AAMC Reporter: October 2007

Holocaust-era Medicine Holds Lessons for Students Today

A Nazi chart shows how the Third Reich used the laws of heredity to try and predict "inferior" human offspring.

During one of civilization's bleakest chapters, Nazi physicians performed mass sterilizations and medical experiments on people their regime deemed inferior. Now, a new initiative led by the United States Holocaust Memorial Museum is designed to educate students and the general public on these atrocities, and the ethical issues that created them, in the hopes that they are never repeated.

The museum recently created a special exhibition titled "Deadly Medicine: Creating the Master Race," that examines the involvement of science and medical professionals in Nazi Germany. In a workshop earlier this year, students at the University of Pittsburgh School of Medicine saw this traveling exhibition and discussed its implications for current bioethics. While in Pittsburgh,museum officials hosted the first in a series of summits with leaders in academic medicine to explore potentially including the topic in health care education curricula.

The Holocaust Museum's ultimate goal, according to Senior Project Manager Kristine Donly, is to develop a health care education curriculum module in ethics. "Students must be able to look at this history and relate it to the dilemmas they see in their training every day," Donly said.

The exhibition and student workshop demonstrated how a politically extreme form of eugenics—the practice of using genetics to deliberately alter some aspect or aspects of the human race—permeated Nazi Germany in the 1930s and 1940s, with physicians sterilizing and killing people they viewed as weakening the gene pool.

"This event was very illustrative of what can happen when physicians become too paternalistic and try to determine who is a valuable or worthy person for receiving care," said Alix Wedge, Ph.D., a third-year Pittsburgh medical student who attended the workshop.

The student workshop began with a private tour of the "Deadly Medicine" exhibition by Holocaust Museum Curator of Special Exhibitions Susan Bachrach, Ph.D. The exhibition weaves a recounting of the rise in the early 20th century of eugenics—a scientific discipline rooted in Charles Darwin's theory of natural selection—in the early 20th century with graphic photographs of people tortured and murdered after the practice went out of control.

"The exhibit reinforced how powerful physicians are in society," said Jessica Ellerman, also in her third year at Pittsburgh's medical school. "We are expected to act in a manner that is truthful, just, and beneficial to society. This demonstrated what can happen if we lose sight of these roles and fall subject to radical ideas."

Afterward, the student group engaged Bachrach and Pittsburgh obstetrics/gynecology professor and genetics expert Marta C. Kolthoff, M.D., on present-day bioethical concerns.

"We discussed how genetic testing and the desire to have the perfect child shares many themes and motivations with the eugenics movement," said Wedge. "We talked about the role of the physician in resisting negative social change, and the bad outcomes that can come from good intentions."

Donly said the student dialogues emphasized the importance of individual responsibility, sound decision-making, and core ethical principles.

"When they first look at the exhibition, many students see the "Nazi" doctors as monsters," Donly said."But as they learn more about the history, they realize these physicians were the leaders in the field at the time and not evil people, but rather ordinary citizens who lost sight of some key principles of their profession."

At the leadership summit, more than 25 regional medical school deans and faculty, health care professionals, scientists, lawyers, and bioethics authorities convened to examine the role of medical professionals during the Nazi era and see how the lessons of this history could be incorporated into health practitioner education.

"I thought this was a very helpful conversation with some of the leaders in academic medicine about creating ways to teach medical ethics in the 21st century," said Eric Kodish, M.D., bioethics department chair at the Cleveland Clinic Foundation. "The need for ethics education is stronger than ever, and the more scientific progress we make, the more challenging the ethical questions are going to be."

One area of emphasis in the summit discussions was the need for medical students to question authority. "Some of the more hierarchical approaches to teaching can have disastrous consequences," said Kodish. "Senior people in academic medicine need to show their vulnerability in front of students. They need to show that they can make mistakes, that they have made mistakes."

Feedback from summit attendees will help Holocaust Museum staff create a module tailored to a student audience, Donly said. Participants stressed that this history can be used as "a case study to examine the degree to which physicians practice in a social and political context... and to examine the process by which these [Nazi] professionals came to believe their approach was good," she said. Attendees suggested that the balance of public health versus individual rights could be incorporated into the didactic tool, said Donly. Also discussed were the physician's relationship with government, as well as the role of multidisciplinary ethics instruction.

A program at Johns Hopkins University School of Medicine—a four-week "selective" structured around the "Deadly Medicine" exhibition—offered a potential model for future education. Part of the university's required second-year course titled "Patient, Physician, and Society," the selective was offered last fall for the first time and is being considered for inclusion in this year's curriculum.

"Deadly Medicine" also stopped in Atlanta, where the museum partnered with the Centers for Disease Control and Prevention (CDC) to display at the CDC's global communications center. Another bioethics education summit took place during that time. Just recently, "Deadly Medicine" moved to Cleveland, where it is collaborating with the Cleveland Clinic Lerner College of Medicine on another summit scheduled for late fall.

After three or four such summits, the Holocaust Museum officials said they hope to begin creating the module.

The intention of any potential module, Donly explained, is to "be a resource that students could use alongside the existing curricular elements dealing with medical ethics." The "Deadly Medicine" case study will provide a new perspective when they examine current moral issues, she added. To develop the product, a small team of professionals from the fields of medicine, nursing, public health, and bioethics will collaborate with Holocaust Museum staff. The museum anticipates an initial pilot by the end of 2008.

—By Elissa Fuchs

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