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NIH Record

Ethicist Explores Nazi Medical Abuses

By Carol Clausen

On May 19, Dr. Warren T. Reich, professor emeritus of bioethics at Georgetown University and editor-in-chief of the Encyclopedia of Bioethics, presented the latest in the series of History of Medicine Seminars sponsored by the National Library of Medicine's History of Medicine Division. The subject was "Betrayal of Care: The Moral Origins of Nazi Medical Abuses."

Reich proposed the thesis that Nazi medical atrocities such as forced sterilization, nonconsensual human experimentation, and euthanasia were the expression of a coherent medico-ethical philosophy, elaborated principally by two physician-theoreticians, Erwin Liek and Karl Koetschau.

Reich described a shift in emphasis that took place in German medical thinking at the end of the 19th century, from Fürsorge (personal, clinical care) to Vorsorge (prior, or preventive, care). The former implied the healing of the individual; the latter, the preservation of a healthy society. In this view, the common good takes precedence over the good of the individual; hence, priority was given to preventive care, or Vorsorge. Fürsorge was associated with scientific, experimental medicine, which was seen as mechanistic and overly rational, Vorsorge with naturalistic, holistic treatment, and the preservation of physiological equilibrium. Supporters of the latter philosophy advocated such preventive measures as exercise, a healthy, natural diet and herbal remedies.

Nazi poster bearing the phrase, translated from German, "A strong and healthy nurse is there only to give care to a dangerous madman. Shouldn't we be ashamed?"

During the Nazi era, the medical establishment and the government were powerfully influenced by and largely adopted the preventive view as the dominant philosophy of medical care. Healthy people, who could contribute most to the general welfare, were of primary concern. The chronically ill or disabled, mentally or physically, were seen as a drain on society, requiring the healthy and robust to care for them and consuming a disproportionate amount of the country's resources while contributing nothing themselves. It was this view that allowed programs of forced sterilization and euthanasia to be carried out, with the cooperation of large numbers of the German medical profession, said Reich. He described this manipulation of the meaning of "care" as a threefold betrayal of medicine: a subversion of the moral standards of medicine, a betrayal of the trust and legitimate expectations of patients, and a betrayal of the public responsibility of the medical profession.

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