A Long Shadow: Nazi Doctors: Moral Vulnerability & Contemporary Medical Culture
For all of that horror and misery Nazi Doctors caused, nobody had to twist any arms to Make them do it. They were the ultimate actualization of the Bureaucrat.
This is the State. And this is Why the State has NO business being In the medical business at all. NO Govt. freebies. Privatize it all, or continue to be victimized by it all.
They're just doing their duty. Filling out the forms. Ticking off the boxes.
More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population. In so doing, these doctors willingly participated in genocide, something that should have been antithetical to the values of their chosen profession. The participation of physicians in torture and murder both before and after World War II is a disturbing legacy seldom discussed in medical school, and under recognized in contemporary medicine. Is there something inherent in being a physician that promotes a transition from healer to murderer? With this historical background in mind, the author, a medical student, defines and reflects upon moral vulnerabilities still endemic to contemporary medical culture.
On a rainy day in Oswieçim, Poland, I stood next to the rusty railroad tracks leading into Auschwitz in the same place where Nazi doctors performed ‘selections’, sentencing millions of innocent people to death or imprisonment by pointing left or right. Although I had spent weeks studying the role of physicians in the Holocaust as part of the Fellowships at Auschwitz for the Study of Professional Ethics, I was incredulous. The value of physicians to the Nazi regime is clear: their support gave scientific legitimacy to the principles of eugenics on which the Nazis built their Rassenpolitik (racial policy) and rationalized murder under the logic of medical necessity. Indeed, without active physician participation, the Nazi regime could not have achieved its murderous aims so efficiently: physicians disguised the horrors by systematizing them and cloaking them in misleading medical jargon. In so doing, they subverted their own professional values. How could so many who had sworn to do no harm have become such an integral part of murder and torture?
What is perhaps more disturbing is the fact that the Nazi regime was neither the first nor the last to facilitate the transformation of physicians into murderers. Physician involvement in torture and murder has been a stain on the profession throughout history.1 In just the last decade, American physicians have been accused of murder in the form of ‘mercy killing’ during the worst of Hurricane Katrina2 and torturing prisoners in Guantánamo Bay.3 If we include murder committed in the name of scientific advancement, the number of physician perpetrators increases still further.
In discussing this issue with medical peers, I have encountered two insufficient explanations. The first is that any physicians who murdered innocent people during the Holocaust were by definition psychopaths, and would have been monsters even if the Nazis had never attained power. I find this explanation unsatisfactory due to the sheer number of physicians who participated: by 1945, half of all German physicians had joined the Nazi party, 6% before Adolf Hitler gained power (by contrast, estimates of physician membership in the American Medical Association are far lower, approximately 20%). Furthermore, 7% of all physicians were members of the Schutzstaffel (SS), compared with
less than 1% of the general population.4 While truly pathological examples exist (Drs Josef Mengele, Sigmund Rascher and Hermann Pfannmüller, among others), most doctors who participated in the Holocaust were regular people who believed that they were doing an unpleasant but morally correct and necessary job.4 In her famous analysis of Adolf Eichmann, who had been in charge of deporting Jews to death camps, Hannah Arendt coined the phrase ‘the banality of evil’ to describe the bureaucratic mentality with which Eichmann completed his deadly work. Eichmann, she argued, was not a monster but a conventional bureaucrat, motivated by career ambition rather than hatred for his victims.5 I view the physicians completing stacks of forms during the T4 ‘euthanasia’ programme, recommending life or death with simple strokes of ink, in a similar light.
The second explanation I have encountered is that even if the Nazi physicians were not monsters, they were forced to participate at risk of their own deaths; they did not have free will and therefore cannot be held accountable for the ‘choices’ they made. However, many studies have concluded that, ‘after almost 50 years of postwar proceedings, proof has not been provided in a single case that someone who refused to participate in killing operations was shot, incarcerated, or penalised in any way’.6 Furthermore, a few doctors did refuse to participate and far from being killed for their actions, they were tolerated and even, in some cases, respected for their decisions.7 Physicians joined the Nazi party and the killing operations not at gunpoint, not by force, but of their own volition. These physicians were normal, sane individuals who chose to commit murder but why? In social psychology, situationism describes the idea that humans make choices based on the circumstances of their social environment rather than an understanding of right and wrong.
Thank You BMJ and Ms Colaianni (hat tip to AHRP.org)