*Alessandra Colaianni [2013] is doing an MPhil in the History and Philosophy of Science at the University of Cambridge. Picture credit: Vichaya Kiatying-Angsulee and http://www.freedigitalphotos.net
"Medicine as a profession contains the rudiments of evil [...] some of the most humane of medical acts are only small steps away from real evil."
- Dr Michael Grodin, physician and Holocaust scholar
A physician is supposed to be a healer. Helping patients is so central to the profession's ideal that newly minted doctors take an oath to "do no harm". As a medical student, I look forward to the unique honour and responsibility of taking care of patients; but I'm also conscious of - and frightened by - a darker side of medical history. In 2011, I took part in the Fellowships at Auschwitz for the Study of Professional Ethics (FASPE) and learned that in World War II Germany, more physicians than any other professional group joined the Nazi Party and became members of the SS. Droves of doctors who had taken oaths to do no harm somehow became the perpetrators of torture and murder in the form of grotesque medical experiments, the T4 "euthanasia" programme that murdered thousands of mentally handicapped individuals, and direct participation in the so-called "Final Solution" at Auschwitz and other death camps.
What is perhaps more disturbing is the fact that the second world war was neither the first nor the last time that groups of physicians have been perpetrators of acts that should have been antithetical to the values of their chosen profession: physicians tortured political prisoners in Argentina under Pinochet; in Guantanamo Bay, American soldiers were accused of torture; during the worst of Hurricane Katrina, American physicians were accused of euthanising their patients. If we include ethical breaches conducted during medical research, the number of physician perpetrators increases still further: the Willowbrook hepatitis experiments, venereal disease experiments in Guatemala and Tuskeegee syphilis experiments all occurred after World War II.
Unique status
What I realised in researching these topics is that the perpetrators became perpetrators not in spite of being doctors' but because they were doctors. Their status as doctors carried with it certain moral vulnerabilities that made it easier for them to make the almost unfathomable transition from physician to murderer. Their knowledge of the human body became knowledge about how far they could take their torture without killing their victims. They had unique status in society that allowed them to do things that in others' hands would have been criminal. Furthermore, they were used to inflicting pain on their patients in order to heal them. When Nazi doctors were exhorted by their superiors to exterminate parts of the populace to "cleanse" German genetic stock, they used a medical explanation to rationalise what they were doing. As one Nazi doctor, Fritz Klein, put it: "Of course I am a doctor and I want to preserve life. And out of respect for life I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind."
I published a paper last year in the Journal of Medical Ethics exploring these moral vulnerabilities. My research this year seeks to answer the questions: are there social pressures operating in contemporary medical society that predispose physicians to unethical behaviour? If so, what can we - as medical students, medical schools, and society in general - do to combat them? To this end I am undertaking an MPhil in History, Philosophy, and Sociology of Science, Medicine and Technology over the course of this year. I look forward to continuing to explore these topics as a way to try to make my future profession a safer one.