Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Harriet A. Washington is a scholar of medical ethics, a subset of bioethics. Bioethics is a field that explores ethical issues related primarily to human health and explores topics like medicine, biotechnology, politics, and law. Within bioethics, medical ethics specifically concerns itself with ethical practices in medicine and scientific research. Conversations about medical ethics were as old as medicine itself, with the Hippocratic Oath dating back to the fifth century BC. In the 19th and 20th centuries, different rules and codes of medical ethics emerged, such as the American Medical Association’s first code of ethics in 1847. As outlined in Medical Apartheid, these codes were often unevenly applied, and many Black people and other marginalized groups suffered medical abuse from doctors. Some medical codes emerged in response to atrocities. For example, the Holocaust led to the Nuremberg Codes (1947), which outline 10 ethical principles for medical experiments on humans.

Medical ethics are rooted in four key principles: autonomy, beneficence, non-maleficence, and justice. Autonomy refers to a patient’s right to refuse treatment or otherwise guide their treatment; in other words, the patient ultimately has control over their body. An important aspect of autonomy is informed consent, meaning that doctors must thoroughly explain procedures so that a patient can make a rational choice, even if that choice conflicts with the doctor’s wishes. Beneficence means that a doctor has to act in their patient’s best interest. Non-maleficence means that a doctor must strive not to cause harm. While some treatments might cause pain or negative side effects, the benefits should outweigh the harm. An example of this is chemotherapy and radiation treatments for cancer, which have detrimental effects on the body but are ultimately effective for treating cancer.

Justice refers to how resources are distributed and who gets treatment. A pressing contemporary medical justice question in the US concerns insulin prices, as many Americans with low incomes cannot afford the drug and ration their insulin use, which can result in severe illness or death. A 2021 survey found that 16.5% of Americans with diabetes rationed insulin (Thomas, Naomi “1.3 million Americans with diabetes rationed insulin in the past year, study finds.” CNN, 17 Oct 2022). Another medical justice question related to Medical Apartheid is the maternal mortality rate in the US. While the American maternal mortality rate is already disproportionately high for a wealthy nation, it affects women of color more severely, with Black women suffering a mortality rate 2.5 times higher than white women (Hoyert, Donna L. “Maternal Mortality Rates in the United States, 2021” CDC, Mar 2023).