David Khorram, MD, focuses his blog on global ophthalmology and issues related to combating global blindness.

BLOG: Privilege and opting out

A couple of years ago, I sat at Virginia Episcopal School in a meeting between the headmaster, Tommy Battle, and a group of parents. Mr. Battle had announced a new activity that would be mandatory for all students. I don’t remember the activity now, and it wasn’t a “core” activity, but the school felt it was important for all students to participate. One parent raised their hand, and after giving a number of valid reasons, asked if their child could opt out of the activity. It seemed reasonable to me. But in response, Tommy gave a simple answer that has stayed with me. He responded by saying, “The ability to opt out is the very definition of privilege, and it’s not something we should accustom our children to.” It was not lost on me that every child there had already opted out of the public school system.

There is a fair bit of discussion these days about various forms of privilege, but this very simple definition — that privilege is the ability to “opt out” — made me think profoundly, particularly as it relates to my work in global ophthalmology.

At the outset, let me say that I very consciously try to change circumstances to make the world conform to my will. As a kid in summer camp, I thought an activity that we all had to participate in was, in today’s parlance, lame, and so I rallied the kids together, bypassed the camp counselor, went to the camp director and got the activity cancelled. I created the circumstances to opt out. I don’t think this is a bad thing because it is how change and progress happen. And I continue to teach my children to be agents of positive change, to challenge systems and to make things better. But I see an important distinction between this kind of opting out and that associated with privilege: Does everyone get to opt out or only a few? Changing circumstances so that everyone can opt out is a good thing. It is what we should strive for: to change systems so that everyone gets to opt out of the inconvenience or injustice of a situation. But opting out because of “special circumstances,” well, I’ve come to view that differently as a result of Tommy Battle’s words.

The perspective that my ability to opt out of something when others do not have that ability to opt out has made me much more conscious of the privilege I yield. When I travel to a low-income country to provide care or training, it’s tough, even at the most basic level (like wondering what using the toilet is going to be like). I have become aware of my privilege to opt out of any number of these situations — an option that the general population residing there does not have. I can opt out of many of the limitations of the country’s infrastructure simply by staying in a hotel. I can opt out of the malaria endemic in the country by taking malaria prophylaxis, which I have brought with me. If I get severely ill, I can opt out of the health care system simply by purchasing evacuation insurance. And ultimately, I do opt out of every single inconvenient or unhealthy or dangerous aspect of the setting by getting on a plane at the end of the 2 weeks and flying away to a place not facing such challenges.

I have never thought of myself as privileged. But this new definition of privilege has broadened my perspective, and I see that I opt out of so many things on a daily basis that others do not have the opportunity to opt out of. Seeing our own privilege shouldn’t make us guilty. I believe being aware of our own privilege strengthens commitment to work in a larger way — as a physician to change health systems and as an individual to change social systems — so that everyone can eventually opt out of the misery.

Disclosure: Khorram reports he serves on the board of directors of Vision Health International.