Bioethics Forum Essay
Bioethics, Nazi Analogies, and the Coronavirus Pandemic
The year 2020 will be remembered as the first year of the coronavirus pandemic. But the pandemic was not alone in creating fear and dismay and raising ethical questions. Think of the rise in antisemitism, police violence against Black people, protests against immigration, and rallies by groups espousing Nazi slogans and symbols. Hate crimes, including murder, are the highest in years, according to the most recent FBI report, and were particularly aimed at Jews and Hispanics. Asian-Americans have been targeted as carriers of the so-called “China virus.”
Some scholars and other writers see parallels between these disturbing trends and the rise of Nazism and observe that the pandemic “becomes the most recent unanticipated place in which Americans invoke Auschwitz, cattle cars, and Holocaust survivors as we struggle to endure our own catastrophe.” But is the comparison apt? This question made me look back to a conference called “Biomedical Ethics and the Shadow of Nazism” held by The Hastings Center in April 1976. It was the first conference to address the impact of Nazism and Nazi analogies on the still-emerging field of biomedical ethics. An edited transcript of the conference was published as a special supplement to the Hasting Center Report’s August 1976 issue.
In his introduction to the conference, Peter Steinfels, co-editor of the Report and the conference organizer, said: “Reasoning and argument often seem less conclusive in determining our ethical positions than certain basic or formative experiences. These may be professional experiences or family tragedies. For our culture as a whole they are major historical events, and no events loom so large in ethical discussions of biomedical science and technology as the actions of the Third Reich in the Europe of 1933-45.”
Nazism ended with the defeat of Germany in May 1945, or did it? And in the future, assuming Planet Earth and humans survive the impact of climate change and potential nuclear wars, will people still draw comparisons, valid or exaggerated, to the Nazi experience? Or will they see the Covid-19 pandemic and the perilous state of American democracy today as novel as the coronavirus itself? The conference offers some insights.
The Nazis and the Volk
Lucy S. Dawidowicz, an American-born historian of the Holocaust, set the tone for the conference. Her book, The War Against the Jews: 1933-1945, had been published in 1975 (and is still in print). Dawidowicz opened the conference with a forceful and unequivocal statement of her views: “I do not think we can usefully apply the Nazi experience to gain insight or clarity to help us resolve our problems and dilemmas.” Terms like medical experimentation and euthanasia and the programs they stood for, she said, “derived from a theory about the ultimate value of the purity of the Volk, a word meaning ‘people’ or ‘nation,’ which in Nazi usage took on a quasi-mystical sense.” In Hitler’s view, Aryans, or racially pure Germans, were destined to rule the world. “Medical experimentation” served military needs and the subjects were forced to participate in experiments that could end in death. “Euthanasia,” she said, was the code name applied to the murder of people regarded as racially valueless–“deformed, insane, senile, or any combination thereof.” (For more information on Dawidowicz, see a discussion by Nancy Sinkoff, professor of Jewish studies and history at Rutgers University, of her new biography, From Left to Right: Lucy S. Dawidowicz, the New York Intellectuals, and the Politics of Jewish History (Wayne State University Press, 2020), in a Hunter @ Home presentation.)
Dawidowicz said that Hitler had set out his goal in Mein Kampf (1925): Jews were to be eliminated, which tapped into a long history of antisemitism in Europe. He needed only the power of the German state, achieved in 1933, to begin to implement the Final Solution.
The Nuremberg Trials and Other Issues
Not surprisingly, medical experimentation was a major topic at the conference. Even today it is hard to read in the conference report’s short but harrowing descriptions of the Nazi experiments. Telford Taylor, America’s chief counsel for the prosecution, described the Nuremberg “doctors” trials as “much more of an improvised affair than it now appears . . . . To put it bluntly, a great deal depended upon who was available to be tried.” Many people who might have been tried had been killed or committed suicide. Other people went into hiding and could not be found. Another factor, he said, was who had custody of the defendants. The Soviets had custody of some prisoners who might have been tried, but after the first trial, the interchange of prisoners between the eastern European and Western countries was blocked.
Other issues were also on the conference agenda: end-of-life practices, abortion, the responsibility of professional organizations in acceding to the Nazi programs, the role of corporate responsibility, and the resistance of some Germans to the devastation. In retrospect, it seems that the participants tried to distance contemporary dilemmas from the Nazi past while also recognizing the power of the analogies. As Milton Himmelfarb, a researcher at the American Jewish Committee, said at the conference, “If everything is Nazi, then nothing is Nazi, and even Nazism wasn’t Nazi.” But, he added, “I’m always appalled when the memory of Nazism seems to have disappeared from people’s minds.”
Is the Nazi Analogy Valid Today?
What might be gleaned from the conference report about our problems today? Following the revelations not only about Nazi abuses but also American research scandals, particularly the 40-year Tuskegee syphilis study of poor Black men, a complex regulatory system has been created to advise and monitor studies involving human subjects. Bioethicists play a major role. That does not mean that there are no disagreements and controversies, but they are more likely to be aired in public than in earlier years. In these controversies, the shadow of Nazism is sometimes dim but not erased.
For example, human challenge studies, in which healthy subjects are exposed to the coronavirus to test potentially effective vaccines, have raised concerns about voluntariness and the risk of serious side effects and even death. Research involving prisoners is another contentious issue. Prisoners living under crowded conditions are at higher risk of contracting Covid-19 so they would be a good population on which to test and receive vaccines. But all the questions that arose in the 1970s about prison research resurface in this new arena. In an interview, George Annas, a health lawyer at Boston University, raised the Nazi analogy directly: “The history is pretty dark. It starts in some respects with the Nazis. . . . It’s a history of research done without consent, without oversight, and without consequences.”
An issue prominent in pandemic discussions that did not come up in the Hastings conference is the allocation of scarce resources, especially a vaccine. While some priorities are mostly accepted (health care workers and nursing home residents, for example), there are differing opinions about other groups: people who have received a placebo in a vaccine trial and Black and Latino communities. Should older adults living in the community be given a higher priority than essential workers? Or should healthy younger people—with more years to live and contribute to society—be the first to receive the vaccine? As an editorial in The Lancet pointed out, “Many societies are so caught up in viewing individuals as contributors to the economy only that they have devalued the lives of older people.” Here the shadow of Nazism, with its explicit ranking of groups to be favored and those who are less worthy, rises to a somewhat more visible level.
Moving outside bioethics to politics and social values, perhaps the most challenging area to explore is the American “white supremacy” or “white nationalist” movement. (The Hastings conference did not address the persistence of racial discrimination in the United States, which has become a leading issue for health care and society as a whole.)
While white supremacist groups have been part of American life for a long time, they have increased visibility through social media and public demonstrations. Yet, as Peter Steinfels pointed out to me in a recent e-mail exchange, while specific characteristics of, say, the Aryan nation are linked to white supremacy and the Volk, “the use of white supremacy as the current term of choice in all questions of racial suspicion, fear, and conflict has become exaggerated and unhelpful.” White supremacy should not, in his view, be used as a convenient catchall phrase to describe events as discrete as suburban women’s voting patterns or defenses of police forces. The overuse of this analogy is similar in some respects to the overuse of the Nazi analogy that was the impetus for the Hastings conference more than 40 years ago.
Fatal Symptoms
Nonetheless, Dan Callahan, co-founder and president of the Center, raised a question for the final section of the conference that led to a specific mention of the Volk concept as well as analogous ideas. He asked, “When we see new moral or social trends developing in our society, what are the dangerous social symptoms one ought to be aware of?” Suggestions included a general coarsening of regard for life or accepting the murder of people on the basis of race and politics. Here is one final exchange between Robert Veatch, director of Hasting’s work on death and dying, and Joel Colton, director of humanities for the Rockefeller Foundation:
Veatch: Wouldn’t … a fatal symptom be a concern for the Volk or its equivalent, some kind of corporate identity beyond the policy commitment to the individual?
Colton: If anything would alarm me, it would be the use of some kind of slogan such as “strong, happy, healthy America” to justify all sorts of policies of scientific experimentation or rugged individualism.
Have we reached a point of alarm? If so, what can we do to protect the moral and social values at stake?
Carol Levine is a senior fellow at the United Hospital Fund, a Hastings Center Fellow, and a former editor of the Hastings Center Report. At the time of the bioethics and Nazism conference, she was managing editor and assisted Peter Steinfels in editing the transcripts of the conversation for publication. In 1993 she was awarded a MacArthur Fellowship for her work in AIDS policy and ethics.
It seems to me that the reference to Nazism is less salient when a negative phenomenon is in some way self-limited or concretely contained, and more salient when it is generative/propagative—when its occurrence contributes to extension and elaboration—completion—of the pattern of Nazi Germany. It’s “less Nazi” when a political leader disparages veterans who were captured, than it is when a leader disparages members of a huge ethnic, or generally disadvantaged population, or those of compromised health. It’s “more Nazi” (or at least more authoritarian) when a president pardons individuals who’ve broken the law at his behest or to serve his interests, or promises pardons to obstruct justice by encouraging non-compliance with investigations or perjury in testimony, than it is to pardon the crimes of family and friends just because they are family or friends. Or so it seems to me. It’s a greater concern to observe beginnings that increase the probability of the Nazi whole, than to witness instances which though substantial wrongs don’t tie into any positive feedback loop. Again, just a thought.
Attests to the importance of generational transmission of the lessons of the Holocaust as relates to contemporary challenges and conflicts. We must continue to teach the role of medicine and in the Holocaust to present and future healthcare professionals/supporters so we do not repeat the failures of the past.
On Carol Levine’s Use of the Nazi Analogy
Metaphorical tip-of-the-hat to Carol Levine for raising the Nazi analogy and for reviewing the 1976 Hastings Center Conference on “Biomedical Ethics and the Shadow of Nazis” as a way of reflecting on the implications of the populist authoritarian, anti-Liberal, anti-expert movement strengthening in America in the shadow of the COVID-19 pandemic. Since scholarship on the Nazi doctors and Nazi medical ethics has progressed in the nearly half-century since the Hastings Center conference, I offer a brief overview of recent work on Nazi medical ethics, and then add some reflections.
Many Nazi doctors believed in a new and better medical ethics based on science and the future needs of a people, Volk, (i.e., a genetically based cultural group). Traditional German medical ethics, much like its American and British counterparts, was a benign paternalistic ethics focused on caring for individual patients. Abortion and euthanasia were deemed unethical and, as in America and Britain, a few liberals or progressives believed in eugenics. When the populist National Socialist German Workers party (Nationalsozialistische Deutsche Arbeiterpartei, NSDAP or NAZI party) assumed control of the German state in 1933 it brought with it a revolutionary new conception of medical ethics based on two older concepts, both introduced in 1895: Rassenhygiene (racial hygiene) and euthanasie (euthanasia in the interests of the community). Rassenhygiene was an ethical view that rejected traditional medical ethics focused on the needs of individual patients as unscientific and backwards; it focused instead on the welfare of the German community, the Volk. Physicians were to become politically active promoters of healthy eating (e.g., whole grain rather than white bread) and campaigners against the use of tobacco (a carcinogen). To prevent the weakening of the Volk’s gene pool they were to refuse to abort healthy pregnancies of the Volk and were to assist with the euthanasie of infants and children with disabilities. These “useless eaters” were living lives unworthy of being lived (Lebensunwertes Leben). Notoriously, such non-Volk as Jews and Roma were viewed as threats to the genetic purity of the Volk and thus were to be sterilized or euthanized. (See any of Robert Proctor’s books or “Nazi Science and Nazi Medical Ethics: Some Myths and Misconceptions” (https://muse.jhu.edu/article/25982) for details.).
The terms “ethics” and “morality” are sometime considered honorifics and anyone who understands them in this way may find my use of the expression “Nazi medical ethics” oxymoronic, if not obscene. Yet, insofar as scholars seek to understand and analyze abhorrent viewpoints, deeming them “unethical” by definitional fiat is unduly restrictive. So, like Proctor, I use the expression “Nazi medical ethics” to describe moral beliefs promulgated by Nazis and subscribed to by many German physicians. Dr Karl Brandt (1904-executed in 1948 by judgment of the Nuremberg Court), for example, justified his role as leader of the Aktion T4 eugenic euthanasie initiative (which surreptitiously killed thousands of German children with disabilities) by appealing to the ideal of Rassenhygiene. “We German physicians” Brandt proclaimed, “look upon the state as an individual to whom we owe prime obedience, and we therefore do not hesitate to destroy an aggregate of, for instance, a trillion cells in the form of a number of individual human beings if we believe they are harmful to the total organism—the state.” Asked about the traditional medical ethics of the Hippocratic Oath, Brandt replied, that had Hippocrates been a German physician in the 1930s he would revise his oath.
In the post-World War II period Western medical organizations rejected the Nazi medical ethics of euthanasie and Rassenhygiene and reasserted an individually focused medical ethics. This is evident from The Nuremberg Code (1947) and the World Medical Association’s Declaration of Geneva (a modernized version of the Hippocratic Oath issued in1948). Thus, the Nuremberg Code opens by rejecting the use of unconsenting human subjects stipulating as it first principle that “The voluntary consent of the human subject is absolutely essential.” Similarly, the Declaration of Geneva commits physicians to the ideal that “THE HEALTH OF MY PATIENT will be my first consideration…. I WILL NOT PERMIT considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient” (https://www.wma.net/wp-content/uploads/2018/07/Decl-of-Geneva-v1948-1.pdf)
The point to appreciate is that, just as Nazi medical ethics was created as a communitarian response to perceived inadequacies of individually focused medical ethics, so too post-World War II medical ethics was created in response to a communitarian medical ethics run amok in the Nazi era. Today, our current bioethics of autonomy and patients’ rights seems inadequate to respond to a populist assertion of individual autonomy: an “Our Bodies, Our Selves” rejection of anti-COVID measures such as mask-wearing, shutdowns, and vaccines that undermines community efforts to mitigate the spread of the pandemic. Any likely response will likely assert a communitarian reformulation of biomedical ethics. Yet, as Carol Levine presciently warns, by bringing forward the Nazi analogy, the history of the not-too-distant past is not reassuring about the nature of such a communitarian revision of biomedical ethics.
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12/10/20
Thanks to the three scholars who have commented on my essay. Professor Baker adds additional information on Nazi
medical ethics, which was discussed in more detail at the Hastings conference than I could summarize. For anyone who
wants to read the original publication it is available through your institution or library from JSTOR https://www.jstor.org/stable/3560386?origin=crossref&seq=1 or through Wiley Online Library at https://onlinelibrary.wiley.com/doi/abs/10.2307/3560386.