Ethicists vital to avoid repeating horrors of past*

I recently visited an exhibition entitled Deadly Medicine in New York. It is about eugenics.  It disabuses the viewer of all delusions about the past moral purity and ethical rectitude of both medicine and public health. It is about our professions’ misguided involvement in the eugenic movement in the 1930s. Little by little it slipped and slid from banal rhetoric about preserving genetic purity to the enormity of Auschwitz-Birchenau. And the medical and public health professions were deeply, deeply complicit.

Excavating the foundations in 1966 for the twin towers of the World Trade Center, produced nearly 1m cubic metres of landfill. It was dumped into the nearby waters of the Hudson to extend the southern tip of Manhattan to form Battery Park City.  The New York Museum of Jewish Heritage was built on the site, a 26 metre-tall granite hexagon representing the six million Jews lost in the Holocaust and the six points of the Star of David.  Now, within sight of the waterfall memorials to the lost of 9/11, it shares an emotional bond with its sinister madness. It is heavy with grief and shock.

It is in this darkly serious place that Deadly Medicine, an educational exhibit from Washington DC, is displayed.  A late winter afternoon is probably not the psychological moment to see such an exhibit. 

Eugenics was a concept that received international endorsement from the scientific community in the early part of the 20^th century.  The eugenics movement in Germany, with which the exhibit is principally concerned, began with sterilization of feeble minded men and women out of concern that racial purity was at risk if they reproduced.  The nation felt the immense loss of healthy young men in World War I. ‘Eugenics advocates in Germany,’ reads the exhibition brochure, ‘included physicians, public health officials, and academics in the biomedical fields, on the political left and right.’

Eugenics were absorbed into the Nazi ideology and enshrined in German law by 1935.  World War II led many who had opposed eugenic euthanasia to now endorse it ‘for the good of the Fatherland’.  The killing of children was expanded to adults in 1939 and ‘patients in private, state and church-run institutions’ were especially vulnerable.  From January 1940 to August 1941 70,000 such people were killed using carbon monoxide in gas chambers ‘disguised as showers’.

Paediatricians helped sort children with rickets or developmental problems into those who should be euthanased.  Few of the doctors suffered as a result of their involvement in the eugenics program and the relation between Hitler and organized medicine was strong.  One psychiatrist was tried for war crimes and executed.  Paediatricians, psychiatrists, physicians and others who participated in the death panels went from strength to strength.  Eugenic theoreticians, with their statistical data and scientific notions of genetics and natural selection who subscribed to the prevailing Darwinian orthodoxy, prospered once the war was over. Pathological specimens taken from the dead were studied for years beyond the end of World War II. Business as usual.  

Medical people helped with the gas chambers, initially reserved for those who had an infirmity or deformity.  The slide into their use as a means of exterminating millions of Jews occurred slowly and methodically, often with medical advice.  Heinrich Himmler saw them as a less traumatic way of ridding the world of Jews because his SS troops were disturbed by having to shoot over 1 million Jews in the open air as part of the Russian campaign.  Then followed the mass extermination of Jews using the Zyklon-fed gas chambers.  Nazi doctors helped selected the fittest subjects for labour rather than immediate death.

We have elaborate checks and balances to maintain the ethical standards for research in Australia.  Ethics committees are frequently pilloried because they impede (so it is said) the progress of science with their picky questions.  But we have no countervailing institution to keep medicine and public health practice on an even keel. 

The message of history suggests that we need to take this more seriously than we do.  It is not the bold leap into ethical error that we need to fear.  It is the slow shift, especially as the professions seek to curry favour with the power brokers in society – politicians, drug companies, the health bureaucracies to name three groups.  Grade report?  We could do a lot better – and should.  We must never forget.

*Printed in the Australian Doctor on 3 February 2012