Lessons from ethics' darkest days: Remembering medicine's role in the Holocaust

Some 70 years ago. Adolf Hitler's Nazi regime took power in Germany. So began the most horrific abuses of medical knowledge in the history of the civilized world.

Starting last year, American Medical Association's Institute for Ethics and the U.S. Holocaust Memorial Museum in Washington, D.C., have developed a lecture series that examines Nazi medicine and provides some perspective on what can be learned from this dark hour for humanity and medicine.

The lecture series, presented so far in more than a dozen medical schools and available for CME credit, is an outgrowth of the museum's special exhibition, "Deadly Medicine: Creating the Master Race." The run of the exhibition and the lecture series were recently extended to May 29, 2006. The cost of the lecture series is partially underwritten by the AMA Foundation.

Early in the last century, German physicians had a code of ethics and were even pioneers in setting standards for human research subjects. Germany in the 1930s was a world leader in medical research. Germans were greatly represented among Nobel Prize winners. The electron microscope was invented there.

Germany was in the forefront of epidemiology and population research; the first recorded studies of the effects of cigarette smoking were carried out there. The Nazi party even conducted anti-smoking campaigns. There were mass screenings for cancer and the first promotion of breast self-examination. Public health was emphasized.

Yet from the very start of the Nazi regime, things went terribly wrong. The idea of public health was perverted into a horrifying scenario: Mixed with the German notion of "racial hygiene," the same motivations for fitness and health ultimately led to policies aimed at exterminating the "unfit." An early form of genetic screening took place, and there was emphasis on "hereditary health."

Under this ideology, Jews and others became targets for eradication. A JAMA article of that era reported that physicians in Hitler's new German state were taught that the "preeminent duties of the profession lie in the field of the care of public health and race hygiene, or eugenics."

This policy eventually would lead to an evil and murderous campaign for "racial purity," based on eliminating anyone considered unhealthy for the nation -- in this case, anyone who had a disability or was non-Aryan.

The doctors who served the Nazis -- and there were plenty of them -- literally wielded the power of life and death over their victims. In doing so, they were physicians in name only. They used the knowledge and techniques created to diagnose and treat, and determinedly employed them to target, exploit, torture and kill.

It is important to recall and examine this abuse of power in the extreme, given that medical ethics is the guide -- and the constraint -- on the unique position of power and trust that will always be inherent in the practice of medicine.

In the here and now, the AMA Code of Ethics strongly emphasizes physicians' professional obligation to protect the most vulnerable in society.

The noted 19th-century German pathologist, Rudolf Virchow, called physicians the "natural attorneys of the poor," because they can protect the interests of those least able to care for themselves. Such thinking is a keystone of today's medical ethics.

Unfortunately, ethical codes become mere pieces of paper if they are ignored or perverted, as was the case in Germany.

In the words of one physician who has delivered the lecture: "Our medical codes must be living documents" and must be part of every physician's life throughout each step in his or her career.

Renewing attention on tragic events remains painful and difficult. But the work of remembrance takes on even more importance as the living witnesses of those years pass away.

If we are to remain a civilized, caring society, events of the past must not be forgotten. In pausing to reflect on the atrocities of the past, the AMA and its partner, the U.S. Holocaust Memorial Museum, are providing guidance to current and future generations of physicians.