"Yale Symposium on Holocaust and Genocide" Presented by the Program for Biomedical Ethics at Yale School of Medicine, Supported by the Lindenthal Family (Part 2)

January 28, 2022

Information

January 26, 2022

Mark R. Mercurio, MD, MA (Moderator)

Professor of Pediatrics, Yale University School of Medicine

Director, Program for Biomedical Ethics

Nazi Physicians and Involvement in Genocide

John Hughes, MD

Professor of Medicine (General Medicine), Yale School of Medicine

Associate Director, Program for Biomedical Ethics

Jewish Prisoner Physicians in Nazi Camps

Sari J. Siegel, PhD

Founding Director, Center for Medicine, Holocaust and Genocide Studies, Cedars-Sinai Medical Center (Los Angeles, CA)

Visiting Assistant Professor, Department of History, UCLA

West German Physicians after the War: Conflict and Complicity

Thorsten Wagner, MA

Executive Director of FASPE (Fellowships at Auschwitz for the Study of Professional Ethics)

Associate Professor, Danish Institute for Study Abroad/University of Copenhagen, Denmark

ID7385

To CiteDCA Citation Guide

00:00OK, the hours upon us.
00:03Welcome back to the Symposium
00:06on Holocaust Genocide.
00:08We had a marvelous panel of speakers
00:10that just finished and for those of you
00:12who are joining us with the midpoint,
00:13we have three more speakers,
00:15followed by a panel discussion,
00:17and the meeting will conclude at 4:30
00:19today and right now I am delighted
00:22to welcome my friend and colleague,
00:24Jack Hughes, MD,
00:25who is Professor of Medicine
00:26at Yale School of Medicine and
00:27Associate Director of this program.
00:29The program for Biomedical
00:30Ethics at our medical school.
00:32He's a member of the Ethics Committee
00:33and directs a course for first
00:35year medical students here at Yale
00:37called Professional Responsibility.
00:38He's also for many years served
00:40as medical faculty for the
00:42fellowships at Auschwitz for the
00:43study of professional ethics.
00:45Dr Hughes received his undergraduate
00:46and medical degrees from the
00:48University of North Carolina.
00:49He trained at internal medicine at
00:51Ohio State and Yale and attended the
00:53Clinical Scholars program at Yale University.
00:56Dr Hughes will be speaking on Nazi
00:59physicians and involvement in genocide.
01:02Jack welcome.
01:02I turn it over to you.
01:04Thank you, mark.
01:06Yes, I'm going to touch on several.
01:09Aspects of this issue that are
01:11familiar to many, but I think a
01:13little review can be harmful.
01:15There is much to be learned from
01:20a review of the behavior of the
01:22Nazi physicians in the midst of.
01:27And let me get started appropriately here.
01:39Alright, so there are several widely
01:42recognized images that have come to
01:45represent the two epitomize the evils
01:48of the Nazi physicians and the first
01:51of these that I want to talk about
01:55is the selection on the ramps for
01:58those prisoners who would be sent
02:01immediately to the gas chambers.
02:03And those who would be allowed to
02:06survive and work, at least for a while.
02:11This is. This is the this is
02:16Hungarian Jews who just arrived in
02:19at at Birkenau Auschwitz 2 in 1944,
02:23and the next picture shows
02:26Doctor Hahn Steelo,
02:28who has been making the selections.
02:29And if you look you can see that he
02:32has just sent this elderly woman and
02:35this young child across the tracks
02:38to join the column in the back,
02:41which consists of those who.
02:44Will go directly to the gas chamber.
02:46Consists of people who are thought
02:49to be incapable of work.
02:51That would be the elderly,
02:52the frail mothers with young children,
02:56and they will go immediately to
02:58the gas chamber.
02:59They will actually be followed by Doctor
03:03Tilo or whichever Auschwitz physician
03:05was serving this function at the time.
03:08Who will give the orders to to
03:11place the gas into the chambers?
03:15And we'll verify that the that all
03:19these people have been killed later.
03:22This role gets consigned to functionaries.
03:25The doctors still make the selections,
03:27but the. But they have.
03:32Devolved some of those processes
03:35to their subordinates.
03:40The next picture shows the.
03:44The cruel torments that the.
03:49And there have been that are being
03:50imposed on the prisoners here.
03:51These two positions are testing to
03:54see how long an individual human
03:57can survive in freezing water.
04:01Sorry, not see physicians conducted a
04:04number of horrific experiments like this,
04:08including in addition to the
04:09freezing hypoxia, high altitude,
04:12altitude, simulation, starvation,
04:14drinking seawater,
04:15high dose radiation,
04:17and surgical techniques for sterilization.
04:20This is the this is the building at
04:22Auschwitz 1 where some of many of
04:25these experiments were carried out.
04:27This as an example of the of the room.
04:31Where the reproduction experiments and
04:34sterilization experiments were carried
04:36out in the words of Elie Wiesel,
04:40the researchers let them die of hunger,
04:43thirst, cold that drowned them.
04:45They amputated their limbs,
04:46they suffocated them.
04:47They did dissected.
04:49There still living bodies to study their
04:52behavior and measure their stamina.
04:54And that's from Elie Wiesel.
04:57So there's still shocking truth is
05:01that physicians played a key role in
05:04the in the whole Nazi enterprise.
05:07They were involved in every phase
05:11of the development of the genocide
05:15and German physicians participated
05:17in greater than much greater
05:19than average numbers.
05:21Almost half joined the Nazi party and
05:247% were members of the Schutzstaffel
05:29general population.
05:33And as I said, the German physicians
05:35participated in every phase of
05:37the creation of the Holocaust,
05:39and they played a key role in
05:41developing and implementing the murder.
05:42The mechanisms for mass murder.
05:47Confronted with this information.
05:51We can ask several questions.
05:53How could the Holocaust have
05:55happened in the 1st place?
05:57How could it be that one of the most
05:59advanced societies in the world could
06:02have descended into such barbarity?
06:04How could a medical establishment
06:05that led to world in Medical Sciences
06:08have have facilitated and and it
06:10led the implementation of much of
06:13the program of murder and genocide?
06:18Ask well, we're German citizens
06:20in the German nation unique and
06:23the answer which you probably are
06:24already aware of is no, not really,
06:26but we'll unpack that just a little bit.
06:28Was the German medical profession
06:31unique and could it happen again?
06:34We will address some of these,
06:38but along the way,
06:40let us take a few minutes to
06:44review how the genocide originated.
06:47And as has been discussed,
06:49sterilization was the first step,
06:52and that came about soon after
06:55Hitler took power in 1933,
06:57and the law for the prevention of
07:01genetically diseased offspring.
07:03And all physicians were required to
07:05report all cases of genetic illness,
07:08some, many of which were outlined in,
07:12and Katie crashes, talk, and so there was.
07:17Involuntary sterilization of anybody
07:19suffering from a genetically
07:21determined illness,
07:22which included alcoholism,
07:24feeble, mindedness, blindness,
07:26deafness, Huntington's disease,
07:28schizophrenia etc.
07:32The hereditary health courts.
07:33My understanding of hereditary health
07:36courts was that these made the
07:38determinations based on forms that
07:40were filled out by the physicians who
07:43made these judgments about what the
07:46problem was with this particular child,
07:49and that the hereditary health courts
07:51actually made the decisions based on a very
07:55perfunctory examination of only the forms,
07:57and invariably the determination.
08:00Was to perform sterilization
08:03so I may be mistaken,
08:06but I believe I believe the hereditary
08:09health courts actually made the
08:11decision and I actually don't know
08:13how the appeals process work,
08:15so there were 400,000 Germans
08:18sterilized between 1933 when the
08:21Nazis came to power in 1939 when
08:24they switched to two mass killings.
08:30Euthanasia.
08:31This is a cover to the magazine
08:35to the publication,
08:36the monthly publication of
08:38the Office of Racial Policy.
08:40It's called new people and this
08:42is a this picture on the front
08:45will translate here.
08:47This person suffering
08:48from hereditary defects,
08:50cost the community 60,000 richmark
08:53during his lifetime fellow German.
08:56That is your money too.
09:01So the.
09:05This was a. Followed way from an
09:09original publication from 1920
09:11by Alfred Ho and Carl Bending,
09:16who wrote a book called the Permission
09:18to Destroy Life Unworthy of Life.
09:20And this notion of life
09:23unworthy of life was not.
09:25It did not arise de Novo
09:27with Hulk and bending.
09:29These were a prominent retired jurist and
09:33a prominent psychiatrist who wrote this.
09:36And in their book.
09:38I discussed the fact that many
09:41of the people that were a burden
09:45to the German population were
09:47already mentally dead.
09:48They were human ballast and
09:50they were empty shells.
09:54So and and hope the.
09:59See the psychiatrist.
10:00So putting such people to death is not to
10:04be equated with other types of killing,
10:07so this was very much before the Nazis.
10:11But this was in the air and was certainly
10:16emphasized after Hitler came to power.
10:19And it began with the quote,
10:22mercy killing or euthanasia of
10:25impaired children, and that program
10:27was lasted officially for two years.
10:31That Nazis used the term
10:34euthanasia to camouflage murder.
10:36And the criteria were the
10:39same for impaired newborns,
10:41and although it started with newborns,
10:43it then expanded to older children
10:46and then it's expanded to Jewish
10:48children and the Jewish children
10:50did not have to be in institutions,
10:52did not have to meet criteria for impairment.
10:58And in the words of Robert Lifton,
11:00this step destroyed the boundary
11:03between healing and killing.
11:05This was the purpose of this.
11:08These mercy killings was to
11:13maintain a pure Nordic race.
11:17One of the more evil of the physicians
11:21who participated and actually
11:23carried out the murder of the
11:27children was doctor Carl Fan motor.
11:31And he was scuse me.
11:33Herman van Miller.
11:34He said for me as a national socialist.
11:37These creatures obviously represent only
11:40a burden for our healthy national body.
11:44The next step is starting in 1939
11:47only a few months after the plan
11:51for euthanasia of the children came,
11:55the Fuhrer's decree,
11:56which led to the killing of
11:59mentally defective adults mostly
12:02in mental institutions.
12:04But at the end it expanded to the
12:06impaired in the concentration camps,
12:09and then in 1940 expanded
12:11it was expanded to Jews and.
12:14Institutions in camps,
12:15but they did not have to meet
12:18the criteria for impairment.
12:20Term.
12:23And here this was in the team
12:26Teargarden 4 or T4 program began.
12:29The use of first carbon monoxide
12:32gas and later Zyklon gas work,
12:34which is hydrogen cyanide and.
12:39Somewhere between 200,250 thousand
12:42and perhaps many more were
12:45euthanized between 1939 and 1941,
12:48when the program the T4 program
12:50was officially discontinued,
12:53but the killing continued in a in
12:57a phase called Wild using Asia.
13:01By the end of World War,
13:05285% of the patients in German
13:07mental hospitals had to start
13:08a World War Two dead.
13:13So.
13:17The implication of the life
13:20unworthy of of living clearly was
13:23that sterilization was not enough,
13:25and so the the euthanasia was initiated.
13:33Doctor Leo Alexander was a
13:37psychiatrist and a neurologist.
13:39He was a consultant at the trials
13:42at Nuremberg and he was actually an
13:45author of the Nuremberg Code regarding
13:48experimentation on human beings,
13:51and I quote from an article that he wrote.
13:53It appeared in the New
13:55England Journal in 1949.
13:56This is Doctor Alexander euthanasia
13:59of those deemed mentally unfit.
14:03In which physicians played a key
14:05role served as the entering wedge.
14:09For exterminations of far greater
14:11scope than a political program
14:13for genocide of conquered nations
14:16and the racially unwanted.
14:18The beginnings at first were merely
14:19a subtle shift in emphasis in the
14:22basic attitude of the physicians that
14:24started with the acceptance of the
14:26attitude basic in the euthanasia movement.
14:28That there's such a thing as
14:31a life not worthy to be lived.
14:34This is.
14:37Leo Alexander points out here that the
14:41the killing process was medicalized the.
14:45Medical profession played a key
14:48role in devising these schemes
14:51and and affecting them.
14:57Now the mass killings began
15:00afterwards and in the autumn of 1941.
15:07At first these were carried out by
15:10the killer troops, the Einsatzgruppen.
15:15And so they executed,
15:17usually at the side of the pits.
15:21The mostly Jews but also
15:24Poles and Russians and Roma.
15:27You see here, and this was here,
15:30it's being observed. The.
15:36That turned out to be,
15:37although most of the killer troops adapted
15:42relatively quickly to the notion of killing.
15:47They it carried a big toll in
15:52terms of their psychic distress.
15:55Many of them had difficulty sleeping.
15:57Many were depressed, many drank heavily.
16:00Actually, the majority drank heavily.
16:03End it. The chief physician at the
16:07SS recognize this and recommend
16:10it that there had to be more
16:13humane ways to do these killings,
16:15and so they use the they move
16:18to the gas chambers.
16:20And so the methods that had been
16:22developed for the euthanasia program
16:24which involved the carbon monoxide
16:26at first and then the Zyklon B.
16:29Turned out to work just fine.
16:30This is a picture of one of the
16:34one of the gas chambers and the
16:37crematoria at Auschwitz 2 or Birkenau?
16:42There were.
16:45There were many physicians
16:47involved in this process.
16:48One of those physicians was Fritz Klein,
16:52and when he was asked by
16:55a Jewish prisoner, Dr.
16:57Doctor Ella Lingens Reiner.
16:59How he could reconcile Auschwitz and
17:02smoking chimneys with his purported fielty
17:05to the physicians Hippocratic Oath,
17:07which requires the prison,
17:09the preservation of life, he said.
17:12And out of respect, of course,
17:14I respect human life and out
17:16of respect for human life,
17:17I would remove a gangrenous
17:19appendix from a diseased body.
17:21The Jew is the gangrenous
17:24appendix in the body of mankind.
17:30And here is lifting has pointed
17:34out this was. The manifestation
17:37of Keeley killing as healing.
17:40The Nordic race, the German population.
17:45And just to summarize,
17:46positions were involved in all of
17:49these that we've talked about so far,
17:51except for their they were not
17:55directly involved in the death.
17:57The shootings by the onslaught group
18:00in 400,000 Germans sterilized 5000
18:02German children were euthanized,
18:04probably more two hundred
18:07250,000 adults were euthanized.
18:10The horrific medical experiments,
18:11millions of Jews and others were
18:14selected for murder in the gas chambers.
18:17Not only. At the ramps,
18:19but also those who became sick after
18:21being allowed to live for a time,
18:23but basically starved and worked to death.
18:27And then there was a systemic removal
18:29of Jewish physicians from medical
18:31practice and from medical education,
18:34which by and large was not resisted
18:38at all by the medical profession.
18:41Certainly by the medical profession
18:42as a whole.
18:46So.
18:49What accounts for the?
18:54For the involvement of the Nazis,
18:57excuse me in the Nazi process by the
19:00profession, and there are a number,
19:03but perhaps one way to summarize this is
19:05to describe it as the nazification of
19:08the medical profession and that involved
19:10emphasis on the care of the people of
19:13the Volk over the care of the individual,
19:17and the notion of carritos, the care,
19:19the compassion for the individual
19:22was totally overruled, the.
19:23Rules the physicians were seen as
19:26servants of the state and guardians
19:29of the health of the Nordic race.
19:32And there was unrelenting propaganda
19:34that we've touched on before.
19:37From the time that the Nazis came into power,
19:40not only emphasizing life unworthy of life,
19:44the useless mouths,
19:46but also Arian.
19:48The Aryan superiority and and the betrayal
19:52of the Jews in World War One and the.
19:57Second rate human status of of
20:01the Jewish population.
20:04So useless mouse there was the exclusion
20:06of the Jewish physicians from medical
20:08practice and from medical education,
20:10and there were changes in medical
20:13education that emphasized these.
20:16Nazification principles here.
20:21Now.
20:24How did doctors actually work?
20:27How could they work at Auschwitz
20:30and Robert Lifton in his books,
20:33the Nazi doctors describe
20:35several coping mechanisms.
20:36One of them is doubling.
20:39That is the the ability to split oneself
20:43into ones ordinary functioning self,
20:46where one dealt with colleagues
20:48and dealt with family,
20:49and then the the self that was sending
20:53people off to the gas chambers.
20:55And sending people in the sick
20:57wards to the gas chambers and
21:00the development of the not be
21:02Auschwitz itself was essential to
21:05maintaining their participation.
21:06It was an implicit command to
21:09bring forth a self that could
21:11adapt to the killing without
21:13one feeling oneself or murderer.
21:16And then there was psychic numbing.
21:18This is numb to be tuation and in
21:20the words of one of the physicians
21:22and one of the Nazi physicians
21:24interviewed by Robert Lifton.
21:26It could largely succeed,
21:27because dead bodies did not
21:29have to be viewed,
21:31but only smelled and one
21:33got used to the smell.
21:35The smell obviously,
21:37of these of the burning bodies.
21:40And distraction was yet another
21:42way that physicians dealt with it.
21:45Immersing oneself in medical
21:46science is a meeting as a means
21:49of evading awareness and guilt.
21:54So. And then we also can
21:58ask this question, did the.
22:02Did the participation of doctors make
22:05any difference to the Nazi enterprise?
22:09Did it really? Did it really help?
22:12And there were various
22:14levels of participation,
22:15starting with full involvement,
22:17most obviously by the doctors at
22:19Auschwitz and at the at the death camps,
22:22who also had to make had
22:25to supervise the killing.
22:28And the experimentation.
22:31And then there were many who,
22:32many more who were partially involved
22:35who facilitated the crimes by other
22:38actions by participa sending people to
22:40to the camps by making choices without
22:44actually causing a direct death.
22:48There are those who.
22:51Did not participate actively,
22:53but by their silence and their acquiescence
22:56allowed the process to continue,
22:59and there was active resistance on the
23:01part of a relatively small proportion
23:03of the Nazi medical profession of the
23:07German medical profession that the
23:08non Nazis would ones who resisted so.
23:13But what about if the German
23:16physicians had resisted?
23:17Would that have had the credibility
23:20of the profession?
23:21Potentially served as a check
23:24against certain transgressions.
23:25That's a counterfactual.
23:27We can't know how much difference
23:29the resistance of a unified
23:31profession could have made,
23:32but certainly the avid participation of
23:36many physicians who lent credibility and
23:41legitimacy to that whole killing enterprise.
23:45And in the words of Robert Lifton,
23:47again it permitted the medicalization
23:51of genocide.
23:52Now as a counter example,
23:54let's just look at the response
23:57of the Dutch physicians who.
24:00Unanimously refused to sign a statement
24:04that the Nazi administrators after
24:08after the Netherlands had been invaded
24:11and conquered that the statement said
24:14that the restoration of individual
24:17health and function was a public duty,
24:20believing that they this was the
24:21first step towards making them
24:23functionaries of the Nazi enterprise.
24:25And that was exactly right when they were
24:28threatened with loss of their licenses,
24:30they surrendered their licenses.
24:31Will continue to see their
24:33patients surreptitiously.
24:36And they stood fast after
24:38100 of their colleagues were
24:39sent to concentration camps.
24:41Several of them died.
24:43They stood by their families
24:45and they stood solid.
24:46No Dutch physician signed an
24:49order for the killing or the
24:52sterilization of Dutch citizens.
24:54So it was possible to resist.
25:00Were German doctors unique?
25:03There are certainly plenty of other
25:06examples of the moral failings
25:08of physicians, the the genocides,
25:10many of the genocides that we
25:13talked about earlier were involved,
25:16involved physicians in Rwanda.
25:19The Hutus slaughtered the Tutsis.
25:21Physicians actually turned to see patients
25:24out into the street where they were
25:27guaranteed to be killed by marauding mobs.
25:30There were Turkish physicians involved
25:32in the murder of Armenians in the 1915.
25:35There were Turkey in there were Turkish
25:38positions in the leadership of the country.
25:40Radovan Carrick was just psychiatrist
25:43and a Serbian leader from 1992 to 96,
25:47and he organized the murder of thousands
25:50of Muslims in Bosnia and Croatia.
25:52Syrian President US trained physician
25:55Bashar al Assad is responsible
25:57for thousands of civilian deaths.
25:59This is no and Soviet psychiatrist committed.
26:02Dissidents to mental institutions.
26:04Over the past several decades.
26:07And what about the US physicians?
26:09Well, we have some bad examples.
26:10Also at Abbey grave physician military
26:13physicians participated in that they
26:15falsified death certificates and people
26:18who died from waterboarding in Guantanamo.
26:21Physicians were present for for torture
26:24to make judgments about how much the
26:29patient could possibly stand before risking.
26:32Before their lives were risk at risk so.
26:39We can ask what about society's
26:42expectations of physicians?
26:43Do we expect more of the medical profession
26:47given its exalted place in society and
26:49its professed dedication to higher goals?
26:52And the question is,
26:54should we and I just want to raise the
26:56possibility that's been raised by others?
26:57Are medical professionals particularly
27:01susceptible to the kind of ethical
27:04lapses that can lead to the Holocaust?
27:08Anti genocide?
27:09Physicians are, after all,
27:11desensitized to suffering and pain in
27:13the course of their training and work
27:16in there and we are inured to death.
27:18There's a sense of entitlement.
27:20There's narcissistic, grandiose
27:21austerity that has been pointed out,
27:24a sense of omnipotence,
27:27objectification through science,
27:28and a belief in the uniqueness
27:30of the group or the profession.
27:32So there's no way to prove this,
27:35but this has been raised as a possibility.
27:37And then there's the hierarchical
27:39nature of medicine.
27:41And a tendency towards obedience.
27:44So where the German?
27:46People unique how can one of the most
27:50advanced civilizations have lapsed
27:52into the routine exercise of human?
27:55In human behavior?
27:57There are these cultural factors.
28:00Ethnocentrism is not unique
28:01to the German people.
28:03The German sense of entitlement,
28:04perhaps is ingrained.
28:06anti-Semitism with not at
28:07all unique to Germany,
28:10but Germany was unique in the loss of
28:12the national status after World War One.
28:14And the humiliating peace terms
28:16and then the psychological factors.
28:19The resentment which can which
28:21can arise from suffering and fed
28:24by the unremitting propaganda,
28:27about the betrayal of the Jewish race.
28:32And I want to just take a moment
28:34to talk about how people,
28:36and therefore how doctors
28:38can become murderers.
28:39The story of the ordinary men.
28:42This is reserve Police Battalion 101.
28:45It was written about by
28:48Christopher Browning. This was.
28:54In this book he tells the story of
28:57the Reserve Police Battalion, 101,
29:00which was a group of mostly middle
29:02aged men who were not eligible for
29:05militant direct military service.
29:06But there's their job was to join the
29:10Einsatzgruppen and to murder Jews and
29:13Poles and others behind the lines.
29:15The their captain was distressed by this
29:19order and he told his men that they did
29:24not have to participate in these cold
29:26blooded murders if they chose not to.
29:29But remarkably,
29:30over 80% of these individuals ended
29:33up participating and Browning.
29:37I suppose it is remarkable that anywhere
29:39from 10 to 20% refused in retrospect,
29:42but Christopher Browning points out that the.
29:46The major contributors to this were a
29:49need for conformity of fear of being
29:52ostracized or fear of being seen as weak.
29:55And also a recognition that
29:57if they didn't do it there,
29:58it would be an increased burden
30:00on their colleagues and also
30:02a deference to authority.
30:07There's other things to note about
30:10how individuals can become murderers.
30:13What does it take approval by the group,
30:16the culture, the society,
30:18the approval of authority,
30:20denial of the humanity of the victim,
30:22and distance from the victim or the outcome?
30:25Fragmentation of the task of killing.
30:28So if an individual does not have to.
30:31Take on that burden as
30:33the Einsatzgruppen did.
30:34It makes it a lot easier if they're
30:37only partially responsible,
30:38but Timothy Kudo in an essay
30:40in the New York Times in 2015,
30:43talks about several of these.
30:45How long does it take in the case of the
30:48ordinary men that we we talked about?
30:51It took about four weeks before they
30:55were able to kill without hesitation.
30:58That doesn't mean they didn't
31:00have psychological consequences,
31:01so I have reached the end of my time.
31:04I do want to just read you this
31:07quote from Hannah or rent.
31:10And here she is.
31:11And this is in her book Eichmann
31:13in Jerusalem.
31:14Excuse me the banality of evil and she
31:17said the problem was not so much to
31:19overcome their conscience as the animal.
31:22Pity by which all normal men are afflicted
31:24in the presence of physical suffering.
31:26And the trick is to turn
31:28these instincts around.
31:29So instead of saying what
31:31horrible things I did to people,
31:33the murderers would be able to say
31:35what horrible things I had to watch
31:38in the pursuance of my duties.
31:40How heavily the task weighed
31:42upon my shoulders? So thank you.
31:45I am out of time and I appreciate
31:49this opportunity. Thank you.
31:51Bark thank you Lindenthal family.
31:57Thank you, Jack.
31:58Very much for an excellent talk.
32:01Our next speaker is Doctor
32:04Sarah Siegel Siegel.
32:05She is the founding director
32:06of the Center for Medicine,
32:08Holocaust, and Genocide Studies at
32:10Cedars Sinai Medical Center and
32:12a visiting assistant professor of
32:14the Department of History at UCLA.
32:16She is currently completing a book
32:18manuscript based on her dissertation
32:21between coercion and resistance
32:23Jewish prisoner physicians in Nazi camps,
32:251940 to 1945.
32:27That's his doctor.
32:29Siegel received her pH D in history
32:31from the University of Southern
32:33California and served as the
32:35Jeffrey H Hartman Postdoctoral
32:36Fellow at Yale Fortunoff.
32:38Video archive for Holocaust testimonies.
32:42Dr Siegel has become an important
32:43figure out on the West Coast with regard
32:46to Holocaust education and awareness,
32:47and we're very pleased that
32:48you agreed to join us today.
32:50Sorry,
32:50I turn it over to you.
32:52Thank you for the kind introduction
32:54and invitation in the 1st place mark.
32:56It's great to be joining you today
32:58for this important event with such
33:00an impressive group of scholars.
33:02I also wish to thank the Lindenthal family
33:04for their support of today's program.
33:12So you've just heard from Doctor Hughes about
33:16Nazi physicians involvement in genocide.
33:19The image of a Nazi doctor Youssif
33:21Mangala in in particular conducting
33:23selections at the arrivals ramp or
33:26performing medical experiments in
33:28Auschwitz is likely to familiar to many,
33:31if not most, in the audience today.
33:34Much less known, however,
33:35is a very different category of doctors
33:38working behind those barbed wires.
33:41Jewish prisoner physicians.
33:42Who might define as Jews, who,
33:45on account of their training as doctors
33:47were recruited by numerous parties,
33:49to utilize their medical knowledge
33:51and skillsets towards a variety
33:53of ends in the prisoners,
33:54hospitals and outpatient
33:56clinics of Nazi camps.
33:58This group is much larger than
34:01historians had previously acknowledged,
34:02or even anticipated.
34:04For example,
34:05despite the destruction and loss of
34:08innumerable innumerable documents,
34:09I've recorded the names of at least
34:11100 male and female Jewish prisoner
34:13physicians who worked in Auschwitz,
34:16Birkenau.
34:16Jewish doctors also worked in many
34:19more camps than previously known.
34:21They were present in all kinds of camps.
34:26Concentration camps like Dachau.
34:30The subcamps of these major concentration
34:32camps like the Auschwitz subcamps of boom
34:35and if it's and you have a show of its.
34:39Transit counts from which Jews of
34:42Western Europe were deported to the east,
34:44including Vester Bourque, seen here.
34:46The Dutch transit camp through which
34:48the family of Anne Frank passed.
34:53There were also Jewish doctors
34:55attending to the ill and injured in
34:57the little known category of camps
34:58known as forced labor camps for Jews
35:00such as Gebers Dorf in Upper Silesia.
35:03There were even Jewish prisoner
35:04physicians in the death camp of Treblinka.
35:10Why haven't historians spent more time
35:12studying the Jewish prisoner physicians?
35:15Where are they in our history books?
35:18Famous Holocaust historian role Hillburg
35:20gets us closer to an answer observing that
35:23quote the shear passage of time governs
35:26the slow disintegration of inhibitions
35:28that have flocked questions and answers.
35:31With respect to the behavior of victims
35:34in extreme situations. End Quote.
35:37This is especially true of Jews whose roles
35:40in the camps place them in what survivor and
35:43author Primo Levy, called The Gray Zone.
35:47Levy explains quote.
35:48The hybrid class of the prisoner
35:51functionary is a Gray zone, poorly defined.
35:54Where the two camps of masters and servants
35:57both diverge and converge End Quote.
36:00In other words,
36:01it is a realm of moral ambiguity because its
36:05occupants including capos and block elders,
36:07were themselves victims of the Nazi regime.
36:10Being concentration camp inmates
36:12at the same time, however,
36:14prisoner functionaries assigned tasks
36:16benefited the Nazi administration
36:18of the camp,
36:19and were often detrimental
36:21to their fellow inmates.
36:23Given Jewish prisoner physicians
36:24roles in the camps, they too,
36:27were prisoner functionaries,
36:28who occupied the Gray zone,
36:30their dilemmas inherently carried
36:32another level of complexity,
36:34though that of medical ethics and
36:37the expectation of beneficence
36:38and nonmaleficence to do good,
36:40and to do no harm.
36:42Unlike the other groups in the camps.
36:46Jewish prisoner physicians were
36:48presumably beholden to a professional
36:51code of conduct that Hippocratic Oath.
36:54Therefore,
36:54any suspected betrayal of this code
36:57often struck their fellow inmates
36:59as an insult more severe than
37:01what they witnessed or experienced
37:03from other prisoner functionaries.
37:06I want to establish that my
37:08position is not one of judgment,
37:11as Primo Levy writes in the
37:13Gray Zone essay quote,
37:14it is necessary to declare the
37:16imprudence of issuing hasty moral
37:18judgment on such human cases.
37:20Certainly the greatest
37:21responsibility lies with the system.
37:24The very structure of the totalitarian state.
37:27Instead,
37:27my goal is understanding to the
37:29extent that it is even possible.
37:32I want to learn what the Jewish
37:34prisoner physicians did,
37:35what their circumstances were,
37:37how they navigated those circumstances.
37:39How did Jewish doctors behave when they
37:42found themselves in the extreme and
37:45unprecedented context of Nazi camps?
37:48So how should we think about this?
37:49This conduct.
37:50Many people are tempted to label prisoner
37:53functionaries conduct as collaboration.
37:56However I consider this
37:57to be a flawed approach.
37:59After all,
38:00the term is weighed down with
38:02substantial negative connotations.
38:04Furthermore,
38:04collaboration implies that an inmate made
38:07a conscious decision to further Nazi goals.
38:10The idea of choice is particularly
38:13troublesome in the context of Nazi camps,
38:16as the gross power imbalance between
38:19Jewish inmates and the Nazi guards and
38:22administrators greatly limited and
38:23perhaps even eliminated the prisoners
38:26ability to pursue a desired course of action.
38:29Especially in the face
38:31of likely consequences,
38:33I also see flaws.
38:36In in use of the term cooperation
38:39because the prefix Co.
38:42Communicates that two entities of equal
38:45or similar stature operate together.
38:48I prefer to frame prison or
38:51physicians conduct differently.
38:52I think of their behavior
38:54as the product of coercion,
38:56as this term immediately communicates
38:58the existence of a power imbalance.
39:00It is behavior that emerges from the use
39:02of bodily harm or the threat thereof,
39:05to compel someone to perform acts
39:07counter to his her their desire.
39:11Central to my thinking,
39:13is the doctor's room for maneuver.
39:16The extent of an inmate's ability to
39:18choose one course of action over another.
39:20It is also crucial to recognize that
39:22this room for maneuver was not static.
39:25It was constantly shifting in response
39:27to ever changing circumstances
39:29in the doctor's midst.
39:30It is hardly surprising, then,
39:33that Jewish prisoner physicians behavior
39:35shifted as they reacted to their
39:38dynamic environment and one of the
39:41important and one important course of
39:43action could be resistance to the Nazis.
39:46I would like to share with you how I first
39:49came to recognize this dynamic framework,
39:51which I called the coercion
39:53resistance spectrum to,
39:54and I named it such to reflect
39:57the spectrum of behavior that
40:00prisoner physicians demonstrated.
40:04The case is that of Doctor Maximilian Samuel.
40:07This photograph of Samuel is from
40:11his study in 1932 in Cologne,
40:14where he was a practicing
40:16obstetrician gynecologist.
40:17Samuel stood out because of the harshness
40:20of survivor statements against him on
40:23account of his behavior in Blockton.
40:26Samuel received the condemnation
40:27of many of those who worked in
40:30the infamous experimental block
40:32in the Auschwitz main camp.
40:34This preliminary impression LED one scholar.
40:37The OFT cited Robert Jay Lifton,
40:40from Doctor Who's.
40:42This presentation to label Samuel
40:44as a Jewish medical collaborator.
40:47Quote Unquote, however,
40:48if one digs deeper and explores
40:51another body of sources,
40:52namely the accounts of women
40:54upon whom Samuel operated.
40:561 emerges with a very different
40:59impression of this man.
41:01At the crux of the matter is
41:04Samuel coerce participation in
41:06the experiments of two SS doctors,
41:08Edward Vertz and Horst Schumann,
41:10who ordered him to perform surgeries
41:13that were likely carried out in
41:15this very room with in Blockton.
41:16Wiertz was studying the early detection
41:19of precancerous lesions of the cervix,
41:22and Schumann sought to perfect a
41:24technique for rapid sterilization
41:26of large numbers of people through
41:28X rays and his protocol called
41:30for the eventual removal of the
41:32irradiated irradiated organs.
41:34So the extent of the damage to
41:37the tissues could be determined.
41:39While some fellow staff members
41:41in Blockton deemed Samuel Asellus
41:44participant in both experiments,
41:46several former experimental victims
41:47praised him and considered him
41:50to be a savior.
41:51The clue that got me thinking was a
41:54witness statement by Gilda Eleazar,
41:56on whom Samuel had performed
41:58an operation in the context of
42:01Schumann's experiment.
42:02Eleazar reported that Schumann,
42:04after performing a cursory examination
42:07of her about three months.
42:09After surgery informed her quote,
42:12the operation of Doctor Samuel
42:14is not in order.
42:15You must have an operation by another doctor.
42:19End Quote and that surgery was
42:21carried out on November 10th, 1943.
42:25After the consultation of
42:27a variety of sources,
42:28documents and testimonies.
42:31I concluded that in Eliezer's case
42:33and those of at least four others,
42:35Samuel did not adhere to orders
42:37and remove the opposite organ and
42:39thereby left in place the one that he
42:42deemed more likely to heal and thus
42:44attempted to preserve the women's fertility.
42:47It appears that he was able to take
42:50such action because Schumann was
42:52not present at the critical moments.
42:54In the end,
42:55several women whom the Nazis had
42:57attempted to render sterile were
43:00actually able to bear children.
43:02The key is that Samuel took advantage
43:04of the additional room for manoeuvre
43:07when Schumann was not present,
43:09and Samuel resisted in the name
43:11of minimizing harm.
43:13The remainder of the time,
43:14however, under direct supervision,
43:16he was unable to pursue any course
43:18of action besides what the Nazi
43:21doctors ordered him to do.
43:24Relatively few Jewish prisoner physicians
43:27encountered orders to participate
43:29in human subject experimentation.
43:32A much more common dilemma they
43:34faced was the extent to which they
43:36should participate in hospital
43:38selections through which SS medical
43:40officers and or SS medical orderlies
43:42reduce the number of patients in
43:45inmate inmate hospitals or clinics.
43:47By sending typically the sickest
43:49and least capable of work to their
43:52deaths loaded onto trucks to take them
43:54from the hospital to the gas chamber
43:57or murdered by lethal injection.
44:00The prisoner physicians had to
44:01decide what to do.
44:03One former prisoner physician points out
44:05quote in our normal in our situation.
44:10So in our situation, sorry,
44:12normal principles of human and
44:14professional ethics broke down because
44:17problems we had to face were previously
44:19non-existent and in dealing with them
44:22we did not know what to do. End Quote.
44:25Their continued presence in the hospital
44:27or clinic meant that these prisoner
44:30physicians were in a position to provide,
44:32at least in principle,
44:34some medical attention,
44:35despite the absence of adequate
44:38medications and supplies.
44:39Yet such a presence was predicated upon
44:42their pleasing, their Nazi overseers,
44:44to refuse the Nazis outright could
44:46lead to removal from their post,
44:49or perhaps something much more severe.
44:53In many cases their course of action was
44:55determined by their room for manoeuvre.
44:57At any given point,
44:59offering some insight is the
45:01testimony of Doctor Paul Heller,
45:03recorded for the Yale Fortunoff Video
45:06Archive for Holocaust testimonies.
45:07The Czech Jewish Doctor Who trained
45:10in Prague is Speaking of his
45:12experiences as a prisoner physician.
45:14Excuse me,
45:15physician in the out Auschwitz subcamp
45:18of vaginal where he was transferred in
45:21mid 1943 after two months in Auschwitz.
45:24So allow me to.
45:27Share the testimony.
45:41Like they came and asked
45:43who's a doctor and they volunteered
45:47and they sent me as
45:48a as a as a physician into a into a
45:53work camp near Auschwitz mining camp.
45:58And that was. That was my good luck again
46:03and that was I did that for 1 1/2 years
46:07and was it was a very very dangerous job.
46:13That's what was it was fruitful.
46:17What is it? Very dangerous job? Yeah no.
46:19I know because you had to take care of.
46:23Called the Kachtick people of all the and
46:26the as as came and made selections
46:30for the. And then I tried
46:33to save a few people as a matter of fact,
46:36some of them are in Chicago.
46:38Of those who are saved and
46:40they they recognize me,
46:42they didn't know that I was here,
46:44but recognized me on television,
46:46just three or four years ago,
46:49and so many expressed
46:52their enormous gratitude.
46:56Well, it was a very very very,
46:58very dangerous job and but I
47:01was again very lucky that my SS
47:05superior was in it was already
47:08taught the end of the war and these
47:11jobs were kept by older people,
47:14so there is as
47:15men who was in charge
47:17of the of the hospital. Was
47:19there an older assessment
47:22and stabbed a passionate
47:25nutsy? So. I could.
47:30Engineer him with little ends and that
47:34made it easier on that. Saved me.
47:36But then when the flood he thought it
47:39was dangerous because it could be Novell.
47:41It could be mean they could have.
47:43They could have stopped at anytime.
47:44Yes, you felt like you were and
47:46certainly if they accused me of having.
47:50Could hide the lot of people you know,
47:53saves them from transports if
47:56they've had found out about this,
47:58I wouldn't have survived.
48:15Sorry at the very beginning
48:17of the clip you just saw.
48:19We see Doctor Heller move past the
48:22deadly nature of the selections in
48:24which he participated and he draws
48:27attention to his actions to save
48:29lives lives he could save because,
48:31as Heller suggests,
48:33his immediate overseers,
48:35political leanings and age afforded him
48:38additional room for maneuver to engineer
48:41as he puts it the dangerous nature, or.
48:45Very dangerous, dangerous nature of the
48:47selections was due to the arrival of
48:50the SS medical officer from Auschwitz,
48:53who Heller suspects would
48:55have punished him severely.
48:58If his efforts to save inmates became known.
49:02While selections mounted a frequent
49:05challenge to prisoner physicians,
49:06attempts to save lives,
49:08the inadequacy of supplies and
49:11horrendous sanitary conditions
49:12constantly undermined medical work.
49:15Not only did they experience moral distress.
49:18But also as Jews,
49:20their lives were constantly under threat.
49:23Nevertheless,
49:23Jewish prisoner physicians
49:25ingenuity could sometimes overcome
49:27these significant hurdles.
49:36Doctor Otto Heller.
49:37The head of the hospital in the
49:40so-called Czech family camp,
49:43indicated here.
49:45In Alfred Spear Canal provides
49:47us with a compelling example.
49:50He was confronted with a burgeoning
49:52epidemic of diphtheria that had
49:54already claimed several lives,
49:56but he had nothing on hand to treat patients.
49:59Hiller reasoned that the antibodies
50:01present in the blood of those who had
50:04survived the infection could help spur
50:06the immune system in patients who are
50:08in the early stages of the illness.
50:16Gottfried Block, a medical colleague
50:18of Heller's at the hospital,
50:20recalls the chief doctors actions,
50:22quote 25CC's of blood of a convalescent
50:27patient were taken in a syringe flashed
50:30with citrate to avoid coagulation and
50:32given intramuscularly to a new patient.
50:35As soon as he was diagnosed as
50:37having the disease. It worked.
50:38We did not lose one more
50:41patient from diphtheria.
50:47Doctor Geza Laperle, a Jewish obstetrician
50:49gynecologist from Sighet, Romania,
50:51also turned to innovation to improve the
50:54health of her patients in Asheboro Canal,
50:57without sufficient medications,
50:59she decided to take advantage
51:01of the placebo effect.
51:03She recalls quote.
51:04One day I had an inspiration I
51:07declared very authoritatively,
51:09that margarine was the best medicine against
51:12all kinds of skin diseases by some miracle.
51:16Psychological rather rather than
51:18physiological, the sores healed.
51:20No new eruptions occurred.
51:22And the value of margarine
51:25soared to an unbelievable height.
51:27Pearl is perhaps best known for
51:29performing abortions to save expectant
51:31mothers lives in the face of the
51:34automatic death sentence for mothers
51:36and their newborns and Auschwitz.
51:38But she was hardly the only
51:40one engaging in this practice.
51:42Lucie Adelsberger,
51:43another Jewish prisoner physician in
51:45Birkenau, explained their reasoning.
51:47Quote medical ethics prescribes
51:49that if during labor the mother
51:52and the child are in danger,
51:54priority must be given to
51:56saving the life of the mother.
51:58We prisoner physicians quietly acted
52:00in accordance with this regulation.
52:02The child had to die so that the
52:04life of the mother might be saved.
52:09Jewish prisoner physicians also saved
52:11patients lives through the acquisition
52:14of medications and medical equipment.
52:16The major source of these
52:18resources was Canada,
52:19the complex of warehouse barracks where
52:22the contents of new arrivals luggage.
52:24Was collected. Sorted and stored.
52:29The luggage contained pupils own
52:32prescription medications and deported
52:34doctors brought medications and equipment
52:37for the treatment of anticipated
52:39patients at their imagined destination.
52:42With the arrival of hundreds
52:44of thousands of deportees,
52:45Canada came to hold enormous
52:47stocks of medical supplies,
52:49and these resources eventually let
52:52trickled out relatively small amounts,
52:55but they made it onto the black market and
52:59were smuggled by underground movements,
53:01and they ended up in camp hospitals and
53:03clinics where they supplemented the
53:05meager supplies the camp administration
53:08allocated for prisoner medical treatment.
53:13There were also life saving strategies that
53:15were on the periphery of medical practice.
53:18Falsification of medical records
53:20and switching lab samples.
53:23The doctors engaged in these approaches
53:24to cover up a diagnosis that would
53:26automatically doom a patient to death.
53:28Typically a contagious
53:30illness like diphtheria.
53:32The disease that prompted Dr.
53:34Otto Heller's creative intervention.
53:37Other lifesaving acts had nothing
53:39to do with medical practice.
53:41Instead, they revolved around selections
53:43for the gas chamber and Birkenau.
53:46When doctors learned that
53:48a selection was imminent,
53:50they turned to a few tactics.
53:52They hid patients,
53:53something to which doctor Paul Heller
53:55referred in his video testimony.
53:57They discharged patients who are able
53:59to walk and then re-admitted them.
54:01Once the selection threat had passed.
54:04And in a few cases where prisoner
54:07physicians were able to form
54:09relatively cordial relations.
54:11With Nazi doctors,
54:12it the inmate doctors could on very rare
54:16occasions leverage those dynamics to
54:18ask for certain patients to be spared.
54:21Everything depended on prisoner
54:24physicians room for maneuver.
54:26So I'll stop there and.
54:30Thank you for your attention and,
54:32uh,
54:32I look forward to answering
54:35questions in our panel.
54:40Thank you so much Sarah
54:42for that excellent talk.
54:43It's A and as a reminder,
54:44I, as Terry mentioned,
54:45that the questions on if you have questions,
54:48I encourage you to put them through
54:50the Q&A task in the zoom function so
54:53that when when after our next speaker,
54:55after Torsten Wagner speaks,
54:57we will then get to the panel the
55:00final half hour will be a panel,
55:02and that's where I'll be reading your
55:04questions to the the final three speakers.
55:07So please, if you have some questions,
55:08go ahead and put them in there
55:09or you can put them in there
55:11during the panel discussion.
55:11And I'll get to as many of them
55:13as we can during that time.
55:14But right now we move to our next speaker,
55:17the final speaker for the afternoon,
55:19and this is a Thorsten Wagner MA,
55:22who is the executive director of
55:24the fellowships at outfits for
55:26the study of professional ethics.
55:27And this is an organization that Full
55:30disclosure I've been involved in for
55:32many years with Torsten and involves
55:35education of professional students,
55:36law students, medical students,
55:38seminary students, journalism students.
55:41And others come.
55:43Specifically related to medical
55:45ethics to professional ethics,
55:47I should say.
55:49Through the lens of the events
55:51of the mid 20th centuries.
55:53And Torsten is an expert
55:54on this as a historian,
55:56and I look forward to a great talk.
55:57He's the associate professor of the
55:59Danish Institute for Study Abroad at
56:01the University of Copenhagen in Denmark.
56:03He was a historical consultant
56:05for the acclaimed new documentary
56:07Germans and Jews and dealing
56:08with the contemporary Germany,
56:09its relationship to its Nazi past,
56:12and the re emergence of Jewish
56:14life in Germany.
56:15Mr Redman completed his undergraduate
56:17studies at the University of Taboo.
56:19Tubingen in Germany graduate studies
56:21at the Hebrew University in Jerusalem.
56:23And that the technician university
56:26Berlin and the Free University of
56:29Berlin and postgraduate studies at the
56:32University of Wisconsin in Madison Thornton.
56:35I'm delighted that you're here.
56:36Thank you so much for being part of this,
56:38and I now turn the program over to you.
56:42Mark Durkan mercurio.
56:42Thank you so much for the invitation.
56:45Also from my side.
56:46Thank you for the support by the little
56:49family and I also wanna say that I'm so
56:52impressed and humbled by my colleague
56:55speakers today and the fascinating
56:56topics that we've seen already.
56:58What I would like to address today is,
57:00as you can see, the attitudes,
57:03the perspectives of German,
57:05particularly West German
57:07physicians after the war,
57:09and we're like us to get started.
57:11And is with two brief vignettes
57:13or stories that I'd like to
57:15tell you in the first one is
57:17connected with this building here,
57:18and because one of the stories that
57:21my mother shared with me about
57:24her youth training as a teacher,
57:28kind of on the outskirts of
57:30Flensborg was that this was the
57:32teacher seminar that you went to in
57:34Flensburg merwick in a building that
57:36had been in the Navy Academy and
57:39she went there in the early 1950s.
57:41And one of the few anecdotes that you
57:44told me was, yeah, it was bizarre.
57:46It was kind of weird to be there
57:48because the whole atmosphere was still
57:51so defined by Nazi Nazi attitudes.
57:53I wonder what these teachers and the
57:56other people that walk around there?
57:58What kind of past they had had?
58:00So that's one anecdote on a
58:03very different note,
58:04I want to tell you in a few
58:06sentences the story of this guy
58:08that some of you will recognize.
58:10Probably this is Verna Haider.
58:13Avana Haider was the medical
58:15director of the T4,
58:17the so called euthanasia program that
58:19we've heard about already today.
58:21I don't need to go into detail
58:23with right now.
58:24He was able to flee towards
58:26the end of the war,
58:29ends up being able to take
58:31on a false identity.
58:33The name of fruits and some of you
58:35will be familiar with the fact that
58:37he all the way from 1947 until 1959
58:40could work in a town called Flint.
58:44Work and continue to make a living
58:47by being a sports doctor and also
58:50writing kind of expert testimonials
58:53expert reports as a psychiatrist
58:56as a neurologist for German West
59:00German authorities of the region.
59:03Now the interesting thing is where
59:05these two stories intersect,
59:06and that's of course the fact that
59:08his job that he finds in 1947 as
59:11he goes underground is to be the.
59:14He also pedic or the sports doctor
59:17at the National Sports Academy,
59:19which is in the same building.
59:21So when my mother had those
59:23anecdotes about these references,
59:25she probably had vanished.
59:26I did walk around there and the
59:28reason why I'm telling you that
59:30story is of course in many of you
59:32will be familiar with this painting.
59:35Actually, by Harvester,
59:37probably one of the most important
59:39post war German artists and
59:41painters is that Vanderhyde ends up.
59:44Eventually getting arrested and
59:45being brought to court in 59.
59:48In the following years ends up
59:50committing suicide shortly before
59:51his trial actually starts in
59:521964. But then the height,
59:54of course, in many ways,
59:55really embodies the continuity of the elites,
60:00the continuity of the legal, political,
01:00:01medical elites in post war Germany
01:00:05in different ways, and I will,
01:00:07for the sake of focus and brevity
01:00:10here mainly focus of course on West
01:00:12Germany in the following remarks.
01:00:15It also gives us a sense of the deeply
01:00:18problematic lack of accountability.
01:00:19Of course by these elites.
01:00:22To be sure, the Nazi past of course,
01:00:26has been a an important topic.
01:00:30Of the medical discussion of the
01:00:34discussion about medical ethics
01:00:35and in the decades after the war.
01:00:37But we can very often see that it's fairly
01:00:40selective and also with a certain kind
01:00:42of narrow focus in many ways at this time,
01:00:45and very often there is this kind of
01:00:49mistaken assumption that the German
01:00:51conversation about in this context was
01:00:55somehow constant or somehow static,
01:00:58and that Germans.
01:01:00Somehow we're burdened by
01:01:02this kind of sense of guilt,
01:01:04and that would have affected
01:01:05in some kind of constant way,
01:01:07also their way of addressing
01:01:10medical ethics contexts.
01:01:11What I'd like to use the next 25
01:01:14minutes or so that I have left is
01:01:16to address the following questions.
01:01:18I'd like to discuss with you.
01:01:20How did medical professionals in Germany
01:01:24come to terms with their own behavior,
01:01:28their way of behaving,
01:01:30the decisions they took in the Nazi period?
01:01:32How did they interpret it?
01:01:33How did they represent it?
01:01:36Secondly,
01:01:36and how did they?
01:01:38How did medical institutions and
01:01:41organizations try to restore
01:01:44their professional identity
01:01:46between Tabooing and remembrance?
01:01:49And eventually,
01:01:49of course,
01:01:50the bigger question,
01:01:51how should we situate that experience
01:01:54and those issues within a wider context
01:01:58of the identity of the profession?
01:02:00And of course also the international
01:02:02setting with this big question.
01:02:03How this should impact medical training and
01:02:06also the conversations about medical ethics.
01:02:09And addressing some of these questions,
01:02:11we can profit from a whole series of
01:02:14relatively recent scholarship that has been
01:02:16published over the last five 10-15 years,
01:02:19examining systematic examining
01:02:21the historical dynamics of the
01:02:24medical profession in Germany.
01:02:26Dealing with this history
01:02:28that we will address.
01:02:31Before we go into depth with that,
01:02:33I just want to add 1 general thought
01:02:36that is a little bit of a comment and
01:02:39addition to what Jack Hughes contributed.
01:02:42And that's of course.
01:02:44That the important thing is that
01:02:46we already in the 1920s in Germany
01:02:49and other parts of the world.
01:02:51Also Catherine told us about the American
01:02:54case here have a shift towards the
01:02:56idea of thinking about the folks car,
01:02:58but there's this national body
01:03:00along among the medical profession,
01:03:02so that already is 1 explanation.
01:03:04Of course,
01:03:05with this pivot towards ideas
01:03:09of social Darwinism,
01:03:11ideas of race and hygiene that
01:03:13it's less surprising that there is.
01:03:15This massive attitude of willing self
01:03:19submission of many German doctors to
01:03:23the rising Nazi movement even before 1933.
01:03:28And of course,
01:03:29what we should not underestimate is also
01:03:31to what degree doctors saw this.
01:03:34Come here and also the Nazis taking over
01:03:36power as a moment of new opportunities
01:03:40for unrestrained research for career
01:03:42advancement for situation where
01:03:44suddenly there were no legal and
01:03:47ethical and social boundaries for their
01:03:51research practices that they wanted
01:03:53to apply with an endless supply of,
01:03:56quote unquote human material.
01:03:58That they could profit from.
01:03:59And of course then also follow
01:04:02their tunnel vision of research
01:04:04research zeal in that context.
01:04:07What we of course see in here is this
01:04:10kind of stark contrast between the
01:04:13self exculpatory attitudes after 45,
01:04:15where doctors then talk about.
01:04:18Having been in an emergency situation,
01:04:20having been obedient to orders that they
01:04:23were given that they were trying to do
01:04:26things for the benefit of the prisoners,
01:04:28or even in the name of humanity,
01:04:30as some of these doctors claimed,
01:04:31after 45,
01:04:32in contrast to what we know
01:04:34about how doctors ended up in
01:04:36these situations of complicity,
01:04:38especially the experiments sometimes
01:04:40being assigned these roles,
01:04:42but very often being invited or
01:04:45also volunteering their suggestions
01:04:47and their projects themselves.
01:04:49And also the fact of course and deck
01:04:52alluded to that that there were no
01:04:54sanctions of any significance for
01:04:56those few cases of disobedience,
01:04:58or where scholars, medical scholars,
01:05:01doctors withdrew or even protested.
01:05:05The other point that I wanted to
01:05:06make and that I think kind of,
01:05:07creates the basis for our conversation
01:05:10about the post 1945 years,
01:05:12is that we actually do not have
01:05:17significant indications of moral
01:05:20doubts from the side of the doctors,
01:05:22not in the end, during the 40s.
01:05:25And for that matter after 1945,
01:05:27and many indications rather point
01:05:31into the direction of some kind of
01:05:33normative shift that is being going on.
01:05:35Obviously this is very much also
01:05:37about how scholarship over the
01:05:39last 10 to 20 years is dealing
01:05:41with Robert Jay Lifton's important
01:05:42work that Jack also referred to,
01:05:45and I assume that his work and his
01:05:47book always be will be one of the most
01:05:50important publications about this whole
01:05:52topic of medicine during the Nazi years.
01:05:54That being said,
01:05:55it seems that there's a body of scholarship
01:05:57that puts the emphasis somewhere else,
01:06:00particularly in terms of the mindset of term
01:06:03doctors that scholarship I'm thinking of.
01:06:05People like Dan deliv.
01:06:07But also people who try to use the analysis
01:06:10and the work by people like Howard,
01:06:13Elsa and to see what that means for
01:06:15the medical context is to emphasize
01:06:17how there is a situation where
01:06:19doctors probably were aware of that
01:06:22they were crossing boundaries and
01:06:24that they were in conflict with
01:06:27more traditional normative codes.
01:06:29But we have little evidence just to
01:06:32repeat that point that they actually
01:06:34had to suppress their ethical qualms.
01:06:37About what they were doing,
01:06:38that they had any kind of
01:06:40conscientious reservations.
01:06:41So the bunt,
01:06:42the punchline.
01:06:43Of course,
01:06:43here is that perhaps there was
01:06:45not even a need for weightlifting
01:06:47assumes in terms of doubling in
01:06:49terms of having two personalities.
01:06:51No need for numbing.
01:06:54No Faustian bargain of choosing
01:06:56evil for the sake of your career,
01:06:59because you actually to begin with,
01:07:02did not feel guilty about
01:07:04what you were entering.
01:07:05And that's of course,
01:07:06an important point so that.
01:07:07Both the ideology but also the
01:07:09transformation of the ethical standards
01:07:11of other Germans and other elites,
01:07:13but also medical professionals.
01:07:15All these ethical standards meant
01:07:17that they only in very limited amounts
01:07:20had any kind of ethical qualms,
01:07:22or were even psychologically affected
01:07:24by the crimes that they committed.
01:07:26They did not have a strongly developed
01:07:28sense of guilt towards the victims,
01:07:30and that's of course an important
01:07:32point to keep in mind that we can
01:07:35share the screen and take us.
01:07:37Fun, but in my PowerPoint here to
01:07:40visualize some aspects so the three
01:07:43different paradigm the five different
01:07:46paradigms that are built on what for
01:07:48Culkin is worked on in terms of the
01:07:51three main points here are different.
01:07:54Kind of you might want to say all
01:07:56those almost narratives of innocence
01:07:59that really have been relevant
01:08:01throughout these years and those are
01:08:03the five points that I want to have
01:08:05a look at here with you and they are.
01:08:08Often,
01:08:08these focusing on the different
01:08:10phases to some degree also kind
01:08:12of in a chronological manner,
01:08:14and they are built on a couple of
01:08:16post war myths that become very
01:08:19important for the medical profession
01:08:21and even also beyond that one is.
01:08:26The assumption that 1933 is this
01:08:29historical accident that is emphasized
01:08:31as some kind of sudden rupture in history.
01:08:35The second one,
01:08:36and you'll see the echo also
01:08:39throughout the other periods here is
01:08:41that the atrocities were committed
01:08:43by a few zealous doctors,
01:08:45and where the result of irrational
01:08:49policies imposed from above from
01:08:52unto non political physicians,
01:08:56and finally.
01:08:56Said policies like for sterilization
01:08:59and quote unquote euthanasia,
01:09:01were the expression of a racial
01:09:03ideology that had nothing to do with
01:09:06state of the art medical practice.
01:09:08State of the art medicine,
01:09:10but were individual responses.
01:09:13Individual perversions disguised as science,
01:09:16and those are some of these kind
01:09:19of fundamental myths that will
01:09:21have a certain longevity and also
01:09:23a story that stays with some of
01:09:27these different narratives.
01:09:28As we pursue the way that I'd like
01:09:30to present these different phases
01:09:32is also to give you a few examples
01:09:34of individuals that end up as
01:09:38directors as chairs of the Heidelberg
01:09:42Psychiatric Hospital at the time.
01:09:45So they are the directors of
01:09:48the psychiatry in Heidelberg,
01:09:49and they give you a good example
01:09:51of embody some of these different
01:09:53trends at the first time.
01:09:54One example here is Carl Schneider so.
01:09:58Schneider is the director of the
01:10:02Heidelberg Psychiatry Department
01:10:03all the way until 1945,
01:10:07and he's actually the director of
01:10:1084 Research Institute and his law.
01:10:14And it's the experiments in the
01:10:16build up to these these experiments
01:10:19that eventually mean that 21 of
01:10:22the 50 children that were
01:10:24at this institution end up
01:10:26being murdered and being killed,
01:10:28mainly because the researchers wanted
01:10:31their brains for their research.
01:10:34He ends up escaping the allies on bike,
01:10:40getting out of Heidelberg,
01:10:41but he is optimistic.
01:10:42We know from his son.
01:10:44Afterwards that he will be able to
01:10:47rehabilitate himself and continue his career.
01:10:49And it's only much later when there
01:10:52are preparations years later for the
01:10:55first trial against Van Heider that I
01:10:57mentioned earlier that he's able to escape.
01:11:00That makes Schneider realize that there is
01:11:02no way that he will continue his career,
01:11:04and he ends up committing suicide
01:11:06not to be a burden for his family.
01:11:08But that's of course so important
01:11:09that we have one case,
01:11:10and there will be several others
01:11:11where some of these doctors who are.
01:11:14Are deeply complicit in the
01:11:16crimes end up committing suicide,
01:11:18but not necessarily because
01:11:19they had a bad conscience,
01:11:21but for other motivations.
01:11:25The important factor for this
01:11:29context is of course that we soon
01:11:31will have the setting of the post
01:11:33war trials the most important one.
01:11:35Of course, the medical trial in Nuremberg
01:11:39that takes place in nineteen, 4647.
01:11:43Actually, they're in.
01:11:45There's a whole row of trials.
01:11:47I'm not go into detail with all of them.
01:11:49Obviously in these few minutes,
01:11:51but the situation in nineteen 4546.
01:11:54For these trials is of course the one
01:11:57that Andrew also reminded us of earlier.
01:11:59And that's of course that we
01:12:01have a country that is in ruins
01:12:03where there a lot of refugees.
01:12:05Where there is a fear of a
01:12:07collapse of the medical system
01:12:09of the most basic medical care,
01:12:12which becomes an argument that German
01:12:14doctors use towards the allies,
01:12:16the occupying forces,
01:12:17saying if you arrest us,
01:12:19if you will have this massive turn
01:12:22around turnover of medical staff,
01:12:25there's a risk that we will not be able
01:12:27to keep up the medical standards in
01:12:29the same level that actually will be
01:12:31able will enable us to prevent epidemics.
01:12:33So that's of course an important tool.
01:12:35But it's factual or not,
01:12:36but it becomes a true to avoid too much
01:12:40intervention from the side of allies.
01:12:42But the important thing,
01:12:43of course, for these years,
01:12:44is that the defensiveness,
01:12:47the denial, the silence,
01:12:49and the suicides that I just talked about.
01:12:52Of course, should not necessarily
01:12:55be interpreted prematurely,
01:12:57and without much evidence as
01:12:59expressions of guilt and shame.
01:13:01As I said,
01:13:01we barely have any indications of that
01:13:03kind of sense of shame or remorse.
01:13:06During these years,
01:13:07and there's also no basis for any
01:13:10kind of psychological constructs
01:13:13of unconscious repression,
01:13:15but rather a very conscious decision
01:13:17to say the way that we can rebuild,
01:13:20trust,
01:13:21and create as much continuity for
01:13:23our institutions and our own careers
01:13:25is by preventing to talk about these
01:13:28crimes and by simply putting the lid
01:13:30on and blaming the state in the end
01:13:34and exculpating the professionals.
01:13:36These trials are covered by.
01:13:41A number of German doctors psychiatrists,
01:13:45the most famous one is of
01:13:47course Alexander Michelli.
01:13:48And Alexander Mitchell Lee and his colleague.
01:13:53100 mil care are the ones who then
01:13:57are actually sent by the medical
01:14:00organization to be at the trial and
01:14:02to report on it to write about it.
01:14:05And it's they already published a
01:14:07brochure about what's going on at the
01:14:10trial and also what it kind of brings
01:14:12to the surface in March 1947 and later on.
01:14:16Of course,
01:14:17he publishes a famous.
01:14:18They publish a famous book that's still
01:14:20very much as the basis for much of
01:14:23what we know about these crimes in 49.
01:14:25But then will later be republished in 1960.
01:14:29There are other scholars that are
01:14:31involved with that trial and documented.
01:14:33Allison Platten is an important person.
01:14:36That people were at the same time
01:14:37Gach Schmidt is an important name.
01:14:39Try to document the crimes to see what's
01:14:43going on in the different clinics,
01:14:45what has happened?
01:14:46They go out and interview survivor
01:14:47as they go out and interview nurses.
01:14:49But what is in common for
01:14:51all of these is that we have.
01:14:55Very little willingness to pick up on this.
01:14:58There's minimal resonance.
01:14:59Some of these books by catchment,
01:15:01for example, end up not being
01:15:04published for another 1-2 decades.
01:15:06They simply don't find publishers.
01:15:08And by and large the German
01:15:12professional public and also the
01:15:15general public is basically just.
01:15:18And willing to engage with any kind
01:15:21of discussion about what these trials
01:15:24and what these reports bring up,
01:15:26and these two other names that I'm
01:15:28presenting you to here are good examples.
01:15:29Of course,
01:15:30how some doctors actually do react.
01:15:32Interestingly enough,
01:15:34transmission and fat in observable
01:15:36who both are.
01:15:39In sometimes in our self
01:15:40perception kind of the good guys.
01:15:42Because Szabo at least tries to
01:15:44present himself as a kind of anti
01:15:47Nazi in many of his attitudes,
01:15:49though his role was more complicated
01:15:51than that and transmission are also
01:15:53already in the fall of 1941 protests
01:15:55against the Nazi regime within the
01:15:58framework that is possible at the
01:16:00time and speaks out against some of
01:16:02the medical practices gives a public
01:16:04lecture that is very critical and
01:16:06becomes the moral authority also at
01:16:08the University of Freiburg at the time.
01:16:10In 4546 and the fact that they are
01:16:14in Pushne is attacked for being
01:16:16quiet and not speaking out in a more
01:16:19systematic and comprehensive way
01:16:21against how medicine is engaged in
01:16:23the crimes and how Mitchell he points
01:16:27that out creates a lot of fury.
01:16:30They are insulted.
01:16:31They are litigious.
01:16:33They are suing Mitchell Ish.
01:16:35They are defending their honor so
01:16:38we can see how there is this sharp
01:16:41controversy and an unwillingness.
01:16:42To engage with the ambivalences
01:16:45ambiguities of their own roles pre 1945.
01:16:49And also now,
01:16:50who's then afterwards are often seen
01:16:52as this big hero ends up writing
01:16:54articles in a gutting university
01:16:56newspaper where he writes about how
01:16:58the human subject experience were.
01:17:01Quote Horrible monstrosities committed
01:17:03by a number of statistic persons and
01:17:07their irresponsible accomplices.
01:17:10But they were not aberrations of science,
01:17:12so again, again, we see this kind of trope,
01:17:15persistent trope of the few bad apples
01:17:17that comes back. Again and again.
01:17:21Now that first period of the trials,
01:17:25then soon will transition to
01:17:26a period that you could call
01:17:29rehabilitation and reintegration,
01:17:30and a good example of
01:17:32that is quote Schneider,
01:17:33who has had kept clear distance
01:17:35from the Nazi regime not to confused
01:17:37with Carl Schneider that,
01:17:39as mentioned earlier,
01:17:40quote Schneider ends up then taking
01:17:42over that clinic that I had picked
01:17:45as an example in Heidelberg,
01:17:46and he's the chair of the department
01:17:49and also director of the clinic
01:17:51in Heidelberg between 45.
01:17:52In 55 and in spite of his anti Nazi
01:17:57or Nazi skeptical stance before 45,
01:18:01his focus very much is on reconstruction
01:18:05and reconciliation of the profession.
01:18:08And he sees that the main path
01:18:11forward is again
01:18:12to keep silent about it,
01:18:14not to have any conflicts.
01:18:16He does not make it easier
01:18:19for immigrants and refugees.
01:18:21Jewish doctors to come back
01:18:23and get their jobs back.
01:18:25He actually prevents that
01:18:26from happening very often.
01:18:28He makes it very hard for victims
01:18:30to get their compensation,
01:18:31and there are no reforms of
01:18:33any kind of institutional.
01:18:35Manners in many ways,
01:18:37Schneider coach Hnyda really embodies
01:18:39how that period is defined by a
01:18:42an ongoing lack of willingness,
01:18:45critically to investigate the
01:18:47recent history of the profession,
01:18:49what was taught was researched
01:18:51both in terms of its implications,
01:18:54politically and militarily.
01:18:55And we can of course,
01:18:57ask why it seems as if in this phase
01:19:01we clearly can see how it very much
01:19:03is about the medical profession in
01:19:06Germany having a very high reputation,
01:19:08Operation,
01:19:08Paper clip and many other operations
01:19:10from the Allies from the Americans
01:19:12to get some of these experts,
01:19:13of course, seems to prove that,
01:19:15and a very interesting expression of that.
01:19:17Also in popular culture,
01:19:19is that there are 65 doctors movies that
01:19:22are made in those years between 1945 and 60,
01:19:26and all these.
01:19:27Kind of entertaining movies that
01:19:29are produced again and again show
01:19:31these demigods in white presenting
01:19:33the the the doctor is in Germany as
01:19:37authorities as leaders as being competent,
01:19:39diligent, trustworthy,
01:19:40ethical,
01:19:41and that's of course the image
01:19:44that they want to try to.
01:19:46Protect and also to continue to
01:19:49have only small or terminological
01:19:52cosmetics are done when people
01:19:54kind of change their definitions
01:19:56of their rotation and talk about
01:19:58genetics and and eugenics instead
01:20:00of the categories that have
01:20:01been used in a Nazi period.
01:20:03And again again we see a lot of
01:20:05the continuity of careers that
01:20:07even some of the worst guys like
01:20:09Fritz Lenz up my fun fish, sure.
01:20:13Laboring in many other people end up
01:20:16becoming Deans of medical schools
01:20:19and hospitals in these years of
01:20:23the late 40s and into the 50s,
01:20:25at the same time.
01:20:26The question is of course,
01:20:27how is that possible?
01:20:28How can we have that degree of
01:20:31reintegration that we see in many
01:20:32other areas of Germany at the same time?
01:20:35The question is,
01:20:36of course whether Nuremberg,
01:20:38especially the doctor's trial of 4647,
01:20:42was misread or could be presented
01:20:44at as some kind of collective
01:20:47exoneration of the rest of the doctors.
01:20:50Those who ended up not being brought
01:20:52to court there in that sense.
01:20:54Of course, focusing on the monster manga.
01:20:57Could be useful because you could
01:20:58demonize mangler and then everybody
01:20:59else was kind of quote unquote.
01:21:01OK,
01:21:01it could have something to do with
01:21:03the fact that the denazification
01:21:04process of the airlines seem to
01:21:06indicate that there were clear
01:21:08categories and if you only wear a
01:21:10fellow traveler, you were kind of OK.
01:21:13And of course,
01:21:14you could probably also assume that
01:21:16confronting the past and ended up
01:21:19being framed as a legal problem,
01:21:22a legal problem of individual culpability.
01:21:26So there was this kind of historical
01:21:28acceleration that was seen as you
01:21:30could something you could obtain
01:21:31by the courts in that system,
01:21:33but there might be 2 deeper reasons
01:21:35that I want want, want to touch on.
01:21:37That's of course that we should not
01:21:40forget that that reintegration that
01:21:41we see here reintegration of the
01:21:44perpetrators of people who are complicit,
01:21:46who were complicit into post war.
01:21:48German West German society was also caused
01:21:53by the continuity of the idea of lives.
01:21:56Unworthy of living that already had existed.
01:22:01As Jack had pointed out,
01:22:03decades before 33 and
01:22:05continued to exist after 45.
01:22:08So these notions of defining
01:22:10lives and worthy of living is
01:22:12something that had a longer history.
01:22:14So people who had been propagating that,
01:22:17of course, not.
01:22:19So surprisingly,
01:22:19we're much more kind of accepted than
01:22:21we probably from our perspective today,
01:22:24would assume.
01:22:25And the second factor probably is,
01:22:27of course, that there.
01:22:28But this had severe consequences
01:22:31because reintegrating these people
01:22:32meant that all legal investigations
01:22:35came to a standstill,
01:22:37even the ones that fits power had stored it.
01:22:40Victims were ignored and
01:22:42still not rehabilitated.
01:22:43And the national profession as a
01:22:46whole soon would be rehabilitated.
01:22:49Let me take us to the third phase.
01:22:52What roll calls triple isolation
01:22:55is and example here is Valdez from
01:22:58buyer who then becomes in 55.
01:23:00The director of Heidelberg Psychiatry
01:23:02and he's interesting also because
01:23:05he really pushes for reforms.
01:23:07He clearly goes into social.
01:23:10Psychiatry wants to deal with
01:23:13the trauma that concentration
01:23:15camp inmates had experienced.
01:23:17So there are many aspects that he really.
01:23:19Where he really causes a change,
01:23:22but also buyer had his clear blind spots,
01:23:26and in certain ambivalence and
01:23:27one of them one of the areas
01:23:30where we can see it is that he
01:23:33still prevents any kind of dealing
01:23:35with Heidelberg specific crimes.
01:23:38So there is no focus on the
01:23:39perpetrators or any kind of victim
01:23:41commemoration that had to do with
01:23:43the own backyard for that matter.
01:23:44Why do we have this change that at
01:23:46least now somebody like front buyer
01:23:48addresses some of these topics?
01:23:50Where we can see that,
01:23:52of course it might have something
01:23:53to do with the fact that as I
01:23:55started out telling you 1959 Volta,
01:23:57Haida is arrested.
01:23:59The court case for him is prepared
01:24:01and the profession now sees itself
01:24:04in this massive confrontation
01:24:06with the past in this situation.
01:24:08And secondly, of course,
01:24:10many of these chairs of academic
01:24:12psychiatry and medicine now find
01:24:14themselves being asked a lot of critical
01:24:17questions by a new generation of students.
01:24:20And often on German colleagues and
01:24:23in the end they initiate lecture
01:24:25series and new publications come
01:24:26out like the ones that buyer does.
01:24:29And there's a student article in the
01:24:32tubing newspaper in 1964 under the headline,
01:24:34The Brown University is also
01:24:36from the students.
01:24:37A lot of things change, but why isolationism?
01:24:39Even though the discourse opens up and
01:24:42there is some degree of willingness to
01:24:45deal with the complicity of doctors,
01:24:47we still can see a triple.
01:24:50Three different dimensions of isolation
01:24:52and one is that there's still this
01:24:55idea of historical discontinuity,
01:24:56so the emphasis is still the problem.
01:24:58Started in 33 and stopped in 45,
01:25:01and it mainly was due to external political
01:25:05pressure that these crimes happened.
01:25:08Secondly, the perpetrators are still
01:25:11seeing as isolated ideological
01:25:14fanatics or perverted pathological
01:25:16minds the scientific community,
01:25:18the doctors of the profession is seen
01:25:21as a political and hence uncontaminated.
01:25:24So there's still this idea that
01:25:26there's this firewall between
01:25:28the bad guys and the rest of us,
01:25:29and that's of course.
01:25:31Also why then the belief is that we can
01:25:33rehabilitate the profession as a whole
01:25:35by bringing the few and easily identifiable.
01:25:38Culprits to justice and finally the
01:25:40third isolation that is happening
01:25:42here is the distinctions, right?
01:25:44So the crimes are seen as isolated phenomena
01:25:48where there's no connection between.
01:25:51The whole idea that human
01:25:53lives have different values,
01:25:54eugenics and the eventual patient killings
01:25:56T4 and the massive numbers of starvation
01:25:59in the hospitals at the end of the war.
01:26:02All of these things are kind of
01:26:05parsed and separated in these times,
01:26:07so we are still an era where
01:26:09the victims are ignored,
01:26:10compensation is rejected,
01:26:12and actually some of these doctors
01:26:15are more depicting themselves as
01:26:19victims and have such a self pity
01:26:21on themselves and their profession.
01:26:22Rather than they actually are
01:26:24willing to talk about the experience
01:26:27of the victims in this period.
01:26:29Now things change, and ironically enough,
01:26:32as you can see from this next slide,
01:26:35it had also something to do
01:26:38with popular culture because.
01:26:39Now we end up with a situation
01:26:42where also in Heidelberg. There is.
01:26:46There are no grassroots movements.
01:26:48There is their student initiatives
01:26:51to research the criminal complicity
01:26:54of local medical professionals
01:26:56and the Holocaust movie that many
01:26:59of you will be familiar with.
01:27:01Of course,
01:27:01had an important role in that because
01:27:03as some of you will remember,
01:27:05there's even a sequence that deals
01:27:07with the killing side of hadama.
01:27:09That was one of the places where
01:27:12patients were murdered and that actually
01:27:14creates a different kind of discussion.
01:27:16Among some psychiatrists and doctors
01:27:18even in Germany study groups self
01:27:21organize so we can really see
01:27:24that shift and we end up having
01:27:26critical outsiders in the medical
01:27:28profession and also journalists.
01:27:30And I just picked and clay here as
01:27:32an example who end up now finding
01:27:35new sources and actually provide a
01:27:37scholarship and start to write about
01:27:39this history in a much sharper and
01:27:42more aggressive way in this period
01:27:44actually point out the careers.
01:27:46Of these professionals also beyond 1945
01:27:49and what they emphasize people like ants.
01:27:52Clay is,
01:27:53of course,
01:27:53that there actually is an important role of
01:27:57the experts for the crimes being possible,
01:28:00and that there was a convergence of
01:28:03expert scientific and political rationales.
01:28:07And on one hand and also Nazi political aims
01:28:11on the other. So the twist is here,
01:28:13and that's something that will stay with us.
01:28:15Also for the last few minutes that
01:28:17I will present here for you is
01:28:19that we now have a focus on the
01:28:22latent problematic potentials that
01:28:24are inherent in modern medicine.
01:28:26Itself, the value hierarchies,
01:28:28the rationality, the reductionist
01:28:31biologist conception of human existence.
01:28:33Those are the things that now are
01:28:36focused on that that are emphasized.
01:28:38So now we can see how there's a shift
01:28:40to reconsideration of the ethical of
01:28:44the epistemological presuppositions
01:28:45of medical research and practice.
01:28:47And that's of course a big step, finally.
01:28:51Particularly after 1990,
01:28:53we can see the A the most recent
01:28:57phase that we are in right now,
01:28:58and that is really how we can.
01:29:02Eventually also in Heidelberg.
01:29:04See how,
01:29:05after another generational shift
01:29:07of leadership at the hospital
01:29:09and at at the university,
01:29:12the archives are opened and Memorial
01:29:15eventually to the 21 murdered
01:29:18children is put up in many ways.
01:29:19That's an important identification
01:29:22because there is a new generation of
01:29:25scholars that now deal with this history.
01:29:27They move a little bit away from the
01:29:31somewhat deterministic tendencies of.
01:29:32Historians of the first generation that are
01:29:35had been more critical in the in the 80s and.
01:29:39In that sense,
01:29:40they are less moralizing,
01:29:41less accusatory,
01:29:41and perhaps a little bit more detached.
01:29:44But what really also defined is,
01:29:45of course,
01:29:46that because of the collapse of East Germany,
01:29:49the Stasi archives will be opened,
01:29:51and as many of you will know,
01:29:54scholars in the 90s start to be
01:29:56able to work with more than 30,000
01:29:58files are victims of people who
01:30:01were murdered in the T4 program,
01:30:04and that really changed the picture,
01:30:07because sudden suddenly we know
01:30:08so much more about what criteria.
01:30:10Were used in this context.
01:30:12We can see much clearer how they're
01:30:14even in the Nazi ideological framework
01:30:16is a very specific utilitarian
01:30:18kind of rationality that was even
01:30:21at the core of this process.
01:30:25The bottom line of this period,
01:30:27and the scholarship that we see
01:30:30today among medical doctors,
01:30:31medical historians,
01:30:32is of course that we can see
01:30:35there's a focus on the individual
01:30:37ethical choices and that goes a
01:30:39little bit back to a term that.
01:30:41We already heard a moment ago
01:30:43that also for the German doctors,
01:30:46there's a certain kind of room
01:30:48for maneuver in very specific
01:30:50historical locations,
01:30:51so there's no automatism people had some
01:30:54scope for action in these situations.
01:30:57So yes,
01:30:58there was external.
01:30:58There were external pressures.
01:31:00There were certain mental depositions
01:31:02and value hierarchies,
01:31:03but they did not necessarily determine how I,
01:31:06as the individual historian sorry
01:31:09medical professional in that situation.
01:31:11Dealt with that situation.
01:31:14So where does this all bring us?
01:31:15I will wrap up and give back
01:31:18to Mark in in two minutes.
01:31:20I just want to bring us to a conclusion here,
01:31:24and that's of course the question
01:31:28how we deal with this.
01:31:30We can now see there's a change.
01:31:32We've seen a development
01:31:34from a desire for stability,
01:31:37for reconstructing professional
01:31:39identity over a polemical,
01:31:41generational rebellion that happened
01:31:43in the 60s, seventies, 80s.
01:31:45Through this more differentiated,
01:31:46more nuanced way of dealing
01:31:48with this history today.
01:31:50Interestingly enough,
01:31:51of course we can see how what both
01:31:53the silence, the exoneration,
01:31:55and the condemnation and apologies
01:31:57now have in common is, of course,
01:32:00that there are different ways of
01:32:02trying to be concerned for of the the
01:32:05trust and the reputation of the profession.
01:32:07But in the end of the day,
01:32:09where it brings us today is that Nazi
01:32:12medicine increasingly also among
01:32:13it or within the German discourse,
01:32:15is seen as an extreme manifestation
01:32:18of problematic potentials.
01:32:20And tendencies in modern medicine in general,
01:32:23which I think that we've touched on
01:32:25several days several times today.
01:32:27As a head of the medical organization in
01:32:29two of the German medical organization,
01:32:322010 said,
01:32:33we increasingly see for sterilization,
01:32:36quote unquote euthanasia not only
01:32:38as a Nazi program,
01:32:40but also as a psychiatry program.
01:32:42That, of course, is important switch,
01:32:44so it's not anymore mainly about
01:32:47the maliciousness of scientists,
01:32:49but about the very nature of modern
01:32:51biomedical science that created
01:32:53part of the problem.
01:32:55Now,
01:32:55the Nuremberg Code that came
01:32:56out of the trial.
01:32:57The growing willingness to be
01:33:00confronted with the history and
01:33:02even the ethics committees that we
01:33:04can see in many German hospitals
01:33:07today have nevertheless not proven
01:33:09have proven not to be sufficient
01:33:12bull works because what scholars
01:33:14today say we have when we look
01:33:17at medical students in Germany
01:33:19and lack of a specific historical
01:33:22knowledge in the current generation
01:33:24of future doctors in Germany,
01:33:26they don't know enough about what.
01:33:28Doctors were complicit of we can
01:33:30see a long series recent series of
01:33:33scandals of medical malpractice
01:33:35and also dubious medical research.
01:33:38We can say shifts of paradigms in
01:33:40the Netherlands, of course, towards.
01:33:44Assisted
01:33:46suicide and even things going beyond that
01:33:49and again in the in the Dutch context,
01:33:51we can say that people say, well,
01:33:52we have nothing to do with the Nazi reference
01:33:55here because that is not our history.
01:33:59Arguably the whole development
01:34:00towards informed consent might not be
01:34:03sufficient because it still puts too
01:34:05much responsibility on the patient,
01:34:07and the question is of course whether we
01:34:09have to some degree in a historical quote,
01:34:12unquote euthanasia, debate.
01:34:13In the current debate,
01:34:15which of course does not mean
01:34:17that everybody who.
01:34:19Is more open to different forms
01:34:22of assisted suicide necessarily?
01:34:24Is led by Nazi ideology,
01:34:26but where we really need a stronger
01:34:29connection between the specific Nazi
01:34:32and other historical experiences with
01:34:34opening up that whole possibility
01:34:36and to look at how again again,
01:34:39we see these trends to expand
01:34:41the killing out of empathy out of
01:34:44some kind of economy or redemption
01:34:46as get hold off called it.
01:34:49This is of course where fast becomes
01:34:52in fellowships at Auschwitz for
01:34:53the study of professional ethics.
01:34:54That mark was kind enough to
01:34:56mention in the beginning.
01:34:58Ask me very much.
01:34:59Still thinks that we have a massive
01:35:01need that there is a massive need for
01:35:03a historically informed reflection
01:35:05of medical ethics in training and in
01:35:08and going beyond that and what we are
01:35:10trying is of course an experiential,
01:35:13immersive UN site discussion
01:35:15with young medical students.
01:35:18Typically 30 year,
01:35:1940 year that fast but takes for two
01:35:22weeks to Germany to Poland and on site.
01:35:25Try to have that kind of nuanced
01:35:27contemporary discussion of medical.
01:35:28Ethics against the backdrop of the
01:35:31historical experience that we're
01:35:33looking at both discussing the
01:35:35professional intellectual paradigms,
01:35:37the transformation of ethics that
01:35:38we can see in the German case,
01:35:40and of course, how,
01:35:41how career,
01:35:42how ambitions of ethical shortcomings in
01:35:44the context of professional ethics can
01:35:47lead people into this kind of complicity.
01:35:49Thank you so much for the attention,
01:35:51and I'll give the floor back to Mark.
01:35:55Thank you so much towards
01:35:56them for that excellent talk.
01:35:58You know the IT was.
01:36:01It was my hope over the course
01:36:02of the day that we could bring
01:36:04you a a breadth of perspectives
01:36:06on Holocaust and genocide,
01:36:08but as well as a great deal of depth
01:36:10and I think having people with
01:36:12historical expertise provide us
01:36:14with that has been hugely valuable
01:36:16and and so I think all of our six
01:36:18speakers are to be applauded for this.
01:36:20One of the things you mentioned
01:36:21in particularly towards,
01:36:22in which a phrase which you used which was.
01:36:25R. Our problematic potentials in
01:36:29the profession and the medical
01:36:31professional looking forward.
01:36:32Of course,
01:36:33these problematic potentials aren't
01:36:34unique to the medical profession,
01:36:36the legal profession and society
01:36:37at large is certainly.
01:36:39It certainly can be found as well,
01:36:40but for those of us who are
01:36:42involved in medical education,
01:36:43the problematic potentials in
01:36:44trying to identify where they are,
01:36:46I think is is hugely important to what we do.
01:36:49You know,
01:36:50I often find myself asking as we look
01:36:53back 80 years ago and we see look.
01:36:55This was obviously problematic here,
01:36:57I always say.
01:36:58I try and imagine that the the scholars
01:37:00as well as the physicians and and
01:37:02the general public 80 years from now.
01:37:04Looking back on our profession
01:37:06and say look what look what these
01:37:08folks were doing in 2022 and they
01:37:10didn't even feel any remorse for it.
01:37:11And I wonder which aspects of what we
01:37:13do might someday be viewed that way,
01:37:15and I think.
01:37:16Constantly asking ourselves that
01:37:18question can perhaps keep us a
01:37:20little bit from going off the rails,
01:37:22but this kind of historical
01:37:24evaluation is hugely helpful.
01:37:26I want to invite invite you folks to
01:37:27ask your questions through the Q&A portion,
01:37:29and I'm going to get to that in one second.
01:37:31There is one I'll answer right now,
01:37:33which is will the recording
01:37:34be shared with attendees,
01:37:35and the answer is yes,
01:37:37that this will be available on our website,
01:37:40biomedical and we can.
01:37:41You can get it by reaching out to
01:37:44us biomedical ethics at yale.edu.
01:37:46And by the way,
01:37:47in that in that and not on that side,
01:37:49you can also see we have seminars
01:37:51about twice a month that you're
01:37:53all cordially invited to.
01:37:55These are on zoom right now and
01:37:57and they're in the evening and we
01:37:59would love for you to be involved.
01:38:00You can get on the mailing list
01:38:02just by reaching out to Karen,
01:38:03who's picture you may see on your screen.
01:38:05Karen Kolb,
01:38:06who you've been in touch with when
01:38:08you're registered for this and we
01:38:09will reach out to the folks who
01:38:11registered on when the recordings
01:38:13become available.
01:38:14But now I want to to ask a few
01:38:16questions in the time we have remaining.
01:38:17We're gonna go till about 4:30
01:38:20and with the speakers we have now,
01:38:23one individual asked,
01:38:24did the Nazis borrow some of their
01:38:26views about euthanasia from eugenics
01:38:28in the United States?
01:38:30Do you well share the view of Henry
01:38:32Friedlander in the origins of Nazi
01:38:34genocide that the final solution was
01:38:36modeled on euthanasia at Hadamar
01:38:38and the other killing centers.
01:38:40Do you think that the that the
01:38:43earlier euthanasia was served as a
01:38:45model for the final solution in this
01:38:47question could be for Jack or for.
01:38:49For any of the folks on the panel.
01:38:52Jack, you're muted. You've got it on you.
01:38:58My understanding is that the the
01:39:01the later euthanasia was very much
01:39:04patterned on the the euthanasia
01:39:07at Hadamar and other other sites
01:39:10and so the the gassings that.
01:39:14And that was transported to the
01:39:19extermination camps into Auschwitz.
01:39:21I I'm going to, I'm going to yield
01:39:24the first part of that question too.
01:39:26To Torsten and sorry.
01:39:31I think the tour center, sorry.
01:39:35Do they remember the first
01:39:36part of the question?
01:39:38The first part of the
01:39:39question had to do with.
01:39:41The again the view that that the final
01:39:44solution was modeled on euthanasia
01:39:45at Hadamar and at the other calling
01:39:46site that was the 2nd portion.
01:39:49Well, that was the portion that borrow
01:39:51some of their views on euthanasia
01:39:52from New Genesis in the US.
01:39:54That was the first part,
01:39:55I think that that certainly Katie
01:39:57touched on that in her talk in the
01:39:59first half of the session as well,
01:40:01I think the answer to that is pretty much in,
01:40:03unless Torsten or sorry want to
01:40:05disagree that that certainly the Nazis,
01:40:08whether or not they were
01:40:09completely informed by that,
01:40:10they certainly borrowed.
01:40:11Some of these views from the euthanasia
01:40:13and eugenics in the US and elsewhere,
01:40:15many other countries as well.
01:40:16Not just the US.
01:40:18I mean Sarri is is probably
01:40:20more of the expert here,
01:40:21but I'll just start out saying that
01:40:23that the way that I see it is a little
01:40:25bit about keeping a balance here, right?
01:40:27And the balance is about that.
01:40:28On the one hand, we do have discourses,
01:40:32attitude changes within the way
01:40:34that people think about medicine,
01:40:37about medical ethics that are connected,
01:40:41and where there is a kind of
01:40:43transnational dimension of it.
01:40:44So what's happened in the US?
01:40:45And what's happened in Sweden
01:40:46and what happens in Germany?
01:40:47Other places and Britain.
01:40:48That they inspire each other
01:40:50that they built together.
01:40:51There is a scientific community
01:40:53and a change of discourse.
01:40:54A change in that regard.
01:40:56On the one hand,
01:40:57that's one part of the balance.
01:40:58And then I would still say that,
01:41:00and that's where much where my thinking,
01:41:01and I think also fast thinking comes
01:41:04from what we what looms large for us,
01:41:06is to at the same time say there are
01:41:09things we can relate to their things
01:41:11that are beyond going on beyond Germany.
01:41:13And then what happens?
01:41:14Of course, in Germany is after
01:41:161933 a radicalization, right.
01:41:18Radicalization.
01:41:19It has to do with not only
01:41:21ideology per southeast,
01:41:22because that's such a
01:41:25kill argument literally,
01:41:27but also a radical transformation
01:41:30of norms and ethics,
01:41:32and it's in that context where
01:41:35suddenly people find themselves
01:41:36being willing and able to put
01:41:39things into practice that they
01:41:41either could not have dreamt
01:41:42about just a few years earlier,
01:41:44or at least thought about more in
01:41:46kind of general and abstract terms.
01:41:47Sorry.
01:41:50Thanks so I just wanna touch
01:41:53upon the fact that things in
01:41:56the US did not progress too.
01:41:58Air quotes euthanasia.
01:42:00So it it's not like.
01:42:05Not Nazi physicians were sort of.
01:42:11Extrapolating that from from the US,
01:42:14sterilization, yes.
01:42:15As as we heard from from Katie earlier
01:42:19and just want to also point out.
01:42:25Just something interesting to think
01:42:27about in terms of how Germany.
01:42:30Deviated from from the US,
01:42:33like what conditions made that possible.
01:42:35If they were both sort of
01:42:37following the same track,
01:42:39believing in in the the same ideas of
01:42:44some life being better than others.
01:42:48The need the need for sterilization.
01:42:51What Germany was working with at the
01:42:53US didn't was absolute devastation of
01:42:55the population after World War One.
01:42:59This belief that the that the First World
01:43:03War just wiped out the the best of the
01:43:07the generation that could procreate.
01:43:10The US did not, I mean the
01:43:12US lost plenty of people,
01:43:14but it was not the wiping out of of a
01:43:16whole generation so that that's just
01:43:19an interesting thing to think about
01:43:22in terms of how there's a deviation
01:43:26to address the question about.
01:43:30Euthanasia sent like killing
01:43:32centers and the final solution.
01:43:34They'd like to remind everyone.
01:43:37We as a team Sunyer points out we.
01:43:44Think of the Holocaust typically
01:43:46as a camp based.
01:43:48Entity, but that's where the history is.
01:43:51But we have to remember and and
01:43:53shift our awareness eastward a bit
01:43:56and consider all the killing that
01:43:58that happened that was conducted
01:44:01by the Einsatzgruppen whom Jack
01:44:04mentioned earlier in in context
01:44:08with of Christopher Browning's work.
01:44:11So it's not like the final solution
01:44:15is only killing in gas chambers.
01:44:18It was multiple means and multiple routes
01:44:23to get to the the the death camps.
01:44:30Thank you, thank you another question.
01:44:34Did German doctors of that era
01:44:37take the Hippocratic Oath upon
01:44:38graduation from medical school?
01:44:42I think so. And they, I mean,
01:44:46there's plenty of talk about that so.
01:44:48Yes. The Hippocratic Oath,
01:44:51by the way, is not this magical.
01:44:56This this magical? Heard.
01:44:59Paradigm of of practice.
01:45:02I mean there's there's problems with it.
01:45:04I mean, it's remarkable for the time
01:45:06it was produced, I suppose, but.
01:45:09But there's plenty of room within the
01:45:12Hippocratic Oath for misbehavior.
01:45:16Certainly, but the but the but the
01:45:18hypocritical with obviously you're right.
01:45:19Jack is is an interesting
01:45:21document in many ways,
01:45:22but one of the fundamental tenets lives in,
01:45:24you know, whoever's house I entered.
01:45:25It will be for the good of of the the,
01:45:28those in that House.
01:45:30And I don't know if they had a specific
01:45:33oath that they that they took.
01:45:35Jackie think that they likely did.
01:45:36I don't know Torsten or Siri has.
01:45:38I couldn't mention that
01:45:39I I'm I'm lucky enough just to find
01:45:41the found to find the right quote.
01:45:43Because if you don't know it yourself,
01:45:44at least you had to find the experts.
01:45:45Paul Vine Ling wrote the
01:45:48Hippocratic Oath was in Germany,
01:45:50never rite of passage taken by all
01:45:53physicians on qualification so.
01:45:55So in other words, you don't have the
01:45:57same kind of rite of passage, role of it.
01:45:59That's one thing.
01:46:00And the other thing that also.
01:46:02And the loose kind of elaborates on that.
01:46:05I find it important and that actually
01:46:07Jack Jack's quote really drove home.
01:46:09I think was that it's you can still
01:46:12choose your own interpretation
01:46:13of the Hippocratic Oath, right?
01:46:15If the if the framework or the
01:46:17basis for the whole thing is,
01:46:19is that you choose to see the fox
01:46:21curve or the the the natural body as
01:46:25the main entity that you have a duty
01:46:28towards that might not make sense or
01:46:30not be logical or plausible to us today.
01:46:32But if it is plausible enough
01:46:34for somebody in the 30s and 40s,
01:46:35suddenly the game change.
01:46:39Just like this then.
01:46:42This leads me to the question,
01:46:44is it possible? Is it likely?
01:46:45Is it something as we see this shift
01:46:48of as Carrie test as Jack referred to
01:46:50with it the the the attention to the
01:46:52end within the medical profession?
01:46:54Now the attention to the individual as
01:46:56opposed to the Volk to our national body.
01:46:59And that's perhaps the house that
01:47:02we enter and need to care for.
01:47:04Is there any analogy to be made or is
01:47:07there any similar tension today in the
01:47:10United States as we look to medical care?
01:47:15Certainly not to the extent that
01:47:17I would never argue that point,
01:47:18but I I would suggest possibly that
01:47:21physicians are under increasing pressures.
01:47:25I think that I hear much more in
01:47:26the last 10 years than I did in the
01:47:281st 10 years of my career about
01:47:29how we are stewards of societies,
01:47:31resources and that we have to
01:47:33consider how this effects everyone.
01:47:36And I don't, and I don't think that
01:47:37although I'm not here to argue that all of
01:47:39these trends are necessarily wrong or bad,
01:47:42but I, but sometimes.
01:47:44The notion of of the Vulcan.
01:47:46The notion of the health
01:47:48of the national body,
01:47:49does sometimes echo in some conversations
01:47:52we have not to say that the that
01:47:55stewardship of resources is wrong,
01:47:56or that distributive justice.
01:47:58Is it inappropriate consideration?
01:47:59I would never make that already,
01:48:01but I think it is appropriate.
01:48:02But some I think that those conversations
01:48:04are very well informed by listening
01:48:06to lectures from people like Torsten
01:48:08Wagon and sorry Siegel and Jack Hughes,
01:48:11because I think that that Torsten,
01:48:13your point that the German.
01:48:15Medical students don't have
01:48:16that sense of history.
01:48:17I suspect that the same is likely
01:48:19true of American Medical students
01:48:21and government policy students
01:48:23and and so many others as well.
01:48:28That the. As I saw in Berlin, pointed out,
01:48:33there isn't inevitable tension that
01:48:35it is impossible to reconcile all
01:48:38competing notions and that there are no.
01:48:41There is no one true answer to
01:48:43any particular ethical question,
01:48:45so we always have to choose,
01:48:47and the tension between societal
01:48:50resources and the care of the
01:48:54individual is is a constant tension,
01:48:57and we always have to be aware of
01:48:59it and be willing to deal with it.
01:49:02So we don't. We don't disagree.
01:49:07If I may add more.
01:49:11Again, what Sarah said earlier is of
01:49:13course extremely important, right?
01:49:14That we don't that we don't blur the
01:49:16lines of what happens in Germany and
01:49:17what happens in America and so on.
01:49:19So let's just keep that in mind.
01:49:21But that being said,
01:49:22I think it's important to see what
01:49:25people like get it honed off and
01:49:28others have have emphasized over the
01:49:30last 1020 years and what they are
01:49:33saying is of course when we look
01:49:35closer at the euthanasia murders.
01:49:38We of course realized that this convenient
01:49:41way of saying this is outlandish.
01:49:44Ideological radicals who do absurd things,
01:49:47and so on that that smolders away
01:49:50because they actually you use or
01:49:54combine motivations and rationales
01:49:56that partially are much closer to home.
01:49:59And what I went going with this
01:50:01is even within the German medical
01:50:05conversation and rationale.
01:50:06We can see this aspect of the economy of
01:50:11this whole aspect as being very relevant,
01:50:14right?
01:50:15The the argument is we're doing
01:50:17XY&Z because we want to unburden.
01:50:21The national economy.
01:50:22We have expenses,
01:50:23and I think that was also one
01:50:24of the pictures that Jack.
01:50:25Of course,
01:50:26one of the classics that he shows about
01:50:27this patient will cost you 60,000 rice mark,
01:50:29right?
01:50:30That's not just one propaganda flicker,
01:50:33right?
01:50:33That's that's the underlying notion
01:50:36that that's what he also talked about
01:50:39when he uses this turn of of. The the.
01:50:45The economy of redemption, right?
01:50:46I'm I'm, I'm merciful,
01:50:47and I'm redeeming these people
01:50:49out of their suffering,
01:50:50and by doing that I do something
01:50:52good to our national economy, right?
01:50:54So there is this kind of economic
01:50:57rationale that in a Nazi context,
01:50:59is woven together with this
01:51:02very specific folks carbon,
01:51:04not the racial hygiene.
01:51:05And so on that that becomes part of it.
01:51:07And the second point that I
01:51:09wanted to make was, I think,
01:51:11Jack you had a quote where
01:51:13the emphasis was on saying,
01:51:15how?
01:51:15Lifting quote that says the boundaries
01:51:18were blurred between healing and killing,
01:51:20healing and killing.
01:51:21This is one way of putting it,
01:51:23but you can also put it in a different
01:51:25way and that is of course to say
01:51:28that your average German doctor.
01:51:29Was able to.
01:51:31Support and identify with the policies
01:51:35of killing because he in most cases.
01:51:39At the same time,
01:51:41saw that as freeing resources for healing,
01:51:43right?
01:51:43So these are not just bad guys who
01:51:45work around and kill everybody.
01:51:46They really think that they can use
01:51:48the resources and invest everything
01:51:50into those people who can be healed.
01:51:53So the crucial point is,
01:51:54as long as you and a German doctor
01:51:56in authority thinks you can recover,
01:51:59you can heal your on the safe side
01:52:02as soon as that gets doubtful,
01:52:04you actually risk being murdered, right?
01:52:06But it's that that's the threshold basic,
01:52:07but there's a massive. Focus on heal.
01:52:11Putting everything into healing and recovery,
01:52:14but then when that has no
01:52:16perspective anymore in that kind of
01:52:191938 or 1941 perspective,
01:52:20it means death and murder.
01:52:24Thank you, thank you another question please.
01:52:30Doctor, this one is for for you,
01:52:32Torsten woman and women in 1996
01:52:36article in the British Medical
01:52:38Journal wrote of German ethical
01:52:39guidelines requiring informed
01:52:41consent that were in place in 1931
01:52:44and beyond and Sarah you may be
01:52:45familiar with this things as well.
01:52:46And the the question is,
01:52:48were German doctors unaware of this
01:52:51or did they disregard it? We know
01:52:54I'm happy to take the first step
01:52:56and then Sarah can correct me here.
01:52:58As far as I know there is a law in
01:53:011927 that and of course built on
01:53:04earlier legislation that has no
01:53:06particular focus on informed consent.
01:53:09And then there is in 1929 there is a
01:53:12legislative initiative at the end of
01:53:15the primary public to rewrite that law,
01:53:18but that takes time and that
01:53:19is still in in making.
01:53:21So that is not finished when the Nazis.
01:53:23Central power in 1931.
01:53:25The what is it exactly called the.
01:53:30The guidelines yes,
01:53:32exactly right there is there is kind of
01:53:35empirical kind of Imperial Health Council
01:53:38comes up with guidelines that sorry.
01:53:42What is the terminology recommends
01:53:44or emphasizes at whatever that.
01:53:46Of course you should not have
01:53:48any kind of experiments.
01:53:50Experience without informed consent and
01:53:52but they remain guidelines and their
01:53:55scholarship that I'm familiar with,
01:53:57say that a lot of the majority
01:53:59of doctors ignored them,
01:54:00or so we have a few cases
01:54:02where they played a role,
01:54:03but in the majority of cases they did not,
01:54:06and that legislative process that started
01:54:08in 29 to actually rewrite the law,
01:54:10of course,
01:54:11is discontinued with the Nazis come to power.
01:54:16Yeah, I'll I'll jump in
01:54:18there and and and say that.
01:54:21The the guidelines were,
01:54:23so to speak, on the books.
01:54:25They were never done away
01:54:27with by by the Nazis.
01:54:29What the what this question asker is
01:54:33pointing to is one of the key issues
01:54:36of the Nuremberg Doctor's trial.
01:54:39Like a lot hinged upon this question of
01:54:42was were the guidelines law and there
01:54:46were different interpretations of that.
01:54:50You know were there penalties for?
01:54:54Going against the guidelines
01:54:56and on the whole,
01:54:58yet it seems like there were plenty
01:55:01of doctors who were not aware or
01:55:03claimed that they were not aware
01:55:06of it because it was published in.
01:55:08Uh.
01:55:10I, I guess,
01:55:11a journal that was read by everyone,
01:55:14but you know everyone should have had
01:55:16their eyeballs on it at some point.
01:55:18As to whether it's stuck with them.
01:55:20Who knows,
01:55:21but then it's just also really
01:55:24interesting to note that the
01:55:26guidelines themselves have higher
01:55:29standards for ethical conduct than
01:55:33the Nuremberg Code that came out
01:55:36of the Nuremberg Doctor's trial.
01:55:39So, just. Something to keep in mind.
01:55:43That's a fascinating observation.
01:55:45And with the Nuremberg code,
01:55:47it one has to be fair.
01:55:48I recognize that even those lesser standards,
01:55:51less strict standards,
01:55:52perhaps that were in the number
01:55:54of code such as rule number one,
01:55:55which was the voluntary
01:55:57consent of the human subject,
01:55:58is absolutely essential.
01:55:59This was largely ignored by
01:56:02clinical researchers in the United
01:56:04States and elsewhere for many,
01:56:05many years following the Nuremberg Code and
01:56:09one of the questioners does ask the question,
01:56:12what about Tuskegee?
01:56:13Which is something I suspect
01:56:14most people on the call,
01:56:15and certainly the panelists
01:56:17are very expert in and.
01:56:18And what about Tuskegee looms?
01:56:21Large is perhaps a reminder
01:56:23that we've spent a fair amount
01:56:25of time this afternoon speaking
01:56:26about the transgressions of the
01:56:28Nazi era and of the Germans,
01:56:30but these transactions are
01:56:31certainly not limited to that era.
01:56:33Or to these people.
01:56:36There was a specific question
01:56:37which I found interesting,
01:56:38which had to do with the religious
01:56:41teachings and give me a moment here.
01:56:43There has been no mention of
01:56:45organized religion or specific
01:56:47religion leaders as restraints
01:56:49on Nancy's transgression.
01:56:50One could extend this to ask what were
01:56:53the religious values of physicians
01:56:55who participated in atrocity?
01:56:57Do we know much about the religious
01:56:59values of the of the Nazi physicians?
01:57:02Particularly those who were very
01:57:03involved in the atrocities.
01:57:07Before before our other two
01:57:09panelists give us the correct answer.
01:57:11Let me just say that the.
01:57:16This is he. The.
01:57:20The physicians had there were.
01:57:25Christ give me repeat the question.
01:57:27I've gotten myself
01:57:29distracted here premature.
01:57:32With extend this to ask what were
01:57:34the religious values of physicians
01:57:36who participated in the atrocities?
01:57:40So OK, it's my mother in law always
01:57:46said that doctors were particularly
01:57:49at risk because they knew too
01:57:51much and therefore they could.
01:57:53They went beyond religion they had.
01:57:56They didn't pay attention to
01:57:57religion or religious values.
01:58:02So, but so that's not that's
01:58:05not unique to. To Germans.
01:58:09We know much about the religious values
01:58:11of of these physicians. Torsten or sorry.
01:58:15It it seems like there were Catholics.
01:58:17There were Protestants.
01:58:19I don't think there was any
01:58:21particular pattern with one
01:58:23group being more susceptible to.
01:58:26Conducting experiments or
01:58:29breaching medical ethics.
01:58:31But I also want to point out
01:58:34this really fascinating aspect
01:58:35of religion during the Nazi era,
01:58:39religion itself changed the Protestant
01:58:43church sort of split and one group went
01:58:48along with with Nazi precepts and got rid of,
01:58:54for example, Jesus Christ.
01:58:57Being a Jew and so religion itself.
01:59:03In Nazi Germany was molded.
01:59:07If you are following a certain church
01:59:10you are hearing from the pulpit.
01:59:13Sort of.
01:59:15That the that the regime
01:59:16is doing good things.
01:59:18So even people going to church
01:59:20God fearing Christians they
01:59:24were getting certain messages.
01:59:26And then, on the flip side there.
01:59:29Brave people like Bishop von Galen.
01:59:34In in sort of pointing out to the
01:59:38population what was going on with
01:59:41the T4 euthanasia program and that
01:59:44is often cited as as something
01:59:47that stopped the the killing so it
01:59:51you know it's just a wide spectrum
01:59:54of religious beliefs and actions.
01:59:57Starting the third life.
02:00:00Just to repeat what everybody already knows,
02:00:03the von Galen neither bond nor
02:00:07practically anybody else objected
02:00:09to the treatment of Jews.
02:00:12This was all directed at the T4
02:00:14killings as far as as far as I know.
02:00:19I think this will be our last question and
02:00:22then I'll just wrap it up in in the US,
02:00:24studies have shown very biased views in
02:00:27medical students and doctors in terms
02:00:29of race and willingness to prescribe
02:00:30pain pills is sent to a specialist.
02:00:33Care do tests for diseases etc.
02:00:36And the questioner asks is
02:00:38is this similar to Nazi era?
02:00:39A form of collaboration in supporting a
02:00:42racist system but at a lesser level is
02:00:45what we're seeing now the same thing,
02:00:47but to a lesser degree.
02:00:49Run a lesser level.
02:00:53The studies that study,
02:00:54in particular the one study in particular,
02:00:57came out actually quite a while ago,
02:00:59and I think most medical students
02:01:01get exposed to it these days,
02:01:03so hopefully that has changed.
02:01:05I'm not sure it has.
02:01:07I can't prove that it has.
02:01:08I have no data, but that's there.
02:01:11Students are increasingly aware of that
02:01:14study and that that set of biases.
02:01:21Thank you. OK, I think this has
02:01:26been an extraordinary afternoon,
02:01:28thanks most especially to the 6th terrific
02:01:30speakers and I want to thank you very
02:01:33much for making the time and coming
02:01:35and sharing your expertise with us.
02:01:37And there's others to thank as well.
02:01:39Karen Cole, who's the manager of
02:01:41our program for Biomedical Ethics,
02:01:42worked very hard to help with
02:01:44this whole thing together.
02:01:45Karen, thank you so much.
02:01:46Andrew Heinrich was, as I mentioned,
02:01:48was in on the thinking of
02:01:50this from the start.
02:01:51Jakob Lindenthal sent him
02:01:52my way or sent me his way.
02:01:54And we put our heads together and
02:01:56came up with some ideas for this.
02:01:58The associate directors of the program,
02:01:59Sarah Holland, Jack Hughes,
02:02:01were helpful.
02:02:02And certainly the support we
02:02:03get from the medical school.
02:02:05From my boss Jessica Lucy,
02:02:08the deputy Dean for education as
02:02:10well as from the Dean Nancy Brown.
02:02:13And I think of course thanks.
02:02:15Most of all to those of you who made
02:02:17the time thanks to the Lindenthal
02:02:19family for their support of this,
02:02:21there's much more going on at the
02:02:23program for biomedical ethics,
02:02:24and we'd like to invite all of
02:02:26you to become as involved as your
02:02:28as your time and interest allows
02:02:30by reaching out to us by our
02:02:31medical ethics at yale.edu,
02:02:32and we will see you with
02:02:34programs in the future.
02:02:35And with that I will once again
02:02:38thank you all and hope you
02:02:40have a beautiful evening.
02:02:41Goodnight
02:02:44goodnight.