Transcript PowerPoint - Medicine After The Holocaust

Medicine After the Holocaust
(contd)
 Election and assassination of John F. Kennedy
 Ask not what your country can do for you…
 Rice Stadium moon speech
 Election and resignation of Lyndon Johnson
 Civil Rights Act of 1964
 Medicare and Medicaid 1965
 The War in Vietnam
 Kennedy Center for Bioethics 1971
 Roe v Wade 1973
 Gertrude Potsma found guilty of mercy killing 1973
Medicine After the Holocaust
(contd)
 (Unconstrained) Rights: The story behind the term
“rights” is the story of social contract. The myth
postulates free and independent if highly
vulnerable beings who voluntarily trade a portion
of their autonomy for a measure of collective
security. The myth makes the collective
arrangement the product of individual choice and
thus secondary to the individual. “Rights” are the
fundamental category because it is the normative
category which most nearly approximates that
which is the source of the legitimacy of everything
else. Rights are traded for collective security.
Medicine After the Holocaust
(contd)
 (Constrained) Duty: The basic myth of Judaism is
obligation or mitzvot. It, too, is intrinsically bound
up in a myth—the myth of Sinai. Just as the myth of
social contract is essentially a myth of autonomy, so
the myth of Sinai is essentially a myth of
heteronomy (subjection to something else). Sinai is
a collective—indeed, a corporate—experience. The
experience at Sinai is not chosen.
 There is no Hebrew word for “right” in the modern
sense of “I am entitled to it.”
Medicine After the Holocaust
(contd)
 The right to an abortion
 The right to die
 The right to a (medical) education
 The right to medical care
 The right to health insurance
 Animal rights
 Gay rights
 Women’s rights
Medicine After the Holocaust
(contd)
 Beauchamp & Childress: Principles of Biomedical
Ethics 1979 includes the four clusters of Basic
Principles:
 Respect for autonomy (a norm of respecting the
decisonmaking capacities of autonomous persons)
 Nonmaleficence (a norm of avoiding the causation of
harm)
 Beneficence (a group of norms for providing benefits
and balancing benefits against risks and costs)
 Justice (a group of norms for distributing benefits,
risks, and costs fairly)
Medicine After the Holocaust
(contd)
 From Roe v Wade, Decided January 22, 1973 by a 7 to 2
majority: “ The principal thrust of appellant's attack
on the Texas statutes is that they improperly invade a
right, said to be possessed by the pregnant woman, to
choose to terminate her pregnancy. Appellant would
discover this right in the concept of personal ‘liberty’
embodied in the Fourteenth Amendment's Due
Process Clause; or in personal, marital, familial, and
sexual privacy said to be protected by the Bill of
Rights or its penumbras; or among those rights
reserved to the people by the Ninth Amendment.”
Medicine After the Holocaust
(contd)
 “Before addressing this claim, we feel it desirable
briefly to survey, in several aspects, the history of
abortion, for such insight as that history may afford
us, and then to examine the state purposes and
interests behind the criminal abortion laws.”
 “Ancient religion did not bar abortion.”
 “Why did not the authority of Hippocrates dissuade
Medicine After the Holocaust
(contd)
Medicine After the Holocaust
(contd)
 “The abortion clause of the Oath, therefore, ‘echoes
Pythagorean doctrines,’ and ‘in no other stratum of
Greek opinion were such views held or proposed in
the same spirit of uncompromising austerity.’”
 “Dr. Edelstein then concludes that the Oath
Medicine After the Holocaust
(contd)
 “But with the end of antiquity a decided change
took place. Resistance against suicide and against
abortion became common. The Oath came to be
popular. The emerging teachings of Christianity
were in agreement with the Pythagorean ethic. The
Oath ‘became the nucleus of all medical ethics’ and
‘was applauded as the embodiment of truth.’ Thus,
suggests Dr. Edelstein, it is ‘a Pythagorean manifesto
and not the expression of an absolute standard of
medical conduct.’”
Medicine After the Holocaust
(contd)
 “This, it seems to us, is a satisfactory and acceptable
explanation of the Hippocratic Oath's apparent
rigidity. It enables us to understand, in historical
context, a long-accepted and revered statement of
medical ethics.”
Medicine After the Holocaust
(contd)
 America’s circumstances today are eerily similar to
those of Germany in the early 1930s. American
biomedical science is now the most advanced in the
world. The Human Genome Project has revitalized a
universal interest in biological determinism and
eugenics. Patient autonomy and patient rights have
become orthodox thinking in the highest circles of
academic medicine, government, and philanthropy
throughout America and the rest of the Western
world. Economic and political power in medicine is
concentrated in a strong, centralized American
government.
Medicine After the Holocaust
(contd)
 The placement of autonomy, patient rights, and law
above other ethical principles, the doctor-patient
relationship, and religious moral values is, in part, a
consequence of our secular bioethics that
originated in the Nuremberg Code. Lisa Eckenwiler
and Felicia Cohn, citing bioethicist Jonathan
Moreno, describe the danger of the dominance of
autonomy over other values this way: “When it
comes to America in the mid-twentieth century, the
creation stories are often summarized in a word—
“Nuremberg,” “Tuskeegee,” “Willowbrook,” and
Medicine After the Holocaust
(contd)
more. All of these stand for part of but not the
whole story. In its foundational beliefs in individual
autonomy, bioethics had a distinctly American cast.
In warning against American ‘bioethics
imperialism,’ however, Moreno cites the experience
of Weimar Germany in the early 1930s when a few
physicians created a journal called Ethics to discuss
various theories of eugenics, then the dominant
social philosophy of medicine. Moreno calls the
devolution of this journal into a Nazi tract for racial
purification, a warning that an intellectual
movement can slide into disaster.”
Medicine After the Holocaust
(contd)
eugenics nonmaleficence beneficence justice
EUGENICS nonmaleficence beneficence JUSTICE
AUTONOMY nonmaleficence beneficence JUSTICE
LIFE nonmaleficence beneficence JUSTICE
Medicine After the Holocaust
(contd)
 In Judaism, the value of human life is supreme;
nearly all Biblical laws are waived to save a life. This
approach contrasts with the secular ethical view,
which considers human life to be one of many
values and often gives greater weight to “the quality
of life.” Nonetheless, the value of human life in
Judaism is not absolute and, in certain rare and
well-defined circumstances, other values may
prevail.
 We neglect 3,000 years of empirical data and analysis
from Jewish medical ethics or bioethics at our peril.
Medicine After the Holocaust
(contd)
 During the Third Reich, eugenics triumphed over
the Jewish medical values of the supreme value of
all human life and the sanctity of the human body.
 In America today, autonomy and rights have
experienced a similar triumph.
 A society that believes in the supreme value of all
human life will legalize neither abortion on
demand nor the right to die.
 A society that believes in the sanctity of the human
body would treat it with respect both during and
after life.
“Nothing About Us Without Us”
Medicine After the Holocaust
(contd)
 Singer, speciiesism, PETA and “holocaust on your
plate,” partial birth abortion, infanticide
 Diversity trumps competence (Major Hassan)
 Homemade eugenics via Preimplantation genetic
diagnosis (PGD):
 Down Syndrome (Sarah Palin)
 Creating a donor for a sibling (My Sister’s Keeper)
 Gender “selection” in about 50% of IVF clinics
 A focus on the “perfect baby” that makes us less
tolerant of people with disabilities (Human Genome)
 Fifty million abortions in America since Roe v. Wade
Medicine After the Holocaust
(contd)
 “In 1989, the Oregon Legislature created the Health
Services Commission and directed it to develop a
prioritized list of health services ranked in order of
importance to the entire population to be covered.”
 “Individual condition/treatment pairs are
prioritized according to impact on health,
effectiveness and (as a tie-breaker) cost.”
 “The resulting prioritized list is used by the
Legislature to allocate funding for Medicaid and
SCHIP, but the Legislature cannot change the
priorities set by the independent Commission.”
Medicine After the Holocaust
(contd)
 In “1997 Oregon enacted the Death with Dignity Act
(the Act) which allows terminally-ill Oregonians to
end their lives through the voluntary selfadministration of lethal medications, expressly
prescribed by a physician for that purpose.”
 “The law states that…a patient must be: 1) 18 years
Medicine After the Holocaust
(contd)
Medicine After the Holocaust
(contd)
expenses are incurred in the final days and weeks of
life, the hastened demise of people with only a short
time left would free resources for others. Hundreds
of billions of dollars could benefit those patients
who not only can be but who want to live.”
[Emphasis in the text.]
 In July 2008 Barbara Wagner and Randy Strop asked
Medicaid to cover their chemotherapy. Each
received a letter from the OHP administrator
refusing to cover chemotherapy but offering to pay
for their assisted suicide or “comfort care.”
Medicine After the Holocaust
(contd)
 America has a unique Judeo-Christian foundation
and remains one of the most religious countries in
the world.
 One (constrained) segment of America accepts, “We
hold these truths to be self-evident, that all men are
created equal, that they are endowed by their
Creator with certain unalienable Rights, that among
these are Life, Liberty, and the pursuit of
Happiness.”
Medicine After the Holocaust
(contd)
 A survey of Baby Boomers in 1996, when we were
turning fifty, asked them the age at which they
thought that old age begins.
 The median response was 79.5 years.
 The average life span was 76.1 years.
 Another (unconstrained) segment of America may
believe, “We hold these truths to be self-evident,
that all men are created equal, that they are
endowed by their Creator with certain unalienable
Rights, that among these are Quality of Life,
Autonomy, and Happiness.”
Medicine After the Holocaust
(contd)
 The transformation of “Life, liberty, and the pursuit
of happiness” into “Quality of life, autonomy, and
happiness” has profound implications for the
medical profession in the area of clinical medicine.
 Consider a story about the namesake of the building
in which we are today, Michael DeBakey, a story
that highlights the differences between an IRB to
evaluate human subjects research applications and
an Ethics Committee to evaluate clinical decisionmaking.
Medicine After the Holocaust
(contd)
 Science or reason and religion or faith can work
together to solve many thorny problems.
 For example, consider the respirator, a great
technical achievement that has brought with it
fundamental questions about the definition of
death.
 Physicians initially utilized respirators to save lives
but quickly realized that, in many cases, they were
simply delaying an inevitable death. What to do?
 Avraham Steinberg and timers on respirators.
Medicine After the Holocaust
(contd)
 A new king arose over Egypt, who did not know of
Joseph.
 “Behold! The people, the Children of Israel are more
numerous and stronger than we.”
 The king of Egypt said to the midwives of the
Hebrews, “When you deliver the Hebrew women, and
you see them on the birthstool, if it is a son, you are to
kill him, and if it is a daughter, she shall live.”
 “But the midwives feared God and they did not do as
the king of Egypt spoke to them, and they caused the
boys to live.”
Medicine After the Holocaust
(contd)
 The King of Egypt summoned the midwives and said
to them, “Why have you done this thing that you have
caused the boys to live!”
 The midwives said to Pharaoh, “Because the Hebrew
women are unlike the Egyptian women, for they are
experts; before the midwives come to them, they have
given birth.”
 God benefited the midwives—and the people
increased and became very strong. And it was because
the midwives feared God that he made them houses.”
Eugenics in Germany (contd)
 This image from controversial German anatomist
Gunther von Hagens’ Body Worlds recalls the Glass
Man.
 It also recalls images from Eduard Pernkopf ’s
infamous Atlas of Topographical and Applied Human
Anatomy, which has been hailed as one of the most
important anatomical atlases since the work of
Vesalius.
 Pernkopf used the murdered bodies of men,
women, and children from the Holocaust for his
atlas of anatomy.
Eugenics in Germany (contd)
 While Pernkopf was a successful anatomist, he was
also a fervent believer in National Socialism. He
joined the Nazi party in 1933. Soon after Hitler
invaded Austria in 1938, Pernkopf was chosen as
Dean of the Vienna Medical School. His first
assignment included purging the medical school
faculty of all Jews and undesirables. This resulted in
the loss of 153 of the 197 faculty members, including
3 Nobel Laureates.
Medicine After the Holocaust
 How do we explain the willing participation of the
medical profession in the most egregious and welldocumented violations of medical ethics ever?
 Three necessary but insufficient conditions must be
present:
 A centralized government.
 A dominant philosophy of medicine.
 Economic distress.
 Proctor identifies six reasons why doctors eagerly
served as Hitler’s henchmen:
Greco-Roman values meet
Judeo-Christian values
 The unconstrained (Greco-Roman or, in this case,
Irish) but beautiful cop meets the constrained but
holy (Jewish) religious leader in a case of a missing
person in 1992’s A Stranger Among Us directed by
Sidney Lumet and starring Melanie Griffith.
Eugenics (contd)
 First see intro to Haas/Greenberg to note conflict
between religion and science.
 Compare French revolution and American
revolution in terms of a conflict of visions i.e. see
Sowell
 Cruelty to humans implies cruelty to animals
 Cruelty to animals implies cruelty to people
 Kindness to humans implies kindness to animals
 Kindness to animals tells us nothing about how people will
treat people e.g. think PETA, which compares eating
chickens to “Holocaust on a plate” i.e. they will lower the
value of people and treat them less kindly
 Hitler forbade vivisection of animals (and opposed smoking)
but demanded vivisection of humans
 See cartoon with animals saluting Hitler
 Include slides which say 1)Why it happened it Germany the
way it happened i.e. Fred’s friend 8 ethics violations and
Proctor’s six explanations plus central government; 2) what
was similar and what was different about Germany and
America; 3) why it happened there and not here; 4) what’s
good about America