How scientific racism's history shapes modern medical ethics
- Christa Kuljian
Steve Biko’s murder exposed deep racism in how medicine was taught and practised in South Africa.
In 1966, Steve Biko began studying medicine at the University of Natal in South Africa, the same year that the general assembly of the United Nations declared apartheid a crime against humanity. As a young man, and a leading thinker, philosopher and activist, Biko made an indelible mark on the resistance against white minority rule and the racist system of apartheid.
At a young age, Biko understood colonial thinking, racism and white supremacy and he knew how destructive they were to society and to individuals. In his book I Write What I Like, which has served as a guide for future generations of activists, he wrote:
The most potent weapon in the hands of the oppressor is the mind of the oppressed.
His contributions to the Black Consciousness Movement in the 1960s and 1970s pushed back against the overwhelming influence of colonial and racist thinking.
Biko also became a powerful symbol of resistance as a result of his death in detention at the hands of the apartheid security police, on 12 September 1977.
Two days earlier, healthy and 30 years old, he had been arrested in a city on South Africa’s south-east coast, Port Elizabeth, now called Gqeberha.
Biko died following savage beatings by the security police. The cause of death – and the circumstances – were repressed by the South African government. However, as more evidence began to emerge about the circumstances of his death it became clear that the medical profession was heavily implicated. Two doctors had been asked to examine him after his beatings, and neither acted to have his wounds treated.
The security police drove Biko over 700km across the country to Pretoria where the security police had its headquarters. Biko made the trip, naked in the back of a van, where he was injured further. He died the next night, alone, in a hospital.
It was the South African Medical and Dental Council’s role to protect patients from improper medical conduct. But the council did not hold the doctors accountable. Instead, it did everything it could to try to cover up the negligence and complicity of the two doctors.
This single death in detention, among many under apartheid, led to an outcry and prompted many efforts by activists and anti-apartheid organisations related to human rights, medicine and health.
The relationship between the medical field, ethics and human rights has a much deeper history that goes back long before Biko.
In the late 1800s and the first half of the 20th century, the concepts of comparative anatomy, race typology and a hierarchy of race flourished among scientists, physical anthropologists, anatomists and doctors in Europe, Britain, the US and South Africa. As a result, scientists promoted disturbing anthropological practices including the unethical collection of human skeletons and measuring physical characteristics without consent. These collections, originally gathered to prove the inequality of races, continue to be held locally and internationally.
I explored these issues in my book Darwin’s Hunch, in the 2023 Steve Biko Bioethics lecture, and in a paper. On the anniversary of Biko’s death, there is still a need to acknowledge and revisit this painful history of scientific racism to build a greater understanding of history, transparency and ethics for the future.
The events
As a result of domestic and international pressure after Biko’s death, the South African government agreed to hold a public inquest later that year. Yet details of Biko’s death remained unclear and the presiding magistrate refused to prosecute. Professor Yosuf (Joe) Veriava, who is now professor emeritus at the University of the Witwatersrand, was one of the people to demand that the doctors and the South African Medical and Dental Council be held accountable.
Submissions to the council were ignored but Veriava, a medical doctor, persisted. He was joined by other doctors including Tim Wilson and Dumisani Mzamane. Phillip Tobias, who was dean of medicine at the university at the time, joined along with professors Frances Ames and Trefor Jenkins.
The group took their case to the Pretoria Supreme Court — Veriava and others v. the South African Medical and Dental Council. After years of effort, to their surprise, on 30 January 1985, the court ordered the council to hold a formal disciplinary hearing for the two doctors involved and to pay the costs for the case.
The two doctors – Ivor Lang and Benjamin Tucker – were found guilty. Lang received only a caution and continued to practise for five more years until he retired. Tucker was struck off the roll, but he issued a public apology and successfully applied to be reinstated.
Addressing the issue of ethics
In the late 1970s and early 1990s doctors at the University of Cape Town and the University of the Witwatersrand (Wits) saw the need to establish local medical ethics committees that would have status in the faculty and offer advice to doctors. Jenkins was involved in creating course material about medical ethics at Wits.
Veriava again played a role in 1997 when the University of the Witwatersrand Faculty of Health Sciences was asked to make a submission to special hearings on the health sector held by the Truth and Reconciliation Commission. The commission was established to expose the truth about the human rights violations that had taken place under apartheid, from 1960 to 1994.
Max Price, who was the dean, Jenkins and Veriava put together the material. In his submission, Price said:
We look specifically at the failure of the faculty to address human rights and ethics as a substantive and formal component of the curriculum prior to 1984.
Price shared that in preparation for the submission, many white staff members believed that the university had offered a liberal environment and an “oasis of freedom” to black staff and students during apartheid. However he said, in interviews, this proved untrue. Many Black staff and students felt angry and bitter because they experienced exclusion, humiliation and hurt by discriminatory practices.
As a result, the university decided to conduct an Internal Reconciliation Commission. But the process was flawed. For example, it did not review the history of the collection of ancestral human skeletons, masks and casts that were built from the 1920s through to the 1980s, some of which was collected unethically. There was no review of the disturbing anthropological practices used at Wits Medical School and the Department of Anatomy as faculty and students conducted research trips across the continent in the same period.
What still needs to be done
The internal reconciliation commission was nevertheless an important process. As a result of its work the university’s Faculty of Health Sciences now carries a plaque at its entrance stating that it “reaffirms its rejection of racism and other violations of human rights.”
In 2007, Professor Ames Dhai became the founder director of the Steve Biko Centre for Bioethics at Wits.
Among other changes, over the past several years, new internal policies and ethics committees have been put in place to oversee the collections at the university.
Yet there is still more to be done. We need to continue to talk about the history of scientific racism, not only to understand the present, but also to make changes to do better in the future. We owe that to future generations, and to our ancestors, including Steve Biko.
Christa Kuljian, Research Associate, WiSER, University of the Witwatersrand. This article is republished from The Conversation under a Creative Commons license. Read the original article.