When Healers Became Killers

75 years after Auschwitz – The importance  today of educating medical professionals on the Holocaust

By Dr. Tessa Chelouche

On the 27^th of January the world commemorates the 75^th liberation of Auschwitz-Birkenau on International Holocaust Remembrance Day. In the past few years, the world has witnessed violent and disturbing antisemitic attacks in many countries. One of the ways to combat antisemitism is to educate on the Holocaust. The medical profession has a major responsible role to play in perpetuating this education because unlike other instances of genocide that the world has witnessed, the Holocaust was a medically sanctioned genocide. The greatest stain on the record of medicine in the 20^th century was the role played by German physicians during the Nazi period.

When the Nazis came to power in Germany, medicine there was among the most sophisticated in the world. German medicine had contributed to, and shaped, academic and clinical medical practice worldwide. Despite its preeminence, however, German medicine became enmeshed in the Nazi ideology and broadly complicit in the conceptualization and promulgation of the Nazi racial and social programs. The engagement of the medical profession was extensive and was led by the active involvement and support of the academic establishment. Medicine was not alone in its support of National Socialist policies, but the medical profession differed from the other professions in its explicit commitment to an ethical basis, to a humanitarian stance and to a 2000-year-old Hippocratic Oath that placed the sufferer first.

German physicians began to elevate service to the state above medical ethics well before the Holocaust – the term used for the genocide of the Jews – occurred. In the early years of the 20^th century, German physicians promoted policies of racial hygiene and eugenics in their eagerness to limit the reproduction of people believed to have hereditary disorders: the disabled and the chronically ill who were considered as a burden to society. Between 1939 and 1945 they sterilized an estimated 400,000 Germans with mental and physical disorders. Following this, German physicians designed and implemented the notorious T-4 “Euthanasia” program, where they performed medical murder on their mentally, physically and socially handicapped patients with the goal of producing a pure Aryan race. This policy was ethically sanctioned by the Nazi medical profession in Germany. Traditional medical ethics was adapted and altered to suit the policies of National Socialism. Nazi physicians did not abandon medical ethics as is usually perceived, but rather replaced traditional fundamental universal medical ethics with selective medical ethics. The disabled and the chronically ill, the feebleminded and the “unproductive” members of society were perceived as living “lives unworthy of living” and as such did not deserve to be treated according to the regular medical code. This new ethical code was taught at every medical school in Nazi Germany and a special textbook was required reading for this compulsory course. More physicians were members of the Nazi party than any other free profession. They were not forced but joined of their own free will and they joined early on. In this manner, German medicine became an arm of Nazi state policy. Nazi physicians failed to see themselves as physicians first, with a calling and an ethic dedicated to healing and caring for the well-being of human beings. Instead they believed that the welfare of the state was to take precedence over their individual loyalty to their patients.

The above-mentioned medical programs of sterilization and “Euthanasia” became enmeshed with the policy of virulent antisemitism, and as such were the forerunners for the Holocaust – the genocide of the Jews at concentration camps like Auschwitz-Birkenau and many others. The ‘medical murders’ that began in the hospitals in Germany and Austria, culminated in the murder of the Jews and other minorities in the camps, as the extermination of millions of people was considered as “treatment” for the state. The same professionals who were involved in the T4-“Euthanasia” program, among them many physicians, were consulted when the camps were built and were the medical experts who were consulted in the design and activation of the gas chambers.

Although the subject of ‘Medicine and the Holocaust’ usually brings to mind the cruel and barbaric experiments, medicine was involved long before the infamous experiments were performed at the various camps, hospitals and clinics. In 1946 one of the first post war trials to be held was the “Nuremberg Doctors’ Trial.” For the first time in history, physicians were tried for crimes against humanity for their participation in murderous and tortuous experiments conducted in the Nazi concentration camps. In the final judgment, the court articulated what is known as the “Nuremberg Code”, the first international code for human experimentation. In fact, it was in the ashes of the Holocaust, through the formulation of the Nuremberg Code that modern medical ethics, known as bioethics, was born. All contemporary bioethical codes are based on what transpired in the profession in the years preceding and during the Holocaust. Every ethical issue under consideration today – among others: the value of human life, disability care, equity in medical care, genetics, public health, research ethics, health system economics, reproductive medicine, abortion, military medicine, refugee care, death and dying – includes inquiry influenced by the Nazi medical crimes.

Medicine is a powerful profession and was especially so under the National Socialist regime. The questions that need to be asked are:

• How did a professional group that was internationally respected, scientifically innovative and ethically advanced, evolve an understanding of their social, ethical and scientific obligations only to lead them to use their advanced medical knowledge and professional ethics to justify committing cruel and heinous medical crimes against humanity?
• How did healers become killers?

It was precisely the success and power of the profession in Nazi Germany that led to its hubris and collusion with a racist political regime. These physicians were not peripheral actors in the attempt at collective regeneration. Rather, they were central and crucial to the running of Auschwitz and the other camps as well as to the evolution and fulfillment of broader extermination policies.

Medicine was abused then and is constantly in danger of being abused today. It is not enough just to say, “Never Again.” As medical professionals, we have a responsibility to act so that this does not happen again, certainly within our profession. Education on ‘Medicine and the Holocaust’ can contribute significantly to professional identity formation of healthcare students. This history can help to instill a moral compass in future generations of healthcare professionals. Learning from the past can provide them with a way of reflecting and discussing inherent medical challenges in the present. Using this lens, we can encourage the aversion to racism and overt prejudice. But in addition to the value that this discourse can have on the next generation of medical professionals, the inclusion of education on the Holocaust in today’s world can also do much to vanquish the evil that is antisemitism.

75 years after Auschwitz the time has come to teach!

Dr Tessa Chelouche, born in South-Africa, is a Family Physician in Israel. She is the Co-chair of the Unesco Deaprtment for Bioethics and the Holocaust, Unesco Chair of Bioethics, Haifa and the Co-director of the Maimonedes Institute for Medicine, Ethics and the Holocaust.