TMC PULSE

t m c » p u l s e | a p r i l 2 0 1 7 14 Medicine After the Holocaust Ethicists cite a slippery slope between eugenics and genetics S ince 2011, Sheldon Rubenfeld, M.D., a clinical professor of medicine at Baylor College of Medicine, has been leading groups of doctors, professors and researchers through Europe to fol- low the progression of medicine during the Holocaust. In May, he will take a group to Nuremberg to honor the 70th anni- versary of the Nuremberg Code, a landmark document that outlined the rules and medical ethics surrounding research experiments on humans. Rubenfeld, executive director of the Center for Medicine after the Holocaust, says that the eugenics pol- icies enacted by the Nazis are not only applicable to modern medicine, but were influenced by eugenics policies in the United States in the early 20th century. "If you trace the history of medi- cine's involvement in the health care policy of the Third Reich, which they called 'applied biology'—applying eugenics to eliminate people they considered inferior from first reproduc- ing, secondly marrying and finally from living—you can begin to understand the need for medicine during the Holocaust to be taught in medical ethics courses today," Rubenfeld said. By the early 1900s, Americans had become captivated by eugenics, a philosophy that stemmed from Charles Darwin's theory of natural selection. Eugenics is defined as the science of improving a human population by controlled breeding, in order to increase the occurrence of desirable inheritable characteristics. "We didn't understand genetics at the time, but we were using theories of inheritance to rid the population or prevent certain members of the popu- lation from procreating through forced sterilization," explained Amy McGuire, J.D., Ph.D., director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. In 1896, Connecticut was the first state to prohibit people who were "epi- leptic, imbecile or feeble-minded" from marrying. Other states soon followed suit. Over the next 30 years, additional laws passed mandating sterilization for people held in mental institutions, individuals with low IQs and violent criminals. From 1907 to 1963, more than 60,000 individuals were forcibly steril- ized in the United States. "Hitler realized this philosophy was very powerful and he decided to take advantage of it because it was a medical philosophy that had already been in place throughout the western world for the past 30 years," Rubenfeld said. "Implementing eugenic policies … eliminated the high cost of caring for the genetically ill and kept the Aryan race pure." Before the Jewish population of Europe was forced into concentration camps, the goal of the Nazi regime was to purify the German race. By 1935, Germany had adopted the Nuremberg Laws, which excluded German Jews from citizenship and forbade them from marrying or hav- ing sexual relations with persons of "German or related blood." The regime only provided medical care to healthy Germans and began mass sterilizations of "feeble-minded" Germans and people with alleged genetic deformities. "Most of the time, the Holocaust is viewed as a war against the Jews," Rubenfeld said, "but it was really a war against the genetically inferior." During his trips to Europe, Rubenfeld and his group visit concen- tration camps and hospitals that were in operation during the Holocaust. This year, in addition to Nuremberg, they will stop at Auschwitz, Goethe University's Institute for the History and Ethics of Medicine, and Hadamar Euthanasia Centre. Hadamar Euthanasia Centre "looks like any other hospital you've ever been to—St. Luke's, Methodist, all white walls," Rubenfeld said. "And then you go down to the basement. The white walls become cinder blocks and you pass a dissection room before walking into a gas chamber. The gas chambers were put into hospitals originally with the intent of providing 'mercy killings' to disabled Germans, not the Jewish population." As the Nazi regime gained more power and control of Europe, what began as a goal to "cleanse" the German population turned into a plan to rid the world of Jewish and non- Aryan people. Concentration camps were used to not only kill Jews but also to conduct research. "In human subjects research, the Germans did very good science," Rubenfeld explained. "Their methods and their scientific protocols were good except for one thing: when they should have been using animals, they were using humans." By the end of the war in 1945, millions had been killed. The doctors who implemented applied biology and participated in the mass murders were brought to trial by the United States, Russia, Great Britain and France during what came to be known as the Nuremberg Trials. Most of the time, the Holocaust is viewed as a war against the Jews, but it was really a war against the genetically inferior. — SHELDON RUBENFELD, M.D. Clinical professor of medicine at Baylor College of Medicine and executive director of the Center for Medicine after the Holocaust B y B r i t n i N . R i l e y

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