Defining medical care in this way, as a project that involves genetic counseling and public health in the individual patient encounter, helps us interrogate Nazi medical ethics and notice similar, relevant motivations in our contemporary practice of medicine. This paradigm allowed doctors who wanted to help others and “follow the science” to ethically endorse and participate in a new approach through which they could focus on the effects of their work at the level of whole populations. In this way, they could support, das Volk, the German people, even if it meant the terrible extermination of millions. Those targeted included congenitally ill children, Jews, Sinti and Roma, anyone not cisgender or heterosexual, and anyone who did not adhere to the Nazi paradigm, lumped together under the catch-all term “asocials.”12
Physicians were the profession with the highest proportions of Nazi Party membership, with 45% joining by one estimate.13 These were not only older physicians who may have wished the world were like it was in some imagined past but also young physicians. Indeed, some of the most thorough support for Nazism came from young doctors, specifically those under forty.14 Their motivations, while partly explicable by a desire to remove Jewish and other competitors from positions of prestige, were not merely about advancing their own careers. These medical providers had motivations that feel contemporary to clinicians today, including a wish to turn away from a commercialized view of medicine. The Nazis, for example, criticized insurance companies and the “trade” of medicine and encouraged physicians to consider medicine a “calling.”15 Physicians in Nazi Germany were encouraged to see themselves as integral members of a flourishing society. In a speech to the National Socialist Physicians League, Adolf Hitler declared, “National Socialist doctors, I cannot do without you for a single day, not a single hour. If not for you, if you fail me, then all is lost. For what good are our struggles, if the health of our people is in danger?”16 What physician could refuse such a position of honor at the center of a society dedicated to purifying medical practice?
In the context of these shifts in medical ethics, Mengele prospered. If Nazism was merely applied science, then a devoted physician like Mengele only had to “follow the evidence.” For this reason, he was drawn to the most active areas of research and discussion at the time—anthropology and genetic transmission—and thus began experimentation for his dissertation. Twin Studies as a field of inquiry was then at the forefront of research, so much so that grants to those working in the field came from major universities and non-profits such as the Rockefeller Foundation.17 Thus Mengele mastered the necessary research methods and positioned himself at the cutting edge of medical anthropology. Two years prior to the war, he started his second doctorate, necessary not to be a community physician but rather to enter the ranks of academic medicine.18 His finished work was met with acclaim. In fact, he published his research in a sufficiently high-impact journal that it received international publicity as a welcome contribution to the field,19 an outcome welcomed by anyone, then or now.
It was in this milieu, after working at the battlefront as a physician, that Mengele received a “serendipitous transfer” to Auschwitz.20 There he stood and made selections on the ramp. There he studied prisoners without their consent and denied them treatment in the interest of scientific discovery. There he earned his reputation, a reputation so terrifying that memories of his actions exceed human capability. Many of those who remember Mengele at Auschwitz describe a person with no resemblance to the man himself. Some describe him as tall and blonde, the Aryan ideal. In reality, he was brown haired and of average build. Memory has transformed him into something inhuman, peculiar, a beastly aberration responsible for each selection, each experiment.21 Mengele undoubtably committed innumerable evils—this is indisputable. Characterizations of him—including the moniker “Angel of Death”—affirm his responsibility and guilt, but they also distance Mengele from his humanity, which we share. We thus shirk confronting whether we could commit such acts too, as illustrated by a question Robert Jay Lifton was asked by an Auschwitz survivor: “Were they beasts when they did what they did? Or were they human beings?”22
Rather than being supernaturally evil, he was motivated by discovery and, as a result, abnegated his human responsibility, making way for his cruelty. He had access to the most “unprecedented” concentration of research subjects possible23 without any oversight, allowing him to research noma24 (a disease), twins,25 eye color,26 and various proteins thought to be related to the diagnosis of disease.27 Marwell’s work speaks for itself here: “[Mengele] pursued his science not as some renegade propelled solely by evil and bizarre impulses but rather in a manner that his mentors and his peers could judge as meeting the highest standards.”28 It is this which disturbs me, the thin but real continuity of his motivations and mine.
In this dark context, I consider my own inspirations and drives. I remember professors for their respect for patients and reflect on the teachers who taught with profound gravity from our cadavers in anatomy lab. I note my aspiration for a career in academic medicine, the pressure to publish insightful research in respected journals and receive complimentary editorials and applause at conferences. I maintain a commitment to practicing medicine at the vanguard of science while benefiting public health. Whatever my prior conceptions about Mengele, I realize now that instead of being opposites, there is a
10
Excerpt from a letter concerning the transfer of Josef Mengele to Auschwitz.
Source: A-BSMA.
11. Ibidem, 22.
12 Lifton, Robert Jay. The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books, 2017, 30.
13 Ibidem, 34.
14 Proctor, 68.
15 Ibidem, 70.
16 Ibidem, 62.