That Nazi Thing

I was noticing a dust up between two regulars here at Secondhand Smoke regarding analogies to Germany and the Holocaust and some of the issues with which we grapple here. I thought it warranted more than a post response from me.

This is a sensitive matter. The bioethicist Art Caplan once said, “Those who see analogies [to the Nazi period] must be specific about what they believe is similar between now and then. Blanket invocations such as . . . ‘euthanasia, if legalized, will lead to Nazi Germany,’ are to be avoided unless they can truly be supported in the scope of the claim being made.” Caplan is right. Just because the Nazis said or believed something, or adopted certain public policies, doesn’t mean, ipso facto, that the belief or policy is inherently evil or immoral. For example, Hitler created the German autobahns. That does not mean that President Dwight Eisenhower was wrong when he facilitated the creation of the Interstate Highway System.

On the other hand, just because “we” are not Nazis, doesn’t mean that era has no lessons to teach us. Moreover, there are many ways to fall off an ethical cliff despite the best of intentions. Indeed, I think the warning I quote below by Dr. Leo Alexander, who served with the U.S. Office of Chief Counsel for War Crimes at Nuremberg, is both apt and prophetic.

Dr. Alexander wrote a penetrating and important analysis about the medical foundation of the Holocaust in the July 14, 1949, issue of the New England Journal of Medicine. This is part of his conclusion: “Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of the physicians. It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.”

Looking at the state of the 1949 culture of American medicine, Dr. Alexander then warned:

“In an increasingly utilitarian society these patients [with chronic diseases] are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated with present knowledge has developed. This is probably due to a good deal of unconscious hostility, because these people for whom there seem to be no effective remedies, have become a threat to newly acquired delusions of omnipotence... At this point, Americans should remember that the enormity of the euthanasia movement is present in their own midst.”

These words are well worth pondering. My only question is whether the editors of the NEJM would permit such an essay to be published in its pages today.