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  • Viewpoints

    The Role of the Center for Medicine After the Holocaust in Medical Ethics Education

    Editor’s Note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members

    This year marks the 70th anniversary of the Doctor’s Trial, the medical case of the Nuremberg proceedings, at which 23 physicians, bioscientists, and public health officials were prosecuted for medical crimes against humanity. The trial highlighted the central role of medical professionals in the ideology, design, and implementation of the Holocaust.

    These events are still relevant in medicine today. We must learn from the past and be vigilant to avoid serious lapses in medical ethics. The Center for Medicine after the Holocaust (CMATH) is dedicated to challenging doctors, nurses, and bioscientists to personally confront the medical ethics of the Holocaust and to apply that knowledge to contemporary practice and research. Our mission is to bring the history of medicine and the Holocaust to the attention of medical professionals and public health policymakers so that the biomedical ethics that guide their decisions will prevent egregious violations of human dignity.

    The Nazi policy of applied biology was built upon the worldwide eugenics movement that was popular for more than 30 years before Hitler became the German chancellor in 1933. Eugenics—rassenhygiene, or race hygiene, in Germany—is the science that aims to improve a race by controlling reproduction.

    Nearly 3,000 physicians joined the National Socialist Physician’s League before Hitler became chancellor. By the end of World War II, 38,000 physicians, slightly less than half of Germany’s doctors, had joined the Nazi party, and 7 percent of physicians were SS members, compared with less than 0.5 percent of the general population.

    Nazi physicians claimed the moral high ground by transforming the Hippocratic Oath from a doctor-patient relationship to a state-Völkskorper—or nation’s body—relationship. They justified the sterilization or elimination of “lives not worth living” as a merciful preventive measure, simultaneously ending the suffering of the genetically inferior and preventing transmission of their presumably hereditary harmful traits.

    In addition to the euthanasia program, German physicians ran medical experiments—with decompression chambers, iatrogenic wounds and infections to test antibiotics, hypothermia, seawater infusions, and starvation—that were cruel and often fatal.

    During the Doctors’ Trial, 16 defendants were found guilty, and seven were executed. In addition, the court developed 10 basic principles of human subjects research that were subsequently labeled the Nuremberg Code. The trial, however, focused primarily on the medical experiments rather than the egregious violations of medical ethics in clinical medicine and health care policy.

    The Nuremberg Code was ignored for almost two decades until 1966, when Henry K. Beecher, MD, published an article in the New England Journal of Medicine detailing multiple unethical medical experiments. And in 1972, whistleblower Peter Buxton leaked the story of the Tuskegee experiments to journalist Jean Heller, who ran the story in the Washington Star and the New York Times. Congressional investigations ultimately led to the institutional review boards that supervise human subjects research today.

    While the original Nuremberg Code is sometimes included in bioethics curricula at medical schools, its origins and history are often neglected. One possible reason that American physicians and scientists ignored the Nuremberg Code is that they were disinterested in highlighting America’s leading role in the worldwide eugenics movement or the moral, legal, and philanthropic support they provided to German Nazis. Another reason may be that American bioscientists were not interested in securing voluntary informed consent of their human subjects. A final reason may be denial of the role physicians played in the design and implementation of the Holocaust.

    “We must learn from the past and be vigilant to avoid serious lapses in medical ethics.”

    The biggest myth of all, though—the one that continues to handicap contemporary medical bioethics—is that neither liberal democracies nor American physicians are capable of committing such evil acts.

    Indeed, involuntary sterilization began in Indiana in 1907. The U.S. Supreme Court declared the practice constitutional by an 8-1 vote in the 1927 Buck v. Bell decision. In Mein Kampf, Hitler praised America’s eugenically driven immigration laws. The Rockefeller Foundation in 1927 provided funding for the Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics in Berlin, which trained Josef Mengele, who later was known as the “Angel of Death” in Auschwitz. Finally, Hitler and his propagandists defended anti-Semitic policies by noting the long history of racism in American medicine and slavery.

    We note with concern Mark Twain’s dictum, “History does not necessarily repeat itself, but it often rhymes.” Indeed, there continue to be occurrences that are alarming for medical ethics. For example, two groups have called for a moratorium on using genome-editing technology CRISPR-CAS9, which could alter the genes of human embryos to attain “better” babies. What will happen to other babies, those who are not genetically enhanced?

    According to the 2013 annual Liaison Committee on Medical Education survey of U.S. and Canadian medical schools, only 22 U.S. medical schools include material about medicine and the Holocaust in their curricula. Because an understanding of this material is essential in shaping the morals and ethics of contemporary health professionals, CMATH provides extensive educational resources at www.medicineaftertheholocaust.org. We recommend that bioethics curricula at all medical schools include education about the medical practices, human subjects research, and public health care policies during the Third Reich.

    This commentary originally appeared in print in the May/June 2016 issue of the AAMC Reporter.