This post will also appear as an editorial in a special January 2021 issue of The American Journal of Bioethics

by Bridgette L. Jones, MD MS

Audre Lorde wrote in her essay The Transformation of Silence into Language to Action, “I have come to believe over and over again that what is most important to me must be spoken, made verbal and shared, even at the risk of having it bruised or misunderstood (Lourde 1984). I recently decided to tell my story, for the first time in my life, to the staff at my hospital during a gathering service for George Floyd. I spoke from my perspectives as a black woman, wife, mother, daughter, pediatric subspecialist and researcher about how silence was no longer acceptable for any of us. This is part of the story that I shared:

I stopped watching the viral videos of black people being killed in the streets by racism several years ago. The last video I actually sat down and watched was in 2016 when Philando Castile, a 32-year-old black man, was stopped while driving and fatally shot by a Minnesota police officer. He was driving with his partner, Diamond Reynolds, and her four-year-old daughter when their vehicle was pulled over. After being asked for his license and registration, Castile told the officer that he had a firearm (which he was licensed to carry), to which the officer replied, “Don’t reach for it then”, and Castile said “I’m, I, I was reaching for…” the officer said “Don’t pull it out”, Castile replied “I’m not pulling it out”, and Reynolds said “He’s not…” the officer repeated “Don’t pull it out” and then shot at Castile at close range seven times, hitting him five times. Castile died, about 20 minutes after being shot. The officer was acquitted of all charges. There was a 4-year-old girl in the car. I watched this video in my bedroom while my own 5-year-old daughter ate breakfast downstairs. I went to work that day to see patients in the clinic and no one mentioned this horrific scene, this crime against humanity, which had been streamed on Facebook live for the world to see. None of the pediatricians or other child health professionals said a thing about the 4-year-old girl whose life was forever changed. Not a word. We discussed the weather, sports, pop culture, patients, everything else but this. Everyone was silent. It was a normal day. But it wasn’t. At least not for me. I was angry at the silence. I am still angry at the silence. Silence is no longer acceptable.

After that day, I decided that, even if I had to be the only one in the room to do so, I had to talk about the racism that continues to harm the children we claim to protect and heal each day. I could no longer remain silent. I especially should not remain silent within the walls of my chosen profession, pediatrics, that I loved. “Tell them about how you’re never really a whole person if you remain silent, because there is always that one little piece inside you that wants to speak out, and if you keep ignoring it, it gets madder and madder and hotter and hotter, and if you don’t speak it out one day it will just up and punch you in the mouth from the inside”(Lourde 1984). This is the advice given to Audre Lorde by her daughter when discussing her own silence and why she had decided against silence.

On that day when I had watched and listened to the sounds of Philando Castile’s killing and when nobody said a thing about it, I had also been complicit in the silence. After that day I felt like I had been punched in the mouth from the inside. After that day I could not remain silent even when I wanted to.

Silence is the great masquerader of comfort. We think that if we remain silent, we can remain comfortable and can keep from making anyone one else uncomfortable. But silence only provides the illusion of comfort to a few at the price of discomfort to many. It is not comfortable to be the only black person in the room while racist words are spoken, or racist actions are done, and no one speaks up. You know that if you decide to speak up, that you will be the only one voice. You will not be supported. So, you remain silent.

On the rare occasions when you have spoken up, the times when the rumble in your head gets so loud that you finally decided to call out racism, your words are most often met with that complete hush and the blank faces of those who are able to seek comfort from the words which are not spoken. In those instances, the silence is loud. It sounds like deafening sirens ringing in your ears.

As Ibram X. Kendi explains, there is no such thing as “not being racist”. Either your words, actions, and policies support racism and are therefore racist, or they work to dismantle racism and are non-racist. In the same way, either you speak or you are silent. Silence is the difference between being racist and non-racist. Either you are speaking or acting to dismantle racism, or, by your silence, you are tacitly allowing racism to remain as an active and oppressive force in our society. Silence supports and props up inequity, bigotry, and racism by allowing them to stand unquestioned or even acknowledged.

As individual healthcare providers, as leaders of medical institutions, and as responsible citizens of a democratic society, we often remain silent about the systems and structures of racism that are woven into the very foundation of our country. We are silent about how racism impacts the care that we provide to our patients. We are silent about the ways that racism affects the communities that we take care of. This silence prevents us from recognizing the ways that our society’s foundation is broken. Silence prevents us from identifying and then extracting racism from our words, actions, systems, policies, and practices. How can we remove something that we won’t even name?

Silence about racism takes on many forms among individuals and organizations. As individuals, silence is often the sound of privilege. There is privilege in being able to sit in a room and feel comfortable enough to not speak or act when racist words or actions are spoken and done, as if those words and actions are someone else’s problem. This privilege allows a person to decide not to say anything so that they can hold on to comfort in that moment. However, in some instances that person will decide to later text or call the black person who was in the room and tell them how horrified they were and how wrong it was. The words in that text or call only function to try to cover over the cowardly public silence. As a person on the other end of the call, you learn that the price of discomfort to preserve the dignity and value of another human being is more than most are willing to pay. You learn that this private response is only meant to ease a troubled conscience. The words in this call or text are only meant to comfort the one who stayed silent even as, by calling or texting, that person acknowledges that something needed to be said. This act of a private response in fact condemns you to continued discomfort and, worse, isolation. People remain silent in those moments because they think those racist words don’t impact them, that it is none of their business and none of their public concern.

When white people leave it up to black people to speak out publically against racism, they are proving Kendi’s point. By waiting for “us” to speak up first, they are complicit in the injurious silence.

Here is my message to my silent and comfortable white friends and colleagues: it is, in fact, your concern. You should be interested because your silence is killing us all. Your silence supports racism, and racism is killing us all. Racist ideas allow inequitable healthcare access to be the norm. This leads to overall poor public health even among those who are called white. Racist policies that remain unchallenged cause disinvestment in educational systems in some neighborhoods and areas across the country, even among those areas where white children live. Racist thoughts prevent us from passing effective gun laws that could prevent mass shootings. They tolerate the increased daily community violence by dint of which our preschool aged children have to participate in “shooter drills”, even white children. These policies affect us all.

You need to compromise your own comfort and speak up. Silence about racism perpetuates racism by doing nothing to dismantle racist systems and structures that harm all of us. There is silence when we ignore the ways that our institutions allow murders such as those of Philando Castile, George Floyd, and Breonna Taylor to go unpunished. There is silence when racist reporting focuses on the individual flaws of the murderer, as if the problem is just an occasional “bad apple.” However, police brutality, a public health crisis, endangers the life of everyone including law enforcement officers and community members who are white. Yet, we dare not recognize how “racism” as a foundational component of our society continues to sustain harms to all of humanity, black and white, even as black people suffer more. Rhea Boyd writes that “death is the inevitable consequence of the full realization of structural racism.” Remaining silent about racism inevitably ends in unnecessary hardship and earlier death for us all.

Institutions are silent when they fail to address equity and inclusion by meaningful actions and policy level changes, instead opting for limp words, muted slogans, tokenistic programs, and empty symbolism. These tactics are an institutional form of silence. Organizations are silent when they talk about and parade their “diversity” but will not name racism. If programs to achieve equity, diversity, and inclusion do not take action against and work to remove racism, they are silent. Health institutions are silent when health inequities are ignored as part of the norm and viewed as problems too enormous to tackle. Health institutions are complicit when they do not allocate resources towards effectively addressing disparities and tearing down racism. Or when they provide miniscule budgets, an enormity of red tape, and a lack of effective tools and power to the community benefit programs that are designed to address the problems caused by centuries of societal racism. The “box check” of meeting minimum community benefit obligations is a form of silence.

During the COVID19 pandemic, alarms have been blaring regarding the disproportionate impact of the virus in black communities. The response? First there were attempts to muffle these initial data reports as congress members wrote to the United States Department of Health and Human Services stating that the government was “currently failing to collect and publicly report on the racial and ethnic demographic information” for COVID-19.Then, there were responses to the glaring disparities with shrugs of silence and empty statements like “this is not surprising” or “this is expected.” In some cases, black people were blamed for their own vulnerabilities based on chosen lifestyles and even their own biology. A U.S. senator who is also a physician said in an interview, “Now, if you have diabetes, obesity, hypertension, then African Americans are going to have more of those receptors” the coronavirus likes to hit (2020). When further asked about the impact of racism on observed disparities the senator and physician dismissed such cause as “rhetoric”(2020). The foundation of racist structures and systems which has led to and sustains this disproportionate vulnerability have mainly been called out by those who are among the community impacted by this devastation. The remainder of our society and healthcare organizations remain silent in their words but most importantly in their actions.

Those of us who are part of these communities clearly see the current devastation and clearly see how it will lead to widening racial disparities for not just health outcomes but also educational attainment, financial stability, and overall lifetime opportunity in the future. However, these implications don’t galvanize an institutional response. Individuals and institutions remain silent. In healthcare there is still silence because we have not moved to structural changes to address the racism that has left black people most vulnerable to death although these vulnerabilities are easily named (e.g. inequitable healthcare access, exclusionary medical science and innovation, lack of a workforce equipped to provide equitable care).

Silence is defined as the complete absence of sound. Sound is a vibration. A vibration is a type of movement or action. Silence is the absence of action or movement. In writing about her silence, Lorde further writes “My silence had not protected me. Your silence will not protect you.”(Lourde 1984). Being silent about racism is ignoring humanity and the right to life. Our continued silence will not protect us. It is harming us. It is killing us.