From ... in History — Nov 13, 2023

Online First for The Lancet Commission on Medicine – Preventing Healers From Becoming Killers.

Now 77 years after the Nuremberg Medical Trial, which charged 23 leading German doctors and and administrators for participating in war crimes and crimes against humanity, the Lancet says “the health professions must now have the moral backbone to prepare students to safeguard against and report atrocities, address institutional racism and antisemitism, defend against unethical research, and report abusive doctors so that this will never happen again.”

For the first time, a Lancet Commission is dedicated to the history of medicine: Nazi medicine. The report, The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow, launched on Nov 9, and said by the Lancet to be the most up-to-date scholarly evidence on the history of Nazi medicine and its central role in the so-called Final Solution—the German Government’s plan to annihilate European Jewry.

Preventing Healers From Becoming Killers

Published: November 08, 2023 by the Lancet.

Executive Summary

The Holocaust, the systematic, state-sponsored persecution and murder of 6 million Jews by the National Socialist (Nazi) regime and its collaborators, is arguably the most extreme instance of crimes against humanity and genocide in history. During its reign of terror, the Nazi regime committed innumerable acts of violence against Jews, Sinti and Roma, people with disabilities or psychiatric illnesses, political prisoners, prisoners of war, LGBTQ people and others. A distinctive and disturbing feature of these atrocities is the important role that health professionals played in formulating, supporting, and implementing inhumane and often genocidal policies.

After World War 2, these crimes were important factors that contributed to the establishment of contemporary health professional ethics. Learning about, and reflecting upon this history can have various benefits for learners and practitioners of health sciences, as well as the patients and communities they serve. Health sciences curriculums, however, rarely cover this topic. The core values and ethics of health care are fragile and need to be protected. They require constant critical assessment and reinforcement.

6 million Jews were murdered, along with 250 000–500 000 Roma and Sinti people, gay men, political prisoners, and others. The Commissioners consider the report necessary due to “the decades-long post-war refusal of the medical community to engage with this history in Germany and worldwide and the long-standing myths about the relation between the Nazi regime and medicine”. The Commission also calls for this history to be taught within all health education curricula.

How do healers become killers? How could medical professionals perform heinous experiments on concentration camp victims? The awful truth that the report painstakingly describes is that the medical profession in Germany subscribed to an antisemitic, racist, and eugenics-based ideology towards populations that they deemed to be genetically inferior. In 1933, Nazi Germany introduced a forced sterilisation law, developed with legislation prepared by German physicians. 310 000–350 000 victims underwent sterilisation.

Between 1939 and 1945, at least 230 000 victims were murdered in killing programmes, including 7000–10 000 children in one programme, as well as others in the Aktion T4 programme to euthanise institutionalised people with physical, mental, and developmental disabilities.

The Commission’s report also calls out several myths about the role of physicians during the Nazi period. For example, there were not just a few extreme cases, such as Dr Josef Mengele. Over half of German physicians were members of the Nazi Party. Another myth is that Nazi science was so-called pseudoscience; yet a substantial amount of the medical research conducted in Nazi Germany was based on the scientific method and published in international journals. The report also eliminates the myth that there was little to no Jewish medical professional life in the ghettos. Jewish physicians managed clinical settings and cared for their patients even in dire circumstances.

Why does this dark chapter in medicine have implications for today? The history of Nazi medicine provides well documented examples that can help to develop a professional identity among future health-care professionals. Physicians have “enormous power over the lives of individuals and communities”, we wrote in 2019. Even with the safeguards first put in place with the Nuremberg Code of Ethics to ensure ethical human research following the Holocaust, no amount of oversight will stop all professional misconduct. The leadership of all bioscientific institutions and professional societies is required to ensure that history-informed professional identity formation is seen as an essential element in health education.

Unfortunately, there is still unfinished business to be addressed from the Nazi medicine era. There are human remains at universities and bioscientific institutions. These institutions should actively identify and commemorate victims of Nazi medical crimes and initiate research to better understand their connections to human rights violations. It is the least that these institutions can do.

There is hope that comes from pointing a spotlight on the worst of physicians’ behaviour. The Commission is an example for all health professionals that truth and reconciliation may be possible. German Commissioners, some the children of Nazi-era parents and others from former Nazi-occupied countries, and Jewish people from the USA and Israel, some the children and grandchildren of Holocaust victims and survivors, worked side by side to wrestle with this history and its implications for the health profession today. An international medical student advisory council provided a fresh view on the relevance of medicine, Nazism, and the Holocaust and were a future-oriented and optimistic presence.

Medicine in the Nazi period left a permanent stain on the medical profession. 77 years after the Nuremberg Medical Trial, which charged 23 leading German physicians and administrators for their willing participation in war crimes and crimes against humanity, the health professions must now have the moral backbone to prepare students to safeguard against and report atrocities, address institutional racism and antisemitism, defend against unethical research, and report abusive doctors so that this will never happen again.

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Obviously we have to agree, medical professionals and all practitioners of health sciences, must learn about this history, but is that enough? We should not have to learn in class how to treat people humanely, but if it helps those who are working as government robots and politicising medicine instead of caring for the actual person as per their oath, then it is a good thing.

The question has to be asked, where the hell were you Lancet when we needed you!? Better late than never perhaps?

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