What the German Medical Association declaration has to teach us about codes of medical ethics

 

“The human rights violations perpetrated in the name of medicine under the Nazi regime continue to have repercussions to this day and raise questions concerning the way in which physicians perceive themselves, their professional behavior, and medical ethics.”  – The Nuremberg Declaration of the German Medical Association 2012

 

65 years ago this month the Doctors Trial concluded in Nuremberg, Germany. Sixteen Nazi physicians were found guilty of organizing and participating in crimes against humanity, including ghastly experiments performed on concentration camp prisoners without their consent. Earlier this summer, the German Medical Association (GMA) admitted that not just the doctors on trial but the whole German medical establishment, its leadership, and its most renowned researchers were responsible for the atrocities committed. “In contrast to still widely accepted views, the initiative for the most serious human rights violations did not originate from the political authorities at the time, but rather from physicians themselves,” according to the GMA statement.

Most sobering is that the German doctors thought that they were practicing ethical, Hippocratic medicine.  Their perception of themselves — doctors of the Nazi state rather than individual patients — coupled with their perception that  certain people contributed to the poor health of the state — Jews, Roma, the disabled — led them to do terrible things in the name of Hippocratic medicine.

The apparent breakdown in the millenia-old Hippocratic ethos led to the elaboration of the Declaration of Geneva to reinforce the humanitarian goals of medicine, and the Nuremberg code to protect human subjects of research. But if the example of the Nazi physicians teaches us anything, it is that neither Hippocrates, Nuremberg, Geneva, nor any other code of medical ethics can protect us if we do not acknowledge the basic human dignity inherent in all human beings. As witness, the original Declaration of Geneva reads, “I will maintain the utmost respect for human life, from the time of its conception . . .” The current version has been shortened to, “I will maintain the utmost respect for human life.” It is not difficult to see which class of humans has been quietly removed from the protections of the Declaration.

Is the AMA in danger of committing the same crimes as those for which the GMA has recently admitted responsibility? Are there some humans whose human dignity we have decided not to acknowledge? No, we don’t practice eugenic sterilization; but we do practice prenatal genetic screening and perform eugenic abortion. No, we don’t declare a “Life not worth living,” but we implicitly (and explicitly) use the calculus of “Quality of Life” as we make ethical decisions. No, we don’t do horrific experiments on prisoners; but we do experiment on the youngest and weakest of our species, our own embryos. And we do it all in the name of practicing good, ethical, humanitarian, Hippocratic medicine.

Some have declared in recent years that the concept of “human dignity” is useless in medical ethics. The GMA declaration shows us that, to the contrary, codes of medical ethics are useless without a robust concept of human dignity.

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