The Holocaust, doctors, and ethics

You’re a physician with the U.S. military in Afghanistan. Before you on the operating table is an enemy fighter. Word comes that a gravely-injured U.S. soldier is on the way to your field hospital. You can save only one patient. Which one do you treat?

A dozen medical students and an equal number of seminary students debated this quandary this summer as part of an exploration of ethics and the Holocaust.

Over the course of 12 days students met with a Holocaust survivor in New York, visited the railroad platform in Berlin where trains set off for Auschwitz, and toured the concentration camp. The exercise included daily discussions of moral issues and much soul searching, but little consensus. “The best part of this was that none of us agreed on any of the cases,” said Dipankan Bhattacharya, now entering his fourth year of the M.D./Ph.D. program at Yale. “There was always somebody challenging what you think.”

Bhattacharya, who arrived at Yale in 2011 with the goal of becoming a physician-scientist specializing in genetics, is the most recent Yale medical student to take the trip sponsored by Fellowships at Auschwitz for the Study of Professional Ethics (FASPE). The program explores the ethics of four professions; medicine, religion, law, and journalism. While it explores how members of these professions acted during the Holocaust, the program’s goal is to apply this knowledge to current ethical issues. Medical and seminary students travel together, and journalism and law students travel in a parallel program. (Next year the program will add students in business and management to the mix.) FASPE starts in New York City in June with an orientation at the Museum for Jewish Heritage. Students and faculty from universities around the country then travel to Berlin, Krakow, and Auschwitz. Yale students have participated in FASPE since its pilot program in 2009.

Traveling with the group this summer were Mark Mercurio, M.D., director of the Program for Biomedical Ethics at the School of Medicine, Sara Goldkind, M.D., formerly senior bioethicist at the Food and Drug Administration, and Thorin Tritter, Ph.D., FASPE’s managing director. They were later joined by Torsten Wagner, FASPE’s European director, as well as local guides and historians.

One of their first visits was to Track 17 at the Berlin-Grunewald station, now unused and covered with shrubbery, Bhattacharya said. “The track exists, you see where the platform started and it just goes off,” he said. “When we got to Auschwitz, we followed the tracks, then we walked the same route people walked into Auschwitz.”

Being at the death camp on a sunny day with birds chirping rendered the visit “creepy and eerie,” Bhattacharya recalled. The camp at nearby Birkenau, he said, is now an empty field, “a vast area of green grass with the foundations of where the buildings were. … It doesn’t settle. It doesn’t fit. When we’re here a lot of things are beautiful, but that doesn’t mean there weren’t horrible things happening there.”

Another disturbing visit took them to the mansion in the Berlin suburbs that hosted the Wannsee conference in 1942, when high-ranking members of the SS, the police, the government, and the Nazi party discussed the “final solution of the Jewish question.” Again, the beauty of the setting contrasted with what went on inside. “It’s one thing to sit in a classroom and discuss these things,” Bhattacharya said. “The value of this trip is that you are in the space where these things happened. There are the sights and the smells. It affects your thinking in a different way. It makes it more real.”

Since his return, Bhattacharya has noted that ethical discussions tend to focus on abortion, end-of-life care, and allocation of resources rather than dilemmas of everyday care of patients. “No one thinks of the more subtle things that happen in the hospital that you might question,” he said. Among his concerns is the schedule of rounds. “We go into the patients’ rooms at 5 in the morning and wake them up and do a history and a physical so we can round at 7. It’s clearly inconvenient. No one wants to be woken up at 5, especially if they are sick and in the hospital. Are there ethical arguments for rounding that early? Is there an ethical reason or is it just convenient for us?”

He also asks whether it is ethical to begin a treatment that may well bankrupt the patient. “One of leading causes of homelessness is medical bills. It’s naïve to say these things don’t matter. Are we only responsible for the medical, not the psychosocial context of medicine?”

Bhattacharya acknowledges that he doesn’t have all the answers, and at times wonders if something is, in fact, an ethical violation. “I am still struggling to define that,” he said. “Something might be an ethical violation, or it just might be something that we should do differently, that we could improve upon. … The trip has given me a tool kit, a way to start asking these questions.”

As to the physician in Afghanistan, students tackled the dilemma from all angles. “You don’t know what that person will or will not do in the future,” Bhattacharya said. “Who’s to say that he won’t become our best informant? Who’s to say that the American soldier we save won’t do something bad in the future? Is the Afghani militant Osama bin Laden or a poor farmer trying to feed his kids? Initially, I was on the side of saving the American soldier. The question that really made me switch over was, ‘What if this wasn’t a militant, but a civilian who happened to live in the territory and got hurt?’ That really unsettled me.”

In the end, Bhattacharya said, the doctor chose to save the militant. The doctor is still struggling with his decision.