OPINION: Using Holocaust education to teach medical ethics and leadership
Justin Shapiro, Ben B. Levy, and Frank Sommers, MD
Holocaust remembrance remains critical in our society as we eternalize the lessons learned from this terrible time in history. Seventy-six years after the liberation of Auschwitz, this still holds true.
Indeed, the medical community is uniquely situated to provide Holocaust education. Many people remain unaware that physicians played significant roles in committing and perpetuating Holocaust atrocities. It is our assertion that Holocaust education provided to the medical community — and medical students in particular — creates an important context in which to explore the principles of medical ethics and leadership. Top
The Holocaust was unique in that it was the only genocide in which health care leaders were enthusiastically involved in the conceptualization, design, and implementation of an apparatus for extermination, which led directly to the systematic torture and killing of millions of Jewish people.1 Although political polarization, racism, and xenophobia are all on the rise, combatting anti-Semitism is not the only reason to educate medical students about the Holocaust. Nearly every ethical issue in health care, from inherent power imbalance to eugenics to inhumane research, can be better understood by examining direct evidence of abuse by physicians during the Holocaust.1 Top
Physicians wield great power in society. Impressionable medical students enter an extremely hierarchical and obedient profession and become socialized to its norms.2 It is only fitting that the next generation of physician leaders should receive Holocaust education to demonstrate that, from time immemorial, power has always been susceptible to abuse.
The case for educating medical students about the Holocaust was bolstered when Richard Horton, editor-in-chief of The Lancet, endorsed the idea. In his editorial, “Medicine and the Holocaust — it’s time to teach,” Dr. Horton argues that teaching medical students about the Holocaust could “instill lessons about the equal worth of human beings, the limits of human experimentation, the importance of ethical regulation of research, and the balance between notions of public health and the duty of health professionals to the welfare of individuals.”3 Dr. Horton also cites preliminary evidence from the Autónoma University of Madrid, demonstrating that the professional values of medical students were enhanced after the introduction of a course entitled The Holocaust: Lessons for Medicine.3 Top
According to Reis et al.,4 learning and teaching about the Holocaust can be a meaningful tool for enriching the formation of professional identity. It can also endow medical students with a moral compass to navigate inherent ethical challenges in their careers and to combat unethical behaviours. In this vein, in November 2020, the University of Toronto instituted a mandatory course for second-year medical students entitled, Physician Obligation: Lessons from the Holocaust. Most recently, The Lancet editorial team has continued to show support for this initiative by launching The Lancet Commission on Medicine and the Holocaust: Historical Evidence, Implications for Today, Teaching for Tomorrow. Top
The accelerating pace of advances in medicine may give rise to a myriad of ethical impasses. Fields such as artificial intelligence and genomics can achieve great triumphs for humanity in fighting a plethora of diseases, yet also carry the potential for flagrant abuse. The Holocaust represents the most egregious example of racism being both medicalized and systematized.1 This was only possible with the willing participation of medical leaders. Indeed, Nazi physicians supervised the selections of which individuals would live or die on arrival at concentration camps, oversaw the operation of gas chambers disguised as showers, and tortured subjects with barbaric medical experiments.5 Just imagine how much more destructive the Holocaust could have been had Nazi physicians been privy to the knowledge and technological capabilities of our era. Implementing Holocaust education will not only enrich medical education at large, but it will also fortify the ethical backbone of medical trainees and empower them to confront the moral challenges they will face throughout their careers.
There may have been German physicians who protested against the crimes perpetrated by the Nazis. However, doctors joined the Nazi party in greater numbers than any other profession.3 They also benefited from their political affiliation through promotions and the ability to carry out ethically unsound research. These physicians began a tortuous journey down a dark path. The murder of six million Jews during the Holocaust did not happen overnight; it did not start with genocide. Rather, the Holocaust began as a series of seemingly small ethical compromises that ultimately led to devastating consequences. Each concession silently ate away at the collective soul of ordinary people. Top
Some might argue that the current ethics and professionalism curricula within Canadian medical schools is sufficient to ensure that medical students appreciate the evils perpetrated by German physicians during the Holocaust. However, Nazi physicians were rigorously inculcated with scrupulous ethical codes. Ironically, Germany was also the first country to enforce a mandatory ethics curriculum in all of its medical schools.1 Thus, merely teaching medical ethics is not enough to ensure that physicians remain faithful to the Hippocratic Oath. If physicians in an advanced society — physicians who sought to pioneer medical ethics education — could implicate themselves in the greatest moral lapse in the history of our profession, we would be demonstrating hubris to assume that the same fate could not befall us as well.
Given the indispensable role the medical community played in orchestrating the mass extermination of millions of people during the Holocaust, physicians bore much responsibility for the flames of the crematoria of Auschwitz.1-3,5-7 Today, we are at a crossroads: in the face of rising anti-Semitism, racism, and xenophobia, we must ensure that these flames serve as a stark warning of the perils of unchecked power and moral corruption. Although it can be emotionally challenging to delve into the horrors of the Holocaust and the role physicians played in enabling such atrocities to occur, we believe it is necessary for all medical learners to do so. Top
Sadly, the forces of human nature that unleashed the Holocaust have not gone away. Physicians are still susceptible to the racism, corruption, and disregard for human life and dignity that served to instigate the horrors of the Holocaust not so very long ago.7 Educating medical students about the Holocaust will bring our profession one step closer to ensuring that the lessons learned through blood, tears, and sorrow will never be forgotten. As the number of Holocaust survivors continues to diminish, the burden has never been greater on medical education to eternalize the lessons of the Holocaust.
1.Chelouche T. Teaching hard truths about medicine and the Holocaust. AMA J Ethics 2021;23(1):E59-63. https://doi.org/10.1001/amajethics.2021.59
2.Sommers F. Medicine and the Holocaust — not on our watch. Toronto: Ontario Medical Association; 2020. Available: https://tinyurl.com/a2chn966
3.Horton R. Offline: medicine and the Holocaust — it’s time to teach. Lancet 2019;394(10193):105. https://doi.org/10.1016/s0140-6736(19)31608-3
4.Reis SP, Wald HS, Weindling P. The Holocaust, medicine and becoming a physician: the crucial role of education. Isr J Health Policy Res 2019;8(1):55. https://doi.org/10.1186/s13584-019-0327-3
5.Geiderman JM. Ethics seminars: physician complicity in the Holocaust: historical review and reflections on emergency medicine in the 21st century, part I. Acad Emerg Med 2002;9(3):223-31. https://doi.org/10.1111/j.1553-2712.2002.tb00254.x
6.Wynia MK, Wells AL. Light from the flames of Hell: remembrance and lessons of the Holocaust for today’s medical profession. Isr Med Assoc J 2007;9(3):186-8.
7.Chelouche T, Brahmer G. Casebook on bioethics and the Holocaust. Haifa, Israel: UNESCO Chair in Bioethics; 2013.
Justin Shapiro is a third-year medical student at the University of Toronto, concurrently pursuing an MSc in health system leadership and innovation.
Ben B. Levy is a second-year medical student at the University of Toronto, concurrently pursuing an MSc in health system leadership and innovation.
Frank Sommers is a child survivor of the Holocaust and a former refugee. A Distinguished Fellow of the Canadian and American Psychiatric Associations, he serves as founding chair of the Section of Disaster Psychiatry in the Canadian Psychiatry Association and of Disaster Psychiatry Canada in the Department of Psychiatry, University of Toronto.