Medicine Ethics, and the Third Reich: Historical and Contemporary Issues
Edited by John J. Michalczyk
Sheed & Ward 240 pages. $19.95

Arthur Cohen has characterized it as “beyond the deliberations of reason, beyond the discernments of moral judgments, beyond meaning itself,” and defined it as “the expression of ordinary secular corruption raised to immense powers of magnification and extremity.” As one who absorbed the hideous drama of the Holocaust from the hushed voices of my parents and the keening of relatives who had successfully fled, I am on this subject afflicted with an aporia bordering on rhetorical paralysis. Several years ago, I visited the Dachau camp in the suburbs of Munich, and the experience was so desolating as to be beyond tears, and yes, beyond meaning itself.

Nonetheless, the literature that attempts to understand the Holocaust is vast and growing, and has matured to the point of specialization. There is a body of work on the failures of the German clergy, another body of work on the origins of the Holocaust in race science, still another on the bankrupt Nazi judicial system-and now we add yet another work on the German medical profession. John Michalczyk has compiled and edited papers presented at a 1993 conference at the Jesuit Institute of Boston College , Medicine, Ethics and the Third Reich: Historical and Contemporary Issues . The participants hailed from markedly diverse disciplines, and included bioethicists Arthur Caplan, George Annas, and Lisa Sowle Cahill; theologians Donald Dietrich and Peter Haas; physician Michael Franzblau; historians Daniel Nadav and Robert Proctor; journalists Nat Hentoff and Peter Steinfels; and Holocaust victims Eva Kor and Vera Laska. There was even one surgeon, Robert L. Berger, who was himself a victim who survived the Holocaust. (Like Lawrence Langer, I abjure the term “survivor” in favor of the more honest word “victim” in describing those who lived through the horror; the word “survivor” strips the drama of its limitless evil and instead suggests a natural-not man-made-cataclysm: one Jewish physician liberated from Auschwitz observed, years later, “If you lick my heart, it will poison you.”)

Kierkegaard wrote that life is lived forward and understood backward. The papers presented at the conference pay the conventional attention to the historical roots of German National Socialism but regrettably do not explore adequately the race science that developed in Germany in the last half of the nineteenth century. John Efron has carried out that task, however, with remarkable thoroughness in his book Defenders of the Race: Jewish Doctors and Race Science in Fin-De-Siecle Europe . Efron examines the “Jewish question” in Germany meticulously, beginning with the egregious tales (carried from the Middle Ages into nineteenth-century Germany) that Jewish males menstruated, that they were uniformly effeminate, that Jews were more subject to insanity than other races. He moves forward to describe the work of race scientists such as Georg Wachter, a Dutch anatomist who studied the skull of a thirty-year-old Jewish male and published his conclusions in 1812. Wachter remarked on the large nasal bones, the square chin, the typical bony impressions on the lateral sides of the orbits and concluded that “among Jews, the muscles primarily used for talking and laughing are of a kind entirely different from those of Christians.”

Efron recounts the work of other race scientists such as Andreas Retzius and Carl Vogt in the mid-nineteenth century who devised the fatuous notion of using craniometry (measuring certain key diameters of the head) to differentiate racial types, and by this mathematizing of racism triumphantly divided Jews into two taxonomic niches: the round brachycephalic and the long dolichocephalic. The Austrian physician (all race scientists in Europe in the nineteenth century were physicians) Augustin Weissbach published a paper in 1877 in a scientific journal confirming the stereotypes based on his study of nineteen Jewish males, and Bernhard Blechman in 1882 supported Weissbach’s conclusions with a study of his own.

Other race scientists built upon this scientifically grotesque edifice to divide Jews into the brachycephalic Ashkenazis (of Eastern European extraction) and dolichocephalic Sephardics (of Mediterranean extraction). Constantine Ikow in the 1880s reclassified Jews into three racial types on the basis of evidence derived from the craniometry method. Prominent German psychiatrists such as Emil Kraepelin and Richard Krafft-Ebbing stressed the emotional fragility and the putatively high rate of insanity among Jews; Krafft-Ebbing remarked that religious fervor in the Jewish community promoted deviant sexual practices such as consanguineous marriages.

By 1900, 16 percent of all physicians in Germany were Jewish (Jews comprised approximately 1 percent of the German population), and these physicians were subjected to intermittent but vicious attacks. In 1875 the world-famous surgeon Theodor Billroth unleashed a lengthy anti-Semitic harangue in the press, protesting the admission of Jewish students in what he termed disproportionately large numbers to the German medical schools. Only the great non-Jewish pathologist Rudolph Virchow battled the anti-Semites by ridiculing the entire racial typing project and defending the Jewish physicians fearlessly. Jewish physicians such as Joseph Jacobs in Great Britain and Samuel Weissenberg in Germany took on the race science question, conducting studies and publishing scientific papers confuting the virulent anti-Semitism of the German non-Jewish medical community-but by 1900 the damage was done. Jews had been thoroughly marginalized, and the ground had been prepared for Alfred Ploetz and Wilhelm Schallmeyer, the founders of the German racial hygiene movement in the first two decades of the twentieth century.

Daniel Nadav and other essayists in Medicine, Ethics, and the Third Reich describe with impressive force the progressive deterioration of medical ethics in the pre-Nazi and Nazi eras, as doctors stepped from forced sterilization of the physically and mentally imperfect through the various euthanasia programs devised first to care for the suffering and then to the more comprehensive programs designed to eliminate the “lives not worth living,” the lives that were a “drag” on the racial hygiene aspiration, and the lives of the “useless eaters.” In the introductory essay, Christian Pross observes that “a combination of pseudoscientific racism, socioeconomic crisis, and abandonment of the ideal of physician as healer produced doctors who sterilized or killed so-called inferiors and social deviants in the name of science.” Pross states that only 350 German physicians directly committed the medical crimes, but “many more were involved, directly or indirectly, among them the cream of German medicine, university professors, outstanding scientists and researchers.” In the Nazi era half of all physicians were members of the Nazi party, 26 percent of them were storm troopers, and 7 percent were in the SS-these were much higher rates than for any of the other professions. Regarding the fate of the German-Jewish physicians, Pross estimates that between 1932 and 1945 at least 5,000 Jewish physicians were expelled from Germany, several hundred committed suicide, and close to 2,000 perished in the death camps.

Lisa Sowle Cahill, in a moving valedictory to this dispiriting account of the systematic betrayal of normative medical ethics, does not tastefully avert her eyes; she calls the Holocaust exactly what it was-an unmitigated and unmitigatable evil. She marks the role of the Nazi physicians-the loyal traitors-as having caved in to “scientific bias, ideological banality, professional self-serving, and moral vacuity.” In bioethical terms, it was a pervasively squalid, unparalleled, and unimaginably destructive perversion of the utilitarian theory of medical ethics.

Unfortunately Cahill-like other participants in the conference-relies on that old saw of the “slippery slope,” as though it were a logical inevitability; she does however warn that “the ‘slippery slope’ argument is a valid one, but it calls for caution and precision in the application.” Mary Mahowald, in her consideration of the “slippery slope” argument, has acknowledged that the “slope” does exist but that one can control the rate of descent (and even arrest it) by driving what she terms “moral wedges” into the slope. This is not far from my own position on the subject: the slope is not a slope at all but a spiralling staircase descending into unfathomable depths of evil. At every step one has the opportunity to rest, to survey the moral landscape critically, to look back, to contemplate with great care the next step, and even to climb back up if the occasion warrants. Had German physicians (and for that matter, the German judiciary, philosophers, academicians, journalists, and even the military) taken this approach to National Socialism, it is a reasonable probability that that terrifying, dizzying descent into hell would not have occurred.

Medicine, Ethics, and the Third Reich is a powerful indictment of the abject collapse of the German biomedical ethical system during (and even preceding) the National Socialist regime. Others have written authoritatively on the subject, but none with the eloquence and force of the contributors to this volume.

Bernard N. Nathanson, M.D., is author of Aborting America and The Abortion Papers.