At the Doctors Trial in Nuremberg, Germany, which ended 65 years ago, 20 physicians and 3 nonphysician Nazi officials were charged with involvement in war crimes and crimes against humanity, including medical experiments conducted on prisoners and others without consent and sterilizing or “euthanizing” those the Nazis deemed “genetically inferior.”
This month marks the anniversary of the conclusion of a 140 day trial that gripped the world 65 years ago, the Doctors Trial in Nuremberg, Germany. On trial were 20 physicians and 3 nonphysician Nazi officials who were charged with organizing and participating in war crimes and crimes against humanity, including medical experiments and procedures conducted on concentration camp prisoners and others without their consent.
Of the 20 physicians on trial, 16 were found guilty, 4 of whom were executed for their crimes. The accounts of these crimes are horrific. One series of medical experiments at Dachau, for example, involved placing prisoners in chambers to simulate the effects of exposure to extremely high altitudes and caused severe injury, including death. In addition to experimentation, German physicians participated in the so-called euthanasia program, which involved the killing of intellectually challenged, mentally ill, or physically challenged individuals in Germany and Germanannexed territories.
But the extent of the involvement of German physicians went well beyond the 20 physicians tried in the Doctors Trial—a fact finally acknowledged by the German Medical Association a few months ago. In a long-awaited and striking statement, the society used the occasion of its 115th meeting, fittingly held in Nuremberg in late May, to adopt the Nuremberg Declaration of the German Medical Assembly 2012, which said, “We acknowledge the substantial responsibility of doctors for the medical crimes committed under the Nazi regime and regard these events as a warning for the present and the future.”
Although only a few names, such as Josef Mengele, are widely associated with medical atrocities during the war, the German medical establishment at large was broadly involved with carrying out Nazi ideology. “In contrast to still widely accepted views, the initiative for the most serious human rights violations did not originate from the political authorities at the time, but rather from physicians themselves,” the declaration said. Those harmed in medical experiments and the so-called euthanasia program included Jewish and other ethnic groups, including Sinti and Roma; among nationalities, those most affected included Poles, Yugoslavs, Hungarians, and Germans, said Paul Weindling, MA, MSc, PhD, of Oxford Brookes University, in the United Kingdom.
“Until the 1990s the Nazi experiments were generally viewed as pseudoscience, but research has uncovered numerous links to leading researchers, clinicians, research institutes, and funding agencies. My recent research has identified over 24 000 individual victims, most by name,” said Weindling, who helped draft the declaration and inserted a mention of the experiments into the document.
When the Nazi party assumed power in Germany in 1933, the head of the German Medical Association, Dr Alfons Stauber, wrote to Hitler that the association “welcome[s] with greatest joy the determination of the Reich government… with the promise faithfully to fulfill our duty as servants of the people’s health.” Nazi doctrine called for physicians to shift “from the doctor of the individual to the doctor of the nation.” Because of their emphasis on national health, the Nazis held physicians in high regard. And from the physicians’ perspectives, there were considerable economic incentives to embrace the Reich. In an era with high physician unemployment, physicians saw a key role for themselves in the new government and joined the Nazi party at a higher rate than any other profession.
They were rewarded with jobs when the Nazis disallowed Jewish people to practice medicine. All medical practice in Germany was organized to fall under the financial and political control of the Nazi government. The Nuremberg Doctors Trial revealed that organized medicine, medical schools, and scores of ordinary physicians participated in unethical human experimentation and genocide. However, despite its key involvement during the Nazi era, the German Medical Association has never acknowledged its role or the role ofGerman physicians in World War II atrocities—until now.
“The crimes were simply not the acts of individual doctors, but rather took place with the substantial involvement of leading representatives of the medical association and medical specialist bodies, as well as with the considerable participation of eminent representatives of university medicine and renowned biomedical research facilities,” the group said in the declaration. “We acknowledge the substantial responsibility of doctors for the medical crimes committed under the Nazi regime and regard these events as a warning for the present and the future.”
One of the legacies of the Doctors Trial is the Nuremberg Code, which defines core principles for rights of participants in medical research, such as voluntary consent and the absence of coercion (http://tinyurl.com/794hahy ).
During the trial, attorneys for the defense had argued that their experiments were not unlike previous studies by researchers in the United States, France, Great Britain, and other countries.
Concerns raised during the trial led to the development of the code, described by the United States Holocaust Memorial Museum as “a landmark document on medical ethics” (http://tinyurl.com/7fdsjql ).
The German Medical Association’s declaration acknowledged that the “human rights violations perpetrated in the name of medicine under the Nazi regime continue to have repercussions to this day and raise questions concerning the way in which physicians perceive themselves, their professional behavior, and medical ethics.” Of the many lessons to be learned from distortions of medical practice that occurred during the Nazi era, among the most important is understanding the human motivations that led physicians to subordinate the needs of individual patients to the demands of the government. “The German physicians believed they were behaving morally and following the dictates of the Hippocratic Oath by transforming the doctorpatient relationship into a new relationship in which the state became the doctor and the German people became the ‘patient,’ or the volk,” said Sheldon Rubenfeld, MD, clinical professor of medicine at Baylor College of Medicine and president of the Center for Medicine After the Holocaust, in Houston, in an e-mail. Thus, by this reasoning, German physicians rationalized eugenic sterilization, euthanasia, and, ultimately, elimination of Jewish, black, homosexual, Roma, and other “genetically inferior” individuals as treatment of their “patient,” the volk, said Rubenfeld.
Another rationale for their actions resonated among the public. “The economic advantages of eliminating expensive utilizers of health care resources were also widely touted and readily accepted by a receptive citizenry during a worldwide depression,” he said.
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