By Edward C. Halperin, M.D. ,M.A.
A lot of what you and I take for granted as lynchpins of modern biomedical ethics are a result of the European Holocaust perpetrated by the Nazis and their collaborators. As a result of the horrific “medical experiments” carried out by German doctors on concentration camp victims and the concepts articulated at the post World War II “Doctor’s Trials” at Nuremberg, it is now generally accepted that medical research on humans requires oversight by a properly constituted institutional review board that evaluates both the scientific and ethical ramifications of the experiment.
Most of us agree that adult patients must provide informed consent to participate in a medical experiment and children must have consent provided for them by a responsible adult. Insofar as German doctors joined the Nazi party more quickly and in larger percentages than any other professional group, it is now recognized that doctors must take care to remember that their primary obligation is to their patients, not to a third party such as the government, an insurance company, or the profitability of their employer such as a hospital or large group practice.
When doctors participate in government-sanctioned torture in the interrogation of alleged terrorists at Guantanamo and elsewhere, and when they do or don’t order medical tests or procedures because it affects the profitability of the hospital or the insurance company or a drug company rather than serve the best interests of the patient, they are ignoring the ethical concept of “The Banality of Evil” as articulated by the philosopher Hannah Arendt after the trial of Adolf Eichmann. She wrote that evil is generally envisioned and articulated by sociopaths.
For evil to succeed in the world, however, the average person has to treat it as a normal, everyday event.
Unfortunately only 16 percent of U.S. and Canadian medical schools have part of their curriculum devoted to the biomedical ethical lessons of the Holocaust. This should change. Medical students need to learn about the role of doctors in promoting concepts of eugenics, inventing gas chambers, murdering psychiatric patients and the mentally retarded, and the creation of killing chambers in concentration camps, as well as the role of white physicians in aiding the American slave trade, the use of African-American bodies in gross anatomy instruction in the 19th and early 20th centuries, and resisting hospital and medical society desegregation in the 1950s and 1960s. And the heroic exceptions who resisted the prevailing mores of their time.
Those who ignore history are doomed to repeat it. Holocaust education is an important tool for educating the next generation of doctors.