Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism

Abstract

Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945. Nazi officials established lecturer positions for the new subject area, named Medical Law and Professional Studies, at every medical school. The appointed lecturers were mostly early members of the Nazi Party and imparted Nazi political and moral values in their teaching. These values included 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. This article shows that there existed not only a Nazi version of medical ethics but also a systematic teaching of such ethics to students in Nazi Germany. The findings illustrate that, from a historical point of view, the notion of "eternal values" that are inherent to the medical profession is questionable. Rather, the prevailing medical ethos can be strongly determined by politics and the zeitgeist and therefore has to be repeatedly negotiated.

Six Values Never to Silence: Jewish Perspectives on Nazi Medical Professionalism

“…As other scholars have implied, 1 , 2 (p593), 3 (p40) a key facilitator in this drastic professional re-evaluation was isolation from any contrary values. In keeping with the nationalist and racial focus toward the supreme German Volk , it was against policy for German doctors to accept the international Nobel Prize (though spreading Nazi medical ideas via hosted conferences was allowed).…”

“…3 (pp21–29,42) The subsequent sterilizations were portrayed as a necessary medical procedure, based on the model compulsory sterilization law proposed by Harry H. Laughlin in the United States. 5 (p312) Beyond legalization, this policy was later reinforced through the Medical Law and Professional Studies (MLPS) medical ethics curriculum, implemented by 1939 and featuring lectures by euthanasia thought-leader Eugen Stähle, and through a key textbook by Rudolf Ramm which redefined the physician’s role as “responsible for ridding society of certain groups ... unable to contribute to society ... in order to heal the organism of the German people.” 2 (pp593–594) Though relatively late in institutional dissemination, this curriculum reinforced what was already professionally accepted. Between 1937 and 1939, concerns were raised that sterilizations had become over -applied by zealous physicians caught up in the new industry, and the Nazi party stepped in to systematize the process, which led to the T-4 program, “improving” (among other things) cost efficiency and economic performance.…”

“…The concept of beneficence was applied toward the health of the general population ( Volk ) rather than the individual, gaining prevalence at least two years before Adolf Hitler’s ascension to power; early talk of euthanizing the incurable to prevent a “financial burden” within the economically destabilized post-WWI Germany had begun but was not yet embraced professionally. 2 (p591) After the fall of the Weimar Republic, the scientific theory of eugenics was used to justify the concept of racial-biological hygiene, both legally and ethically. The Nuremberg Law for the Prevention of Progeny of Hereditary Diseases 4 led to the creation of the Hereditary Health Courts ( Erbgesundheitsgericht ), an infrastructure utilizing physicians and judges to provide scientific justification for decisions which were intended to improve the genetic health and racial purity of the German population.…”

“…It would be a mistake to attribute this forceful exclusion solely to the idea that Jews were convenient targets for Nazis’ racism or nationalism during a period of economic hardship. Physician-educator Rudolf Ramm rejoiced in particular that “the profession had been extensively cleansed of politically unreliable elements foreign to our race.” 2 (p593) A Jewish presence within German medicine would not only be seen as a racial impurity in general, but as a source of “unreliable” ideology contrary to Nazi medical ethics. In order to reinvent the medical profession as one which values individual life by economic and eugenic parameters, discards life for the sake of a monolithic national culture, and furthermore considers doing so to be a justified professional duty, voices had to be silenced first.…”

“… 1 Professionals and institutions relinquished their duties to the individual patient in favor of a societal emphasis on economic worth and eugenic hygiene, which, as recent scholarship has shown, even became codified into professional ethics curricula for German medical students. 2 This obsession with racial-national identity purity escalated into a distinctly medical form of genocide. While the escalation was due to many complex factors beyond the scope of a single paper, the initial ethnocentric-based exclusion of voices from powerful professional institutions contributed to the degradation of social mores.…”