How Do U.S. and Canadian Medical Schools Teach About the Role of Physicians in the Holocaust?

To the Editor: Almost every aspect of contemporary medical ethics is influenced by the history of physician involvement in the Holocaust. Most notorious is the unethical research by Nazi doctors, which led to the Nuremburg Code,1 but physicians and their organizations played many other roles, including in rationalizing and implementing programs of forced sterilization and “euthanasia” of disabled individuals, and in developing, testing, and refining the killing, cremation, and camouflage technologies used in the death camps.2,3 This history informs modern debates about economic and social forces in medical practice, genetic testing and therapies, public health research and practice, physician involvement in prisoner interrogations and executions, end-of-life decision making, and many other issues.1–4 Although teaching on ethics and professionalism is uniformly required in medical schools, it is not known whether or how medical students today learn this specific history. To address this, the Liaison Committee for Medical Education (LCME) included two new questions in its 2013 annual survey of U.S. and Canadian Medical schools: “Does the curriculum include required sessions that address the role of physicians in the Holocaust?” and a follow-up item on the teaching format(s) used. The methods of the survey, which is completed by every LCME-accredited medical school in the United States and Canada, are described in detail elsewhere.5 Responses to these questions reveal a stunning fact: Only 22 of 140 (16%) medical schools in the United States and Canada have any required curricular elements on the roles of physicians in the Holocaust, and half of these (11/22) teach this material using a lecture format only. Of course, surveys are imperfect, and some schools might have underreported their required course work. Also, the LCME asked only about “required sessions,” which might not cover electives that address this history or spontaneous discussion of the topic during other sessions. Still, it appears that specific attention to arguably the most influential set of events in the history of professional ethics in medicine is required at only a fraction of U.S. and Canadian medical schools—and this despite a uniform requirement to teach ethics and professionalism. Now that the LCME has documented this deficiency, the medical profession should be galvanized to ensure more focused attention to this history and its continuing relevance in training programs, such as by developing standardized curricular materials and fostering collaborations between medical schools and Holocaust resources such as museums. If the situation does not improve with voluntary efforts, the LCME should consider adopting more specific training requirements. Matthew K. Wynia, MD, MPH Director, Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado; [email protected] William S. Silvers, MD Clinical professor of medicine, University of Colorado, Aurora, Colorado. Jeremy A. Lazarus, MD Clinical professor of psychiatry, University of Colorado, Aurora, Colorado.

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