Review of the Polish edition of Bioethics and the Holocaust. Case studies (en)

Recenzja polskiego wydania książki Bioetyka i Holokaust. Studia przypadków
Jakub Pawlikowski, MD, MA, PhD, JD

During the trial of Adolf Eichmann, one of the chief organisers of “the Final Solution to the Jewish Question,” the German defence attorney shocked the jury and the observers by claiming that “the collection of skeletons, sterilizations, killings by gas” were “medical matters” because they were “prepared by physicians; it was a matter of killing, and killing, too, is a medical matter.” (Arendt, H., 1964. Eichmann in Jerusalem. A Report on the Banality of Evil). That statement revealed how radically the understanding of the role of medicine shifted in many minds in the period preceding and during the Second World War. At that time medicine became an element of an oppressive social policy, while the medical knowledge and skills were cut off from their essence—a patient’s good. The medicine’s internal purposes—protection of life and health, and alleviating pain—were replaced by those set by political leaders or social revolutionists. A great number of medical professionals were transformed into means to achieve the ideological ends. Conscience was replaced by obedience to orders, and natural law by the positive law.

Many times in history medical skills and knowledge were treated instrumentally to achieve ideological aims set in contradiction of the good of human beings. It was a surgeon, Joseph Ignace Guillotine, who came up with the eponymous guillotine during the French revolution, and another doctor, Antoine Louis, was the one who authored its fine details. At the time of another revolution in the Soviet Russia Lenin’s decision guaranteed a wide availability of abortion, which has since become one of physicians’ standard duties. Eugenic ideas made way for the forced sterilisation in the early twentieth-century US and Sweden. “Medical killing” in Nazi Germany started well before WW2, when the terminally ill were offered “mercy killing,” viz. euthanasia. Such “medical innovations” were sometimes to serve high-minded goals (making the capital punishment more humanitarian, painless death, increasing the quality of life, or “healing the society”), however it is hardly possible to deny that all of them were entangled in evil ideological structures and turned against humanity. More often than not they were based on the subjective assessments on the value of human life, entrenched in utilitarian assumptions, contradictory to the values of dignity and equality of every human being. It was forgotten that “To everyone their life is one hundred percent of life” (Krall, H., To Outwit God).

This book by Tessa Chelouche and Geoffrey Brahmer makes an important contribution into the understanding of the involvement of the German and Austrian medicine in the Nazi ideology. It shows also examples of those who were faithful to the medical ethos in spite of the cruel conditions and circumstances. The authors analyse a number of moral questions which are as pressing now as they were back then: the fidelity to conscience in the light of unfair laws, the limitations placed on medical confidentiality, truthfulness, and documentation in the context of care for a patient’s life and health, the conflicting loyalties to the political authority, law, and professional ethics. With a greater distance provided by looking into the past it is easier to discern the substantial from the transient and to see the proper hierarchy of moral norms and values. The crucial bioethical and legal documents in Polish translation serve as a valuable supplement to the book.

What caused the involvement of so many German physicians, the world’s medical elite at the time, in the Nazi ideology is a question that has not been adequately answered for several decades. It is certain that the erosion of the ethical consciousness had started earlier and manifested itself in the deletion of the references to conscience in the medical oath in the 19th-century Prussia, which were replaced by obligations to the laws of the country. Philosophical idealism, increased industrial collectivism and the cult of power, law, and progress, alongside with the rejection of traditional religions and their moral requirements facilitated judgemental subjectivism, favoured collectivity over individuality, and advanced inequalities as well as competition unrestricted by any moral norms whatsoever. Still, why so many 20th-century medical luminaries willingly used their skill and knowledge to eliminate the ill, weak, and racially undesirable? Was it the German post-First World War trauma? Or the power of attraction of the Nazi ideology and its foundation in biological criteria? Excessive faith in scientific progress combined with the idea of “the Death of God” which made it easier to favour the findings of criminal experiments over human dignity, and to transform the evolutionary category of “the survival of the fittest” into the extermination of “the less fit”? Was it a temptation of power? Frustration in the face of the medicine’s limitations? The answers to these questions will in all probability remain a mystery of the human mind, will, and conscience.

It cannot be forgotten that Poland hold a special place on the map of the Shoah because of the country’s location and history. During the war, the centre of the territories occupied by the Third Reich was right there. Having hosted the greatest number of European Jews before the war due to the centuries’ long policy of tolerance, the pre-war territories of Poland became the place where the greatest number of Jews were exterminated by the German Nazi and their collaborators. It should be added that in the German plans “the Final Solution to the Jewish Question” was a prelude to the broader Master Plan for the East (German Generalplan Ost), which consisted of displacing and physically destroying Poles and other “racially deficient” Slavonic nations in the Central and Eastern Europe. It started with the mass displacement of the indigenous population of the Zamość Region. Thus the cruelty of Nazi ideology was the experience of both the Jews and the non-Jewish citizens of Poland.

The present book mentions the noble actions of the physicians important to both the Polish and the Jewish historical memories, such as Janusz Korczak (paediatrician and pedagogist), Ludwik Fleck (microbiologist and philosopher of science). A number of figures whose heroism became a part of the history of the Shoah could be added to that list, including Stefania Perzanowska (doctor from Majdanek concentration camp), Stanisława Leszczyńska (midwife from Auschwitz), Stefania Łącka (a teacher by education who worked as a nurse in Auschwitz).

It should also be mentioned that the crimes committed by physicians in the German extermination camps and the history of their victims and those who came to their help started to be documented and investigated very early in Poland. In 1961 the scientific annual Przegląd Lekarski – Oświęcim (Medical Review – Auschwitz) was published for the first time. The journal was issued every year until 1991. The Polish psychiatrists (Antoni Kepiński, Wanda Półtawska, Zdzisław J. Ryn) made a great contribution to the research into the concentration camp syndrome.

The stories presented in this book remind the reader about the imperfection of human nature and show how prone even the best educated and intelligent individuals are to become entangled in criminal ideologies. However, the power of human spirit able to remain faithful to the fundamental values even in the direst of circumstances is showed as well. The book is a call to stay vigillant and to critically analyse the reality that surrrounds us as well as our own value judgements. As Marek Edelman, the last leader of the Warsaw Ghetto Uprising and a well-known cardiologist after the War, once said, “Holocaust can happen again because the humankind does not consist of angels.”

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