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.
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.
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.
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.
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.
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.
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.