Nazi war crimes provide lessons in medical ethics
■ German physicians and scientists helped carry out the regime's policies. What can today's doctors learn from this tragic history?
Skokie, Ill. -- In the 1930s and 1940s, hundreds of German medical professionals took part in a euthanasia program that targeted children younger than 3 years old with severe birth defects. Doctors and midwives were required to report such cases, and parents were told that advanced care could be given to children at 30 special pediatric wards around Germany.
Instead, the children were murdered, usually with sedatives. Physicians drew up falsified death certificates, and parents were told their children died of natural causes such as pneumonia. An estimated 5,000 children fell victim to physicians and other medical professionals who went from healers to killers.
These actions were far from the exception in Nazi Germany, said experts at a recent lecture on this ghastly chapter in medical history.
The misguided scientific ideas of physicians and scientists were integral to Nazis' crimes against humanity and should serve as a reminder to doctors to put patients before political ideology, they said.
"We all believe medicine to be about healing and caring, but those traditional concepts of medicine were profoundly shaken and profoundly challenged in the 1930s and 1940s when medical professionals lent their services to the policies of National Socialism," said Patricia Heberer, PhD, a historian with the Center for Advanced Holocaust Studies at the U.S. Holocaust Museum Memorial in Washington, D.C.
Heberer spoke here in November before a crowd of more than 100 people at the Illinois Holocaust Museum & Education Center. Through Jan. 2, 2011, the center is hosting a traveling exhibit called "Deadly Medicine: Creating the Master Race."
The exhibit, which opened in Washington, D.C., in 2004 and will go next year to St. Louis and New York City, tells the story of how German scientists and doctors infatuated with eugenics devised a legal program that sterilized 400,000 Germans with disabilities. An additional 200,000 "incurables" were killed under various Nazi euthanasia programs developed and supervised by physicians.
"There was an international movement of eugenics that helped shape these policies, especially this idea that human heredity is fixed and immutable," said Heberer, a specialist on medical crimes and policies in Nazi Germany. "Unlike anti-Semitism, these were ideas that did not start with Hitler, but rather were cutting-edge scientific ideas."
In 1933, a eugenic sterilization law required physicians to report any patients with epilepsy, "feeble-mindedness" and conditions such as alcoholism to "hereditary health courts" for review. Physicians and other medical professionals analyzed the reports and gave approval for forced sterilization. About 64,000 Americans were coercively sterilized under similar U.S. laws.
Along with the child euthanasia scheme, adults were targeted through Operation T-4, named after the program's headquarters at Tiergartenstrasse 4 in Berlin. Medical experts reviewed perfunctory patient reports to determine who was fit -- and "unfit" -- to live. Medical professionals used carbon monoxide poisoning in gas chambers disguised as showers to carry out the euthanasia program.
"So much of the technology and camouflaging techniques were later borrowed by the designers of the Final Solution," Heberer said.
Monsters or medical leaders?
As evil as these actions appear in retrospect, they arose out of a highly sophisticated German medical culture, said Matthew K. Wynia, MD, MPH, who also spoke at the event.
More than half of the Nobel Prizes that were awarded in science through the 1930s went to Germans. They were the first to link smoking and cancer, encouraged pregnant women to avoid alcohol and tobacco, and adopted an ethics code in 1931 that barred clinical research without getting patients' "unambiguous" consent.
Where German medicine then went wrong is that physicians began to view improving the health of the "body politic" as a whole as their principal aim, said Dr. Wynia, director of the American Medical Association Institute for Ethics. "They underwent a psychological shift, where they pursued national goals rather than the protection of their patients."
At the same time, he said, German physicians who helped devise and carry out the Nazi sterilization, euthanasia and wartime experiments should not be seen as pure monsters.
"If we divorce ourselves from them or view them as entirely alien, then our ability to understand these medical crimes is thwarted, as well as is our ability to prevent other medical crimes," Dr. Wynia said. "These doctors became killers, not despite their training but in the name of their science and training."
Twenty-three physicians were tried at the so-called Nuremberg Doctors' Trial in 1946, which gave birth to the Nuremberg Code of ethics regarding medical experiments.
Physicians today continue to be tested by issues such as racial and ethnic health care disparities as well as the dual-loyalty dilemma in military service, Dr. Wynia said. That is why it is so important for doctors to maintain their professionalism in the face of political and other pressures.
"Ethical codes are of little use if they are not acted upon," he said. "The Germans had excellent ethical codes."
The lessons of the Nazi era, he said, are ones that physicians should heed.
"This is not just Jewish history," Dr. Wynia said. "All doctors and medical professionals need to know and understand this material."