Confronting the past: Contemporary German paediatric response to medical practice in the Third Reich

In 1995, the German Society of Pediatrics and Adolescent Medicine undertook an initiative to document publicly the suffering that was endured by its German-Jewish paediatric colleagues from 1933 to 1945. At the society's annual meeting in Dresden, Germany in the fall of 1998, the memory and suffering of those colleagues were recalled. In the presidential address, Lothar Pelz acknowledged the society's collective guilt, both as an active participant in the National Socialist policies of racial purification, and its failure to stand by and speak out for German-Jewish colleagues who were being persecuted (1). A commitment to describe events that occurred in paediatrics during the Third Reich was also undertaken by the society. The events recalled by the initiative launched in 1995 illustrate vividly that medicine does not exist in a vacuum. It is subject to the same historical and political influences as are any other elements of a society. Sometimes, these influences converge to alter the practice of medicine grotesquely in ways that can appear on the surface to be beyond comprehension and understanding. Expressions of medicine's ‘dark side’ recur repeatedly throughout history. For physicians in the present, they are extremely discomforting to consider, and we often choose to ignore and distance ourselves from such expressions by citing separations of time, space and personality. We frequently adopt a defensive and comforting “it cannot happen here” mind frame when considering previous medical abuses. Medicine's dark side was no more evident than during Germany's Third Reich. Racial reform of the German Volk was at the core of the Nazi social and political agendas. Borrowing heavily from the ‘pseudo science’ of racial hygiene for objective justification, the Nazis envisioned and implemented biological solutions (ie, sterilization, elimination) to a perceived problem of racial fitness, which was framed in medical terms. Individuals with disabilities and Jews were specifically targeted for marginalization and, then, elimination (2). German medicine at the dawn of the Third Reich was the envy of the world (3). No country had produced more Nobel Prize winners in physiology (3). German research laboratories attracted the best and the brightest fellows from overseas (3). Germany's combined private and public payer systems provided an enviable, near universal access to health care services (3). Germany's educational structure had served as the model for the Flexner report, which had reformed North American medical education (3). Against this backdrop of medical sophistication, the number of physicians who joined the Nazi party and its elite formations was greater in terms of percentage than that of any other professional group (4). Physicians were attracted to the prospect of greater professional powers and prestige under a Nazi regime. Physicians became the “guardians of the nation's genetic constitution”, trusted agents of the state's array of biological solutions (2). Physicians administered the policy of compulsory sterilization. Physicians served as arbitrators of the Nuremberg Race Laws. Physicians formulated and implemented a policy of active euthanasia for those with mental and physical disabilities, which necessitated the development of novel means of mass extermination. Physicians segregated the living from the soon-to-be dead on the arrival ramps of concentration camps (2,5). The actions of physicians as agents of the state have primarily occupied the attention of medical historians of the Third Reich. The ‘purification’ of German medical ranks through the removal of Jewish practitioners has largely been ignored (6,7). Through the systematic and rigid application of escalating bureaucratic rules, the rights of German-Jewish physicians were steadily narrowed. Academic appointments and research grants were rescinded. Salaried positions were revoked. Hospital privileges were lost, and practices were closed. The end result was a ‘de-judification’ of the profession that led to the emigration of many German-Jewish physicians; those who were not able to emigrate were, ultimately, caught in the web of the ‘Final Solution’ (6,7). The practice of paediatrics was no exception to the developments outlined above. The first systematic attempt to eliminate a defined population group in the Third Reich targeted children with disabilities (8). Paediatricians formulated the guidelines and protocols for the child euthanasia program, reported children to state authorities, staffed the expert clinics and carried out euthanasia protocols on selected children. More than one-half of all academic and practising paediatricians experienced Nazi persecution, largely because of their religious affiliation or heritage (9). The tragedy of their personal suffering, displacement, pain and loss is enormous, and so very difficult for us to comprehend adequately from a contemporary perspective. It is not easy to grapple publicly with such a painful past. The German Society of Paediatrics and Adolescent Medicine should be commended for doing so. Its efforts are poignant and should serve as a paradigm for other groups in German medicine to engage honestly in dialogue, and confront previous institutional and personal actions, and indifference. It should, however, be noted that any mention of paediatricians' involvement in the child euthanasia program that selectively targeted German children with disabilities is missing from the society's actions. It is all too easy to ignore and forget – to believe that the abuses all happened a long time ago, in a place much different from our own, with actions committed by marginal, extremist physicians to people who are not like us and, thus, not worth remembering. An open and frank dialogue about the Nazi epoch is necessary to honour truly the victims' memories. We can only do so by lessening, in some tangible way, the chance that such abuses will ever happen again in such a noble profession as medicine.

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