Medical ethics after Holocaust.
The medical professions, including nursing, bioscience, and public health, committed egregious and well-documented violations of medical ethics. We were willing and enthusiastic participants in the events of the Third Reich. We sterilized disabled German citizens. We decided who would marry and who would not marry. We euthanized German children and adults whose lives were “not worth living.” We designed the gas chambers for mass murder–and we were on the ramps making selections. We were there.
In answering the question about medical ethics after the Holocaust–“How We Have Changed, or Have We?”–I can say that the medical ethics of human- subject research has improved greatly. The Nuremberg Doctors’ Trial focused on the medical experiments, and the court issued ten points about human-subject research that is now known as the Nuremberg Code. Although there was resistance by bioscientists to restrictions on human-subject research, the United States eventually accepted the Nuremberg Code and established Institutional Review Boards, which effectively protect most volunteers in medical-research projects.
As serious as the medical ethics violations were in the medical experiments, the most serious violations occurred in clinical medicine and public health, which were philosophically dominated by eugenics. “Eugenics” is defined by the Oxford English Dictionary as “the science [sic] dealing with factors that influence the hereditary qualities of a race and with ways of improving these qualities, especially by modifying the fertility of different categories of people.” Positive eugenics favors the transmission of desirable genetic traits by encouraging procreation and medical care for the superior races, while negative eugenics discourages the transmission of undesirable genetic traits by suppressing procreation and medical care for the inferior races.
The Nazis promoted eugenics to the German public via posters, movies, and public education. For example, German propagandists devised mathematical problems for school children that compared the cost of caring for healthy children with the cost of caring for children with various disabilities. Hitler also used eugenic theories to enroll the medical professions in the elimination of the inferior races and the creation of a superior German yolk able to compete with and even conquer the rest of the world.
Dr. Robert Jay Lifton, in The Nazi Doctors: Medical Killing and the Psychology of Genocide, described the Nazi philosophy of applied biology as one of “absolute control over the evolutionary process, over the biological future. Making widespread use of the Darwinian term ‘selection,’ the Nazis sought to take over the natural functions of nature (natural selection) and God (the Lord giveth and the Lord taketh away) in orchestrating their own ‘selections,’ their own version of human evolution.” Indeed, Hitler was promoted as the doctor to the German people, fundamentally changing the Hippocratic doctor-patient relationship into a new state-volk relationship.
Shortly after becoming Chancellor of the Reich in 1933, the “doctor to the German people” passed the Sterilization Law, which led to the involuntary sterilization of 400,000 German citizens, not necessarily Jews, suffering from “genetically determined” illnesses. In 1935, the Nuremberg Laws were drafted to protect “German Blood and German Honor” and to protect the “Genetic Health of the German People” from contamination from the genes of the Untermenshen. In 1938, a parent and grandmother of infant Knauer, born with multiple malformations, petitioned Hitler to mercifully end the life of the child, who was the first of more than 5,000 children killed in the children’s euthanasia program. Jewish children were originally excluded from this program on the grounds that they did not deserve the “merciful act.” Ultimately, 200,000 German adults were euthanized or granted “mercy killings” as well.
The euthanasia program was the fulcrum for the Holocaust. If German medical professionals were willing to sterilize their fellow German citizens, to decide who will marry and reproduce, and to euthanize German children and adults, then we should not be surprised that German physicians and nurses were also willing to perform cruel and murderous experiments on humans and to end 6,000,000 Jewish and 5,000,000 other “lives not worth living.”
More than 38,000 physicians, almost half of all doctors in Germany, had joined the Nazi party by war’s end; those who did not join the party were not punished. More than seven percent of all physicians were members of the SS, compared with less than 0.5% of the general population. In January, 1940, Drs. Karl Brandt, Philip Bouhler, Leonardi Conti (Reich Health Fuhrer), and Victor Brack (head of the euthanasia program) met in the psychiatric hospital at Brandenburg with August Becker, a chemist, to conduct the first large-scale test of euthanasia. According to Becker:
At the end of the experiment Victor Brack … addressed those in
attendance. He appeared satisfied by the results of the experiment,
and repeated once again that this operation should be carried out
only by physicians, according to the motto: “The needle in the hand
of the doctor.” Karl Brandt spoke after Brack, and stressed again
that gassings should only be done by physicians. That is how things
began in Brandenburg.
According to an eyewitness at Auschwitz interviewed by Lifton, doctors were intimately involved in mass murder and had an on-call schedule for their routine duties, which included:
First, the chief doctor’s assignments to his subordinates
concerning duty schedules and immediate selections policies;
second, the individual doctor’s service on the ramp, performing
selections “in a very noble [seemingly kind] manner”; third, the
doctor riding in the ambulance or Red Cross car to the crematoria;
fourth, the doctor ordering “how many [pellets] of gas should be
thrown in … these holes from the ceilings, according to the
number of people, and who should do it…. There were three or four
Desinfektoren”; fifth, “He observed through the hole how the people
are dying”; sixth, “When the people were dead, … he gave the
order to ventilate, … to open the gas chamber, and he came …
with a gas mask into the chamber”; seventh, “He signed a [form]
that the people are dead … and how long it took”; and eighth, “he
… observed … the teeth … extraction [from] the corpses.” This
was the survivor who concluded that “the killing program was led by
doctors–from the beginning to the end.”
The transformation of the doctor-patient relationship into the state-volk relationship was the fundamental flaw that led to the euthanasia of hundreds of thousands of German citizens and the mass murder of millions of Jews. Once physicians and nurses accepted Hitler as the “doctor to the German people,” the German volk became the patient. People with disabilities, Jews, homosexuals, blacks, and others became the germs under the microscope to be eliminated in order to save the German volk.
The focus of the Nuremberg Doctors’ Trial on the medical experiments and the indictment of only twenty-three defendants led, in part, to myths about medicine during the Holocaust that obscure the truth. The notions that Nazi doctors were few in numbers, incompetent or mad, out of step with contemporary medical ethics, and not real scientists are all false, but they do prevent our seriously studying medicine during the Holocaust. After all, since we are neither mad Nazis nor incompetent scientists, we could not possibly behave as they did, so why should we bother learning about them?
In fact, the German doctors were the best in the world at the time. Dr. Michael DeBakey, one of the outstanding cardiovascular surgeons of the twentieth century, trained in Germany because that was where the best doctors and bioscientists were in the 1930’s. Abraham Flexner, at the request of the Carnegie Foundation, examined American and Canadian medical schools and found them wanting. In his “Flexner Report,” he recommended that these schools adopt the German medical educational model of medical schools affiliated with research universities, which is the model still used today.
The U.S. was the leader in the eugenics movement, and many Germans felt that they needed to catch up with the U.S. to avoid being left behind in the competition for improved human racial stock. Eugenics became orthodox thinking in the highest circles of American academics (David Starr Jordan and Charles Eliot, presidents of Stanford and Harvard), science (Alexander Graham Bell, Nobel Laureate Alexis Carrel), government (Presidents Theodore Roosevelt and Woodrow Wilson), law (Chief Justice Oliver Wendell Holmes, Jr.), social activism (Margaret Sanger), and philanthropy (Carnegie, Rockefeller, and Kellogg).
The U.S. had the first involuntary sterilization law in the world in 1907. In 1916, Madison Grant, a lawyer and friend of Presidents Theodore Roosevelt and Herbert Hoover, argued in The Passing of the Great Race for the superiority of the Nordic race, which he suggested was a master race. Many German scientists were avid fans of Grant’s scientific racism, including a disgruntled corporal in the German Army who wrote a fan letter to Grant thanking him for writing The Passing of the Great Race and telling him that “the book is my Bible.” The corporal was Adolf Hitler.
Residents of the U.S. had discriminated against blacks for decades, and Hitler’s propagandists referred to segregation in the U.S. They pointed out that the German definition of a Jew in the 1935 Nuremberg Laws was more liberal than Jim Crow’s definition of an American Negro according to the “one drop rule.” Germany’s foremost racial hygiene journal reported on the refusal of the American Medical Association to admit black physicians)
In 1924, Harry Laughlin of Cold Spring Harbour Laboratory in Long Island, NY, testified in Congress in support of an immigration-restriction bill. He brought poor quality data from his Eugenics Record Office that showed that immigrants were more likely to become criminals and vagrants. The resulting Immigration Restriction Act halted the immigration of “dysgenic” Italians, Russians, and eastern European Jews, whose numbers had mushroomed between 1900 and 1920, thereby legally prohibiting Jews from coming to the U.S. from Europe in the 1930’s. In Mein Kampf, Hitler singled out the U.S. as the one country whose immigration policies he favored.
Funding for the Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics, a training ground for Josef Mengele, was provided by the Rockefeller Foundation, which, according to historian Paul Weindling, “intervened from 1922 to save German medical sciences” because “American scientists, many of whom had trained in Germany, regarded German medicine as being of world significance…. training researchers from all over the world.” America’s disgraceful experiments on black citizens with syphilis in Tuskegee began one year before Hitler became chancellor and ended forty years later.
German doctors and other medical professionals were willing perpetrators, believed they held the moral high ground, and almost never acknowledged their guilt. American doctors and other medical professionals have not seriously examined the role of their American colleagues in supporting eugenics both here and in Germany. The history of medicine during the Third Reich demonstrates that human beings in general and medical professionals in particular can easily do evil while claiming to do good. We, therefore, have a moral obligation to study, remember, and learn from this history and to apply that knowledge to contemporary medical practice and research.
So, rather than answering the question posed in the title of this essay, I choose to emulate Franklin Littell and ask another question: If the best doctors of the early twentieth century could abandon their patients, can we be certain that the best doctors of the twenty-first century are not doing the same?
COPYRIGHT 2011 Journal of Ecumenical Studies