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CHICAGO -- Some members of the American Medical Association (AMA) House of Delegates (HOD) argued that "dissenting and unpopular voices" have been censored by the association, and put forward new policies aiming to reaffirm the right to free speech, during a on Saturday.

The Louisiana delegation submitted a policy proposal titled "" and a second titled

The first called for the AMA to "unequivocally" allow open discourse and debate, and the second pressed the organization to state that no individual person or group should be characterized as "racist."

Both proposals were strongly opposed by a majority of delegates who spoke during the session, with more than one member suggesting that the efforts were an attempt to undermine the .

The first resolution from the Louisiana delegates described a "loss of professionalism" and members being "attacked and threatened by others for their thoughts and ideas" during previous virtual meetings when the strategic plan was discussed.

The proposed policy called for the AMA to state that the organization "unequivocally commits" to the following set of principles and ideas, among others:

• "Dissenting and unpopular voices must be afforded the opportunity to be heard"
• "The mere exposure to ideas that some may find offensive is not an act of violence or hatred"
• "The listing of people or organizations to be regarded as unacceptable, untrustworthy, excluded, or avoided based on ideological positions or differences" should be prohibited
• "Ideological demonization of opponents to block debate and to silence disagreement in the proceedings of the American Medical Association is unprofessional conduct subject to appropriate disciplinary action"

Luis Alvarado, MD, past president of the Louisiana State Medical Society, read aloud portions of the resolution, including a clause stating that the AMA "unequivocally commits that members of the American Medical Association of different faiths, philosophies, and persuasions may speak their minds and honor their deepest convictions without fear of punishment or retaliation," and concluded with "I actually support this resolution."

But Alvarado saw little support from other delegates.

Maggie Oliver, a delegate from South Carolina, speaking on behalf of the Medical Student Section, took issue with the statement that the "mere exposure to ideas that some may find offensive is not an act of violence or hatred."

"This is objectively false," Oliver said. "Verbal abuse is still abuse and an act of violence. Hate speech is by definition hatred, regardless of whether its speaker claims they're just sharing an idea."

She also said the idea of a prohibition on deeming certain persons or organizations "unacceptable" sets a "dangerous precedent."

"We cannot know what potentially extremist or dangerous organizations will ever come to be," Oliver said.

Pino Colone, MD, a delegate from Michigan, speaking on his own behalf, also panned the resolution in light of concerns around COVID-19 disinformation: "The way that I read this resolution is that, should I choose to espouse ivermectin ... advocate against vaccines or masks, that I should not be held accountable for that inaccurate unscientific information which I'm espousing."

Luis Seija, MD, of Icahn School of Medicine at Mount Sinai in New York City and a delegate for the AMA Minority Affairs Section (MAS), argued that the resolution, with the exception of some newly inserted contextual language, mirrored a previous resolution that was already voted down during a previous HOD meeting.

Moreover, the intent of the policies is "redundant" as the HOD already adopted a comprehensive in 2017 that continues to be updated, in addition to an established digital code of conduct.

Seija acknowledged that he himself had been cited for conduct violations and investigated, alongside "multiple MAS members" after the last special meeting.

"So we can attest that current mechanisms are most definitely enforced," he said.

A second resolution from the Louisiana delegation calling for the AMA to commit to a policy "that no person or group of persons shall be considered or characterized as racist based on personal attributes of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, or genetic information" was also soundly rejected.

Alvarado, representing the authors of the proposed policy, said it was prompted in response to the AMA "publicly promulgating statements that are racially exclusive and racially characterizing" -- presumably a reference to the AMA's recent strategic plan.

Thomas Eppes, MD, a delegate from Virginia, speaking on his own behalf, voiced support for the policy. He said he has seen racism across his lifetime, and was there when his father's lunch counter was integrated.

Both he and his father have matured in their views since that event, Eppes said. "I think this is a very simple statement about what we should be about as physicians, not casting anyone by any ethnicity, and I support what Louisiana has written."

Rohan Khazanchi, an MD, MPH student at the University of Nebraska, a co-author of a previous resolution in which the AMA recognized racism as a public health threat, opposed the proposed policy.

The Louisiana resolution "seemingly aims to re-litigate our organization's strategic plan to advance health equity ... which is simply not up for debate," Khazanchi said, speaking on his own behalf.

He argued that while the authors of the resolutions appear concerned that the strategic plan "names racism and white supremacy as fundamental causes of inequity," such statements do not imply that all white individuals are racists and that all non-white individuals are not racist. Instead, he said, the resolutions affirm that white supremacy, because it is so deeply entrenched in our society, has sidelined the needs of minorities and exacerbated health and social inequities.

Seija agreed about the importance of being able to "name and define structural racism," in order to understand its drivers.

"This resolution isn't about the characterization of individuals as racist, it's about white comfort," he said. "If these terms make you uncomfortable, good. It means we have some work to do."

Albert Hsu, MD, an ob/gyn in Missouri, speaking on his own behalf, reaffirmed the current policy, but stressed the need for humility.

"We all have blind spots," he said, recalling how he referred to a male physician on a recent Zoom call as "doctor" but called the female physician on the call by her first name, which could be seen as sexist.

"I want us all to take a moment and have some grace with each other," Hsu said.

The AMA's HOD held a on Sunday afternoon. The event was not open to press.

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