sense of mission and conviction that I share with him. Admittedly, there are certain moral barriers I have difficulty imagining I could cross—I cannot imagine selecting those who would be sent to their immediate deaths; his research methods were patently inhumane. But, if we are unable to imagine ourselves committing such acts, is a deficit in imagination real evidence we could not commit evil?
I consider my communication with patients, especially the skills I have developed to help have difficult conversations. I wonder though: what if I nudge them to make decisions that they would not have made otherwise? For example, perhaps I believe that CPR is not in their best interest. Having listened to their values and goals and through my influence, convincing words, tone, and phrases, they then choose not to undergo CPR, dying prematurely because of this decision. Did my encouragement, even well intentioned and based on respectfully listening to their views, hasten their death? I have, after all, seen patients recover from CPR in ways I never would have imagined before. Further, do we as clinicians, chaplains, and visitors, walk along intensive care units, shake our down-turned heads, and ponder whether those lives are worth living? It takes no great mental leap to land at the concept of Lebensunwertes Leben—life unworthy of life, a principle that propelled so much of Nazi decision-making. Members of my profession have been perpetrators; neither the institution of medicine itself, nor medical education, nor membership in academic communities can stand as an antidote to malformed thinking or complicity with terror. German physicians made this gravely apparent in their rush toward Nazism.
As I read about Mengele, reflected on these truths, and searched other books about Nazi physicians and Nazi medical ethics, I consistently found the same themes again and again. I noticed points of agreement between their motivations and those in my personal statements for medical school and residency. What could this mean?
My complicity in contemporary evils is immediately apparent. In recent years, there has been a necessary and awfully belated effort to reveal the malicious effects of many professions and systems within the United States. The complicity of medicine and physicians in racism has been widely documented and increasingly illuminated, for example, in the methods used to teach the diagnosis of common skin disorders.29 Gender bias in medicine is prolific and continues to require enthusiastic and durable change. I knew about this type of complicity before reading about Mengele. Through these and other readings, workshops, and conversations, I continue to recognize my own active and passive complicity in inequity, and work to align myself with a wholly patient-centered, historically informed, and forward-thinking practice of medicine.
Yet, despite my intentions and efforts, it remains especially unnerving to note similarities I have with a Nazi physician at Auschwitz. I can be on guard, think myself to be doing the best for the best reasons. But might he have thought the same? In our contemporary climate, people frequently identify similarities between different political and social groups—or governmental agencies—and the Nazis (some, more appropriately than others). At times, it has seemed a flagrant and inappropriate comparison—simply nothing is comparable to the Holocaust. Still, as the memory of the Doctors’ Trial still looms large, I think in our attempt to acknowledge the incomparable horrors of that era, we have forgotten how much one comparison can shed light on our actions and guide us each day—what motivations we share with those who perpetrated such incomparable evils—the similarity, that is, between Mengele and me.
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Karl Wallenkampf was a 2022 FASPE Medical Fellow. He is an Internal Medicine resident through Barnes-Jewish Hospital and Washington University in St. Louis School of Medicine.
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29 Nolen, LaShyra. “How Medical Education Is Missing the Bull’s-Eye.” New England Journal of Medicine, tom 382, nr 26, czerwiec 2020, str. 2489–91. Taylor and Francis+NEJM, https://doi.org/10.1056/NEJMp1915891.