April 18, 2002
Physician, Heal The Soul
Physicians played a significant role in the Holocaust, and today's doctors can learn from the ethical failures of that period, according to an article recently published by Dr. Joel Geiderman, co-chair of the emergency department (ED) of Cedars-Sinai Medical Center.
"I've always taken an interest in the Holocaust and its lasting effects, because my mother was a survivor," Geiderman said. With 23 years of emergency medicine at Cedars-Sinai under his belt, he has always taken an interest in the philosophies of bioethics but became "passionately" involved five or six years ago. Now, he serves on the ethics committees of Cedars-Sinai and the Academy of Emergency Medicine. "Most of us know about the medical experiments, the doctors in the camps," he said, "but as I started reading about this, about the history, I was blown away."
In "Physician Complicity in the Holocaust: Historical Review and Reflections on Emergency Medicine in the 21st Century," Geiderman sets out a series of moral failures he attributes to German physicians before, during and after WWII. Published in the March issue of Academic Emergency Medicine journal, the two-part article enumerates ethical challenges requiring greater vigilance from today's physicians.
"So much of the Holocaust is unexplainable. But when you start to break it down, step by step, it starts to make sense in a perverse way," Geiderman said. "So much of what doctors contributed to the horror came out of economic opportunism, greed and convenience."
The first part of the article traces the German medical establishment's slippery slope, from being healers toward full participants in genocide. Starting long before Hitler came to power, Geiderman shows how German doctors embraced the false science of eugenics, or "racial hygiene." This made it easier to accept, with the rise of National Socialism, the exclusion of Jewish physicians from the practice of medicine (which also advanced many non-Jewish doctors' careers).
When the Nazis passed the Sterilization Act, doctors not only participated in designing the program to forcibly sterilize the "genetically diseased," they exceeded the government's goals for implementation. Throughout the regime, ordinary physicians acted as instruments of racist Nazi policies; doctors became murderers, and later made efforts to hide the truth about their activities.
In Part Two of his "Physician Complicity" article, Geiderman examines the ethical challenges faced by his colleagues in emergency medicine today. He worries about doctors being asked to serve as agents of the state, as with mandatory reporting laws for patients whose injuries might be caused by foul play or infectious disease. He considers the denial of modesty to patients when "reality television" films in an emergency room. He considers the various ways in which patients are dehumanized by their doctors, who may refer to them by room number, by their ailment or even by nasty nicknames. Economic pressures affecting the practice of medicine and technology that allows for genetic screening, testing and even genetic engineering also pass through Geiderman's bioethical radar.
"These are not Holocaust analogies," he says of Part Two, adding that in the article, "I took a neutral stance on physician-assisted suicide. Personally, I'm against it. But I don't think it's useful to play the so-called Holocaust card in these debates."
The doctor compares his research and writings to reflection on the Holocaust in other fields. "In 'Au Revoir les Enfants,' the French director Louis Malle described the Holocaust through his childhood eyes in a French monastery ... while others responded by building new lives or even a new nation. For me, as an emergency physician who has spent 25 years in an ED, dedicated my most recent years to the study of bioethics, and who is the son of a survivor, Part Two is the natural expression of my feelings or philosophy."
It is a decidedly practical sort of philosophy for a doctor of emergency medicine to study. "What's become really clear to a lot of us who advocate bioethics is that you have to have considered these issues in advance," Geiderman says. "In emergency medicine, there's not always a lot of time to call in an ethical consult." He views the product of his historical and ethical research as timeless. "Unlike hard science, where the science will change, this will never change."
Though his research relies on previously published materials, and his description of physician complicity in the Holocaust is carefully documented, Geiderman says some peer reviews of his work came back with incredulous comments -- doctors who could not believe such events could have happened. He writes: "The keys to preventing such a recurrence lie in understanding and teaching the lessons of the past; in speaking, teaching and writing about ethics; in incorporating ethical principles and professionalism into our medical practices, and in being willing to stand up and make personal sacrifices for the ethical principles in which we believe."
And, as he says, "Certain things need to be learned over and over again."
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