The ongoing reckoning with history’s darker episodes, and most notably with the legacy of racism in the United States, has driven many institutions of higher learning from Princeton’s Woodrow Wilson School of Public and International Affairs to Yale’s Calhoun College, to grapple with (and in these cases, ultimately reject) names associated with controversial historical figures. The medical community has not been immune to such challenges. Over the past two decades, physicians have been forced to confront the widespread use of eponyms derived from the names of Nazi physicians including Hans Reiter, Friedrich Wegener, Max Clara, and Carl Clauberg.Footnote 1 , Footnote 2 , Footnote 3 , Footnote 4 A statue of J. Marion Sims (1813–1883), long heralded as the “father of modern gynecology,” and more recently denounced for his experimental surgeries on female African-American slaves (conducted without either consent or anesthesia), which stood in New York City’s Central Park opposite Mount Sinai Hospital, generated considerable opposition until its removal in 2018.Footnote 5 , Footnote 6 , Footnote 7 California-based Sutter Health mothballed a bronze of its namesake, John Sutter of 1849 Gold Rush fame, after the monument was defaced in 2020 over objections to Sutter’s mistreatment of Native Americans.Footnote 8 Notably, the healthcare system did not rename itself. Universities housing medical schools christened after slaveholders from Rutgers to Johns Hopkins have been steadfast in their resistance to renaming.Footnote 9 , Footnote 10 In contrast, the Association of American Medical Colleges did retitle its Award for Distinguished Service to Medical Education, which had previously honored Abraham Flexner, after scrutinizing his racist and sexist writings.Footnote 11 In addition, Columbia University’s College of Physicians and Surgeons scrubbed the name of its medical school dormitory, Bard Hall, which had previously honored Samuel Bard (1742–1821), both George Washington’s physician and a slaveholder.Footnote 12 Whatever one’s views on these specific changes, or the broader questions of reexamining historical legacies critically, debates of this nature—impassioned, emotional, often drawing on competing traditions, and sometimes implicating entrenched financial interests—are likely to persist.
These debates are important. Unfortunately, while the dialogue surrounding controversial names and monuments occurs within the broader national conversation on race and justice, what has been missing all too frequently is a systematic effort to develop uniform, trans-institutional standards for reevaluation and removal that can be applied at a granular level. Individual institutions have often developed clear benchmarks or conducted self-directed investigations leading to local guidelines. Among the most notable are Yale’s “Letter of the Committee to Establish Principles on Renaming” (2016) and Stanford’s “Principles and Procedures for Renaming Buildings and Other Features at Stanford University” (2018).Footnote 13 , Footnote 14 Yet individual school policies differ widely from one another. For instance, Yale’s policy includes a “presumption against renaming” and states that doing so “on account of values should be an exceptional event.”Footnote 15 After outlining a series of factors to consider, Yale’s approach notes that “[n]o single factor is sufficient, and no single factor is determinative,” but that “renaming will typically prove warranted only when more than one principles listed here point toward renaming” and even more than one factors may not prove sufficient.Footnote 16 In contrast, Stanford, while acknowledging that such renaming “should not be undertaken lightly,” offers criteria any of which might justify renaming, and allows any member of the university community to petition its president to do so.Footnote 17 In addition, both policies are complex: Stanford weighs seven principles, whereas Yale’s three principles require six pages of explication. There is no reason to expect that similar committees currently at work at Harvard, Brown, and Columbia will produce guidelines that are any more concise or consistent. Too often, the practical and political barriers to renaming override the symbolic significance of such choices, so that a school may remove an objectionable building name or controversial portrait, but resist higher profile actions related to more prominent aspects of an institution. Nor are the recommendations of these committees dispositive: four years after Princeton’s Trustee Committee recommended against renaming the Woodrow Wilson School, arguing that “the original reasons for adopting [the name] remain valid,” the school rebranded anyway.Footnote 18 Rather than achieve the goal of commemorating history in a just and productive manner, these inconsistencies create the undesirable impression that renaming merely reflects the momentary intersection of transient political power with public relations. A simple, uniform approach to these cases that focuses on symbolic significance would enhance the moral clarity of such changes in commemoration.
Scope of the Challenge
One of the challenges in establishing any policy on renaming is that all injustices are not created equal and that policymakers may be reluctant to be perceived as comparing them. One might adopt a bright-line test that excludes Nazi officials and slaveholders from commemoration—although one wonders what is to be done with ancient slave owners such as Galen. Lesser offenses pose a greater challenge, especially when the perpetrators responsible also generated knowledge that saves thousands or millions of lives. For instance, Joseph Goldberger (1874–1929), heralded today for his work preventing pellagra, ran ethically problematic experiments in which prisoners’ diets were altered to induce the disease.Footnote 19 The progenitor of the polio vaccine, Jonas Salk (1914–1995), conducted human challenge trials for influenza on institutionalized psychiatric patients in Ypsilanti, Michigan, in the 1940s.Footnote 20 DNA pioneer James Watson has tarnished his reputation for many critics with a wide range of comments on race and gender including drawing connections between skin color, intelligence, and libido.Footnote 21 How is one to sort through such cases to generate a coherent policy which can meet the subjective needs of stakeholders and the higher goals of symbolic justice?
One might throw up one’s hands and argue that no names or monuments should be removed. An editorial published in Nature in 2017—controversial even after its retraction and revision—argued that, “Erasing names…runs the risk of whitewashing history.”Footnote 22 The editors suggested the possibility that rather than removing problematic statues, institutions might also set up monuments to victims alongside “a plaque noting the controversy.”Footnote 23 Such an approach runs the risk of whitewashing history in the opposite direction and of ignoring legitimate objections by current community members who rightly feel unheard and marginalized. At the opposite extreme, one might take the view that all objectionable names should be removed. Yet such an approach—even if society or the medical community could collectively agree on a standard—runs the risk of diluting the power of such interventions. Renaming and monument removal are better thought of as symbolic acts designed to convey evolving attitudes, rather than as comprehensive efforts to scrape objectionable characters from the public square. Some universities have argued that a close, high profile relationship to an institution might justify retaining a name. For instance, Yale’s guidelines state that when “buildings are named for people who have made major contributions to the life and mission of the University…renaming will be appropriate only in the most exceptional circumstances” and even that “to change a name in one institution or place, where the namesake played a relatively modest role, is not necessarily to say that the name ought to change in another, where the namesake played a larger role.”Footnote 24 Stanford’s approach is similar. Both institutions have it precisely backward. The symbolic nature of the process means that removing an objectionable, high profile figure’s name, such as John Calhoun’s, is far more important than deleting that of a more obscure figure. (Needless to say, doing so also requires more political capital.) Similarly, proposals to change all names periodically to avoid such controversies miss the point.Footnote 25 The goal is not merely the result of naming, but the act of renaming with its moral gravitas.
The purpose of this paper is not to address the merits of particular claims. (The author has addressed several particular claims elsewhere.Footnote 26 , Footnote 27 ) Rather, one of the principle goals of this paper is to shift the discussion toward specific facts rather than standards. Agreeing on a set of principles is not an end to the work, but a beginning: the next step will be to ascertain the facts of specific cases, often a laborious and thankless task. In some cases, the facts will prove unclear or subject to debate. For example, a University of Pittsburgh committee was unable to determine to what degree former Surgeon General Thomas Parran (1892–1968) was aware of the infamous Tuskegee syphilis experiment that occurred under his tenure.Footnote 28
The principles outlined below are aimed at addressing commemorative names designed to honor historical figures. This author has proposed much stricter guidelines for recent and current donors seeking to name medical schools.Footnote 29 Similarly, this paper focuses on the goal of addressing specific historic wrongs. Strong arguments also exist for honoring overlooked historical figures from diverse backgrounds, and for achieving race and gender diversity more broadly among figures honored in hospitals and medical schools, but that requires a different framework for analysis.Footnote 30 Finally, this paper does not address the use of research data or materials generated in an unethical manner that might be of value in current practice, such as Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy. Footnote 31 The goal here is must narrower: by establishing simple and straightforward principles that can be used across healthcare institutions, leaders in American medicine can make a clear statement of values, reduce future controversy, and harness the power of the renaming process as an important tool for reconciliation and social justice.
A Model Policy
This paper proposes a three-pronged test drawn from the best elements of a wide range of previously proposed renaming standards in various fields. Triggering any one of these measures justifies removing a controversial name or monument:
1. Connection of Controversial Acts to Scientific/Medical Accomplishment: The first inquiry should be to what degree the honorees fame results from his controversial conduct. A nonmedical example offers a clear distinction between those whose conduct is tied to their “achievement” and those whose fame occurs independent of it. Vice President John Calhoun’s fame rests almost entirely on his defense of Black chattel slavery in the antebellum American South. President Woodrow Wilson, in contrast, while a deeply problematic figure who segregated the federal bureaucracy, does not rest his claim to prominence on his racist acts, but on a legacy of steering the nation through World War I and his subsequent internationally minded foreign policy. Under this section of the three-part test—but not necessarily those described below—a case can be advanced for removing Calhoun’s name but not Wilson’s. For a medical example, one might compare the work of António Egas Moniz (1874–1955) and Julius Wagner-Jauregg (1857–1940). Egas Moniz, a Portuguese neurologist, won a Nobel Prize specifically for his work developing the now discredited and barbaric practice of leucotomy. His fame stems directly from his ethical transgressions. In contrast, Austrian psychiatrist Wagner-Jauregg won plaudits and a Nobel Prize for his use of malaria inoculation to treat general paresis. That later in his career, he became a Nazi sympathizer, anti-Semite, and President of the Austrian League for Racial Regeneration and Heredity, is largely incidental to the medical achievements that gained him renown at an earlier date. As a general rule, those figures who acquired their recognition principally as a result of unethical endeavors should see their names scrubbed from public honors, whereas those whose fame and controversy were independent should see their names removed only if they meet one of the additional criteria below.
2. Seriousness × Entanglement: The second area of inquiry should examine both the seriousness of the underlying conduct and the subject’s degree of entanglement with it. Some behaviors—possibly involvement with Nazi medical experiments or Black slave ownership—might be deemed automatically exclusionary. Once having crossed these bright lines, policies might mandate removal of honors. (Yet these bright lines can prove problematic: what of Benjamin Rush, namesake of Rush University Medical Center, both an abolitionist and briefly a slave owner?)Footnote 32 For conduct that is troublesome but does not cross such bright lines, the inquiry might focus on the degree to which the subject was involved with the disturbing acts. As the conduct becomes less objectionable, the level of entanglement required for renaming should increase. Few would endorse retaining honors for Egas Moniz or his American disciple, Walter Freeman, who performed approximately 4,000 lobotomies, many fatally, between 1936 and 1967; in contrast, a psychiatrist who referred a single patient for a lobotomy early in an otherwise illustrious career might still be honored in light of her low level of entanglement with the procedure.
3. Symbolic Significance: The third inquiry should be to what degree the continued presence of the name or monument has come to symbolize historic injustice. Such significance might arise in two distinct ways. First, the name might be so prominently attached to the institution—as is arguably the case with Sutter Health or the Woodrow Wilson School—that removing the name offers a powerful statement (as, in the opposite direction, does letting the name remain). In contrast, removing an obscure bigot’s name from an endowed professorship is unlikely to convey a message of the same weight. Or the name might be attached to a venue or institution that gives it undue prominence in the lives of community members. Being asked to live in a dormitory named after a slaveholding physician seems an unreasonable expectation; tolerating the presence of a slaveholding physician’s portrait alongside those of other many university deans or professors in a research library might prove less so. Cornell University seems to have missed this distinction in recently removing the name of anti-Semitic historian Goldwin Smith (1823–1910) from a set of university professorships, but not from the campus’s most prominent building. Second, the name or monument may commemorate a relatively inconsequential figure, but have come to symbolize a larger struggle for social justice and historical revision. While J. Marion Sims was reasonably prominent as a physician, his statue opposite Mount Sinai acquired considerably greater significance during years of conflict. Independent of the prominence of the subject, the prominence of the controversy may itself argue for removal of a name or public memorial.
The above three criteria are designed to be applied to historical figures. The issue of living, or recently deceased, individuals beset with complex or blemished legacies is more challenging, as here there is a symbolic statement to be rendered, but also a moral judgment that affects an actual human being or his immediate survivors. More caution should be used in this regard, noting that the point at which a deceased figure shifts from contemporary to historical is somewhat subjective.
Factors Not Relevant
An exhaustive list of factors that should not be given weight in the reassessment process is impossible, but three (which often find their way into such debates) are particularly problematic.
1. Contextualization of Behavior in Historical Context: One problematic approach to these questions is to ask: were the individual’s attitudes or actions acceptable in the moral framework of the time that they occurred? In the debate surrounding the renaming of the Woodrow Wilson School, for example, a question often raised was whether his racial views were regressive even in the context of early twentieth-century America.Footnote 33 This approach, which in many ways mirrors the originalist approach to legal interpretation, unravels rapidly under careful scrutiny. First, the implication is that one’s actions are less objectionable if others accepted them. But avowed Nazis like Reiter and Wegener shared the views of millions of Germans. Hundreds of thousands of American Southerners shared Calhoun’s values, electing him to the House of Representatives, the Senate, and the Presidency. Second, this approach raises the question of whose gaze one uses in making these assessments: to Germans of the 1930, Reiter’s and Wegener’s ideas may have been mainstream. To many Americans or Britons of the same era, they might have shocked the conscience. An approach that relies on historical context fundamentally misunderstands the question at the heart of the renaming debate. The inquiry is not whether to pass a moral judgment on an historical personage, but rather whether to offer a symbolic judgment on whether that individual should continue to be honored in a public way. Samuel Bard or Julius Wagner-Jauregg may just have been men “of their times,” as the expression goes—and there is no particular reason for history to offer a conclusive, definitive judgment on them one way or another. This is not a trial. Since they are long deceased, the personal consequences for them are absent and largely irrelevant. However, displaying values no more objectionable than one’s peers is a dubious basis for continued public honor.
2. Dilution of the Connection to Controversial Conduct: A second problematic approach to these cases incorporates the degree to which the name’s association with controversial conduct has been diluted by its association with the named entity itself. Most students entering Bard Hall—as this author once did—never reflected on the life of Samuel Bard. Students at Johns Hopkins could not possibly have reflected on the philanthropist’s slave ownership, because it was unknown to the general public until 2020. This troublesome approach argues that the names have been used for so long, they have become detached from their original meaning—or have even subsumed it. To the vast majority of contemporary Americans, Johns Hopkins is the name of a university, not the name of a nineteenth-century investor. Stanford’s report terms this phenomenon: “community identification with the feature.”Footnote 34 One might also think of it as an alternative narrative. (Of course, alternative narratives, no matter how sincerely held, can prove dangerous: a flag used as a symbol of rebellion and later segregation is transformed, but only for some individuals, into an icon of regional pride.) Unfortunately, dilution of this sort is not universal and does not impact all community members equally. One is much more likely to take umbrage at the “In God We Trust” minted on coins if one is an atheist or to notice the underlying implications of sports teams named Redskins and Indians if one is Native American. One might reframe the issue as follows: what does it say about a medical institution or a society that its justification for retaining an objectionable name is that its members have become inured or indifferent to its indecency to the degree that they no longer even register its offensiveness?
3. Magnitude of Rebranding: A third problematic approach to these controversies is one that incorporates the reputational and economic cost of rebranding. Institutions of higher learning have, on the whole, proved far more willing to make small changes than large ones. Amherst College, for instance, removed the name of Lord Jeffrey Amherst, responsible for biological warfare against the Delaware tribe, from both its mascot and college-owned hotel, but has made no steps toward renaming the school.Footnote 35 Enacting change on a large scale is costly in economic terms, running into the millions of dollars.Footnote 36 In addition, brand names themselves, especially among elite institutions, carry considerable value. Fans may still root for the Washington Football Team—one of the few institutions to make a high magnitude name change—but would applicants similarly flock to Massachusetts Liberal Arts College? (One the other hand, donors might be glad to pick up the cost of rebranding in order to claim the name of an elite institution.) Only two American schools have seriously considered name changes for social justice reasons: Dixie State in Utah and Washington and Lee in Virginia. The Utah Board of Higher Education recommended dropping the “Dixie” to placate students and alumni who did not want the term on their resumes, so the decision was as much practical as moral.Footnote 37 Meanwhile, Washington and Lee’s faculty voted to drop the name Lee in a nonbinding resolution that will leave the school named after only one slaveholder.Footnote 38 Yet the greater the magnitude the rebranding, the larger its symbolic value. The prominence of a name is an argument for changing it, not against doing so.
Conclusions
The issue of controversial names is not going away any time soon. Institutions, including hospitals and medical schools, are unlikely to succeed at riding out objections to high profile names and monuments. They would be wise to embrace the symbolic nature of the acting of removing problematic names and monuments and to do so with criteria that are straightforward, internally consistent, and strive for a common standard across institutions. Rather than going it alone, medical schools might issue a joint statement of principle—ideally, modeled on the rubric above—that can then be applied to specific fact patterns at their own institutions. Over the past generation, institutional medicine has adopted best practices in nearly every aspect of patient care. The time has come to apply a consistent, best practice model to renaming that looks beyond momentary political pressures to the greater symbolic significance of strong, consistent action. Dropping a few names may render the world of medicine more welcoming to all.
