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Medicine after the Holocaust

Sheldon Rubenfeld (ed.), Medicine after the Holocaust; From the Master Race to the Human Genome and Beyond, Basingstoke: Palgrave Macmillan, 2010. Pp xxi + 233. £52.50. ISBN 978 0 230 618947.
  1. Naomi Baumslag?

  1. Georgetown University Medical School

This book consists of a compilation of 20 articles from the Michael DeBakey Medical lecture series at the Holocaust Museum in Houston from 2007 to 2009. The lectures focused on the role doctors played before, during, and after the holocaust. Sheldon Rubenfeld, an internist, proposed this lecture series which explored the question ‘if the best physicians of the twentieth century could abandon their patients, can we, the best physicians of the twenty-first century do the same?’ (p. 5). The book has 20 chapters: six are devoted to eugenics, euthanasia and extermination and the remaining 14 chapters focus on medicine after the holocaust. The speakers in the series included a wide variety of luminaries of various professions: geneticists, bioethicists, physicians, lawyers, historians, rabbis and politicians. Amongst the speakers were three Nobel laureates—James Watson, Ferid Murad and Eric Kandel—but no survivor spoke.

In an effort to create the master race, Nazi physicians and scientists used American models, money (from the Rockefeller Foundation) and support. The United States was the first country to require compulsory sterilisation. German doctors during the Third Reich sterilised 400,000 and euthanised 200,000 German citizens. German doctors applied the euthanasia technology they had learnt from the creation of crematoriums to build gas chambers and gas vans to murder 6,000,000 Jews. Volker Roelcke states that during the Nazi period, 50–65 per cent of the German medical profession voluntarily joined the Nazi party but the rest did not. However, some of these German doctors who conducted unethical experiments and murderous actions were not Nazis. Michael Grodin covers the physician healers who tortured and murdered. Joining a political party, according to Grodin, is one thing, using ideology to torture and exterminate an entire people is another. In the foreword Francis Collins, current director of the National Institute of Health, states that the medical profession must not forget its role in the eugenics horrors of the past and must be vigilant against the appearance of any recurrence so the past does not become a prologue of the future. But how to do this is not explained.

Pre-war Germany had the most advanced code of ethics and directives in relation to human experimentation. Medical ethics was handled by the German medical association and Reich chamber of physicians. During the Third Reich, German doctors ignored the traditional Hippocratic Oath of Ethics, ignored the Berlin Code of 1900 and violated the 1931 Reichsrichtlinien Directives on human experimentation and drug therapy. German public health doctors established ghettos on the pretext that if the typhus infected Jews were not isolated they would cause epidemic typhus. Doctors disguised the crematoriums for gassing as ‘disinfection baths’. In December 1941, as typhus was taking a toll on the war front and guinea pigs were in short supply, Germany’s top doctors concluded that as animal tests could not provide adequate evaluation of typhus vaccines, experiments on humans must be conducted. To save thousands of German soldiers it was necessary to sacrifice prisoners. In none of the hundreds of experiments was voluntary consent obtained as a prerequisite for ethical experiments.

The post holocaust chapters cover a variety of topics and include many interesting chapters on genetics and eugenics, including James Watson’s ‘Personal Odyssey’, Arthur Caplan’s ‘The Stain of Silence’ and the chapter by Leon Kass ‘A More Perfect Human’, which identifies some of the deadly dangers of seductive ideas and practices of science for salvation and measures to prevent the birth of ‘defectives’. Kass believes that genetic screening and choices of genes targeted for testing have been made by scientists, not the public, and ‘the eugenic mentality is taking root’ (p. 115). Through ‘science’ we are learning that certain lives are unworthy, drugs can erase troubling memories or alter personalities in pursuit of perfection. He closes by stating that ‘the good we will do with science and medicine can only be completed by avoiding those evils that come from seeing health as salvation, the soul as biochemicals, and medicine as the messiah’ (p. 121).

Ethical challenges are emerging with technology. These new challenges include: pre-implantation genetic diagnosis to avoid Tay-Sachs disease, and other less severe genetic diseases of later onset; and gender selection, which is offered by 42 per cent of in vitro fertilisation clinics. ‘Homemade eugenics’ provides a classic collision of ethical, legal and social principles that make regulation difficult. According to Wesley Smith, the Dutch have legally permitted euthanasia and assisted suicide since 1973 expecting it would not be common, but unfortunately the Dutch euthanasia guidelines have failed to prevent euthanasia. In addition to killing babies, Dutch physicians routinely euthanised patients who had not asked to die. One study reported that involuntary euthanasia by lethal injection, without request or consent, accounted for 1,040 deaths. Doctors killed thousands of Dutch patients who never asked to be euthanised.

Most doctors and medical students are unaware of the German doctors’ atrocities that were perpetrated in the holocaust, but one fears that if there is not better enforcement of ethical code regulations science will be put ahead of humanity. Public health doctors killed Jews to eradicate typhus, but not lice. Better ways of enforcing ethical codes and rules regarding human experimentation need to be devised. Very few German medical perpetrators were prosecuted. It is not enough to leave ethical monitoring and enforcement to the medical profession. A consumer oversight committee with the ability to enforce ethical regulations and human rights is urgently needed so such evil never recurs. It is questionable if anything will change as a result of this compilation of lectures. The book is expensive, but it is also available on the internet. Individuals must be held accountable for their unethical actions. Above all, humanity must come before science.