Bioethics Forum Essay

The AMA’s Apology: What’s the Benefit?

This past week, the AMA officially issued a “mea culpa” for its history of engaging in discrimination against African-American physicians – except it’s more like a “they-a culpa,” since the AMA administrators are actually apologizing for bad behavior on the part of their predecessors. “They-a culpas” can be just a wee bit self-serving, which might explain the snickering on the part of a lot of progressive physicians to whom I’ve mentioned the AMA’s apology. When you pull a “they-a culpa,” you don’t actually have to admit to any sin of your own, and you accrue all the social capital of being decent enough to apologize. (See Bill Clinton’s apology for the Tuskegee Syphilis Study.) So is there any benefit to the AMA’s apology?

Yes. But not as much as there could be.

The most obvious benefit will accrue to those African-American physicians who were actually harmed by the discrimination. As I’ve learned from being an historian, no matter how much a person is convinced that she or he experienced something significant, it gives solace and comfort to hear confirmation (especially public confirmation) from some authority figure. Heaven knows that, after the ridiculous barriers they have struggled against, African-American physicians – indeed, all African-Americans – are owed at least that validation.

The AMA’s apology also hints that more subtle forms of discrimination may still exist. In that sense, it draws attention to possible remaining problems. The AMA’s press release suggested ways the organization is trying to address some of those problems through financial and academic support.

But wouldn’t it be great if the AMA did more – namely, use this opportunity of insight about past pathology to spur the organization toward preventative behavior?

Inevitably, the lesson most people will take from public accounts of the AMA’s apology is this: Bad, racist doctors discriminated against good people – the same lesson most people take from the Tuskegee Syphilis Study. But the truth about the Tuskegee Syphilis Study, like the truth in this case, is more complicated. As I’ve written in another column for Bioethics Forum, the real lesson we ought to take from the Tuskegee Syphilis Study is that, caught up in positions of power within lumbering institutions, even decent people sometimes do bad things.

So what if, rather then just issuing a “they-a culpa,” the AMA administrators hired some historians to ask a really interesting question: What are we doing right now that our successors are going to feel the need to apologize for? What is the AMA doing now that might look later like racial discrimination looks to us now?

Just like the question of how to prevent disease, this question could be harder to answer than it first appears. But one way to approach it would be for the AMA to gather up, in a forum like the South African Truth and Reconciliation Commission, those who harmed and those who were harmed by the AMA’s history of racial discrimination. Administrators of the AMA would be asked to witness this forum, and they then might gain the sympathy they really need to maximize benefit from this situation – not just sympathy for those were harmed (for whom, I believe by virtue of their apology, they already feel sympathy), but those who harmed.

This idea of using something like the Truth and Reconciliation Commission comes to me from the sociologist Arthur Frank  who floated the idea as a way of moving forward the medical treatment for children born with atypical sex anatomies. Art and I met through the Surgically Shaping Children Working Group, led by Erik Parens, and he witnessed there the pain that had been caused by well-meaning physicians, as well as the inability of some physicians to admit to having done anything wrong. (“We’re good people,” went the classic logic, “so we can’t have done anything that wrong.”) On a walk during one of the breaks, Art was thinking out loud to me about how to acknowledge the travesty that was the standard of care for children with genital anomalies, when he hit upon the idea of using the South African model.

The humbling, humanizing effect of such a forum could be an enormously powerful force for good if used in circumstances like the one before the AMA. And me, I don’t at all mind the idea that, if such a model were used in such circumstances, fewer of us historians might be needed in the future to help investigate tragedies that might have been prevented.


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