Strong Understanding Of Nazism And Holocaust Necessary To Bolster Medical Education And Ethics
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A strong understanding of medicine’s role during the Nazi regime, and studying Nazism and Holocaust is necessary to bolster medical education and ethics, according to a new report from the Lancet Commission. The report, titled Studying medicine, Nazism, and the Holocaust crucial to strengthening medical education and ethics today states that healthcare professionals studying historical evidence of atrocities committed in the past and what enabled them will help these medical professionals resolve their moral and ethical medical dilemmas and take the correct decision to protect vulnerable populations and patients.
A group of 20 experts with prowess in history, medical education and bioethics wrote the report. This is the first Lancet Commission focused on the history of medicine.
Why is it important to learn about the atrocities committed by the medical community during the Nazi regime and Holocaust?
In the report, the authors have cited examples of discriminatory and inhumane medical policies and practices under the Nazi regime, with the aim to inform medical professionals of the issues in medicine, and highlight the significance of giving utmost importance to human rights and dignity during medical conduct. This means that medical professionals must be willing to voice against wrongdoings at all times.
In a Lancet statement, Commission Co-Chair Dr Sabine Hildebrandt said that Nazi medical atrocities represent some of the most extreme and best-documented examples of medical involvement in human rights violations in history. She explained that people may view the perpetrators as “incomprehensible monsters”, but evidence put forward by the Commission shows how many health professionals were capable of committing ethical transgressions and crimes against their patients under certain conditions and pressures.
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Healthcare professionals are people who care for living beings at their most vulnerable, and they have a duty to develop and preserve a strong moral agency. Therefore, learning about the role of medicine and the behaviour of healthcare professionals under Nazism can help today’s medical professionals further develop their own moral reasoning and stand up to abuses of power. They can protect patient rights and the dignity of all human beings, regardless of race, ethnicity, religion, and other individual characteristics, Dr Hildebrandt said.
While the Nazi era is not the only instance in history in which members of the medical community were involved in crimes against humanity, the regime is one of the most extreme, well-organised, and extensively documented examples of medicine’s active participation in human rights violations, the statement said. The human rights violations included antisemitism, discrimination, genocide, racism, and mass atrocities.
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Today’s healthcare professionals can learn from history to orient their moral compass in the right direction.
In the statement, Commission Co-Chair Professor Herwig Czech said a wide range of debates are seen in medicine now. For instance, there are debates about who should receive care during a catastrophic event, end-of-life care, and new developments in genetics. This indicates that medicine and science are linked with politics, personal beliefs, and socio-economic factors, Professor Czech said.
He asserted that medical professionals and bio-scientific researchers must be aware of these influences and their manifold implications for patients and study participants.
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Inhumane medical practices under Nazi regime documented in the report
The medical community during the Nazi era changed their understanding of medical ethics according to the Nazi doctrine, and also created and implemented policies in accordance with the doctrine.
The profession which saw the highest number of people joining the Nazi Party and its affiliated organisations was that of physicians. During the Nazi regime, Germany’s medical and research institutions played instrumental roles.
The Lancet Commission’s report has mentioned several examples of how the Nazi “ethical code” was weaponized as a tool to value, prioritise, and advance people of German “Aryan” descent above all others in medical care and research.
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The medical community of that era also justified rationalising eugenics, forced sterilisation, euthanasia patient murder programmes, and brutal human experiments by using the Nazi ethical code as a tool.
During the T4 patient murder program of 1939-41, as many as 70,000 institutionalised patients were killed by gas. The methods developed and applied during this program were later applied to the extermination camps in Poland. In these camps, victims were murdered upon arrival in gas chambers disguised as showers.
In the statement, Professor Czech said that it is often surprising how limited the knowledge about Nazi medical crimes in the medical community is today. The only knowledge today’s medical community has about the atrocities committed during the Nazi regime using medicine are the experiments of Josef Mengele in Auschwitz. Mengele is nicknamed the “Angel of Death” because he performed deadly experiments on prisoners at the Auschwitz II concentration camp, selected the victims to be murdered in gas chambers, and administered gases to the prisoners.
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Professor Czech explained that in the report, the experts have presented extreme examples of how medicine was used to commit atrocities during the Nazi regime. He said that studying medicine under Nazism highlights the critical role of societal factors and of ethics in medical and scientific advancement.
According to Professor Czech, today’s health professionals operate in systems and structures that do not benefit all patients equally, and while there is no simple path ahead, knowledge of historical extremes can make the health professionals better prepared to work through ever-evolving ethical dilemmas in medicine.
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The Nuremberg Code laid the foundation of modern bioethics
After World War II was over, the world started discussing medical ethics, including human rights-based medicine, health care, and voluntary consent in research. The first international principles for ethical research on humans, which went on to be known as the Nuremberg Code, were laid down in 1946, as part of the Nuremberg Doctors’ Trials. These trials lasted 140 days, and 85 witnesses testified and over 1,500 documents were introduced. About 20 German physicians and three non-physicians who either participated in the Nazi program to euthanize persons deemed unworthy of life, or who conducted experiments on concentration camp prisoners without their consent, were put on trial. As many as 16 defendants charged were proved guilty, and seven were executed.
After the trials, many declarations were established, and modern bioethics was developed.
How medicine in Nazi Germany proves to be beneficial to medical science today
It is commonly believed that medicine in Nazi Germany was pseudoscience. But this is not the case. Medicine in Nazi Germany was based on the standards and practices of biomedical science developed in the late 19th and early 20th centuries.
There were several international networks exploring and promoting eugenics and developing racist medical rationales, and German scientists were a part of these.
The dead bodies of Nazi victims were used for research and teaching. In some cases, the specimens of their scientific remains were kept in scientific collections for decades after the war.
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Modern medical professionals have obtained a lot of knowledge about medicine with the help of Nazi research.
According to the September 2021 study published in the journal Annals of Anatomy, Pernkopf’s Anatomy, the anatomical drawings of revered doctor Eduard Pernkopf, is a masterpiece among traditional anatomical atlases, and represents “the pinnacle of color anatomic illustration”, in the words of one of Pernkopf’s students. The original drawings produced for the atlas are an important element of anatomy’s cultural and scientific heritage.
Many publications and atlases have copied re-drawings of the Pernkopf images, some of which were derived from the bodies of victims of the Nazi regime.
Research conducted in the Nazi era has helped medical professionals understand aviation safety, hypothermia, and the effects of tobacco and alcohol use on the body. But not much is known about how the research was conducted, and the knowledge obtained.
In the statement, Commission Co-Chair Professor Shmuel Pinchas Reis said that accountability for and recognition that crimes were committed in the name of medicine in the Nazi era and during the Holocaust remains inadequate, and that medical students, researchers, and practising healthcare professionals should know where, and from whom the foundations of medical knowledge come from.
He explained that the victims of Nazism are owed that, and they have a right to be honoured and treated with dignity in life and death for coerced contributions to medicine.
Professor Pinchas Reis explained that the goal of the Lancet Commission report is to provide additional resources and information for medical schools, research institutions, and medical associations worldwide to continue accountability efforts as part of their responsibility to past and future generations.
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What recommendations has the Commission put forward to strengthen medical ethics?
The report emphasises that medical and health care delivery must prioritise human rights. The authors of the Commission have also given some recommendations to ensure that medical education focuses on developing history-informed moral agency and resilience among medical professionals.
These recommendations include incorporating the study of medicine, Nazism, and the Holocaust in the curricula for all medical students and health professionals, across the medical field, and encouraging students and medical professionals to develop a history-informed professional identity. The students should be able to recognise their own potential biases or conflicts of interest, and challenge hierarchies.
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Another recommendation is that it is important for universities, psychiatric hospitals, and other medical institutions worldwide to actively identify and commemorate victims of Nazi medical crimes. Also, these institutions must initiate research to better understand the direct connections of Nazi medical crimes to human rights violations in the past.
The Commission also states that institutions should look at their own past, identify and document patterns of medical abuse, and integrate this history in their curricula.
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In the report, the experts have also documented the stories of Jewish and non-Jewish health professionals who worked and cared for their patients in extreme circumstances, such as in ghettos and concentration camps.
It is important for people studying medicine to understand the horrors of the Holocaust, the personal testimony of the Jewish and non-Jewish health professionals, and recognise their efforts to provide human rights-based care.
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This is what today’s health professionals must do in the present as well as in the future.
The selfless actions of the health professionals who cared for Nazi victims are in sharp contrast to the dehumanising practices of the medical professionals during the Nazi regime. The contributions of the selfless health professionals are a testament to the fact that moral courage can be exhibited even in the grimmest situations.
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