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First and second year Baylor College of Medicine students enrolled in Healing by Killing: Medicine during the Third Reich are required to write a paper on a topic of their choosing at the end of the nine-week course. They may write about any topic that is stimulated by the material in the course, which includes eugenics, involuntary sterilization, Nuremberg and Jim Crow laws, involuntary euthanasia, human subjects research, the Nuremberg Doctors’ Trial and Code, how healers become killers, the implications of this history for contemporary medicine, and personal reflections of a distinguished physician, which was Dr. Joseph Gathe this year. Second year student Cody Miller address two fundamental issues about the US response to the medical crimes of the Holocaust: dismissing the bioethics of the Third Reich and thereby disregarding its own eugenic past; and the paucity of education about medicine and the Holocaust. The Selective Memory of Bioethics: Nazi Germany, Ethics, and Education By C. Cody Miller The field of bioethics, whether it be applied to health policy, research, or clinical practice, is a rapidly growing and evolving field. With the arrival of the internet age and a subsequent abundance of information, misinformation, and overall visibility, healthcare professionals are being unprecedentedly held accountable for their actions. Medical bioethics, specifically, is being pressed in this new era to the frontline of ethical dilemmas. The days of unquestioned medical paternalism have been replaced with a greater emphasis on patient autonomy and transparency in care. American philosophers in medical bioethics have postulated that the birth of the field can be attributed as occurring stateside in the 1960’s due to advances in medical technology and greater awareness of social justice issues (Callahan 2008; Garrett, Jotterand, and Ralston 2013). However, this declaration of the birthplace and time of bioethics—that is being in the second half of the 20th century and occurring in the United States—fails to recognize the very real field of bioethics that had substantial scholarship and prevalence in Germany both during and prior to the Holocaust. In the author’s own medical ethics education, bioethics was predominantly presented as having its roots resulting from the Nuremburg Code of 1947, rather than preempting the Third Reich. As mentioned above, many scholars further push the field’s conception decades beyond the end of the second world war. Additionally, there is an apparent exclusive focus on Third Reich German medicine and eugenics as the ultimate failure of ethics without acknowledgement of the American eugenics movement that preceded the Holocaust by nearly 40 years (Allen 2002). It bears mentioning that while a deficit in scholarship on the subject of pre-World War II bioethics exists in the English literature, work has been done by German-speaking scholars (Muzur and Sass 2012). Indeed, while the purpose here is not to in any way justify the horrific events that occurred in Nazi Germany, it is hoped that some light might be shed on the preexistence of bioethics as a field in early 20th-century Germany, that we might take lessons from history and prevent future misapplications of bioethics to unethical ends. The earliest use of the term “bioethics” identified by literature review is not found in 1960s, nor even 1940s American scholarship, but rather in 1920s Germany. Paul Max Fritz Jahr, a German pastor and theologian, wrote on the subject of der Bioethik as early as 1926 (Jahr 1926), and quite likely drew inspiration from the Bio-Psychik discussed in 1908 by the Austrian philosopher Rudolf Eisler (Eisler 1908). Jahr describes his bioethical imperative in a command, that we must “always, as a principle, respect every living being, as an end in itself and treat it as such wherever it is possible!” Beyond the ethics of Eisler and Jahr, which were more theologically-oriented and broad in their approach, examples of bioethics in a research context can also be found in early 20thcentury Germany and Austria. One such example is how the Prussian government responded in the trial of Dr. Albert Neisser. Neisser, a German physician known for discovering the eponymous bacterium Neisseria gonorrheae, had been conducting vaccination research in which he injected cell free serum from patients with syphilis into patients who were admitted for other medical conditions. Neisser did not explain the experiment to nor acquire informed consent from these patients, most of whom were prostitutes. When some of the patients contracted syphilis as a result of his experimentation, Neisser would merely retort they contracted the illness through their line of work (Vollman and Winau 1996). Neisser was fined by the Royal disciplinary court due to the absence of consent in these experiments, and in 1900 the Prussian government issued a directive that “all medical interventions other than for diagnosis, healing, and immunization were excluded under all circumstances if ‘the human subject was a minor or not competent for other reasons’ or if the subject had not given his or her ‘ unambiguous consent’ after a ‘proper explanation of the possible negative consequences’ of the intervention.” (Idem). Additionally, one of Neisser’s few medical opponents in his trial–few in that much of the medical establishment supported Neisser during his case, a psychiatrist named Albert Moll published an account of unethical cases of non-therapeutic research on humans and re-emphasized the need for informed consent only two years after the Prussian directive (Moll 1902). If bioethics existed as early as 1900 in Germany, why then is there such an insistence that the field we know today is not cut from the same cloth? The answer, simply put, is that association with the terrors of the Holocaust, no matter how thin, is unthinkable to most people. The events of Nazi Germany and the physicians and scientists involved in concentration camp experimentation are demonized as having abandoned all ethical pretense. However, it must be understood that the perpetrators of the Holocaust, many of them academics and scholars, believed they were furthering an ethical imperative not unlike the sorts of doctrine conceived by earlier ethicists. Richard Weikart writes in his book Hitler’s Ethic, that “Hitler’s ethic was essentially an evolutionary ethic that exalted biological progress above all other moral considerations. He believed that humans were subject to immutable evolutionary laws, and nature dictated what was morally proper.” (Weikart 2009). While modern hindsight allows us to certainly recognize the evils of Hitler’s ethic, we must not allow this to cloud the reality of the Nazi movement’s roots in Social Darwinism and eugenics, bioethical theories that were equally, if not more popular in the early 20th-century United States as in contemporary Germany (Allen 2002). Moreover, we must not allow our discomfort in this recognition to mold how the history of bioethics is understood, researched, and taught. The state of Holocaust education in the United States has much to be desired. Recent media coverage of anti-Semitic and neo-Nazi crimes and displays in the United States highlight American misunderstandings of the Third Reich in painfully obvious ways. As of November 2013, only five of the fifty-two states and organized territories of the United States have explicit requirements for Holocaust education on their legal books, and no laws have been successfully passed in the United States prohibiting Holocaust denial (Wikipedia). This trend of lackluster recognition of the true events, origins, and ethical, psychosocial, and economic underpinnings of the Third Reich needs to be addressed. As self-identifying ethical clinicians, researchers, and philosophers, the least we can do is recognize the good work done in bioethics before us, regardless of how it may have been later abused by Hitler’s Nazi agenda. We cannot presume to have all the answers, nor to be above the human mistakes of the past. “Into this pond were flushed the ashes of some four million people. And that was not done by gas—it was done by arrogance, it was done by dogma, it was done by ignorance. When people believe that they have absolute knowledge with no test in reality, this is how they behave. This is what men do when they aspire to the knowledge of gods.” -Jacob Bronowski, The Danger of Dogma.

German doctors and scientists were perhaps the best in the world prior to WWII. Despite their immoral behavior during the Third Reich, they were highly valued by the victorious allies. The Soviet Union and the United States competed for the services of the best of them, most notably rocket scientist Wernher von Braun, who used slave labor in the production of the notorious V-2 rocket that rained death and destruction on the British people during the war. The US military employed four of the defendants in the Nuremberg Doctors’ Trial, wavering between prosecution and procurement. Dr. Hubertus Strughold, for example, was father of the American Space Medicine program after he was the father of the German Space Medicine program during WWII. When this fact came to light, the US government attempted without success to prosecute Strughold. In her essay for the Healing by Killing elective, medical student Elizabeth Adams shares her thoughts about Operation Paperclip. Operation Paperclip: The Great Moral Compromise By Elizabeth Adams Following the Holocaust, the United States became a safe haven for many of the persecuted individuals that were targeted under the Nazi regime. The United States also became a safe haven for the persecutors. In fact, we recruited them. Operation Paperclip was a secret program by the United States Office of Strategic Services that ultimately brought more than 1,500 German engineers and scientists onto American soil. Not only did they gift us with the inner ear thermometer and the microwave oven, but they also built our space program. For example, Dr. Hubertus Strughold was a Nazi scientist that was brought to the United States and ultimately designed the space suit and then launched a rhesus monkey into space. Both were monumental steps in sending astronauts into space. There are countless similar stories of Nazi scientists and their accomplishments in the US. These are the same scientists behind the gas chambers and inhumane medical experiments performed on prisoners. Instead of being sentenced to life in prison or given the death penalty, either quite reasonable for some of the war crimes committed, they were found leading many organizations and scientific programs. President Harry Truman approved the program, originally referred to as Operation Overcast. However, he explicitly stated that scientists and engineers that were Nazi members or active Nazi supporters were not eligible for recruitment. According to historian Laura Schumm in her article, What is Operation Paperclip, “officials within the JIOA and Office of Strategic Services (OSS)—the forerunner to the CIA—bypassed this directive by eliminating or whitewashing incriminating evidence of possible war crimes from the scientists’ records, believing their intelligence to be crucial to the country’s postwar efforts.” Without the knowledge of the general public, or even the president of the United States, the OSS began to falsify the documents. They would put an ordinary paperclip on the files as a secret identifying mark for those German scientists whose files had been altered. What factors contributed to this moral compromise on the part of the OSS? The OSS was fully aware of the severity of the war crimes committed, but chose to hide this information, and bring many German scientists into America. It is important to consider the other events going on in the world following World War II to begin to understand this decision. A new war was brewing between the United States and the Soviet Union, and The Space Race would prove an important competition to establish technological dominance. The OSS feared that the Soviet Union could rise to power above the United States threatening national security and our way of life. Many of the German scientists were highly trained in defense and aerospace engineering. Dr. Wernher von Braun was an intelligent space engineer that was brought to the United States as part of Operation Paperclip. He designed the V-2 Rocket for Nazi Germany, and also the Saturn V launch vehicle. Von Braun went on to serve as the chief architect for the Saturn V launch and his group was assimilated into the National Aeronautics and Space Administration (NASA). In order to defend the United States, the OSS felt that it was necessary to bring over the best and brightest engineers and scientists from Germany, regardless of what they had been involved with during World War II. From this viewpoint, the OSS was doing what was thought to be in the best interest of the future of the United States – but, does this make it any less wrong on moral grounds? Laura Schumm addresses this, stating that “although defenders of the clandestine operation argue that the balance of power could have easily shifted to the Soviet Union during the Cold War if these Nazi scientists were not brought to the United States, opponents point to the ethical cost of ignoring their abhorrent war crimes without punishment or accountability.” Is this kind of executive action by the OSS permissible because it resulted in a successful space program and brought a great deal of superior military technology to the United States? According to Annie Jacobsen, author of Operation Paperclip, the contemporary public regards Operation Paperclip as a “bad idea.” In addition to the overwhelming evidence against the ethical cost of the operation, she argues that the monetary cost of the program was significant. The cleanup and disposal of the biological and chemical weapons designed by these scientists took decades and more the $30 billion. The human cost should also be considered when experimentation on humans continued in America in direct violation of the Nuremberg Code, as experiments continued on American soldiers testing new chemical warfare. It is easy to argue against Operation Paperclip because of the very obvious violation of morality and justice, but it is hard to imagine what would have happened if the program had not existed. How long would it have been before an American made it to the moon? Would the United States be a communist country? No one really knows what American history would look like without this great moral compromise.

Few people realize that eugenics was the driving force behind the Nazis’ political philosophy of “Applied Biology.” Even fewer realize the essential contributions to eugenics by the United States, the world’s leader in eugenics. Indiana’s legislature was the first in the world to legalize involuntary sterilization, for example, and at least 12 countries had legalized involuntary sterilization before Nazi Germany did so in 1933. America provided legal, moral, and philanthropic support for Nazi eugenicists prior to the outbreak of WWII. German propagandists also highlighted the failure of American medical schools to admit African-Americans and could have also pointed to the exclusion of African-American doctors to the American Medical Association. Medical schools often had quotas for Jews and Italians—Edmund Pellegrino, one of the world’s great bioethicist physicians was denied admission because of his Italian heritage—and Nazi propagandists also noted that our Jim Crow laws defined African-Americans much more broadly than the Nuremberg Laws defined a Jew. Amanda Broderick discusses modern eugenics in her essay. Genetics and Modern Eugenics By Amanda Broderick Throughout this course, we broached the subject of eugenic thought and action, mostly as it was carried out in the past during the Nazi regime and earlier in the United States. Since the end of World War II, the word and discussion of eugenics has been greatly decreased to almost zero because of stigma and belief that it was no longer relevant and simply an evil “Nazi concept” with no foundation in a modern context. While the Nazi regime used the idea of eugenics as an excuse for many of their actions such as sterilization without consent and the mass killing of different populations including the Jewish and the disabled, eugenic thought has also influenced action in modern United States with uninformed sterilization of female inmates in California happening as recently as 2010.1 Eugenics was initially defined as “well-born” but has morphed to mean “control of or improvement of genetic qualities in a population” in more modern times.2 Many of the thought processes underlying this definition of eugenics are still relevant to our society, especially as reproductive and gene-editing technologies advance. The availability and use of prenatal genetic testing, in-vitro fertilization and selection, and the possibility of even newer technologies, such as CRISPR, has sprouted a new chapter of ‘modern eugenic’ thought and fear. Prenatal testing allows for the detection of genetic abnormalities before birth, allowing parents to decide whether they will continue with a pregnancy. In-vitro fertilization allows for selection against embryos that have known severe genetic anomalies. CRISPR, while it has not yet been used in human embryos, gives the ability to specifically edit the genome before implantation to change any part of the genome that is unwanted. These technologies could be used to all but eradicate certain genetic conditions as well as to “enhance” the genome in ways not related to disease processes. The negative and positive implications of these technologies should be more widely debated and expanded upon so that genetic scientific advancements can continue without ethical boundaries being irreparably crossed or pushed too far. Current philosophies on the use of these technologies is polarized. On one side of the spectrum, critics believe that using them at all is morally apprehensible and leads to greater discrimination of populations with certain disabilities or diseases. On the other side, philosophers, such as Peter Singer, believe that many eugenic concepts are logical and that if we have these technologies, they should be used without a doubt before children are born with severe disabilities. He believes this is the only logical solution because it will save both the family and the child from a more difficult life. He goes as far as to argue that families of babies born with severe mental or physical disabilities should be allowed to decide whether that baby should be euthanized or not after its birth (even up to an age of a few years before there is “selfawareness”). 3 Both views seem to be ignoring the intricacies of a lot of the situations in which these technologies may or may not be used. For example, in the latter argument, how is a disability or disease classified as severe enough to be “edited” out and who decides this? In the former, is it actually immoral to try to spare the family and child from a fatal and painful disease? Taking a more moderate stance, there are many potential positives to these technologies, like curing or stopping fatal diseases. But if they are unregulated, they could be used in negative ways. One possible solution is that preventing disease (negative engineering) should be allowed but so called ‘enhancement’ eugenics (positive engineering) in which genes for eye color, athletic ability, ect are chosen for or changed.4 It is difficult, however, to ascertain exactly where to draw the line when deciding what diseases/disabilities are so severe as to warrant genetic modification/selection. Current disability rights groups and others fear that any type of selection causes more discrimination against those that are still born disabled.3 This type of discrimination to an already marginalized group is something that has had terrible consequences in the past. The most important thing to consider to avoid repeating these kinds of horrible atrocities of the past made under the guise of eugenics is that genetic technology choices must always be informed and with consent and never controlled by the government. Following these basic guidelines while keeping an open dialogue about where future technologies may lead or should be stopped will allow this aspect of medicine to grow in a morally responsible way.

Robert Proctor was widely acclaimed for his 1988 book Racial Hygiene: Medicine Under the Nazis. He did not receive similar acclaim for his 2000 book The Nazi War on Cancer, perhaps because he pointed out some of the successes of Nazi medicine—occupational carcinogenesis, the campaign against tobacco, and opposition to additives in food, for example—that are similar to public health programs in contemporary Western liberal democracies. Baylor College of Medicine medical student Varun Bora’s essay examines the Good, the Bad, and the Ugly of Nazi physicians and sums up this way: “Thus, while their actions were abominable, appreciation for their contributions to modern medicine as well as an examination of their perspective remains paramount to preventing history from repeating itself. The Good, the Bad, and the Ugly By Varun Bora During the 1930’s and 1940’s, the Nazis of Germany conducted some of the most heinous acts the world has ever seen. From medical experiments on children to “mercy killings” of those deemed to possess harmful genes to mass genocide, the Nazi’s actions are attributed to the nefarious intentions of Adolf Hitler and his political supporters. However, Hitler’s regime gained its legitimacy due to the backing of scientists and doctors, who provided the medical expertise and justification that allowed Hitler to kill so many innocent people. Even more terrifying remains the fact that these doctors truly believed that their actions were noble and at the cutting edge of science. As a medical community today, we dismiss the actions of some of our infamous predecessors as outliers and cast them aside; however, doing so prevents us from examining the invaluable contributions they made to modern medicine as well as the similarities we share with physicians such as Josef Mengele – the “Angel of Death” – and his colleagues. To ignore these qualities represents in itself another danger in that we believe ourselves immune to the “brainwashing” and false logic these Nazi doctors possessed. Thus, while their actions were abominable, appreciation for their contributions to modern medicine as well as an examination of their perspective remains paramount to preventing history from repeating itself. Many of modern medicines hallmarks owe their conception to the Nazi doctors. For instance, large scale vaccination began with Nazi research in the internment camps. There, doctors performed innumerable experiments on the Jewish prisoners, formulating and reformulating their mixtures until they were able to synthesize vaccines to diseases such as tuberculosis1 . These internment camps provided human subjects who the doctors themselves believed were no better than animals and that by sacrificing their lives in the experiments, these prisoner’s lives finally were given some value and meaning. Today, we would abhor such actions, yet we use vaccines on a daily basis to protect ourselves and our children. Thus, we owe the doctors some degree of appreciation, although their methods were completely wrong; furthermore, from them, we can learn the dangers of taking science too far. As doctors, we straddle the edge of known knowledge, and in our quest to push the boundaries, we may be blind enough to lose sight of the ethics underlying the quest itself. However, not all of the Nazi’s contributions were attained using inhumane methods. One of their greatest successes lie in legitimizing the anti-tobacco movement. Through years of research and meticulous data collected, Dr. Franz Miller – a Nazi scientist – provided the first convincing proof of the link between cigarette smoking and tobacco. These results were found using ethically sound science and illustrate that the Nazi doctors were not inherently evil, but rather, simply disillusioned and ignorant to their actions – something we all are capable of. Thus, despite some of their dubious beliefs and methods, we shouldn’t just cast these doctors and their contributions aside; rather, we owe these doctors some of the same appreciation we offer to famous predecessors such as Salk and Banting while at the same time learning from their greed and ignorance. The second – and more important – aspect of the Nazi doctors that we cannot ignore lies in the relevance of their situation to each and every one of us. We forget today that the Nazi doctors and scientists were the finest in the world during that time period; they made countless contributions to all fields – not just medicine. Many of our most famous doctors, including Dr. Michael DeBakey, traveled to Germany for a stellar education. Thus, it wasn’t inferior medical training or ineptitude that led to these doctors committing such heinous acts. Rather, it was their belief that they were absolutely in the right to act in the manner in which they did. Today, we know these actions to be wrong and claim to never repeat the same mistakes. However, the Nazi doctors probably said the same things regarding themselves and the doctors that came before them while they performed cruel experiments on children and innocents. We are in the same position that these doctors before us were in; while the circumstances themselves are vastly different, we still hold the same heightened status in society and are still looked upon as leaders. People trust us with their lives and we owe it to them to not make the same mistakes our predecessors did. Issues such as stem cell research and genetic engineering could put our generation of physicians in the same situation that the issues faced by the Nazi doctors put them in, and thus, we should make it a priority to learn from the Nazi doctors, rather than label them as ignorant individuals with whom we have no relevance. In conclusion, modern day physicians have been quick to dismiss the Nazi doctors as a different breed of people with whom we today have no similarities. We find it more appeasing to delineate ourselves from them in order to separate their brand of medicine from our own. However, we still base much of our medicine on breakthroughs made by the Nazi physicians and thus, owe them their due respect, however terrible their methods were may have been. Even more importantly, many of the issues we face today and moving forward will put us in similar situations the Nazi doctors faced. One false step or misguided belief and we could end up committing actions that our successors will vilify. At the cutting edge of science, there is a fine line between morality and immorality, and the promise of breaking barriers can entice even the best of us to overreach and turn a blind eye towards our ethics, just as it did for the Nazi doctors. Thus, in the educational setting and as a community as a whole, we should make it a priority to study both the good and bad of these physicians.

I ask first- and second-year Baylor College of Medicine students who take the Healing by Killing: Medicine in the Third Reich elective to submit a final paper that has been stimulated by the content of the course. Most write essays and a few like Andrea write poems. Another uncommon aspect of her submission is that it speaks directly about religion. In poetic form she addresses the  difficult problem of suffering in the world and a nation’s disastrous choice of a false messiah to relieve the suffering. Her poem is a short cautionary tale about the choices we all make. Fear God Alone By Andrea Gerberding After hardship has fallen for many a year, The whispers for change become yells, Some in the government may lend an ear, But little anger or sadness it quells. When along comes a man of unorthodox cause, Who promises change of great scale, Many embrace him outright without giving pause, The opening chapter of a familiar tale. On whose shoulders to place the suffering of masses? Those whose religion deigns them a stranger! They threaten the safety of worthier classes, Their presence is surely an imminent danger. The man proclaims he alone is the answer, He knows how to yield a society purer, “We will be great again! We will crush the dissenters!” All will rejoice the might of the Führer. His swift rise to power caught many off guard, At least those who thought his vision absurd, Their silence has left the country a graveyard, In which progress and amity are now interred. What is there to say when hate conquers all? The precedent has surely been set, Naïvely we pray for a quick rise and fall, But history will never forget. They say not to worry, he’s only one person, What could he possibly do? On the wrong side of history, he pushes his mission, Life as we know it is through. “Fear God alone” the scriptures proclaim, Do not dare to worship a fraud, But when one man decides who is spared versus slain, Has he not made himself our true God?

In my Baylor College of Medicine elective Healing by Killing: Medicine during the Third Reich, students struggle with their newly discovered knowledge about the best doctors in the world murdering Jews, people with disabilities, homosexuals, blacks, and many others. They find it even more difficult to understand how these medical killers could justify their actions by transforming the Hippocratic Oath from a doctor-patient relationship to a eugenic state-Volkskörper relationship, thereby enabling the elimination of human beings perceived as a cancer on the nation’s body. Katherine notes that “Everyone has prejudices and everyone makes judgments about people before getting to know them, but as a physician your prejudices can have life-threatening consequences.” Her personal prescription to avoid repetition of the Nazi physicians’ medical crimes is “to take a look at the prejudices I have and confront them, however uncomfortable it might make me.” Healing by Killing: Medicine in the Third Reich By Katherine French This course has taught me the immeasurable value of my own ethical principles in regards to my future line of work as a physician. Taking a look at the example of the science and health care field during Nazi Germany has educated me in ways that I was not expecting and was honestly quite uncomfortable learning. Before this course, I knew little about healthcare during Nazi Germany and held the inaccurate belief that the German physicians’ hands were somehow forced to commit the various atrocities they did during the Holocaust. I held the notion that Joseph Mengele was among a few bad apples that conducted human experiments during the Holocaust. However, the German physicians intentionally harmed people that they had either convinced themselves were not people at all or for their notion of the greater good. “Harmed” is putting it all too lightly. German physicians experimented on people, derived efficient ways to kill people in mass, starved people, and tortured people. They went far beyond “do no harm”. The German physicians were driven by the emerging science of genetics and ancient philosophy of eugenics in a time of economic struggle and with the authority of a dictator, but most importantly and most tragically they were driven by prejudice. This course has reminded me how important it is to take a look at the prejudices I have and confront them, however uncomfortable it might make me. I find myself thinking about the initial judgments I had about certain people in my life, or people that I pass by everyday. Everyone has prejudices and everyone makes judgments about people before getting to know them, but as a physician your prejudices can have life-threatening consequences. I hope by getting into the practice of recognizing my biases, I will be able to prevent the negative consequences of prejudiced actions. The book Health Disparities in the United States by Dr. Donald A. Barr is a great resource for anyone in the health care field who wants a research-based introduction to the conflation of race/ethnicity and socioeconomic status in America on health outcomes. In this book, the author concludes that race/ethnicity should only be used to guide medical decisions in “circumstances based on clear scientific evidence and with the full knowledge and consent of the person on whose behalf the medical decision is being made.” This is a rational conclusion that I will follow in my future career as a physician. Part of the attraction to the profession of a physician is the ability to solve problems – you hope to cure a patient’s disease and improve that patient’s life. Physicians in Nazi Germany were driven by the same desires, and thought perhaps they could take it up a notch– they through that they could solve their societies’ problems through eugenics. They excluded huge groups of people from their selfcreated image of a “fixed” society and destroyed communities in the process. The problem of prejudice is not a new one, but I want to prevent it from having an effect in my professional career as much as possible.

The medical profession’s status and its attitudes about patient care usually result from a negotiation between physicians, culture, and politicians. Students in my Healing by Killing: Medicine during the Third Reich are often shocked by Nazi physicians’ eugenic view of their patients and the subsequent elevation of their already high status in the political order. After learning of the indispensable role of the medical profession in the design and implementation of the Holocaust, medical student Maya Firsowicz asks, “….is there some aspect of medicine performed by physicians today that is not in the best interest of patients?” In particular she is concerned about constraints on the time physicians spend with patients and the focus of the healthcare system on “disease intervention rather than disease prevention and health promotion.” She hopes that by asking these questions medical students can “not only learn from the mistakes made by physicians of the past, but also to continue to uphold the true values of the profession of medicine.” Healing by Killing By Maya Firsowicz Through studying medicine in the Third Reich, various myths concerning the physicians of that time are exposed and invalidated, oftentimes opening our eyes to aspects of modern medicine to which we may ourselves be blinded. One of these myths is that physicians during the Third Reich must have been inherently mad, incompetent or evil in order to have committed the horrible acts known for the time. However, this myth is rapidly disproved when the caliber of their work prior to the Holocaust and their overall status as the “best” doctors in the world is demonstrated. Physicians of that time were not mad, nor were they physicians who openly rejected the Hippocratic Oath. While their practice became infiltrated by the concepts of eugenics that were taking over society, and the Hippocratic Oath was refashioned in Hitler’s image, these physicians genuinely believed they were still upholding the values of the profession. They believed the work they were conducting was best for their patients and for the nation. It is evident when we look at their work today that the opposite was true, but it begs the question, is there some aspect of medicine performed by physicians today that is not in the best interest of patients? An increasing pressure that has been placed on physicians over the past few decades has been on the value and efficiency of health care delivery, frequently resulting in a constraint on the amount of time physicians have to spend with patients. One point of concern here is that this decrease in amount of time physicians spend with patients may have a negative effect on the actual care being provided. As argued in an article in the Journal of General Internal Medicine, “no doctor can do a good job without spending substantial amounts of time meeting with and thinking about patients” (2). Unfortunately, it can be difficult to establish what constitutes a “substantial” amount of time, and the time constraints being placed on physicians each day may result in individual patient visits simply being too short. As a result, physicians are unable to attain a complete understanding of their patient’s story and the quality of care subsequently declines. Furthermore, in an effort to make up for the decreased time allotted for each patient, physicians may be trying to compensate by conducting unnecessary tests or overprescribing medications (2). As additional medications and tests cannot substitute for the care that a physician can provide, writing prescriptions instead of talking with our patients is not a solution to the existing time constraint problem, and it could actually be causing harm to some patients. We must therefore question if the actions of physicians today in this regard are truly in the best interest of the patient, or rather in part of meeting the time demands of an increasingly busy work day. A recent documentary film on the flaws of the current United States healthcare system, Escape Fire: The Fight to Rescue American Healthcare, elicits yet another angle of the problem. Attributing flaws in U.S. healthcare to the current profit-driven system, the documentary argues that there has been a shift from patient-care to “sick care” in the U.S., treating symptoms of conditions that could be avoided with preventative care. Medical journalist Shannon Brownlee explains that we have “a disease care system, not a health care system…it wants patients to keep coming back for symptom relief of chronic care and not prevention – which is cheaper” (3). While it is a systematic problem, physicians are undoubtedly a part of today’s healthcare system and must therefore play some role in this “disease care” system. Trying to discern what role this may be, it is interesting to consider the very core of a physician’s practice: their training. As Escape Fire points out, much of medical education focuses on disease intervention rather than disease prevention and health promotion (3). Topics such as nutrition, which are valuable to preventative medicine, are oftentimes entirely omitted from medical curriculum (1). This is a fundamental problem that may perpetuate the current “disease care” system, as physicians have been primarily trained to treat disease rather than prevent it, and this is what they continue to do in their practice. While this keeps hospitals full and systematically benefits hospitals and their employees, it may not be in the best interest of the individual patient. Just as it is impossible to evaluate the work of physicians in the Third Reich separately from their society, it is crucial to take the current healthcare system into account when assessing the work of contemporary physicians. The modern U.S. healthcare system is placing increasing demands on physicians: to treat more patients in less time, and this often comes at the expense of teaching patients about preventative health efforts. Whether or not this has led to physicians practicing outside the best interest of their patients is an important question that arises from these considerations. While it is not a question that can be easily answered, the sole act of questioning our own system is beneficial. By considering our potential blindness and posing these questions, we can hope to not only learn from the mistakes made by physicians of the past, but also to continue to uphold the true values of the profession of medicine. References (1) Adams, K. M., Lindell, K. C., Kohlmeier, M., & Zeisel, S. H. (2006). Status of nutrition education in medical schools. The American Journal of Clinical Nutrition, 83(4), 941S–944S. (2) Dugdale, D. C., Epstein, R., & Pantilat, S. Z. (1999). Time and the Patient–Physician Relationship. Journal of General Internal Medicine, 14(Suppl 1), S34–S40. (3) Heineman, M., & Froemke, S. (2012). Escape Fire: The Fight to Rescue American Healthcare. United States: Roadside Attractions, Lionsgate.

The content of the Healing by Killing: Medicine During the Third Reich elective is very stimulating for the first- and second-year students at Baylor College of Medicine. As part of the requirements for the course, they must write about a topic of their choosing that is stimulated by the history of medicine during the Third Reich and of American eugenics. Jessica Tran was troubled by the justifications offered by Nazi physicians for the euthanasia programs and chose to write about abortion and the death penalty in the United States. Noting how difficult it is to judge one’s own culture and practices, she asks herself, “In 60 years, will my grandchildren look back on my generation with shock because of the current accepted ideas of abortion and the death penalty?” Healing by Killing: Medicine in the Third Reich By Jessica Tran While I have greatly enjoyed every topic that we have discussed in this class, there was one topic that particularly intrigued me – Euthanasia. As I learned about the events that progressed during the Third Reich period and the number of lives that were taken, I began to think about abortion, the death penalty, and other laws that are currently in place in America. I wondered if we are still living in an age in which the same types of concepts and ideas have become socially acceptable for us just as they did for the individuals in support of “mercy killings” during the Third Reich period. The first euthanasia in Germany was in 1938 through a petition from Mr. Knauer who had a son that was blind, mentally retarded, and missing one leg and one arm. Hitler granted a “mercy killing” to Mr. Knauer allowing his son to be euthanized. Something I found interesting was that the T4 program was not eligible to Jewish individuals, as this program was considered to be “humane”. Instead, Jews were killed by inhumane methods such as gas chambers and starvation. I found it astonishing how easy the process was – simply filling out a questionnaire (T4 form) and three referees would review the questionnaire for approval. As I learned about the T4 program in Germany, I began to see links between what was considered medicine in the Third Reich period and our current ideas and acceptance of abortion and the death penalty. Currently, there’s a wide acceptance of both abortion and the death penalty in America. These ideas are still so widely accepted that 31 states still perform the death penalty and 18 states allow abortion. There are many reasons why individuals support abortion, whether it be to eliminate suffering for the child, mom, or an inability to support the child. I began to ask my friends what their views were on abortion, and I found that many of them do not actively support abortion, but would consider it if they were to become pregnant right now or have a child with a disorder. For most of my friends, their justification for abortion was to eliminate the suffering of the child. I found this to be extremely similar to the thought process that the Germans used to justify mercy killings during the Third Reich period. Mercy killings were supposed to relieve the suffering of those with mental issues. Not only would it “relieve suffering” for the individual but for the rest of the population as these genes would no longer be passed on to the next generation. In addition, the death penalty is still widely accepted. I have heard many people say that they support the death penalty because “criminals would do no good for the rest of the population anyway”. This sounded a lot like the justification for mercy killings as those individuals with bad genes would contaminate the rest of the population. So ultimately, mercy killings would be doing something good for the country, as would the death penalty. While I am quick to judge mercy killings, I try to take a step back and realize that I did not live during the Third Reich, I do not know what values and ideas they prioritized, I do not know what the culture was like. However, I do know what the American culture is like now and have a better idea of the values and ideas that are prioritized. I can follow the justification of those that support abortion or the death penalty, and I wonder if those that did not oppose or stand against mercy killings were perhaps just like me. I now ask myself, “in 60 years, will my grandchildren look back on my generation with shock because of the current accepted ideas of abortion and the death penalty?” I find it easy to look back in time and judge the culture and practices of those before us, but I find it hard to step out of the current time and objectively judge our own culture and practices.

In his quest for a master race, Hitler has been compared to Mary Shelley’s creation Dr. Victor Frankenstein. Inspired by eugenics and empowered by the rediscovery of Mendel’s genetic work with peas, Hitler’s scientists attempted to rid Germany of presumed inferior genes and promote procreation among those with superior genes. We now know that genetics in the first few decades of the twentieth century was imprecise and many of the eugenic assumptions about improving a nation’s gene pool were both naive and unethical. The Human Genome Project has renewed interest in biological determinism and eugenics, and scientific advances have created possibilities that could only be dreamed of before, such as a head transplant. Reflecting upon her undergraduate research with severed axons and the recruitment of a volunteer for a head transplant by Dr. Sergio Canavero, Monika Pyarali asks, “Where should we draw the line?” The Making of a Modern Frankenstein: Where to Draw the Line? By Medical Student Monika Pyarali Even in the face of declining government funding, the rate of scientific advances has been on the rise since the 1990s (5). This may be due, in part, to the incredible rate of technological advancement during the last quarter of a century. With new developments in technology arising nearly every day, scientists are constantly tempted to push the limits of plausibility. However, experimentation is a double-edge sword. On the one hand, experimentation is what continually enables humanity to progress. For example, Alexander Fleming’s experiments led to the discovery of penicillin, which is still used to save the lives of millions of patients suffering from bacterial infections (1). Similarly, nearly every major advancement in science and medicine can be attributed to clever experimentation. Conversely, experimentation could also lead scientists to perform unthinkable acts in the interest of gaining knowledge. Perhaps the most infamous examples of a scientist gone astray is Dr. Mengele, known as “the Angel of Death”. Dr. Mengele’s experiments on the prisoners of Nazi death camps ranged from injecting substances in the eyes of twins to attempt to fabricate blue eyes to ripping fetuses from the wombs of their mothers to examine them. Often, experimental subjects were killed to perform autopsies on the bodies and obtain after-death measurements (6). Dr. Mengele and other Nazi doctors involved in prisoner experiments claimed that these studies were done with the interest of learning more about genetics to help purify the Aryan race. Regardless of the purpose, these experiments clearly crossed the boundaries of acceptable harm to the experimental subjects. While experiments like those conducted by Nazi doctors during World War II would not be plausible under modern standards of ethical research, it is not always clear where to draw the line. In some experiments, the potential harm to the subjects may not be apparent before the experiment is conducted. For example, Dr. Zimbardo’s famous Stanford Prison Experiment was approved by the ethics committee at Stanford because it followed ethical guidelines (9). Retrospectively, however, Dr. Zimbardo’s study is widely recognized as an unethical study in psychology. In other cases, the benefit to be gained from conducting an experiment may be perceived as much greater than the possible harm to the research subject(s). Experiments that could objectively put the research subject at harm may be approved because of their potential benefit for the advancement of humanity. But where should we draw the line? One specific case of high-stakes human experimentation drew my attention while I was still an undergraduate because of its relation to the research I was conducting. In 2015, an Italian surgeon by the name of Dr. Sergio Canavero proposed to perform the world’s first head transplant. In his article, titled “HEAVEN: The head anastomosis venture”, Dr. Canavero details his surgical procedure and supports his methodology using previous experiments conducted on animals. He notes that the success of his procedure is mainly dependent on two factors: maintaining the donor and recipient under hypothermia and successfully fusing the severed axonal connections (2). This daring proposal rapidly sparked much interest in the scientific community. Dr. Canavero was invited to universities across the world to speak of his procedure. He was also invited to give a TED talk by an independently organized TED event in Limassol, Cyprus. However, his proposal also sparked many debates about the ethics head transplantation. Dr. Canavero recruited Mr. Valery Spiridonov, a 30-year-old computer scientist who has WerdnigHoffman disease, to volunteer his head for transplant. Critics of the procedure argue that there is a high likelihood Mr. Spiridonov will not survive the procedure. While Dr. Canavero acknowledges this possibility, he refutes that the only way Mr. Spiridonov has a chance at regaining mobility, or even surviving the next couple of years, is if the procedure is successful. Analyzing the ethics of Dr. Canavero’s proposed procedure is complex because of what the procedure itself entails and the potential outcomes. First we must consider whether Dr. Canavero’s head transplant procedure has the potential to be successful. While the entire endeavor may seem ludicrous to some, it is quite frightening how plausible the procedure might actually be. Dr. Canavero proposes to carry out the first human head transplant in 2017 (2). He reasons that by 2017, the technology required to carry out the procedure will be available. All the methods delineated by Dr. Canavero have independently been supported by research on animals, including some of my own research. As an undergraduate, I was involved in the development of a procedure to fuse severed axons using biochemically engineered solutions of poly-ethylene glycol (PEG). Though our nerve transplantation experiments were successful on rats, these experiments left many unanswered questions regarding potential immune reactions, the viability of the technique in humans, and the underlying biochemistry that resulted in the success of the procedure. Even though PEG research on animals has yet to be fully worked out, using PEG to fuse the donor and recipient spinal cords together is one of the cornerstones of Dr. Canavero’s HEAVEN procedure. As further support for the plausibility of the procedure, Dr. Canavero cites Dr. Robert White’s experiment on head transplantation in monkeys (2). In the 1970’s, Dr. White was able to successfully graft the head of one monkey onto the body of another (7). While the recipient animal only survived for a short time after the experiment, Dr. Canavero argues that advances in medical equipment since the 1970’s would allow for prolonged survival if this procedure were done on a human (4). While the biochemistry behind Dr. Canavero’s procedure may not yet be worked out, the prior success of Dr. White’s procedure on monkeys suggests that there is a very slight possibility that the HEAVEN procedure might be successful. The next ethical consideration in analyzing Dr. Canavero’s proposition would be whether the potential benefits to society would outweigh the risks to his research subject. Many argue that the head transplantation procedure Dr. Canavero intends to carry out violates the Hippocratic Oath because if unsuccessful, Dr. Canavero would have caused Mr. Spiridonov harm. This is a viable concern because there is a high risk that Mr. Spiridonov might not survive the procedure. However, it is also arguable that any surgical procedure puts the patient at an equivalent risk. Furthermore, the potential benefit of this procedure, both for Mr. Spiridonov and for the fields of transplantation and neurosurgery, would be great. If successful, this procedure could completely alter the prognosis for spinal dystrophy diseases and provide patients who are immobilized an opportunity of regaining mobility. In volunteering for the procedure, Mr. Spiridonov has made the decision that the risk of failure outweighs the potential benefits. But since this procedure would impact many more people than just Dr. Canavero and Mr. Spiridonov, is this a decision that they ultimately have the power to make? Since there is a possibility that the procedure may be “successful”, or specifically, that Mr. Spiridonov will survive the procedure, the ethical evaluation of head transplantation must consider the positive result as well. If Dr. Canavero managed to successfully transplant Mr. Spiridonov’s head onto the body of a donor, there is a chance that the results would turn out similar to Dr. White’s monkey experiments – Mr. Spiridonov may not survive very long following the procedure or may be left moribund (4). In this case, the ethical consideration that must be examined is whether it would be appropriate to sustain Mr. Spiridonov alive for as long as possible to observe the results of the procedure or whether euthanasia would be appropriate in his case. In animal research, strict guidelines mandate that animals in severe distress following any experimental procedure should be euthanized. However, euthanasia in humans is considered unethical and in many places, illegal. Conversely, leaving Mr. Spiridonov in a vegetative state and observing until he passes naturally could also be considered unethical and is reminiscent of the practices of Nazi scientists during World War II. Finally, we must consider Dr. Canavero’s procedure in the rare case that everything works as expected and Mr. Spiridonov survives and regains mobility. If this were the case, ethical considerations arise surrounding Mr. Spiridonov’s psychological well-being and quality of life. The first issue is whether the procedure was a head transplant or a body transplant. Since the head is widely viewed as “the seat of the mind” and contains the person’s memories and thoughts, it can be argued that the procedure would be a body transplant for Mr. Spiridonov (7) However, if the procedure were to be successful enough to allow Mr. Spirinov to have children, the gametes in his body would belong to the donor (3). From an evolutionary standpoint, one might be inclined to say that Mr. Spiridonov’s head is just acting as a control center for the donor’s body that is being kept alive. In either case, this uncertainty could have severe psychological impacts on both Mr. Spiridonov and the donor’s family. Another consideration is whether Mr. Spiridonov’s psychological well-being would be impacted during the procedure itself. Dr. Silver, a colleague of Dr. White who observed his procedures, noted that the monkey who survived the head transplant procedure awoke in a state of “pain, confusion, and anxiety”. While this might have been due to the animal’s lack of understanding of the procedure, it is possible that the procedure itself may have altered the animal’s psychological status. While Mr. Spiridonov may be willing to take the risk because of the potential of regaining mobility, many considerations about Mr. Spiridonov’s well-being in the case that Dr. Canavero’s procedure succeeds may not have been evaluated in making this decision. Additionally, many considerations may not even be evident before the procedure is completed. We owe all our advancements to the great minds of the past, present, and future who were willing to pursue an idea as an experiment. But in conducting an experiment, scientists must make take into consideration the potential outcomes to determine whether their proposed experiment should be conducted. Retrospectively, it is easy to point out the experiments that were blatantly unethical as well as those who may have been borderline unethical. However, making the decision of whether a future experiment might be unethical is not always clear-cut. The first consideration of whether an experiment should be carried out is its plausibility. Albeit, the success of some experiments could make such a huge impact in the field that they might be worth a try. However, before a risky experiment is attempted, the potential outcomes of the experiment must also be taken under consideration. In this example, each of the potential outcomes of the experiment present an ethical dilemma that must be further thought through, adding to the complexity of determining whether this experiment is worth pursuing. While Dr. Canavero’s experiment has the potential of changing the outlook for patients with limited mobility, it also has the catastrophic potential of ending Mr. Spiridonov’s life, or perhaps worse, creating a modern Frankenstein. Where should we draw the line?

After WWII and the revelations of the Nazi Doctors’ Trial, eugenics was looked upon with disfavor. American eugenicists still believed in eugenics exported sterilization, abortion, and population to Third World countries like India, Korea, and the Philippines through the United Nations and non-governmental organizations (NGOs). They also consciously transformed the discredited (pseudo)science of eugenics into medical genetics, which seemed avant garde, scientifically sound and, most importantly, culturally acceptable. Because of recent scientific advances such as assisted reproductive technologies and the Human Genome Project, concern about eugenics, biological determinism, and dehumanization in medicine have resurfaced. Reflecting on the resurgence of eugenics, Baylor College of Medicine student Zane Foster expresses his hope “that as modern physician-scientists we would make better decisions that were made in the early 20th century” and his fear that “in another century, who knows what actions today will be considered barbaric.” Eugenics: Science as Morality By Medical Student Zane Foster Today, it seems completely obvious that eugenics is morally unjustifiable. However, this was not the case historically. In the early 20th century, it was a controversial, yet still widely accepted idea. Why was it accepted then, yet so abhorrent now? I seriously questioned this myself throughout this term of medical school. I decided it came down to a combination of two major factors: the culture of science and the culture of the times. As early as grade school, we are taught that science is a tool that we use to observe nature, and philosophy and religion tell us what matters or what is important. This is as idealistic as it is untrue. In anthropology and society, we learn that culture is always being built and reinforced in us from the day we are born until our last breath. Interactions with others modify our habitus, which in turn shapes our outlook on the world. Science is a community much the same as any communities in the world, and the interactions of scientists produce a culture of science. This culture has its creation myths – who can forget Galileo and Darwin, and their stands against the establishment? or Newton and his encounter under the apple tree? – and this culture has its philosophies. In order to conduct science, we must operate under a single philosophical maxim: that which is observable and quantifiable is meaningful, and that which is not observable or quantifiable does not exist and/or does not matter. Put simply, the philosophical framework of science is raw materialism. This works very well for sciences such as physics and chemistry, but causes problems when used in medicine, where the subjects are not mere atoms or chemicals, but living humans with their own sets of values and meaning. The response by the physician-scientists is to label them as “subjects” or “patients”, tolinguistically and symbolically rob them of their human value and turn them into a quantifiable number which can be studied materially. This dehumanizing of subjects for research isn’t necessarily a bad thing: it must be done, or scientific studies could simply not be conducted at all, and the field of medicine would be at a standstill. However, it has the effect of psychologically priming the researcher to treat the subject as a mere statistic, paving the way for mistreatment, if the conditions of the community are just right. In addition to being materialists, scientists are also idealists. Science as a whole is founded on the fundamental idea that nature can be tamed, and obstacles can be overcome. It is this process of overcoming that defines the culture of science. This narrative is so pervasive and so fundamental that it takes on a moralistic tone. That which produces scientific progress, that is to say, intellectual advancements, is thought of as “good”, and whatever stands in the way of this progress is “bad”. Science, like all cultures in the world, is ripe with its heroes such as the aforementioned Darwin, Galileo, and Copernicus, all valiantly fighting against the forces of ignorance. Like materialism, this cultural mindset is mostly harmless. However, what happens if, for example, traditional morality prohibits a study from being conducted? The reaction of the scientist is frustration, as their moral code doesn’t recognize this alien morality. How dare the objections of mainstream culture stand in the way of intellectual progress? An example of this today is the subject stem cell research. In my own undergraduate education, professors always approached the topic from the perspective of stem cell research as a wonderful, untapped research opportunity. The surrounding controversy of the topic was only ever mentioned in a frustrated tone, as something getting in the way of progress. Stem cell research is incredibly difficult to conduct, due to ethics and grant committees set up by individuals often more in tune with the surrounding controversy. No doubt, many researchers would enthusiastically pursue stem cell research if they had the opportunity to do so. This is not to say that scientists are amoral monsters, waiting to be unleashed on the world. No doubt, nearly every scientist in the country today would decry eugenics as a horrible evil. It is just that they have an additional moral code that they follow, which society at large may not necessarily follow. Whenever an individual encounters a new topic, they approach it with whatever moral or philosophical frameworks they were raised or trained to follow. In the early 20th century, eugenics was a new idea. Scientists and academics approached it with the aforementioned moral frameworks, and concluded it was a very good, very progressive, idea. This brings us to the final piece of the puzzle: the culture of the world in the early 20th century. At this time, the western world achieved unprecedented wealth and power – and unprecedented scientific achievement. Within a very short amount of time, physicists had applied theories of their field and provided the world with electricity, telephones, cars and planes. Chemists did likewise and gave the world plastics and petroleum. Economists provided a blueprint for solving the economic boom and bust cycle (or so they thought). Nothing was outside of the reach of science, or so it was thought. Biology promised to apply Darwinian theory to humanity, to improve not just the population of a country but the entire human race. It was an incredibly progressive and innovative idea – and it has a very logical, scientific grounding. Were there those who objected? Most certainly. But at the time, society was so caught up in the idea of human progress that the promises of eugenics captivated the imagination of a vast number of people. This is why eugenics was possible merely a hundred years ago. As materialists, scientists were trained to see humans as scientific subjects, not as people. Their indoctrination into the culture of science trained them to pursue scientific advancement as a moral good in and of itself. Because eugenics existed in a grey, morally ambiguous, area at the time, scientists approached it with this framework, and saw it as a wonderful, untapped opportunity to improve the world. The culture at large was equally receptive of this narrative, also believing it would lead to progress akin to what they had already witnessed from the other scientific fields. It wasn’t until after the horrific images of Nazi Germany were widely disseminated that culture began to shift and eugenics was universally decided upon as morally abhorrent. We hope today that as modern physician-scientists we would make better decisions that were made in the early 20th century, but the truth is, we haven’t a clue. Hindsight alone is what leads us to know today that eugenics is barbaric, and in another century, who knows what actions today will be considered barbaric.

CMATH presented an international webinar on January 29, 2018 titled The Vienna Protocol: Ethical Issues in Dealing with Human Remains from the Holocaust. This webinar reviewed recent discoveries of human remains from the Holocaust, both underground and in museums and medical schools, and the challenges of disposing of them. Leading international scholars on medicine and the Holocaust discussed two key issues: The ethical issues around the initial use of Holocaust victims in medical research and education; and The religious and moral challenges of how to properly dispose of human remains as they are discovered. Speakers included Dr. Barbara Hales from CMATH (moderator) and Dr. Sabine Hildebrandt, Dr. William Seidelman and Rabbi Joseph Polak A Video of Rabbi Polak’s presentation can be found within this article by him Webinar Series - Dealing with Human Remains from Morphological Research in Nazi Germany – The Vienna Protocol The Vienna Protocol and Reflections on Nazi Medicine: Murder à la Carte

Dr. Stacy Gallin, DMH is founder of the Maimonides Institute for Medicine, Ethics, and the Holocaust, and works in the Medical Humanities field, focusing on the philosophy of psychiatry, bioethics and the Holocaust, with attention to various ways to remedy the healthcare system in America. Gallin’s course syllabus focuses on the state of biomedical ethics in World War II, noting how the Holocaust is a unique example of medically sanctioned genocide. The biomedical ethics established during the Third Reich remain relevant for current medical and scientific practice. Gallin notes: “Eugenics, disability studies, end-of-life care, genetic testing, and human experimentation are all topics that are vital to the history as well as the future of bioethics. Exploring the pivotal role played by science and medicine in the labeling, persecution, and eventual mass murder of those deemed ‘unfit’ is essential to preventing other instances of human rights abuses in modern society.” Purpose: This course will focus on the abrogation of biomedical ethics in World War II Germany, demonstrating how the Holocaust is a unique example of medically sanctioned genocide. The biomedical ethical considerations brought to light as a result of the alliance between medicine and the Nazis remain relevant for current medical and scientific practice. Eugenics, disability studies, end-of-life care, genetic testing, and human experimentation are all topics that are vital to the history as well as the future of bioethics. Exploring the pivotal role played by science and medicine in the labeling, persecution, and eventual mass murder of those deemed “unfit” is essential to preventing other instances of human rights abuses in modern society. Objectives: Bioethics and the Holocaust: An Introduction Eugenics: The Pseudo-Scientific Foundations of Genocide The International Eugenics Movement The Biological State: Eugenics in Germany German Medicine and the Nazi Doctors A Method Behind the Madness: How Nazi Ideology Became National Policy Euthanasia and The Final Solution Nazi Medical Experiments Nazi Medical Experiments Debate The Nuremberg Trial: The Birth of Bioethics Current Ethical Implications: Beginning of Life Care, Current Ethical Implications: End of Life Care Medicine After the Holocaust: The Future of Bioethics