A few aspects of medical deontology in Nazi German concentration camps

One of the principles in Nazi concentration camps was that prisoners were to be exploited to implement some of the objectives of the SS program related to camp administration, labor and the eradication of undesirable groups and individuals, with just a relatively small staff.

It might be asked what made a prisoner accept a functionary’s job or tolerate the exploitation of his professional skills.

From the very outset, in accordance with SS objectives, functionaries’ jobs in concentration camps were meant to be held by criminal prisoners. No attention was paid to their professional qualifications to perform the duties of the given office. The underlying principle was to break the morale of political prisoners¹ by subordinating them to criminal individuals. The actual value of the work performed was of secondary importance. It wasn’t until later, when the camp began to expand and the administrative challenges intensified, that the exacerbation of the economic situation in Germany made it necessary to pay greater attention to labor efficiency.

On the other hand, the number of political prisoners was steadily rising, so much so that they began to constitute the absolute majority in the camp. For obvious reasons, they wanted to break free from the direct regime of the criminal prisoners, and the main means to achieve that goal was to take over functionaries’ jobs.

This kind of aspiration was connected with the risks involved in playing a double game, since the political prisoner would then have to carry out the orders of the SS, which was strictly controlled; at the same time he wanted to stay faithful to the ethical standards and help his colleagues whenever possible.

An individual taking up a functionary’s job had to give up the passive attitude, which did not generate moral conflicts as such, but it did not benefit the prisoners’ community in any way, either.

A functionary prisoner’s job usually gave better living conditions, increasing the individual’s chances of survival, which was his main motive to apply for the position. Moreover, such a job offered its holder a way of protecting himself against the deindividuation the camp produced, and the overwhelming sense of being “just a number,” as it gave him a chance to utilize his professional skills. For some individuals, it was even a way to satisfy their ambitions and craving for power.

Everything a functionary prisoner did was under constant fire from two antagonistic groups, the prisoners and the camp authorities. A political prisoner holding a functionary’s job decided to perform the orders of the SS in a way which did as little harm as possible to the prisoners’ community. Oftentimes the task was extremely difficult, since the orders of the SS were clear‑cut and their ultimate aim was the annihilation of prisoners. So the functionary prisoner’s procedure boiled down to choosing the lesser evil, deceiving the SS and buffering the commands he received.

The battle for “red self-governance”²—political prisoners having the predominant say in the general community of prisoners—did save a small number of political prisoners’ lives.

The situation of a political prisoner who was a doctor had its own professional specificity.

The SS tended to staff the so‑called “camp hospitals” with highly unprofessional individuals, many of them criminals.

The prisoner doctor would face situations requiring his professional intervention virtually all the time. If he stayed outside the camp hospital, he would not be able to administer even the humblest medical aid to his sick colleagues. Moreover, the camp hospital manned by the SS with non‑specialist prisoners—the so‑called Pflegers [German “nurses”]—did not fulfill its curative role.

Thus, it was only natural for prisoner doctors to try to get into the hospital and have the opportunity to administer professional aid to their fellow prisoners, at the same time getting a chance to improve their own living conditions (working indoors in their own profession, a white‑collar job, better food rations). Nevertheless, it gave rise to a number of ethical dilemmas, since a doctor working in the camp hospital was a subordinate of the SS doctors.

The SS doctors wanted to have severely ill prisoners die as soon as possible; they performed unethical experiments on patients and were working on methods to procure genocide—in short, their work was part of the overriding Nazi German agenda of eradication.

The bounds to what a prisoner doctor could do were set by the orders he got from the SS physicians and orderlies who supervised his work. He was also limited by the conditions in the camp hospital, which were not at all what a hospital should be like; and by a struggle against the criminals appointed to functionary jobs in the hospital, many of them in positions of authority. Prisoner doctors were morally responsible for the lives and future of sick fellow prisoners. So the tasks facing a prisoner doctor could not but stray from the principles of medical deontology that hold in normal conditions.

Situations of this sort happen in unusual conditions, e.g. on the front line, during disasters, epidemics, etc., when the individual is forced to choose between the devil and the deep blue sea. Any assessment of someone’s conduct in such a situation done in retrospect should consider even the smallest details, the specificity of his plight and, most of all, his intentions. The doctor’s deontology in a Nazi German concentration camp is currently a subject of hot discussion and debate in communities of medical professionals and legal practitioners, since the actions of a prisoner doctor may arouse many doubts and reservations in light of moral standards valid in “normal” life.

The main moral dilemmas resulted from conflicts of interest between the SS doctors and prisoner doctors. As I have already said, the aim of the former was destruction, whereas the latter wanted to save the lives of patients. However, outright and ill‑considered opposition to the SS will would have brought consequences not only for the doctor, but also for his patients and prejudice the interests of the whole hospital, which could then be handed back to the criminal prisoners.

Another source of moral conflict were the difficult conditions preventing the proper administration of aid to patients.

Nevertheless, there were certain barriers in this “concentration camp deontology,” which could never be crossed, e.g. when a prisoner doctor was told to participate in administering phenol injections (“jabs”), selecting patients for the gas chambers, or conducting criminal experiments. There was a tendency for SS doctors to issue orders which tried to get prisoner doctors directly involved in criminal activities. A prisoner doctor in such a situation had to use all his “diplomatic” dexterity to dodge such commands. Such situations occurred, for instance, when an SS doctor wanted to give a prisoner the right to select patients for the gas chamber or for a phenol injection.

An outline of the “medical camp deontology” emerged somewhat spontaneously. It is important to remark that usually all the prisoner doctors of different nationalities, ages and political views were unanimous on the basic principles governing their conduct in the camp. The same rules were acknowledged by all the political prisoners, even though not all of them worked in the camp hospital and perhaps were not so familiar with the conditions there. These principles could be summed up in the following way:

1. No doctor or hospital worker could take part in killing prisoners. However, indirect yet compulsory participation in crimes such as bringing out patients to vehicles to transport them to the gas chambers, escorting patients to the room where phenol injections were administered, keeping registers of patients sentenced to death, bringing out the corpses, etc., was not considered against professional ethics. Every hospital worker was obliged to deceive the SS authorities in order to save patients whenever possible, even to the point of risking his own life.
2. If a doctor could not provide treatment for all of his patients, the generally applicable principle was to save young lives in the first place, as young inmates had the biggest chance of survival, as well as the lives of those who were generally recognized for their achievements and attitudes, either in the camp or prior to their imprisonment. The shortage of medicine forced doctors to be discriminative in dispensing aid. If 100 patients were suffering from diarrhea and the doctors only had 10 tablets of medicinal carbon or Tannalbin³ at their disposal and 5 light diet rations to distribute, making distinctions was unavoidable. Also, when a doctor had to perform an order to discharge a certain number of not fully cured patients, he was forced to make a choice.
3. The diagnoses of patients suffering from tuberculosis, epidemic typhus, or other infectious diseases were never disclosed, even to the detriment of other patients, in order to save their lives.⁴
4. It was considered against this moral code for prisoner doctors to join in the criminal medical experiments performed by the SS, and even if they were forced to participate, they were expected to do all they could to reduce the harm to patients as much as possible, and curtail any advantages the SS doctors might have drawn from such procedures, e.g. by falsifying test results.

Obviously, these general principles did not give prisoner doctors foolproof protection against serious moral conflict, e.g. if a doctor wanted to keep his relative or friend in hospital and to give them better conditions, but under the “rules” the relative or friend did not qualify for it.

Members of the hospital staff who did not keep to the “rules” were given a warning, reprimanded, or ostracized by the entire community of prisoners.

The moral evaluation of a prisoner doctor’s deeds should consider even the smallest details and circumstances in order to shed light on his chances and freedom to make a choice between the right or wrong path in a given situation.

It seems that in specific situations a social group creates its own “ethical” standards adjusted to the unusual conditions, but not considered to be in breach of the basic moral values.

The aim of this outline of the general principles of the medical deontology observed in the concentration camps was to stimulate discussion on the subject.

Translated from original article: Stanisław Kłodziński, Niektóre zagadnienia deontologii lekarskiej w hitlerowskich obozach koncentracyjnych. Przegląd Lekarski – Oświęcim, 1963.

Notes

1. Most of the “political prisoners” in Nazi German concentration camps were Poles (translator’s note).
2. A reference to the red triangular badges political prisoners wore on their concentration camp gear (translator’s note).
3. German brand name for an albumin tannate antidiarrheal (website editor’s note).
4. If an SS physician learned that a patient had TB or another infectious disease, he would select the prisoner for the gas chamber or phenol injection (translator’s note).