Commission on Nazi era medicine to inform modern ethics teaching

The most comprehensive report to date on medical atrocities under Nazism and during the Holocaust will help the medical community to be better equipped and resilient in the face of ethical pressures, it was announced today.

The Lancet Commission challenges long-held misconceptions about medicine in the Nazi era, such as that only a few extremist doctors carried out medical crimes, its participants say.

The authors say the detection and prevention of crimes against humanity and genocide, as well as care for the victims, should be integrated into the medical ethos.

They urge universities, medical schools, research institutes and other professional organisations to consider the evidence and recommendations.

The report, which was written by an international group of 20 scholars, physicians, and researchers with expertise in history, medical education, and bioethics, is the first Lancet Commission to focus on the history of medicine.

Commission co-chair Dr Sabine Hildebrandt of Boston Children’s Hospital and Harvard Medical School, USA, said: “Nazi medical atrocities represent some of the most extreme and best-documented examples of medical involvement in human rights violations in history.

“While it is tempting to view the perpetrators as incomprehensible monsters, the evidence put forward by the Commission demonstrates how many health professionals were capable of committing ethical transgressions and even crimes against their patients under certain conditions and pressures.

“Health professionals — who often care for people at their most vulnerable — have a unique and important duty to develop and preserve a strong moral agency. By learning about medicine’s role and health professionals’ behaviour under Nazism, they can further develop their own moral reasoning and stand up to abuses of power in the name of individual patient rights and the dignity of all human beings, regardless of race, ethnicity, religion, and other individual characteristics.”

While the Nazi regime is not the only instance in history in which members of the medical community were involved in crimes against humanity, it is one of the most extreme, well-organised, and extensively documented examples of medicine’s active participation in human rights violations, say the authors.

During the Nazi era, the medical community helped to create, justify, and implement policies to meet the Nazi doctrine and changed their understanding of medical ethics accordingly, with physicians joining the Party and its affiliated organisations in higher proportions than any other profession.

Germany’s medical and research institutions also played instrumental roles in the regime, rationalising eugenics, forced sterilisation, the “euthanasia” patient murder program, and brutal human experiments.

In life and death, the bodies of Nazi victims were used for research and teaching, and specimens of their human remains were sometimes kept in scientific collections for decades after the war. Current understanding of aviation safety, hypothermia, as well as the effects of tobacco and alcohol use on the body has also been informed by research in the Nazi era but awareness of how the research was obtained is scarce.

Commission co-chair Professor Shmuel Pinchas Reis, of the Center for Medical Education at Hadassah/Hebrew University Faculty of Medicine, Israel, said: “Accountability for and recognition that crimes were committed in the name of medicine in the Nazi era and during the Holocaust remains woefully inadequate.

“Medical students, researchers, and practising health professionals should know where – and from whom – the foundations of medical knowledge come from. Victims of Nazism are owed that; they have a right to be honoured and treated with dignity in life and death for coerced contributions to medicine as we know it today.

“The goal of our report is to provide additional resources and information for medical schools, research institutions, and medical associations worldwide to continue accountability efforts as part of their responsibility to past and future generations.”

Among the key recommendations are: incorporating the study of medicine, Nazism, and the Holocaust in curricula for all medical students and health professionals; encouraging students and medical professionals to develop a history-informed professional identity; universities, psychiatric hospitals, and other medical institutions actively identifying and commemorating victims of Nazi medical crimes and initiate research to better understand their direct connections to human rights violations in the past.

Dr Hildebrandt added: “Over the last few years, scientific research, medical, and health policies have been subject to great scrutiny. Our report sets out some of the most horrific distortions of medical practice and policies in history, and it is incumbent on all in the health and medical community to keep the memory of the events of the Nazi era from fading.

“We must study this history of the worst of humanity, to recognise and work against similar patterns in the present, with the goal of promoting the best. We must speak out against antisemitism, racism, and other forms of discrimination, uphold and advocate person-centred, human rights-based medicine, protect the vulnerable, serve the marginalised, and acknowledge the humanity and dignity of each and every patient.”

The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow. Lancet 9 November 2023

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