Slaves Can’t Give Informed Consent.

So heres the thing – we don’t sanitize slavery here. Not on this blog, not in my house, and not in my universe.

source

Now a few weeks ago, I was doing some light reading on the slave gynecological experiments. I came across a scholarly article that was defending the reputation of of J. Marion Sims – The medical ethics of Dr J Marion Sims: a fresh look at the historical record by Dr. L. Lewis WallWidely considered the Father of Gynecology, Sims was an 19th-century American surgeon who perfected the surgical repair of the vesicovaginal fistula.

*trigger warning for the squeamish folks in the back*

Vesicovaginal fistula is a very painful opening between the bladder and the vagina that causes consistent incontinence. It’s main cause is from obstructed labor. Good news ladies – its rare. Barely happens anymore in the United States. I will own that Sims’ perfection of a consistent surgical technique to repair vesicovaginal fistula was an important contribution to society. However, it came through the avenue of painful and unethical experimentation on African American female slaves. Wall used Sims’ accounts in his medical journals to stipulate that Sims’ obtained informed consent from his slave patients and that they would’ve been ultimately grateful for the surgeries themselves. And I have a simple response – No.

Claiming that these slaves had given informed consent contradicts the principle of informed consent itself. Informed consent requires autonomy – you cannot have one without the other. There was no autonomy – much less autonomous decision making here.  Harriet A. Washington says in her book, Medical Apartheid, “The planter, not the slave, had to be satisfied with the results. The planter, in every important sense of the word, was the patient…with the slave left outside, unconsulted, uninformed, and with no recourse if she or he was unsatisfied, injured, or killed…”. Wall quotes Sims saying that he would not perform an operation on these particular slave women without their full consent to support his argument. However, in that same statement, Sims says that “three young, healthy, colored girls ,were given to me by their owners…” These procedures were done without anesthesia and while the women were naked on their hands and knees. The surgeries were so painful that the doctors assisting Sims in restraining the women eventually quit because they could not take the women’s screams. Ironically though, Sims held the popular perspective that blacks did not feel as much pain as whites. Slaves generally were not given adequate recovery time during illnesses because a day out of the fields was money out of their owners pockets. A sick or recovering slave was essentially worthless. Humoring Wall –  if the women did want the procedure, it is not clear from the historical record if most of these women were actually cured of the vesicovaginal fistula. Furthermore, this still does not negate the problem of informed consent. At minimum these women were under duress from their masters. They were given away for the purpose of experimentation. What slave in their right mind would actually resist? They could’ve been beaten, sold, or even killed if they were or appeared to be resistant. At minimum – this is duress.

Also – slaves were property. They were not considered people. Any surgery that would make a slaveholders’ slaves better and more efficient child bearers was a surgery worth giving to their slaves. The resale value of a slave was of the upmost importance and reproduction was a key part of that package. Thomas Jefferson himself said, “I consider a slave woman who breeds once every two years as profitable as the best worker on the farm.” Breeding was so important that even though slaves could not be legally married, slave marriage was created so slaves could “morally” procreate. To say that receiving this surgery ultimately benefitted these women trivializes the nuances of slavery and of slave medicine. This was ultimately for the slave owners benefit. The idea that this was a benevolent favor is misguided. Slave medicine was not an autonomous or benevolent practice of medicine. There are shows on HGTV dedicated to showing how people can improve on the resale value of their homes. These surgeries were the Antebellum equivalent. You want to sell a house? You renovate your kitchen. You want to sell a slave? Get their vagina fixed.

In all, Sims did experimental surgery on eleven slave women and performed 30 surgeries one particular slave named Anarcha. These women were victims of nonconsensual human experimentation – sadly not uncommon for the slave population at this time. The whole point of the Neighborhood Bioethicist is have authentic conversations about healthcare. Sanitized slavery is not authentic. Its a lie. And claiming that slaves can give informed consent is sanitizing slavery. Because fun fact – a slave inherently cannot give informed consent. A slave’s master giving a slave away to a doctor to have surgeries performed on them is not informed consent. A slave saying yes to a surgery under duress because they understand that they are property and that their life would be in danger either way is not informed consent. Call it what it is – unethical human experimentation on human property for convenience and resale value. Too many black women suffered for this to be cheapened like fool’s gold.

*insert rolling eyes emojis*,

The Neighborhood Bioethicist

HELPFUL READING

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

SOURCES

Darlene Goring. “The History of Slave Marriage in the United States.” The John Marshall Law Review. Accessed May 3, 2017. http://digitalcommons.law.lsu.edu/cgi/viewcontent.cgi?article=1262&context=faculty_scholarship.
“Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology.” NPR.org. Accessed April 30, 2017. http://www.npr.org/2016/02/16/466942135/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology.
Spettel, Sara, and Mark Donald White. “The Portrayal of J. Marion Sims’ Controversial Surgical Legacy.” The Journal of Urology 185, no. 6 (June 2011): 2424–27. doi:10.1016/j.juro.2011.01.077.
Stamatakos, Michael, Constantina Sargedi, Theodora Stasinou, and Konstantinos Kontzoglou. “Vesicovaginal Fistula: Diagnosis and Management.” The Indian Journal of Surgery 76, no. 2 (April 2014): 131–36. doi:10.1007/s12262-012-0787-y.
Wall, L L. “The Medical Ethics of Dr J Marion Sims: A Fresh Look at the Historical Record.” Journal of Medical Ethics 32, no. 6 (June 2006): 346–50. doi:10.1136/jme.2005.012559.
Washington, Harriet A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Knopf Doubleday Publishing Group, 2008.

 

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