Health professionals’ education and medical ethics should be informed by an in-depth understanding of how medicine was abused by the Nazi regime. By examining this dark phase in modern medical history, it is believed future generations of medical and healthcare professionals will be empowered to face moral and ethical dilemmas, as well as their own biases, so they can protect vulnerable populations and patients. 

The Commission on medicine, Nazism, and the Holocaust was organized by the Lancet and consisted of a diverse and international group of 20 scholars, physicians, and researchers with expertise in history, medical education, and bioethics. This was the first Lancet Commission focused exclusively on the history of medicine. 

In their report, the Commission members have focused on instances of discrimination and inhumane medical policies and practices that were conducted under the Nazi regime. The aim is to inform approaches to current and future issues in medicine, protect human rights centered on the individual, and encourage medical professionals to stand up against institutional power and wrongdoing.

“Nazi medical atrocities represent some of the most extreme and best-documented examples of medical involvement in human rights violations in history”, the Commission Co-Chair Dr Sabine Hildebrandt of Boston Children’s Hospital and Harvard Medical School said in a statement. 

“Health professionals—who often care for people at their most vulnerable—have a unique and important duty to develop and preserve a strong moral agency. By learning about medicine’s role and health professionals’ behaviour under Nazism, they can further develop their own moral reasoning and stand up to abuses of power in the name of individual patient rights and the dignity of all human beings, regardless of race, ethnicity, religion, and other individual characteristics.”

A history of atrocities 

During the Nazi era, the medical community played an active role in shaping, justifying, and implementing policies that led to the deaths of countless numbers of vulnerable people. For decades, historians have been aware that physicians were among the most eager supporters of the regime in its early days, as members of this profession joined the Nazi Party and its affiliated organization in higher numbers than any other profession. 

Moreover, these professionals distorted and inverted medical ethics to justify barbaric methods. The Nazi’s “ethical code” was weaponized as a tool to value, prioritize, and advance the German “Aryan” race at the expense of everything else. This was used to inform, structure, and run programs related to eugenics, forced sterilization, brutal human experimentation and to “euthanize” thousands of patients. 

Between 1939 and 1941, 70,000 institutionalized patients were killed by gas as part of the T4 patient murder program, the method of which was later used in the Polish extermination camps. 

“It is often surprising how limited the knowledge about Nazi medical crimes in the medical community is today, perhaps apart from a vague notion of Josef Mengele’s experiments in Auschwitz. Our report aims to change this. Although the examples we present are extreme, studying medicine under Nazism highlights the critical role of societal factors and of ethics in medical and scientific advancement. Today’s health professionals operate in systems and structures that do not benefit all patients equally. While there is no simple path ahead, knowledge of historical extremes can make us better prepared to work through ever-evolving ethical dilemmas in medicine,” added Prof Czech.

Following the end of the Second World War, in 1946, the subject of Nazi medical ethics became the focus of the Nuremberg Doctor’s Trials, where the main perpetrators responsible for atrocities were tried and executed. As an outcome of this trial, the international community drew up the principles enshrined in the Nuremberg Code, the first international code of medical ethics that guides research on humans. At its core, the code protects the rights of the individual, and calls for their informed and voluntary consent to be the cornerstone of ethical conduct. 

The Nuremberg Code formed the basis of many subsequent declarations and remains a fundamental piece of modern bioethics. 

A bloody legacy

To be sure, the atrocities conducted by the German medical community under the Nazi regime were not mere “pseudoscience” as it is often characterized today. The medical community was actively taking part in standards and practices of biomedical science that were developed in the 19^th and early 20^th centuries. Such developments were also being enthusiastically pursued by scientists across the world, in particular in Britain, France, and America who all had their own versions of racist medicine. 

In fact, following the war, the results of medical experiments conducted under the Nazi’s became part of medical education in the west. For instance, the bodies of Nazi victims remained as specimens within scientific collections for decades. The Pernkopf anatomy atlas is a powerful example here as it formed part of the canon of medical knowledge, but included images derived from the bodies of victims – images that were copied and republished in other publications without reference to their original source.  

“Accountability for and recognition that crimes were committed in the name of medicine in the Nazi era and during the Holocaust remains woefully inadequate. Medical students, researchers, and practicing health professionals should know where—and from whom—the foundations of medical knowledge come from. Victims of Nazism are owed that; they have a right to be honoured and treated with dignity in life and death for coerced contributions to medicine as we know it today”, said Commission Co-Chair Prof Shmuel Pinchas Reis, of the Center for Medical Education at Hadassah/Hebrew University Faculty of Medicine. 

Lessons for the future

In order to strengthen the pursuit of scientific knowledge and medical conduct that is in keeping with current ethical standards, the Commission put forward several recommendations for medical education. The key recommendations include:

• “Incorporate the study of medicine, Nazism, and the Holocaust in curricula for all medical students and health professionals, across the medical field and in continued medical education initiatives.”
• “Encourage students and medical professionals to develop a history-informed professional identity, including being able to recognise their own potential biases or conflicts of interest, challenge hierarchies, and equip them with the tools necessary to overcome them.”
• “Universities, psychiatric hospitals, and other medical institutions worldwide should actively identify and commemorate victims of Nazi medical crimes and initiate research to better understand their direct connections to human rights violations in the past. They should also look at their own past, identify and document patterns of medical abuse, and integrate this history in their curricula.”

In addition to examining the misconduct performed by German doctors, the Commission also examined the personal testimonies of Jewish and non-Jewish health professionals who worked with patients under extreme conditions. This included those who worked in ghettos and concentration camps. These testimonies have become fundamental for educating people about this hideous context.

“Over the last few years, scientific research, medical, and health policies have been subject to great scrutiny. Our report sets out some of the most horrific distortions of medical practice and policies in history, and it is incumbent on all in the health and medical community to keep the memory of the events of the Nazi era from fading," said Dr Hildebrandt.

"We must study this history of the worst of humanity, to recognise and work against similar patterns in the present, with the goal of promoting the best. We must speak out against antisemitism, racism, and other forms of discrimination, uphold and advocate person-centred, human rights-based medicine, protect the vulnerable, serve the marginalised, and acknowledge the humanity and dignity of each and every patient,” Dr Hildebrandt concluded.

The Commission’s report is published in The Lancet.