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President, Jewish Life Network/Steinhardt Foundation Rabbi Greenberg—rabbi, scholar and former Chairman of the United States Holocaust Memorial Museum—tells us why each one of these failures could recur. The infrastructure that sustained the Holocaust remains with us today: technology, bureaucracy, ideology, the ethos of science and scientism, universalism, the authority and credibility of modernism, and the unification of society or gleichschaltung. Rabbi Greenberg encourages us to promulgate pluralism—a principled commitment to absolute values, matched by an affirmation of the limits of that absolute—as the most powerful antidote to a recurrence of another Holocaust. He encourages pluralism in many spheres, including: Political Ideology Cultural Moral If you are interested in reading more about science and religion during the Holocaust, check out some of our other media.

Director, National Human Genome Research Institute, Bethesda, Maryland

Professor and Chief of the Division of Transplant Surgery and Assist Devices in the Michael E. DeBakey Dept. of Surgery, Baylor College of Medicine, Houston, Texas

Director of the Center for Medical Ethics, Hebrew University-Hadassah Medical School, Jerusalem and winner of the Israel Prize for his Encyclopedia of Jewish Medical Ethics

NASA is an organization that has been notorious for holding a lot of community and media attention. Space sciences in general seem to draw a lot of interest, especially aspects that are unknown to the vast majority of the public. This has led to a high level of curiosity. Hearing about this subject from someone who has actually been involved in NASA is something special. Neil Pellis, past leader of the Biotechnology Cell Science Program at NASA, discusses this subject from his perspective and experience. He even addresses audience questions at the end of his lecture. Pellis specifically discusses Dachau, Hubertus Strughold, and NASA. In all of these topics of discussion, he discusses the moral and ethical side of research and experimentation. This opens us up to questions about ethical practices in past science and science today. Ethics is a very serious and relevant topic in aerospace medicine and space sciences. Dachau, Hubertus Strughold, and NASA are three areas in particular that should get a lot of attention. While some questioning of ethical practices is addressed, some seem to be forgotten.

Pioneering cardiovascular surgeon; developed the mobile army surgical hospital (MASH) units and established the Veteran’s Administration Medical Center Research System; Chairman of the Department of Surgery (1948-1993), President (1969-1979), Chancellor (1979-1996), and Chancellor Emeritus (1996-2008) at Baylor College of Medicine; recipient of the Congressional Gold Medal in 2008; deceased July 13, 2008.

I recently watched four films with relevance to medicine and the Holocaust: The Architecture of Doom, which indicates that half of the Nazi leadership were artists. Their thinking about beauty influenced their acceptance and promotion of eugenics. The Suicide Tourist, which describes a man’s journey to Dignitas for his physician-assisted suicide. The Border, which stars Jack Nicholson as a US border patrol agent struggling to resist the temptations available to him by being on the front lines of immigration from Mexico. Aftermath (Poklosie in Polish), which describes the fate of two brothers who discover a secret about the original ownership of their farm and their neighbors’ farms. You can see other relevant films in CMATH’s growing Film Collection.

Eugenics and euthanasia are discussed at length in the Healing by Killing: Medicine during the Third Reich elective I teach to first and second year medical students at Baylor College of Medicine.  The students appreciate that medical genetics and eugenics are opposite sides of the same coin and carefully examine the issues posed by the Human Genome Project and genomics. Often they choose to write about eugenics and genetics as they affect contemporary medical practice or healthcare policy and, in some cases, they write about very intimate experiences. Zach Solomon and his family gave  permission to post his essay on CMATH’s website, an essay that describes medical challenges in both his personal and professional life. Reflections on Eugenics By Zach Solomon I want to start this paper by talking about what I think was the most impactful class for me and how our discussion made me reflect on a very personal part of my life. About midway through the semester you asked us to imagine that we were working in the ICU and we had to talk to a family about their recently born child. We were to imagine that this child had an absolutely appalling physical birth defect that would have ramifications for both their physiological function and their outward appearance. You then asked us to give what would be our initial reaction, and how we would approach the parents. What would we say to them, what would we counsel them to do? How would we feel and react? I say that this is a personal topic for me because my little sister was born with a previously uncharacterised FBN1 mutation with pathological consequences similar to those of a Marfan’s patient. However, her phenotype is very markedly different. The condition is unnamed and there are currently only 4 other people that are thought to have the same mutation. If you are interested in getting an idea of what my sister looks like and how it relates to our task of imagining an “appalling defect”, look up Lizzy Velazquez, a girl who has the same mutation. Her first claim to fame was being named the “ugliest girl in the world” by a viral youtube video, and she has recently made a name for herself as a motivational speaker on TED after being invited to several talk shows. It was an odd experience indeed when I was living in Spain the year before starting medical school and I had my Spanish friends posting videos of Lizzy on their facebook with subtitles declaring that she was an inspiration to them. Anyways, despite having Abby in my family, it wasn’t until after class that her presence in my life impacted my thinking on your scenario. I want to share my initial reaction, and thoughts that I have had during med school, and then share how those thoughts changed during the course of your class, but particularly after that specific session. I first confronted the question ­ what would you do for the life of this child ­ in a lecture for the elective Compassion in the Art of Medicine. We had a family who spoke about their child ­ born at 26 weeks with short gut syndrome, autism, and a whole other host of problems. He spend the first 9 months in the ICU to the tune of 6 million dollars. Today he is a relatively healthy boy, but I kept finding myself asking the question during the presentation ­ why would medicine go to such lengths and expend so many resources to keep alive a child who had such an abysmal prognosis. Would it not be better to allow this child to pass, via an act of omission and while administering palliative care, in a manner similar to hospice? Another experience made me confront this question. I was at my preceptor site and we had a child come in for a check up. He was also born very preterm, and suffered from severe cerebral palsy. My preceptor showed me how he was unable to relax the adductor muscles in his thighs, and I noticed that he seemed unable to even control where his eyes moved. He was attended all hours of the day and would never be independent. He couldn’t even feed himself. It was a very emotional encounter, and I couldn’t help but ask myself why this child was kept alive? What kind of quality of life does he enjoy, and how big must the burden be on his caretakers, both financially, emotionally, and time wise? It is a very difficult thing to explain to yourself why your first, visceral reaction upon seeing another human being is asking why they has been kept alive. I was prepared to face this question in the context of hospice, where I am very against heroic end of life care that provides little value. But these experiences made me confront this challenging question in beginning of life care. I am at Baylor because I wanted to make a career out of helping people improve their health, and here I am in my first year wondering why medicine had intervened to keep these sick children alive? As a Jewish person who is very connected to the Jewish community, if not the religion, I was even more distraught when we discussed the rationale that the Nazi party used to justify euthanasia. Their thinking, that disabled individuals would use too many resources, would require too much investment, was part of my initial reaction when I saw this child with cerebral palsy. It is very shocking to see the beginnings of their perverse logic existing within my own instinctual reaction. When you fostered the discussion in class, I was relieved to hear, both during and after, that many people shared my reaction and reasoning. I was not the only heartless monster. People admitted to feelings of disgust, shock, sadness, guilt. Some of my friends that I talked with after class admitted that they have felt similar reactions to mine, particularly during the Compassion’s lecture that I mentioned earlier. Essentially feelings that wrestling with this question provoked in me seemed to be universal. I was a little bit taken aback and decided to call my Father, who is a OBGYN who has been practicing for 28 years. He has had many premature deliveries, and I wanted to listen to his take on omission of care for critically ill babies. I caught him on call and laid out everything I had been thinking, focusing on the cerebral palsy patient. He agreed that it was difficult to see a sick baby, but asked me: “Well, what about Abby?” When she was born nobody could give my parents a prognosis. There were predictions that she would die at 2 days, at 2 weeks, at one month. That she would never walk, talk, or be intellectually capable. My parents told me that every day for months they were afraid that she would suddenly pass away. She spent months in the ICU and completely upended our family life. I was young when all of this took place but there were things that I remember. My Dad stopped working, my Mom didn’t sleep and both of them were constantly breaking down into tears and sobs around the house. Today Abby is perfectly healthy and just recently flew to New Orleans by herself to spend her 21st birthday with her camp friends. While I was wrestling with these questions, it never occurred to me to consider Abby’s situation. I think this is in part because I don’t see her as being any different than anyone else; she is simply my sister. After some reflection, I have realized that it is ok to have these reactions, and that they stem in part from us being unfamiliar with what we are seeing and scared of what is different. During the Compassion’s lecture, I will never forget that the father himself admitted that he will never forgive himself for being disgusted by his own baby the first time he saw him. However, I now realize that it is not our place to decide the value inherent in each human life and deem that others, although burdened by difficulties, do not deserve or enjoy life enough to justify their care. What I consider to be a low quality of life is specific for me and is a product of my own life experiences and observations. Thus, it is not applicable to others, especially when used as a means to advocate the termination of their life­saving medical care. Just because because the cerebral palsy patient is disabled and unable to communicate doesn’t mean that life as he knows it is less worthy than my own. For that matter, I don’t know how any normal healthy person other than myself experiences their life. Having Abby in my family wasn’t necessary for these conclusions, but it made my feelings that much more real and important. In my initial reaction I was essentially justifying what would have been the omission of care from my own sister. It was very difficult admitting this to myself, and like the father from the Compassions lecture, I will always be ashamed. However, it is empowering to know that I didn’t let my first thoughts guide me and that I used my ability to reason and discuss my feelings with others to come to a new conclusion. After all, it is not our emotions that define us as humans but rather our actions. I am very grateful that this class has provoked me and allowed me to confront these difficult moral questions that I am sure to face during my career. I think that it is very important for people to study how the atrocities committed by Germany could have been seen as normal by well intentioned physicians. As I have experienced myself, it is very easy to let your instincts take over your judgment and reasoning, but as physicians we must adhere to the belief that we cannot judge the value of a life. When faced with difficult decisions we must search to discuss with our colleagues and search people outside of medicine who can help to provide a broader context to our thinking. We have a privilege to take care of our fellow human beings, and we cannot betray our duty by succumbing to flawed logic, whether it comes from a political or medical establishment, or even from within ourselves.

By MEIR SOLOVEICHIK (from the Wall Street Journal, July 1, 2016) Mr. Soloveichik is the rabbi and minister of Congregation Shearith Israel in Manhattan and director of the Straus Center for Torah and Western Thought of Yeshiva University. See also: video lectures by Haas, Greenberg, Kass, and Pellegrino.

Dr. Aaron Kheriaty is a psychiatrist and medical ethicist at the University of California, Irvine. He has been writing, debating, and video recording his opposition to California’s law on physician-assisted suicide. He has focused on the role of treatable depression in a patient’s decision to request physician-assisted suicide, the “social contagion” aspect of suicide, and economic incentives for state governments to pay physician-assisted suicide rather than expensive medical treatments. Examples of his work can be found at: https://www.washingtonpost.com/opinions/the-dangerously-contagious-effect-of-assisted-suicide-laws/2015/11/20/6e53b7c0-83fb-11e5-a7ca-6ab6ec20f839_story.html http://www.mercurynews.com/opinion/ci_28746571/aaron-kheriaty-oregon-assisted-suicide-law-no-model http://www.firstthings.com/article/2015/04/apostolate-of-death https://www.youtube.com/watch?v=SJbM4mYNLyA&index=13&list=FLuiJWuv6U_3xH5nm-0-GSfw https://www.youtube.com/watch?v=iiK3B0Cofc0&index=1&list=FLuiJWuv6U_3xH5nm-0-GSfw https://www.youtube.com/watch?v=JUhVMII0Ch0&index=10&list=FLuiJWuv6U_3xH5nm-0-GSfw

In May 2017, almost 100 scholars, educators and medical professionals from around the world met in Western Galilee, Israel to discuss medicine during and after the Holocaust. The conference resulted in the drafting of what is now known as the Galilee Declaration, which affirms the Declaration of the Stockholm International Forum on the Holocaust and supplements it for health professions. It calls upon medical schools and other healthcare institutions to incorporate the study of medicine and the Holocaust. Below is the full text of the Galilee Declaration. The Galilee Declaration The participants in the Galilee Second International Workshop on Medicine after the Holocaust pledge the following: We unequivocally support the universal principles of the 2000 Declaration of the Stockholm International Forum on the Holocaust, namely: The Holocaust (Shoah) fundamentally challenged the foundations of civilization. The unprecedented character of the Holocaust will always hold universal meaning. The magnitude of the Holocaust, planned and carried out by the Nazis, must be forever seared in our collective memory. With humanity still scarred by genocide, ethnic cleansing, racism, anti-Semitism and xenophobia, the international community shares a solemn responsibility to fight those evils. Together we must uphold the terrible truth of the Holocaust against those who deny it. We must strengthen the moral commitment of our peoples, and the political commitment of our governments, to ensure that future generations can understand the causes of the Holocaust and reflect upon its consequences. We pledge to strengthen our efforts to promote education, remembrance and research about the Holocaust, both in countries that have already undertaken such initiatives and in those that choose to join this effort. We unequivocally assert that a moral imperative compels all health professions to supplement the Stockholm Declaration as follows: Professionals from science, medicine and other healthcare and social science fields played decisive roles in justifying, developing and carrying out some of the most appalling atrocities of the Third Reich, including the compulsory sterilization and medicalized murder of Germans, Austrians and other lives deemed unworthy of living; unethical, brutal experimentation on hospital patients and prisoners; and the unprecedented persecution, including mass murder and the Holocaust – the unique, partially-medicalized genocide of Jews and many others.Health professionals were prominent among the Nazi perpetrators and their collaborators with these heinous crimes, which were ostensibly designed to improve the health of the German population. Most of them remained unrepentant long after the Nuremberg trials. Acknowledging these medical atrocities is a continuing responsibility for all health professionals, their societies, and institutions. We acknowledge that the destructive potential of science focused solely on knowledge acquisition and population health without care for individual human beings peaked during the Third Reich with its extreme dehumanizing political conditions and profound moral failures of its health care and scientific establishments. These failures pose a major challenge to contemporary medicine, and they compel us to ensure that the lessons of the Holocaust are integrated into the identities of present and future physicians and other health professionals. We share a commitment to encourage the study of the roles of health professionals in medical atrocities committed during the Nazi period, leading up to and including the Holocaust, and the many implications that this legacy holds for us for today. This study should also include the achievements in maintaining high professional and human standards by some physicians and other persons entrusted with health care during the Holocaust. We share the general obligation of humanity to remember all the victims of medical atrocities during the Nazi period including the Holocaust and to honor all those who stood against it. We also share a special obligation to prevent the abuse of power in our healing professions. We therefore believe in recognizing the unique and critical roles played by health professionals, remembering those who were their victims, and honoring those who held true to their healers’ oaths in extreme circumstances. We share a commitment to shed light on the still obscured shadows of physicians and other health professionals, societies and institutions that perpetrated medical atrocities during the Nazi period. We will take all necessary steps to facilitate the opening of archives to ensure that all documents relevant to the role of medicine in the Holocaust are available to researchers. We call on institutions of higher learning in all healthcare professions and allied fields to incorporate into their curricula courses and programs on medicine and the Holocaust and its implications for contemporary practice, research and healthcare policy, and to support each other in implementing this Declaration. *emulating the Stockholm declaration

Professor, Department of Family and Community Medicine, University of Toronto