Program for Biomedical Ethics Lindenthal

Transcript

• 00:19Right.
• 00:24So you
• 00:25I have you're right.
• 00:50Good evening.
• 00:54And congratulations to those who
• 00:55found their way here.
• 00:57I think, Jack, are we
• 00:58pretty much cleared out there
• 00:59from the folks who have
• 01:00their dinners?
• 01:02We're good. Okay.
• 01:03Well,
• 01:04welcome
• 01:05to the Lindenthal Lecture
• 01:07on Holocaust and genocide, which,
• 01:09as you know, as we've
• 01:10talked about, is an annual
• 01:11event here at the Yale
• 01:11School of Medicine,
• 01:13hosted by the program for
• 01:14biomedical ethics
• 01:15and sponsored,
• 01:17by our friend Jacob Lindenthal.
• 01:20And we we very much
• 01:21appreciate,
• 01:22doctor Lindenthal's,
• 01:24words to us a few
• 01:25minutes ago. I wanna spend
• 01:26a few minutes now speaking
• 01:28about tonight's guest speaker.
• 01:30And,
• 01:31we were very fortunate that
• 01:32that,
• 01:34doctor Matt Winya, professor Matt
• 01:35Winya agreed to come and
• 01:37join us this year. So
• 01:38let me tell you a
• 01:38bit about Matthew Winya, MDMPH.
• 01:41He's board certified in internal
• 01:43medicine and infectious diseases with
• 01:45additional training in public health
• 01:46and health services research. He's
• 01:48worked nationally and internationally
• 01:51on issues related to professionalism
• 01:53and on the social roles
• 01:54of physicians, including the roles
• 01:56of health professionals in the
• 01:57holocaust
• 01:58and the contemporary implications of
• 02:00this legacy.
• 02:01He's worked with organizations, including
• 02:03the American Medical Association, the
• 02:05National Academies of Medicine, Engineering,
• 02:07and excuse me. Sciences, Engineering,
• 02:09and Medicine,
• 02:10and the American Board of
• 02:11Medical Specialties,
• 02:12as well as the US
• 02:13Holocaust,
• 02:14Memorial Museum.
• 02:16And he's led national projects
• 02:17on medicine and the holocaust,
• 02:19professionalism
• 02:20and medicine and public health,
• 02:22ethics in wartime, and so
• 02:23much other important work.
• 02:26He's a member of the
• 02:26Lancet Commission, most notably, which
• 02:28so many of you are
• 02:29familiar with, the Lancet Commission
• 02:30on Medicine, Nazism, and the
• 02:32Holocaust, and he's served on
• 02:34numerous other major major commissions.
• 02:37He's delivered more than two
• 02:38dozen named lectures
• 02:39and visiting professorships, and he's
• 02:41authored,
• 02:42well over two hundred papers.
• 02:44He served as, in various
• 02:46societies, but notably to the
• 02:48ethicists in the in the
• 02:49audience. He's the past president
• 02:51of the American,
• 02:52Society for Bioethics and Humanities,
• 02:54which is kind of like,
• 02:56our mother ship in in,
• 02:58medical ethics.
• 02:59He currently leads the University
• 03:01of Colorado's
• 03:02Center for Bioethics and Humanities
• 03:04where the holocaust, genocide, and
• 03:05contemporary bioethics program
• 03:08spans all health sciences trainings
• 03:09programs
• 03:10in all four campuses.
• 03:13He's educated,
• 03:15for
• 03:16college and medical school in
• 03:18Oregon
• 03:18and received his clinical training
• 03:20at the Deaconess in Boston
• 03:23and then, was on faculty
• 03:25for many years in Chicago
• 03:26until he has moved to
• 03:28Colorado. And now tonight, he's
• 03:30in New Haven and is
• 03:31our very good fortune. So
• 03:32thank you so much. Please
• 03:33join me in welcoming doctor
• 03:35Matt Wenea.
• 03:42So much.
• 03:44Can you guys hear me
• 03:45okay? I'm sorry. I apologize.
• 03:47Before you start, so you
• 03:49folks know, because some folks
• 03:50are wondering,
• 03:51how this is going to
• 03:53what the the lay of
• 03:53the land is. You saw
• 03:54the code for, registering for
• 03:56CME if you wanted. And
• 03:58there, Matt's gonna share it
• 03:59with you again. So so,
• 04:01Matt's gonna speak for about
• 04:03forty five minutes plus or
• 04:04minus a little bit. And
• 04:05after that, he and I
• 04:06are just gonna sit down
• 04:06here. We're gonna entertain questions
• 04:08from the audience. And I
• 04:10invite you to line up
• 04:11at either microphone, and please,
• 04:13we're interested in your comments
• 04:15and your questions,
• 04:16for doctor Winiya, and we're
• 04:17looking forward to that. But
• 04:19I will tell you that
• 04:20we will end let's see.
• 04:22So we're half an hour
• 04:23behind, so we will finish
• 04:24at,
• 04:25seven o'clock. Yes? Yes. That's
• 04:27right. So the the evening
• 04:29will end at seven o'clock.
• 04:30Until then, we're gonna have
• 04:31a terrific session, and thanks
• 04:32so much for being here.
• 04:33Sorry about that. Yeah. No
• 04:34worries.
• 04:38So this is a
• 04:40this is a difficult talk.
• 04:41This is a a talk
• 04:42that,
• 04:43I developed in collaboration with
• 04:46a woman who at the
• 04:47time was the senior historian
• 04:48for medical crimes
• 04:50at the Holocaust Museum in
• 04:51Washington, DC.
• 04:53She always
• 04:54and I I put this
• 04:55up just to say,
• 04:57these are the major groups
• 04:58that do work in this
• 04:59area.
• 05:00And one of the things
• 05:01that I've
• 05:03taken from my work with
• 05:04the Lancet Commission is
• 05:06the emphasis on bringing this
• 05:07history into
• 05:09contemporary
• 05:10thinking
• 05:11and the importance of connecting
• 05:15this history, which, you know,
• 05:16for many of us is
• 05:17kinda distant,
• 05:18both in time and in
• 05:20space,
• 05:21to an American context.
• 05:24So I am not going
• 05:26to give you the Lancet
• 05:27Commission version, and I'm not
• 05:29gonna give you the Holocaust
• 05:30Museum version. I'm gonna I'm
• 05:32gonna give you what I
• 05:33consider to be sort of
• 05:34an American view
• 05:36on this history.
• 05:38My great colleague at the
• 05:40museum, doctor Patricia Haber Rice,
• 05:42likes to start her version
• 05:44of this
• 05:45history by saying,
• 05:46this is a story of
• 05:48medicine betrayed
• 05:51by a notorious dictatorship.
• 05:54And the the more I
• 05:56have thought and learned about
• 05:57this,
• 05:58the,
• 05:59the more
• 06:01nuance, I think, needs to,
• 06:04be brought to that sentiment.
• 06:07This is a story about,
• 06:09you know, our history, and
• 06:11it's a it's a story
• 06:12that is
• 06:14really, difficult
• 06:16for many people in health
• 06:17care to assimilate because we
• 06:19like to think
• 06:20that our
• 06:22ethics are two thousand years
• 06:24old,
• 06:25and they are robust
• 06:28and, you know, solid
• 06:30underneath us.
• 06:32And yet
• 06:33this history shows
• 06:35that that is not true,
• 06:38that our ethics are more
• 06:40fragile than we think,
• 06:42and that some of the
• 06:43reasons for that fragility are
• 06:44baked in to the type
• 06:47of work we do and
• 06:48to the entire scientific enterprise.
• 06:53And
• 06:56the the thing I remember
• 06:57the most when I first
• 06:58started learning about this, I
• 07:00I was invited to DC
• 07:01to see
• 07:02this special exhibit that the
• 07:04museum was putting together. It
• 07:05was still up on storyboards.
• 07:08So I'm walking around this
• 07:09room, looking at these storyboards,
• 07:11and I remember thinking, Oh
• 07:12my God,
• 07:14there is not a single
• 07:16issue
• 07:17that we are dealing with
• 07:18today. And at that time,
• 07:19I was director for managed
• 07:21care ethics at the American
• 07:23Medical Association.
• 07:25And I thought, you know,
• 07:27this is
• 07:28pervasive.
• 07:29This history
• 07:31influences the way we think.
• 07:33Even if we're not thinking
• 07:35of this history,
• 07:36it influences the way we
• 07:38think
• 07:39about abortion,
• 07:40about end of life care,
• 07:42about cost control,
• 07:44about public health ethics, about
• 07:45genetics and ethics. Like, I
• 07:48defy you to think of
• 07:49a modern
• 07:51bioethics issue
• 07:53that is not in some
• 07:54way influenced
• 07:56by the legacy of health
• 07:57professional involvement in the holocaust
• 07:59and Nazism.
• 08:02So what I'm gonna do
• 08:04today and I have a
• 08:05blank slide here. This is
• 08:06blank intentionally because I need
• 08:08to say two things to
• 08:10you without you looking at
• 08:11a slide.
• 08:13I give a lot of
• 08:14difficult talks.
• 08:15I like to say if
• 08:16it's not controversial,
• 08:18it's not ethics.
• 08:20Right? If everyone already agrees,
• 08:22it's not really an ethical
• 08:23issue anymore.
• 08:24So every talk I give
• 08:26has the possibility of controversy.
• 08:28This one is different in
• 08:30two ways,
• 08:31one personal and one professional.
• 08:34On a personal level,
• 08:38many of you give lectures.
• 08:39You know,
• 08:41when you give a lecture,
• 08:42there's a possibility someone in
• 08:43the audience
• 08:44might know the topic
• 08:46as well as or better
• 08:47than you do.
• 08:49Right? That happens.
• 08:51With this topic,
• 08:53there are people,
• 08:54including some people, I'm sure,
• 08:56in this audience,
• 08:58who own
• 08:59this history
• 09:02in a way that I
• 09:02never will.
• 09:05Right? I'm not Jewish. I'm
• 09:07not German.
• 09:08I have no direct familial
• 09:10connection to this history.
• 09:13And yet,
• 09:16somehow,
• 09:17we have to all
• 09:19own this history.
• 09:21The more I learn about
• 09:22it, the more I think
• 09:23it is actually unfair
• 09:26for the Jewish community
• 09:28to be responsible for bearing
• 09:30this history.
• 09:32This is our history. This
• 09:33is the history of our
• 09:34profession. It's not Jewish history.
• 09:36I mean, it is Jewish
• 09:37history. It's not just Jewish
• 09:39history.
• 09:40This is medical history. This
• 09:42is about how we got
• 09:44to the ethics that we
• 09:45have today
• 09:46and about how they were
• 09:47challenged
• 09:48and how we failed to
• 09:49stand up for
• 09:51them.
• 09:52The second piece is professional
• 09:54challenge, and this one I
• 09:55do not have an answer
• 09:56to, but,
• 09:59there is a real dilemma
• 10:01in trying to bring this
• 10:02history forward.
• 10:04If
• 10:05I do a good job
• 10:06tonight
• 10:08in explaining
• 10:09how Nazi
• 10:11physicians and nurses and dentists
• 10:13and pharmacists
• 10:15came to think the way
• 10:17they did and came to
• 10:18do what they did,
• 10:21that is perilously close
• 10:24to excusing or rationalizing
• 10:26Nazis.
• 10:31And worse,
• 10:32if I do anything that
• 10:34meet makes it sound like
• 10:35I'm comparing
• 10:37something that's happening today
• 10:38to something that happened then,
• 10:41that's called playing the Nazi
• 10:42card,
• 10:44and it is more likely
• 10:45to cause people to shut
• 10:47down
• 10:48than it is to cause
• 10:49them to open up.
• 10:50No one who hears you're
• 10:52behaving like a Nazi says,
• 10:54oh my gosh. You're right.
• 10:57Let me rethink this.
• 11:00Right? It provokes defensiveness, and
• 11:02there's a reason for that.
• 11:03Right? I I will say
• 11:05I do some work in
• 11:06research ethics,
• 11:08plenty of research ethics scandals
• 11:09to go around.
• 11:12There is nothing happening today
• 11:15that is the same as
• 11:17intentionally
• 11:18infecting a young child with
• 11:20typhus
• 11:21and then waiting until she
• 11:23dies
• 11:24and then killing her healthy
• 11:26twin so that you can
• 11:27compare their organs.
• 11:30Right? Nothing happening today is
• 11:32that.
• 11:34So there is a very
• 11:35real sense in which this
• 11:37history
• 11:38is impossible to learn from
• 11:40because it is so heinous.
• 11:44And yet,
• 11:47somehow, we have to figure
• 11:49out how to learn from
• 11:49this history,
• 11:52and I don't know how.
• 11:54I just know that as
• 11:56as I start to tell
• 11:57this story, I appeal to
• 11:59you to try to just
• 12:00have an open mind.
• 12:03I am not going to
• 12:05tell you what the meaning
• 12:06of this history is for
• 12:07today.
• 12:08I will have a few
• 12:09words about that at the
• 12:10end, but for the most
• 12:11part, I'm just gonna tell
• 12:12the story.
• 12:15This story starts
• 12:18way before Hitler,
• 12:21and it starts,
• 12:23well outside of Germany.
• 12:28I'm gonna make this argument,
• 12:30and I put this slide
• 12:31up because I want you
• 12:32to know I'm not the
• 12:33first person because this will
• 12:34sound outrageous.
• 12:36Without doctors'
• 12:38involvement,
• 12:39the holocaust itself might never
• 12:41have happened.
• 12:43That sounds weird. I understand
• 12:45because Hitler did not need
• 12:47doctors to be anti Semitic.
• 12:49He did not need doctors
• 12:51to carry out the holocaust
• 12:52by bullets.
• 12:53Right? There are many facets
• 12:54of World War two
• 12:56that did not rely on
• 12:57medicine.
• 13:00But this idea
• 13:03that mass factories of death
• 13:05were tools
• 13:07of a public health intervention
• 13:10is critical to understanding this
• 13:12history, and that's why you
• 13:14have to start this history
• 13:15way before Hitler.
• 13:17This is from Plato's Republic
• 13:20many, many years before.
• 13:23And already at that time,
• 13:24they are talking about what
• 13:25would later become known as
• 13:26eugenics.
• 13:27Right? Eugenics is just the
• 13:29idea of selective breeding,
• 13:31which has been done on
• 13:32farms forever.
• 13:33If you want
• 13:35a faster horse
• 13:36or a stronger ox,
• 13:40you do selective breeding to
• 13:41achieve that. And if you
• 13:42want a better human race,
• 13:44you can do that in
• 13:45the same way.
• 13:47That's the basic idea of
• 13:49eugenics.
• 13:51Eugenics has both positive
• 13:53and negative
• 13:55aspects or ways of thinking.
• 13:57In the positive aspect is
• 13:59the pick the people that
• 14:00you think ought to be
• 14:01having lots of babies,
• 14:03as Plato was saying, with
• 14:04the with the young, healthy
• 14:06soldiers,
• 14:07and encourage them to have
• 14:09more babies.
• 14:10And make sure that those
• 14:11babies are healthy. Discourage the
• 14:13mothers from drinking and smoking
• 14:15during pregnancy. Right?
• 14:17And then there's the negative
• 14:18eugenics.
• 14:19That's for those you deem
• 14:21less valuable to society.
• 14:23Those people,
• 14:24you wanna make sure do
• 14:25not have as many babies.
• 14:27So you discourage reproduction
• 14:29or you make it impossible
• 14:31for them to reproduce. Or
• 14:32if you think they actually
• 14:33pose a threat to the
• 14:34whole community, maybe you kill
• 14:36them.
• 14:37Right? And that's
• 14:39this is the whole story
• 14:40kind of in a nutshell.
• 14:41Right?
• 14:42Eugenics comes along at a
• 14:44really interesting time,
• 14:46which I think in many
• 14:48ways is is a perfect
• 14:49storm.
• 14:50Right? So eugenics is,
• 14:53is Galton's,
• 14:55term. Galton, cousin of Darwin.
• 14:59So this idea of,
• 15:02of evolutionary
• 15:03progress
• 15:04is in the air,
• 15:06and then you have the
• 15:07rediscovery of Mendelian genetics at
• 15:10the same time, which makes
• 15:11it sound like if that's
• 15:13your under if that's your
• 15:14simplified understanding of genetics,
• 15:16within a few generations, you
• 15:18can change entire populations.
• 15:21Right? So Mendelian genetics,
• 15:23Darwinian evolution,
• 15:25Galton's ideas around selective breeding
• 15:28of the human race, and
• 15:30then you add on top
• 15:31of that,
• 15:32issues of public health or
• 15:34social medicine, which are just
• 15:36being born in the same
• 15:37era,
• 15:38along with epidemiology
• 15:40and statistics,
• 15:42all being all being
• 15:44created in the same time
• 15:46frame, and they all come
• 15:47into play.
• 15:48So I'll give you an
• 15:49example here. Most of the,
• 15:52famous eugenicists are not German.
• 15:54Carl Pearson is English. You
• 15:56may recognize this name from
• 15:57the Pearson chi square test.
• 15:59He also,
• 16:01discovered regression to the mean,
• 16:02the p value,
• 16:04an extreme, you know, polymath.
• 16:07And Pearson's books by the
• 16:09way, The Grammar of Science
• 16:11was the first book that,
• 16:12Albert Einstein assigned to the
• 16:14Olympia Academy in New York.
• 16:16So these are very famous,
• 16:18very popular books.
• 16:20And you can see that,
• 16:21you know, he's talking about
• 16:22how,
• 16:23a healthy and sound stock.
• 16:25You can try to build
• 16:27up,
• 16:28a degenerated
• 16:29community, but the next generation,
• 16:31you're gonna have to build
• 16:32them all back up again
• 16:33because it's this is all
• 16:34nature, no nurture.
• 16:36Right? I'll also notice, by
• 16:38the way, that the concept
• 16:39of an Aryan race
• 16:41as being a superior race
• 16:43is present in nineteen o
• 16:45one
• 16:46when Hitler is twelve years
• 16:47old.
• 16:49So he does not invent
• 16:50this idea.
• 16:52This is the first international
• 16:53eugenics conference. The attendees, if
• 16:55you recognize them, are probably
• 16:57not the Nazis, although there
• 16:58are a couple of infamous
• 17:00Nazis on this list.
• 17:03But people like William Osler
• 17:05and
• 17:06Charles Davenport and Winston Churchill
• 17:08and Alexander Graham Bell and
• 17:10Leonard Darwin.
• 17:12Let me just show you,
• 17:13one of the pieces from
• 17:14the International Eugenics Conference. This
• 17:16is the very first one,
• 17:17and you may recognize this
• 17:19guy. This is Alfred Punnett,
• 17:22who Punnett squares anyone
• 17:24from biology, high school biology?
• 17:27Alfred Punnett says, if we
• 17:29could just get feeble minded
• 17:30people to stop having babies,
• 17:32within a few generations, we
• 17:33would have no more feeble
• 17:34minded people.
• 17:36This is, of course, a
• 17:37diagnosis that we don't recognize
• 17:39today, but it was a
• 17:41recognized diagnosis at the time.
• 17:44This is the first international
• 17:45conference on, not eugenics,
• 17:48but what we called it
• 17:49in the US mostly,
• 17:51race betterment.
• 17:53The US and Germany
• 17:54eugenics and racism are not
• 17:56always linked,
• 17:57but they are in the
• 17:58US, and they are in
• 17:59Germany.
• 18:01This idea
• 18:02that, that genes and race
• 18:05are connected
• 18:06was very important in our
• 18:07country.
• 18:09And, again, you'll see, you
• 18:10know, some very famous names
• 18:11here, including a guy named
• 18:12Harry Laughlin, whom I'll mention
• 18:14again in a moment.
• 18:16This is a book I
• 18:17picked up in Michigan at
• 18:19a used bookstore years ago.
• 18:20It's a it's a set
• 18:22of lectures
• 18:23that you could invite someone
• 18:25from your local medical society
• 18:26to come out and give
• 18:27a talk, like, at your
• 18:28church group. So this is
• 18:29from nineteen thirteen,
• 18:31And I'll just show you
• 18:32the one from Colorado because
• 18:34it's the one that I
• 18:35happen to have a slide
• 18:36on.
• 18:37I would say maybe a
• 18:39quarter of these are titled
• 18:41something like this, about eugenics.
• 18:45So this was a very
• 18:47common,
• 18:48belief system
• 18:50within the medical community in
• 18:52the US.
• 18:54I mentioned already that Americans
• 18:57and Germans
• 18:58had some unique,
• 18:59cross fertilization that went on.
• 19:02Part of the reasons for
• 19:03that were that Hitler saw
• 19:05our conquest of the American
• 19:07West
• 19:08as comparable
• 19:09to his attempt to conquer
• 19:11the European
• 19:13East.
• 19:14In fact, he called Eastern
• 19:15Europeans Indians,
• 19:18and he talked at length.
• 19:19He in fact, there was
• 19:20a guy named Karl May
• 19:21who wrote these books about
• 19:23the American,
• 19:24Indian wars,
• 19:26and he assigned these were
• 19:27children's books, but it would
• 19:29be young adult fiction.
• 19:31He actually assigned some of
• 19:32these books to his generals
• 19:34because he thought they were
• 19:35so, articulate
• 19:37about the manifest destiny idea
• 19:41and the and the war
• 19:42tactics
• 19:43of the Americans
• 19:44in getting rid of the
• 19:45Indians.
• 19:47So he Hitler famously said
• 19:49that the Volga will be
• 19:51our Mississippi.
• 19:52Right? So we're going to
• 19:54conquer everything west or every
• 19:56in his case, everything east
• 19:57of it.
• 19:59There are a number of
• 19:59books about this, by the
• 20:00way, so none of what
• 20:01I'm saying is brand new,
• 20:03thinking.
• 20:06The ways in which
• 20:08American policy
• 20:10influenced the Nazis is interesting,
• 20:13because
• 20:14when the Nazis come to
• 20:15power in nineteen thirty three,
• 20:17outside
• 20:18of some of their colonial
• 20:20laws,
• 20:21there were no laws in
• 20:22Germany that were defining people
• 20:25by groups, by racial groups,
• 20:26by religious groups, or anything
• 20:28like that.
• 20:29So they had to find
• 20:30other countries.
• 20:32And the country that has
• 20:33generations
• 20:35of experience by this time
• 20:38in defining people and creating
• 20:40public policy based on their
• 20:42racial categorization
• 20:43is, of course, the US.
• 20:46We had been doing this
• 20:47for a long, long time.
• 20:49And at the time of
• 20:50the war, you know, all
• 20:52of
• 20:53the,
• 20:55all of the,
• 20:56red, all of the,
• 20:59green,
• 21:00all of the,
• 21:02yellow, these all have anti
• 21:04miscegenation
• 21:04laws, laws that prevent marriage
• 21:06based on race.
• 21:08So they actually the Nazis
• 21:10send scholars, legal scholars to
• 21:12the US to travel through
• 21:13the American South, to look
• 21:15at these race laws, to
• 21:16talk to the policymakers,
• 21:17to try and learn about
• 21:19how you do this.
• 21:20One of
• 21:21the, perhaps, ironies of this
• 21:23is that they go back
• 21:24to Germany and they describe
• 21:25what they saw in the
• 21:26US, which is a number
• 21:28of these states have what
• 21:29what we call the one
• 21:31drop rule.
• 21:32Right? If you have any
• 21:33black person in your history,
• 21:35you are black.
• 21:37Does doesn't matter. It could
• 21:38be, you know, a second
• 21:40cousin twice removed.
• 21:43That is,
• 21:45too extreme for the Nazis.
• 21:48Right? When they passed the
• 21:49Nuremberg race laws,
• 21:51in nineteen thirty five,
• 21:53you have to have three
• 21:55grandparents who are Jewish to
• 21:56be fully Jewish. If you
• 21:57only have two grandparents Jewish,
• 21:59you're half.
• 22:00And if you only have
• 22:01one, you're not Jewish anymore.
• 22:04So they are much less
• 22:06stringent
• 22:07in their racial categorizations
• 22:08than we were.
• 22:10So those laws do not
• 22:12make a huge impact. This
• 22:14law does.
• 22:15So this is Harry Laughlin's
• 22:16law that I was, mentioning
• 22:18Harry Laughlin before. He writes
• 22:19a model law on forcible
• 22:21sterilization.
• 22:23And as you may know,
• 22:24the first forcible sterilization laws
• 22:26in the US are from
• 22:27the early nineteen hundreds, nineteen
• 22:29o seven in Indiana.
• 22:31So that law in Indiana
• 22:32had been back and forth
• 22:33in the courts
• 22:34as well as in the
• 22:35court of public opinion. It
• 22:36had been overturned and then
• 22:38reinstated.
• 22:39So that law had had
• 22:40sort of the kinks knocked
• 22:42out of it through the
• 22:42American policy making process.
• 22:45In fact,
• 22:46that law had gone to
• 22:47the Supreme Court in the
• 22:49infamous case of Buck versus
• 22:50Bell,
• 22:51in which Carrie Buck, who
• 22:53had a child who was
• 22:54deemed to be feeble minded,
• 22:56and Carrie herself was deemed
• 22:58then to be feeble minded
• 22:59because she had this child
• 23:00out of wedlock.
• 23:02She was probably raped by
• 23:03the son of the family
• 23:05that she was being raised
• 23:06by.
• 23:07But in any event,
• 23:09she,
• 23:10in later interviews, showed no
• 23:11signs of cognitive disability. Her
• 23:13child, by the way, also
• 23:14didn't have any cognitive disabilities,
• 23:16but only lived to, I
• 23:17think, third grade, but had
• 23:19normal grades, through the first
• 23:20couple years of school.
• 23:22In any event, the famous
• 23:24quote from this is three
• 23:25generations of imbeciles are enough.
• 23:29That if you've seen, her
• 23:30mother was institutionalized,
• 23:32probably did have a significant
• 23:33cognitive disability.
• 23:35So mother,
• 23:36Carrie, baby, those are the
• 23:38three generations of imbeciles,
• 23:40and enough means this justifies
• 23:43cutting her fallopian tubes by
• 23:44force, by the way. I
• 23:46highlighted the sentence before that,
• 23:48though,
• 23:49because,
• 23:50I guess, I don't have
• 23:51a light. But I just
• 23:52want you to notice this.
• 23:53The only case the only
• 23:55other Supreme Court case that
• 23:57is cited in this is
• 23:58the Jacobson case from nineteen
• 24:00o five, which justifies,
• 24:03compulsory vaccination.
• 24:06Now compulsory vaccination
• 24:08at that time was a
• 24:09fine of five dollars if
• 24:11you didn't get vaccinated.
• 24:13Quite a bit different, honestly,
• 24:15than literally tying someone down
• 24:18and cutting her fallopian tubes
• 24:20as a surgical procedure.
• 24:22But the I put this
• 24:23up here because
• 24:24this is the mindset. This
• 24:26is a public health law.
• 24:30Forcible sterilization
• 24:31in the US is a
• 24:33public health law, and one
• 24:34of the first major
• 24:36acts of the Nazis
• 24:38in July of nineteen thirty
• 24:39three, so six months after
• 24:41they come to power, it
• 24:42takes a few months to
• 24:43consolidate power,
• 24:45and then they start passing
• 24:46laws. Right? So, initially, they
• 24:49don't pass laws because that's
• 24:50not how you consolidate power.
• 24:53You destroy court systems and
• 24:54that kind of thing. Right?
• 24:55So they're working on that
• 24:56the first few months. They
• 24:58get into power. They start
• 24:59passing laws.
• 25:01One of the first laws
• 25:03is this one,
• 25:04which is essentially
• 25:05a carbon copy of the
• 25:07California law.
• 25:09I will say the Germans
• 25:11are going to implement this
• 25:12in a much more stringent
• 25:14way, a much more active
• 25:16way than we ever did
• 25:17in the US. We had
• 25:18forceful sterilization programs in the
• 25:20United States from nineteen o
• 25:22seven until at least the
• 25:23nineteen seventies. The well, the
• 25:25eighties, really. The last woman
• 25:27sterilized in my home state
• 25:28of Oregon was in nineteen
• 25:29eighty two,
• 25:31the year I graduated high
• 25:32school, by the way.
• 25:34So these laws did not
• 25:35go away after the war.
• 25:37In fact, they ramped up
• 25:39after the war. The
• 25:40the
• 25:41largest number of forcible sterilizations
• 25:44in the US took place,
• 25:45we think, in nineteen sixty
• 25:47two.
• 25:47So long after the war.
• 25:50Different story. The Germans are
• 25:52going to so we, in
• 25:53about seventy years,
• 25:55American physicians
• 25:57will sterilize
• 25:58about seventy thousand people against
• 26:00their will.
• 26:02In Germany, they will sterilize
• 26:04almost four hundred thousand people,
• 26:06three hundred and fifty about,
• 26:08three hundred and fifty thousand
• 26:09people in less than five
• 26:10years.
• 26:12So they are very much
• 26:13more aggressive than we are.
• 26:14And the way they do
• 26:15this is by setting up
• 26:16these hereditary health courts.
• 26:18Hereditary health courts are set
• 26:20up in parallel to the
• 26:21normal German legal system.
• 26:24Hitler hates the court system,
• 26:27because courts put limits on
• 26:29what you can do. And
• 26:30so he sets this up
• 26:31as a parallel process. So,
• 26:34they don't have juries in
• 26:35Germany. They just have jurists,
• 26:37judges.
• 26:38So in this case, there
• 26:40are about two hundred and
• 26:41fifty of these hereditary health
• 26:42courts. They're set up all
• 26:43over Germany.
• 26:44They comprise
• 26:45three decision makers, two of
• 26:47whom must be physicians,
• 26:49and one of whom is
• 26:50a judge.
• 26:51So the judge would break
• 26:53the tie if the two
• 26:54physicians disagree.
• 26:56They see these cases. They
• 26:58are typically, people are turned
• 26:59in by their doctors or,
• 27:02neighbors sometimes or other family
• 27:04members,
• 27:07and they will make a
• 27:08decision purely by looking at
• 27:10a piece of paper
• 27:11in very rapid fashion.
• 27:13There was an appeals process
• 27:15just like in the US,
• 27:16but if you lost your
• 27:17appeal, the jarred arms could
• 27:19come and pick you up
• 27:20and take you forcibly to
• 27:21the hospital to be sterilized.
• 27:24So
• 27:24they do,
• 27:26you
• 27:27know, in a country about
• 27:28a third the size of
• 27:29hours at the time,
• 27:31they're going to do
• 27:33four to five times as
• 27:34many sterilizations in a very
• 27:36short period of time, which,
• 27:37by the way, folks in
• 27:39the US in the eugenics
• 27:40movement here thought was this
• 27:42is what they should be
• 27:43doing. I I put the
• 27:45picture up here because I
• 27:46just wanna be clear. They
• 27:48know
• 27:49in Germany
• 27:50that other countries are doing
• 27:51this, and that gives them
• 27:54authorization. Right? They're saying here,
• 27:55we are not alone. And
• 27:57they've got on the left
• 27:57hand side other countries around
• 27:59the world that are already
• 28:00doing this,
• 28:02forcibly sterilizing people.
• 28:05So the question arises,
• 28:07if your goal as a
• 28:09public policy matter is to
• 28:10prevent
• 28:11children with disabilities from being
• 28:13born,
• 28:14and then a child is
• 28:15born with a disability,
• 28:18what do you do?
• 28:21This is,
• 28:22a quote from Karl Brandt
• 28:24at the Nuremberg medical trial.
• 28:27I will say Karl Brandt
• 28:29is the chief defendant at
• 28:30the Nuremberg trial. He was
• 28:32Hitler's personal physician, deeply involved
• 28:34in every program I'm gonna
• 28:35talk about,
• 28:36and you have to take
• 28:37him with a giant grain
• 28:39of salt.
• 28:39He lies a lot
• 28:42on the stand at Nuremberg.
• 28:44He was eventually killed,
• 28:47for his crimes. But what
• 28:48he says is that there
• 28:50was a child who was
• 28:51born, and the parents appealed
• 28:54to the fuhrer
• 28:55to allow them to have
• 28:56their child put to death
• 28:57because the child was suffering.
• 28:59It had no arms, half
• 29:00of a leg,
• 29:01something like that.
• 29:03And that they went and
• 29:04visited
• 29:05the child and agreed that
• 29:07the child should be euthanized,
• 29:11and
• 29:12he said he did not
• 29:14think
• 29:15that that should be a
• 29:16choice that parents should be
• 29:18forced to make.
• 29:20Doctors
• 29:21should make that choice.
• 29:25But it's not humane
• 29:28for parents to have to
• 29:29make that choice. Doctors should
• 29:31do it.
• 29:33This program
• 29:35becomes the first mass murder
• 29:37program of the Nazi regime.
• 29:40Under this program, about ten
• 29:42thousand children will be murdered.
• 29:44This precedes the Shoah, the
• 29:46holocaust, by about two years.
• 29:49In this program,
• 29:50children with disabilities
• 29:52are turned in by their
• 29:55midwives primarily because midwives delivered
• 29:57most babies in Germany at
• 29:58the time. The midwives are
• 30:00actually paid
• 30:01to turn in children to
• 30:02this program.
• 30:04If the child is turned
• 30:05into the program, the parents
• 30:07get a notice
• 30:08saying that your child has
• 30:10been selected for a special
• 30:11treatment program.
• 30:14They send their child to
• 30:15the special treatment program, which
• 30:17is a distant facility.
• 30:19In that facility, they are
• 30:20either starved to death or
• 30:21they are killed with an
• 30:22injection of phenol to the
• 30:24heart.
• 30:25In neither case are the
• 30:27parents told the truth.
• 30:28The parents are told that
• 30:29the child was doing okay,
• 30:31and then they're told, oh,
• 30:33sorry. They've taken a turn
• 30:34for the worse. They've developed
• 30:35pneumonia, and they've died. And
• 30:37mostly, they claimed death by
• 30:38pneumonia on the death certificate,
• 30:40although many of these children
• 30:42also had their brains removed
• 30:43for scientific study. Scientific study.
• 30:48This process
• 30:49of getting health professionals to
• 30:51turn people into a special
• 30:53treatment program
• 30:54does not stop with babies.
• 30:57It fairly rapidly progresses
• 30:59to what now is known
• 31:00as the axiom t four
• 31:02program.
• 31:03T four is for
• 31:05four. That's the building,
• 31:06in Berlin
• 31:07where the central central office
• 31:10where these assessments are done.
• 31:12It is staffed by,
• 31:14honestly, high ranking academic physicians
• 31:17primarily.
• 31:19And these,
• 31:20these physicians receive reports from
• 31:23all of the institutions in
• 31:25Germany where people are in
• 31:26long term care.
• 31:28Everyone is, everyone who runs
• 31:30one of these institutions
• 31:31has to fill out a
• 31:32form, a a survey, basically,
• 31:34on each of the patients
• 31:35that looks very much like
• 31:37the form that the,
• 31:39of the of the infant,
• 31:41murder program.
• 31:42It's by the way, they're
• 31:43they're calling this a euthanasia
• 31:45program. We always put that
• 31:46in scare quotes because this
• 31:47is not euthanasia
• 31:49in any contemporary sense of
• 31:51that word. This is these
• 31:52are both cynical programs of
• 31:54mass murder that are illegal
• 31:56under German law.
• 31:58There is no law in
• 31:59Germany that allows this. There
• 32:00is an authorization,
• 32:03in October of nineteen thirty
• 32:05nine that Hitler puts forward
• 32:07authorizing the t four program,
• 32:08but it's a secret authorization
• 32:11and also backdated to the
• 32:12beginning of the war,
• 32:14presumably because people thought it
• 32:16would be better accepted
• 32:18if they thought this was
• 32:19a wartime measure.
• 32:21So the t four program
• 32:23ramps up out of the
• 32:25child,
• 32:26program
• 32:27and involves killing of adults
• 32:29with disabilities in institutional settings
• 32:32across Germany.
• 32:33There are,
• 32:34seven different locations that are
• 32:36established, mostly in the basements
• 32:38of existing psychiatric facilities.
• 32:41So long term psychiatric hospitals
• 32:43would develop would be picked,
• 32:46for participation in this program.
• 32:47There would be a facility
• 32:49set up in the basement.
• 32:51People would would arrive.
• 32:53They would be transferred from
• 32:55their home facility and buses.
• 32:58They would arrive at one
• 32:59of these facilities.
• 33:00They would be stripped down,
• 33:02told that they were going
• 33:03to take a shower. It
• 33:04was not a shower. It
• 33:05was a gas chamber.
• 33:07They would be killed in
• 33:08the gas chamber. Their dental
• 33:10gold would be removed. Sometimes
• 33:12their brains would be removed,
• 33:13and then they would be
• 33:14cremated
• 33:15in specially designed high volume
• 33:17crematory ovens.
• 33:21And if that sounds familiar
• 33:22to you, it should
• 33:24because
• 33:25the camouflage techniques
• 33:28that get someone to walk
• 33:29right into a gas chamber,
• 33:32the,
• 33:33gassing
• 33:34technology to some extent,
• 33:36the crematory technology.
• 33:39All of these are transferred
• 33:41into
• 33:42the mass factories of death
• 33:44in German occupied Poland.
• 33:48There's one another factor that
• 33:49comes into play here, which
• 33:51is,
• 33:52Hitler is a dictator in
• 33:54a terror state, but he
• 33:55still cares about public opinion.
• 33:58So in,
• 33:59nineteen
• 34:00forty,
• 34:01two
• 34:02nineteen forty one, sorry, August
• 34:04of nineteen forty one, he
• 34:06calls a halt
• 34:07to the t four program
• 34:09publicly.
• 34:10That program was a secret
• 34:12program, but it got out.
• 34:15In the towns where people
• 34:16were being cremated,
• 34:18there would be hair sometimes
• 34:20falling from the sky, the
• 34:21acrid smoke from these crematory
• 34:23ovens.
• 34:24The children of the town
• 34:25would tell their children
• 34:27sorry. The parents of the
• 34:28town would tell their children,
• 34:30you know, if you're bad,
• 34:31we'll send you to the
• 34:32hospital up on the hill,
• 34:33and you know what happens
• 34:34there.
• 34:35There were even there were
• 34:36even,
• 34:38newspaper articles about this in
• 34:39the international press,
• 34:41Germany killing its disabled citizens.
• 34:44So Hitler calls a formal
• 34:46halt to this program
• 34:47after about seventy thousand people
• 34:49had been killed in
• 34:52it in, nineteen forty one.
• 34:54This does two things. Number
• 34:56one, it drives the t
• 34:57four program back into a
• 34:58more clandestine
• 34:59phase.
• 35:01Another almost two hundred thousand
• 35:03people will be killed in
• 35:04this program, but now in
• 35:05dispersed manner in hospitals all
• 35:07over the country.
• 35:09So they're not using these
• 35:10seven facilities.
• 35:12They're not burning people.
• 35:13They're now killing people in
• 35:15hospital beds.
• 35:17And this is just such
• 35:18a juxtaposition
• 35:19now because you've got a
• 35:21normal ward where some people
• 35:22are getting better. But if
• 35:23you deem that someone is
• 35:24gonna not get better, you
• 35:26can have them killed.
• 35:29So we have people healing
• 35:30and killing right next to
• 35:32each other in the same
• 35:33hospital, in the same wards,
• 35:35all through Germany.
• 35:36The other thing this does,
• 35:38though, is it puts about
• 35:39a hundred people out of
• 35:40work
• 35:41because there were staff,
• 35:44medical staff of the t
• 35:45four program.
• 35:47And these are people who
• 35:48are immured to the killing
• 35:50process,
• 35:52who
• 35:53are expert
• 35:55in the killing process,
• 35:57and who are devoted,
• 35:59who can keep a secret.
• 36:01And those people are largely
• 36:04transferred
• 36:05to the Reinhardt camps. The
• 36:07Reinhardt camps are Belzec, Sobibor,
• 36:09and Treblinka.
• 36:12I'll give you one example.
• 36:14The first common dot at
• 36:16Treblinka was a guy named
• 36:17doctor Imfrid Eberl.
• 36:20You know, I'm afraid. I
• 36:21never know that I'm saying
• 36:22his name right.
• 36:24Doctor Eberl
• 36:25was trained in the t
• 36:26four program.
• 36:28He becomes the commandant at
• 36:29Treblinka. If you're not familiar
• 36:31with Treblinka, Treblinka is
• 36:33the it's a pure extermination
• 36:35camp. There's no work going
• 36:37on there.
• 36:38It's an extermination camp to
• 36:39which the,
• 36:41Jews of the Warsaw ghetto
• 36:42are sent.
• 36:44So nine hundred thousand people
• 36:46are killed at Treblinka.
• 36:52So there you know, it's
• 36:54always
• 36:55it's always a hazard talking
• 36:56about this history to make
• 36:58it sound like it's, you
• 36:59know, obvious
• 37:00step by step path.
• 37:03At any point, there were
• 37:04alternative paths that could have
• 37:06arisen.
• 37:07But the reality is that
• 37:09there are many connections
• 37:11between
• 37:12the formal death camps of
• 37:14the Nazis
• 37:15and the formal medical programs
• 37:18of
• 37:19killing, disabled people.
• 37:23So let me just go
• 37:24backwards for a minute before
• 37:26we jump forwards
• 37:28to the German medical profession
• 37:29before the war.
• 37:32Given what happens,
• 37:34you might think that they
• 37:35were ethically backwards, scientifically backward,
• 37:37that they were sort of
• 37:38set up for failure.
• 37:41Unfortunately,
• 37:42really nothing could be further
• 37:43from the truth.
• 37:45One of the great ironies
• 37:46of the Nuremberg doctors trial
• 37:48is that the medical ethics
• 37:51experts
• 37:52for the trial went looking
• 37:54for ethical guidance on research
• 37:57on human beings.
• 37:59And they looked worldwide
• 38:01for any country
• 38:03that had
• 38:04national guidance
• 38:06on ethical research
• 38:08on human beings.
• 38:09And they found only two
• 38:11examples.
• 38:12Both were German.
• 38:16In the eighteen nineties, a
• 38:17guy named Albert Neisser, whom
• 38:19you might recognize from Neisseria
• 38:21gonorrhea,
• 38:23Neisser had intentionally
• 38:25infected orphans and prostitutes with
• 38:27syphilis
• 38:28in Prussia.
• 38:29And when the Prussian government
• 38:31found out about this, the
• 38:32public found out about it,
• 38:33they were outraged, and they
• 38:34passed a law. So this
• 38:36was not a code that
• 38:37was passed by doctors for
• 38:38doctors. This was a law
• 38:40imposed on doctors because we
• 38:42had misbehaved.
• 38:45That law
• 38:46is
• 38:47expanded, in fact, under the
• 38:48Weimar Republic.
• 38:50So at the time that
• 38:51Hitler comes to power, there
• 38:53is a national law
• 38:54that requires the unambiguous
• 38:57informed consent
• 38:59of any human subject of
• 39:01biomedical research.
• 39:03It even has IRBs, what
• 39:05we would today call IRBs,
• 39:06that you have to have
• 39:07independent review of your research
• 39:08projects.
• 39:10So
• 39:11the Germans were ahead of
• 39:12us
• 39:14in terms of ethics of
• 39:15human subjects research.
• 39:17They were also ahead of
• 39:18us in science generally. This
• 39:20is a picture of the
• 39:21Siemens electron microscope,
• 39:23which was invented in Germany
• 39:24and was used to discover
• 39:26asbestos in lung tumors.
• 39:29Let me give you a
• 39:30data point that you should
• 39:32remember.
• 39:34In the ten years before
• 39:36the outbreak of the war,
• 39:38German speaking scientists
• 39:40won six of the Nobel
• 39:42prizes.
• 39:45Imagine that kind of a
• 39:46string of victories in Nobel
• 39:48Prize winning science.
• 39:51So I'm blending together Germany
• 39:52and Austria, but,
• 39:56Germany was the place
• 39:58that you went if you
• 40:00wanted excellent medical training,
• 40:03and that was true through
• 40:05into the thirties.
• 40:07The Germans were also well
• 40:09advanced in terms of epidemiology
• 40:11and public health. This is
• 40:12one of the first ever
• 40:13studies looking at the association
• 40:15between smoking and health,
• 40:19and they used
• 40:20their scientific
• 40:22knowledge
• 40:23to inform public policy.
• 40:26And so, for example, this
• 40:27is, you know, twenty years
• 40:29before you would see anything
• 40:30similar in the US. This
• 40:32would be, like, on buses,
• 40:34a poster telling women
• 40:36to do breast self exam
• 40:38and to to keep track
• 40:39of your period to detect
• 40:41early signs of cancer.
• 40:44This is
• 40:45encouraging women not to smoke
• 40:47or drink when they're when
• 40:48you're pregnant.
• 40:51Famously,
• 40:52the Nazis banned smoking in
• 40:54public offices, including Nazi party
• 40:56offices.
• 41:00They also so those are
• 41:02all the positive eugenics, encouraging
• 41:04people to be healthy.
• 41:05They also, of course,
• 41:07dive deeply into negative eugenics,
• 41:10starting with a plan that,
• 41:11many people in the US
• 41:13also endorsed. One of the
• 41:14presidents of the AMA in
• 41:16nineteen eleven said that he
• 41:17thought there should be a
• 41:18screening process before you got
• 41:20married for genetic diseases,
• 41:22and we shouldn't let people
• 41:23get married if they had
• 41:24a risk of bringing together
• 41:26two genetic you know, two
• 41:27people with poor carriers.
• 41:29Germans implemented that law.
• 41:33You were required to meet
• 41:34with a genetic counselor before
• 41:36you could get married.
• 41:38They also
• 41:39blend
• 41:40science and economics.
• 41:42Right? So this is from
• 41:43a high school biology textbook,
• 41:45but I'll I'll note that
• 41:46this doesn't really have much
• 41:47to do with biology.
• 41:49This is about the cost
• 41:50of caring for someone
• 41:52with
• 41:53a debilitating
• 41:54condition.
• 41:57At the time, it became
• 41:58required
• 41:59that all
• 42:01high school students, all medical
• 42:02students, all doctors
• 42:04take coursework additional coursework in
• 42:06the science of hereditary health.
• 42:09And the German medical practice
• 42:11law is actually changed
• 42:13to say that the first
• 42:14priority of doctors is to
• 42:16the racial health of the
• 42:18bulk,
• 42:19to the racial health of
• 42:20the community,
• 42:22and not to their individual
• 42:24patients.
• 42:24So for example, privacy laws
• 42:27are explicitly to be subverted
• 42:29if it serves
• 42:31the priorities of the Volk.
• 42:34This is, really illustrates this
• 42:37sort of biologicalization
• 42:38of public policy.
• 42:40This is hit Adolf Hitler,
• 42:42doctor of the German people.
• 42:45Hitler uses a lot of,
• 42:47medical metaphors,
• 42:49and I don't even know
• 42:50that he thinks they are
• 42:51metaphors. I think he I
• 42:53think he thinks they are,
• 42:55like, at least analogies,
• 42:57if not direct
• 42:59like to like comparisons. He
• 43:01he says he is the
• 43:02one who discovered that Jews
• 43:04are the tubercle bacillus of
• 43:06Germany
• 43:08or of Europe, actually.
• 43:10He says, I am the
• 43:11Albert Koch
• 43:13of politics
• 43:15because I've made this discovery
• 43:18of the infection
• 43:19in our community.
• 43:21So this idea of
• 43:24people as vermin,
• 43:25as,
• 43:26parasites, as bacteria,
• 43:29as opposing a threat to
• 43:31everyone else, a genetic threat,
• 43:34biological
• 43:35threat. They carry disease. Right?
• 43:36That kind of thing.
• 43:39One of the ways that
• 43:40healers become killers in this
• 43:42story
• 43:43is by the state takeover
• 43:44of German professional associations.
• 43:48So,
• 43:49there are multiple
• 43:50medical professional associations in Germany
• 43:52before the Nazi takeover,
• 43:54but within a year or
• 43:55so, they are all consolidated
• 43:57into a single state sponsored
• 43:59medical professional association. This is
• 44:01the first
• 44:03issue of this,
• 44:04new medical association's
• 44:06journal.
• 44:11Sorry. That is a disturbing
• 44:12slide I'm about to show
• 44:13you, and I need a
• 44:14a little setup for this.
• 44:18I wanna say something about
• 44:19the extent to which
• 44:21medicalized
• 44:22language is used by the
• 44:24Nazis.
• 44:25So at Treblinka,
• 44:27which as I said, is
• 44:28a pure extermination camp.
• 44:30So,
• 44:32if you get there and
• 44:33you get off the train,
• 44:35what you walk into looks
• 44:37like
• 44:38a normal train station, like
• 44:40with timetables
• 44:41on the walls as if
• 44:42trains both come and go,
• 44:44and posters on the walls
• 44:45that say, you know, vacation
• 44:46in Greece,
• 44:48because they want people to
• 44:49think
• 44:50that this is a legit
• 44:52train station.
• 44:53Right?
• 44:54On one side, there is
• 44:56a door with a red
• 44:57cross over it. So it
• 44:58looks like this is the
• 44:59infirmary.
• 45:01In fact, this is the
• 45:03door to the killing pit.
• 45:05The killing pit is where
• 45:06people who come off the
• 45:07train and are too weak
• 45:09to march to the gas
• 45:10chambers
• 45:11are taken.
• 45:13This is not an image
• 45:14of the killing pit at
• 45:15Treblinka. There are actually no
• 45:16known photographs of the camps
• 45:18of the camp at Treblinka.
• 45:21It was raised to the
• 45:22ground,
• 45:22before the allies got there.
• 45:25But this is a a
• 45:26typical killing pit.
• 45:30When this happened,
• 45:31it was recorded.
• 45:34And how it was recorded
• 45:36is this is is as
• 45:37follows.
• 45:38The patient was cured
• 45:41with one
• 45:45pill.
• 45:47So at that level
• 45:49of
• 45:50medicalized
• 45:51murder,
• 45:52it actually becomes easier to
• 45:54see
• 45:55some of the more well
• 45:56known aspects of medical involvement
• 45:59in the Nazis. Right? You'll
• 46:00notice, by the way, I've
• 46:01I've said nothing about
• 46:03human experimentation except that we
• 46:05didn't have any rules about
• 46:06it here.
• 46:08I've said nothing about Mengele.
• 46:12Patricia Rice at the museum
• 46:15says that Mengele was a
• 46:16criminal of opportunity.
• 46:20Right? He was put in
• 46:21an environment
• 46:22where he could do whatever
• 46:24experiments he wanted with no
• 46:26penalty,
• 46:28and so he did.
• 46:29He didn't create that environment.
• 46:33Many other health professionals at
• 46:35higher levels than he
• 46:36created that environment.
• 46:40This is the most famous
• 46:42or infamous,
• 46:44medical duty at Auschwitz. Not
• 46:45only doctors, but, pharmacists and
• 46:48others did this duty as
• 46:49well,
• 46:51ramp duty where you would
• 46:52decide in the moment who
• 46:54goes to labor
• 46:56or medical experimentation
• 46:57and who goes directly
• 46:59to the gas chambers at
• 47:00Birkenau
• 47:01and Auschwitz.
• 47:08These last two slides may
• 47:10be, the most disturbing, and
• 47:12they're cartoons.
• 47:14But you may be surprised
• 47:15to learn that one of
• 47:17the first proclamations of the
• 47:18third right was to bar
• 47:20vivisection of lab animals in
• 47:22experiments.
• 47:24So here you have the
• 47:25lab animals of Germany. Right?
• 47:26Hitler was
• 47:28a animal fanatic. He loved
• 47:29dogs. He was a vegetarian.
• 47:32So one of the first
• 47:33things they do is to
• 47:34say,
• 47:35we will commit to a
• 47:36concentration
• 47:37camp,
• 47:37anyone who treats lab animals
• 47:39as though they are inanimate
• 47:41property.
• 47:43And given how they go
• 47:45on to treat
• 47:47Jewish people, prisoners of war,
• 47:50gay people, Jehovah's witnesses, right,
• 47:53What are those people that
• 47:54are they are less worthy
• 47:56of respect
• 47:57than a lab animal.
• 48:02And and this is the
• 48:03answer.
• 48:05Right? This shows
• 48:07the scientific
• 48:08gaze of the microscope
• 48:10looking down on the petri
• 48:12dish of society.
• 48:14Here,
• 48:15people
• 48:17have become pathogens.
• 48:21They're cancer cells.
• 48:24They're infectious
• 48:25germs,
• 48:26not just germs.
• 48:28Infectious germs, they pose a
• 48:29threat to the rest of
• 48:30us.
• 48:33So what do we do
• 48:34with this history?
• 48:40The museum in Washington, DC
• 48:42pictured here,
• 48:44holds a lot of memories,
• 48:45in this case,
• 48:46shoes.
• 48:48And most of the people
• 48:49who visit the museum today
• 48:51are like me.
• 48:52Right? They have no familial
• 48:54personal connection
• 48:56to this history.
• 48:58How do we, as a
• 48:59professional group,
• 49:02understand
• 49:03and learn from this history?
• 49:05And I I will say
• 49:06there is a traditional
• 49:09story about this, which I
• 49:11think is wrong.
• 49:12And that traditional story is
• 49:14that because of this,
• 49:16we got the declaration of
• 49:18Helsinki,
• 49:19and
• 49:20we got human subjects research
• 49:21protections.
• 49:24Here's what actually happened.
• 49:26Doctor Andrew Ivy,
• 49:28was sent to the Nuremberg
• 49:29trial by the American Medical
• 49:31Association as an ethics expert.
• 49:34And he realized
• 49:36very early on, So the
• 49:37trial starts in early December
• 49:39of nineteen forty six,
• 49:41and he realizes,
• 49:42oh my gosh. We have
• 49:44no AMA standards for human
• 49:46subjects research.
• 49:48So he rushes back to
• 49:49Chicago.
• 49:50And by the end of
• 49:51that month,
• 49:53the AMA has put together
• 49:55three
• 49:56points
• 49:57about human subjects research protections,
• 50:00which they publish in JAMA.
• 50:02He goes back to Germany.
• 50:05He gets caught about this
• 50:06because it turns out the
• 50:08Nazi lawyers are smart.
• 50:10They're not idiots.
• 50:12They call him on this.
• 50:14They call him on a
• 50:14number of other things,
• 50:18which we don't have time
• 50:19to get into, but
• 50:24this this code
• 50:26developed by the AMA right
• 50:28after the war during the
• 50:29Nuremberg trial
• 50:32was written for Nazis.
• 50:35It was not written for
• 50:36us.
• 50:38It was a scientist at
• 50:40Harvard who said it was
• 50:41written for Nazi monsters,
• 50:43not for fine upstanding researchers.
• 50:48And the consequence of this
• 50:50is that the Nuremberg
• 50:51Code itself, which comes out
• 50:53of this,
• 50:54is never adopted anywhere.
• 50:58It is modified into the
• 50:59Helsinki Code and so on,
• 51:00but,
• 51:02you know, a few people
• 51:04get prosecuted
• 51:06after the war. The vast
• 51:07majority
• 51:08of German doctors who were
• 51:09in one way or another
• 51:10involved in this are never
• 51:12brought to account,
• 51:13the vast majority.
• 51:18And we go on in
• 51:19the US
• 51:20to the Jewish
• 51:22hospital studies, to the Willowbrook
• 51:24studies, to Tuskegee.
• 51:28When has Tuskegee stopped?
• 51:31Nineteen seventy two,
• 51:34twenty five years
• 51:36after the Nuremberg tribe.
• 51:40How does that happen?
• 51:41That happens because we can't
• 51:43learn from Nazis,
• 51:46because they're monsters,
• 51:49and we are fine upstanding
• 51:50people.
• 51:53So if that's not the
• 51:54lesson
• 51:55that came out of the
• 51:56Nazi era, what are the
• 51:58lessons that came out of
• 52:00the Nazi era? Well, I
• 52:02I think public health ethics
• 52:05today is pervaded by concerns
• 52:07about not overstepping and inhibiting
• 52:10individual liberties unless you absolutely
• 52:12must.
• 52:13That is because of the
• 52:14Nazis.
• 52:16We don't talk about it,
• 52:18but that's why.
• 52:21Genetic ethics,
• 52:23super concerned today about neo
• 52:25eugenics.
• 52:26Right? I'm not saying we're
• 52:28handling it all properly and
• 52:29perfectly,
• 52:30but the fact that we
• 52:31are so worried
• 52:33about neo eugenics, that is
• 52:35a legacy of this history.
• 52:38We still think and talk
• 52:39about racial and ethnic health
• 52:41care
• 52:41differences. Right? Disparities, different outcomes
• 52:44based on race and ethnicity.
• 52:46Today, we are very explicit
• 52:48that the reason we are
• 52:49looking at these is because
• 52:51we wanna figure out how
• 52:52to bring up the people
• 52:54who are having worse health
• 52:55outcomes. What is happening
• 52:56that causes that? What are
• 52:58the factors that lead into
• 52:59that?
• 53:01That is that is absolutely
• 53:02the opposite
• 53:04of how the Nazis thought
• 53:05about this. Right? If you
• 53:06were having a bad health
• 53:07outcome
• 53:08as a result of, you
• 53:09know, your race or ethnicity,
• 53:11it was because of your
• 53:12race or ethnicity.
• 53:13It was not something going
• 53:14on in society. It was
• 53:16not, you know, anything social.
• 53:18It had to be genetic.
• 53:23This comes up all the
• 53:24time.
• 53:25It you know, the Nazi
• 53:26era comes up all the
• 53:27time during wartime.
• 53:29Every war,
• 53:33I spent an enormous amount
• 53:35of time on this at
• 53:35the American Medical Association
• 53:37when American soldiers were torturing
• 53:39detainees.
• 53:41And I'm being drawn right
• 53:43back into this because,
• 53:45you know, of detainee abuse
• 53:47in Israel.
• 53:49This is not,
• 53:51you know, political.
• 53:53These are the rules of
• 53:54the road for medicine,
• 53:56for doctors. And when doctors
• 53:58are in a wartime setting,
• 54:00we will get pulled.
• 54:02We will be
• 54:03put in situations
• 54:05where we are
• 54:06pressed into service
• 54:08to do things that are
• 54:09contrary to our ethics. It
• 54:11is guaranteed.
• 54:12It will happen. It happened
• 54:13here. It happens everywhere.
• 54:19And I'll just end with
• 54:20these reflections because,
• 54:26there is, you know, throughout
• 54:28bioethics today, this, you know,
• 54:30really primary sentiment
• 54:32of empathy
• 54:33and altruism
• 54:35and protection of human rights,
• 54:37protection of the most vulnerable.
• 54:40That is not easy to
• 54:42maintain.
• 54:43And right now, we are
• 54:45seeing
• 54:46direct attacks on the concept
• 54:48of altruism and empathy.
• 54:51And and we are seeing
• 54:53our codes of ethics being
• 54:54challenged,
• 54:56And it's it's worth remembering
• 54:58that the Nazis
• 55:00inherited a code of ethics.
• 55:02Right? The the doctors who
• 55:04became Nazi doctors
• 55:06had a code of ethics
• 55:09that precluded the things that
• 55:10they ended up doing.
• 55:13So codes of ethics alone
• 55:15do not help us.
• 55:17Having
• 55:18written words on a page
• 55:19doesn't help us. These have
• 55:20to be living documents.
• 55:23They have to be continuously
• 55:24in every generation
• 55:25recreated
• 55:27and rebought into. And along
• 55:29the way, we have to
• 55:30figure out what parts of
• 55:31our code do we leave
• 55:31behind
• 55:33because we got that wrong.
• 55:35Right? And what parts of
• 55:36professionalism do we bring forward?
• 55:39This is a challenge for
• 55:40every generation
• 55:41in American medicine and medicine
• 55:43writ large.
• 55:45So this is my last
• 55:46slide.
• 55:48I just like to put
• 55:48this up because it's a
• 55:50nice articulation, I think, of
• 55:51where I started
• 55:53and where I'd like to
• 55:54end, which is,
• 55:57it would be easy
• 56:00to learn nothing from this
• 56:01history.
• 56:03It is comforting
• 56:05to learn nothing from this
• 56:07history
• 56:09because it it allows us
• 56:10to separate ourselves
• 56:12from Nazi doctors,
• 56:14and that is comforting.
• 56:18I think the question we
• 56:19have to grapple with is
• 56:20not how did a few
• 56:22Nazi monsters
• 56:24crawl up from the depths
• 56:25in Germany in this one
• 56:27era.
• 56:28It's how could
• 56:31most of the doctors
• 56:33in the most advanced industrialized
• 56:36nation on Earth at the
• 56:37time
• 56:39become killers
• 56:40together,
• 56:41and not despite
• 56:43their training, but in the
• 56:45name
• 56:46of medicine
• 56:47and science and public health.
• 57:23Matt, that was an extraordinary
• 57:24lecture,
• 57:27and
• 57:27I think it's not unreasonable
• 57:29for us to sit here
• 57:30for a minute
• 57:33and let us continue to
• 57:34sink in. But I would
• 57:36invite you,
• 57:38any any of you, please,
• 57:40to if you have something
• 57:41you'd like to ask or
• 57:43say,
• 57:44please line up. There's micro
• 57:46microphones,
• 57:47on each side.
• 57:50Is
• 57:55Dawn?
• 57:56Go ahead. Doctor Bea, please.
• 57:58Thank you.
• 57:59So thank you for an
• 58:00extraordinary and a moving lecture.
• 58:03And I see many, many
• 58:05medical students
• 58:06in the audience tonight.
• 58:09And they are in a
• 58:10world right now, in a
• 58:12country right now, where we
• 58:13are seeing what we never
• 58:15thought we would see before.
• 58:18And some of them soon
• 58:20or later gonna be taking
• 58:21the Hippocratic oath.
• 58:23What advice would you give
• 58:25to young medical students
• 58:28to keep some kind of
• 58:29a center in them
• 58:30so that they don't fall
• 58:32prey
• 58:33in terms of politics or
• 58:35the country or their own
• 58:36safety,
• 58:38to what many of the
• 58:39Nazi doctors
• 58:41ended up doing?
• 58:47There's no simple answer to
• 58:49that question, obviously.
• 58:52There is something about
• 58:54having a community,
• 58:57and there is something about
• 58:58having that community oriented
• 59:00around a set of core
• 59:03moral values,
• 59:05not just science. Right? I
• 59:06think one of the classic
• 59:07lessons of the holocaust is
• 59:09that science alone will not
• 59:10save us,
• 59:12that science
• 59:14needs to be integrated,
• 59:16if you will, bounded within
• 59:17a moral framework.
• 59:19So thinking about the moral
• 59:21framework of what it means
• 59:22to be a healer,
• 59:24right, what it and and
• 59:25so this is not unique
• 59:26to doctors, by the way.
• 59:27I think nurses, pharmacists,
• 59:30dentists, right, everyone
• 59:32should be in these conversations,
• 59:34and being explicit about that.
• 59:36We've had,
• 59:37I would say, in the
• 59:39last
• 59:40fifteen, twenty years, kind of
• 59:41a backlash against the concept
• 59:43of professionalism,
• 59:46but professionalism
• 59:47is an important concept. It's
• 59:50the idea that we are
• 59:51a moral community,
• 59:52that we all profess
• 59:54a similar set of standards
• 59:56and values that guide our
• 59:58work. Right? Profess means to
• 60:00speak out,
• 01:00:01to to to speak in
• 01:00:02public.
• 01:00:04So
• 01:00:05being a part of a
• 01:00:06profession
• 01:00:08and knowing what that entails,
• 01:00:12is is important.
• 01:00:14And I understand, by the
• 01:00:15way, professionalism has sometimes become
• 01:00:17a cult cudgel for social
• 01:00:19conformity
• 01:00:20around, you know,
• 01:00:22norms that not everyone should
• 01:00:24buy
• 01:00:25or does buy.
• 01:00:27That to me is a
• 01:00:28problem of generational change.
• 01:00:31You know, we figure this
• 01:00:32out in every generation. There
• 01:00:33are aspects of our professional
• 01:00:35standards as values that we
• 01:00:36probably ought to figure out
• 01:00:37better, that we ought to
• 01:00:38do better,
• 01:00:39and there are aspects of
• 01:00:40it that we ought to
• 01:00:41reinforce and defend.
• 01:00:43And knowing the difference
• 01:00:44is the is the core
• 01:00:46dilemma here.
• 01:00:47Right?
• 01:00:48What aspects of
• 01:00:50your personal belief system, our
• 01:00:52shared belief system
• 01:00:54do you
• 01:00:56stand up and defend, and
• 01:00:58which ones do you think
• 01:00:59are actually not worth defending
• 01:01:01or should be changed?
• 01:01:04Thank you. Yes, sir.
• 01:01:06Thank you, doctor Wenya, for
• 01:01:08your your really touching talk.
• 01:01:11I I really appreciate like,
• 01:01:12in history, we often look
• 01:01:14at, you know, organizations as
• 01:01:15a monolith rather than breaking
• 01:01:16it down into, like, key
• 01:01:18actors, and that's what you've
• 01:01:19done in this lecture is
• 01:01:20to look at what were,
• 01:01:21like, some of the official
• 01:01:22saying at the time. But
• 01:01:23I was a bit more
• 01:01:24curious if you could elaborate
• 01:01:25on,
• 01:01:27who were the thought leaders
• 01:01:28in in this kind of
• 01:01:29thinking? Was it, like,
• 01:01:31the Hitler listening to the
• 01:01:32medical community, to the medical
• 01:01:34leaders, or were the medical
• 01:01:35leaders listening to Hitler, or
• 01:01:36was it just a public
• 01:01:37opinion?
• 01:01:38If you could break it
• 01:01:39down more of the power
• 01:01:40dynamics at the time.
• 01:01:42Thank you.
• 01:01:43Yeah.
• 01:01:45Sadly,
• 01:01:46it it is I I
• 01:01:48mean, it's both, obviously,
• 01:01:49because it is a social
• 01:01:50milieu, and they're building off
• 01:01:52of each other.
• 01:01:54But there is a lot
• 01:01:55more thought leadership coming from,
• 01:01:58you know, leading lights in
• 01:02:00the academic community
• 01:02:02than you might hope.
• 01:02:05The, you know, people who
• 01:02:07run the Max Planck Institute,
• 01:02:10which had a different name,
• 01:02:11but, you know, like,
• 01:02:13major academic,
• 01:02:16organizations
• 01:02:17were often the the thought
• 01:02:19leaders on these things, including,
• 01:02:21you know, the programs that
• 01:02:22I described. The t four
• 01:02:24program was designed entirely by
• 01:02:26doctors. It was not, you
• 01:02:27know, designed by Hitler and
• 01:02:29then assigned to doctors.
• 01:02:31Thank
• 01:02:35you. I'm
• 01:02:36I've really appreciated your talk.
• 01:02:39And I'm wondering
• 01:02:42where were the voices
• 01:02:44in the profession
• 01:02:47standing up against this?
• 01:02:50I'll also mention that I've
• 01:02:53had an odd experience
• 01:02:55as a boy of about
• 01:02:56ten
• 01:02:57spending
• 01:02:58two weeks inadvertently
• 01:03:00with a
• 01:03:02group of Nazi officers at
• 01:03:04their reunion
• 01:03:05wasn't my choice.
• 01:03:08I came away from those
• 01:03:09two weeks.
• 01:03:10The most disturbing
• 01:03:12part was the complete banality
• 01:03:14of the entire
• 01:03:16set of interactions.
• 01:03:18They weren't monsters
• 01:03:20at that time They seemed
• 01:03:21like the most ordinary,
• 01:03:23loving family members
• 01:03:25I'd ever encountered in my
• 01:03:27life
• 01:03:29Where was the medical profession
• 01:03:31here
• 01:03:32that tried
• 01:03:33to rebel, stand up, or
• 01:03:35resist this?
• 01:03:37Yeah. Very,
• 01:03:38quiet.
• 01:03:40Medical
• 01:03:41professionals,
• 01:03:42by and large, were more
• 01:03:44like by quite a lot,
• 01:03:46more likely to join the
• 01:03:47Nazi party than other professions.
• 01:03:50So engineers,
• 01:03:51lawyers, teachers
• 01:03:53were all in the twenty
• 01:03:54to thirty percent range.
• 01:03:57For physicians writ large,
• 01:03:59it was probably about fifty
• 01:04:01percent
• 01:04:02of doctors joined the Nazi
• 01:04:04party. And to me, that
• 01:04:05says two things.
• 01:04:06Number one,
• 01:04:08fifty percent didn't.
• 01:04:11So this was not a
• 01:04:11requirement.
• 01:04:13It was a career advancing
• 01:04:15move,
• 01:04:16and undoubtedly some
• 01:04:17did it for career advancement.
• 01:04:20But it was not a
• 01:04:21requirement. You weren't punished.
• 01:04:24Even at Auschwitz,
• 01:04:26you could refuse
• 01:04:27ramp duty.
• 01:04:28You did not have to
• 01:04:29do that. There's only one
• 01:04:32known case
• 01:04:34of a doctor refusing, but
• 01:04:36he was not punished.
• 01:04:38So these were by and
• 01:04:40large activities that doctors undertook
• 01:04:43voluntarily.
• 01:04:45And
• 01:04:46so the second piece is
• 01:04:47why were doctors
• 01:04:49higher levels of joining
• 01:04:51than other professionals, and I
• 01:04:53think it is because of
• 01:04:55this idea. You know, the
• 01:04:56Nazis called Germany a biocracy.
• 01:05:00So this was a a
• 01:05:02a distinct
• 01:05:04explicit
• 01:05:05blending
• 01:05:07of science
• 01:05:08molding society.
• 01:05:10And so doctors, you know,
• 01:05:12coming out of the first
• 01:05:13World War, there was doctor
• 01:05:15unemployment
• 01:05:15in Germany at the time
• 01:05:17of the that the second
• 01:05:18World War started. There were
• 01:05:20a lot of Jewish doctors
• 01:05:21who were in plum positions.
• 01:05:23There are a lot of
• 01:05:24reasons that, you know, people
• 01:05:26have given for why so
• 01:05:27many doctors joined the Nazi
• 01:05:29party and were so
• 01:05:30on board.
• 01:05:32I think all of those
• 01:05:33probably hold some truth. There
• 01:05:35was opportunism,
• 01:05:36careerism,
• 01:05:38the, you know,
• 01:05:40getting rid of the Jewish
• 01:05:41competition.
• 01:05:43All of that also comes
• 01:05:44into play, but I I
• 01:05:46do think there's something about
• 01:05:47this biocracy idea,
• 01:05:49and that this was, you
• 01:05:51know, doctors were
• 01:05:53nurse midwives also, by the
• 01:05:54way, the way they framed
• 01:05:55these programs around turning in
• 01:05:57babies for the,
• 01:05:59for the infant
• 01:06:01murder program was that you
• 01:06:04are serving
• 01:06:06you know, you are you
• 01:06:06are doing this heroic thing
• 01:06:08for the state.
• 01:06:10Thank you.
• 01:06:15A couple of questions here.
• 01:06:16And then we'll absolutely have
• 01:06:17the time for your questions
• 01:06:18as well.
• 01:06:21How do you see the
• 01:06:22contemporary,
• 01:06:23relevance of teaching about the
• 01:06:25role of medical professionals
• 01:06:27in the Holocaust, including their
• 01:06:28exterminatory
• 01:06:29antisemitism,
• 01:06:31in the context of the
• 01:06:32current surge of antisemitism
• 01:06:34in medicine also manifested by
• 01:06:36students and residents
• 01:06:38since the terrorist attack of
• 01:06:39Israel on October seventh,
• 01:06:42with, hostile learning and work
• 01:06:44environments.
• 01:06:45How should teaching this history
• 01:06:47be adapted to address
• 01:06:48these contemporary
• 01:06:49echoes of the holocaust
• 01:06:51that can threaten provisions
• 01:06:53of nonbiased
• 01:06:55patient care?
• 01:06:57Yeah.
• 01:06:59Well, you'll notice that,
• 01:07:02I
• 01:07:03prefer to just tell the
• 01:07:05story.
• 01:07:07I think people will take
• 01:07:08the lessons.
• 01:07:09I don't think you have
• 01:07:10to beat them over the
• 01:07:11head with these lessons.
• 01:07:14And the lesson of the
• 01:07:15holocaust
• 01:07:16as regards antisemitism
• 01:07:18is
• 01:07:19profound
• 01:07:20and really obvious.
• 01:07:24So I I I don't
• 01:07:26emphasize that through the talk.
• 01:07:29I emphasize the role of
• 01:07:30doctors
• 01:07:32in developing these programs.
• 01:07:35I think that antisemitism
• 01:07:38on
• 01:07:39medical campuses
• 01:07:40is real, and it is
• 01:07:41and it has risen.
• 01:07:43And,
• 01:07:44I think anti Muslim bias
• 01:07:46is also real and has
• 01:07:47risen.
• 01:07:49Wars
• 01:07:50will do this.
• 01:07:53So
• 01:07:54I I don't think just
• 01:07:55learning this history
• 01:07:57is enough.
• 01:07:58I think we need to
• 01:07:59get this war done,
• 01:08:01and that
• 01:08:02is unfortunately far outside of
• 01:08:04my can.
• 01:08:07Understood. Appreciate that.
• 01:08:09Yes, please.
• 01:08:12Hi. I just wanted to
• 01:08:13thank you so much for
• 01:08:14your talk. I definitely learned
• 01:08:15a lot speaking from a
• 01:08:17public health student perspective rather
• 01:08:19than a medical student perspective.
• 01:08:21I really would just love
• 01:08:22your thoughts on how we
• 01:08:23can further incorporate
• 01:08:25bioethics and empathy into our
• 01:08:27curriculum.
• 01:08:28At the Yale Miles per
• 01:08:29hour program,
• 01:08:30we are required to take,
• 01:08:32health threats and ethics as
• 01:08:33well as a social justice
• 01:08:34course. However, I really feel
• 01:08:36like
• 01:08:37these kinds of topics aren't
• 01:08:38talked about enough that sort
• 01:08:41of curriculum is not really
• 01:08:43adequate to cover these really
• 01:08:45complex topics within our field,
• 01:08:47especially with something as multidisciplinary
• 01:08:49as public health. So I
• 01:08:51would just love your thoughts
• 01:08:52as someone who specializes in
• 01:08:53bioethics.
• 01:08:55Yeah. Boy, I wish there
• 01:08:57were thousand more people like
• 01:08:58you.
• 01:09:00We have been trying to
• 01:09:01get ethics as a required
• 01:09:02part of public health curriculum
• 01:09:04nationally for
• 01:09:05twenty five years, thirty years,
• 01:09:08like, since the beginning of
• 01:09:10my career.
• 01:09:11I got
• 01:09:12one lecture about public health
• 01:09:14in the Nazi era during
• 01:09:16my public health training and
• 01:09:17no other ethics.
• 01:09:20And,
• 01:09:22you know, for many public
• 01:09:23health students, I will probably
• 01:09:24say most public health students,
• 01:09:26they get no ethics training
• 01:09:27at all,
• 01:09:29because it's not required.
• 01:09:31And so it is you
• 01:09:32know, it's an elective almost
• 01:09:34everywhere,
• 01:09:35but it's not a requirement
• 01:09:37almost anywhere.
• 01:09:40I think it should be
• 01:09:41required. I but I I
• 01:09:43honestly also think some medical
• 01:09:45history ought to be required
• 01:09:46of medical school,
• 01:09:48and it's not required there
• 01:09:49either. These are all tend
• 01:09:51to be elective things, which
• 01:09:53I've I find disturbing because,
• 01:09:56you know, this is not
• 01:09:57just,
• 01:09:58Santiana
• 01:09:59and, you know, those who
• 01:10:00fail to learn the Lester
• 01:10:01e lessons of history are
• 01:10:03bound to repeat them. This
• 01:10:04is more like Faulkner.
• 01:10:07There's a quote about the
• 01:10:08past is never past.
• 01:10:10Right?
• 01:10:11Now the past is never
• 01:10:13dead. Past is not dead.
• 01:10:14The past is not even
• 01:10:15past.
• 01:10:16The past is never, gone.
• 01:10:18It's never even really past.
• 01:10:19Something along those lines. Yeah.
• 01:10:21In any event, this is
• 01:10:22this is not like ancient
• 01:10:24history that is long ago.
• 01:10:25Right? This has
• 01:10:27obvious repercussions for our contemporary
• 01:10:29standards, obvious repercussions
• 01:10:31for the future, obvious repercussions
• 01:10:33for how we think about
• 01:10:34building a better future.
• 01:10:36I think you can't really
• 01:10:37understand how we got to
• 01:10:38where we are today without
• 01:10:39a little study of history.
• 01:10:42But, you know, I'm a
• 01:10:43humanities guy.
• 01:10:46Doctor. Tolchin.
• 01:10:48Thank you so much for
• 01:10:49a wonderful talk.
• 01:10:51One
• 01:10:53area where where
• 01:10:55I I think we we
• 01:10:56very much see the the
• 01:10:57echoes
• 01:10:58of
• 01:11:00the health care system's involvement
• 01:11:02and and not the atrocities
• 01:11:04is in
• 01:11:06our thinking about,
• 01:11:08public health versus
• 01:11:10individual
• 01:11:11patient rights. And I I
• 01:11:12think the the US health
• 01:11:14care system has
• 01:11:17in many but not all
• 01:11:18cases, has has very strongly
• 01:11:20prioritized the the rights of
• 01:11:21the individual patient. And American
• 01:11:23medical ethics is very much
• 01:11:24focused on the the rights
• 01:11:26of the individual patient as
• 01:11:28the the priority and the
• 01:11:30sort of synchronic non for
• 01:11:32ethical consideration.
• 01:11:35We've seen areas where where
• 01:11:37this we've run into limits
• 01:11:39there,
• 01:11:41particularly
• 01:11:42with with your talk in
• 01:11:43mind and and
• 01:11:45and sort of
• 01:11:46where we can go when
• 01:11:48we stop prioritizing the individual.
• 01:11:50I'm curious, how do you
• 01:11:51think about,
• 01:11:54times when the individual's
• 01:11:58welfare comes into conflict with
• 01:12:00the
• 01:12:02public health.
• 01:12:03I'm thinking particularly
• 01:12:04of,
• 01:12:07involuntary vaccination
• 01:12:09Vaccination. In the setting of
• 01:12:10the pandemic or in the
• 01:12:11setting of a, perhaps, a
• 01:12:13coming,
• 01:12:15avian flu
• 01:12:16pandemic. But I'm kinda curious
• 01:12:18how how you
• 01:12:19would
• 01:12:20think about weighing that conflict.
• 01:12:23Yeah. I so I I
• 01:12:24do think, you know, there's
• 01:12:25this, there's a joke about
• 01:12:27a bit American bioethics that
• 01:12:29there are four principles of
• 01:12:31biomedical ethics.
• 01:12:32There's,
• 01:12:33autonomy,
• 01:12:34autonomy, autonomy, and one other
• 01:12:36I can't remember.
• 01:12:41And
• 01:12:42and I
• 01:12:44that,
• 01:12:45to me, is a legacy
• 01:12:46of the holocaust.
• 01:12:47Right? That we the thing
• 01:12:49we never talk about, but
• 01:12:50we definitely learned.
• 01:12:53And I will say my
• 01:12:54historian friends tell me I'm
• 01:12:56oversimplifying
• 01:12:57this and that,
• 01:12:59there were many other factors
• 01:13:00that were involved in, like,
• 01:13:02how AMA set policy coming
• 01:13:04out of the war
• 01:13:05and that,
• 01:13:06there was a very strong,
• 01:13:09sentiment against any kind of
• 01:13:11state involvement of medical care
• 01:13:13well before the war in
• 01:13:15the US that persisted after
• 01:13:17the war, but I think
• 01:13:18was very much buttressed
• 01:13:20by this history.
• 01:13:22So our idea that the
• 01:13:23government should not be involved
• 01:13:26in medical care,
• 01:13:28which, by the way, is
• 01:13:29not sounding like such a
• 01:13:30bad idea.
• 01:13:32But the I that sort
• 01:13:33of resistance
• 01:13:35to government involvement,
• 01:13:36and the focus, the emphasis
• 01:13:39on autonomy and the rights
• 01:13:40of individuals
• 01:13:42has become, you know, the
• 01:13:43cornerstone really of American bioethics,
• 01:13:45and it did not serve
• 01:13:46us well
• 01:13:48during the pandemic.
• 01:13:50And I you know, this
• 01:13:51is the problem with this
• 01:13:52history is it's not simple.
• 01:13:55There's not just this simple
• 01:13:56lesson that you come out
• 01:13:57of this and say, oh,
• 01:13:58gosh. Okay. So all doctors
• 01:14:00should put the one patient
• 01:14:01sitting in front of them
• 01:14:02first.
• 01:14:04Period. They should think of
• 01:14:05nothing except the one person
• 01:14:07sitting in front of them.
• 01:14:08Well, that doesn't work.
• 01:14:11Right? Like, we end up
• 01:14:13with a health care system
• 01:14:15that is completely out of
• 01:14:16control,
• 01:14:17right, because we don't want
• 01:14:19someone second guessing us.
• 01:14:21So,
• 01:14:22you know, there's a there's
• 01:14:23a lot more to be
• 01:14:24said about this, but I
• 01:14:25think that I think the
• 01:14:26way we think about this
• 01:14:27in public health ethics is
• 01:14:28pretty,
• 01:14:30helpful,
• 01:14:30which is, you know, your
• 01:14:32right to swing your arm
• 01:14:33ends at the tip of
• 01:14:34my nose.
• 01:14:36So you get to do
• 01:14:38whatever you'd like until you
• 01:14:39start hurting other people or
• 01:14:41putting them at risk.
• 01:14:43And that's generally why we
• 01:14:46have stop signs.
• 01:14:48Right? A speed limit is
• 01:14:49an infringement on my liberty.
• 01:14:51I would like to drive
• 01:14:52faster.
• 01:14:53So is a stop sign.
• 01:14:54So is a red light.
• 01:14:56So right? We we put
• 01:14:57limits on people's personal liberties
• 01:14:59all the time
• 01:15:00in order to prevent us
• 01:15:02from hurting each other inadvertently
• 01:15:04or inadvertently.
• 01:15:06And I think we should
• 01:15:07think of that the same
• 01:15:08way in, you know, in
• 01:15:10public health. It gets a
• 01:15:11lot more complicated, of course,
• 01:15:13because you start talking about,
• 01:15:14well, so if you use
• 01:15:16up all the funds on
• 01:15:17this patient, is that hurting
• 01:15:19these other patients?
• 01:15:20Right? So it's not none
• 01:15:22of this is simple.
• 01:15:24Could it be that it's
• 01:15:26interesting because when the the
• 01:15:27harm principle, right, John Stuart
• 01:15:29Mill, which you're which you
• 01:15:30evoke accurately, I I think
• 01:15:33I I think,
• 01:15:35and correct me if I'm
• 01:15:36wrong, that this was really
• 01:15:37articulated
• 01:15:38by Mill
• 01:15:40in an effort to tell
• 01:15:41people
• 01:15:42in an effort to increase
• 01:15:44personal autonomy, which is to
• 01:15:46say that, no. You can't
• 01:15:47stop people from doing this
• 01:15:48stuff unless it causes harm
• 01:15:50to others. And now it
• 01:15:52seems like that that
• 01:15:53what you're suggesting is, no.
• 01:15:55We're not saying it. Everybody
• 01:15:56can do what they want,
• 01:15:57but at some point when
• 01:15:57it causes harm to others,
• 01:15:59that's justification for stopping,
• 01:16:01individual freedom. So it's almost
• 01:16:03like we it's we're arguing
• 01:16:05from the other side at
• 01:16:06this point that that the
• 01:16:07same the principle is being
• 01:16:08used, if you will, the,
• 01:16:10you know, the individual rights.
• 01:16:11Defining the limits of individual
• 01:16:13rights at one time was
• 01:16:14perhaps meant to say, individual
• 01:16:16rights should really go this
• 01:16:18far. But now it's defined,
• 01:16:19so to say, it really
• 01:16:20shouldn't go past that point.
• 01:16:22If if if you have
• 01:16:23never read the Jacobson decision,
• 01:16:26this is a supreme court
• 01:16:27decision from nineteen o five,
• 01:16:29and it's literally one page,
• 01:16:31page and a half, very
• 01:16:33short,
• 01:16:34very worth reading for exactly
• 01:16:35this reason.
• 01:16:36It is the most concise
• 01:16:38articulation of the harm principle,
• 01:16:40and when it's a when
• 01:16:42it is not only acceptable,
• 01:16:44but when infringements
• 01:16:46on everyone's liberty a little
• 01:16:47bit allows everyone to have
• 01:16:49a larger set of liberties
• 01:16:51available to
• 01:16:52them. So it is it
• 01:16:53is about capturing the maximum
• 01:16:56possible liberty,
• 01:16:58and the maximum possible liberty
• 01:16:59actually involves
• 01:17:01curtailing some liberties sometimes.
• 01:17:05Thank you. Yes, sir.
• 01:17:07Thank you very much for
• 01:17:08your talk. I wanted to
• 01:17:10take some of the concepts
• 01:17:11that you talked about,
• 01:17:12the idea of the physicians
• 01:17:14buying into Nazi ideology,
• 01:17:16and ask you a question
• 01:17:17related to that. Robert Lifton
• 01:17:19wrote a book called the
• 01:17:20Nazi doctors some thirty years
• 01:17:21ago, and I oftentimes think
• 01:17:22about something that he said
• 01:17:24in that book, and I
• 01:17:25wanted to get your take
• 01:17:26on it. So he reflected
• 01:17:27on somebody in,
• 01:17:29concentration camp asking the Nazi
• 01:17:31doctors, Fritz Klein was his
• 01:17:33name,
• 01:17:33how he could justify Would
• 01:17:35you have done this? Killing
• 01:17:36the Jews. And he said,
• 01:17:37well, as a doctor,
• 01:17:38I can take out the
• 01:17:39purulent appendix to save a
• 01:17:41patient's life. The Jew is
• 01:17:42the purulent appendix in the
• 01:17:43body of Europe. And he
• 01:17:45took it to the next
• 01:17:46step saying that we're used
• 01:17:47to causing temporary pain to
• 01:17:50cause gain. We do surgery.
• 01:17:52We put IVs in. Whatever
• 01:17:53we do for
• 01:17:54we may restrain patients.
• 01:17:56And the idea that doctors
• 01:17:58were used to that and
• 01:17:58then the idea of the
• 01:18:00focus you talked about in
• 01:18:01healthy parts and sick parts,
• 01:18:03do you think that lifting
• 01:18:04is correct in what he
• 01:18:05said, and was that part
• 01:18:05of what happened?
• 01:18:07Yeah. Yeah. I use that
• 01:18:08quote quite a lot, actually.
• 01:18:09I didn't use it tonight.
• 01:18:10But,
• 01:18:11but, yeah, this idea of,
• 01:18:13you know, the Jews are
• 01:18:14the puerulent appendix or the
• 01:18:16tubercle bacillus or the cancer,
• 01:18:19you see all of those,
• 01:18:20as
• 01:18:22and I mentioned before, I
• 01:18:23don't even think they were
• 01:18:24thinking those were metaphors.
• 01:18:26I think they thought that
• 01:18:27was a direct application of
• 01:18:29medical thinking and science
• 01:18:32to a social circumstance.
• 01:18:35So it was it was
• 01:18:37clearly,
• 01:18:38you know, part of Nazi
• 01:18:39ideology
• 01:18:41to,
• 01:18:41to think of Germany as
• 01:18:43being a literal body politic,
• 01:18:46which could be ill or
• 01:18:47healthy
• 01:18:48according to the genetic makeup
• 01:18:50of the people who live
• 01:18:52there.
• 01:18:57Steve,
• 01:19:00thank you, Matt. Great talk.
• 01:19:01Really, really enjoyed.
• 01:19:04You know,
• 01:19:06you and I have been
• 01:19:07involved with issues about professionalism
• 01:19:09in medicine for a very
• 01:19:10long time.
• 01:19:12And
• 01:19:13there's a way in which
• 01:19:14we might wanna
• 01:19:17there's an outfit called FASPI,
• 01:19:19the fellowship at Auschwitz for
• 01:19:21the study of professional ethics
• 01:19:23that takes groups of graduate
• 01:19:25students in different professional schools
• 01:19:27to sites in
• 01:19:28Poland and Germany
• 01:19:30associated with the rise of
• 01:19:31Nazism and tries to use
• 01:19:33those sites
• 01:19:34to teach them about contemporary
• 01:19:37issues in their own professions.
• 01:19:39There's nothing like talking about
• 01:19:41research on human subjects in
• 01:19:43in Mengele's lab.
• 01:19:45Right?
• 01:19:46There's a certain kind of
• 01:19:47power of place.
• 01:19:50Add over.
• 01:19:55But
• 01:19:56we might,
• 01:19:59you know, if you go
• 01:20:00to the Museum of the
• 01:20:01Resistance
• 01:20:01in
• 01:20:03one of the really disturbing
• 01:20:05things is
• 01:20:06how few resistors there were.
• 01:20:09Mhmm. And they have them
• 01:20:10organized
• 01:20:11by professions on the wall.
• 01:20:13And there's,
• 01:20:14like,
• 01:20:16two doctors
• 01:20:18and three journalists.
• 01:20:21And, I don't know, no
• 01:20:22lawyers.
• 01:20:23There's some, but I'm exaggerating.
• 01:20:25But these are professional groups
• 01:20:27that have our professional ethics
• 01:20:29and try to articulate them
• 01:20:31to one another.
• 01:20:33And on the other hand,
• 01:20:36as you know from having
• 01:20:37worked for a long time
• 01:20:38at the AMA,
• 01:20:42professional organizations
• 01:20:44are also notoriously
• 01:20:46self serving.
• 01:20:48They're lobbying groups. Right?
• 01:20:50So so,
• 01:20:53where should professional
• 01:20:55ethics
• 01:20:56be
• 01:20:57fomented?
• 01:20:59Right? Should we be should
• 01:21:01universities
• 01:21:02be trying to tell
• 01:21:05docs as they graduate, this
• 01:21:06is what professional ethics are
• 01:21:08for you, or should we
• 01:21:09trust the people out in
• 01:21:10the professions who join the
• 01:21:11AMA
• 01:21:12as volunteers who who are
• 01:21:14trying to do good things?
• 01:21:15Should we trust them
• 01:21:17to articulate the professional ethics?
• 01:21:19Where do you think,
• 01:21:22the robust kind of ethics
• 01:21:24a profession should have
• 01:21:27should be developed? Yeah. So,
• 01:21:31I'll just start by saying
• 01:21:32the,
• 01:21:34really most famous resistance organization
• 01:21:37among medical professionals was the
• 01:21:39White Rose Society,
• 01:21:41which was medical students Yeah.
• 01:21:43Primarily.
• 01:21:45They were all killed, but
• 01:21:48they were a major
• 01:21:50group
• 01:21:51that, you know, tried to
• 01:21:52do real stuff to to
• 01:21:54actually stand up and resist.
• 01:21:57And I think there's a
• 01:21:57lesson there, which is,
• 01:21:59and I'll just I'll just
• 01:22:00say this broadly in case
• 01:22:02people don't know how the
• 01:22:04AMA and your state medical
• 01:22:06societies and your specialty societies
• 01:22:08all kind of work
• 01:22:09politically.
• 01:22:11The American Medical Association has
• 01:22:13about a five hundred person
• 01:22:15house of delegates, which is
• 01:22:16like congress.
• 01:22:18Every person there is sent
• 01:22:19from a medical specialty society
• 01:22:21or a state society
• 01:22:22or represents
• 01:22:24a specialized group like medical
• 01:22:26students, for example, or the
• 01:22:28minority affairs section,
• 01:22:30or the organized medical staff
• 01:22:32section,
• 01:22:33so or the military physicians.
• 01:22:36Right? So so the AMA
• 01:22:38makes policy in this incredibly,
• 01:22:41representative
• 01:22:42democratic way.
• 01:22:44Right? So it actually doesn't
• 01:22:45matter to the AMA that
• 01:22:47much how many individual doctors
• 01:22:48choose to join.
• 01:22:50What gives the AMA its
• 01:22:51credibility
• 01:22:52is this is the democratic
• 01:22:54structure of the house of
• 01:22:55delegates
• 01:22:56in which every state, every
• 01:22:58specialty, and many subgroups
• 01:23:00are represented and get votes.
• 01:23:02The AMA house of delegates
• 01:23:04is in session twice a
• 01:23:05year for a couple days,
• 01:23:07and they have the authority
• 01:23:09to do all the lawmaking
• 01:23:10for the AMA. Right? They
• 01:23:12set all the policies.
• 01:23:14Between times,
• 01:23:15it's up to the board
• 01:23:16of trustees and the executive
• 01:23:18staff of the AMA to
• 01:23:20make decisions about which policies
• 01:23:22they're gonna push and which
• 01:23:24ones they're gonna hold back
• 01:23:25on.
• 01:23:27And they are,
• 01:23:28notoriously
• 01:23:30conservative,
• 01:23:31and I don't mean that
• 01:23:32in a political sense. I
• 01:23:33mean that in the sense
• 01:23:34that they do not want
• 01:23:35to take any risks
• 01:23:37without the clear backing of
• 01:23:39the house of delegates.
• 01:23:42So between times, you're going
• 01:23:44to see very conservative decision
• 01:23:45making.
• 01:23:47And then when the house
• 01:23:47of delegates comes together,
• 01:23:50you get pushing
• 01:23:51on the AMA
• 01:23:53leadership
• 01:23:53to do stuff.
• 01:23:55The next meeting of the
• 01:23:56AMA House of Delegates is
• 01:23:58in June,
• 01:24:00and I think it is
• 01:24:01notable that we have seen
• 01:24:03zilch from the AMA,
• 01:24:05except for one advocacy issue,
• 01:24:08which is trying to reform
• 01:24:09Medicare payments for doctors.
• 01:24:12That's that's the AMA's policy
• 01:24:14agenda right now. Medicare payments
• 01:24:17for doctors need to be
• 01:24:18reformed, and they do.
• 01:24:20Fair enough.
• 01:24:23I think there's gonna be
• 01:24:24some delegations
• 01:24:25at the AMA House of
• 01:24:26Delegates
• 01:24:27who and I would point
• 01:24:29to potentially the medical student
• 01:24:31section
• 01:24:33to bring some resolutions forward
• 01:24:35saying
• 01:24:36medical
• 01:24:37practice today is under threat.
• 01:24:39Science today is under threat,
• 01:24:41and I know there is
• 01:24:43a diversity of political opinions
• 01:24:44within the house of medicine.
• 01:24:46Totally understandable. I would hope
• 01:24:47that we can all come
• 01:24:48together
• 01:24:49to protect the legitimacy and
• 01:24:51integrity of science
• 01:24:53and medical education and medical
• 01:24:55publishing.
• 01:24:56All of these are are
• 01:24:58currently
• 01:25:00being pushed at and prodded
• 01:25:01at and poked at and
• 01:25:03and, you know, just like
• 01:25:04the the rest of the
• 01:25:05academy,
• 01:25:07medicine is not exempt from
• 01:25:08this. I don't know how
• 01:25:09many of you kept track
• 01:25:10of the Harvard situation, but
• 01:25:12the medical school and the
• 01:25:13public health school were explicitly
• 01:25:14named
• 01:25:17as, you know, these bastions
• 01:25:18of wokeness.
• 01:25:20And,
• 01:25:22you know,
• 01:25:24that's that's a threat
• 01:25:26to and it's especially a
• 01:25:28threat to remove a bunch
• 01:25:29of funding
• 01:25:31for
• 01:25:32completely unrelated science
• 01:25:35as a punishment
• 01:25:37for, you know,
• 01:25:39some other issue that, you
• 01:25:42know, undoubtedly legitimate critiques of
• 01:25:45all universities. But
• 01:25:48but that's a real thing.
• 01:25:50And our
• 01:25:52professional association has said nothing
• 01:25:53about it so far.
• 01:25:55And I so I think
• 01:25:56it's both, bottom line. I
• 01:25:59think it is the AMA.
• 01:26:00It is the ACP. It
• 01:26:02is the AAP. It is
• 01:26:03the ACS. It is right?
• 01:26:04It's it's all of these
• 01:26:06professional and quasi professional organizations,
• 01:26:08but it's really all of
• 01:26:10us.
• 01:26:11It's really us being involved
• 01:26:13and engaged in the creation
• 01:26:15of our code of ethics
• 01:26:16and in helping our organizations
• 01:26:19have a spine
• 01:26:20and stand up for the
• 01:26:21for the values that we
• 01:26:23say motivate us. Right? Standing
• 01:26:25up for altruism, for empathy,
• 01:26:27for protection of the vulnerable.
• 01:26:29Those are important values. We
• 01:26:31keep saying so.
• 01:26:35So thank you for saying
• 01:26:37it. And the final question
• 01:26:39or comment to the evening,
• 01:26:41please.
• 01:26:42Hi. Thank you for the
• 01:26:43talk and, for your scholarship.
• 01:26:46When I think of of
• 01:26:48Nazi science,
• 01:26:50I think,
• 01:26:51it's, in my mind at
• 01:26:52least, pretty clear that there
• 01:26:54were fundamental
• 01:26:55advances in physics that we
• 01:26:57can't that just have contributed
• 01:27:00to how we think about,
• 01:27:03physics. And I'm wondering in
• 01:27:04biomedical research,
• 01:27:06was there anything in the
• 01:27:08absence
• 01:27:09of
• 01:27:10an IRB
• 01:27:11or,
• 01:27:13studies that just would never
• 01:27:14get approved anywhere where a
• 01:27:16moral compass is necessary
• 01:27:19that advanced medicine?
• 01:27:22Yeah.
• 01:27:24Yeah. This is a this
• 01:27:25is a very important question.
• 01:27:27For many years, I think
• 01:27:28the conventional wisdom
• 01:27:30was the comforting
• 01:27:32version of the answer, which
• 01:27:34is,
• 01:27:35gosh, even if you were
• 01:27:36doing good science, you were
• 01:27:37doing it on victims who
• 01:27:39were emaciated,
• 01:27:41who were stressed.
• 01:27:42Nothing can be learned from
• 01:27:43them that is applicable,
• 01:27:46to anyone else.
• 01:27:47The reality,
• 01:27:49sadly, is a lot more
• 01:27:50complicated than that.
• 01:27:52Has anyone ever worn a
• 01:27:53personal flotation device
• 01:27:55that keeps the back of
• 01:27:56your head out of the
• 01:27:57water?
• 01:27:58Nazi science.
• 01:28:01So there were plenty you
• 01:28:03know, these were not idiots.
• 01:28:05They were and for the
• 01:28:07most part, they were real
• 01:28:08scientists.
• 01:28:10Mengele is a weird case,
• 01:28:12but most of the people
• 01:28:13who were doing these experiments
• 01:28:15were actually
• 01:28:16respected
• 01:28:17medical scientists who
• 01:28:19did,
• 01:28:20you know,
• 01:28:22bad ethics,
• 01:28:24but
• 01:28:25science.
• 01:28:26And so they they did
• 01:28:27learn stuff that could be
• 01:28:29applied. And what do you
• 01:28:30do with that? Right? And
• 01:28:31this idea that,
• 01:28:33you know,
• 01:28:34there's consensus,
• 01:28:36among even the victims, unfortunately,
• 01:28:39is not true.
• 01:28:40There are men there's a
• 01:28:41group of Mengele twins. There's
• 01:28:43about three hundred of them.
• 01:28:45Many have died by now,
• 01:28:47but they had very vigorous
• 01:28:49debates
• 01:28:51about whether,
• 01:28:52and how,
• 01:28:53if ever, the information from
• 01:28:55experiments in which they were
• 01:28:57victims
• 01:28:58should be used within themselves,
• 01:29:00with some saying
• 01:29:02this was heinous. If we
• 01:29:03ever use the information, it
• 01:29:05will encourage someone else to
• 01:29:06do something terrible someday in
• 01:29:08the future. We shouldn't use
• 01:29:09it at all. We should
• 01:29:10burn it all.
• 01:29:12And others saying, if my
• 01:29:13suffering
• 01:29:14can be used to alleviate
• 01:29:16someone else's suffering, I would
• 01:29:18like to think that it
• 01:29:19would have, you know, some
• 01:29:20benefit for someone else. I
• 01:29:22know it's never gonna benefit
• 01:29:23me, but it helps me
• 01:29:25to think that it might
• 01:29:26benefit someone else.
• 01:29:29The AMA policy on this,
• 01:29:30by the way, is that
• 01:29:32it is,
• 01:29:34occasionally,
• 01:29:35rarely
• 01:29:36acceptable to cite
• 01:29:38a Nazi
• 01:29:39research project,
• 01:29:41a Nazi publication,
• 01:29:42if
• 01:29:44it is the only such
• 01:29:46of information available, so there's
• 01:29:48not an alternative source
• 01:29:49for that information that you
• 01:29:51could cite.
• 01:29:52And if you explicitly say
• 01:29:55in the paper, not just
• 01:29:56in a footnote,
• 01:29:58that this was unethical research,
• 01:30:01recognize that, and then cite
• 01:30:03it.
• 01:30:05That's the that's a compromised
• 01:30:07position, I guess.
• 01:30:09Recognizing that
• 01:30:11this was real science. It
• 01:30:13was an it was immoral
• 01:30:15science. It was evil science.
• 01:30:17I I'm
• 01:30:19we have we have disputes
• 01:30:20within the Lancet Commission on
• 01:30:21using the word evil for
• 01:30:23exactly the reason that we've
• 01:30:24been talking about it sort
• 01:30:25of as a distancing
• 01:30:27mechanism, but this was evil.
• 01:30:29And there's plenty of here
• 01:30:30plenty here that is clearly
• 01:30:32evil.
• 01:30:33It's evil that was justified
• 01:30:35in in the way that,
• 01:30:37that Fritz Klein justified it,
• 01:30:40right, by saying, well, sometimes
• 01:30:42short term pain for long
• 01:30:43term
• 01:30:44gain. You gotta break a
• 01:30:45few eggs to make an
• 01:30:46omelet.
• 01:30:52Good evening.
• 01:30:53Please try me to thank
• 01:30:54you.
• 01:31:08Me.
• 01:31:19It'll be a breeze going
• 01:31:20to do as well.
• 01:31:22Alright. And I gotta see
• 01:31:24what the nature of the
• 01:31:24You gotta do what you're
• 01:31:24doing?
• 01:31:54Oh, thanks, John. Thanks, Ken.
• 01:31:58Oh, those can't.
• 01:31:59Alright.