by Mildred Cho, PhD
Recently, on a panel at a conference of a medical professional society, the president of the society used a racist term that is an ethnic slur used to refer to Asians. The speaker did not publicly apologize but did resign from official duties of the society. Other leaders of the society issued a series of underwhelming apologies, the final one asking for “tolerance”. This request puzzled me. Did it mean there should not be harsh consequences for using a racist term in a professional setting? Why should I or anyone else tolerate this behavior? This incident, and in particular the muted reaction of colleagues, forced me to articulate arguments for why it is important to call out racist language amongst our professional peers. I thought that the reasons should be obvious, but apparently, they’re not. So, since the job of bioethicists is to make arguments for why things are right or wrong, I got to work.
When racist language is used in a professional context, some peers seem to be willing to call it “inappropriate,” or maybe “offensive” but many balk at calling it racist. Sure, it’s “inappropriate.” But when thinking about it, I wasn’t even sure it was offensive. The OED says that offensive means: “Causing someone to feel deeply hurt, upset, or angry.” So, a thought experiment: Am I offended by an ethnic slur generally used to refer to Asians, used in a professional context, but not directed at me personally? Offense didn’t really describe what I felt. It was fear.
For me, and I imagine for many others who live in this country who look even vaguely like they might be “not from here”, speak English with a foreign accent, or have darkish skin, ethnic slurs are more than just un-PC descriptors. As an Asian American child growing up in the quintessentially nice Midwestern college town of Ann Arbor, Michigan, I learned that such words are cues to brace for a possible physical attack, and that the price of misreading those cues was being punched, kicked, or hit by rocks as I walked to school or waited for the bus-by my neighbors. These words signaled aggression. Incidentally, OED says that offensive also means “actively aggressive; attacking” so maybe the word does fit. Even though that was fifty years ago, this violence is still happening. Where I live. And probably where you live, too.
I also learned that these attacks are never conducted in private, but are done for an audience. They are never conducted in silence, but always accompanied by racial epithets. The attacks are performative and the words are the script to the violent acts. The aggressor communicates to the audience, “they are not one of us” – “people like us have the power to hurt people like that”. And importantly, “and I know I can do this because nobody is going to stop me.” There will be no consequences. People tolerate it. This is what we’re now seeing over and over again, Asian people being pushed to the ground, stabbed, and punctured, punctuated by racial epithets, while others stand by and watch. And do nothing.
As professionals, we can’t be those people who do nothing. By definition, professionals self-evaluate and self-regulate. It is our professional ethical obligation to call out bad behavior among our peers for what it is. It casts its shadow on all of us in medicine and clinically-related professions because of medicine’s history of pathologizing difference and legitimizing racist beliefs by covering them with the veneer of medical terminology. That’s what Dr. Samuel Cartwright did when he coined the term “drapetomania” to describe the disease that caused slaves to run away, an affliction that he suggested could be treated by whipping. John Langdon Down used the term “Mongoloid idiocy” in an article published in the London Hospital Clinical Report, “Observations on an Ethnic Classification of Idiots” to describe what is now known as Down Syndrome. The National Library of Medicine included “Mongoloid” as one of its four racial classifications until 2003, but only discarded it after being called out by a bioethicist. Imagine what not calling out this language signals to others outside the profession, such as patients. Imagine what not calling out this behavior does to the credibility of already long-overdue diversity, equity and inclusion efforts.
Why is this so hard? Reading the transcript of the recent troubling podcast on systemic racism published by JAMA Clinical Reviews, there are clues. The now former deputy editor of JAMA Ed Livingston said, “I think using the term racism invokes feelings amongst people, as I just said, my own feelings earlier on, that make it—that are negative, and that people do have this response that we’ve said repeatedly, I’m not a racist. So why are you calling me a racist?” I found this statement to be totally perplexing even though it seemed to be uttered in sincerity. Fortunately, in an interview for BU Today, Robin DiAngelo, author of White Fragility: Why It’s So Hard for White People to Talk about Race, had the perfect explanation:
“As long as we understand racism as individual acts of intentional meanness, we will feel defensive about any suggestion of our complicity. When we understand the systemic nature of racism, however, we understand that our complicity is inevitable. It’s actually liberating to start from that premise, because then we can turn our attention to identifying what our complicity looks like and how we might change it.”
Please, don’t be complicit. Be uncomfortable. Elie Wiesel described the indifferent person as one for whom “his or her neighbor are of no consequence… Their hidden or even visible anguish is of no interest. Indifference reduces the Other to an abstraction.” We all have to call out racist language for what it is: racism, even if it’s uncomfortable and scary. If there’s anything about the use of racist language that makes me feel deeply hurt, upset, or angry, it’s seeing my friends and colleagues say nothing and do nothing about it. I promise to put my fears aside and I ask you to do the same.