Different River

”You can never step in the same river twice.” –Heraclitus

April 13, 2005

Doctors Without Conscience

Filed under: — Different River @ 9:30 pm

The current issue of the New England Journal of Medicine has what is, for that journal, a rather unusual article — an article by Elie Wiesel (PDF version) about doctors under the Nazi regime.

I wonder if the timing of the article is significant.

In any case, Wiesel writes better than I do, so here are some key excerpts:

This is one of those stories that invite fear.

Now we know. During the period of the past century that I call Night, medicine was practiced in certain places not to heal but to harm, not to fight off death but to serve it.

In the conflict between Good and Evil during the Second World War, the infamous Nazi doctors played a crucial role. They preceded the torturers and assassins in the science of organized cruelty that we call the Holocaust. There is a Talmudic adage, quite disturbing, that applies to them: Tov she-barofim le-gehinom — “The best doctors are destined for hell.” The Nazi doctors made hell.

Inspired by Nazi ideology and implemented by its apostles, eugenics and euthanasia in the late 1930s and early 1940s served no social necessity and had no scientific justification. Like a poison, they ultimately contaminated all intellectual activity in Germany. But the doctors were the precursors. How can we explain their betrayal? What made them forget or eclipse the Hippocratic Oath? What gagged their conscience? What happened to their humanity?

We know the facts. The motives as well. One day, Hitler and Himmler’s health minister made it known to leaders in the medical field that, according to a secret decision made at the highest level, it was necessary to get rid of “useless mouths” — the insane, the terminally ill, children, and elderly people who were condemned to misfortune by nature and to suffering and fear by God. Few in the German medical profession believed it worthy or good to refuse.

Thus, instead of doing their job, instead of bringing assistance and comfort to the sick people who needed them most, instead of helping the mutilated and the handicapped to live, eat, and hope one more day, one more hour, doctors became their executioners.

Where have we heard this before? In the news of the past month or two, perhaps?

In October 1939, several weeks after the beginning of hostilities, Hitler gave the first order concerning the Gnadentod, or “charitable death.” On the 15th of that month, gas was used for the first time to kill “patients” in Poznán, Poland. But similar centers had already been created in Germany three years earlier. Now, psychiatrists and other doctors collaborated in a professional atmosphere exemplary for its camaraderie and efficiency. In less than two years, 70,000 sick people disappeared into the gas chambers. The Gnadentod program was going so well that the head of the Wehrmacht Hospital psychiatric ward, Professor Wurth, worried, “With all the mentally ill being eliminated, who will want to pursue studies in the burgeoning field of psychiatry?” The program was interrupted only when the bishop of Münster, Clemens August Graf von Galen, had the courage to denounce it from his cathedral’s pulpit; protest, in other words, came not from the medical profession, but from the church. Finally, public opinion was moved: too many German families were directly affected.

Now, sometimes the families are complicit — and when religious figures denounce euthenasia, they are told that it’s unconstitutional to consider their opinions. No, they must not “impose their views” on the euthenizers, who must be free to impose their views on those deemed to have insufficient “quality of life.”

Like the fanatical German theorists, Nazi doctors did their work without any crisis of conscience. They were convinced that by helping Hitler to realize his racial ambitions, they were contributing to the salvation of humanity. The eminent Nazi doctor responsible for “ethical” questions, Rudolf Ramm, did not hesitate to declare that “only an honest and moral person may become a good doctor.”

Now every American hospital has an “ethics committee.” Isn’t that reassuring?

Did I meet other doctors? In my barracks at Buna, some of them supervised the division of those permitted to live from those who were to die. I have described elsewhere the silence that preceded this event: it filled our being. We were afraid to look at one another. As on Yom Kippur evening, I had the feeling that the dead were mixed with the living. As for the doctors, I knew not who they were and have forgotten their faces.

Over the succeeding years, as I studied documents and archives about the Final Solution, I became familiar with the dominant role played by Nazi medicine and science. They were integral to the concentration-camp system and were as guilty as the various branches of Hitler’s armed services and police force of the monstrous crimes committed in occupied Europe out of hatred for the Jews and other so-called inferior races and groups. Yet after Germany’s defeat, with rare exceptions, criminal doctors calmly returned home to resume normal practices and ordinary life. No one bothered them at home, nothing threatened them. Only on the occasion of the trial of Adolf Eichmann in Jerusalem did German justice suddenly remember their crimes. The police found their addresses in telephone books.

Why hide, if you did nothing (recognized as) wrong?

But if an Eichmann shocks us, a Mengele revolts us. Eichmann was a rather ordinary low-life, without education or culture, whereas Mengele spent a number of years at a university. The existence of an Eichmann casts doubt on the nature and mentality of the German people, but the possibility of a Mengele throws into question the very basis of German education and culture. If the former represents Evil at a bureaucratic level, the latter embodies Evil at an intellectual level.

There is actually a quite simple explanation for this. (It’s a maxim of mine, and I should someday write a full-length essay on it.) That is: Academic education makes one an “educated person,” which is not the same as a “good person.” Academic education is not moral education; that is, it does not provide any morality whatsoever.

Of course, the environment in which academic education is delivered can provide moral education, but that can go either way. My daughter attends an Orthodox Jewish school, where students are explicitly taught, and rewarded for, good behavior in their interactions with each other and with teachers. This is in addition to, and distinct from, their learning of reading, mathematics, and other subjects (though not entirely distinct from their learning of religious subjects). On the other hand, it can be argued that the modern American (at least) university provides an environment which is actively detrimental to the moral development of students.

In any case, the environment is separate from the curriculum. There is absolutely no reason to believe that learning mathematics, or engineering, or biology, or medicine will protect someone from becoming a murderer or a thief or a racist. We don’t even need to look to the Nazis to see this; just look at the financial scandals and sexual harassment scandals at our to universities. There is no evidence education makes people moral, and the fact that people continue to believe it in the face of overwhelming evidence to the contrary is completely mystifying.

Eichmann denied having been anti-Semitic and pleaded not guilty: he was only following orders. But the Nazi doctors? None among them acted under duress — neither those who presided over the nocturnal division of new arrivals, nor those who killed the prisoners in their laboratories. They could have slipped away; they could have said no. Until the end, they considered themselves public servants loyal to German politics and science. In other words, patriots, devoted researchers. Without too great a stretch, maybe even societal benefactors. Martyrs.

No doubt some of them did slip away, or say no. Which makes the guilt of those who remained, and thought themselves heros, even less excusable.

Must one conclude that, since a humane science exists, there was also a science that wasn’t humane? I won’t even consider racist theorists who tried to treat racism as an exact science. Their vulgar stupidity deserves nothing but disdain. But there were excellent physicians, well-informed chemists, and great surgeons — all racist. How could they seek truth and happiness for human beings at the same time that they hated some of them solely because they belonged to human communities other than their own?

Science is neither good nor evil. It can be, and has been, used for either.

One of the brutal shocks of my adult life came the day I discovered that many of the officers of the Einsatzgruppen — the death commandos in Eastern Europe — had received degrees from Germany’s best universities. Some held doctorates in literature, others in philosophy, theology, or history. They had spent many years studying, learning the lessons of past generations, yet nothing kept them from killing Jewish children at Babi Yar, in Minsk, Ponàr. Their education provided them with no shield, no shelter from the temptation and seduction of cruelty that people may carry within. Why? This question still haunts me.

Why would you think that a doctoral degree would teach one not to be a murderer? The questions haunts Wiesel, but I don’t even understand it. What is there in a doctoral program in literature that teaches one right from wrong? Theology, maybe — but look what they teach in the madrasses. That’s theology, too.

Yet inside the concentration camps, among the prisoners, medicine remained a noble profession. More or less everywhere, doctors without instruments or medications tried desperately to relieve the suffering and misfortune of their fellow prisoners, sometimes at the price of their own health or their own lives. I knew several such doctors. For them, each human being represented not an abstract idea but a universe with its secrets, its treasures, its sources of anguish, and its poor possibilities for victory, however fleeting, over Death and its disciples. In an inhumane universe, they had remained humane.

When I think about the Nazi doctors, the medical executioners, I lose hope. To find it again, I think about the others, the victim-doctors; I see again their burning gazes, their ashen faces.

Why did some know how to bring honor to humankind, while others renounced humankind with hatred? It is a question of choice. A choice that even now belongs to us — to uniformed soldiers, but even more so to doctors. The killers could have decided not to kill.

Yet these horrors of medical perversion continued beyond Auschwitz. Traces may be found, for example, in the hellish Stalin and post-Stalin eras. Communist doctors betrayed their brethren. Psychiatrists collaborated with the secret police to torture prisoners.

I hope every doctor who reads this article in the New England Journal of Medicine thinks about the questions it raises in light of the increasing acceptance — indeed, advocacy — in the medical profession for euthenasia of the young, the old, and the disabled.

It might be a good thing if some judges read it, too.

2 Responses to “Doctors Without Conscience”

  1. Snowdancer Says:

    This just turns my stomach. The lack of respect for human life is disturbing, to say the least. Lookat how many doctors no longer take the Hippocratic Oath.

  2. Different River Says:

    Or if they take it, don’t take it seriously. If you read the Hippocratic Oath you’ll see that it doesn’t allow a doctor to perform an abortion. (It also doesn’t allow a doctor to perform surgery, implying that surgery is a separate profession than medicine.)

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