The Role of Professions in a State: The Effects of the Nazi Experience on Health Care Professionalism

Abstract

This paper reviews three competing ways of organizing health care delivery—professionalism, consumerism and statism—and explores how Germany’s exclusively statist model facilitated the ascendency of an alternative Nazi medical ethics predicated on eugenic conceptions of national “race hygiene.” The primary obligation of health care personnel became using their skills and knowledge to achieve the aims of the Nazi state, which justified forcible eugenic sterilization programs, and then the killing of children and adults with mental or physical disabilities and, eventually, the medicalized mass murder of other groups seen to pose a genetic threat to the health of the state, such as homosexuals, Jews, and Roma. The evolving international response to these medical crimes would come to affect medical professional approaches to virtually every issue in contemporary Bioethics, from abortion to xenotransplantation. In the early post-war years, news of German health care professionals’ participation in these actions shocked fellow health care professionals. Many denied these accounts, some defended German researchers, others dismissed the Germans’ justifications of their actions as madness parading as medicine or medical ethics. Ultimately, however, reformers seeking to remedy or prevent actions reminiscent of Nazi medicine created the foundational documents of modern health care professional ethics and the new field of Bioethics. These are the Nuremberg Code, the Declaration of Geneva, and the Belmont Report. In firmly rejecting Nazi medical ethics, these documents emphasize the rights of autonomous individuals, with health professionals serving as their agents, thus cementing modern ideals of health care professionalism.