents this world in specific ways and is omnipresent in the interactions and communications between people. At the same time, it conveys particular emotions, values and judgments, and therefore influences the intuitive process of making moral judgments. Perceiving a specific color or range of colors produces an immediate and intuitive experience which generates a value judgment prior to rational deliberation. In this way, ethics already starts in the concrete experience of perceiving which then necessitates critical examination and explanation with the help of systematic theory and moral reflection. Perhaps this is what Emmanuel Levinas has in mind when he writes that ethics is an optics, a way of seeing (Levinas 1961, 8, 15).

1.10 Conclusion

The world around us has an infinite and dynamic variety of colors which make our visual experiences beautiful, enjoyable and wonderful. Colors have an effect upon us; they can be stimulating or irritating, they can attract or make us nervous, bring us to rest or encourage reflection or meditation. Experiencing colors not only has aesthetic or psychological effects but also influences normative valuations since they are associated with positive and negative values and intuitive judgments. Because colors are not inert or indifferent but have the power to touch or move us, it is important to reflect upon their role in ethical debates of health and disease, life and death. This book will examine color in the context of healthcare and bioethics. It will argue that color fundamentally is an experience rather than a sensation or perception. It is not an illusion constructed in our mind, nor a physiological phenomenon in the outside world but the experience of relationships between perceiving subjects and their life-world. This experience is active since it makes the world meaningful and relevant, shaping and structuring it in order to allow us to orientate ourselves, to make us feel at home, to fulfill our intuitions, and to flourish. Interpreting color as a relational phenomenon explains what is often referred to as the power of color.

This power is noticeable in numerous areas of human activity, though perhaps least of all in healthcare and bioethics. As argued in this book, there is a fear of color especially in Western culture that clarifies why color is often considered as trivial, superficial and irrelevant. Nonetheless, this book argues that color plays a significant, and mostly positive role in healthcare practices, particularly in diagnostics and therapy. In bioethical debates, little attention until recently has been given to the relevance of color. In the past, ethical theories articulated the color of the skin as indicator of differences between human races. Because of this racial and racist history, color in bioethics has negative connotations and the prevailing ideology is that color should not play a role in healthcare interactions. The argument in this book is that color in bioethics cannot be denied or ignored. On the contrary, it should be acknowledged as a positive experience that connects our appreciation of both the goodness and beauty of the surrounding world. But first, it is essential to ask: What is color, fundamentally?

References

Adams, F. M., and Osgood, C. E. 1973. A cross-cultural study of the affective meaning of color. Journal of Cross-Cultural Psychology 4 (2): 135–156, https://doi.org/10.1177/002202217300400201

Al-Ayash, A., Kane, R. T., Smith, D., and Green-Armytage, P. 2016. The influence of color on student emotion, heart rate, and performance in learning environments. Color Research and Application 41: 196–205, https://doi.org/10.1002/col.21949

Amawi, R. M., and Murdoch, M. J. 2022. Understanding color associations and their effects on expectations of drug efficacies. Pharmacy 10 (82): 1–23, https://doi.org/10.3390/pharmacy10040082

Anderson, M. 1990. Colour therapy. The application of color for healing, diagnosis and well-being. Wellingborough: The Antiquarian Press (original 1975).

Batchelor, D. 2000. Chromophobia. London: Reaktion Books.

Benedictow, O. J. 2004. The Black Death 1346–1353. The complete history. Suffolk: The Boydell Press.

Braun, L. 2014. Breathing race into the machine. The surprising career of the spirometer from plantation to genetics. Minneapolis, MN: University of Minnesota Press.

Bruno, N., Martani, M. Corsini, C., and Oleari, C. 2013. The effect of the color red on consuming food does not depend on achromatic (Michelson) contrast and extends to rubbing cream on the skin. Appetite 71: 307–313, https://doi.org/10.1016/j.appet.2013.08.012

Dass, A. 2023. Humanae, https://angelicadass.com/photography/humanae

De Craen, A. J. M., Roos, P. J., De Vries, A. L., and Kleijnen, J. 1996. Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness. British Medical Journal 313 (7072): 1624–1626, https://doi.org/10.1136/bmj.313.7072.1624

Dyer, R. 2017. White. Twentieth anniversary edition. London and New York: Routledge, https://doi.org/10.4324/9781315544786

Gage, J. 1999. Colour and meaning. Art, science and symbolism. London: Thames & Hudson.

Gage, J. 2013. Colour and culture. Practice and meaning from Antiquity to abstraction. London: Thames & Hudson.

Garcia, M. A., Homan, P. A., Gracia, C., and Brown, T. H. 2021. The color of COVID-19: Structural racism and the disproportionate impact of the pandemic on older Black and Latinx adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 76 (3): e75–e80, https://doi.org/10.1093/geronb/gbaa114

Guéguen, N., and Jacob, C. 2014. Clothing color and tipping: Gentlemen patrons give more tips to waitresses with red clothes. Journal of Hospitality & Tourism Research 38(2): 275–280, https://doi.org/10.1177/1096348012442546

Haidt, J. 2001. The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review 198 (4): 814–834, https://doi.org/10.1037//0033-295x.108.4.814

Hopkins, D. R. 2002. The greatest killer. Smallpox in history. Chicago, IL and London: The University of Chicago Press.