In October 2015, during the 11th World UNESCO Bioethics, Medical Ethics and Medical Law Conference in Naples, Italy, Professor Amnon Carmi, Head of UNESCO Chair in Bioethics (Haifa) proposed celebrating an annual event to foster the principles of bioethics, as set forth by UNESCO. UNESCO adopted the ‘Universal Declaration on Bioethics and Human Rights’ on the 19th of October 2005, and so beginning in 2016 it was unanimously agreed upon to celebrate an annual World Bioethics Day on the 19th of October.
The 2005 UNESCO declaration was not issued in a vacuum. There is a vast history behind the formulation of this vital document.
Bioethics is largely regarded to have its beginnings in the 1960s in the United States. But on closer reflection of the literature a different picture comes to light. In a recent publication we have learned that the very term "bioethics" actually originated in 1927 with a German Protestant theologian named Fritz Jahr who defined the term in his paper "Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants" and proposed a "Bioethical Imperative," outlining the concept of bioethics as an academic discipline, principle, and virtue. Hence as early as 1927, we had a progressive conception of the ethical aspects of biology and medicine and the understanding of the importance of including this discourse in education. It is thought provoking to note that this notion was formulated in Germany during the same morally turbulent period when the racist racial hygiene theories were being proposed. Jahr's proposal, however, did not achieve its deserved recognition.
2017 marks the 70th anniversary of another important event in the history of bioethics. In August 1947, for the first time in history physicians were tried for for their participation in murderous and tortuous medical programs and experiments conducted in Nazi occupied Europe. In the final judgment the court articulated what is known as the "Nuremberg Code" which declared the rights of research subjects, and condemned the experiments and most of the defendants. Other codes for human experimentation were already in existence, including an extremely detailed German one formulated in 1931, but the Nuremberg Code was the first international code. The trial and the Nuremberg Code did not receive sustained attention until the mid-1960s. What the medical profession had done in Nazi Germany seemed altogether irrelevant to physicians in the rest of the world. The Code was described by some as, “A good code for barbarians but an unnecessary code for ordinary physician-scientists.” But it has been argued that the field of bioethics originated in Nuremberg, and not in the 1960s, as is generally perceived.
There may be varied opinions on where bioethics originated, but what is certain is that medicine during the Nazi period was the main impetus for the modern bioethical codes and regulations. There is a vital connection between bioethics and the Holocaust. The Holocaust differs from other instances of genocide in that it involved the active participation of medicine and science. While there have been many other genocides in the world, the Holocaust was a medically and scientifically based genocide. The discourse on Nazi medicine does not only concern human experimentation ethics but encompasses almost every bioethical topic relevant to modern medicine. In addition there are many misconceptions pertaining to the Nazi physicians' moral reasoning for their conduct. Some of these are the myths of incompetence, madness or coercion. It may be disconcerting, but the fact remains that they did indeed have moral underpinnings for their murderous medical crimes and this comprehension augments our sense of discomfort. The approach of learning and discussing these aspects of medicine's history has evolved due to the extensive medical historical research that has been published and today it is quite acceptable, and even imperative, that we medical professionals examine our past and in doing so reflect on our present perceptions. The difficulty of addressing these issues does not mean that we should avoid them. The difficulty in addressing these issues is exactly what bioethics is all about. Bioethics is the vehicle that is available for health professionals to use when difficult challenges arise. And difficult challenges certainly arise when medicine's complicity in the Holocaust is confronted.
In a UNESCO document called "Why Teach about the Holocaust" published in 2012 Irina Bokova, the Director General wrote: “The history of the genocide perpetrated during the Second World War does not belong to the past only. It is a ‘living history’ that concerns us all, regardless of our background, culture, or religion. Other genocides have occurred after the Holocaust, on several continents. How can we draw better lessons from the past?”
How can we draw better lessons from the past?
In 2013 the Casebook on Bioethics and the Holocaust' was published as one of the teaching manuals of the UNESCO Chair in Bioethics, Haifa. This casebook is one of the series of manuals that the Chair has produced which present ethical manuals to be used for ethics education of the medical professionals worldwide. The UNESCO Chair in Bioethics Haifa, Professor Amnon Carmi, wrote in his foreword to the Casebook: "The formation of ethical codes and books is not enough until their implementation. Implementation means education. Bioethics and the Holocaust offers the understanding of the Holocaust phenomenon."
It is understood by the UNESCO Chair in Bioethics, Haifa that education on bioethics and the Holocaust should be an integral part of medical ethics education worldwide. As a continuation of the perception of the importance of this issue, the UNESCO Department of Bioethics and the Holocaust was developed in 2017 as part of the UNESCO Chair in Bioethics, Haifa. The mission of this Department is to form an international group of interested professionals who will work together to provide various tools for educating undergraduates, graduates and professionals in the field of healthcare regarding the continuing relevance of bioethics and the Holocaust for current issues in society pertaining to medical practice, public policy and human rights.
The moral failures of physicians and the medical establishment in Germany and Austria during the Third Reich challenge medicine and medical education in a way few other events do. Almost every aspect of medical ethics has been influenced by the history of health professionals’ involvement in the Holocaust. Inquiry into the value judgments and moral actions of the Nazi doctors can inform current debate and practices.
In the spirit of World Bioethics Day 2017, we ask to include this important topic of Bioethics and the Holocaust in the general bioethical discourse and education. Some of these topics include: genetics and reproductive technologies, euthanasia, physician-assisted suicide, research ethics, abortion, medical education and professionalism, military medical ethics, utilitarianism, pharmaceutical ethics, medical ethical decisions in complex situations and many other issues that are pertinent not only to medical ethics but to human rights in general. Please join us in our quest to learn better lessons from the past and ensure that history never repeats itself.
Dr. Tessa Chelouche M.D
Dr. Stacy Gallin D.M.H