German doctors apologise for the crimes perpetrated by Nazi doctors

On 23 May 2012, the German Medical Association (Bundesärztekammer [BAK]) issued a declaration — significantly, in Nuremberg — acknowledging the crimes perpetrated by their predecessors during World War II and asking for forgiveness. Several leading medical journals have responded with commentaries or editorials.1-4 My present reflections expand on those in a previous article,4 by providing further historical background to the BAK declaration and considering it in the context of Australian medicine.

It is perhaps appropriate that comment should appear in the journal of the medical community in Australia, the country with the third largest intake of survivors of World War II. Indeed, many refugee doctors underwent recertification or requalified in Australia and have descendants currently practising medicine here. I am doubly entitled to comment. As a child, I was a displaced person whose father had been deported to a forced labour camp for 3.5 years; and I have been a practising Sydney surgeon for the past 37 years.

The BAK declaration is important in several respects. It is a significant acknowledgement of past crimes perpetrated by German physicians in the name of eugenics, the philosophy that aimed to eliminate any “threat to the purity of the Aryan race”. Eugenics, with its subsequent sterilisation and euthanasia debate, had started long before the Nazis established a state based on the rule of the Führer, who was empowered to authorise murderous policies, including those involving “medical experimentation”. The debate in Germany had commenced in 1871 — with the formation of the German Reich and in the wake of the emergence of eugenics, the “racial science”, in 1865. Health professionals were familiar with the demand to sterilise and euthanase those labelled as “unfit”, “unworthy for life”, “useless eaters”, “burdens on society”, or “threats” to the “purity” and “strength” of the Aryan (ie, Germanic, in their interpretation) master race.

It is worth mentioning that it was in the German parliament that the demand for a code of ethics had originated with a Jewish physician–parliamentarian. In 1932, Julius Moses had raised the need for a law protecting against experimentation. This followed a disastrous experiment in which 90 children had died as a result of a tuberculosis (TB) immunisation program in Lübeck. But no such law emerged.5 The proposal was permanently shelved in January 1933, when the National Socialist German Workers’ Party took power. The politicisation of Nazi medicine led to what I have previously referred to as “the darkest page in the history of medicine”6 — the implementation of the “quadruple-E” program of eugenics, euthanasia, experimentation and extermination, to eliminate the “unfit” or “inferior”.7

To justify this, the Nazis needed little scientific rationalisation. The Führer turned to the medical community for assistance, stating: “Doctors, I cannot live without you for a day, not for a moment”. The reply was enthusiastic, with 44% of the medical profession joining the Nazi Party and 7% joining the SS.8 My first presentation on this topic was an exhibition, Nazi Medicine 1933–1945, originally held at the Sydney Jewish Museum, and later that year at the University of New South Wales and the Jewish Holocaust Centre in Melbourne. I also presented accompanying lectures at the University of New England, the University of Newcastle and Monash University.7 The exhibition exposed the crimes, the active contribution of the doctors, the paucity of doctors taken to trial, and the support they obtained in restarting their practices after the war. For example, Herta Oberheuser, responsible for hundreds of amputations in the Ravensbrück women’s concentration camp, was sentenced to 20 years’ imprisonment, but was released in 1952. Returning to her home town, she was warmly embraced by the local medical association and received an interest-free bank loan to restart her practice. Two years after being recognised in 1956 by a Ravensbrück survivor, she was deprived of her licence to practise.9

The first aspect of the recent BAK declaration, for which the organisation must be commended, is its acknowledgement of atrocities: “doctors were not forced by politicians to kill and experiment on prisoners, but became enthusiastic Nazi supporters”. One should be aware that no physician was ever punished or demoted for refusing to collaborate; they were simply transferred to other duties.

The major role of a number of doctors is noteworthy: Irmfried Eberl, an Austrian doctor who was the commandant of the Treblinka extermination camp, which had the second-largest gas chamber; Josef Mengele (with a group of associated physicians), who selected for gassing some 1.5 million people at Auschwitz; and Karl Brandt, the chief medical officer of the Reich and private physician to the Führer, who performed the very first “mercy killing” of a German newborn.

The apology notes, “outstanding representatives of renowned academic medical and research institutions were involved in organising and carrying out mass extermination of millions”. Indeed, numerous world renowned medical authorities were among the experimenting “scientists”. Of note was the neurologist Julius Hallervorden, who examined children before and after their euthanasia, and accumulated hundreds of brains for histological examination. He described Hallervorden–Spatz syndrome, more recently renamed pantothenate kinase-associated neurodegeneration.

The most heinous crimes were the Neuengamme TB experiments conducted at the Bullenhusser Damm school in Hamburg in 1945. Twenty emaciated children under the age of 12 years, transferred from Auschwitz to Hamburg, were injected intravenously with Mycobacterium tuberculosis or it was instilled into their tracheas. Soon, the cachectic children developed haemoptysis. When the Allies were closing in, the children were given morphine and hanged until death on hooks in a changeroom (one child, being too thin, had to be manually strangled as the noose did not catch), and then all of the experimental “material” was cremated. The “scientific” conclusion drawn by these doctors was that Jewish children, being from an “inferior race”, were more susceptible to TB.

The BAK declaration issued apologies to “the victims of sterilisation, of euthanasia of 200 000 psychiatric and disabled people, of non-consented human experiments, as well as of 360 000 forced sterilisations”. All these experiments had been suggested by the doctors themselves and must have obtained approval from the Reichsführer of the SS, Heinrich Himmler. However, although well intended, the declaration is only a half measure. There is no mention of many of the victims, such as the thousands of German children with intellectual disabilities and treatable diseases who were euthanased in six “children’s hospitals”; the Roma (Gypsies) in Auschwitz who were infected with a rare facial gangrene (noma) and then gassed; and the Polish, Russian and British prisoners who were infected with malaria, hepatitis or anaerobic gangrene. Finally, there is no mention of the word “Holocaust”.

The second aspect of the declaration is that, apart from being an acceptance of guilt, it is also a request for forgiveness. It states that Nazi doctors were “guilty, contrary to their mission to heal, of scores of human rights violations and we ask for forgiveness of their victims, living or deceased and of their descendants”.

Reflecting on the apology, one can ask: how can forgiveness be accorded for the fatal “freezing” or “high-altitude” experiments?7 One can ask: how can forgiveness even be asked for the children who suffered and perished in Neuengamme?

The prerogative of offering forgiveness belongs only to people like the twin sisters, now aged 85 and living in Melbourne, who were experimented on by Mengele.

My personal view is that the present generation of German doctors is guiltless, but in no circumstances should any forgiveness be accorded to their Nazi predecessors. Now, with a generational change — with the old guard no more — today’s German physicians are trying to “master the past”, which probably prompted this apology.

Why now, so long after the war? What do today’s German doctors hope to achieve? We need to remember that, after the war, German doctors, regardless of their complicity in heinous crimes, mostly continued undisturbed in their practices. This belated, but novel, declaration by the BAK is commendable. One can but hope that it will soon be followed by an apology from the Austrian Medical Association, which has, I believe, sheltered under the pretext that Austria was the first victim of the invading Third Reich.

This declaration should alert physicians in all other countries. Following the Doctors’ Trial in 1947 of Brandt and others, the Counsel for War Crimes adopted the Nuremberg Code of ethics on the need for consent for treatment and experimentation.10 The essential points in the Nuremberg Code concern the seeking of consent, doing no harm and the right of each person to cease the process at any time. This excellent first step was later improved upon in Helsinki and then in Tokyo, but in general, all are valid with individual local variants.

The Code of Ethics of the Australian Medical Association and the Code of Conduct of the Royal Australasian College of Surgeons, rigorously respected today, are protection against any such ethical deviation in this country.