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Offline: Medicine and the Holocaust—it's time to teach

2019; Elsevier BV; Volume: 394; Issue: 10193 Linguagem: Inglês

10.1016/s0140-6736(19)31608-3

1474-547X

Richard Horton,

Ethics and Legal Issues in Pediatric Healthcare

How can it be that in the 21st-century European nations are debating the rise of antisemitism? On the continent torn apart by a fascism that quickly became a genocide, it seems barely credible that antisemitism not only survives but also flourishes in increasingly populist and nationalist democracies. But survive and flourish it does. The UK's Labour Party, proud of its anti-racist history, has been reputationally wounded by repeated failures to expel those responsible for anti-Jewish activities. Last week, former Labour Prime Minister Gordon Brown wrote in The Guardian that “The Labour party owes the Jewish community an unqualified apology.” The UK's Equality and Human Rights Commission is currently conducting a formal inquiry into Labour's antisemitism and the party's ambivalent response. The problem of anti-Jewish hatred is not the UK's alone. Surveys across Europe show that Jews living in Austria, Belgium, Denmark, Germany, France, Hungary, Italy, the Netherlands, Poland, Spain, and Sweden believe that antisemitism is growing. In the US, 2018 saw the most lethal attack on Jews in the nation's history with the murder of 11 worshippers at the Tree of Life synagogue in Pittsburgh. Worldwide, the Anti-Defamation League has estimated that over 1 billion people harbour antisemitic attitudes. What is the responsibility of physicians to address, challenge, and defeat antisemitism? Writing recently in the Israel Journal of Health Policy Research, Shmuel Reis and colleagues argued that teaching the history of the Holocaust “can help ‘equip’ learners with a moral compass for navigating the future of medical practice”. One could go further: teaching medical students about the Holocaust can provide a powerful societal bulwark against antisemitism. Reis reminds us that doctors and other health professionals “were among the most avid” of Nazi ideologues. Healers became killers. Their “abandonment of moral principles” and the resultant “unprecedented breach of ethics” have “global implications for present and future healthcare professionals' education and practice”. Medicine contains inherent risks for abuse. A hierarchical profession. Obedience to that hierarchy. And enormous power over the lives of individuals and communities. Teaching medical students about the Holocaust would instil lessons about the equal worth of human beings, the limits of human experimentation, the importance of ethical regulation of research and practice, and the balance between notions of public health and the duty of health professionals to the welfare of individuals. The contemporary relevance for eliminating antisemitism is clear. And it goes beyond antisemitism too—promoting and embracing the needs of migrants and refugees, those with different cultural and ethnic backgrounds, the socially and economically dispossessed, and those living under occupation and in conflict. Teaching the Holocaust in medicine would be an act of resistance against depravity and discrimination. Preliminary evidence from the introduction of such a course—“The Holocaust: Lessons for Medicine”—at the Autónoma University of Madrid, Spain, shows that professional values can indeed be enhanced. Reis calls for the Holocaust “to be included in all healthcare professions education”. Sceptics might argue that Nazi atrocities could never happen again. But as Matthew Wynia and Alan Wells pointed out over a decade ago, an uncomfortable question has to be asked: “How did a professional group that was internationally respected, scientifically innovative, and ethically advanced, evolve an understanding of their ethical, social, and scientific obligations which led them, with only rare exceptions, to use their advanced scientific knowledge and professional ethics to justify committing murder and the most heinous crimes against humanity?” The difficult truth is that it was the profession's success that contributed to its hubris and collusion with a racist political regime. Medicine today is even more powerful than it was in the 1930s. The risks of abuse are greater now than then. In benign political times, the accrual of such power may be a theoretical danger only. But these are not benign political times. David Grossman notes, in his book Writing in the Dark (2008), that the Jewish people share “a profound lack of confidence in the possibility of existence”. In 2019, that confidence might have reached a nadir. By including the Holocaust in the curriculum of health professionals, medicine could do much to vanquish the evil that is antisemitism.