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  • New Conference Videos from Houston Methodist Research Institute

    Houston Methodist Research Institute (HMRI) has generously co-hosted several conferences with our Center for Medicine after the Holocaust (CMATH). They have posted selected videos from two of these conferences, HUMAN SUBJECTS RESEARCH AFTER THE HOLOCAUST and the FIRST INTERNATIONAL SCHOLARS WORKSHOP ON MEDICINE AFTER THE HOLOCAUST on their website at: http://www.houstonmethodist.org/cmath A full listing of the speakers and their lecture topics will be found on the attached pdf.

  • Michael Burleigh's "Film Selling" Murder, Followed by Lecture "Cinematic Perspectives on Euthanasia and Assisted Suicide"

    Brown Foundation Professor of Psychoanalysis, Professor, and Director, Baylor Psychiatry Clinic, Baylor College of Medicine

  • Radical Evil: 2013 Film Deconstructs Psychology of Nazi Killers

    Streaming film directed by Stephen Rosewitzki | Austria / Germany / 2013 | 96 minutes | English, German, Ukrainian | Hebrew subtitles. The film deconstructs the process of transforming average men into ideologically motivated killers and takes the viewers on a psychological and intellectual journey into the roots of evil. Purpose: Directed by Austrian Oscar-winning director, Stephen Ruzowitzky, the film deconstructs the process of transforming average men into ideologically motivated killers and takes the viewers on a psychological and intellectual journey into the roots of evil. Ruzowitzky’s film is composed of re-enactments of actors portraying the Einsatzgruppen soliders, archival footage and sounds recordings from the Holocaust era as well as interviews with psychologists, historians and academic researchers.

  • Recently Viewed Films

    I recently watched four films with relevance to medicine and the Holocaust: The Architecture of Doom, which indicates that half of the Nazi leadership were artists. Their thinking about beauty influenced their acceptance and promotion of eugenics. The Suicide Tourist, which describes a man’s journey to Dignitas for his physician-assisted suicide. The Border, which stars Jack Nicholson as a US border patrol agent struggling to resist the temptations available to him by being on the front lines of immigration from Mexico. Aftermath (Poklosie in Polish), which describes the fate of two brothers who discover a secret about the original ownership of their farm and their neighbors’ farms. You can see other relevant films in CMATH’s growing Film Collection.

  • Remember

    Remember is a film about two elderly men living in an assisted living facility: Max has physical impairments and Zev has worsening dementia. After the death of Zev’s wife, the two men combine forces to hunt down and kill the man they believe killed their families at Auschwitz. Max makes the plans and Zev executes them, so to speak. The film stars Academy Award winners Christopher Plummer and Martin Landau, acclaimed German actors, and Dean Norris (“Hank” from Breaking Bad, another excellent morality play in five seasons). It reminded me of a statement about aging: “Of all the things I miss, I miss my memory the most.” Very good film that raises many issues about remembrance.

  • American Eugenics

    As unfamiliar as most people are with Nazi eugenics, they are even less familiar with American eugenics. American eugenicists provided legal, moral, and philanthropic support for Nazi eugenics. For example, Hitler wrote a fan letter that referred to Madison Grant about his book The Passage of the Great Race, saying “This book is my bible.” The 1933 Nazi involuntary sterilization law was modeled after the Virginia involuntary sterilization law that was declared constitutional in the 8-1 US Supreme Court decision, Buck v. Bell; in 1907 Indiana became the first place in the world to pass an involuntary sterilization law. In Mein Kampf, Hitler praised America’s restrictive immigration policies and defended his treatment of Jews by comparing it to the treatment of black Americans in general and black physicians in particular. You can learn more about American eugenics at Cold Spring Harbor Laboratory’s (CSHL) Image archive on the American Eugenics Movement, which was conceived by Nobel Laureate James Watson, in part to reveal the central role of CSHL in the American eugenics movement.

  • Euthanasia, or Youth in Asia? By Brigette Lee

    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. The murder of disabled Germans began with the involuntary “euthanasia” or “mercy killing” of 5,000 German children, which led to the adult euthanasia or “T4” program that euthanized approximately 200,000 German adults. Jews were initially excluded from the euthanasia programs because they were not considered worthy of “mercy killing.” Euthanasia or Youth in Asia? Child Euthanasia in Nazi Germany or Female Infanticide in China By Brigette Lee It’s a Girl: The Three Deadliest Words in the World. (1) Euthanasia or Youth in Asia? “Mercy” killing It’s a good death For the betterment of the children The parents The Society (2) Euthanasia or Youth in Asia? Hearing her cries What is the best way? Exposure? Suffocation? Burying alive? Strangulation? Drowning? Cold water? Boiling water? Abandonment? (3) Euthanasia or Youth in Asia? Sons are more useful They will care for the parents Support the family Be hard workers Girls are a burden Feet must be bound They must be cared for Dowries must be paid For someone else to care for them (3) Euthanasia or Youth in Asia? Intravenous lethal injections. Overdose. A coping mechanism? (2) Euthanasia or Youth in Asia? Fu Xuan said it best - “How sad it is to be a woman, Nothing on earth is held so cheap. No one is glad when a girl is born, By her the family sets no store.” (3) Euthanasia or Youth in Asia? Brigette Lee Citations: 1. Youtube. “It’s a Girl: The Three Deadliest Words in the World.” Youtube. Last modified 2011. https://www.youtube.com/watch?v=ISme5-9orR0 2. Susan Benedict, Linda Shields and Alison J. O’Donnell, “Children’s ‘Euthanasia’ in Nazi Germany,” Journal of Pediatric Nursing 24, no. 6 (December 2009): 506-516. 3. Bernice J. Lee, “Female Infanticide in China,” Historical Reflections 8, no. 3 (Fall 1981): 163-177.

  • 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.

  • A Medical Student's Personal Reflections on Eugenics by Zach Solomon

    Eugenics and euthanasia are discussed at length in the Healing by Killing: Medicine during the Third Reich elective I teach to first and second year medical students at Baylor College of Medicine.  The students appreciate that medical genetics and eugenics are opposite sides of the same coin and carefully examine the issues posed by the Human Genome Project and genomics. Often they choose to write about eugenics and genetics as they affect contemporary medical practice or healthcare policy and, in some cases, they write about very intimate experiences. Zach Solomon and his family gave  permission to post his essay on CMATH’s website, an essay that describes medical challenges in both his personal and professional life. Reflections on Eugenics By Zach Solomon I want to start this paper by talking about what I think was the most impactful class for me and how our discussion made me reflect on a very personal part of my life. About midway through the semester you asked us to imagine that we were working in the ICU and we had to talk to a family about their recently born child. We were to imagine that this child had an absolutely appalling physical birth defect that would have ramifications for both their physiological function and their outward appearance. You then asked us to give what would be our initial reaction, and how we would approach the parents. What would we say to them, what would we counsel them to do? How would we feel and react? I say that this is a personal topic for me because my little sister was born with a previously uncharacterised FBN1 mutation with pathological consequences similar to those of a Marfan’s patient. However, her phenotype is very markedly different. The condition is unnamed and there are currently only 4 other people that are thought to have the same mutation. If you are interested in getting an idea of what my sister looks like and how it relates to our task of imagining an “appalling defect”, look up Lizzy Velazquez, a girl who has the same mutation. Her first claim to fame was being named the “ugliest girl in the world” by a viral youtube video, and she has recently made a name for herself as a motivational speaker on TED after being invited to several talk shows. It was an odd experience indeed when I was living in Spain the year before starting medical school and I had my Spanish friends posting videos of Lizzy on their facebook with subtitles declaring that she was an inspiration to them. Anyways, despite having Abby in my family, it wasn’t until after class that her presence in my life impacted my thinking on your scenario. I want to share my initial reaction, and thoughts that I have had during med school, and then share how those thoughts changed during the course of your class, but particularly after that specific session. I first confronted the question ­ what would you do for the life of this child ­ in a lecture for the elective Compassion in the Art of Medicine. We had a family who spoke about their child ­ born at 26 weeks with short gut syndrome, autism, and a whole other host of problems. He spend the first 9 months in the ICU to the tune of 6 million dollars. Today he is a relatively healthy boy, but I kept finding myself asking the question during the presentation ­ why would medicine go to such lengths and expend so many resources to keep alive a child who had such an abysmal prognosis. Would it not be better to allow this child to pass, via an act of omission and while administering palliative care, in a manner similar to hospice? Another experience made me confront this question. I was at my preceptor site and we had a child come in for a check up. He was also born very preterm, and suffered from severe cerebral palsy. My preceptor showed me how he was unable to relax the adductor muscles in his thighs, and I noticed that he seemed unable to even control where his eyes moved. He was attended all hours of the day and would never be independent. He couldn’t even feed himself. It was a very emotional encounter, and I couldn’t help but ask myself why this child was kept alive? What kind of quality of life does he enjoy, and how big must the burden be on his caretakers, both financially, emotionally, and time wise? It is a very difficult thing to explain to yourself why your first, visceral reaction upon seeing another human being is asking why they has been kept alive. I was prepared to face this question in the context of hospice, where I am very against heroic end of life care that provides little value. But these experiences made me confront this challenging question in beginning of life care. I am at Baylor because I wanted to make a career out of helping people improve their health, and here I am in my first year wondering why medicine had intervened to keep these sick children alive? As a Jewish person who is very connected to the Jewish community, if not the religion, I was even more distraught when we discussed the rationale that the Nazi party used to justify euthanasia. Their thinking, that disabled individuals would use too many resources, would require too much investment, was part of my initial reaction when I saw this child with cerebral palsy. It is very shocking to see the beginnings of their perverse logic existing within my own instinctual reaction. When you fostered the discussion in class, I was relieved to hear, both during and after, that many people shared my reaction and reasoning. I was not the only heartless monster. People admitted to feelings of disgust, shock, sadness, guilt. Some of my friends that I talked with after class admitted that they have felt similar reactions to mine, particularly during the Compassion’s lecture that I mentioned earlier. Essentially feelings that wrestling with this question provoked in me seemed to be universal. I was a little bit taken aback and decided to call my Father, who is a OBGYN who has been practicing for 28 years. He has had many premature deliveries, and I wanted to listen to his take on omission of care for critically ill babies. I caught him on call and laid out everything I had been thinking, focusing on the cerebral palsy patient. He agreed that it was difficult to see a sick baby, but asked me: “Well, what about Abby?” When she was born nobody could give my parents a prognosis. There were predictions that she would die at 2 days, at 2 weeks, at one month. That she would never walk, talk, or be intellectually capable. My parents told me that every day for months they were afraid that she would suddenly pass away. She spent months in the ICU and completely upended our family life. I was young when all of this took place but there were things that I remember. My Dad stopped working, my Mom didn’t sleep and both of them were constantly breaking down into tears and sobs around the house. Today Abby is perfectly healthy and just recently flew to New Orleans by herself to spend her 21st birthday with her camp friends. While I was wrestling with these questions, it never occurred to me to consider Abby’s situation. I think this is in part because I don’t see her as being any different than anyone else; she is simply my sister. After some reflection, I have realized that it is ok to have these reactions, and that they stem in part from us being unfamiliar with what we are seeing and scared of what is different. During the Compassion’s lecture, I will never forget that the father himself admitted that he will never forgive himself for being disgusted by his own baby the first time he saw him. However, I now realize that it is not our place to decide the value inherent in each human life and deem that others, although burdened by difficulties, do not deserve or enjoy life enough to justify their care. What I consider to be a low quality of life is specific for me and is a product of my own life experiences and observations. Thus, it is not applicable to others, especially when used as a means to advocate the termination of their life­saving medical care. Just because because the cerebral palsy patient is disabled and unable to communicate doesn’t mean that life as he knows it is less worthy than my own. For that matter, I don’t know how any normal healthy person other than myself experiences their life. Having Abby in my family wasn’t necessary for these conclusions, but it made my feelings that much more real and important. In my initial reaction I was essentially justifying what would have been the omission of care from my own sister. It was very difficult admitting this to myself, and like the father from the Compassions lecture, I will always be ashamed. However, it is empowering to know that I didn’t let my first thoughts guide me and that I used my ability to reason and discuss my feelings with others to come to a new conclusion. After all, it is not our emotions that define us as humans but rather our actions. I am very grateful that this class has provoked me and allowed me to confront these difficult moral questions that I am sure to face during my career. I think that it is very important for people to study how the atrocities committed by Germany could have been seen as normal by well intentioned physicians. As I have experienced myself, it is very easy to let your instincts take over your judgment and reasoning, but as physicians we must adhere to the belief that we cannot judge the value of a life. When faced with difficult decisions we must search to discuss with our colleagues and search people outside of medicine who can help to provide a broader context to our thinking. We have a privilege to take care of our fellow human beings, and we cannot betray our duty by succumbing to flawed logic, whether it comes from a political or medical establishment, or even from within ourselves.

  • Operation Paperclip, and Essay by Medical Student Elizabeth Adams

    German doctors and scientists were perhaps the best in the world prior to WWII. Despite their immoral behavior during the Third Reich, they were highly valued by the victorious allies. The Soviet Union and the United States competed for the services of the best of them, most notably rocket scientist Wernher von Braun, who used slave labor in the production of the notorious V-2 rocket that rained death and destruction on the British people during the war. The US military employed four of the defendants in the Nuremberg Doctors’ Trial, wavering between prosecution and procurement. Dr. Hubertus Strughold, for example, was father of the American Space Medicine program after he was the father of the German Space Medicine program during WWII. When this fact came to light, the US government attempted without success to prosecute Strughold. In her essay for the Healing by Killing elective, medical student Elizabeth Adams shares her thoughts about Operation Paperclip. Operation Paperclip: The Great Moral Compromise By Elizabeth Adams Following the Holocaust, the United States became a safe haven for many of the persecuted individuals that were targeted under the Nazi regime. The United States also became a safe haven for the persecutors. In fact, we recruited them. Operation Paperclip was a secret program by the United States Office of Strategic Services that ultimately brought more than 1,500 German engineers and scientists onto American soil. Not only did they gift us with the inner ear thermometer and the microwave oven, but they also built our space program. For example, Dr. Hubertus Strughold was a Nazi scientist that was brought to the United States and ultimately designed the space suit and then launched a rhesus monkey into space. Both were monumental steps in sending astronauts into space. There are countless similar stories of Nazi scientists and their accomplishments in the US. These are the same scientists behind the gas chambers and inhumane medical experiments performed on prisoners. Instead of being sentenced to life in prison or given the death penalty, either quite reasonable for some of the war crimes committed, they were found leading many organizations and scientific programs. President Harry Truman approved the program, originally referred to as Operation Overcast. However, he explicitly stated that scientists and engineers that were Nazi members or active Nazi supporters were not eligible for recruitment. According to historian Laura Schumm in her article, What is Operation Paperclip, “officials within the JIOA and Office of Strategic Services (OSS)—the forerunner to the CIA—bypassed this directive by eliminating or whitewashing incriminating evidence of possible war crimes from the scientists’ records, believing their intelligence to be crucial to the country’s postwar efforts.” Without the knowledge of the general public, or even the president of the United States, the OSS began to falsify the documents. They would put an ordinary paperclip on the files as a secret identifying mark for those German scientists whose files had been altered. What factors contributed to this moral compromise on the part of the OSS? The OSS was fully aware of the severity of the war crimes committed, but chose to hide this information, and bring many German scientists into America. It is important to consider the other events going on in the world following World War II to begin to understand this decision. A new war was brewing between the United States and the Soviet Union, and The Space Race would prove an important competition to establish technological dominance. The OSS feared that the Soviet Union could rise to power above the United States threatening national security and our way of life. Many of the German scientists were highly trained in defense and aerospace engineering. Dr. Wernher von Braun was an intelligent space engineer that was brought to the United States as part of Operation Paperclip. He designed the V-2 Rocket for Nazi Germany, and also the Saturn V launch vehicle. Von Braun went on to serve as the chief architect for the Saturn V launch and his group was assimilated into the National Aeronautics and Space Administration (NASA). In order to defend the United States, the OSS felt that it was necessary to bring over the best and brightest engineers and scientists from Germany, regardless of what they had been involved with during World War II. From this viewpoint, the OSS was doing what was thought to be in the best interest of the future of the United States – but, does this make it any less wrong on moral grounds? Laura Schumm addresses this, stating that “although defenders of the clandestine operation argue that the balance of power could have easily shifted to the Soviet Union during the Cold War if these Nazi scientists were not brought to the United States, opponents point to the ethical cost of ignoring their abhorrent war crimes without punishment or accountability.” Is this kind of executive action by the OSS permissible because it resulted in a successful space program and brought a great deal of superior military technology to the United States? According to Annie Jacobsen, author of Operation Paperclip, the contemporary public regards Operation Paperclip as a “bad idea.” In addition to the overwhelming evidence against the ethical cost of the operation, she argues that the monetary cost of the program was significant. The cleanup and disposal of the biological and chemical weapons designed by these scientists took decades and more the $30 billion. The human cost should also be considered when experimentation on humans continued in America in direct violation of the Nuremberg Code, as experiments continued on American soldiers testing new chemical warfare. It is easy to argue against Operation Paperclip because of the very obvious violation of morality and justice, but it is hard to imagine what would have happened if the program had not existed. How long would it have been before an American made it to the moon? Would the United States be a communist country? No one really knows what American history would look like without this great moral compromise.

  • Genetics and Modern Eugenics by Medical Student Amanda Broderick

    Few people realize that eugenics was the driving force behind the Nazis’ political philosophy of “Applied Biology.” Even fewer realize the essential contributions to eugenics by the United States, the world’s leader in eugenics. Indiana’s legislature was the first in the world to legalize involuntary sterilization, for example, and at least 12 countries had legalized involuntary sterilization before Nazi Germany did so in 1933. America provided legal, moral, and philanthropic support for Nazi eugenicists prior to the outbreak of WWII. German propagandists also highlighted the failure of American medical schools to admit African-Americans and could have also pointed to the exclusion of African-American doctors to the American Medical Association. Medical schools often had quotas for Jews and Italians—Edmund Pellegrino, one of the world’s great bioethicist physicians was denied admission because of his Italian heritage—and Nazi propagandists also noted that our Jim Crow laws defined African-Americans much more broadly than the Nuremberg Laws defined a Jew. Amanda Broderick discusses modern eugenics in her essay. Genetics and Modern Eugenics By Amanda Broderick Throughout this course, we broached the subject of eugenic thought and action, mostly as it was carried out in the past during the Nazi regime and earlier in the United States. Since the end of World War II, the word and discussion of eugenics has been greatly decreased to almost zero because of stigma and belief that it was no longer relevant and simply an evil “Nazi concept” with no foundation in a modern context. While the Nazi regime used the idea of eugenics as an excuse for many of their actions such as sterilization without consent and the mass killing of different populations including the Jewish and the disabled, eugenic thought has also influenced action in modern United States with uninformed sterilization of female inmates in California happening as recently as 2010.1 Eugenics was initially defined as “well-born” but has morphed to mean “control of or improvement of genetic qualities in a population” in more modern times.2 Many of the thought processes underlying this definition of eugenics are still relevant to our society, especially as reproductive and gene-editing technologies advance. The availability and use of prenatal genetic testing, in-vitro fertilization and selection, and the possibility of even newer technologies, such as CRISPR, has sprouted a new chapter of ‘modern eugenic’ thought and fear. Prenatal testing allows for the detection of genetic abnormalities before birth, allowing parents to decide whether they will continue with a pregnancy. In-vitro fertilization allows for selection against embryos that have known severe genetic anomalies. CRISPR, while it has not yet been used in human embryos, gives the ability to specifically edit the genome before implantation to change any part of the genome that is unwanted. These technologies could be used to all but eradicate certain genetic conditions as well as to “enhance” the genome in ways not related to disease processes. The negative and positive implications of these technologies should be more widely debated and expanded upon so that genetic scientific advancements can continue without ethical boundaries being irreparably crossed or pushed too far. Current philosophies on the use of these technologies is polarized. On one side of the spectrum, critics believe that using them at all is morally apprehensible and leads to greater discrimination of populations with certain disabilities or diseases. On the other side, philosophers, such as Peter Singer, believe that many eugenic concepts are logical and that if we have these technologies, they should be used without a doubt before children are born with severe disabilities. He believes this is the only logical solution because it will save both the family and the child from a more difficult life. He goes as far as to argue that families of babies born with severe mental or physical disabilities should be allowed to decide whether that baby should be euthanized or not after its birth (even up to an age of a few years before there is “selfawareness”). 3 Both views seem to be ignoring the intricacies of a lot of the situations in which these technologies may or may not be used. For example, in the latter argument, how is a disability or disease classified as severe enough to be “edited” out and who decides this? In the former, is it actually immoral to try to spare the family and child from a fatal and painful disease? Taking a more moderate stance, there are many potential positives to these technologies, like curing or stopping fatal diseases. But if they are unregulated, they could be used in negative ways. One possible solution is that preventing disease (negative engineering) should be allowed but so called ‘enhancement’ eugenics (positive engineering) in which genes for eye color, athletic ability, ect are chosen for or changed.4 It is difficult, however, to ascertain exactly where to draw the line when deciding what diseases/disabilities are so severe as to warrant genetic modification/selection. Current disability rights groups and others fear that any type of selection causes more discrimination against those that are still born disabled.3 This type of discrimination to an already marginalized group is something that has had terrible consequences in the past. The most important thing to consider to avoid repeating these kinds of horrible atrocities of the past made under the guise of eugenics is that genetic technology choices must always be informed and with consent and never controlled by the government. Following these basic guidelines while keeping an open dialogue about where future technologies may lead or should be stopped will allow this aspect of medicine to grow in a morally responsible way.

  • The Good, the Bad, and the Ugly by Medical Student Varun Bora

    Robert Proctor was widely acclaimed for his 1988 book Racial Hygiene: Medicine Under the Nazis. He did not receive similar acclaim for his 2000 book The Nazi War on Cancer, perhaps because he pointed out some of the successes of Nazi medicine—occupational carcinogenesis, the campaign against tobacco, and opposition to additives in food, for example—that are similar to public health programs in contemporary Western liberal democracies. Baylor College of Medicine medical student Varun Bora’s essay examines the Good, the Bad, and the Ugly of Nazi physicians and sums up this way: “Thus, while their actions were abominable, appreciation for their contributions to modern medicine as well as an examination of their perspective remains paramount to preventing history from repeating itself. The Good, the Bad, and the Ugly By Varun Bora During the 1930’s and 1940’s, the Nazis of Germany conducted some of the most heinous acts the world has ever seen. From medical experiments on children to “mercy killings” of those deemed to possess harmful genes to mass genocide, the Nazi’s actions are attributed to the nefarious intentions of Adolf Hitler and his political supporters. However, Hitler’s regime gained its legitimacy due to the backing of scientists and doctors, who provided the medical expertise and justification that allowed Hitler to kill so many innocent people. Even more terrifying remains the fact that these doctors truly believed that their actions were noble and at the cutting edge of science. As a medical community today, we dismiss the actions of some of our infamous predecessors as outliers and cast them aside; however, doing so prevents us from examining the invaluable contributions they made to modern medicine as well as the similarities we share with physicians such as Josef Mengele – the “Angel of Death” – and his colleagues. To ignore these qualities represents in itself another danger in that we believe ourselves immune to the “brainwashing” and false logic these Nazi doctors possessed. Thus, while their actions were abominable, appreciation for their contributions to modern medicine as well as an examination of their perspective remains paramount to preventing history from repeating itself. Many of modern medicines hallmarks owe their conception to the Nazi doctors. For instance, large scale vaccination began with Nazi research in the internment camps. There, doctors performed innumerable experiments on the Jewish prisoners, formulating and reformulating their mixtures until they were able to synthesize vaccines to diseases such as tuberculosis1 . These internment camps provided human subjects who the doctors themselves believed were no better than animals and that by sacrificing their lives in the experiments, these prisoner’s lives finally were given some value and meaning. Today, we would abhor such actions, yet we use vaccines on a daily basis to protect ourselves and our children. Thus, we owe the doctors some degree of appreciation, although their methods were completely wrong; furthermore, from them, we can learn the dangers of taking science too far. As doctors, we straddle the edge of known knowledge, and in our quest to push the boundaries, we may be blind enough to lose sight of the ethics underlying the quest itself. However, not all of the Nazi’s contributions were attained using inhumane methods. One of their greatest successes lie in legitimizing the anti-tobacco movement. Through years of research and meticulous data collected, Dr. Franz Miller – a Nazi scientist – provided the first convincing proof of the link between cigarette smoking and tobacco. These results were found using ethically sound science and illustrate that the Nazi doctors were not inherently evil, but rather, simply disillusioned and ignorant to their actions – something we all are capable of. Thus, despite some of their dubious beliefs and methods, we shouldn’t just cast these doctors and their contributions aside; rather, we owe these doctors some of the same appreciation we offer to famous predecessors such as Salk and Banting while at the same time learning from their greed and ignorance. The second – and more important – aspect of the Nazi doctors that we cannot ignore lies in the relevance of their situation to each and every one of us. We forget today that the Nazi doctors and scientists were the finest in the world during that time period; they made countless contributions to all fields – not just medicine. Many of our most famous doctors, including Dr. Michael DeBakey, traveled to Germany for a stellar education. Thus, it wasn’t inferior medical training or ineptitude that led to these doctors committing such heinous acts. Rather, it was their belief that they were absolutely in the right to act in the manner in which they did. Today, we know these actions to be wrong and claim to never repeat the same mistakes. However, the Nazi doctors probably said the same things regarding themselves and the doctors that came before them while they performed cruel experiments on children and innocents. We are in the same position that these doctors before us were in; while the circumstances themselves are vastly different, we still hold the same heightened status in society and are still looked upon as leaders. People trust us with their lives and we owe it to them to not make the same mistakes our predecessors did. Issues such as stem cell research and genetic engineering could put our generation of physicians in the same situation that the issues faced by the Nazi doctors put them in, and thus, we should make it a priority to learn from the Nazi doctors, rather than label them as ignorant individuals with whom we have no relevance. In conclusion, modern day physicians have been quick to dismiss the Nazi doctors as a different breed of people with whom we today have no similarities. We find it more appeasing to delineate ourselves from them in order to separate their brand of medicine from our own. However, we still base much of our medicine on breakthroughs made by the Nazi physicians and thus, owe them their due respect, however terrible their methods were may have been. Even more importantly, many of the issues we face today and moving forward will put us in similar situations the Nazi doctors faced. One false step or misguided belief and we could end up committing actions that our successors will vilify. At the cutting edge of science, there is a fine line between morality and immorality, and the promise of breaking barriers can entice even the best of us to overreach and turn a blind eye towards our ethics, just as it did for the Nazi doctors. Thus, in the educational setting and as a community as a whole, we should make it a priority to study both the good and bad of these physicians.

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