In my early years, I, like every other American toddler, had to recite the Pledge of Allegiance during the homeroom period every morning. “I pledge allegiance, to the flag, of the United States of America. And to the republic for which it stands, one nation, under God, indivisible, with liberty and justice for all.” It was 1965 when I first learned this – two years after President Kennedy was assassinated and three years before the assassinations of Martin Luther King Jr. and Senator Robert Kennedy. If I knew then what I know now, I probably would refuse to recite it. At that time, this nation was divided along racial lines. The movie “Detroit” and other films evince the nightmare known as American life for African-Americans during that time period. Today, we are a divided nation where the belief in a sovereign God splinters into politically co-opted faiths or belief systems where the mere mention of God is an anathema. Just recently, Heather Heyer lost her life when James Alex Fields Jr., an advocate for white nationalism and supremacy, plowed his car into a crowd of anti-racism protestors. This sparked the snowballing of denouncement after denouncement of flags and figures that symbolized a dark past in this nation’s history.
But is this a sign that there is finally an awakening of conscience by a cathartic defibrillation? Only time will tell, because there have been other flashpoints in our history that appeared to bring about such an awakening only to later find regrowth of the weeds of incivility. In my opinion, there is still a theological, philosophical and ideological thread weaving through national discourse that considers racial purity a must, with whiteness serving as the ideal. Some may think the location of this discourse is relegated to a minority faction of extremists; I would agree to some extent. I agree there is a minority faction that is vocal about their beliefs. It’s those who share this spirit in their silent demeanor that is more troubling to me. This spirit is reflected in social policy and legislation. I use the term “spirit” intentionally because I believe it is foundationally spiritual.
A brief history of medical experimentation
Seventy years ago, in August of 1947, the Nuremberg Code was enacted. It followed the trial, known as the “Doctors’ Trial,” in which Nazi doctors were accused of experimenting on prisoners in the concentration camps, with some fatalities. This trial was before an American tribunal that challenged the unethical nature of these experiments, specifically the fact that there was no evidence of consent on the part of the prisoners. In addition, their acts were clearly a violation of the “do no harm” principle of the Hippocratic Oath. During this trial, there were 23 defendants, 20 of which were physicians. In the end, seven were sentenced to death by hanging. This trial and the creation of the Nuremburg Code brought to fore the atrocities against humanity and the international collective stance against it, specifically as it pertains to human experimentation. Generally speaking, this also opened the door to consider medical treatment more broadly and the need for explicating the importance of physician-patient relationships and informed consent.
Concomitant with what was happening in Europe, the United States was involved in the Tuskegee Syphilis Experiment with African-American men in Alabama. The Tuskegee Syphilis study is perhaps one of the most well-known examples of the inhumane treatment of African-Americans for the advancement of medical science. Beginning in 1932 and lasting through 1972, the government-funded experiment tested the effects of untreated syphilis with a trial of 400 African-American men who were sharecroppers in Macon County, Alabama. This program (sponsored by the U.S. Public Health Service) deceived infected men into thinking they were going to receive free medical care only to be used as guinea pigs in the study. These men were profiled as intellectually inferior, degenerate, impetuous and sexually aggressive.
This type of profiling had its antecedents as early as 160 A.D.. when the Roman physician Galen described African men as having oversized genitalia and being intellectually inferior. This disparaging and condescending way of thinking even made its way into the thought and works of the 18th century philosopher Immanuel Kant, who proffered, “The Negroes of Africa have by nature no feeling that rises above the trifling.” He further asserts that the difference between whites and the African Negro is as great in “mental capacities as in color.” So while the U.S. was involved in prosecuting crimes against humanity overseas, physicians, politicians and policymakers were equally guilty of inhumane acts on our own soil.
Once the syphilis experiment was made known, actions were taken to prevent a reoccurrence of it or any other forms of unconsented human experimentation in the U.S. The result was the Belmont Report, written in 1978 by the National Commission for the Protection of Human Services of Biomedical and Behavioral Research. One of its primary tenets was respect for individuals as well as the establishment of Institutional Review Boards. This was a flashpoint in U.S. history and the expectation was that human beings would be treated with dignity and respect by the medical community. However, paralleling the atrocious period of human experimentation on African-Americans was a eugenics movement.
Eugenics and sterilization
Beginning in 1929, for over 40 years the state of North Carolina administered the largest sterilization program in the country, long after other states had rolled back their efforts in light of the sterilization movements in Nazi Germany. More than 30 other states had eugenics sterilization programs, but none to the extent of North Carolina. Their premise was population control – namely, reducing the population of mentally and physically ill and curbing social malignancy through sterilization. The victims were primarily poor and predominantly African-American residents. The whole idea was that a “bad gene” was the reason for the subject’s condition. The North Carolina legislature passed a law in 1929 and rewrote it in 1933 authorizing sterilization on people that were feeble-minded, epileptic and had other sicknesses. North Carolina was also the only state where even social workers had the authority to recommend sterilization. This was uncovered through an investigation by the Winston-Salem Journal, who then discovered their complicity in the movement through their relationship with certain advertisers. The Journal found that the program managed to persist in North Carolina due to the self-interest and financial support of James G. Hanes of the Hanes Hosiery undergarment enterprise and Clarence Gamble of Boston, benefactor of the Proctor & Gamble chest. They argued that welfare mothers as well as the mentally ill were a burden to taxpayers.
Johanna Schoen, assistant professor of women’s history at the University of Iowa, combed through about 7,000 patient records and estimates that only about 446 of the patients desired the sterilization procedure. For some patients in mental institutions, it was required as a condition of release. Over 2,000 people under the age of 19 were questionably sterilized including a 10-year-old boy who was castrated. The program ended in 1974. One victim, Ruth Cox, an 18-year-old unwed mother, successfully sued the state of North Carolina, opening the door for other such lawsuits. This attention eventuated in the establishment of the 1978 Federal Sterilization Guidelines. It must be stated that some poor and minority women used these sterilization programs to their benefit; not everyone was coerced. According to Schoen’s research, those who sought the program can be identified across class and racial lines thereby signifying the lack of other resources available to them.
While North Carolina has been the poster child for bringing this practice to light, no other state has allowed access to its sterilization records. During the 1970s, African-American women who were pregnant and wanted abortions were forced to compromise for sterilization with some physicians. It was also estimated that between 100,000 to 150,000 poor women were sterilized every year in Alabama.
One significant point to address on the issue of eugenics and sterilization, which still has an echoing effect today, is the work of Margaret Sanger, pioneer behind women’s birth control and the founder of what is now known as Planned Parenthood. Sanger started the Negro Project designed to assist African-American women unable to access health services in the city. Through her family planning centers, eugenics principles were used as a means of reducing the African-American population. When abortion was still illegal, it was Sanger who supported the development of the birth control pill and intentionally made it available through Planned Parenthood free to African-American women in the urban areas. This connection was already in place through the Negro Project clinics. Consistent with this are the reports of countless African-American women who underwent involuntary hysterectomies. In the South, it became so common for an African-American woman to have an involuntary hysterectomy during surgery for other issues that it became tagged as a “Mississippi appendectomy.” But this practice was not limited to the South. In hospitals in New York and Boston, these procedures were performed on African-American and Puerto Rican women to give medical residents practice. However in 1972, Boston City Hospital medical students raised a protest against this practice.
How could this happen?
The reason why these things could happen during the 20th century is because the spirit of its roots had never been destroyed. Ethics are based on morals and values, but when the origin of such morals and values are suspect then one has to question its fruit. Harvard magazine published an article self-critiquing the history of its institution and the involvement in the eugenics movement in the early 19th century. Oliver Wendell Holmes Sr., former dean of Harvard Medical School and father to Supreme Court Justice Oliver Wendell Holmes Jr., had written extensively on “human breeding” and attributed the physical and mental acuity of his social class to “congenial and hereditary” traits. Harvard’s president emeritus, Charles William Eliot, also expressed his support for the forced sterilization of the feebleminded, physically disabled and those prone to criminal activity. This form of thought was not isolated to the president emeritus or the dean, it was also supported by the faculty. These beliefs stemmed from one of our most distinguished institutions of higher education in this country. But if it were possible to think that such thoughts and practices are simply a dark moment in history, that would be great – but it’s not accurate.
Prisons and contemporary applications
Even today, there is evidence that women – particularly African-Americans, Native American and Latinas – are being sterilized without consent in our nation’s prisons. Prisoners are a vulnerable population because in prison they are least likely to reject an order coming from a prison official even if that order is sent through a physician. In the 1970s, Congress passed legislation prohibiting the use of federal funds for the sterilization prisoners without the informed consent of the patient and to limit human experimentation on prisoners. Under the Center for Medicare and Medicaid Services rules, reimbursements are only disbursed if the Medicaid rules are followed. In addition, states have to expressly state in their Medicaid plans that informed consent is required in order for providers to be reimbursed for hysterectomies and other forms of sterilization and that such acts are prohibited on anyone who is under the age of 21, incapable of making decisions and institutionalized. The Public Health Services has its own rules and unlike the Center for Medicare and Medicaid Services, offers grants to recipients. However, the basis of their rules is that all programs that receive funding, “in whole or in part,” are prohibited from providing or arranging for the sterilization of any incarcerated or otherwise institutionalized person without informed consent.
With the rising number of women incarcerated due to this country’s obsession with criminalizing drug users, possessors and distributors, more and more women of color are ending up behind bars. There is evidence that from 1997-2010 women were sterilized in California state prisons directly in violation of state policies. In addition to California, there are at least nine other states whose correctional facilities have policies for sterilizing women. California records indicate that most of the women sterilized were women who also had more than one child, which would lead one to believe that the intent behind the sterilizing was to enforce population control. Anecdotally, there are testimonies from women who were formerly incarcerated that report comments from the physicians who performed procedures on them that they “had enough children.”
So, one has to wonder what the underlying motive is of physicians who participate in these practices on incarcerated women when it violates medical ethical principles and state policies. Also, one has to wonder about the motives of lawmakers and the supposed morals and values they support when they craft legislation that continues to suppress the rights of individuals. For example, the Prison Litigation Reform Act was passed in 1996, making it more difficult for anyone incarcerated to file claims to the court of any mistreatment.
I’m not totally convinced that the recent denouncements against White nationalism and supremacy is a sign of the awakening of the national conscience because despite the other flashpoints in history, the unhealthy foundational morals and values have not been dismantled, as evidenced by the fact that even as monuments come toppling down across the country, the right to choose for too many incarcerated women is being buried alongside the truth of this country’s identity.
John Welch is the vice president for student services & community engagement and dean of students at Pittsburgh Theological Seminary. He and his wife are both ruling elders in the PC(USA), parents of four and grandparents of three children.
Sources and further reading:
- “Against Their Will: North Carolina’s Sterilization Program and the Campaign for Reparations” by Kevin Begos, Danielle Deaver, John Railey and Scott Sexton, Gray Oak Books.
- “On the Different Races of Man” by Immanuel Kant in “Race and the Enlightenment: A Reader” edited by Emmanuel Chukwudi Eze, Blackwell Publishing.
- “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” by Harriet A. Washington, 1st ed. New York: Doubleday.
- “A brief review of the Belmont Report” by J.M. Sims. Dimensions of Critical Care Nursing, 2010;29(4):173-174.
- “Between choice and coercion: Women and the politics of sterilization in North Carolina, 1929- 1975” by Johanna Schoen. Journal of Women‘s History, 2001;13(1):132-156.
- “Fifty years later: The significance of the Nuremberg Code” by Evelyne Shuster. New England Journal of Medicine, 1997; 337(20):1436-1440.
- “If they hand you a paper, you sign it: A call to end the sterilization of women in prison” by Rachel Roth and Sara L. Ainsworth. Hastings Women‘s Law Journal, 2014; 26:7.
- “Slavery, segregation and racism: Trusting the health care system ain‘t always easy! An African American perspective on bioethics” by Vernellia R. Randall. St. Louis University Public Law Review, 1996;15(2)191-235.