This post was crafted in partnership with the UF-VA Bioethics Unit.
On Friday, October 22, 2021, the UF-VA Bioethics Unit participated in an online event featuring Dr. Stacy Gallin, Director of the Maimonides Institute for Medicine, Ethics & the Holocaust. During the event, Dr. Gallin discussed long-term bioethical implications of how German physicians and medical professionals not only contributed to the horrors of the Holocaust, but also laid the groundwork that made it possible. This event was offered as a Grand Rounds by the University of Florida Department of Psychiatry. The recording can be viewed on the UF Psychiatry website.
Bioethics is an expansive field, encompassing all ethical issues related to health and medicine. Bioethicists address questions about diverse topics, such as invasive research on human participants and decisions on which patients should get access to scarce resources, such as hospital beds and ventilators.
The overarching question in bioethics to keep in mind is: Just because we can, does that mean we should?
In her talk, Dr. Gallin relayed that, in 20th-century Germany, physicians conceptualized the country as a living, breathing organism, the Volk, with its own health and hygiene. In caring for the Volk, the body of the organism, individuals did not matter separately beyond their role in it.
This shifted the medical perspective from caring for the individual to caring for the society. Once this paradigm in medicine and science became prominent in Germany, physicians began debating whether certain people deserved to be part of the Volk based on their ability to benefit the Volk.
This shift in mindset pervaded all sectors of German society, and physicians were given the ability to euthanize or sterilize persons who were seen to be of no use to Germany. These were individuals who were deemed mentally or physically unfit, those who were perceived as taking from society and not giving. This prompted the establishment of euthanasia centers (the precursor to World War II’s death camps), which used gas chambers installed in hospitals to execute these victims.
The presence of trusted physicians at these sites provided an ostensible scientific backing to such unjust killing, making it seem justifiable. Doctors even decided which babies would live or die based on a questionnaire filled out by a variety of people including nurses, administrators, or “another doctor who, by law, had a responsibility to report any potential ‘genetic defects,’” as written by Dr. Gallin.
Soon, the state moved from just killing those deemed mentally unfit to also killing those who were deemed racially unfit and/or politically unfit. Medical logic came to infiltrate politics, with the Nazi party using it to justify the mass murder of millions of Jews. The procedure of murdering these people was medicalized, with doctors frequently present during the executions, justifying the killings with science. “By the end of the Holocaust when the Nazis knew that the Allied Forces were near, they abandoned any pretense of reason for killing and just tried to exterminate as many people as possible,” Dr. Gallin added.
Dehumanization and medicalization are still evident today, according to Dr. Gallin’s talk. This was recently demonstrated during the COVID-19 pandemic. Hospitals were unable to support all of the patients due to the large outbreak of the virus, and they lacked the necessary resources. Physicians had to decide who should get ventilators and who should have access to protective equipment. While not on the same scale or based on the same rationale as the Holocaust, questions such as who should be given extra protection or who should be given a ventilator demonstrate the current role of “fitness” in determining who receives treatment in medical bioethics in present day.
We conducted an exclusive interview with Dr. Gallin, in which we asked her questions about how the current generation can use historical events to change the future. While Dr. Gallin’s presentation focused on the role of medicine in the Holocaust, her talk extends beyond medicine to the concept of human dignity, making it relevant to a broader audience than the medical community.
“By virtue of being members of humanity,” Dr. Gallin said in our interview, “we are all entitled to be treated with dignity and respect.”
It may be intimidating to realize that systems of power can create hierarchies of life, where certain groups are marginalized and can be made to feel powerless. According to Dr. Gallin, the best way to combat that systemic discrimination is through advocacy, activism, and positive actions (that view every person as an individual, someone to be treated with dignity and respect) which actively takes power away from these systems and gives it back to the individuals.
We asked Dr. Gallin for the advice she gives to students who are interested in learning more and fighting against bioethical violations. “Bioethics is very reactive,” she said. “Think of the codes of bioethics that came about in response to finding out about yet another horrible thing that happened, right? Think about what would happen if instead of being reactive, we were proactive. If respect for human dignity was prioritized over scientific or societal progress, if this type of ethics was ingrained in education for healthcare professionals, we could create a new paradigm in which we shift away from what not to do and towards the theory that each of us has a responsibility to uphold bioethical principles and be role models in society.”
Dr. Gallin mentioned that students can help shape bioethics by being mindful of the challenges of their own era.
For students interested in furthering their interest in bioethics and getting involved with Dr. Gallin’s work, she recommended exploring mimeh.org. She also pointed out the College Athletes for Respect and Equality (CARE) program, which is a social justice initiative that educates college athletes on how to use their platform to inform their community about how to harness their power to dismantle systemic oppression.
Dr. Gallin also notified us that MIMEH and the USC Shoah Foundation have fully launched their Project on Bioethics and the Holocaust: Using Testimony in Medical and Health Professions Education, which is a first of its kind, multimedia clearinghouse for resources and tools for education and research related to bioethics and the Holocaust.
Dr. Gallin told us that she is privileged to have the platform that she does, giving her a sense of responsibility to engage, educate, and empower the next generation by amplifying the voices of current and past generations.
“And I think now more so than ever, particularly, due to COVID, is this idea of positive bioethics,” Dr. Gallin said. “We have a younger generation, a new generation that I think wants to add something to what medicine should be, what their role should be.”
“I think that’s advocacy and I think that’s activism. I think that’s, to me, rehumanizing medicine.”
Aniqa Ahmed, the author of this post, interned with FCI during the Fall 2021 semester and worked on this post as a volunteer in Spring 2022.
Additional reporting contributed by Stefany Marjani, a UF graduate who volunteers with the UF-VA Bioethics Unit.