Bioethics Forum Essay
The American Medical Association’s Apology in Context: The Need for Restoration
The AMA’s recent apology to black physicians marks another moral milestone in white America’s ritualized confession of its racist past, standing alongside President Clinton’s 1997 apology to the survivors of the American government’s infamous syphilis study of black males. The AMA’s commissioned research panel previously had made a conclusive study of the organization’s racist history, and that study informed the AMA’s apology. The study noted that the AMA’s racist rejection of blacks forced the latter to organize their own racially inclusive professional group – the National Medical Association. The AMA’s practice of systemic racism toward blacks has been a barrier to the nation’s pursuit of medical excellence. Resolution of this problem, which we perceive as a moral imperative as well as a practical challenge, must move to the forefront of American public discourse, and then be kept there. Otherwise, the playing field for health practitioners, black or white, will remain unleveled, with continuous serious repercussions both for society in general and for one group of citizens in particular.
In the name of race, black physicians were denied membership on whites’ medical playing fields and teams. Something the Lord Made, a film based on a true story, both illustrates the problem and suggests what might have been. The film recounts the struggles of Alfred Blalock, a wealthy white head of surgery at Johns Hopkins Hospital in 1940s Baltimore, and Vivien Thomas, a gifted black carpenter and skilled tool-maker. Defying the racially segregated Jim Crow America, these unlikely collaborators launched a medical revolution. Pioneering a technique for performing heart surgery on “blue babies,” these two men raced against time to save a dying baby. Blalock praises Thomas’ surgical skill as “like something the Lord made,” insisting that Thomas coach him through the heart surgerydespite protests from hospital administrators. However, when public praise appears in Life magazine, praise for Thomas is conspicuously absent. One can only sadly speculate on what advances might have been made in medicine and health care in this country had this racial divide not existed. But we hope that the AMA apology signals the beginning of a major effort to heal the wounds that racism created in the medical arena.
Our response to the recent apology is to recommend that the AMA partner with the NMA to actualize the recommendations of Missing Persons: Minorities in the Health Profession, the 2004 report of the Sullivan Commission on Diversity in the Health Care Workforce. Page two of the report’s executive summary “emphasizes the need for leadership, commitment, and accountability at the highest levels in institutions of learning and professional organizations” to address the dire shortage of minorities and minority leaders in health care as well as inadequacies in our health care educational infrastructure. These shortages and inadequacies not only detrimentally affect health outcome, they also represent a profound social injustice that undermines the trust of minorities in our nation’s government and institutions of health and education.
The AMA has taken a courageous first step in acknowledging its past moral failures. It can indicate its continued resolve by conspicuously collaborating with the NMA and appropriate stakeholders to re-examine the rules of engagement and change them to more inclusive ones that reject historical prejudices. While holding each other accountable to the public on this issue, both organizations can lead a national effort to identify and include missing persons in the annals of medical history, in the admission classes to medical schools, and in leadership positions in the medical profession. More should be done to involve popular arts and media in grassroots education about the need for minority physicians, researchers, and a variety of other health practitioners. Ethics training in health professions and medical schools must have as one of its goals the complete racial openness of all specializations in practice and research.
The emotive and unconscious underpinnings of the current closed medical society may, also, like the mass education project just mentioned, require that ethics professors work with “non-rational” cultural productions, such as films and novels, to debunk the unwholesome state of affairs. Failure to address the issue programmatically will sink our society deeper into health and moral crisis. A chief practical challenge will be finding ways to make this a critical political agenda needing substantial financial and human resources. This will mean that we, as a society, should garner the requisite moral courage and political will to get all stakeholders engaged with the issue long enough that corrective policy recommendations to Congress are not based on historical faulty assumptions.
Riggins R. Earl, Jr., is a Visiting Scholar, Connie C. Price is Associate Professor of Philosophy; Leonard Ortmann is Senior Associate for Programs; and Stephen Olufemi Sodeke is Interim Director at the Tuskegee University National Center for Bioethics in Research and Health Care. The work of the National Center for Bioethics in Research and Health Care is supported by Cooperative Agreement Number P76PS424229-04 from The Centers for Disease Control and Prevention, but the contents of this essay are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.