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  • BIOETHICS FORUM ESSAY

Caring for My First Neo-Nazi Patient

Published on: October 19, 2020
Published in: Hastings Bioethics Forum, Health and Health Care, Professional Ethics

I could tell it was early evening from the way the lights glimmered on the East River as we transferred the patient from the operating room to the post-anesthesia care unit. The fractures had been successfully reduced and plated, the consults seen, and we would soon return home. The scene was similar to many before, but the patient’s tattoos caught what was left of my waning attention. Horror and anger began to percolate as I realized that I had seen these symbols before, in museums, textbooks, pawn shops, and in the death camps themselves. This was my first neo-Nazi patient. 

Some of the details of my patient’s care have been changed to protect his confidentiality, but I will never forget his tattoos: The iron cross, Schutzstaffel bolts, Die Partei. It’s strange that I would need to worry about protecting my patient’s privacy given his body artwork and what it stood for with respect to human rights. But I was not alone in acknowledging the importance of confidentiality. The American psychiatrist Robert Lifton, author of Nazi Doctors: Medical Killing and the Psychology of Genocide, observed that he too had to respect the confidentiality of his Nazi interviewees. He wrote of the irony of having to obtain informed consent, a “requirement [that] itself stemmed from the Nuremberg Medical Trial, and was therefore a consequence of the misbehavior of the very doctors [he] was interviewing or their associates.”

With this historical referent, I consider myself in good company. As physicians, we adhere to ethical norms, regardless of our patients’ belief systems and backgrounds. While we wield the knowledge and technologies of the most modern science, we bind ourselves to the ancient virtues of our profession. In our ethics seminars, we are confronted with the impossible hypothetical scenario of Hitler or bin Laden presenting in our emergency room in need of life-saving intervention. Will we save him, let him expire, or kill him? In these hypotheticals, we first learn about our obligation as physicians to do no harm and to do good by our patients. Despite these promises, it is rare to actually encounter such extreme conflict between these core ethical tenets and our powerful human tendencies. 

My first inclination upon realizing that I had just unknowingly assisted in the urgent surgery of a neo-Nazi was to see him as my antithesis. He hates unconditionally; I took an oath to embrace all comers. He subscribes to racist pseudoscience; my profession demands a credible, scientific basis for every action I take. I feared that when he screamed out in pain, my contempt for neo-Nazis might overcome my promise, even if by omission. For the first time, I felt that my professional commitment was in direct conflict with the disgust I felt towards my patient. I left the hospital that evening unsure about which force would prevail. I pondered whether the consensus we had come to countless times in our ethics coursework and the oath I had taken were mere words or something more special, designed precisely for these moments of uncertainty. 

Upon further reflecting on the experience with a colleague, I came to realize that my inclination to see my patient as the other was as dangerous as it was human. While my emotional reaction was fully expected, my responsibility was undeniable. The moral durability of our profession relies on the continued fulfillment of our ancient obligation, generation after generation. To be a physician is to take on the unique responsibility so many have taken on before us. Of course, we have failed to live up to these ideals, but it is the fact that we have an obligation that helps us beat tirelessly back against the current. 

It is cosmic irony to learn from a neo-Nazi how important it is to care for the individual patient unconditionally. The evil orchestrated by Nazi physicians teaches us firsthand the risk to our patients and profession of abandoning this timeless responsibility. The willingness of physicians in Nazi Germany to be steered off course by prevailing racial and political ideology created the groundwork to transform healers into among the world’s greatest accessories to murder. In fact, physicians surpassed all other professions in early enrollments in the Nazi party, and Nazi physicians were instrumental in the marginalization of Jewish physicians, coercive experimentation, euthanasia, and ultimately, genocide. Physicians selected prisoners for killing. Physicians developed the machinery for mass extermination, including the gas chambers. When Auschwitz S.S. Dr. Fritz Klein was asked how he could reconcile killing Jewish prisoners with his obligation to do no harm, he justified his role as an accessory to murder by arguing that killing Jews was akin to removing the gangrenous appendix from the diseased body of society. In seeing himself as a “physician” to a nation actively engaged in genocide, his oath to do no harm and to do good by his patients became warped beyond recognition. 

Inherent in the primacy of the physician-patient relationship is the principle of beneficence. Our obligation, thus, is not simply to do the bare minimum, but to optimize the care of each and every patient, regardless of how we may personally feel about them. I at first found this commitment even less palatable than nonmaleficence. How could I, the grandchild of four Holocaust survivors, be obligated to provide not just satisfactory, but exceptional care to such a morally repugnant character? To do so, I would not only need to internalize the obligation to promote beneficence as a duty, but also to appreciate the incredible power of developing a healing relationship in such an unlikely scenario. We would need to treat his pain promptly and appropriately, to initiate and organize proper follow-up, and to ensure that the entire care team followed through on our commitments without exception or the slightest hesitation. 

For each new generation of physicians, it is always tempting to prioritize personal opinions, public sentiment, utilitarian compromise, or political considerations. In a time of immense political polarization in our country, this temptation is evermore present. If we allow these divisive forces to drive patient care, we risk eroding the special and timeless commitment we have made to our patients. By rededicating ourselves to the enduring principles that guide medical practice in every single patient encounter, we can serve as a light in darkness, reminding others of the importance of obligations and virtues. We must remain firm in the tempest and reaffirm our role as heirs of the dual promise to do no harm and to do good by our patients. 

I would like to acknowledge my colleague and friend, Dr. Joe Scarpa, for helping me to reflect thoughtfully on this experience and for his invaluable feedback. 

Noah Feit is a fourth-year medical student at Weill Cornell Medical College applying into otolaryngology and a 2020 FASPE (Fellowships at Auschwitz for the Study of Professional Ethics) Fellow.

 

 

 

 

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  1. Aaron Rothstein on

    Noah – very powerful and impressive piece.
    The values and sentiments that you espoused are the very ones that Nazis (May their memories be blotted out!) wanted to destroy. Noah you can claim victory! יישר כחך!

    Reply
  2. Eva Kittay on

    I too am the offspring of two Holocaust survivors. Both my parents lost most of their families at Treblinka and they were among the slave labors in various concentration camps including Auschwitz and Bergen-Belzen. I too ponder questions in bioethics and was horrified to learn about the role of physicians. Its hard to imagine the dissociation that must have been at work as you cared for this patient. The argument you make is impeccable. But what if you knew that by treating this patient you would have to compromise on the care of a patient who was not a Neo-Nazi? And was it ever disclosed to him that your family were direct victims of the Holocaust–those gangrenous Jews? If so, I would have loved to hear his response.

    Reply
    • Noah Feit on

      Hi Eva,
      Thank you so much for commenting on the reflection and for sharing your own story. The answer to your first question about having to balance the care of a neo-Nazi with that of another “normal” patient is a situation I hope to never confront. But, as we’re learning during COVID times, we may at some point confront such unfathomable scenarios. The answer is that, in an emergent situation, we would need to triage by acuity of the condition without regards to the patient’s belief system. This algorithm is obviously easier said than done, and I believe I would go through a similar process of discomfort and reflection. In terms of my interaction with the patient: I never brought up my religion or background. I wonder if doing so might have itself interfered with optimal medical care. What are your thoughts? Is it within the scope of a medical provider’s job to point out bigotry seemingly unrelated to the physician-patient care relationship? I’d love to hear your impressions.
      Best,
      Noah

      Reply
      • Amie Schumacher on

        Hi Noah,
        Thank you for sharing your experience and struggles.
        You ask if having a talk with your patient about “bigotry” would be beyond the scope of the physician-patient care relationship. I believe this kind of talk is well within the realm of your professional care for this patient.

        First of all, as the author of a previous reply (njoseph) stated very well, until you practice curiosity and explore this with the patient, whether or not he is actually a “bigot” is still only your assumption.

        Secondly, bigotry is not serving this patient well: physically, mentally, spiritually, psychologically, socially, etc. If he truly is a bigot, than he probably socializes with others of like mind. When hate is magnified, oftentimes there also exists concomitant health risk behaviors. If this patient has a family, he is likely passing on these harmful beliefs and way of being — and so the generational pattern continues. As we have all seen and heard so much lately in these racially unsettled times: Silence is consent.

        This was an opportunity to help break into a generational cycle of hate.

        I could envision you sitting down with him and saying: “I’m curious, tell me about these tattoos…how did you come to get them and what do they mean to you?” And then listen. If he truly is a bigot and shares his distorted beliefs, you might ask: “Help me understand how you came to believe that? What happened that has lead you to this point?”

        If, then, you feel lead to share your perspective, experience, and history, it may prove to be a very powerful visit — for both of you. You see, you will be learning from him, just as he would be learning from you. There would be no need to argue or try to change his position. Seek to understand, share your perspective, then connect this kind of hatred, and any associated health-risk behaviors, with how this harms his human body, spirit, mind, and soul – and that of his family.

        Again, thank you Noah!

        Reply
  3. njoseph on

    If I had time, I’d write a more substantial reply, but for today, suffice to say I find aspects of this reflection to be ethically problematic.

    First, to point out what should be obvious, the author has literally no idea if the patient is a neo or any other kind of Nazi- that is, what his political beliefs are- all he knows is that the patient has some odious tattoos. But without actually speaking to the patient, he has no idea what those tattoos mean to the patient himself. Maybe the patient was a dumb rebellious kid and got them to make other people angry but doesn’t really believe that stuff. Or maybe he’s repented of his beliefs but doesn’t have enough money to have the tats removed. Or maybe his grandfather was an actual Nazi and he got the tattoos to remind himself of what not to become- granted, that’s farfetched, but what person in the camps would have imagined that their grandchildren in America would have concentration camp tattoos of their grandparent’s arm numbers?

    Second, while it is commendable that the author anonymized the details of the patient’s identity, you know who could, in fact, identify this putative Nazi? The patient himself, since the facility and doctor’s name are published. Is it right to potentially publically humiliate this man and interpret what you think he believes? Not only that, but if your desire is to change his mindset from one of hate to one of tolerance (assuming he’s a real Nazi and not just a guy who got a bunch of tattoos in a drunken fit), is publishing this article the best way to influence him? Wouldn’t private influence and at least an attempt at dialogue be better than learning through a public website that his doctor had to “overcome contempt” for him?

    Lest you think I’m exaggerating the possibility of tattoos not meaning what you think they mean, I can say I’ve seen it many times in my work as a hospital chaplain . People get tattoos when they’re 17 that they are embarrassed by just a few years later. Or they get tattoos and don’t even know what they mean: twice in about ten years I’ve had to tell people that their cool Hebrew tattoo doesn’t say what they think it says. (Background: I’m a rabbi too.)

    If I’ve learned anything in my years of working as a chaplain- and member of a hospital ethics committee- it’s that you don’t know what anything means to someone else until you ask. Curiosity is a key trait for anyone in the helping professions, even if it means asking: so, what does that iron cross mean? What’s that about for you?

    You might in fact confirm the guy is a neo-Nazi, but something else might happen too. Always be open to possibilities, the world will surprise you.

    Reply
  4. Denise on

    Hi Noah,

    I loved your thoughtful, candid reflection of this situation, which so many can relate to. Not only does it apply to healthcare providers, but to humans interacting with other humans. I echo, “Yasher koach.”

    Reply

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