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Casebook on Bioethics and the Holocaust 1 2 Casebook on Bioethics and the Holocaust Casebook on Bioethics and the Holocaust Authors: Tessa Chelouche Geoffrey Brahmer Contributor: Susan Benedict THE UNESCO CHAIR IN BIOETHICS Chairholder: Prof. Amnon Carmi The International Center for Health, Law and Ethics, Faculty of Law, University of Haifa, Israel Israel National Commission for UNESCO The International Center for Health, Law and Ethics Faculty of Law, University of Haifa, Israel Chairholder: Prof. Amnon Carmi Casebook on Bioethics and the Holocaust 1 May 2013 UNESCO Chair in Bioethics e-mail: [email protected] ISBN 978-965-444-034-9 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written and signed permission of UNESCO Chair in Bioethics. As a rule, permission will be given to the review, abstraction, reproduction and translation of this publication, in part or in whole, but not for sale nor for use in conjunction with commercial purposes, subject to acknowledgement of original publication by the UNESCO Chair in Bioethics, the University of Haifa, Israel. The views expressed in this document are solely the responsibility of the authors and do not necessarily represent the view of organizations with which they are associated. COPYRIGHT © UNESCO Chair in Bioethics Graphic design: Vered Bitan Studio Publication: Publications Division, Ministry of Education, Israel All rights reserved © 2013 2 Casebook on Bioethics and the Holocaust Acknowledgments We are especially indebted to Professor Amnon Carmi, UNESCO Chair in Bioethics, International Center for Health, Law and Ethics, University of Haifa. This special project would not have been possible without his perception of the importance of a study like this one. In addition we would like to acknowledge his inspiration, invaluable suggestions, facilitation and support. Casebook on Bioethics and the Holocaust 3 4 Casebook on Bioethics and the Holocaust Table of Contents Foreword 7 Introduction 9 Part One: The Nazi Doctors 15 Historical Background 1. The Adoption of the Concept of Eugenics by Nazi Medicine 21 1.1 Eugenics: Physician Participation in Decisions Concerning the Value of Human Life 21 1.2 Eugenic Sterilization 25 2. Racism and Nazi Medicine 29 2.1 The Use of Race as a Medical Diagnosis 29 2. 2 Racism within the Nazi Medical Community 34 3. Medical Education under Nazi Rule 38 4. Medical Press under the Nazis 42 5. Dual loyalty of Physicians: State vs. Individuals 46 6. The Pressure of Economics on Medicine 50 7. Euthanasia 55 8. The Significance of the Hippocratic Oath 62 9. Medical Research 67 9.1 Doctor-Patient Confidentiality 67 9.2 Informed Consent in Human Experimentation 70 9.3 Parental Consent to Medical Treatment 76 9.4 Utilitarianism in Clinical Research 79 9.5 Use of Unethically Acquired Body Parts 83 9.6 Falsification of Medical Records 88 9.7 Whether to Use the Data from the Nazi Doctors? 91 Casebook on Bioethics and the Holocaust 5 10. Doctors and Torture 97 11. Physician Participation in Genocide 101 12. The Ethics of Pharmaceutical Companies in Medical Research 105 13. Medical Conscience and Whistle- blowing 111 Part Two: The Prisoner Doctors 117 Historical Background 117 1. Medical Futility in Extreme Circumstances 121 2. Medical Triage 124 2.1 Abuse of Medical Triage: The Nazi “Selections” 124 2.2 Distributive Justice 128 3. The Risks of Medical Care 131 3.1 Disclosure of Professional Identity when Confronted with Mortal Danger 131 3.2 Treating the Enemy 134 3.3 Medical Care in Dangerous Circumstances - The Doctor’s/Nurse’s Duty of Obligation 137 3.4 Altering Ethical Stances 140 3.5 Complying with the Nazi Doctors 143 4. Abortion: The Perspective of the Nazi doctors and the Prisoner doctors 146 5. Treating Dying Patients: Refusing to assist patients to die 151 6. Truth Telling 154 7. “Choiceless” Choices in Medicine 157 Appendixes: 160 1. Nuremberg Code, 1947 160 2. The Prussian Ministry of Religious, Educational and Medical Affairs Directive, 1900 161 3. The Reich Health Circular: Regulations on New Therapy and Human Experimentation, 1931 162 4. Declaration of Helsinki 164 6 Casebook on Bioethics and the Holocaust Foreword The initiation of Dr. Tessa Chelouche, a well-known Israeli physician and scholar of medical history, to edit a book on the phenomenon of medical treatment and physicians’ behavior during the holocaust should be highly appreciated. The collection of the relevant data and its drawing out from the hidden archives should have been not only a complicated scientific mission, but also an incredibly difficult emotional experience. It is told about Shimon Dubnov, the great Jewish historian, that when he was led, together with other Jews in Riga, to the execution, he turned to them, saying: “Remember, remember (in Yiddish: schreibt un verschreibt), write down everything”. Remembering – what good will come of it? Why should we conjure up ghosts? Why should we open the gas chambers, the Pandora box of torture and despair that the holocaust evokes? Why should we gather every string of our strength in order to remember, when it hurts so much? “If we look too intently in the direction of the dead”, Elie Wiesel said, “we run the risk of being tempted to join them”. Remembering is not an end in itself, it is only a tool. The use of this tool might be justified for one purpose only: NEVER AGAIN! Not for the purpose of scientific recording, not for the purpose of glorifying the martyrs’ deaths. What’s done cannot be undone, and remembering dead will not bring them back. “Never again” calls for the survival of mankind, of humanity. While reading the cases that have been collected by Tessa Chelouche, Geoffrey Brahmer and Susan Benedict, it is difficult to understand how a people could become a people of killers or accomplices of killers, and how the medical doctors could afflict such pain on human beings. Casebook on Bioethics and the Holocaust 7 In the words of Elie Wiesel: “I don’t understand how it happened. And the more I live, the less I will understand. But I will go on learning, and that is another lesson- although we don’t understand, we must continue to learn”. The Bioethics Chair (Haifa) was authorized by UNESCO to promote and advance the teaching of ethics in medical schools worldwide. The Chair satisfies the need of teachers and students by producing and providing them with a series of guiding books of which this publication is one of them. The formation of ethical codes and books is not enough until their implementation. Implementation means education. Bioethics and the Holocaust offers the understanding of the Holocaust phenomenon. The struggle with the insoluble question – how could it happen – may enable our students to realize the wish and the need of Never Again, and to fulfill the testament of :schreibt un verschreibt. Prof. Amnon Carmi, Head UNESCO Chair in Bioethics (Haifa) 8 Casebook on Bioethics and the Holocaust Introduction The greatest stain on the record of medicine in the 20th century is the role played by German physicians in the Nazi period. When the Nazis came to power, German medicine 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 then 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. At the post war trial at Nuremberg, only twenty German physicians were tried for crimes against humanity. After this trial, the world medical establishment cultivated the theory that the violations that had occurred within the profession were the acts of a handful of physicians working in a few notorious places like the concentration camps. The trial and the Nuremberg Code which emulated from the trial did not receive sustained attention until the mid 1960s. What the medical profession had done in Nazi Germany seemed altogether irrelevant to physicians in the rest of the world. Today, we know better. The whole profession and not just a handful of doctors, was implicated in the gross offenses that occurred under Nazi rule. In the 1980s, historians began to publish studies that showed the full extent to which Nazism had permeated German medicine. More than half of the German physicians were members of the Nazi Party, the highest percentage by far of all other free professions. German physicians began to elevate service to the state above medical ethics well before the Holocaust, the term used for the genocide of the Casebook on Bioethics and the Holocaust 9 Jews, occurred. In the early years of the 20th century, German physicians promoted policies of racial hygiene and eugenics in their eagerness to limit the reproduction of people believed to have hereditary disorders. Between 1939 and 1945, they sterilized an estimated 400,000 Germans with mental and physical disorders. German physicians designed and implemented the notorious T-4 program, where they performed medical murder on their mentally and physically handicapped patients in the name of “Euthanasia.” The goal of producing a pure Aryan race took precedence over fundamental medical ethical principles. German medicine became an arm of state policy.
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