- BIOETHICS FORUM ESSAY
Caring for My First Neo-Nazi Patient
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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