In the Interest of Science or Humanity: J. Marion Sims Was Wrong Then and Now! Rueben C. Warren, D.D.S., M.P.H., Dr. P.H., M.Div., Camille A. Clare, M.D., M.P.H., Rachel Villanueva, M.D., Vivian W. Pinn, M.D. Author affiliations: Rueben C. Warren, National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL, USA; Camille A. Clare, New York Medical College, Department of Obstetrics and Gynecology, Office of Diversity and Inclusion, Valhalla, NY, New York City Health þ Hospitals/Metropolitan, New York, NY, USA; Rachel Villanueva, New York School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA; Vivian W. Pinn, Founding Director (Retired), Office of Research on Women’s Health, National Institutes of Health, Washington, D.C, USA M uch is written about the importance of human- subjects research and health care delivery. This Commentary addresses the ethical problematic of justifying the scientific merit of J. Marion Sims’ surgical abusive behavior on enslaved Black women. Sims violated principles of bioethics and public health ethics. Dis- tinguishing between the goal of human-subjects research and that of health care delivery is essential for fully un- derstanding bioethics and public health ethics, and the tragedy of Sims’ unethical behavior. Bioethics is “an applied ethics focusing on the doctor-patient relationships and how changes in the health care system affect it”. 1 Public health ethics “places emphasis on the ethical problematic related to interest and health of groups, the social justice of the distribution of social resources and the positive or social rights of individuals. The study of public health ethics requires the practitioner to effectively conceptualize and operate between the tension of indi- vidual rights and collective interest”. 2 Human-subjects research employs the scientific discov- ery process to improve human health. Ideally, health care delivery provides evidence-based care resulting from that process. In both instances, the subjects are in vulnerable positions. If you are a person of color, particularly African American, or if you are low-income of any race or ethnicity, you are disproportionately vulnerable to potential ethical abuses and/or violations. If you are an African American woman and low-income, you are among the most vulner- able. You are, as Kottow writes, in a state of susceptibility . 3 The enslaved Black women, abused by Marion Sims, by his vesicovaginal surgeries, were in a state of susceptibility. The bioethics principles violated were autonomy, benevolence and justice, in that the women on whom Sims operated did not voluntarily give consent, an autonomy violation. He did not provide anesthesia during the surgery, an ill-intent violation. Nor did he treat these women fairly, a justice violation. Some of the women underwent as many as thirty separate vesicovaginal surgeries. The public health ethics principles violated were community engagement, benefi- cence and social justice. There was a specific racial and sex group targeted for this inhumane surgery, a community engagement violation. Sims ignored the pain that the women clearly endured during the surgery, which was an ill deed, not a good deed, a beneficence violation. The group viola- tion is consistent with the exploitation of Black women during enslavement and the social class that Sims targeted for his surgical experiments, a social justice violation. During the1830s through1880s, J. Marion Sims pur- chased enslaved Black women and performed numerous surgeries without anesthesia, sometimes twenty to thirty times, to correct vesicovaginal fistulae. It is disappointing to learn that in this twenty-first century, there remain persons who justify Sims’ barbaric behavior, under the guise of improving surgical innovation. They argue that history should applaud the surgical advancements by Sims because of the technical improvements that resulted from his work. The article published by Leonard F. Vernon (JNMA VOL. NO. 2019) makes such an assertion. The Black Feminist Health Science Studies Collective pub- lished an Open Letter to the Editor of the Journal of the National Medical Association, expressing how appalled they were by the “misattribution and misinformation” in the Vernon article. Fourteen transdisciplinary academi- cians and others were deeply disturbed that Dr. Vernon had not directly engaged any of the Black women in the Col- lective, who are producing work on Sims. They ended their Open Letter by including a bibliography of seventeen articles that Vernon did not include in his list of references. This Commentary will not review if Sims’ abuse of enslaved Black women for the common good was justified ª 2020 by the National Medical Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jnma.2020.01.002 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL 112, NO 2, APRIL 2020 233