EDITORIAL

Profiles in cowardice

I've just finished reading a compelling biography of John F. Kennedy written by the eminent historian Robert Dallek¹ and am struck by the contrast between JFK's courageous support of the civil rights movement and a disturbing incident that played out in a delivery room in Pennsylvania very recently. The latter events suggest that 40 years after JFK's tragic death, we still have a long way to go to eradicate racial discrimination.

Kennedy plays a prominent part in my childhood memories because I grew up in an Irish Catholic enclave just outside Boston, where his election was viewed as something akin to the Second Coming. Kennedy's assassination is indelibly ingrained in my memory, partly because it occurred on my 9th birthday and partly because it was one of the rare times when I saw my very stoic father openly weep.

As is the case with most Americans, over time, my idolatry of JFK was replaced by cynicism. Yet Dallek's book seems to make the man's foibles recede and his accomplishments expand, despite the fact that the biographer provides an unvarnished and highly objective glimpse of Kennedy's life and times. I had forgotten how perilously close we were to nuclear annihilation over the Berlin and Cuban Missile crises. Also forgotten amongst the subsequent salacious stories about JFK was his successful negotiation of a test ban treaty, creation of the Peace Corps and the Alliance for Progress, and his championing of the space program. He also brought energy, optimism, and panache to Washington at the height of the Cold War, when those qualities were so desperately needed.

Dallek's book, however, reveals JFK's true legacy in his progressively bold embrace of the civil rights movement. Faced with implacable opposition from a reactionary coalition of Southern Democrats and conservative Republicans, he was initially reluctant to press for legislation to end the de jure apartheid system present throughout the South and the more subtle and hypocritical forms of de facto racism endemic in the North. So he turned to executive orders. He formed the Committee on Equal Employment Opportunity and charged it with eliminating discrimination in hiring federal employees. He appointed prominent African-Americans to diplomatic, judicial, and executive branch posts; mandated minority hiring by federal contractors; and had the Justice Department file numerous voting rights suits and take legal action to integrate public schools. Events soon overtook Kennedy and forced him to abandon his initially cautious approach. The unconstitutional measures taken by the governors of Mississippi and Alabama to block integration of their states' respective universities prompted the dispatch of federal marshals to Mississippi and the federalization of the Alabama National Guard. Finally, the murders of Medgar Evers, civil rights workers in Mississippi, and innocent black children in Alabama—coupled with the lofty rhetoric of the Reverend Martin Luther King, Jr.—prompted JFK to ask Congress to enact a sweeping Civil Rights Act.

According to Dallek, with the exception of JFK's brother, Robert, all of the president's advisors spoke out against introducing the bill. They believed it was doomed to legislative failure and would cost him the South. That advice was exceedingly practical, given that Kennedy had won the 1960 presidential election by only 118,574 votes while carrying most of the old South. But JFK, perhaps remembering his own book, Profiles in Courage, would not be dissuaded. He introduced the Civil Rights Act in a speech in which he said, "One hundred years of delay have passed since President Lincoln freed the slaves, yet their heirs, their grandsons, are not fully free ... Now the time has come for this nation to fulfill its promise". Indeed, his advisors were correct: It would take his murder and the overwhelming grief and guilt of the American people to galvanize Congress into action.

Forty years have come and gone since that extraordinary moment of political courage, and few can contest the enormous progress that has been made in the field of civil rights. Indeed, as I finished Dallek's book, I concluded that it was in this one field of endeavor that JFK's legacy was on the firmest ground. However, no sooner had I put down the book than I read an October 4th AP story describing how hospital supervisors in a posh Philadelphia suburb had agreed to a pregnant patient's husband's demands that no black employees assist in delivering their child.

The couple's racism is repugnant and the supervisors' acquiescence is equally shameful. What prompted such perverse bureaucratic decision-making? I doubt it was motivated by racism; more likely it resulted from a desire to please a "customer." In medicine, that attitude is laudable when coupled with ethical conduct, quality care, sound business practices, and a harmonious work environment. In this case, however, the hospital supervisors' actions met none of those criteria.

First, agreeing to a racist request was patently unethical. Second, preventing the patient from having access to African-American staff reduced the number of trained "eyes" observing her medical and obstetrical care. Third, widespread publicity about the situation could have sparked a consumer backlash or outright boycott, not only by African-Americans, but also by anyone who values justice, fairness, and basic human rights. So, the supervisors' decision was also bad business. Finally, as director of an obstetrical unit that delivers nearly 5,000 infants a year, I can think of no surer way to poison the collegial atmosphere in an institution.

In short, "customer friendly" can only go so far! To be fair, when administrators at the Pennsylvania hospital learned of the bad decision that was made in their delivery room, they issued an apology to their employees and acknowledged that it was wrong to have accommodated a patently racist request.

Three lessons can be gleaned from this awful story. The first is that racism is still with us, though more subtle and discreet, its hard edges softened by the increasing education and affluence of its victims and the capitalist sensibilities of its practitioners. The second lesson is that in their heated competition for patients, hospitals are at risk of losing sight of their true mission: to heal their patients physically and emotionally. And the final lesson is that you don't have to be president to exhibit political courage. What would it have taken for just one of the employees in the delivery room to articulate the hospital's own stated policy that care be "provided on a non-discriminatory basis?"

Charles J. Lockwood, MD

Charles J. Lockwood, MD, Editor in Chief, is Anita O'Keefe Young Professor and Chair, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Conn.

Charles Lockwood. Editorial: Profiles in cowardice.

Contemporary Ob/Gyn

Nov. 1, 2003;48:12, 15.