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Czech H, Hildebrandt S, Reis SP, Chelouche T, Fox M, González-López E, Lepicard E, Ley A, Offer M, Ohry A, Rotzoll M, Sachse C, Siegel SJ, Šimůnek M, Teicher A, Uzarczyk K, von Villiez A, Wald HS, Wynia MK, Roelcke V. The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow. Lancet 2023; 402:1867-1940. [PMID: 37951225 DOI: 10.1016/s0140-6736(23)01845-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Herwig Czech
- Ethics, Collections, and History of Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Shmuel P Reis
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel; Department of Digital Medical Technologies, Holon Institute of Technology, Holon, Israel
| | - Tessa Chelouche
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Matthew Fox
- Jakobovits Center for Jewish Medical Ethics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Esteban González-López
- Division of Family Medicine and Primary Care, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Etienne Lepicard
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Astrid Ley
- Memorial and Museum Sachsenhausen, Oranienburg, Germany
| | - Miriam Offer
- Center of the Study of Jewish Medicine during the Holocaust, Western Galilee College, Acre, Israel
| | - Avi Ohry
- Rehabilitation Medicine, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maike Rotzoll
- Institute for the History of Pharmacy and Medicine, Marburg University, Marburg, Germany
| | - Carola Sachse
- Institute of Contemporary History, University of Vienna, Vienna, Austria
| | - Sari J Siegel
- Center for Medicine, Holocaust, and Genocide Studies, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michal Šimůnek
- Institute of Contemporary History of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Amir Teicher
- Department of History, Tel Aviv University, Tel Aviv, Israel
| | - Kamila Uzarczyk
- Department of Humanities and Social Sciences, Wrocław Medical University, Wrocław, Poland
| | - Anna von Villiez
- Memorial Israelitische Töchterschule, Hamburger Volkshochschule, Hamburg, Germany
| | - Hedy S Wald
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew K Wynia
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Volker Roelcke
- Institute for the History, Theory and Ethics of Medicine, Giessen University, Gießen, Germany
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Skinner-Dorkenoo AL, Sarmal A, Andre CJ, Rogbeer KG. How Microaggressions Reinforce and Perpetuate Systemic Racism in the United States. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 16:903-925. [PMID: 34498526 DOI: 10.1177/17456916211002543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The consequences of racial microaggressions are most often discussed at an interpersonal level. In this article, we contend that microaggressions play an important role in maintaining systems of racial oppression beyond the interpersonal context. Specifically, we illustrate how microaggressions establish White superiority in the United States by othering people of color (e.g., treating people of color as if they are not true citizens) and communicating that they are inferior (e.g., environmental exclusions and attacks, treating people of color as second-class citizens). We also present evidence that microaggressions play a role in protecting and reinforcing systemic racism. By obscuring systemic racism (e.g., false color blindness, denial of individual racism) and promoting ideas that maintain existing systemic inequalities (e.g., the myth of meritocracy, reverse-racism hostility), microaggressions provide cover and support for established systems of oppression. Overall, we find considerable evidence-from both empirical studies and real-world examples-that microaggressions contribute to the maintenance of systems of racial oppression in the United States. We conclude with a discussion of how we might begin to challenge this cycle by increasing awareness of systemic racism and the microaggressions that aid in its perpetuation.
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Jach Ł, Buczek A. Who says “yes” to science without ethics? Acceptance of the violation of ethical norms due to scientific reasons in the context of empathy, systemizing, and the scientistic worldview. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hildebrandt S. Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today. Anat Rec (Hoboken) 2021; 305:886-901. [PMID: 34118137 DOI: 10.1002/ar.24691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.
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Affiliation(s)
- Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children' Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Frush BW, Malone JR. Suffering and the moral orientation of presence: lessons from Nazi medicine for the contemporary medical trainee. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106061. [PMID: 32332152 DOI: 10.1136/medethics-2020-106061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting such a moral orientation for contemporary trainees.
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Affiliation(s)
- Benjamin Wade Frush
- Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jay R Malone
- Department of Pediatrics and Critical Care Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Yee A, Zubovic E, Yu J, Ray S, Hildebrandt S, Seidelman WE, Polak RJA, Grodin MA, Coert JH, Brown D, Kodner IJ, Mackinnon SE. Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study. Surgery 2019; 165:860-867. [PMID: 30224084 DOI: 10.1016/j.surg.2018.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.
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Affiliation(s)
- Andrew Yee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shuddhadeb Ray
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - William E Seidelman
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, ON, Canada
| | - Rabbi Joseph A Polak
- School of Public Health, Boston University, MA, USA; Elie Wiesel Center for Jewish Studies, Boston University, MA, USA; Rabbinical Court of New England, Boston, MA. USA
| | - Michael A Grodin
- School of Public Health, Boston University, MA, USA; Elie Wiesel Center for Jewish Studies, Boston University, MA, USA
| | - J Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery, Utrecht University Medical Center, Utrecht, Netherlands
| | - Douglas Brown
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ira J Kodner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Yee A, Hildebrandt S, Seidelman WE, Mackinnon SE. Letter to the Editor: Nazi Medicine-Part 2: The Downfall of a Profession and Pernkopf's Anatomy Atlas. Clin Orthop Relat Res 2018; 476:2465-2466. [PMID: 30427319 PMCID: PMC6259895 DOI: 10.1097/corr.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/12/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Andrew Yee
- A. Yee, S. E. Mackinnon, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA S. Hildebrandt, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA. W. E. Seidelman, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Nicholson I. The normalization of torment: Producing and managing anguish in Milgram’s “Obedience” laboratory. THEORY & PSYCHOLOGY 2015. [DOI: 10.1177/0959354315605393] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Milgram framed his “Obedience” experiments as an inquiry into the Holocaust, posing state directed mass murder as a “conflict between conscience and authority.” However, recent research into atrocities suggests that “moral conflict” is often absent; murder is frequently undertaken willingly in a spirit of idealism and “normalcy.” The question is not why do people obey orders they find morally objectionable as Milgram suggested, but rather how does it become “normal” and “ok” to torture or kill defenseless people? I examine this question through a reinterpretation of the Obedience study. Instead of focusing on the confused and entrapped participants, people who were tricked into “immoral” action, I study the scientists themselves—individuals who applied enhanced stress techniques on innocent people repeatedly and enthusiastically, fully aware of what they were doing. Inverting Milgram’s Holocaust analogy, I suggest that recent scholarship on Nazi doctors can provide insights into the various ways that torment became “normalized” for Milgram and his assistants.
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Ethical considerations in clinical training, care and research in psychopharmacology. Int J Neuropsychopharmacol 2011; 14:413-24. [PMID: 20860879 DOI: 10.1017/s1461145710001112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.
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Hildebrandt S. Anatomy in the Third Reich: an outline, part 3. The science and ethics of anatomy in National Socialist Germany and postwar consequences. Clin Anat 2009; 22:906-15. [DOI: 10.1002/ca.20874] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hildebrandt S. Anatomy in the Third Reich: An outline, part 2. Bodies for anatomy and related medical disciplines. Clin Anat 2009; 22:894-905. [DOI: 10.1002/ca.20873] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Strous RD. Psychiatry during the Nazi era: ethical lessons for the modern professional. Ann Gen Psychiatry 2007; 6:8. [PMID: 17326822 PMCID: PMC1828151 DOI: 10.1186/1744-859x-6-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 02/27/2007] [Indexed: 11/29/2022] Open
Abstract
For the first time in history, psychiatrists during the Nazi era sought to systematically exterminate their patients. However, little has been published from this dark period analyzing what may be learned for clinical and research psychiatry. At each stage in the murderous process lay a series of unethical and heinous practices, with many psychiatrists demonstrating a profound commitment to the atrocities, playing central, pivotal roles critical to the success of Nazi policy. Several misconceptions led to this misconduct, including allowing philosophical constructs to define clinical practice, focusing exclusively on preventative medicine, allowing political pressures to influence practice, blurring the roles of clinicians and researchers, and falsely believing that good science and good ethics always co-exist. Psychiatry during this period provides a most horrifying example of how science may be perverted by external forces. It thus becomes crucial to include the Nazi era psychiatry experience in ethics training as an example of proper practice gone awry.
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Affiliation(s)
- Rael D Strous
- Department of Psychiatry, Beer Yaakov Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Reuben A. First do no harm. 2005. Hepatology 2006; 43:S243-9. [PMID: 16447277 DOI: 10.1002/hep.21083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Adrian Reuben
- Division of GI/Hepatology, Department of Medicine, Medical University of South Carolina, SC, USA
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Hildebrandt S. How the Pernkopf controversy facilitated a historical and ethical analysis of the anatomical sciences in Austria and Germany: A recommendation for the continued use of the Pernkopf atlas. Clin Anat 2006; 19:91-100. [PMID: 16425297 DOI: 10.1002/ca.20272] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eduard Pernkopf's Topographical Anatomy of Man has been a widely used standard work of anatomy for over sixty years. International inquiries about the National Socialist (NS) political background of Eduard Pernkopf and the use of bodies of NS victims for the atlas were first directed at the University of Vienna in 1996. A public discussion about the further use of the book followed and led to the creation of the Senatorial Project of the University of Vienna in 1997. This historical research project confirmed the strong NS affiliation of Pernkopf and revealed the delivery of at least 1,377 bodies of executed persons to the Anatomical Institute of Vienna during the NS time. The possible use of these bodies as models cannot be excluded for up to half of the approximately 800 plates in the atlas. In addition tissue specimens from NS victims were found and removed from the collections of the Viennese Medical School and received a burial in a grave of honor. The Pernkopf controversy facilitated the historical and ethical analysis of the anatomical sciences in Austria and Germany during the NS regime. The continued use of the Pernkopf atlas is not only justifiable but desirable as a tool in the teaching of anatomy, history, and ethics.
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Affiliation(s)
- Sabine Hildebrandt
- Division of Anatomical Sciences, Office of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan 48109-0608, USA.
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Affiliation(s)
- Adrian Reuben
- Division of GI/Hepatology, Department of Medicine, Medical University of South Carolina, USA
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