The Nazi Physicians, Eugenics & Euthanasia: Lessons for Today PDF

AJPH NUREMBERG TRIAL The Nazi Physicians as Leaders in Eugenics and “Euthanasia”: Lessons for Today This article, in commemoration Michael A. Grodin, MD, Erin L. Miller, BA, and Johnathan I. Kelly, MA of the 70th anniversary of the Doctors’ Trial at Nuremberg, reflects on the Nazi eugenics...

AJPH NUREMBERG TRIAL The Nazi Physicians as Leaders in Eugenics and “Euthanasia”: Lessons for Today This article, in commemoration Michael A. Grodin, MD, Erin L. Miller, BA, and Johnathan I. Kelly, MA of the 70th anniversary of the Doctors’ Trial at Nuremberg, reflects on the Nazi eugenics See also Annas and Grodin, p. 10; Wilensky, p. 12; Crosby and Benavidez, p. 36; Annas, p. 42; and “euthanasia” programs and and Shuster, p. 47. their relevance for today. The Nazi doctors used eugenic ideals MEDICINE AND PUBLIC Nazified more thoroughly and health practitioners added pow- to justify sterilizations, child and HEALTH IN NAZI much sooner than any other erful justification and facilitated adult “euthanasia,” and, ultimately, GENOCIDE profession, and as Nazis they did a State-run program of forced genocide. The involvement of health more in service of the nefarious sterilization and murder that Contemporary euthanasia has practitioners in conceptualizing, regime than any of their extra- would have been much harder to experienced a progression from initiating, and implementing Nazi professional peers.”3(p4–5) By accomplish without the willing voluntary to nonvoluntary and mass murder remains an un- 1942, 38 000 physicians had participation of physicians. What from passive to active killing. paralleled case of medicine and joined the Nazi Party. In addi- began as purification would ulti- Modern eugenics has included public health’s participation in tion, the Nazi Physicians League mately lead to genocide. both positive and negative genocide.2 By January 1933, more began a process of removing A series of recurrent themes selective activities. than half of the German medical Jewish physicians from the arose in Nazi medicine as physi- profession had joined the Nazi medical profession in March cians undertook the mission The 70th anniversary of the Party and many participated in the 1933, and in April 1933 a law was of cleansing the State: the de- Doctors’ Trial at Nuremberg murder of Jews, Sinti, and Roma; passed forbidding Jewish physi- valuation and dehumanization of provides an important opportu- the disabled; the mentally ill; and cian civil servants from practicing segments of the community, nity to reflect on the implications other “unfit” persons under the medicine at universities and medicalization of social and of the Nazi eugenics and “eu- hospitals throughout Germany.3 guise of improving public health political problems, training of thanasia” programs for contem- Physicians further medicalized and Rassenhygiene (racial hygiene, physicians to identify with the porary health law, bioethics, and Nazi ideology by propagating the the German version of eugenics).3,4 political goals of the government, human rights. In this article, we Doctors in Germany became “science” that formed the foun- fear of consequences of refusing to will examine the role that health tightly integrated into the Nazi dation of a supposed truth. By cooperate with civil authority, practitioners played in the pro- Party and supportive of its ideals. portraying or certifying Jews and bureaucratization of the medical motion and implementation of During the Weimar period, a large other peoples as racially, physi- role, and the lack of concern for State-sponsored eugenics and number of German doctors were cally, or mentally unfit, physicians medical ethics and human rights. “euthanasia” in Nazi Germany, unemployed or under-employed and government officials claimed Nazi physicians viewed the State followed by an exploration of and witnessed a decline in their to be cleansing Germany of the as their primary “patient”; some contemporary parallels and de- honor and prestige. The Nazi Party hereditarily imperfect and the came to see quarantine (ghetto- weak. Nazi physicians rose to ization), exclusion (emigration), bates in modern bioethics.1 (Am seemed like an organization that could reestablish physicians with power and prestige as they used then extermination of an entire J Public Health. 2018;108:53–57. the power and status they had lost. their skills to treat a supposed people as “treatment” required for doi:10.2105/AJPH.2017.304120) In 1929, physicians within Ger- “racial” sickness that threatened to the State’s health. These physi- many formed Nationalsozialistischer contaminate the Volkskörper (body cians thought of themselves as Deutscher Ärtzebund (The National of the German people). Co- “biological soldiers” instead of Socialist German Physicians’ operation between the Nazis and healers and caretakers.5 League) and unified the goals of physicians and the State. Physi- ABOUT THE AUTHORS The authors are with the Center for Health Law, Ethics, and Human Rights at the Boston cians joined the Nazi Party both University School of Public Health, Boston, MA. earlier and in larger numbers than Correspondence should be sent to Michael A. Grodin, MD, Boston University School of Public any other group of professionals. Health, 715 Albany St, Talbot Rm 358W, Boston, MA 02118 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. As the historian Michael Kater This article was accepted September 4, 2017. writes, “Physicians became doi: 10.2105/AJPH.2017.304120 January 2018, Vol 108, No. 1 AJPH Grodin et al. Peer Reviewed Analytic Essay 53 AJPH NUREMBERG TRIAL EUGENICS AND RACIAL Though Mein Kampf is known for 360 000 to 375 000 persons be- appropriate solution was the HYGIENE its promotion of eugenic ideas, it tween 1933 and 1939.10(p533) killing of these populations. Al- Eugenics arose in the late 19th was preceded by a number of though not accepted by the ma- century as a science that dealt other formative texts and acts that jority of German physicians at the with the improvement of he- developed the scope of eugenics time, many of the procedures put reditary qualities.2 Indeed, it was to include eradicating diseases, EUTHANASIA forward by Binding and Hoche, considered to be the leading, disabilities, mental illnesses, and, “Euthanasia,” which literally including the 3-person panel de- cutting-edge science of the finally, whole races. means a “good death,” is most ciding whether a patient should be time, as it was developed and Following World War I, Ger- commonly understood today as the killed, were adopted into the Nazi practiced in several countries. man health practitioners openly bringing about of a merciful death “euthanasia” program.12(p46–48) This included the United States, discussed sterilization of the “un- for the terminally, irreversibly ill A pivotal case of State- where scientists and politicians fit,” labeling the care of certain who are in pain and are suffering. sponsored “euthanasia” occurred worked together to research and populations a financial burden Many patients also fear a loss of in fall 1938 and was granted implement ways of decreasing on the State.10 In Germany, autonomy and wish not to be personally by Hitler.15 The father the number of people considered State-sponsored sterilization began a burden. In a medical context, of an infant born blind, with to be hereditarily weak (negative in the early 1930s, in the waning voluntary euthanasia is understood a malformed brain, and with 1 eugenics) and increasing the days of the Weimar Republic, after as the patient’s decision to end his arm and part of 1 leg missing, number of people thought to be legislation was approved to en- or her life. But in the Third Reich, petitioned Hitler for the right to hereditarily strong (positive courage, but not require, the “euthanasia” was a program of a “mercy death” for his son. Karl eugenics). sterilization of patients deemed State-sponsored medicalized mass Brandt, Hitler’s personal physi- In some ways, US eugenics “unfit.”11 Compulsory steriliza- murder. The Nazi “euthanasia” cian at the time, was sent to programs served as models for tion of the “unfit,” promoted for program was part of negative eu- Leipzig by Hitler, where the baby the early eugenic initiatives pro- decades by prominent figures in genics and Nazi racial hygiene’s was hospitalized, to consult with mulgated in Germany.6 Though German medicine, quickly be- claim that the only way to purify the doctors in charge.15 At the the Nazi regime later made eu- came official policy soon after the Volk was by eliminating the Doctors’ Trial, Brandt described genics infamous through mass Hitler took power in 1933. “unfit.” To purify the Aryan the orders Hitler gave him: “If genocide, Britain and the United On July 14, 1933, the “Law for German population, 200 000 to the facts given by the father States also promoted policies to the Prevention of Genetically 300 000 people were murdered were correct, I was to inform apply eugenics to social problems. Diseased Offspring” required the under the guise of “mercy killing,” the physicians in Hitler’s name that The United States was at the compulsory sterilization of people including many of the mentally ill, they could carry out euthanasia,” an forefront of the eugenics move- with any of the following cate- disabled, asocials, and others order that Brandt followed.12(p51) ment and initiated involuntary gories of disease: hereditary or deemed “unfit.”13 Brandt attempted to defend sterilization through laws often congenital feeble-mindedness, Like the eugenics movement, his decision at the Trial by testi- drafted by physicians. In 1907, schizophrenia, bipolar disease, he- advocacy for a large-scale program fying that the decision to kill the Indiana became the first state to reditary epilepsy, Huntington’s of State-sponsored euthanasia infant was hardly unique and in enact a law sanctioning the ster- disease, chorea, hereditary blind- preceded the Third Reich. The line with a procedure already ilization of “social misfits.” By ness, hereditary deafness, malfor- prominent German jurist Karl followed in many German hos- 1926, 23 states had involuntary mation, and severe alcoholism. Binding and German psychiatrist pitals. “In maternity wards in sterilization laws motivated pri- Patients were sent to eugenic Alfred Hoche published a widely some circumstances it was quite marily by eugenic ideas.7 In 1927, health courts by their primary care discussed book, Die Freigabe der normal for the doctors them- Virginia’s law was found consti- doctors—further integrating the Vernichtung Lebensunwertes Lebens selves to perform euthanasia in tutional by the US Supreme State and doctors into Germany’s (Permitting the Destruction of Life such a case without anything Court in an opinion by Oliver eugenic mission. Decisions regard- Unworthy of Living), in 1920.14 In further being said about it,” Wendell Holmes Jr, which used ing sterilization were then made their text, written as a standard Brandt said at the Doctors’ an analogy to the wartime draft.8 by “Hereditary Health Courts,” academic treatise, Binding and Trial.12(p51) Upon returning to Hitler’s enthusiasm for eu- which consisted of a 3-person Hoche introduced the idea of Berlin, Brandt was told by Hitler genic theory is well-known. He panel. Two panel members were lebensunwertes leben (“life un- to proceed in similar fashion with read Menschliche Erblichkeitslehre physicians, one a health official worthy of living”) and the legal- other incurably ill children, an likely tied to the Nazi Party and the ization of the “mercy killing” of order that initiated the estab- und Rassenhygiene (Principles of other an expert in eugenics and such populations. Drawing on lishment of a formal structure for Human Heredity and Racial Hy- hereditary diseases.12 A district eugenics and Social Darwinism, the “euthanasia” program.12 giene), the standard eugenics judge, usually a Nazi Party they argued that the burden on A systematic program of textbook during the Weimar member, served as the third, co- society by having to care for these “euthanasia” of “unfit” children years, and incorporated its ideas ordinating member of the panel. individuals was too high and their and adults became official policy into Mein Kampf (My Struggle).9 German physicians forcibly sterilized human status too low, that the in Germany in 1939 when Hitler 54 Analytic Essay Peer Reviewed Grodin et al. AJPH January 2018, Vol 108, No. 1  AJPH NUREMBERG TRIAL issued a decree commissioning for at least 5 years.12(p65–66) These Sonnenstein, and Hadamar. The 6 practitioners serving the Nazi doctors to perform “mercy kill- reports resembled a standard sites were selected for their isolated eugenics and “euthanasia” pro- ings” on those who were judged medical questionnaire and led locations; each had been mental grams exemplify how small steps “incurably sick by medical ex- some physicians to believe that hospitals, nursing homes, or jails along a slippery slope can lead to amination.”4 It was thought that these reports were merely being before being transformed into crimes against humanity. The the killing of the very young, used to further scientific research. killing centers.12(p71) At first, kill- Nazi doctors gradually progressed newborns, and children up to age Then, solely on the basis of these ing was done by lethal injection, from eugenic sterilization to child 3 or 4 years, would be considered questionnaires, a panel of 3 and it was later performed through and adult “euthanasia” and ulti- the most “natural” or acceptable, “medical experts” was asked to carbon monoxide in gas chambers mately to murder and genocide. and so the “euthanasia” program judge whether the patient needed disguised as showers.12(p71) After Framed in such medical terms as began with the killing of chil- “treatment”—killing—or whether SS chemists had “perfected” the “healing work” and “death assis- dren. These first “mercy death[s]” “postponement” or “observation” gassing operation, Brandt insisted tance,” German health practi- involved “5,000 children killed was appropriate.12(p52–53) The that only doctors should carry out tioners carried out the murder of by starvation, exposure in un- 3-member panel consisted of the gassings.12(p71–72) The bodies thousands of the “unfit.” Seventy heated wards, or the adminis- representatives of the T4 lead- were disposed of in crematoria years after Nuremberg, it is im- tration of cyanide, chemical ership, usually Brandt or Herbert and the ashes sent in urns to the portant to reflect on lessons we warfare agents, or other poi- Linden of the Interior Ministry, families along with falsified death can draw from the history of the sons.”4(p187–188) The program along with “outside consultants” certificates issued under a false Third Reich and to examine the was then expanded to include such as Werner Catel or Hans name by the “Condolence Letter role of contemporary eugenics adults in mental hospitals in ac- Heinze, who were in charge Department.”12(p70) and euthanasia in medicine today. cordance with the decree issued of the child euthanasia opera- Hidden from the German Contemporary euthanasia is by Hitler in October 1939 and tions at several hospitals. The public for years, knowledge about legally sanctioned in several backdated to September 1 to whole process encouraged the the true nature of the “euthanasia” countries and states. Euthanasia coincide with the beginning of 3 “experts” to issue a decision program became increasingly began by facilitating a “good the war.12(p62–63) The killing of for killing.12(p55) The killing was common in Germany in 1940 and death” in dying patients who were adults was further employed as usually ordered by the supervis- 1941. After widespread public terminal and irreversibly ill and in means of freeing space in hospi- ing doctor and often was done by opposition in Germany, including pain and suffering. Increasingly tals for soldiers who suffered in- repeated dosages of strong seda- by churchmen, such as Münster there has been a move away from juries in battle.4(p182) Hitler chose tives or morphine. False death Bishop Clemens von Galen, the these narrow inclusion criteria to Brandt and Philipp Bouhler, certificates were then issued; the program appeared to end when euthanasia in the nonterminally ill, chief of Hitler’s Chancellery, to cause of death usually listed an Hitler ordered its termination in those with chronic disease, re- lead and administer the program. ordinary disease.12(p55) August 1941. But the official or- versible treatable disease, and Brandt assured the doctors op- In the case of the larger killing dering of the end of the “eutha- broad notions of psychological and erating the program that Hitler’s operation of adults and children, nasia” program occurred just as existential suffering. In addition, decree had the force of law and “transport lists” were issued for killing in concentration camps there has been a progression from that they would not be prose- those ordered to be transferred began, and a decentralized killing voluntary euthanasia to reliance cuted for their involvement.16 and murdered at one of the campaign continued in the hos- on advance directives or previous The overall program for killing killing centers.12(p70) Buses op- pitals.17 Further murder of the statements in cases such as de- adults was given the codename erated by Schutzstaffel (SS) offi- “unfit” started in concentration mentia and expanding assisted Aktion T4 after Tiergartenstrasse 4, cers dressed in white medical camps in Germany after August suicide to active killing. Finally, the address that housed the offices uniforms took patients to the 1941, where a new program ti- there has been a limited expan- for the program in Berlin. killing centers. The destination tled 14F13 continued as a way sion to include euthanasia of The doctors and administra- of the buses was kept secret from of killing large numbers of infants and children as well as the tors responsible for carrying out the staffs of most hospitals and inmates.12(p133) In total, between incompetent. the program created a medi- the patients themselves. Thus, 200 000 and 300 000 people were Several US states have “Death calized structure for each step of from the reporting of heredi- killed under T4, 14F13, and other with Dignity Statutes” allowing the killing process. Midwives and tarily ill children and adults related “euthanasia” programs.18 physician involvement in assisted doctors were ordered to report all to the killing operation itself, suicide, including California, cases of children with serious the whole “euthanasia” pro- Colorado, Oregon, Vermont, hereditary diseases to the Reich gram was a medical procedure Washington, and Washington, Health Ministry. Similarly, doctors administered by medical DC. Montana allows the end-of- were required to report adult pa- personnel.12 CONTEMPORARY life option through a state Su- tients with certain diseases, patients Six sites were chosen as “eu- EUTHANASIA preme Court ruling. In June deemed mentally ill, or patients thanasia centers”—Brandenburg, The atrocities justified and 2016, Canada by judicial opinion who had been institutionalized Bernburg, Hartheim, Grafeneck, performed by the health legalized medically assisted dying January 2018, Vol 108, No. 1 AJPH Grodin et al. Peer Reviewed Analytic Essay 55 AJPH NUREMBERG TRIAL to relieve the suffering of termi- euthanizing children and new- accomplished by using gene when sterilization is permissible, as nally ill adults. This legislation borns.19 Current practices raise editing tools such as CRISPR- well as criteria for reporting that specifies that assisted suicide is the question of ensuring the es- Cas9, which can remove, add, or such a procedure has been only permitted if there is vol- tablishment of proper limits, es- alter sections of DNA. All of performed.27 The case highlights untary, informed, and un- pecially in protecting competent these tools can be used to pro- the continued responsibility to derstanding consent from the individuals through voluntary mote a healthier population, but guard and raise concern for vul- patient. Increasing the slippery and informed consent and de- also contain the potential for nerable people and their rights, slope, however, Canada allows fining the role of the State in abuse. Thus, genetically modi- especially those who are under not only assisted suicide but also preventing abuses.20,21 fied human embryo work that guardianship of the State. Of par- direct killing for those unable to goes beyond disease prevention ticular concern is the role of doctors kill themselves, thus permitting has become a global concern.23,24 in carrying out the sterilizations.28 active euthanasia. Assisted suicide Further modifying DNA of living for the relief of suffering from human beings may have evolu- CONTEMPORARY tionary impacts.25 The use of em- a mental illness is permitted by EUGENICS bryo selection and genetics blurs the statute in the Netherlands, Bel- A focus primarily on positive LEGACY OF THE distinction between positive and gium, and Switzerland. Using eugenics differentiates modern negative eugenics. In addition, there DOCTORS’ TRIAL advance directives to provide Although the proceedings of eugenics as it exists today from is a blurring of public and private prior consent for euthanasia is American and Nazi eugenics of the Doctors’ Trial accomplished roles in eugenics. Rather than practiced in Belgium. The the early to mid-1900s. Con- much in documenting the medical government mandate, social pres- Netherlands allows an active crimes performed under the Third temporary examples of positive sures arguably “encourage” private ending of the life of an infant or eugenics widely discussed among Reich, the Trial did not go as far as eugenic practices. child who is “classified” as having bioethicists include sex selection, it could have done in establishing An example of contemporary no hope of a good quality of genetic screening or testing, and the crucial role that medicine, in negative eugenics is the case of life or no hope of improvement. the more recent controversy over particular the frameworks of eu- the sterilization of female inmates (See the box on this page). “designer babies.” As research on genics and euthanasia, played in in California prisons, performed Despite this contemporary genome editing has developed, Nazi ideology and mass murder. without proper legal permission progression of acts of euthanasia, some foresee a danger in modi- One of our aims in this review is to do so or without appropriate the modern protocols are open fying human DNA and the cre- thus to add to the understanding informed consent procedures.26 and transparent, and publically ation of “genetically modified we now have of the degree of According to the California State reported and debated. None- humans.” A “designer baby” is an participation of physicians in Auditor, 144 female inmates theless, there is evidence of the embryo whose genetic makeup medical crimes and mass murder were sterilized via bilateral tubal slippery slope moving from has been selected or modified during the Third Reich. ligation during the years from competent suicide with physician to eradicate a particular defect In his discussion of the Trial, 2005-2006 to 2012-2013.26 At assistance for adults to the in- or to ensure a particular gene is the historian Michael Marrus has least 39 of those women, about competent, including present.22 This can be argued that the Trial “offered only a quarter of the female inmates the crudest of explanations for sterilized, were sterilized fol- what had occurred and made lowing an improper “informed no links with eugenic thought STATUTES ALLOWING PHYSICIAN INVOLVEMENT IN consent” process, making these and the medical culture of ASSISTED SUICIDE 39 sterilizations illegal.26 The Germany.”29(p118) As Marrus audit also found that medical staff points out, because the Nuremberg The Oregon Death with Dignity Act of 1997 rarely requested approval from trials focused on crimes committed Vermont Act 39 Patient Choice and Control at End of Life of 2016 prison administrators to sterilize against peoples of the nations who The Washington Death with Dignity Act of 2009 inmates, and when they did so, it triumphed over Germany rather was not always clarified that the District of Columbia Death with Dignity Act of 2016 than on the German people, the requests were approved.26 As California End of Life Option Act of 2016 trial gave little attention to the a result of this investigation, a law history of forced sterilization and Colorado End of Life Options Act of 2016 was enacted prohibiting the use the “euthanasia” program within Baxter v Montana, 224 P3d 1211 (Mont 2009) of sterilization as birth control for Germany, programs that involved Carter v Canada, 1 SCR 331 (2015) any inmate under the supervision the widespread participation of of the Department of Correc- Netherlands Termination of Life on Request and Assisted Suicide Act (April 1, 2002) physicians.29 As Marrus writes, tions and Rehabilitation or in Belgian Euthanasia Act of 2002 a county correctional facility in The Trial’s focus on Swiss Civil Code of 1942—legal and not prohibited by the code the state of California.27 Within non-German victims, mainly in this law are specified criteria for the concentration camps, entailed 56 Analytic Essay Peer Reviewed Grodin et al. AJPH January 2018, Vol 108, No. 1  AJPH NUREMBERG TRIAL a downplaying of forcible profession encourages group rights is no more than hollow der NS-”Kindereuthanasie [The Leipzig Case sterilization and “medicalized (Alias Fall “Kindknauer”) and the Planning of obedience to authority and the words. the NS Child Euthanasia]. Münster, Ger- killing”—the victimization of diffusion of responsibility. Phy- many: Klemm & Oelschläger; 2008. several hundred thousand people, CONTRIBUTORS mainly Germans, in which sicians may be particularly vul- All authors contributed research, con- 16. Hohendorf G. The National Socialist physicians were so heavily nerable to these pressures, as they ceptualization, writing, and review. patient murders between taboo and involved.... As a result, the trial argument—is it possible to draw conclusions have a tendency to compart- on the current debate on medical decisions suffered grievously as a chronicle mentalize, justify, and rationalize ACKNOWLEDGMENTS concerning the end of life from the history of the medical crimes of the Third Partial funding was provided by the Project of National Socialist “euthanasia?” In: Reich... and deflected attention problems as a way of coping with on Ethics and the Holocaust at the Elie Bialas W, Lothar F, eds. Nazi Ideology and from the involvement of the what the profession requires. Wiesel Center for Jewish Studies at Boston Ethics. Newcastle upon Tyne, UK: medical profession as a whole in Regardless of whether one finds University. Cambridge Scholars Publishing; 2014. the Nazi enterprise.29(p115) any of these theories of the per- 17. Decentralized euthanasia. Available petrator convincing, there is no REFERENCES at: https://www.t4-denkmal.de/eng/ Most startling, as Marrus 1. Annas GJ, Grodin MA, eds. The Nazi Decentralised-euthanasia. Accessed June denying the vast role that phy- Doctors and the Nuremberg Code. New York, 8, 2017. highlights, is the judges’ response sicians played in shaping and NY: Oxford University Press; 1992. 18. Euthanasia program. US Holocaust to Brandt’s claim, discussed pre- implementing the worst genocide 2. Grodin M. Nazi legacy and bioethics. In: Memorial Museum. Available at: https:// viously, that there was basis in Jennings B, ed. Bioethics. 4th ed. Farmington the world has ever witnessed.5 www.ushmm.org/wlc/en/article.php? precedent and humanitarian rea- Hills, MI: Gale; 2012: 2162–2166. ModuleId=10005200. Accessed June 6, 2017. Seventy years after the Doc- sons for the “euthanasia” killings.29 3. Kater MH. Doctors Under Hitler. Chapel 19. Lerner BH, Caplan AL. Euthanasia in tors’ Trial, we recognize that it is Hill, NC: The University of North Car- Belgium and the Netherlands on a slippery In their verdict the judges stated, the duty of those in the medical olina Press; 2000. slope? JAMA Intern Med. 2015;175(10): profession to discuss the impli- 4. Proctor RJ. Racial Hygiene: Medicine 1640–1641. Whether or not a state may validly Under the Nazis. Cambridge, MA: Harvard cations of the Trial and its lessons 20. Rachels J, Jonsen AJ, Jecker NS. enact legislation which imposes University Press; 1988. Active and passive euthanasia. In: Jecker euthanasia upon certain classes of for today. We have offered this NS, Jonsen AS, Pearlman RA, eds. Bio- 5. Grodin MA. Mad, bad, or evil: how its citizens is a question which preliminary discussion of exam- ethics: An Introduction to the History, physician healers turn to torture and murder. does not enter into the issues. ples of contemporary parallels in In: Rubenfeld S, ed. Medicine After the Ho- Methods, and Practice. Sudbury, MA: Jones Assuming that it may do so, the locaust: From the Master Race to the Human and Bartlett; 2007: 64–69. Family of Nations is not obligated pursuit of this goal, but much Genome and Beyond. New York, NY: Pal- 21. Jotkowitz A, Glick S, Gesundheit BA. to give recognition to such work remains. As we have made grave Macmillan; 2010: 51–55. Case against justified non-voluntary active legislation when it manifestly gives clear, although some aspects of 6. Whitman JQ. Hitler’s American Model: euthanasia (The Groningen Protocol). Am legality to plain murder and torture The United States and the Making of Nazi J Bioeth. 2008;8(11):23–26. the contemporary cases are of defenseless and powerless human Race Law. Princeton, NJ: Princeton 22. Lander ES. Brave new genome. N Engl troubling, we must be careful not beings of other nations.30(p11 395) University Press; 2017. J Med. 2015;373(1):5–8. to conflate instances of contem- 7. Kevles D. In the Name of Eugenics. 23. Lanphier E, Urnov F, Haecker SE, These words ought to give us porary eugenics and euthanasia Berkeley and Los Angeles, CA: University Werner M, Smolenski J. Don’t edit pause as we consider medical and with Nazi eugenics and “eutha- of California Press; 1985. the human germ line. Nature. 2015; 8. Buck v. Bell, 274 US 300 (1927). 519(7544):410–411. legal defenses of cases of contem- nasia.” The misuse of the Nazi 9. Seidelman W. Academic medicine during 24. Baltimore D, Berg P, Botchan M, et al. porary eugenics and euthanasia. analogy is not only offensive and A prudent path forward for genomic the Nazi Period. In: Rubenfeld S, ed. Medicine One of the most troubling irresponsible, but it can also pre- After the Holocaust: From the Master Race to the engineering and germline gene modifi- vent a clear and important un- cation. Science. 2015;348(6230):36–38. unanswered questions about the Human Genome and Beyond. New York, NY: derstanding of current cases we Palgrave Macmillan; 2010: 29–36. 25. Doudna JA. A Crack in Creation: Gene Third Reich is how it was pos- 10. Weindling P. Health, Race, of German Editing and the Unthinkable Power to Control sible that physicians could have so need to examine. Evolution. Boston, MA: Houghton Mifflin Politics Between National Unification and willingly participated in mass The 70th anniversary of the Nazism, 1870–1945. Cambridge, UK: Harcourt; 2017. murder. Were physicians true Nuremberg Doctors’ Trial re- Cambridge University Press; 1989. 26. Howle EM. Sterilization of Female believers in Nazi racial ideology minds us of the great atrocities 11. Friedlander S. Nazi Germany and the Inmates. Sacramento, CA: State of Cal- Jews: The Years of Persecution. New York, ifornia. 2014: 1–43. or instead were they willing and that physicians can inflict when NY: Harper Collins; 1997. 27. Cal Penal Code §3440 (2014; enacted). enthusiastic opportunists, who, medical ethics is distorted by the 12. Lifton RJ. The Nazi Doctors: Medical 28. Stern AM, Novak NL, Lira N, like Germans in many other ideology of a totalitarian State. It Killing and the Psychology of Genocide. New O’Connor K, Harlow S, Kardia S. Cal- professions, joined the Nazi Party is our obligation to study how York, NY: Basic Books; 1986. ifornia’s sterilization survivors: an estimate for the purposes of career ad- and why physicians dedicated to 13. Faulstich H. Die zahl der “euthanasie”- and call for redress. Am J Public Health. opfer [The number of euthanasia]. In: Frewer A, 2017;107(1):50–54. vancement? In dealing with this health and healing can turn to Eickoff C, eds. Die Historischen Hintergründe 29. Marrus MR. The Nuremberg Doc- problem, it could be argued that torture and murder in the “ser- Medizinischer Ethik [The Historical Background tors’ Trial in historical context. Bull Hist the medical profession itself in- vice” of their country. Reflection of Medical Ethics]. Frankfurt, Germany: Med. 1999;73(1):106–123. cludes elements of dehumanization on the Doctors’ Trial reminds us Campus-Verlag; 2000: 218–229. 30. Trials of War Criminals Before the and numbing, as means of coping that physicians have a special 14. Binding K, Hoche A. Permitting the Nuremberg Military Tribunals Under destruction of unworthy life: its extent and Control Council Law No. 10, Nurem- with the suffering of patients. obligation to use their power to form. Issues Law Med. 1992;8(2):231–265. berg, October 1946–April 1949, 15 vols. Alternatively, it could be asked protect human rights and that 15. Benzenhoefer U. Der Fall Leipzig Washington, DC: US Government whether the modern medical medical ethics devoid of human (Alias Fall “Kind Knauer”) und die Planung Printing Office; 1949;2:198. January 2018, Vol 108, No. 1 AJPH Grodin et al. Peer Reviewed Analytic Essay 57