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The Selective Memory of Bioethics by C. Cody Miller

First and second year Baylor College of Medicine students enrolled in Healing by Killing: Medicine during the Third Reich are required to write a paper on a topic of their choosing at the end of the nine-week course. They may write about any topic that is stimulated by the material in the course, which includes eugenics, involuntary sterilization, Nuremberg and Jim Crow laws, involuntary euthanasia, human subjects research, the Nuremberg Doctors’ Trial and Code, how healers become killers, the implications of this history for contemporary medicine, and personal reflections of a distinguished physician, which was Dr. Joseph Gathe this year. Second year student Cody Miller address two fundamental issues about the US response to the medical crimes of the Holocaust: dismissing the bioethics of the Third Reich and thereby disregarding its own eugenic past; and the paucity of education about medicine and the Holocaust.


 

The Selective Memory of Bioethics: Nazi Germany, Ethics, and Education

By C. Cody Miller

The field of bioethics, whether it be applied to health policy, research, or clinical practice, is a rapidly growing and evolving field. With the arrival of the internet age and a subsequent abundance of information, misinformation, and overall visibility, healthcare professionals are being unprecedentedly held accountable for their actions. Medical bioethics, specifically, is being pressed in this new era to the frontline of ethical dilemmas. The days of unquestioned medical paternalism have been replaced with a greater emphasis on patient autonomy and transparency in care. American philosophers in medical bioethics have postulated that the birth of the field can be attributed as occurring stateside in the 1960’s due to advances in medical technology and greater awareness of social justice issues (Callahan 2008; Garrett, Jotterand, and Ralston 2013). However, this declaration of the birthplace and time of bioethics—that is being in the second half of the 20th century and occurring in the United States—fails to recognize the very real field of bioethics that had substantial scholarship and prevalence in Germany both during and prior to the Holocaust.


In the author’s own medical ethics education, bioethics was predominantly presented as having its roots resulting from the Nuremburg Code of 1947, rather than preempting the Third Reich. As mentioned above, many scholars further push the field’s conception decades beyond the end of the second world war. Additionally, there is an apparent exclusive focus on Third Reich German medicine and eugenics as the ultimate failure of ethics without acknowledgement of the American eugenics movement that preceded the Holocaust by nearly 40 years (Allen 2002). It bears mentioning that while a deficit in scholarship on the subject of pre-World War II bioethics exists in the English literature, work has been done by German-speaking scholars (Muzur and Sass 2012). Indeed, while the purpose here is not to in any way justify the horrific events that occurred in Nazi Germany, it is hoped that some light might be shed on the preexistence of bioethics as a field in early 20th-century Germany, that we might take lessons from history and prevent future misapplications of bioethics to unethical ends.


The earliest use of the term “bioethics” identified by literature review is not found in 1960s, nor even 1940s American scholarship, but rather in 1920s Germany. Paul Max Fritz Jahr, a German pastor and theologian, wrote on the subject of der Bioethik as early as 1926 (Jahr 1926), and quite likely drew inspiration from the Bio-Psychik discussed in 1908 by the Austrian philosopher Rudolf Eisler (Eisler 1908). Jahr describes his bioethical imperative in a command, that we must “always, as a principle, respect every living being, as an end in itself and treat it as such wherever it is possible!”


Beyond the ethics of Eisler and Jahr, which were more theologically-oriented and broad in their approach, examples of bioethics in a research context can also be found in early 20thcentury Germany and Austria. One such example is how the Prussian government responded in the trial of Dr. Albert Neisser. Neisser, a German physician known for discovering the eponymous bacterium Neisseria gonorrheae, had been conducting vaccination research in which he injected cell free serum from patients with syphilis into patients who were admitted for other medical conditions. Neisser did not explain the experiment to nor acquire informed consent from these patients, most of whom were prostitutes. When some of the patients contracted syphilis as a result of his experimentation, Neisser would merely retort they contracted the illness through their line of work (Vollman and Winau 1996). Neisser was fined by the Royal disciplinary court due to the absence of consent in these experiments, and in 1900 the Prussian government issued a directive that “all medical interventions other than for diagnosis, healing, and immunization were excluded under all circumstances if ‘the human subject was a minor or not competent for other reasons’ or if the subject had not given his or her ‘ unambiguous consent’ after a ‘proper explanation of the possible negative consequences’ of the intervention.” (Idem). Additionally, one of Neisser’s few medical opponents in his trial–few in that much of the medical establishment supported Neisser during his case, a psychiatrist named Albert Moll published an account of unethical cases of non-therapeutic research on humans and re-emphasized the need for informed consent only two years after the Prussian directive (Moll 1902).


If bioethics existed as early as 1900 in Germany, why then is there such an insistence that the field we know today is not cut from the same cloth? The answer, simply put, is that association with the terrors of the Holocaust, no matter how thin, is unthinkable to most people. The events of Nazi Germany and the physicians and scientists involved in concentration camp experimentation are demonized as having abandoned all ethical pretense. However, it must be understood that the perpetrators of the Holocaust, many of them academics and scholars, believed they were furthering an ethical imperative not unlike the sorts of doctrine conceived by earlier ethicists. Richard Weikart writes in his book Hitler’s Ethic, that “Hitler’s ethic was essentially an evolutionary ethic that exalted biological progress above all other moral considerations. He believed that humans were subject to immutable evolutionary laws, and nature dictated what was morally proper.” (Weikart 2009). While modern hindsight allows us to certainly recognize the evils of Hitler’s ethic, we must not allow this to cloud the reality of the Nazi movement’s roots in Social Darwinism and eugenics, bioethical theories that were equally, if not more popular in the early 20th-century United States as in contemporary Germany (Allen 2002). Moreover, we must not allow our discomfort in this recognition to mold how the history of bioethics is understood, researched, and taught.


The state of Holocaust education in the United States has much to be desired. Recent media coverage of anti-Semitic and neo-Nazi crimes and displays in the United States highlight American misunderstandings of the Third Reich in painfully obvious ways. As of November 2013, only five of the fifty-two states and organized territories of the United States have explicit requirements for Holocaust education on their legal books, and no laws have been successfully passed in the United States prohibiting Holocaust denial (Wikipedia). This trend of lackluster recognition of the true events, origins, and ethical, psychosocial, and economic underpinnings of the Third Reich needs to be addressed. As self-identifying ethical clinicians, researchers, and philosophers, the least we can do is recognize the good work done in bioethics before us, regardless of how it may have been later abused by Hitler’s Nazi agenda. We cannot presume to have all the answers, nor to be above the human mistakes of the past.


“Into this pond were flushed the ashes of some four million people. And that was not done by gas—it was done by arrogance, it was done by dogma, it was done by ignorance. When people believe that they have absolute knowledge with no test in reality, this is how they behave. This is what men do when they aspire to the knowledge of gods.”

-Jacob Bronowski, The Danger of Dogma.


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