Eric Reinhart
Trump just deported a transplant surgeon and professor at Brown University
living in the US on a valid H1B work visa with no alleged crimes. No due
process. As fits the racist Trump regime’s bill, she is from Lebanon.
We now live in a fascist nation.
OPINION
Health workers face a stark choice: become collaborators or resisters
Do not comply in advance
By Eric Reinhart Feb. 11, 2025
Reinhart is a political anthropologist, social psychiatrist, and psychoanalytic
clinician.
A medical school scrubs mention of gender and racial health inequalities from
its websites. A city health system advises its workers not to use their legal
rights to protect patients or co-workers but to instead cooperate with ICE raids
on hospitals. A university hospital instructs its physicians to stop providing
gender-affirming care to their trans patients. A state health department
compels its staffers working on abortion complications to hand over personal
details of doctors and patients involved. University administrators threaten
faculty members with firing if they don’t cancel publications on U.S.-Israeli war
crimes against Palestinian hospitals and health workers and withdraw support
from protesting students.
Actions like these have been rapidly multiplying across the United States’ most
prestigious hospitals, universities, and research foundations. Thick
administrative curtains and threat-reinforced walls of silence are helping many
doctors, nurses, and professors remain ignorant of the creeping
authoritarianism that surrounds them. But whether we allow ourselves to
acknowledge it or not, American medicine and public health are at a
crossroads.
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Hospital and university administrators across the country have been fearful that
the Trump regime will target their federal funding, or that billionaire donors may
withdraw their support, unless they comply with Trump’s demands. As a result,
many have been preemptively implementing changes they imagine he wants
and pushing physicians to alter their practice to accommodate his bigotry
against gender and racial minorities.
These administrators received their predictable reward last Friday: Draconian
cuts to National Institutes of Health funding that have, overnight, created large
budget shortfalls at key research and health care institutions. Although this
shocked many, it should have come as no surprise.
History teaches us that anticipatory obedience and appeasement in response
to fascist regimes are not only ethical travesties that sacrifice the vulnerable for
the convenience of well-protected elites; they are also profoundly naive. Rather
than protect their institutions, attempts at strategic collaborationism by hospital
and university administrators will only accelerate the destruction of the ideals
upon which their organizations are supposedly based. And, as we are already
seeing, they will also embolden Trump’s attempts to exert yet further control
over medical practice, academic research, university policies, and public
discourse.
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Under these conditions, clinging to an imaginary “middle ground” or “centrism”
is untenable. In the face of demands to deny care or assist in persecuting
targeted groups, health workers face a stark choice: become collaborators or
resisters.
Trump’s looming threats to Medicaid, Medicare, and essential childhood
vaccination programs could quickly inflict thousands of preventable deaths, as
his withdrawal of U.S. support for global public health has already begun to do.
Given these realities, health workers cannot wait on hospital administrators to
finally stand up for us, our patients, and the ethical foundations of medicine and
caregiving rather than the profit motivations on which administrators’ careers
are based. We must urgently organize among ourselves, to protect one another
as well as the communities in which we live.
Despite increasing levels of unionization among nurses and doctors that
suggest growing recognition of the importance of organizing and solidarity,
persuading health workers to disobey unjust laws and rules remains an uphill
battle. American health care professionals are not well-known for being eager
rule-breakers, political organizers, nor principled objectors to cruel policies that
exclude people from health care.
In fact, we’re well-trained to comply, after having spent decades normalizing
the deadly exclusion of millions of people from care by our for-profit health care
system. This tradition of American medical ideology — something that the
historian of authoritarianism Timothy Snyder has called “an invitation to
tyranny” — makes it feel easy, almost like a natural reflex, for us to go along with
rising medical fascism now.
We must now check that ingrained impulse. As we do so, we have historical
examples and brave, principled colleagues to whom to look for collective
courage today. And to appreciate what’s at stake and the challenges ahead, we
should also revisit our past ethical failures.
Throughout the history of modern medicine, authoritarian regimes or
oppressive governments have often relied on doctors and other health workers
to provide a facade of legitimacy and willing hands armed with scalpels,
syringes, pens, or simply locks on doors by which they kept those in need from
receiving care.
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Most notoriously, under the Nazis, physicians played a central role in their
eugenic campaigns of mass sterilization and extermination to, in essence,
“make Germany healthy again.” Their roles began gradually. At first, many
simply complied with demands to deny care to certain groups of people. Later,
they began carrying out forced sterilization procedures on these groups. Soon,
they actively identified both Jewish individuals and other ethnoracial minorities
alongside queer people and political dissidents for arrest and transport to
concentration camps. There, physicians selected victims for the gas chambers
and performed barbaric human experiments. As this was transpiring, most
American doctors did shamefully little to address or condemn it, even
publishing praise for Nazi public health practices in our most prestigious
medical journal.
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That was not the only time U.S. medicine failed to do the right thing — far from
it. In the U.S., medical professionals famously participated in the Tuskegee
syphilis study, withholding treatment from Black men for decades in order to
observe the natural progression of the disease. Likewise, multiple state-
sponsored forced sterilization programs targeted Indigenous women and other
women of color well into the 1970s, with medical workers complicit in the denial
of basic bodily autonomy to oppressed people. And for decades, the American
Medical Association supported segregated hospital care and exclusion of Black
doctors, only apologizing for this in 2008. In the 1980s, when doctors in
apartheid South Africa were complicit in the state torture and murder of Black
dissidents like Steve Biko, the AMA — unlike all other national medical societies
across the world — opposed global efforts to isolate South African physicians
to force an end to apartheid medicine.
More recently, in a reminder that little about our vulnerability to complicity with
state violence has changed, American psychologists collaborated with the CIA
to design and conduct “enhanced interrogation” procedures at Guantanamo
Bay and elsewhere that were later named by the Senate Select Committee on
Intelligence for what they were: torture. As Trump now moves to open a
concentration camp for immigrants at the same Guantanamo Bay site, we
should remember such gruesome legacies of collaboration with state violence
and refuse to allow their repetition.
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Frantz Fanon observed in 1959 that although we doctors present ourselves as
healers of “the wounds of humanity,” we frequently serve as “an integral part of
colonization, of domination, of exploitation.” He also noted that, under
conditions of state-sanctioned oppression, we are structurally disposed to be
more aligned with policing than with caregiving. To counter this reality, we must
be honest with ourselves and accountable to our co-workers, patients, and
communities — rather than to hospital administrators, insurance companies, or
government authorities.
This was obviously true when Fanon described it during the violent French
suppression of the Algerian independence movement. And it remains true
today. This is evident in hospitals’ widespread cooperation in restricting
abortion access and criminalizing their patients and workers after the Dobbs
ruling, when many hoped that our field would do more to resist rather than
simply fall in line with unjust laws. It has also been reflected over the past 16
months in many American, European, and Israeli doctors’ choices to lend either
passive or active support for Israeli war crimes in Gaza, including the
systematic destruction of its hospitals.
A key lesson we should draw from all of these histories is that authoritarian
agendas rarely surge forward without the tacit or overt collaboration of
purported healers. Doctors and nurses have too often failed to say no —
sometimes because we insisted we were “just following orders,” other times
because we were threatened with the loss of income, and sometimes because
we have been supporters of violent ideologies, whether explicitly or through
convenient indifference.
But even in periods of profound moral collapse, there have always been doctors
and nurses who have refused to abandon their patients or to be complicit with
state violence, often at great personal cost. Recently, we have seen this most
dramatically from Palestinian health workers and international teams delivering
care in Gaza with Doctors Without Borders, for example.
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For a more direct parallel with our present situation in the U.S., we can look to
the history of those who resisted the Nazi regime. During the Nazi occupation
of the Netherlands, for example, many Dutch physicians surrendered their
licenses rather than practice under Nazi directives that would have required
them to deny and distort care on racial or political grounds. They turned instead
to illegal underground practice in order to evade Nazi surveillance and rules. By
sacrificing their status and income, they not only preserved their ability to treat
whoever came to them but also defended the fragile integrity of the medical
profession against its total destruction, showing us still today that organized
resistance is always possible no matter how grave the danger or how cruel
government or collaborationist hospital administrators may become.
We should mine such histories to formulate strategies for effective response,
including various forms of collective civil disobedience, to the rising fascist
encroachments on American medicine now. Heroic individual self-sacrifice
without a collective plan is rarely a useful strategy, but urgently investing in
coordination, preparation, and mutual aid to protect one another at the same
time that we act to protect our patients is essential.
Some of my colleagues may consider such warnings premature and regard it as
alarmist to worry that many among us may, once again, become complicit with
state violence. But it’s worth noting that — as the history of fascism teaches us
— once such acts are fully underway, it is usually too late to still be able to say
so publicly.
Eric Reinhart is a political anthropologist, social psychiatrist, and psychoanalytic
clinician.
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