Editor’s Note (3/29/21): The murder trial of Derek Chauvin, the former Minneapolis police officer charged in the death of George Floyd, began with the defense arguing that Floyd died of underlying medical conditions and drug use. This contradicts two autopsy reports—one by the Hennepin County Medical Examiner’s Office and the other by private doctors commissioned by Floyd's family—that ruled the cause of death was homicide. This story from June 2020, written by 12 physicians, explains how inaccurately portraying the medical findings from Floyd’s autopsy emboldens white supremacy under the cloak of authoritative scientific rhetoric.
The world was gaslit by misreporting about George Floyd’s initial autopsy report. As concerned physicians, we write to deconstruct the misinformation and condemn the ways this weaponization of medical language reinforced white supremacy at the torment of Black Americans.
Gaslighting is a method of psychological manipulation employed to make a victim question their own sanity, particularly in scenarios where they are mistreated. The term comes from a 1938 play and, later, a popular film, wherein a predatory husband abuses his wife in a plot to have her committed to a mental institution. He dims the gas lights in their home; then, when she comments on the darkness, knowingly rejects her observation and uses it as evidence that she’s gone insane. It’s a torturous tactic employed to destroy a person’s trust in their own perception of reality. It’s a devastating distraction from oppression. It’s insidious. And it happened recently when millions of people who had seen nine agonizing minutes of murder were told by an autopsy report that they hadn’t.
In America, widespread anti-Black violence is often paired with structural gaslighting. Racism, after all, thrives when blame for its outcomes are misattributed. When Black families are refused loans in criminally discriminatory housing schemes, their credit is blamed. When youth of color are disproportionately stopped and frisked, they are told the process is random, and for their safety.
And when Black people are killed by police, their character and even their anatomy is turned into justification for their killer’s exoneration. It’s a well-honed tactic. One analysis of the national database of state-level death certificate data found that fewer than half of law enforcement–related deaths were reported. In addition to this undercounting, police actions were further minimized by the use of diagnostic codes that incorrectly labeled the cause of death as “accidental” or “undetermined” rather than police-related. For centuries, our systems have relied on this psychological torture—a host of mental gymnastics—to deny the truth of what Black people have always known. The cause of death is racism.
On May 29, the country was told that the autopsy of George Floyd “revealed no physical findings that support a diagnosis of traumatic asphyxiation,” and that “potential intoxicants” and preexisting cardiovascular disease “likely contributed to his death.” This requires clarification. Importantly, these commonly quoted phrases did not come from a physician, but were taken from a charging document that utilized politicized interpretations of medical information. As doctors, we wish to highlight for the public that this framing of the circumstances surrounding Floyd’s death was at best, a misinterpretation, and at worst, a deliberate obfuscation.
A timeline of events illustrates how a series of omissions and commissions regarding Mr. Floyd’s initial autopsy results deceptively fractured the truth. On May 28, a statement released by the Hennepin County Medical Examiner’s office reported ongoing investigations and acknowledgement from the forensic pathologist that an “autopsy … must be interpreted in the context of the pertinent investigative information.” As per standardized medical examination, Floyd’s underlying health conditions and toxicology screen were documented. These are ordinary findings that do not suggest causation of death, yet headlines and the May 29 charging document falsely overstated the role of Floyd’s coronary artery disease and hypertension, which increase the risk of stroke and heart attack over years, not minutes. Asphyxia—suffocation—does not always demonstrate physical signs, as other physician groups have noted.
Without this important medical context, however, the public was left to reconcile manipulated medical language with the evidence they had personally witnessed. Ultimately, the initial report overstated and misrepresented the role of chronic medical conditions, inappropriately alluded to intoxicants, and failed to acknowledge the stark reality that but for the defendant’s knee on George Floyd’s neck, he would not be dead today.
By Monday, June 1, in the context of widespread political pressure, the public received two reports: the preliminary autopsy report commissioned by Floyd’s family by private doctors, and—shortly thereafter—a summary of the preliminary autopsy from the Hennepin County Medical Examiner’s Office. Both reports stated that the cause of Floyd’s death was homicide: death at the hands of another.
By inaccurately portraying the medical findings from the autopsy of George Floyd, the legal system and media emboldened white supremacy, all under the cloak of authoritative scientific rhetoric. They took standard components of a preliminary autopsy report to cast doubt, to sow uncertainty; to gaslight America into thinking we didn’t see what we know we saw. In doing so, they perpetuated stereotypes about disease, risky behavior and intoxication in Black bodies to discredit a victim of murder. This state of affairs is not an outlier—it is part of a patterned and tactical distortion of facts wherein autopsy reports are manipulated to bury police violence and uphold white supremacy. As Ida B. Wells said, “Those who commit the murders write the reports.” A similar conflict of interest between police departments and medical examiners offices continues today.
As physicians, we will not be complicit in the ongoing manipulation of medical expertise to erase government-sanctioned violence. Though we are relieved that two independent examinations invalidated the preliminary findings in the charging document and the headlines that deceitfully undermined Chauvin’s culpability in Floyd’s murder, our initial incense is not replaced by celebration.
For three days, Black Americans sat—and still sit—with the all-too-familiar pangs of being told that the truth is not true. Of fearing that the law would believe a physician’s report over the reality they saw with their own eyes, and have lived with their own lives. It's a miscarriage of justice that deepens the cut; not only can Black people be killed with impunity; a physician’s autopsy report can be twisted to replace the truth.
Medical science has long been used for the consolidation of power rather than for solidarity with the oppressed. We see how Black mothers are blamed for their own mortality in childbirth and how starkly high rates of COVID death in Black communities are preposterously misattributed to differences in hormone receptors or clotting factors; all the while letting racism off the hook.
We wish to remind fellow physicians that medical science has never been objective. It has never existed in a vacuum; there have and will always be social, political and legal ramifications of our work. Our assessments may be employed in criminal justice cases; our toxicology screens may have profound effects on the livelihood of patients; our diagnoses may perpetuate sexist and racist stereotypes. Our lack of ill intent cannot be our alibi—we must be accountable for not just our work but also how it is used, lest our medicine becomes the very weapon that harms. Medicine requires inclusion of the social context of disease in order to uphold its sacred oath of doing no harm. If we focus only on molecular pathways and neglect to articulate the role of structural inequities—of racism—in our country, our reports on the causes of death and injury in our patients will erase the roles of their oppressors.
We also write to remind our physician colleagues that the medical field is a place ripe for gaslighting. Bolstered by the perceived strength and legitimacy of a white coat and a stethoscope, our diagnoses and conclusions—about physical or psychological “abnormalities,” about causes of illness and death—have the power to eclipse reality, as we’ve seen in the case of George Floyd. Often, we stand by while other agents co-opt our frameworks, obscure our research and weaponize our language in the service of oppression.
The declarations, the truths, the realities of Black people in America are too often disregarded. Across the nation, Black people are suffocating under the weight of anti-Black hatred. They cannot breathe. And even as they gasp for air, structural gaslighting operates to deny the truths of the causes of their suffocation.
We write as physicians to denounce this psychological manipulation. We write to apologize for the discrimination our patients of color have received in the hospital under our watch, we write in gratitude for the tireless labor of Black activists, and we write to condemn how medicine has been weaponized in the service of white supremacy. We write to validate what Black people already know—have always known—that racism is a most pressing public health crisis. We pledge to fight this crisis as if our own breath depended on it.