Medical ethics after Auschwitz

I am inspired by Franklin Littell's accomplishments of the past forty years and, in particular, by his question about the Holocaust, "Where were you?" As a physician, I can say that we were right there. The medical professions, including nursing, bioscience, and public health, committed egregious and well-documented violations of medical ethics. We were willing and enthusiastic participants in the events of the Third Reich. We sterilized disabled German citizens. We decided who would marry and who would not marry. We euthanized German children and adults whose lives were "not worth living." We designed the gas chambers for mass murder--and we were on the ramps making selections. We were there. In answering the question about medical ethics after the Holocaust--"How We Have Changed, or Have We?"--I can say that the medical ethics of human- subject research has improved greatly. The Nuremberg Doctors' Trial focused on the medical experiments, and the court issued ten points about human-subject research that is now known as the Nuremberg Code. Although there was resistance by bioscientists to restrictions on human-subject research, the United States eventually accepted the Nuremberg Code and established Institutional Review Boards, which effectively protect most volunteers in medical-research projects. As serious as the medical ethics violations were in the medical experiments, the most serious violations occurred in clinical medicine and public health, which were philosophically dominated by eugenics. "Eugenics" is defined by the Oxford English Dictionary as "the science [sic] dealing with factors that influence the hereditary qualities of a race and with ways of improving these qualities, especially by modifying the fertility of different categories of people." Positive eugenics favors the transmission of desirable genetic traits by encouraging procreation and medical care for the superior races, while negative eugenics discourages the transmission of undesirable genetic traits by suppressing procreation and medical care for the inferior races. The Nazis promoted eugenics to the German public via posters, movies, and public education. For example, German propagandists devised mathematical problems for school children that compared the cost of caring for healthy children with the cost of caring for children with various disabilities. Hitler also used eugenic theories to enroll the medical professions in the elimination of the inferior races and the creation of a superior German yolk able to compete with and even conquer the rest of the world. Dr. Robert Jay Lifton, in The Nazi Doctors: Medical Killing and the Psychology of Genocide, described the Nazi philosophy of applied biology as one of "absolute control over the evolutionary process, over the biological future. Making widespread use of the Darwinian term 'selection,' the Nazis sought to take over the natural functions of nature (natural selection) and God (the Lord giveth and the Lord taketh away) in orchestrating their own 'selections,' their own version of human evolution." (1) Indeed, Hitler was promoted as the doctor to the German people, fundamentally changing the Hippocratic doctor-patient relationship into a new state-volk relationship. Shortly after becoming Chancellor of the Reich in 1933, the "doctor to the German people" passed the Sterilization Law, which led to the involuntary sterilization of 400,000 German citizens, not necessarily Jews, suffering from "genetically determined" illnesses. In 1935, the Nuremberg Laws were drafted to protect "German Blood and German Honor" and to protect the "Genetic Health of the German People" from contamination from the genes of the Untermenshen. In 1938, a parent and grandmother of infant Knauer, born with multiple malformations, petitioned Hitler to mercifully end the life of the child, who was the first of more than 5,000 children killed in the children's euthanasia program. …