On Not Betraying Our Trainees, Especially Now

In 1963, James Baldwin said to a group of students, “I’ll make you a pledge. If you will promise your elder brother that you will never, ever accept any of the many derogatory, degrading, and reductive definitions that this society has ready for you, then I, Jimmy Baldwin, promise you I shall never betray you” (1).

I claim neither James Baldwin’s talent nor his towering moral courage; I am inspired by him. The implications of Baldwin’s 1963 pledge for American Thoracic Society members in 2025 begin with the recognition that science, democracy, higher education, and respect for rights and due process are under substantial attack in the United States and elsewhere (2, 3). Many in our pulmonary, sleep, and critical care community are not publicly defending basic institutions and norms; but without those institutions and norms we cannot optimally care for patients now and improve their care in the future. Therefore, in this Viewpoint, I analogize our current societal moment to complex medical emergencies and argue that we have resources to act now to reverse the erosion of democratic norms, scientific independence, and educations institutions.

I, for one, cannot ignore attacks on norms and institutions, because my mentees face ever more frank opposition to the value of who they are as human beings and what they do as science. Neither should actually be in question. There have been repugnant and false attacks on women, trans folk, faculty of color, immigrants such as my father, and first-generation scholars by fringe elements in newly powerful positions. In the face of such attacks, there appear to be reasons for quiet compliance, especially for those of us who have had success. We can even frame quiet compliance as being a good steward or protecting our team. But James Baldwin challenges us to ask instead: what resources our careers give in times of would-be authoritarian upsurge to defend our learners and thereby our patients (3)?

Four Skills Particularly Relevant Now

First, I propose that our careers have taught us to see with clarity and speak truth. We can look at the Trump administration’s attacks on science and universities and discern them for what they are. They are not reasonable policy disagreements about the public–private partnership that has made American academic medicine the envy of the world (4). Instead, they attack basic structures of science, teaching, and publishing. The administration’s goal is to cow sources of independent thought, replacing verified facts with the opinions of the powerful (5).

Our careers taught us when people are hiding behind bureaucratic obscurantism. We recognize violations of the rule of law and the abandonment of fair policies and procedures. There is now meanness and cruelty—glee in the pain of others—that goes beyond normal politics. It is wrong. Even if it is an awkward conversation, our careers give us tools to name this wrongness.

Second, we know to distinguish the hard case from the futile. Critical care teams exist to accomplish hard saves. Precisely because we too often have to say “there is nothing more to be done,” we discern acutely when there is, in fact, still more to be done. We know there is still time to act to save American democracy and science. Although we face lawlessness and corruption on an unprecedented scale, our nation is not currently East Germany under the Stasi. Many of us can speak out effectively.

Third, when the emergency is now, we act now, even if there might be other people who we wish would act instead. We begin to help as we can, with the confidence that if we begin, others will join us.

Our own elders have modeled this for us. After all, our American institutions have not always lived up to our American ideals. There was never a straight path to the first women joining our faculties as professors; to desegregating our own hospitals; to organizing so that our grown children can marry the love of their lives, whatever their gender identity or sexual orientation. Despite uncertainty, our forebearers began and persisted; our own professional capacity for adaptation, and for trying again even if yesterday failed, is a deep resource.

And fourth, we work purposefully and calmly even when we are terrified. Even when we are not sure that we will be enough. I do not believe I am alone in knowing fear. Indeed, many of us cultivate our fear. We use it to recognize when a patient will crash unless we do something. We hear from our fear when we need to read one more article or call one more friend for advice. We know, in May 2025 as I write this, that we fear for the future of our institutions.

A Renewed Pledge

Working with purpose rather than panic, we must learn new things. Thankfully, there is a rich and rigorous literature on fighting corruption and defending democracy and science (6–9). There are techniques for doing this together, in community, on the basis of decades of scholarship. There is no one-size-fits-all strategy but instead an array of actions to meet specific challenges with available resources (10). Many in our community already know some techniques, and we can each learn more from experts and in coalition (6–11).

I say to my professional community, particularly our younger members: If you will promise your elder brother that you will never, ever accept any of the many derogatory, degrading, and reductive definitions that this society has ready for you, then I, Jack Iwashyna, promise to you that I shall never betray you, the future of our great professions.

I promise, as part of not betraying you, that I shall act visibly and publicly to defend you and your noble life’s work from the attacks of those who would tear it all down.

They shall not succeed.

You will not be alone.

This is no time to “keep my powder dry” for some future emergency. The moment to act for our patients, our science, our children is now (11).