Bioethics Forum Essay
A Call for Medical Students to Learn the Full Story about the “Father of Gynecology”
Along with the recent public debates over Confederate memorials, there have been calls to remove or modify the statue of Dr. J. Marion Sims, called the father of gynecology in medical histories, who conducted horrific experiments on enslaved black woman. Removal of the structures alone will not effectively address the depth and present-day impact of racism generally and existing disparities in health care and research specifically. However, medical schools are in position to make a difference by including curricular content that examines the conflicting narratives about Sims.
One narrative is that Sims was a surgical hero who developed the first successful operation to repair fistulas in the vaginal wall, a serious complication of childbirth. Another narrative is that he “manipulated the social institution of slavery to perform human experimentations, which by any standard is unacceptable.” A narrative that gets little attention in medical schools explains the ways that the laws of enslavement uniquely impacted women. It is not uncommon to hear doctors, during gynecological surgery and in outpatient practice, say, “Pass me the Sims” referring to the speculum, the duckbilled medical instrument used for examining the vagina and cervix that Sims is credited with having invented. But rarely discussed in medical school classrooms are the enslaved women who were subjected to numerous experimental surgeries to perfect the instrument. In the interest of historical truth-telling, medical education should not only explore Sims’ contributions to gynecology, but also the means he used to achieve them.
Medical schools and graduate residency programs are required to satisfy a cultural competency accreditation standard that addresses existing health care disparities. I propose that the curriculum should include narratives of vulnerable women whose bodies have been used for and affected by medical research and advancement—stories that have been neglected in the annals of medical history. Addressing cultural competency from a critical race-feminist perspective would help equip medical doctors to “see” their diverse patients as humans with a history and a “her-story,” not simply potential subjects of scientific advancement in reproductive health care.
A more complete narrative about Sims would focus attention on Anarcha, Betsey, and Lucy, the enslaved women whom he experimented on, and document the role that race has played and continues to play in health care delivery in America. As a law professor also serving as an adjunct associate professor of medicine in medical education, I am developing a lecture with medical faculty for ob/gyn residents that will integrate narrative medicine, critical race-feminist- legal scholarship and bioethical perspectives on the development of gynecology in the U.S. My aim is to address the domains relevant to culturally competent care: professionalism, interpersonal and communication skills, and patient care.
Sims conducted his experiments before informed consent was recognized as essential to the ethical practice of research on human subjects, and at a time when people legally considered to be property were dehumanized. But the legacy of his work has implications today for women of color who voluntarily enter medical corridors or seek inclusion into ethical research protocols now. Teaching ob/gyns in training the full narrative of Sims can help ensure that the next generation of medical doctors and researchers become culturally competent health professionals who practice with cultural humility.
Deleso A. Alford, JD, LLM., is an associate professor of law at Florida A&M University College of Law and codirector of the culture, health, and society longitudinal curricular themes at the University of Central Florida College of Medicine Health Sciences Campus. Her book, Tuskegee’s Forgotten Women: The Untold Side of the U.S. Public Health Services Syphilis Study, will be published by Praeger next year.