Program for Biomedical Ethics Lindenthal Lecture on Holocaust and Genocide. The topic: Nazi Doctors; Learning from Complicity.

Name: Program for Biomedical Ethics Lindenthal Lecture on Holocaust and Genocide. The topic: Nazi Doctors; Learning from Complicity.
Uploaded: 2026-04-28T02:59:37.7666667Z
Duration: 1 h 33 min 14 s
Description: Program for Biomedical Ethics April 22, 2026 Lindenthal Lecture on Holocaust and Genocide Nazi Doctors; Learning from Complicity David Goldman, JD Founder and Chairman of Fellowships at Auschwitz for the Study of Professional Ethics (FASPE)

April 28, 2026

Program for Biomedical Ethics

April 22, 2026

Lindenthal Lecture on Holocaust and Genocide

Nazi Doctors; Learning from Complicity

David Goldman, JD

Founder and Chairman of Fellowships at Auschwitz for the Study of Professional Ethics (FASPE)

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ID: 14146
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00:02So yeah. Let me just
00:03ask ask everybody to, like,
00:04mute their devices and
00:07alright.
00:07So
00:09thank you all for joining
00:10us today for the Lindenthal
00:12lecture on Holocaust and genocide
00:14supported by, doctor Jacob Lindenthal
00:16and the Lindenthal family.
00:19We're delighted to introduce to
00:21you today,
00:22David Goldman,
00:23the founder and chairman of
00:24the fellowship at Auschwitz for
00:26the study of professional ethics
00:28or FASB.
00:30FASB
00:31promotes ethical leadership within the
00:33professions.
00:34Toward that end, FASB provides
00:36graduate students in professional schools
00:38and early career professionals
00:40with fellowships to study professional
00:43ethics and leadership against the
00:44backdrop
00:45of the actions and choices
00:46of their professional counterparts
00:48in Nazi Germany.
00:50These fellowships
00:52focus on medicine, law, the
00:54clergy, journalism, and business.
00:58FASB also conducts ethical leadership
01:00training for professionals within law
01:01firms, private equity funds, and
01:03other corporate organizations.
01:06In addition to founding FASB,
01:08David Goldman is a retired
01:09partner at the law firm
01:10of McDermott, Will, and Emery.
01:13He served as head of
01:14the firm's international corporate advisory
01:16practice group and of the
01:18firm's New York office.
01:20He's been recognized by the
01:21legal five hundred as a
01:23leader in his field
01:24and by the American lawyer
01:25as a dealmaker of the
01:26year.
01:29Today, David will be speaking
01:30on Nazi doctors learning from
01:32complicity.
01:34We're enormously grateful to David
01:35not only for speaking to
01:36us today, but also for
01:38offering summer fellowships in professional
01:40ethics and leadership as an
01:41opportunity for Yale medical students
01:43and residents since two thousand
01:44nine.
01:46We hope that interested medical
01:48trainees will consider applying to
01:49FASB and joining them for
01:50a summer fellowship,
01:51traveling to Berlin and Auschwitz
01:54to engage in intensive interdisciplinary
01:56discussion of the meaning and
01:57content of professional ethics.
02:00Without further ado, I'm honored
02:02to introduce this year's Lindenthal
02:04lecturer on holocaust and genocide,
02:06David Goldman. Thank you so
02:07much for doing the
02:15We have today's,
02:16CME code that can be
02:17texted for CME, but I'm
02:19gonna turn that over for
02:20now.
02:28I was dealmaker of the
02:30year, so I'd like to
02:31make sure everybody heard that.
02:37Jacob
02:38Lindenthal, it's wonderful
02:40to see you here, and
02:41I wanna thank you
02:43for
02:44being part of this program.
02:46I've known Jacob for
02:48a few years, and it's
02:50been one of the great
02:51honors of my life to
02:52spend time with you.
02:56Also, great thanks to Ben
02:58and,
02:59my friends at Yale Medical
03:01School. I have a
03:03Mark Mercure, you're staring at
03:04me like I'm talking to
03:05you. It's not just about
03:07you.
03:11Okay.
03:14FASB
03:15really began
03:17at Yale Medical School.
03:19I have wonderful memories of
03:21I I would talk about
03:23the idea of FASB to
03:24many people, the idea of
03:26studying professional ethics and thinking
03:29about it through the lens
03:30of
03:31why the professionals in Nazi
03:33Germany did what they did.
03:34And I would go to
03:35meetings,
03:36and people would say, what
03:37a wonderful idea you had
03:40have. And I would go
03:42home and
03:43say to my wife, what
03:44a wonderful idea I have.
03:47And,
03:48the then dean of the
03:49medical school here,
03:52heard about FASB and
03:54invited a group of people
03:55to come talk about it.
03:57And it was really through
03:58that meeting, and Jack Hughes
04:00was there.
04:01Tom Duffy was there. Nancy
04:04Angoff was there.
04:08Oh, Mark Mercurio was there.
04:10Right. I've I've I've forgot
04:11about I forgot about Mark.
04:13Mark's at Harvard in case
04:14anybody hasn't heard
04:16that.
04:19Yale Medical School means an
04:20enormous amount, an enormous,
04:23amount to me, so I'm
04:25thrilled to be here.
04:29When I walked in just
04:31now, they asked me,
04:34about my deck,
04:36my
04:37PowerPoint
04:38deck for the presentation
04:40today.
04:41I hope you like it.
04:48I want to just describe
04:49what I'm hoping to do
04:51today.
04:52I I warn you though,
04:54as those of you who
04:56know me,
04:57I have a tendency to
04:59digress. I have a tendency
05:01to meander.
05:03I ask that you
05:05bear with
05:06me. I will do that
05:07on occasion. There is a
05:09plan that I have if
05:10I don't forget it.
05:12My goal,
05:13today is to to address
05:15a few things. One,
05:17I'd like to begin
05:20talking about
05:21why
05:22what we call the Holocaust,
05:24and I'll come back to
05:25why I frame it that
05:26way,
05:28why the Holocaust remains important
05:30today,
05:32ninety years after really the
05:34beginning of
05:36the policy making that led
05:38to it? Why is it
05:39still relevant?
05:41Though I will
05:43frame that with a bit
05:44of a discussion about warnings
05:46as we think about the
05:47Holocaust today.
05:49I then want to spend
05:52time talking about
05:54something I've been thinking about,
05:56which is I'm testing it
05:57a bit today.
06:01I'm testing it. What I
06:02think of and Ben and
06:03I were talking about this
06:05a tad earlier.
06:07I'm testing an idea
06:09about how we should think
06:10about Nazi medicine that is
06:13quite different, I think, than
06:15is the norm,
06:16different than how over the
06:18past
06:19eighty years we've thought about
06:22the lessons, if you will,
06:24of of Nazi medicine.
06:26And then,
06:28I want to talk about
06:29doctors today.
06:30I want to talk about
06:32what we can
06:34think about in terms of
06:36doctoring
06:37in
06:38twenty twenty six,
06:40in a time of the
06:41commercialization
06:42of
06:43medicine, at a time of
06:45the,
06:47JFK
06:48junior
06:50ish of medicine.
06:54And then we'll have some
06:55time for, to talk about
06:56ourselves, which is what I
06:58look forward to the most.
06:59I do want to note
07:00one thing. I see my
07:01friend, Dick Kravitz, out in
07:04the audience.
07:05If for any reason this
07:07doesn't all come together,
07:09I'm going to ask Dick
07:10to give a summary in
07:11verse.
07:13Dick is a great writer
07:15of poetry, so I think
07:17that he can help us
07:18bring it all together.
07:21I spent forty three years
07:23living in New Haven, in
07:25particular,
07:26three years,
07:28at the law school.
07:30I've been out of New
07:31Haven now for
07:33almost ten years, but when
07:35I return to New Haven,
07:37I I think a lot
07:38about memory,
07:41especially of those three years.
07:44And it reminds me of
07:45a book
07:47by a wonderful writer named
07:49Alan Lightman. You may know
07:51of him. He's the only
07:52person, I think,
07:54to have a joint appointment
07:56at MIT
07:57in physics and literature.
07:59And Alan wrote a book
08:01some years ago called Reunion
08:03in which he describes,
08:07he describes somebody going back
08:09for his thirtieth or fortieth
08:11or fiftieth reunion to his
08:13college. I don't remember which.
08:15And the book is set
08:16up in
08:17two phases. There are two
08:18different,
08:20narratives in the book,
08:22each on a the two
08:23narratives on each page. One
08:25is what he remembers
08:29from being in college,
08:32and the second is what
08:33actually happened.
08:34That is his memory was
08:36different
08:37than what had happened.
08:40And so every time I
08:41come back to New Haven
08:43and I I'm
08:45walk past the law school,
08:46I'm
08:47thinking about which will I
08:50which will focus for me.
08:51Is it what I remember
08:53happening,
08:54or is it what really
08:56happened? And then I realized
08:57it's neither. I don't remember
08:58anything.
09:02So I mentioned that
09:06so that we can think
09:07about memory
09:08today. I wanna think about
09:10memory a bit in the
09:11context of the Holocaust.
09:14And in particular,
09:16how to approach
09:18that history
09:21without having
09:22eyewitnesses
09:23present anymore.
09:25What is our responsibility
09:27today to think about that
09:29history,
09:31recognizing
09:32that we don't have people
09:34either talking about what happened
09:37or what they remember happening.
09:40And I think that's an
09:41enormous responsibility
09:42for us given the magnitude
09:44of what did happen.
09:51I want to
09:54focus for a moment, though,
09:56on what I think of
09:58as the enormous
09:59risks,
10:01maybe especially today for reasons
10:03that may or may not
10:04seem obvious,
10:05about employing
10:07the memory of the holocaust.
10:10The risks of talking about
10:11the holocaust today,
10:15it is being instrumentalized.
10:19Let's recognize that that there
10:21are those who use the
10:23holocaust
10:24for purposes that are unrelated
10:27to what I might suggest
10:29should be our memories of
10:31it, our the lessons we
10:33can learn from it, what
10:34we derive from it.
10:39We draw analogies.
10:41Analogies to the holocaust, and
10:43I admit that I might
10:44be a bit guilty of
10:46it because I'm going to
10:47talk today about a few
10:50of the doctors in particular
10:52whom we study.
10:54But there is a risk
10:55of analogizing.
10:57Any analogy to the holocaust
11:00almost demands a response which
11:02says,
11:04this is not the holocaust.
11:06I am not a Nazi.
11:08Don't call me that.
11:09And so I begin by
11:12urging that while I'm going
11:13to talk about the holocaust,
11:15while I'm going to talk
11:16about that period,
11:18let's always keep in mind
11:21the purpose
11:22for which we use that
11:24history, the purpose for which
11:26we draw
11:27information
11:29for ourselves.
11:32And lastly,
11:33in thinking about
11:35the holocaust,
11:38there is a risk of
11:39framing it in terms of
11:41victimization.
11:43It forces us it forces
11:46us too much
11:47to think about ourselves
11:50as the victims, to think
11:52about ourselves
11:54in the role of the
11:56victims.
11:59That's dangerous. Victimhood
12:02victimhood is itself dangerous.
12:05And so part of what
12:06I want to talk about
12:08today is how to turn
12:09that notion
12:10of
12:12the use of the holocaust
12:13as a victim narrative
12:16into something different, which is
12:18a focus on ourselves,
12:21a focus on the perpetrators,
12:24a focus on the risk,
12:27the vulnerability,
12:29the tendency that we may
12:31all have not to commit
12:32a genocide for sure,
12:34but our own vulnerability
12:40to behave badly. My journey
12:44into this topic really, I
12:46think, has two components to
12:48it.
12:50Both around the question of
12:52who was truly responsible
12:55for it,
12:57and what we can learn
12:59by understanding
13:01who was responsible
13:03and
13:04not why it happened. We
13:06can never
13:07fully understand the depths of
13:09the evil,
13:10but really
13:12the intellectual component of it.
13:14And that leads me to
13:15two extremely
13:18inconvenient
13:18truths.
13:20Truths that are not just
13:22inconvenient
13:23because they are disturbing because
13:25they but they are inconvenient
13:27that because they bring
13:29the holocaust
13:30back to us.
13:33The first topic
13:36is the notion of Nazi
13:37ethics
13:39that seems
13:41incongruent.
13:42How could we be talking
13:43about Nazis and ethics
13:46within the same phrase?
13:49The fact is,
13:51however uncomfortable
13:53it may be to accept
13:54this,
13:56if we look into the
13:58basis, the fundamentals
14:01of the Nazi policies
14:03and the Nazi activities,
14:05they were grounded on a
14:08notion
14:08of ethics.
14:13I think that the most
14:15interesting way of approaching that
14:17is
14:18by listening to a speech
14:21given by Heinrich Himmler, one
14:23of the bad guys. Heinrich
14:25Himmler was the head of
14:25security. He was responsible for
14:27the genocide. He was in
14:29charge of the the concentration
14:31camps. He gives a speech
14:33in October of nineteen forty
14:35three
14:36to ninety two of the
14:39most senior people in the
14:41SS. He ran the SS.
14:43That was part of his
14:43responsibility. He gave a speech
14:46to the ninety two most
14:48senior people in the SS,
14:50the elite organization
14:52of Nazi Germany.
14:57He didn't talk about the
14:58absence of ethics.
15:01He talked about the existence
15:03of ethics. He talked about
15:05how what the Nazis were
15:08doing, the policies of Nazi
15:10Germany,
15:11how it is framed in
15:14an an ethical construct.
15:18He uses words that are
15:20very familiar to us as
15:22we think about ethical behavior.
15:25He uses words like loyalty,
15:27honesty,
15:28truth. He uses words of
15:29faith.
15:31The word god comes up
15:32frequently in this speech.
15:35The speech is three hours
15:37long. I don't invite any
15:38of you to suffer through
15:40three hours. There's a six
15:41minute portion that that we
15:44at FASB
15:45focus on.
15:46And for me, the most
15:48telling part of this speech
15:50is when he says to
15:52these ninety two people,
15:54I know that what you
15:57are seeing every day is
15:59very difficult.
16:01I know seeing fifty bodies,
16:04one hundred bodies, two hundred
16:05bodies, very difficult.
16:08But
16:10if I catch one of
16:11you stealing one mark,
16:14if I catch one of
16:16you stealing a cigarette, a
16:18fur, a piece of jewelry
16:20off with your heads, we
16:22don't do things like that.
16:26And so what that should
16:27lead us to, I think,
16:29is to
16:32understand that ethics can't be
16:34thought of in universal
16:35terms.
16:37Though many of you in
16:38the audience have studied ethics
16:40far more than I,
16:43but
16:43what we need to understand
16:46is the concept of particularist
16:48ethics.
16:49And most importantly, a term
16:50that that I play with,
16:53which I call microenvironments.
16:56Each of us creates
16:59for ourselves
17:01an environment, a microenvironment
17:04in which we can justify
17:07our behavior, even call it
17:09ethical,
17:11even think of ourselves as
17:13moral actors
17:15in that environment,
17:17even though from the outside,
17:20it's nothing
17:22close to what we would
17:23think of as ethical.
17:26I think of it as
17:27I practice law for a
17:28long time.
17:29I developed a microenvironment
17:32with my clients.
17:35Doctors create microenvironments
17:37with their patients.
17:41Elite institutions
17:42create microenvironments.
17:45The Navy SEALs, a perfect
17:47example of a microenvironments
17:50in which
17:51we are all able because
17:54of our cleverness,
17:56because of our ability to
17:58rationalize our behavior, we are
18:00all capable
18:02of justifying
18:03our behavior
18:06even as ethical, as moral,
18:09even though
18:11in the abstract, if we
18:12were to look at it
18:13from the outside, if we
18:14were to look at it
18:16as if we were an
18:18audience looking at a play,
18:20it would not look that
18:21way.
18:23That was one of my
18:24first realizations.
18:27The second,
18:29I'm describing my journey.
18:31The second was
18:33thinking about who made it
18:34happen.
18:36And what became very clear
18:37to me was that it
18:39was the professionals.
18:41Hitler,
18:43Himmler, those guys,
18:45bad guys. And they were
18:47all guys. Bad guys.
18:49But they're not interesting.
18:52Without the professionals,
18:54it could not have happened.
18:55Everything was done under law.
18:59So who were these lawyers
19:00who wrote the laws? Why
19:02did they write the laws?
19:03What were they thinking about?
19:06The journalists became propagandists.
19:08The clergy became apologists. The
19:10business people created the machinery
19:13of murder, not just the
19:14machinery board, the machinery of
19:15murder.
19:17And the doctors
19:18will talk a bit about
19:20the doctors committed unthinkable
19:22acts.
19:24Why did they do that?
19:26So here another inconvenient truth,
19:28and that is
19:30they did not do it
19:31with a gun to their
19:32head. They were not forced.
19:35They had choices.
19:37Yes. The foot soldiers had
19:38no choices. Yes. The guards
19:40at Auschwitz had no choices.
19:41They had to do what
19:42they
19:43did.
19:45The professionals had choices.
19:47There are many, many examples
19:49of doctors, lawyers, others
19:52who said, no. Thank you.
19:53I don't want to be
19:54part of this.
19:55They weren't sent to the
19:56Russian front. They were given
19:58other jobs.
20:03Even more
20:04even more disturbing perhaps
20:07is that they were largely
20:09not ideologues.
20:11The individuals who we look
20:12at, the professionals whom we
20:14study
20:15were not rabid ideologues. They
20:17were not crazy
20:20genocidists.
20:20They weren't motivated
20:23in what they did through
20:24antisemitism.
20:25Why did they do it
20:26then?
20:27And the answer is they
20:29did it for very
20:30familiar reasons.
20:32I'm gonna be talking,
20:34a a bit about a
20:35few of them
20:36shortly.
20:37But what we understood
20:40is that their motivations,
20:43status,
20:43money,
20:45problem solving,
20:48choosing loyalty,
20:50their motivations
20:52look extremely
20:53familiar to us today. And
20:55so, therefore,
20:57for me, the question is,
20:58what can we learn about
21:00ourselves
21:02from them?
21:04I I have this
21:06notion in my
21:08own attempt to analyze myself,
21:12not
21:13successfully,
21:14is that
21:16we all are guided by
21:18the idea of mentors. We
21:20love the idea of mentors,
21:22and we think of mentors
21:24as being those exemplary people
21:27whom we can learn from,
21:28who will teach us how
21:30to behave well.
21:32What I'm suggesting is flipping
21:35the mentor idea on its
21:37head, and that is
21:40to look at them,
21:42the people who did
21:44bad things, and ask why
21:46they did them.
21:48What can I learn from
21:49those who did bad things
21:52about how I can behave
21:54badly?
21:59On one of my
22:01earliest trips to Auschwitz,
22:03an odd way to start
22:05a sentence,
22:07I, at one point, heard
22:09marching
22:10sounds.
22:12And I went over, and
22:14it was a group of
22:15soldiers from the IDF, the
22:17Israeli Defense Force.
22:19And
22:20what I learned was that
22:21at the time, I don't
22:22know whether this is still
22:23true, all officers in the
22:25IDF were required to go
22:27to Auschwitz.
22:30And
22:31what they said and what
22:33seemed at the time to
22:34be obvious to me was
22:36they were going to Auschwitz
22:38to learn
22:40what the purpose of the
22:41IDF was. And I'm not
22:42here to talk about Israel.
22:43That's not my point at
22:44all.
22:49What I learned,
22:51and this took me several
22:52years,
22:54is the reason to go
22:55to Auschwitz
22:56is not to think about
22:58the risk of my becoming
23:00a victim.
23:02Again, it's not to learn
23:05how I can prevent
23:07being a victim.
23:09Is to look at it
23:11through the eyes of the
23:12perpetrators
23:13and to ask myself,
23:16how can I avoid
23:18being a perpetrator?
23:26I believe it starts with
23:27the basic point
23:30that we all are vulnerable.
23:32We all have the capacity
23:36to misbehave.
23:40Perhaps consciously,
23:41largely not consciously,
23:43largely for reasons that we
23:45don't think about.
23:48I,
23:49I was telling somebody earlier
23:50today that I recently listened
23:52to a podcast. Anderson Cooper
23:54has a series of podcasts
23:56on grief.
23:58I don't recommend them to
23:59anybody. They made me so
24:00sad.
24:02But I listened to one,
24:05with a holocaust survivor named
24:06Irene Weiss.
24:08And in it, she said
24:11something to the effect that
24:14humans
24:16have the capacity to do
24:17unthinkable
24:18things
24:19when given permission to do
24:21so.
24:22And I thought that was
24:24so interesting, and it it
24:25was so helpful. And then
24:29I had a disturbing thought,
24:31and that is
24:33I think she's wrong.
24:35I don't think we have
24:37the capacity when we're given
24:39permission to do so.
24:41I think we have the
24:42capacity because we are human.
24:45And so
24:47as I'm here talking
24:49largely to doctors, other professionals,
24:52what I am suggesting
24:55is that it is our
24:58ability to stand as the
25:00bulwark
25:01against that tacit permission
25:05that we all feel exists,
25:07that we all have
25:09the capacity
25:12to behave badly, and it's
25:13the responsibility
25:15of leaders,
25:17professionals,
25:19to stand in the way
25:21of that tacit permission.
25:27So I wanna talk a
25:28bit about
25:29Nazi medicine and this idea
25:31that I'm toying with, and
25:34all of you can,
25:35give me advice afterwards as
25:37to what you think about
25:38this or how how to
25:39approach it.
25:41Noting
25:42that
25:44I have the
25:45great
25:47benefit of being neither a
25:48doctor nor a historian,
25:51which you could say is
25:52either an invitation
25:54to you to be suspicious
25:56of me,
25:57or maybe it's an opportunity
25:59for me to think a
25:59little bit differently.
26:01You you'll decide which side
26:03you're on.
26:05We've all heard of the
26:07notion,
26:09and, Ben, you talked about
26:10this earlier, that bioethics
26:13some will say bioethics started
26:15at Auschwitz using Auschwitz as
26:17a a proxy for the
26:18the the
26:19the
26:21unthinkable acts committed by doctors
26:23during the holocaust.
26:28We've all heard about
26:30the doctor's trials. We've all
26:31heard about
26:33the learning,
26:34the codes that came out
26:36of Nuremberg about,
26:39what we can learn from,
26:41what we can take from
26:42Nazi medicine.
26:45The fact is
26:47that
26:49all of it, nearly all
26:51of it
26:52focuses on research ethics.
26:55When we think about Nazi
26:57ethics, Nazi doctors, and when
26:59we think about what we
27:01learn about
27:03and from the Nazi
27:04doctors, and when we think
27:06about the ethical lessons
27:09and learnings
27:10and directives
27:11that we take from
27:14Auschwitz, from
27:16the behavior of the doctors,
27:18it's almost entirely
27:20focused on research.
27:22It's focused on informed consent
27:25as it relates to research
27:27subjects.
27:28It's focused on what research
27:30we should or shouldn't do,
27:32the conduct of research, the
27:33protections against inappropriate
27:35research.
27:37What I'd like to do
27:38today
27:39is explore what I think
27:41are three
27:44different
27:45constructs
27:47for thinking about Nazi medicine.
27:52The first is
27:54the power of the doctors,
27:59The power of the medical
28:00profession.
28:02We talk a lot at
28:03FASB about the power of
28:04professionals.
28:05No set of professionals
28:08have more power,
28:11more authority, more influence
28:14than doctors.
28:17And so I think that
28:19when we think about
28:21Nazi
28:22medicine,
28:24we should spend a good
28:25amount of time as we
28:27educate about it,
28:29thinking about
28:30medicine
28:31as the influencing
28:33profession.
28:37At Auschwitz,
28:39as you all know,
28:40there was a selection point.
28:44The people at the selection
28:45point, the Nazis
28:47at the selection point would
28:49point left, right.
28:51We all know
28:53what the choices were.
28:55Who were they?
28:57Who were those people making
28:59the selections?
29:01It was doctors.
29:04Why
29:06was it doctors
29:07who the Nazis placed at
29:09the selection point at Auschwitz?
29:13It wasn't
29:14because they were making medical
29:16decisions.
29:19They weren't examining the people
29:21and deciding
29:23whatever they might decide or
29:25whatever decision making. It wasn't
29:27because of that. They didn't
29:28need medical degrees
29:30to determine which was a
29:32man and which was a
29:32woman. They didn't need a
29:34medical degree
29:35to decide whether somebody was
29:37too old to work or
29:38too young to work.
29:39So why was it doctors?
29:42And the answer is because
29:45people trusted
29:46doctors.
29:47Even those people at the
29:49selection point
29:52trusted that there was something
29:54legitimate
29:55happening here. They trusted that
29:58there was something
30:00relevant, important being done here,
30:03and therefore,
30:05doctors.
30:08One of the,
30:11one of the people we're
30:12studying right now we do
30:14everything through cases. We look
30:15at individual,
30:19especially young professionals and and
30:21try to learn more about
30:22them. One of the those
30:23whom we're looking at right
30:24now is a doctor
30:26named Heinrich Bunka.
30:28You've not heard of Heinrich
30:30Bunka.
30:32He was a young doctor
30:36who worked at
30:38one of the t four
30:40sites. The t four sites
30:42in Germany were the sites
30:44where
30:45the first gassings took place.
30:48Gassings of handicapped beginning in
30:50nineteen thirty nine thirty nine.
30:54His job
30:57he had one job.
30:59His job
31:00when
31:02these
31:03handicapped,
31:03largely children,
31:06got off the bus
31:08and their parents had told
31:09them they were going to
31:10a special hospital that could
31:13cure their diseases.
31:16And there were doctors and
31:17nurses on board the bus.
31:19When they got off the
31:20bus,
31:21Heinrich Bunka had one job,
31:24and that was
31:26to establish
31:27the cause of death
31:29that he would write on
31:31the death certificate
31:32that would be sent
31:34to the parents.
31:38That wasn't a mystery what
31:40the cause of death was.
31:41They were gassed.
31:43But he, in the death
31:44certificates,
31:45would write down heart attack,
31:48pneumonia,
31:49appendicitis,
31:50pick a disease.
31:53His job was solely
31:57to ensure that what he
31:58would write down, the lie
32:00that he would write down
32:02would be plausible
32:03so that he wouldn't write
32:04down appendicitis
32:06for somebody who had had
32:07a a a scar that
32:08suggested
32:11surgery.
32:13Why did he do that?
32:15He was a
32:17doctor.
32:18He had a white coat
32:20on. Why would he do
32:21that?
32:23Why was he placed there?
32:25First of all, we can
32:26establish without a doubt
32:28the reason he was placed
32:29there was because he had
32:31a white coat on,
32:33and he could create
32:34the aura of influence, the
32:37aura of professionalism,
32:39the aura of legitimacy.
32:41And why did he do
32:43that?
32:46He did it
32:48because it was an opportunity
32:50for him to work with
32:52a mentor
32:53who was the head of
32:54that facility.
32:55I'll come back to that
32:56in a moment.
32:59So I suggest
33:02one of the things that
33:03we should be talking about
33:04as we think about Nazi
33:05medicine is
33:07medicine
33:08as the influencing
33:09profession.
33:12Secondly, is the idea of
33:13clinical ethics.
33:17Nazi medicine has been used
33:18for purposes of studying
33:21research ethics.
33:25Two things I'd like to
33:26think about, and again, I
33:28invite
33:29all of you, especially the
33:30doctors, to
33:32think about this a bit
33:33more
33:34in the context of of
33:37clinical ethics, and there are
33:38three parts to that that
33:39I think about. One is
33:42how we think about
33:44the Hippocratic Oath.
33:47Many people when they visit,
33:49think about, talk about
33:53the sites where the doctors
33:54did unthinkable acts, and the
33:56question will be,
33:58what about the Hippocratic Oath?
33:59How could they possibly have
34:01done that?
34:02Where does do no harm
34:04fit into that?
34:05And the answer is that
34:07they were complying with the
34:09Hippocratic
34:10oath.
34:11The problem,
34:12as we think about
34:15it retrospectively,
34:16is that they define the
34:18patient
34:20to whom they should commit
34:22no harm
34:23as being the Volk,
34:25the German people.
34:28And so for them,
34:30they were
34:31the ultimate carriers
34:33of the Hippocratic Oath
34:35because the patient
34:37whom they were serving
34:39was the nation,
34:41was the German nation.
34:44For me, that's an invitation
34:47to think about
34:49who the patient is in
34:51the role of of
34:53clinician.
34:54Who is the patient? How
34:56do I think about the
34:57patient? I don't I certainly
34:59understand
35:00that there can be different
35:02priorities.
35:04But I think
35:06and this for me is
35:07the most important part is
35:08self awareness.
35:11In thinking about that, be
35:13aware
35:14of
35:15the decisions that you are
35:16making as doctors, as all
35:18of us as professionals,
35:20when we think about
35:22who we're serving and why
35:24we're serving, how we're serving
35:25them, whether as doctors, lawyers,
35:27or otherwise.
35:32The second
35:33component of the clinical
35:35ethics
35:37construct,
35:38for me, is one about
35:40motivations.
35:41What motivates us as doctors,
35:44as other professionals?
35:45Why are we in this
35:46profession?
35:48Who are we serving?
35:50What is our
35:52personal motivation? What drives us?
35:55And, again,
35:57we look at
35:58individuals.
35:59We look at specific
36:01individuals at that time.
36:04Bunka is a prime example.
36:05I mentioned him earlier, the
36:07doctor
36:08at the
36:09at the t four site.
36:11Bunka,
36:12whom we've studied a good
36:13amount,
36:15volunteered for this job. He
36:16volunteered to be interviewed.
36:19He did that
36:21because he had learned that
36:23a very important doctor in
36:25Germany
36:26was running that site. He
36:28was a young doctor looking
36:30about
36:32focusing on his future career.
36:35And he decided
36:37not as a rabid ideologue.
36:39He didn't care about this.
36:41It wasn't
36:42important to him. But he
36:44decided that by being at
36:46that place,
36:47he could develop a relationship
36:49with this senior doctor,
36:52and therefore, he did it.
36:53And the fact is it
36:55worked out well with him.
36:56This doc worked out fine
36:58for him.
36:59This doctor was an important
37:01neurologist,
37:02and over time, he started
37:04working Bunka started working in
37:06this neurologist's lab. So
37:08worked out fine for him
37:10because his motivation
37:12was one of
37:15status. It was one of
37:17careerism,
37:17if you will.
37:20We look at another
37:22doctor,
37:23an uncomfortable
37:27examination. It's of a doctor
37:28named Herta Uberheiser,
37:30a woman
37:32who ended up
37:34at,
37:35Ravensbruck,
37:36a
37:37terrible place where there was
37:39it was a women's camp
37:40where the the the
37:43research was awful. The work
37:44that was being done was
37:45awful.
37:47Essentially, she
37:49answered an ad in a
37:51newspaper.
37:52This was an opportunity
37:54for her as a female
37:56doctor with limited
37:57opportunities
37:59to get a well paying
38:00job.
38:03Now that
38:04I mean, as we think
38:05about it, I can see
38:07people
38:08shaking their heads.
38:10Again,
38:12we must not analogize
38:14to the risk that we
38:15become
38:17genocidal.
38:19The question is what motivates
38:21us and where we go
38:23to do what we do,
38:25and it's a it's a
38:27call, I believe, for self
38:28awareness.
38:30The third part that I'm
38:33urging that we think about
38:34in terms of a different
38:35approach to to to Nazi
38:38medicine
38:40is
38:41the concept
38:43and I don't know how
38:44to think about this, so
38:45I invite you. It's I
38:46don't know where to take
38:47this really,
38:49but it's the concept of
38:50self regulation.
38:53Is self regulation
38:56adequate? Is it successful?
38:59One of the
39:00individuals whom we study
39:03is a guy named Conrad
39:05Morgan.
39:07Conrad
39:07Morgan,
39:09a accomplished lawyer, becomes a
39:11judge.
39:14And,
39:15by the forties,
39:19he becomes a judge
39:20in
39:21the SS.
39:22The SS
39:24was self regulatory.
39:27So his job
39:28think of it in terms
39:30of the adjutant generals in
39:31in the in the, military
39:33today,
39:34the JAG.
39:36He
39:37his job
39:39was to preside over cases
39:41brought against SS members
39:46for their misbehavior.
39:49What were the crimes
39:51that he
39:52was presiding over?
39:54Well, they were corruption.
39:57They were sexual misconduct.
40:01These are people who were
40:02committing murder
40:04every day,
40:06and his job,
40:08because the SS had established
40:10their own means of self
40:11regulating,
40:12his job
40:14was around
40:16what he would describe as
40:18issues of morality,
40:20issues of lawfulness,
40:22but he was so focused
40:23on what
40:25I call today, rightly or
40:26wrongly, concepts of trade craft,
40:28the rules of the profession,
40:31the rules that govern SS
40:32members. He was so focused
40:34on that
40:37that the fact they were
40:38committing murders every day was
40:40irrelevant.
40:41So it raises for me
40:43the question of self regulation.
40:45I'm not arguing I'd if
40:46I'm a doctor, I'd rather
40:48be judged by a doctor
40:51who knows
40:52whether what I do is
40:54right or wrong. But I'd
40:55want that doctor,
40:56I'm hoping,
40:59to be thinking about true
41:01concepts of morality,
41:02true concepts of right and
41:04wrong, not mere
41:06what I call tradecraft.
41:10So I've talked about
41:13medicine as the
41:15influencing profession. I've talked about
41:17clinical ethics.
41:19One last
41:20component that I think we
41:22can learn a bit about
41:24from the Nazi doctors,
41:26I'm sorry to say, is
41:27commercialization.
41:32The,
41:36I'm I'm tempted to admit
41:38that
41:39these topics aren't
41:41that appetizing.
41:44The most awful
41:47place at Auschwitz
41:49and, Mark, we've been there
41:50many times. I I find
41:51the most awful place at
41:53Auschwitz
41:55is the facility where there
41:57was
41:58sterilization
41:59experimentation
42:00done on women,
42:02young women.
42:04Horrifying place to be in.
42:06There's nothing there,
42:08but being in that place
42:10is is
42:11unspeakably
42:12uncomfortable.
42:14What we learned
42:17is that
42:19the drug company's sharing.
42:22Some of
42:23you may
42:24know the word shearing because
42:26Shearing became Shearing Plow, a
42:28very large British
42:30German,
42:32pharma company now owned by
42:35Bayer.
42:37Shearing was seconding
42:40employees
42:42to this place.
42:46They were responsible
42:47for helping the doctors
42:50who were doing this experimentation
42:52to identify
42:54the cocktail
42:55that would be best for
42:57sterilization.
42:59Shearing not just seconded people
43:01there and worked with them
43:02on the chemical ingredients.
43:05They even put the X-ray
43:06machines there.
43:09I don't know what to
43:10say about that. I don't
43:12think any of us
43:14here or elsewhere need warnings
43:16about the risk of commercialization.
43:20But at the same time,
43:22I think maybe we do
43:23need warnings about the risk
43:25of commercialization
43:27and how to think about
43:28it.
43:34A moment talking about
43:37medical
43:37ethics
43:38today
43:40and how I how I
43:41think about it and a
43:42and a few thoughts.
43:45One is and I've talked
43:46enough about
43:48your duty, your power, your
43:50responsibility,
43:51your responsibility
43:52to the patient.
43:53For me, one of the
43:54primary take takeaways
43:57is
43:58your duty and who you
43:59are responsible to.
44:03The second
44:05is around trust.
44:10Let's be clear.
44:12One of the
44:14most important tools
44:16in the toolkit
44:20of autocrats
44:22is sowing distrust in expertise.
44:26One of the most important
44:28tools
44:30that they employ
44:33is distrust
44:34of professionals,
44:36of expertise,
44:37of science.
44:40Let's not ignore that that
44:42is
44:43what we are seeing today.
44:47And so
44:48my response to that is,
44:50yes,
44:52We have to recognize
44:53that,
44:55but
44:56it leads me to the
44:57question is, what is the
44:59responsibility of the professional
45:00to earn
45:02the trust back? How do
45:04we become trustworthy?
45:07How do we do that
45:08one doctor at a time?
45:10I'm not I have the
45:11answer, of course, but I
45:12don't want to give it
45:13to you today.
45:15I'm asking you as doctors
45:18and other professionals
45:19to focus on the question
45:21of trustworthiness
45:24and what it is you
45:25can do, maybe one patient
45:27at a time, to earn
45:28back
45:29that trust.
45:37I was talking to somebody
45:38at lunch today. We were
45:39talking about
45:41professionals
45:42as the trusted adviser.
45:47I grew up in a
45:48small town in Ohio,
45:50and doctor Garber was our
45:53doctor.
45:54Doctor Garber
45:56knew my family.
45:57He knew my grandparents. He'd
45:59he'd been doctor for
46:01generations.
46:02He knew everything about
46:05our family.
46:06He was the trusted adviser.
46:11For many, many reasons,
46:13the concept of trusted advisor
46:15has been absent for some
46:16time
46:17in medicine, in law,
46:19in other professions.
46:23I wonder
46:25how it is one doctor
46:27at a time, one lawyer
46:28at a time, we can
46:30we can regain
46:31some component
46:32of that concept of
46:34trusted advisers so the patients
46:37have reason to trust us.
46:43So I'd like to suggest,
46:45if I could,
46:46four
46:47punch lines, if you will,
46:49that I'd like perhaps you
46:51to take away from
46:53this discussion.
46:55One is
46:56the importance
46:57of intentional
46:59self awareness.
47:02Be conscious of why you
47:03are doing what you're doing.
47:05Be conscious of what your
47:06duty is. Be conscious of
47:08what your responsibility
47:10is.
47:12Like it or not,
47:14when you took on that
47:16white coat, you took on
47:18a responsibility.
47:21I'm not here to lecture
47:22you. I'm stating a fact.
47:25You took on a responsibility,
47:28and so I urge
47:30intentional
47:31awareness of that responsibility
47:34and it and intentional
47:36self awareness
47:37of why you do what
47:38you do.
47:40Secondly, back to the trustworthiness
47:42part,
47:44we need you.
47:47We need
47:48a medical community that is
47:50trusted.
47:53Earn it,
47:55please.
47:58Thirdly,
47:59and related
48:00perhaps to that is,
48:02a word that we use
48:04in FASB.
48:07A German word,
48:08that is spielram.
48:11Spielram
48:13means,
48:14essentially, wiggle room.
48:19My suggestion
48:21is
48:22that
48:24in your day to day
48:26work,
48:28you are facing
48:29enormous
48:31difficulties. You're facing the challenges
48:33of having to do too
48:35many reports. You're facing the
48:37challenges of insurance companies.
48:39You're facing the challenge of
48:40not enough time. You're facing
48:42the all the the challenges
48:43you have, the commercialization of
48:45medicine,
48:46all those challenges.
48:48Don't give into it.
48:51Find
48:52spiel ram.
48:53Find areas,
48:55little areas,
48:57where you can exercise
48:59wiggle room
49:00and do the right thing,
49:02where you can exercise wiggle
49:04room.
49:05And with that,
49:07you are actually
49:09in your own way fighting
49:10against
49:11the system.
49:14Lastly,
49:18and I say
49:20this coming back to New
49:22Haven and to Yale Medical
49:23School.
49:25I had this wonderful friend
49:27here
49:28named Tom Duffy.
49:31Many of you
49:32knew Tom Duffy.
49:34Those of you who didn't,
49:37regrets.
49:39Tom was a
49:41a magnificent doctor in all
49:43respects.
49:46He was a humanist.
49:47He was a dietitian.
49:51For reasons that I can't
49:53understand, he raised three kids
49:54who were athletes. That part
49:56never made sense to me.
49:59My admonition
50:00to you
50:02as you're facing issues
50:05day to day in your
50:06day to day practice,
50:09ask yourself what Tom would
50:11do.
50:12I try to do that
50:14not even as a doctor.
50:16So my urge to you
50:17is
50:18keep Tom Duffy in your
50:20mind.
50:21Thank you.
50:34How long? What did I
50:35do? How long?
50:37Too long. Too short. Oh,
50:39okay.
50:41Thank you so much, David.
50:46I I think what we'll
50:47we'll do now is is
50:48we'll,
50:49we'll we'll we'll sit down
50:50and and, open the
50:53this up to a discussion
50:54with the with the audience.
50:55And
50:57and if if it's possible,
50:59you have we have,
51:01microphones on either side. And,
51:03Karen,
51:04do you have access to
51:05the questions coming in online?
51:07Okay. So we'll we'll,
51:09we'll move into a discussion,
51:12with the audience.
51:22It works better when it's
51:24on. Okay.
51:27So,
51:30I wanna invite folks to
51:31to come to the microphones.
51:33I have some questions, but
51:35but I want to,
51:36prioritize first the, the folks
51:38here in the audience, and
51:39I see,
51:40one,
51:41participant already.
51:53Thank you so much.
51:55The one as you were
51:56speaking,
51:57you're speaking specifically
51:58of
51:59the the junior physician
52:02at the t four site
52:05and the female physician at
52:06Ravensbruck
52:08and the job opportunities
52:10that they were seeking.
52:12It made me wonder,
52:14sometimes people seek jobs for
52:16self
52:17gain,
52:18and often folks are seeking
52:19job opportunities because they have
52:21a family to care for.
52:23And I was wondering if
52:24you knew
52:25whether or not those two
52:26physicians were parents
52:28or if they were responsible
52:30for other folks,
52:31and that's a part of
52:32their thinking of thinking about
52:33a job.
52:35I,
52:37when when I think about
52:40what motivates us,
52:42I'm not suggesting that motivations
52:44are necessarily
52:46bad.
52:47And so,
52:50we're motivated by paying back
52:52student loans.
52:54We're motivated by providing for
52:56a family. We're motivated by
52:58wanting to advance in in
52:59our careers. We're motivated by
53:01things that are not
53:04bad. All that I ask
53:05for is self awareness
53:08that we understand what we're
53:09doing and take that motivation
53:13into account as we are
53:14making the decisions that we're
53:16making.
53:17I'm not
53:18again, I'm not here really
53:19criticizing
53:21that doctor for well, I'm
53:23criticizing her for what she
53:24did.
53:25But what I'm saying is
53:26I understand her motivation. I
53:28take it as a directive
53:30to us.
53:33No. That's exactly what I
53:34was and just the complexity
53:35of how it especially, again,
53:37just in terms of seeking
53:38job advancement. And, again, in
53:40a space where we are
53:41training people for the next
53:42step in their professional recognizing,
53:44often
53:45when we're thinking of that,
53:46it is not exclusively self
53:49gain. But in fact, our
53:50care for others and our
53:51responsibility to those closest to
53:53us
53:53is often a lens
53:55on that motivation.
53:57This ethics thing,
53:59as I like to call
54:00it,
54:01is complicated.
54:02Yes. It's not binary.
54:06We all have to understand
54:07there's no right or wrong
54:09answer,
54:11usually.
54:13And so our job is
54:14to make sure that we're
54:15taking into account as we're
54:17making our decision
54:19all components.
54:20Thank you.
54:24Thank you, mister Goldman.
54:26One of the things that
54:27I was
54:28considering while you were speaking
54:30today was the sort of
54:31this classic trolley car,
54:34construct
54:35in ethics, which for people
54:36who aren't familiar with it,
54:38has to do with,
54:39this notion of pushing
54:41a man off of just
54:42for the audience, pushing man
54:43off bridge to save people
54:45in a, you know, runaway
54:47train.
54:48And, you know, I've I've
54:50thought about how
54:52we think
54:53in our relationships with other
54:55people and patients in particular
54:58that were affected by the
55:00person
55:00right in front of you
55:02and somehow
55:03managed to be psychologically
55:05or ethically disengaged from the
55:07people you don't see.
55:09And and one thing that
55:11I I didn't really hear
55:12you get into a lot
55:13today, but, I've always been
55:15curious about,
55:16is
55:17how
55:18the doctors
55:19actually,
55:21managed to
55:23dehumanize the people who were
55:26physically in proximity to them.
55:28Right? So the physician at
55:30the train,
55:32stopped
55:33pointing to a person who's
55:34right there,
55:36alright, or shooting somebody in
55:37the back of the head
55:38or something like that.
55:40And and so I'm I'm
55:41wondering how you you think
55:42about that
55:43because because I think that
55:45today, you know, I think
55:46that regardless of the influences
55:49that we struggle with in
55:51modern
55:52medicine, it's when a patient's
55:54in the room in front
55:55of you,
55:56it's easier to remember your
55:58ethical obligation to them. But
55:59somehow, the Nazi physicians lost
56:02that.
56:03Right? Like, it's not it's
56:04it's another area that I
56:06think is really profound,
56:07like, to dehumanize and simply
56:09not think about the consequences
56:11of a human being you're
56:12doing an experiment on with
56:14your hands
56:15on them.
56:17Could I just note,
56:18he's really smart too.
56:21Oh, yeah. Yeah. Ben, what
56:22do you think?
56:25Do you wanna
56:27I I have a related
56:28question. I wanna hear hear
56:29your response, but I've I've
56:30a sort of a follow-up
56:31question to this actually.
56:33I think,
56:35I would approach this in
56:36in a few ways. One
56:38is
56:41talking about the Nazis
56:43is complicated
56:44because,
56:46yes, that that makes the
56:48question almost impossible because the
56:50answer is
56:52that they were not human.
56:55The people at the selection
56:56point were not,
56:58to them, human.
57:03I always hate to do
57:05this because it's so unpleasant.
57:07The
57:08the the manufacturer of the
57:09crematoria
57:10at Auschwitz referred to units,
57:13not bodies. How many units
57:15could be processed?
57:19Mengele, subject longer subject.
57:22Mengele
57:23at one point said
57:26that
57:28he, in a way,
57:30kept people alive.
57:33When they arrived at Auschwitz,
57:35they were already
57:36effectively dead.
57:38And so
57:40in a way,
57:41he was
57:43I know this is ridiculous.
57:44He was helping them. He
57:45was keeping them alive for
57:47a period of time.
57:49So
57:50that was part of the
57:50mindset.
57:51I
57:53to to jump ahead maybe,
57:56I I think that
57:58and maybe this is part
57:59of the question.
58:00I think one of the
58:01duties that we have to
58:02have today,
58:03we have to think about
58:05is potential adverse consequences.
58:08And so,
58:10in all of our decision
58:11making,
58:12we have to think not
58:14just about what we're doing
58:15today, but the potential adverse
58:17consequences.
58:19And I think that that
58:20again was one of the
58:21failures of that period.
58:24So I have a sort
58:25of a a follow-up question
58:26to this. I, you know,
58:27I think
58:29I
58:30perhaps share Mark's perspective that
58:32the sort of the the
58:33obvious takeaway
58:35lesson
58:36from
58:37the atrocities of the camps
58:39was was that
58:42it it is essential for
58:43physicians to to keep the,
58:46the individual patient
58:48foremost
58:49in,
58:51in their mind as their
58:52top priority. And that that
58:53one of the great failings
58:56of of the Nazi physicians
58:57was to,
58:59you know, look at the
59:00Volk, look at the people
59:01or state as their patient
59:03rather than at individual human
59:05beings. And that allowed
59:07all of these monstrous behaviors
59:09because
59:11the the the benefit to
59:13the bulk, the benefit to
59:15the peep to the people
59:16as a whole outweighed
59:18the atrocities.
59:24But at the same time,
59:27one of the great failings
59:29of the American healthcare system
59:32is that
59:33we are
59:36providing,
59:38in many cases, very
59:40poor care to
59:45the the people and to
59:47the collection of individuals that
59:49make up the people at
59:50enormous cost far greater than
59:52any other nation in the
59:53world
59:54with with worse outcomes.
59:57And
01:00:05it it is
01:00:07any any
01:00:08in my mind, any thought
01:00:10of
01:00:13limiting
01:00:14treatment,
01:00:16limiting
01:00:20the the,
01:00:22interventions and costs
01:00:24provided to an individual patient
01:00:27feels like the first small
01:00:28steps down the road
01:00:31of the Nazi physicians. And
01:00:32and I'm
01:00:34I'm I I I struggle
01:00:36with how to think about
01:00:41public health
01:00:43analysis,
01:00:45cost effective analysis
01:00:47in the aftermath
01:00:49of those atrocities. I'm curious
01:00:50if if you have thoughts
01:00:52about whether
01:00:54that kind of thinking
01:00:57whether there's room for that
01:00:58that kind of thinking,
01:01:01in the aftermath of of
01:01:02the Holocaust.
01:01:08I think,
01:01:11I I hate to use
01:01:13the phrase that we we're
01:01:15all hearing so much right
01:01:16now, which is,
01:01:18we can have two thoughts
01:01:19at the same time.
01:01:21And so I think
01:01:23I don't know how else
01:01:24to think about that other
01:01:26than
01:01:30what you describe
01:01:31is a caution
01:01:34that should serve as warnings
01:01:37to us,
01:01:39but not to dictate answers.
01:01:42And so
01:01:44when you say,
01:01:46are we going down that
01:01:48path
01:01:50by beginning to think about
01:01:51limited well, how however you
01:01:53approach it, are we going
01:01:54down that path?
01:01:56Well, the answer may be
01:01:57yes and maybe no.
01:01:59But it seems to me
01:02:01you are serving
01:02:03the
01:02:04purpose
01:02:06of analysis
01:02:07and the purpose of awareness
01:02:10by having the risk in
01:02:12mind.
01:02:14There
01:02:15again, it's it's the
01:02:17the the problem
01:02:19the problem of the holocaust
01:02:20is it's is
01:02:22there are no equivalencies.
01:02:25And to fear that you're
01:02:26creating the equivalency
01:02:28takes you down
01:02:30a really
01:02:32ugly and perhaps not
01:02:34helpful path,
01:02:36but it can so it
01:02:38but it can serve as
01:02:39a warning, not as an
01:02:40answer.
01:02:42Is that
01:02:43I think that that that
01:02:44is a a a helpful
01:02:45framing.
01:02:46I wanna
01:02:47allow folks in the audience
01:02:49to follow-up. But can I
01:02:51just say something?
01:02:53When
01:02:54when
01:02:55I didn't realize that part
01:02:56of the deal was that
01:02:57you could ask questions.
01:02:59Is that Like, cheating?
01:03:01Well, I'd I'm worried that
01:03:02they'll be more complicated.
01:03:07So I laughed a little
01:03:08earlier when you said that
01:03:09you're neither
01:03:10historian nor a doctor because
01:03:12I have the unfortunate distinction
01:03:13of being both.
01:03:15But more delightfully than that,
01:03:17I also have the honor
01:03:19of being the mother of
01:03:20two children with Down syndrome.
01:03:22And so because of the
01:03:23intersection of those three identities,
01:03:25I have obviously learned about
01:03:26action t four.
01:03:28But my question for you
01:03:30is,
01:03:31as someone who knows through
01:03:33your research and through this
01:03:34institute
01:03:35far more about action t
01:03:36four
01:03:37and the,
01:03:39gassing
01:03:39of
01:03:40people with disabilities, you know,
01:03:42far more about this than
01:03:43I do. I'm wondering
01:03:45what you what lessons do
01:03:47you think are to be
01:03:48gleaned,
01:03:50for physicians
01:03:51about the care and the
01:03:52ethics of caring for people
01:03:54with disabilities, particularly
01:03:56intellectual disabilities?
01:04:06Is the question,
01:04:13the question is not
01:04:17for sure
01:04:20whether
01:04:22people with disabilities
01:04:24deserve less.
01:04:26Is it?
01:04:28Absolutely not.
01:04:30And so No. I don't
01:04:34or if the question is
01:04:40the medical care for people
01:04:42with disabilities may cost more
01:04:43or may use different resources,
01:04:45should we think about that?
01:04:49I think
01:04:51we all have disabilities, so
01:04:53I don't
01:04:54needing medical care may be
01:04:56a disability. So I don't
01:04:58I'm not sure that I
01:05:01have
01:05:02an answer
01:05:03I don't know that I
01:05:04understand the question well enough
01:05:06because
01:05:07I think that
01:05:09one of the,
01:05:11things we learned
01:05:13through
01:05:14t four, through the the
01:05:15treatment of
01:05:17people with disabilities
01:05:20was the concept
01:05:23of othering
01:05:24in the medical
01:05:25context.
01:05:28And I think that the
01:05:30ethical lesson
01:05:31is that
01:05:34othering
01:05:35cannot be, should not be
01:05:37used as a means to
01:05:39create different standards of care
01:05:42or to create different obligations
01:05:45of care.
01:05:47And I think let let's
01:05:48not
01:05:49ignore
01:05:51that,
01:05:54that
01:05:56the euphemistically
01:05:57called euthanasia,
01:05:59which was murder, began with
01:06:01eugenics.
01:06:03And eugenics
01:06:04was far more refined
01:06:07and used in America than
01:06:09in Germany.
01:06:11And so I think that
01:06:12that
01:06:13there again is a warning
01:06:16to us
01:06:18that
01:06:19the other ring of those
01:06:22who are different
01:06:24than we are
01:06:25through medical care
01:06:28is just plain wrong
01:06:31in my opinion.
01:06:34Thank you.
01:06:37Yeah. I'll I'll just say,
01:06:38you know, what we I
01:06:39was,
01:06:42researching this topic for for
01:06:43the the recent event that
01:06:44we had with the,
01:06:46mister Sukarni, the survivor. And
01:06:49and one of the things
01:06:50that really struck me was
01:06:53how the
01:06:55social Darwinist and eugenics
01:06:57thought that really set the
01:06:59the framework
01:07:00for the
01:07:01p four program and later
01:07:02the the, concentration camps and
01:07:05the extermination camps
01:07:06really came from
01:07:08American
01:07:09and British
01:07:10academia.
01:07:11Not it did not originate
01:07:13in Germany. The Germans
01:07:14considered themselves students of,
01:07:18American and British,
01:07:20positions in academics.
01:07:22The the author of The
01:07:24Passing of the Great Race,
01:07:25which was one of the
01:07:25most,
01:07:26influential
01:07:28eugenics
01:07:28books of of all time,
01:07:30was written actually by a
01:07:31Yale graduate,
01:07:33a,
01:07:34a lawyer in, in the
01:07:35United States.
01:07:37When when,
01:07:39with our fellows, we'll spend
01:07:41three days
01:07:42at Auschwitz.
01:07:44And leaving there is
01:07:46complicated.
01:07:47It's difficult to get back
01:07:49into the real
01:07:50world after spending three days
01:07:52there.
01:07:53And one of the questions
01:07:54we ask the fellows
01:07:57is where
01:07:59in Auschwitz
01:08:00did they see their profession?
01:08:03So we ask the doctors
01:08:04where
01:08:06in Auschwitz did you see
01:08:08your profession?
01:08:10And for us, the answer
01:08:11is not
01:08:15at the selection point.
01:08:17It's not
01:08:19just
01:08:20in the research
01:08:21buildings.
01:08:23It's in
01:08:25I see my doctors, I
01:08:27see my profession at Auschwitz
01:08:30first
01:08:31in the eugenics facilities in
01:08:33America.
01:08:35And I think that that's
01:08:36how we have to think
01:08:38about the professions and what
01:08:39they did
01:08:41is where did it begin,
01:08:42not where did it end.
01:08:45In nineteen thirty three or
01:08:47in America nineteen ten, nobody
01:08:49knew the word Auschwitz. Nobody
01:08:51knew where that would end
01:08:52up.
01:08:54And so we have to
01:08:55look at where that mindset
01:08:57began that led us there.
01:09:35So I just I just
01:09:36wanna repeat the question because
01:09:38there are we have audience
01:09:39online who who who are
01:09:40not gonna be able to
01:09:41hear things without a microphone.
01:09:42So the question was about
01:09:44whether there's
01:09:45a difference between medical specialties
01:09:48in,
01:09:50the the role
01:09:52in the Nazi party and
01:09:53in the holocaust?
01:09:58Well,
01:10:00are there some people who
01:10:01we can say aren't allowed
01:10:02to ask questions?
01:10:05That's,
01:10:07Jacob,
01:10:09that's interesting.
01:10:11I would say I hadn't
01:10:12thought about that so much,
01:10:14and maybe I should have.
01:10:20And and, Ben, I know
01:10:21that you have thought I
01:10:22I think that
01:10:24eugenics
01:10:27was very much around,
01:10:30what they called feeble mindedness,
01:10:35which leads me
01:10:38to the obvious answer.
01:10:41And so
01:10:43there wasn't specialization
01:10:44at that point like there
01:10:45is today,
01:10:47but
01:10:48the eugenics leading to the
01:10:51euthanasia,
01:10:52which I hate calling it
01:10:54that, the murders of the
01:10:57handicap,
01:10:59was around particular diseases,
01:11:02particular,
01:11:04conditions,
01:11:07epilepsy.
01:11:09And so with that as
01:11:10one so that leads me
01:11:12to believe that the specialists
01:11:14and, Ben, I think you
01:11:15have are gonna have a
01:11:16better answer than this. I
01:11:18think the specialties then were
01:11:20around the categories
01:11:21that they had identified
01:11:23as
01:11:24leading to
01:11:27eugenics euthanasia.
01:11:29My my impression is that
01:11:32the
01:11:33the the specialization
01:11:34and sub specialization that is
01:11:36so commonplace in the United
01:11:37States, and particularly in academic
01:11:39medical centers today, didn't
01:11:42exist to nearly the same
01:11:43extent then. There was a
01:11:44lot more,
01:11:46general practice. There there were
01:11:48much
01:11:49there was,
01:11:51there there there's much fewer,
01:11:53subspecialty training programs
01:11:56at that time, both in
01:11:57Germany and in the United
01:11:58States and and England.
01:12:03So I I I'm I'm
01:12:04not aware of
01:12:06differences between specialties,
01:12:10in in the,
01:12:11enrollment in the Nazi party
01:12:12and the enrollment in the
01:12:13SS, but but also I
01:12:15I think there
01:12:17was a lot more fluidity
01:12:18and that you could train
01:12:19as a physician and practice
01:12:21in in areas of your
01:12:23interest.
01:12:24I do think that in
01:12:26addition to
01:12:27medicine, there was a lot
01:12:28of
01:12:31thinking about eugenics and what
01:12:33they called rosin hygiene or
01:12:34racial hygiene
01:12:35coming out of,
01:12:37schools and departments of anthropology.
01:12:40In in particular, there there
01:12:42were a number of
01:12:44leading
01:12:45physicians who were faculty
01:12:47in institutes of anthropology
01:12:49who played leading roles in
01:12:51the development of the,
01:12:53Nuremberg race laws and who
01:12:55were inspirational
01:12:57to Hitler,
01:12:59when when he was writing
01:13:00Mein Kampf and and
01:13:02Yeah.
01:13:04Mengele had two PhDs,
01:13:08one in medicine, one in
01:13:10anthropology.
01:13:12And his I think it
01:13:14was his thesis was on
01:13:15the potential relationship between cleft
01:13:18palate and
01:13:19and
01:13:22and,
01:13:24psychological problems. And but but
01:13:27still, I I think
01:13:29what, Ben, you say is
01:13:31right. It's not as if
01:13:32the specialties
01:13:33led people to misbehave.
01:13:37It wasn't
01:13:38specialized like that. To nearly
01:13:40the same extent.
01:13:42We we have some more
01:13:43folks waiting to ask questions.
01:13:46Thank you for the talk.
01:13:48One of the things I
01:13:49appreciated
01:13:51about it was that you
01:13:53did not tell any stories
01:13:54of people who helped,
01:13:56or people who did good
01:13:57things.
01:14:00I'm sure you've seen probably
01:14:02lots of people have seen
01:14:03the photo of I think
01:14:04it's the Nazi rally in
01:14:05Hamburg where there's one guy
01:14:07who's got his arms crossed
01:14:08while everybody else is is
01:14:10giving the Nazi salute.
01:14:12And
01:14:15I think everybody clings to
01:14:16the to the imagination that
01:14:18they would be the guy
01:14:19with their arms crossed.
01:14:22But, I mean, it would
01:14:23be one of us if
01:14:24we were at the Nazi
01:14:25rally,
01:14:26you know, in the room
01:14:27today.
01:14:31And it seems like
01:14:33there's something deeply human about
01:14:35wanting to associate yourself
01:14:38with the good
01:14:39and with doing the good.
01:14:41And I'm wondering what you
01:14:43have found to be,
01:14:46the conditions
01:14:47under which people can imagine
01:14:49themselves as perpetrators
01:14:51productively,
01:14:54and and and meaningfully.
01:14:56Because the risk seems to
01:14:57be that you would,
01:14:59put people in a a
01:15:00feeling of such,
01:15:02of being under attack,
01:15:04of being,
01:15:06themselves accused
01:15:07of doing wrong,
01:15:12sentiments that I think are
01:15:13active in our politics
01:15:15now,
01:15:16where people feel on the
01:15:18defensive. And so I'm curious
01:15:19how you think about
01:15:21productive engagement,
01:15:23what conditions
01:15:25we can imagine ourselves as
01:15:27perpetrators and work through that.
01:15:32Well,
01:15:33I'm very interested in the
01:15:36and I hope this answers
01:15:37your question or addresses it
01:15:39in some way. I'm very
01:15:39interested in the question of
01:15:41complicity.
01:15:44What constitutes complicity
01:15:45today?
01:15:46How we should think of
01:15:48complicity?
01:15:50Active complicity
01:15:51versus
01:15:52not active complicity?
01:15:56And
01:15:57I think that,
01:16:00I think that there are
01:16:01elements, there are categorizations,
01:16:03there are concepts that we
01:16:04need to
01:16:05be mindful of,
01:16:08complicity
01:16:10out of a failure of
01:16:11imagination
01:16:13of the consequences of your
01:16:14acts,
01:16:16complicity
01:16:17that grows out of self
01:16:19interest.
01:16:23I
01:16:25I believe
01:16:27the complicity
01:16:28that that grows out of
01:16:29ignorance. You they're all different
01:16:31categories,
01:16:33but they all end up
01:16:34with complicity
01:16:36often born out of a
01:16:38lack of intention or a
01:16:40lack of understanding.
01:16:43I I don't know where
01:16:45to go with this question
01:16:49other than
01:16:51what,
01:16:54energized me a few months
01:16:56ago, and that was the
01:16:57behavior of the law firms
01:16:58that that complied with the
01:17:00executive orders.
01:17:02For me,
01:17:04that's
01:17:05apologies
01:17:06if anybody
01:17:07in the audience is offended.
01:17:10Well, I don't know about
01:17:11apologies.
01:17:13I
01:17:15think that
01:17:17as I think about that,
01:17:19that was pure complicity
01:17:22because,
01:17:27because
01:17:28it was serving
01:17:30the interests
01:17:31of,
01:17:34of the administration.
01:17:36The problem though is that
01:17:41for
01:17:42those who were
01:17:43paying the money, they would
01:17:45say that
01:17:48they were protecting their institutions.
01:17:52And so
01:17:53complicity
01:17:55is difficult. It's complicated.
01:17:59And I think that in
01:18:01a period
01:18:02like today
01:18:04I hope I'm I'm talking
01:18:05slowly, not out of fear
01:18:07of what words might come
01:18:08out. I just talk slowly.
01:18:11I think that,
01:18:14the question of complicity
01:18:16requires
01:18:18understanding what the bar of
01:18:20behavior is, what the risks
01:18:22of the behavior are, what
01:18:24the symbols of the behavior
01:18:25are,
01:18:26what the adverse consequences
01:18:28may be.
01:18:30And depending upon what
01:18:32where all those are, they
01:18:34influence the risk reward ratio.
01:18:37For me, if I look
01:18:39at the law firms as
01:18:40an example,
01:18:42I think that there there
01:18:44were no existential
01:18:45risks. I don't think that
01:18:47the law firms were at
01:18:48risk of going under.
01:18:50And so, therefore,
01:18:52for me, the bar was
01:18:53such that
01:18:54the complicity
01:18:55was unacceptable.
01:19:00I think
01:19:02one other thing, and that
01:19:03is in a period
01:19:05like today,
01:19:07and I'm
01:19:08I want to say that
01:19:09I'm not I don't I'm
01:19:11not being partisan. I'm talking
01:19:12about ethical behavior.
01:19:15That is a partisan, I
01:19:17would argue.
01:19:18I think that today that
01:19:20there are significant
01:19:22attacks
01:19:22against
01:19:24what we know of as
01:19:27the foundations of the ethical
01:19:30constructs of professions.
01:19:32There are
01:19:33attacks on science and so
01:19:35forth.
01:19:36What that what that requires
01:19:39is that all of us
01:19:41with power, with influence,
01:19:44think about both the extent
01:19:46to which our behavior is
01:19:48complicit
01:19:50even in small ways
01:19:52and what our responsibility is
01:19:54to fight against that complicity.
01:19:57Thank you.
01:20:04I see doctor Hughes is
01:20:05on the other mic, so
01:20:06I won't take too long.
01:20:09Thank you for taking the
01:20:10time to be here today.
01:20:12I wanted to return to
01:20:13your point about,
01:20:15microenvironments.
01:20:19And I think about this
01:20:20often with,
01:20:21prison and jail doctors
01:20:23and folks who are,
01:20:25prosecutors,
01:20:26etcetera. What? Can can you
01:20:28speak loudly Yeah. Yeah. Earlier?
01:20:30Is this better?
01:20:36Yeah. That thinks that. Yeah.
01:20:38Great. I'll start screaming if
01:20:40that helps.
01:20:41Yeah. I just wanted to
01:20:42return to the point of
01:20:44microenvironments.
01:20:46I think about this often
01:20:47with,
01:20:48prison and jail doctors and
01:20:50in the legal profession, prosecutors.
01:20:53It feels like it's very
01:20:54easy to be caught up
01:20:55in
01:20:57local minimums,
01:20:59sort of immediate instances of
01:21:01ethical violations,
01:21:04and
01:21:06how our idea of what's
01:21:07acceptable or ethically acceptable
01:21:09could be shifted over time
01:21:12in that microenvironment.
01:21:14I'm curious what you think
01:21:16is
01:21:17an effective way to link
01:21:19those
01:21:20local minima
01:21:22to global atrocities
01:21:24or historical atrocities,
01:21:26which are on a much
01:21:27larger scale and may be
01:21:28difficult to think about when
01:21:30we're, you know, overwhelmed.
01:21:32We're dealing with ethical violations
01:21:34that are on a much
01:21:35more
01:21:36personal
01:21:40scale. Is I didn't get
01:21:42the entire question, but if
01:21:44if it
01:21:45around
01:21:46the microenvironments
01:21:47and ethical violations that are
01:21:49very personal.
01:21:51Yeah. And how we connect
01:21:52those two
01:21:53more global
01:21:55behaviors or ethical issues.
01:22:01Oh, well, I
01:22:03I think
01:22:04ethical behavior starts at home.
01:22:09Is that not a good
01:22:10enough answer?
01:22:12It's a good enough answer.
01:22:13I feel like I should
01:22:13have put it down immediately,
01:22:14though.
01:22:16I think that that the
01:22:17microenvironment,
01:22:21it can be it it's
01:22:22not the the the the
01:22:24the simplest,
01:22:25easiest to understand microenvironment
01:22:28is the home,
01:22:29what we do with our
01:22:30family.
01:22:33Elite institutions
01:22:36create
01:22:37microenvironments.
01:22:39Countries
01:22:40create microenvironments
01:22:42so that
01:22:45one might
01:22:46argue
01:22:47that
01:22:48the United
01:22:49apologies.
01:22:53One might argue that America's
01:22:56approach to Iran
01:22:58represents
01:23:00a view of
01:23:02the microenvironment
01:23:04being
01:23:06America
01:23:07as a moral
01:23:08carrier
01:23:10no matter what.
01:23:12If we say part of
01:23:13part of
01:23:15the notion of the microenvironmentalist
01:23:19is because
01:23:21of my
01:23:22because I'm in an elite
01:23:24institution,
01:23:26therefore, what I say is
01:23:28right.
01:23:30If I'm a member
01:23:32of the Navy SEALs,
01:23:34we create our own code
01:23:37that allows us to do
01:23:38what we do.
01:23:39I'm not arguing whether it's
01:23:41right or wrong. I'm just
01:23:41saying that it forces it
01:23:43it it runs the risk
01:23:46of not
01:23:47allowing the self examination
01:23:49that's required.
01:23:52So, yes, it can be
01:23:53both at home, and it
01:23:54can be
01:23:55a much larger risk.
01:23:57Thank you. So so we
01:23:58are at time, and I
01:23:59wanna be respectful of people's
01:24:00time. If it's okay, I'm
01:24:02gonna, allow for two more
01:24:03questions, and then then we'll
01:24:04wrap. I do wanna respect
01:24:06people's time. Is that okay
01:24:07with you? Yeah. But if
01:24:08the two questioners are Jack
01:24:09Hughes
01:24:13and Steve Latham, that seems
01:24:14completely
01:24:17time's up.
01:24:20Let let's do,
01:24:22Jack and and and then
01:24:24you, sir.
01:24:25I'll do my best.
01:24:27You referred to the survivor
01:24:30who said that when,
01:24:33when human beings are given
01:24:34permission, they are capable of
01:24:36great evil or words to
01:24:37that effect.
01:24:39And then you said you
01:24:41it sounded like you disagreed
01:24:42with that, although I didn't
01:24:43quite track all of that.
01:24:46But
01:24:47given
01:24:48the
01:24:51well and repeatedly described
01:24:54instances of of human in
01:24:56behavior
01:24:58misbehavior to other human beings
01:25:01to,
01:25:02as,
01:25:04Primo Levi said,
01:25:06every stranger and enemy given
01:25:08the amount of distrust, the
01:25:09amount the the
01:25:11tendency for humans to misbehave
01:25:14towards one another,
01:25:16what might be might there
01:25:17not be a role for,
01:25:21for denying permission for certain
01:25:24actions given that the impulses
01:25:26are always there,
01:25:28if the social structure
01:25:30is sufficiently
01:25:31robust
01:25:32to
01:25:34to to,
01:25:36prohibit
01:25:37those behaviors, would that not
01:25:39be
01:25:40a a reasonable
01:25:42partial solution?
01:25:48I think it's related, Jack,
01:25:51or I'd ask you,
01:25:53to the
01:25:55discussion of complicity,
01:25:59and
01:26:00our
01:26:01our
01:26:03the requirement
01:26:05that we, I believe, must
01:26:07impose
01:26:07on
01:26:08people with power,
01:26:11institutions with power
01:26:14to
01:26:16be not complicit
01:26:18and by their actions of
01:26:21not complicity
01:26:23to serve as examples
01:26:25to others.
01:26:28To not but but by
01:26:29saying no
01:26:34to complicit behavior, I think
01:26:36that you stand as a
01:26:38bulwark against,
01:26:42the permission that's otherwise
01:26:44tacitly granted
01:26:45to misbehave.
01:26:49Okay.
01:26:51We we can talk some
01:26:52more.
01:26:58Thank you for,
01:26:59your discussion. That was very
01:27:00thought provoking,
01:27:02and I'm sure you know
01:27:03this. But, after having lived
01:27:05through it and gone through
01:27:06many years of thinking about
01:27:08it, Elie Wiesel said that
01:27:09he thought the ultimate
01:27:11cause of the holocaust was
01:27:12lack of empathy,
01:27:15which is something that I
01:27:16see probably every day and
01:27:18can attribute a lot of
01:27:19the
01:27:21problems we have today.
01:27:23And I was just wondering
01:27:23how that fit into your
01:27:24framework.
01:27:30FastPate operates through themes.
01:27:35Themes
01:27:36like,
01:27:38moral neutrality.
01:27:39Is it
01:27:41good enough to do my
01:27:42job well?
01:27:44Themes like loyalty. Who do
01:27:45I owe loyalty to?
01:27:48One
01:27:49of the themes that we
01:27:52talk about is empathy.
01:27:56I think that
01:27:58if,
01:27:59that
01:28:01in all professions,
01:28:03part of the path towards
01:28:05unethical
01:28:06behavior
01:28:08is the failure of empathy.
01:28:10And so
01:28:12I agree with you. Thank
01:28:14you.
01:28:15I would just say, you
01:28:16know, my my experience of
01:28:18medical training and medical culture
01:28:20is that,
01:28:23one of the things that
01:28:24happens during
01:28:26residency training in particular is
01:28:29the suppression of empathy in
01:28:31for the sake of efficiency.
01:28:35You know, I I think
01:28:36that as one is learning
01:28:37to to practice medicine,
01:28:40particularly at high speeds, at
01:28:41high volumes,
01:28:44that that empathy is often
01:28:46suppressed.
01:28:47I think it it it
01:28:48is incumbent on us as
01:28:50as faculty both to
01:28:53create space for that within
01:28:55the training process and then
01:28:56also to help
01:28:59trainees
01:29:00to recover that sense. Unfortunately,
01:29:03in my experience, I think
01:29:04the
01:29:05the modern health care system,
01:29:07even for more senior clinicians,
01:29:11is putting greater and greater
01:29:13emphasis on
01:29:15efficiency
01:29:16and,
01:29:19on sustainability of the system
01:29:21and that that can often,
01:29:24take priority over empathy. I
01:29:26I think that we as
01:29:29faculty, as
01:29:31more senior physicians can,
01:29:34again, stand
01:29:35as as a bulwark and
01:29:37and insist on the importance
01:29:39of empathy
01:29:42in in training,
01:29:43in in the practice of
01:29:45medicine, but it's it's very
01:29:46difficult. Could could I ask
01:29:47you a question?
01:29:49Is
01:29:51it fair
01:29:53for me, the non doctor,
01:29:56to demand empathy
01:29:59from you if you are
01:30:01I don't I'm not talking
01:30:02about you having to see
01:30:03a thousand patients a day.
01:30:05Even for you dealing
01:30:07with
01:30:08ten patients in the hospital,
01:30:11Is it
01:30:12fair for me to ask
01:30:14you
01:30:15to have that kind of
01:30:17emotional,
01:30:21awareness,
01:30:22emotional presence,
01:30:24emotional generosity. Is that fair
01:30:26for me to ask you
01:30:27that,
01:30:30or
01:30:32is it enough to ask
01:30:34humility
01:30:35of you?
01:30:38Right.
01:30:39I I I think there
01:30:40there is a a debate
01:30:41within within medical ethics about
01:30:43whether
01:30:44we we can sustain empathy,
01:30:49meaning that, you know, sharing
01:30:50the emotion
01:30:52of the patients and that
01:30:53that might be an unrealistic
01:30:56ask, but
01:30:57certainly
01:31:00awareness of the emotions
01:31:03of the patient and sympathy
01:31:04with the emotions of the
01:31:06patient, even if
01:31:07those
01:31:09feeling those emotions
01:31:11may be
01:31:12a impossible task for a
01:31:14physician to take on and
01:31:15sustain
01:31:16care over
01:31:18years and decades.
01:31:20And, and I think, you
01:31:21know, that that ladder
01:31:23might be the,
01:31:25the, the minimal requirement that
01:31:27we should be
01:31:29asking of our, our students,
01:31:31our colleagues, and ourselves.
01:31:33I think it's something you
01:31:34learn. You have to learn
01:31:35to do it without losing
01:31:36yourself, but you have to
01:31:38do it.
01:31:40Takes time.
01:31:42I mean, if you were
01:31:43completely empathetic with every patient,
01:31:45that's impossible, but it's possible
01:31:47to have a certain amount
01:31:48of empathy, enough empathy
01:31:50with everybody.
01:31:52Thank you.
01:31:55There there are more questions,
01:31:56and I'm sorry that we're
01:31:57not able to get to
01:31:58everybody's questions, but I do
01:31:59wanna be respectful of both
01:32:00the audience and,
01:32:02the speakers' time. And, I
01:32:04wanna thank everybody for their
01:32:05time and interest. And I
01:32:07do wanna
01:32:08encourage you to to think
01:32:09about
01:32:10this task that we discussed
01:32:12of carrying these these memories,
01:32:14these lessons forward
01:32:16as, you know, we, a
01:32:18a new generation, are sort
01:32:19of taking on this responsibility.
01:32:20And thank you very much
01:32:21for your time and attention.
01:32:39They're running.