November 29, 2021

Where did Nazi doctors learn their ethics? From a textbook

There was no lack of ethical training in the Nazi era

Karl Brandt, one of the defendants in the “doctors’ trial”   

German medicine under Hitler resulted in so many horrors – eugenics, human experimentation, forced sterilization, involuntary euthanasia, mass murder – that there is a temptation to say that “Nazi doctors had no ethics”.

However, according to an article in the Annals of Internal Medicine by Florian Bruns and Tessa Chelouche (from Germany and Israel respectively), this was not the case at all. In fact, medical ethics was an important part of the medical curriculum between 1939 and 1945. Nazi officials established lectureships in every medical school in Germany for a subject called “Medical Law and Professional Studies” (MLPS).

There was no lack of ethics. It was just the wrong kind of ethics.

The focus of their study is a Rudolf Ramm, a German general practitioner who became the pre-eminent purveyor of Nazi medical ethics. He was editor-in-chief of the journal of the German Medical Association, Deutsches Ärzteblatt, and published a textbook, Ärztliche Rechts- Standeskunde (Medical Law and Health). The textbook sold out within a year. Ramm did not survive to be a defendant in the famous “doctors trial” in 1947. He was tried and shot by the Soviets in August 1945. His book was banned a few months later.

What did medical students learn during the Nazi era? According to Bruns and Chelouche, it was “the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual’s obligation to stay healthy, and the priority of public health over individual-patient care”.

Ramm taught his students that:

Nazism brought the “reinstatement of a high level of professional ethics.” He welcomed the fact that “the profession had been extensively cleansed of politically unreliable elements foreign to our race” (that is, German-Jewish physicians).

Ramm saw 3 distinct dangers facing the German people: “racial miscegenation,” a declining birthrate, and the “growth of inferior elements” in the German population. He traced the origins of these perceived dangers to a “disregard for the laws of nature,” caused by church dogma and socialist ideologies. Ramm denounced any form of health care for “hereditarily inferior” people and asserted that every person in Nazi Germany had a moral duty to stay healthy.

After this brief survey, Bruns and Chelouche argue that today’s doctors must resist the temptation to believe that they are much more ethical than “the bad old days”. A commitment to ethics can wax and wane. In fact, in the Weimar Republic, the ethical standards for human experimentation were “remarkably advanced”. The Nazis did not even bother to repeal them, but simply redefined the subject of experimentation to exclude concentration camp inmates. They conclude by warning that:

It is important to realize that ethical reasoning can be corrupted and that teaching ethics is, in itself, no guarantee of the moral integrity of physicians. The history of bioethics reveals that the professional ethos of physicians is more fragile than we might believe because it depends on the moral zeitgeist and politico-social circumstances, both of which are subject to change …

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