Doctors were complicit in Holocaust atrocities. Current and future health care workers need to know that

The liberation of the concentration camp at Auschwitz on Jan. 27, 1945, revealed many horrors. Among them were the atrocities perpetrated by doctors who took ethics very seriously, albeit with an unusual code of ethics with the State as the “patient.”

When SS physician Fritz Klein was asked by a prisoner-physician how he reconciled his actions in concentration camps with his ethical obligations as a physician, he answered, “Out of respect for human life, I would remove a purulent appendix from a diseased body. The Jews are the purulent appendix in the body of Europe.”

These weren’t just a few “bad apples,” however, who knowingly harmed thousands of people in Auschwitz and other death camps. To understand what happened, and how it happened, it’s important to look at the entire tree from which the apples came:  medicine, public health, and biomedical research in Nazi Germany involving doctors, nurses, midwives, and many others, and encompassing disciplines such as psychiatry, neurology, neuropathology, anatomy and physiology, infectious diseases, surgery, genetics and twin research, and beyond.

Physicians voluntarily joined the Nazi party and, without any pressure, took part in forced sterilization in hospitals between 1933 and 1939, in forced human experiments at Auschwitz and other camps, and in programs to kill individuals diagnosed as “unworthy of life,” including people with mental illness and developmental disabilities. These programs were implemented in collaboration with nurses and midwives.

Some of the physicians and technical staff of the Aktion T4 forced “euthanasia” program then willingly lent their murderous technical expertise to the establishment of gas chambers in the extermination camps.

Medical and other scientists used their unfettered access to people in concentration camps to study things like the physiological impact of high altitude, freezing temperatures, and drinking seawater, of typhus and infectious jaundice, and to develop practical means of sterilization, maiming, and killing thousands of their “subjects” with extreme cruelty.

Although Josef Mengele, also known as the Angel of Death, was the best known of these morally corrupt physicians, he was certainly not alone. Many of them continued in their academic and clinical work after the war, in Germany and abroad; some were invited to come to the United States to continue their research. They did so supported by a pervasive silence about this history.

This gruesome episode in world history and human life continues to raise a deeply disturbing question: How could healers have become complicit in mass murder?

We believe that all health care workers, from doctors and nurses and midwives to radiation technologists, respiratory therapists, and others need to know this history and systematically reflect on its meaning in light of current health and other societal crises now underway: disparities in the Covid-19 pandemic fed by racism; political divisions and right-wing extremism that pose an immediate threat to democracies around the world; the new rising tide of antisemitism; the existence and continued risk of mass atrocities around the globe which create significant public and mental health issues; and more.

Health care practitioners need to be aware that the vulnerabilities and temptations in their profession that existed in Nazi Germany are still present today. At the same time, they should be aware of the health professionals in ghettos and camps who exhibited moral courage and resistance under oppression. These can serve as inspiration in health systems with their rapidly evolving technologies and economic pressures. They may also serve as inspiration for fundamental health care systems changes based on the recognition of the shared humanity of health professionals and patients.

Reflecting on this dark history of medicine and the Holocaust, as well as on examples of moral courage, can support the orientation of health care workers’ moral compasses. Health care trainees and professionals face “echoes” of this history when confronted with ubiquitous ethical dilemmas in medicine. As one health care trainee wrote upon learning this history, “Realizing our connection with the past is crucial…It is especially important not to dismiss the physicians who were compliant with the Holocaust as simply evil monsters. We all have the potential to do good or to do bad, and we have to be critically aware of this.” History can inform.

Learning the history of medicine during the Holocaust should become part of the toolkit of health care professionals as a guide to ethical vigilance and needs to be included in curricula. When the doctor in the white coat or the nurse in blue scrubs approaches you in your hospital bed, it is not enough that they bring a stethoscope, technical skills, and knowledge. They must bring humanity, moral character, and agency.

Every health care organization must be structured around a culture of moral leadership with adherence to core values that acknowledge universal human rights, including the right to health; the fight against social inequalities and racism that affect access to health care and education; and maintaining high professional and ethical standards in caring for patients and conducting biomedical research. Understanding the role medicine played during the Nazi period and especially in the Holocaust can inform these core values.

Trust in medicine is a precious and fragile resource that we simply cannot afford to lose, as the pandemic has cruelly shown us. When 8-year-old Irene Izme was liberated from Auschwitz, she said, “I hate doctors.” She had been deported to the camp as Renate Guttmann with her twin brother, René, and they were selected by Mengele for his inhumane and unethical research on twins. She never trusted another physician in her life.

Her story, and the stories of countless other people harmed or killed by unethical medical professionals, must not be forgotten, and instead must serve as a moral compass. We need to work for trust by learning from what all humans, including doctors, are capable of, and being aware of how this history still informs the trust that is so critical to the doctor-patient relationship today. Studying this history can help us remember and furthermore be inspired in our society to renew our dedication to truth and humanity in science in the decisions we make and the actions we take.

Hedy S. Wald is a clinical professor of family medicine at Alpert Medical School of Brown University in Providence, Rhode Island. Herwig Czech is a professor of history of medicine at the Medical University of Vienna, Austria. Shmuel P. Reis is a professor of medical education at Hebrew University/Hadassah Faculty of Medicine in Jerusalem. The authors are members of The Lancet Commission on Medicine and the Holocaust. They thank Sabine Hildebrandt, associate professor of pediatrics at Boston Children’s Hospital and Harvard Medical School, and Volker Roelcke, professor of the history of medicine at Giessen University in Germany, for their significant contributions to the essay.