We idealize physicians as heroes. We want to go to medical school to help people. Maybe we’re inspired by how we saw physicians care for a family member who was sick. Maybe we feel that medicine is a calling and that there is nothing else we would rather do. We go through our white coat ceremonies promising to do no harm. We commit ourselves to altruistically serving others. But what happens when physicians betray their patients, warp the ideals of their profession, and become perpetrators of injustice?
In the early part of the 20th century, German medicine and science were the best in the world. Students from other countries went to Germany to study from Nobel Prize-winning professors. There was a strong belief in many countries, including both the United States and Germany, that science could be used to improve the human race. This idea, called eugenics, could be brought about in a positive sense by selecting for desired traits. It could also be brought about in a negative sense, by preventing those with undesirable traits from breeding.
Within months after Adolf Hitler and the Nazis came to power in 1933, a compulsory sterilization law was passed that targeted German mentally and physically handicapped people. Over time, the Nazis began to murder young children who were born with birth defects, then adolescents and adults. They used multiple methods, including starvation, gassing, and lethal injection. By the time World War II began in 1939 with the German invasion of Poland, the Nazis were well-versed in all of these killing techniques, which were subsequently used in the infamous death camp Auschwitz.
At every point along the way during the Nazi administration, physicians played an indispensible role. Physicians developed the pseudoscientific racial ideology of the Nazis. Physicians legitimized the Nazi regime by couching that ideology in medical terminology. Physicians joined the Nazi party and the SS in large numbers. Physicians performed the forced sterilizations of their own handicapped patients, and ultimately, physicians put their own patients to death. Physicians selected concentration camp prisoners to die in the gas chambers. Physicians conducted inhumane research on prisoners. Physicians tortured prisoners.
Although I was aware of some of the roles played by physicians in the Nazi regime, I wanted to study the topic in more depth. Last year, I applied for the Fellowships at Auschwitz for the Study of Professional Ethics (FASPE) medical student program. FASPE is an all-expenses paid two week fellowship that comprises assigned readings, workshops, and visits to historical sites including Auschwitz and the Wannsee House. Fellows spend time in New York City; Berlin, Germany; Krakow, Poland; and Oswiecim. (Oswiecim, pronounced “OSH-vee-EN-shim,” is the Polish town where the Auschwitz death camps are located.) The readings and workshops focus on both the Nazi physicians and modern medical ethics issues, such as whether to resuscitate premature infants. At the end of the program, the Fellows complete a final project that can take one of several forms such as a reflective essay, a research paper, or a photoessay.
Throughout the trip, I was continually surprised by the unexpected thoughts and feelings that I had. One of the first things I realized was that this was by far the most intense medical school small group that I have ever been a part of. Since all of the Fellows were very interested in the topics covered, we had incredibly passionate and provocative discussions, both formally and informally. I was also surprised by how emotional it was to visit one of the Berlin train stations used to deport the Jews. Of course, visiting the Auschwitz I museum, where mounds of items belonging to the gas chamber victims are displayed, was tremendously emotional. But we went to the Auschwitz II camp, also known as Birkenau, on a perfect June day. Except for the barbed wire surrounding the camp and the ruins of the gas chambers in the ground, the scenery was so beautiful that it felt almost like we were visiting a city park.
The very biggest surprise of all, however, was the change in my self-conception. As a Jew, I had always thought of myself as a victim with respect to the Holocaust. No doubt I would have been among the persecuted if I had been living in Nazi Germany or occupied Europe. For this reason, I was shocked to discover that over the course of the time I spent in Germany and Poland, I came to view myself not so much as a potential victim, but as a potential perpetrator. It was unsettling to realize that the knowledge and skills I have been gaining during medical school can be turned against patients just as easily as these skills can be used to help them. I thought of some of the little things we trainees do that violate patient autonomy, from performing genital exams on patients under anesthesia without their consent, to marginalizing patients by referring to them as “that gallbladder” or “the GOMER.”
It was also unsettling when I realized that no amount of studying, no classes, and no computer modules on medical ethics can guarantee that physicians will stay true to our professional ideals. As much as we may try to distance ourselves from the Nazi physicians, and as much as we may tell ourselves that we are nothing like they were, the truth is that we each have the potential to become like they were. All we have to do to see examples of this is to look at current events. You may remember seeing in the news that a New Orleans physician was accused of euthanizing some of her patients in the aftermath of Hurricane Katrina. There were also allegations that physicians were involved in the torture of accused terrorists in the Abu Ghraib and Guantanamo Bay prisons.
In my own case, I was horrified when I found myself becoming scientifically interested in the results of some of the most egregious Nazi medical experiments. These were experiments where prisoners were immersed in ice water for hours until they died painfully, or kept in a vacuum chamber until their lungs exploded. Even after all of the reading I had done, and all of the experiences I had while participating in this program, it was still too easy to forget for a while about all of the innocent people who died horrible deaths in order to provide those data that I found so fascinating.
Any hope of preventing future atrocities along the lines of those committed by the Nazi physicians must involve serious self-reflection about our shortcomings as individuals, and also as a profession. We must be honest about the evil that we are capable of committing. We must continually make the effort to advocate for our patients by treating them as their own ends, rather than treating them as the means to our ends whenever behaving ethically and professionally is inconvenient for us. We can start this process by becoming aware of the potential we have to do evil. Developing this awareness is both the goal and the result of participating in the FASPE fellowship.
If you are interested in learning more about the fellowship, you can visit the FASPE website at http://www.mjhnyc.org/faspe/. The medical student program is described at http://www.mjhnyc.org/faspe/pr_medical.html, and the application can be found at http://www.mjhnyc.org/faspe/apply.html. The fellowship is open to current first, second, and third year allopathic and osteopathic medical students. Besides filling out the application form, you will need to submit an unofficial transcript, a resume, two essays, and a letter of recommendation. All of these materials must be received by December 15, 2010. Decisions will be made by February 4, 2011, and the 2011 trip will run from June 26-July 7.
Although the fellowship is sponsored by the Museum of Jewish Heritage, you do not have to be Jewish to apply or participate. In fact, the more different backgrounds and viewpoints that the participants bring to the table, the better everyone’s experience will be.