"NO NEW FREEDOMS"
Merkel's vaccination summit of insolence - what is she really planning?
BY ROLAND TICHY
Mon, February 1, 2021
Rarely has one of Merkel's rounds been fraught with more expectations - even if participating prime ministers like Bodo Ramelow prefer to practice girls' games on the cell phone or, like Armin Laschet, fail to dial into the virtual conference: Erren is presidential in Merkel's republic .
Sometime in autumn ...
And then came the disappointment: sometime in summer, early autumn, at the end of September, maybe everyone should get a vaccination offer. Aha. Israel will have its people vaccinated this month, with Britain and the US following suit. Then nothing comes for a long time, and then what? Because what does that mean: "Receive an offer"? Can you be vaccinated by then? Or is there then an offer that you can be vaccinated in the future, e.g. in May 2022? That's not a petty question. Too much depends on it, and Merkel argues like an insurance agent who wants to hide the small print from an older electric blanket buyer, which she uses to sell her a car wash instead.
And of course, she says, it depends on the delivery going smoothly. Now with such complex products it is in the nature of things, she argues, cumbersome and as complicated as vaccine production, that delays can occur. But probably only in Germany and the EU. Other countries vaccinated much faster - not just Israel and the USA, but also most of the European countries. The delay lies in the wrong order management. And the fact that the USA does not want to share the vaccine produced there can be criticized. Both Donald Trump and Joe Biden appear to be acting in the interests of their people. Should the Americans sacrifice themselves for some stupid EU-Europeans who are too stingy when it comes to medicines for the population? Great. The US should defend us for free and vaccinate us for free. Does what she understands by politics “for the good of the people” work? Maybe she thinks that because she no longer knows a people, just an anonymous planet that she wants to save at the expense of her own people.
There are no more freedoms - an open breach of the constitution
Germany is somehow the wrong size: Israel, our brilliant Minister of Health declared the day before, is faster because it is so small - and the USA is faster because it is so big. The truth is probably very simple. Like the UK, these countries are not in the EU. It works better there - because of that or because of it. Merkel's press conference was not just an excuse and justification press conference.
In a democratic state with a valid constitution, human and fundamental rights, it would be a real scandal. Because she also said: "As long as it is still the case that only a small part of the people is vaccinated, there will be no new freedoms."
Anyone who argues like this has not understood the democratically constituted republic.
Freedoms are fundamental rights, not handouts given when the government allows it. Whoever grabs freedoms like a chicken thief is an enemy of the constitution. Let's put it as hard as it is: You don't have to be a linguist or a constitutional lawyer to tell just from the choice of words what meaning is in this “new” of Merkel's words “no new freedoms”: the “new freedoms” are immediate tied to conditions and thus inevitably lack of freedom. Freedoms that are granted are not.
This country is not made up of 14-year-olds who can be told when to be home in the evening. Unless you're Merkel. Then you turn a people into a kindergarten and even worse: The ruler takes and the ruler gives, just as she pleases. Who do the rights of freedom belong to? Not the state, but its citizens! A head of state who has not understood this cannot lead a democratic community. With all due respect: Ms. Merkel, we are not the GDR of your youth.
We remember that at the beginning of the Corona protests, demonstrators in Berlin carried the Basic Law in front of them like a protective shield. The Berlin police beat it away or dragged demonstrators into their cage wagons. This was thought to be excesses of overburdened officials. It's a system. We have long been so unfree that hardly anyone can get upset about it. And that in a week in which we should only talk about easing. Because the numbers show: The danger posed by the “mutants” is a fantasy of the rulers, the numbers of those affected are falling, as TE shows with current statistics.
We are approaching a point at which the open breach of the constitution by this government can no longer be glossed over or justified, even with an alleged threat.
What is Merkel really planning?
Since there are no epidemic reasons, one must ask about the real intentions of this Chancellor: Does she want to influence the upcoming six state elections and the federal election? Postpone to extend your term of office or switch to postal votes, which are extremely prone to manipulation?
Because the vaccination debacle is the yardstick by which this government must be measured. Merkel and her character in Brussels, Ursula von der Leyen, screwed it up. Instead of drawing the consequences, they seem to be building on it a political re-election strategy, the method of which we do not yet see through, but the aim of which is obvious: to prevent critical voters from voting out this government of proven ineptitude. The burden of proof for this lies with Merkel: Her actions can no longer be explained differently depending on the circumstances.
The trio infernals of the Merkel successor
But even in detail, the non-result of the vaccination summit is disappointing, the aim is wrong: We don't need the eternal whining and the justifications that there is too little vaccine. We need large amounts of vaccines quickly . To do that, we need premiums for additional and early deliveries. And this is exactly where Merkel's rifle clamps drop their masks.
Equally, CSU boss Markus Söder and the two green chairmen Robert Habeck and Annalena Baerbock are calling for an emergency vaccination economy. That sounds like the proclamation of a centrally planned war economy, but it does not serve the purpose of success. It is thanks to researchers and a highly developed industry that vaccines were developed so quickly in the first place. The criticism is so far from business that one may be ashamed.
As if there were any company that hides its capacities in the bicycle cellar! It attracts the business of the century with manufacturers, suppliers and the suppliers of suppliers. Everyone wants to take part and rightly earn money, you don't need Söder, Habeck or Baerbock to understand that. What we do n't need is a state-owned Berlin airport based on vaccines. This trio infernal of Merkel's successor policy pretends to have the Thermomix at home, with which you can cook vaccine without even having to stand by.
And then there is another Söder: “The more equal it is, the fairer it is,” he says. With his plans for a state-controlled emergency economy, one no longer knows which party he is talking about. In any case, it cannot be the CSU.
|Why Did So Many Doctors Become Nazis?
In the answer, and its consequences, a bioethicist finds moral lessons for today’s professional healer
ASHLEY K. FERNANDES
DECEMBER 10, 2020
This essay is written from the point of view of a physician, medical educator, and bioethicist who sees the deplorable fact of physician involvement in the Shoah as an opportunity to highlight enduring moral lessons for the medical professions. Medicine and law are intimately connected to one another, and, since the professionalization of medicine in the United States and Europe in the latter half of the 19th century, even more so. One discipline that connects both is moral philosophy; for both law and medicine involve reason and the will, directed toward the good of the person. Thus, the story of the Holocaust is a tragedy that unfolded because of the corruption of moral philosophy first, and medicine and law second.
Why is this important? The reason is that there are those who argue against the contemporary application of lessons learned from the horrors of Nazi medicine. Some say that “Nazi medicine” was not real medicine or science: We cannot even call what the Nazis did “medicine,” since medicine contains within it an assumption of rigor and beneficence. This is an objection I hear from medical scientists, who point to safeguards such as the Nuremberg Code (1947), the Declaration of Helsinki (1964), and the Belmont Report (1978) as proof of the radically different nature of science today. But this argument is circular. It defines science as “good science,” (relegating anything unethical to “bad science” or “pseudoscience”) when in fact these very safeguards were born out of abuses from what was then the most scientifically advanced country in the world. Medicine then, as now, is not somehow immune from this abuse, as the horrific postwar abuses at Tuskegee and elsewhere make clear.
Other scholars have suggested that the real cause of the Holocaust was an economic, political, or racial one—not a moral one—and that, since the United States has a radically different political, economic, and cultural system, the use of the “Nazi analogy” should be restricted. Medical abuses today are somehow less likely because economic, political, and cultural considerations are highly specific. One prominent bioethicist, for example, noted:
A key component of Nazi thought was to rid Germany … of those deemed economic drains on the state … a fear rooted in the bitter economic experience after the First World War. … [These themes] have little to do with contemporary debates about science, medicine, or technology.
While I agree that the so-called “Nazi analogy” has been misused and even abused, and therefore should be used with restraint and precision, denying the risk of backsliding steps too far. It may be falsely reassuring to suggest that the Holocaust was “merely” politically motivated. Even granting the (disputable) claim that the primary motivation for the Holocaust was economic or political, the Nazis somehow made the leap from identifying persons as “economic drains” to becoming completely and utterly disposable.
Finally, it should be noted that just as philosophy has a decisive impact on both medicine and law, medicine and law exert important effects on one another. The Nazi sterilization laws, Nuremberg marriage laws, and euthanasia directives all changed irrevocably the nature of the physician-patient or physician-subject relationship and gave license and purpose to craven ideas that hitherto were discussed but not technically allowed.
It is worthy of emphasis that although many professions (including law) were “taken in” by Nazi philosophy, doctors and nurses had a peculiarly strong attraction to it. Robert N. Proctor (1988) notes that physicians joined the Nazi party in droves (nearly 50% by 1945), much higher than any other profession. Physicians were seven times more likely to join the SS than other employed German males. Nurses were also major collaborators.The Holocaust should be studied by every health care professional as a reminder of how sacred the substance of our craft is, and what the consequences may be if we forget the dignity of persons again.
Between 1933 and 1945, the Nazis established a “biocracy,” which ultimately murdered millions of innocent persons. The notion that doctors were somehow “forced” to participate has been shattered as myth; Proctor’s (1988) unparalleled volume makes this vividly clear; Robert J. Lifton’s The Nazi Doctors (2000) meticulously traces both the medicalization of death, from eugenics to euthanasia to Auschwitz, and the stories of physicians who perpetrated genocide, were subjected to it, and resisted it. Thus, with a wealth of historical research on the subject, a full accounting of this progression from trusted healers to state-sanctioned killers is beyond the scope of this essay.
In 1859, Charles Darwin published The Origin of Species. This scientific theory elucidated the theory of evolution in a pre-genetic era but made no broad claims about philosophical anthropology. Darwin’s work was decidedly descriptive, not prescriptive. Later, Francis Galton coined the term “eugenics” in his work Inquiries into Human Faculty and Its Development (1883),and the application of “evolution” on a societal level was born. Social Darwinists such as Charles B. Davenport in the USA and Karl Pearson in England, for example, made the case, in different ways and utilizing the “language of science,” that the genes of the “fit” should be promoted, and the genes of the “unfit” discouraged. Daniel J. Kevles (1995) traces the origins of the eugenics movement through Europe and the United States, and the powerful influence on social policy in the prewar era, including resistance to it, notably from the Catholic Church and its intellectuals (such as G.K. Chesterton), as well as a minority of brilliant secular scientists.
Still, German eugenicists took “discouragement of the unfit” further, cooperating eagerly with the Nazi party—as they were willing to support forced sterilization of the “unfit.” More than a decade before the Nazis, Alfred Hoche and Karl Binding (1920) published their influential book, Die Freigabe der Vernichtung lebensunwerten Lebens (The Authorization of the Destruction of Life Unworthy of Life). The book had spoken of the “incurable feebleminded” who should be killed—but for now, sterilization was a good start.
Most know how the tragic story unfolded from here: The Nazis came to power in Germany in 1933, through a democratic process, and that same year, laws for compulsory sterilization of the mentally ill were passed. The Law for the Prevention of Genetically Diseased Offspring was based on American laws passed in the 1920s, and required 50,000 sterilizations annually. By 1939, 350,000 persons had been sterilized against their will. In 1935, the Nuremberg Laws were passed, forbidding sexual relations and intermarriage between Germans and Jews and establishing “genetic health courts.” The sterilization laws led to rapid advancement in the science and technology of sterilization, as well as a major financial gain for many German physicians—racial hygiene had become a veritable cottage industry.
For Hitler and the Nazi physicians, the state was analogous to a living organism– a supreme political vitalism. In fact, it was much more than an analogy. Nazi doctors and scientists, in conceiving the biological metaphor, created a powerful, easily understood concept for the general populace: The German Reich is a body; whatever contributed to the health and well-being of the racial state was to be preserved, that which did not could be labelled a “disease.” The Jews are a disease; disease must be completely cut out (not merely suppressed), for it will otherwise poison and kill the body.
Thus, sterilization would never be enough. Suppression of a disease is inferior to ridding the body of it. In October 1939, Hitler authorized euthanasia of the “incurably sick.” The right to life now had to be “justified” under a Nazi program to euthanize “lives not worth living.” The program began secretly with disabled children, and between 1937 and 1945, the Nazi physicians organized and implemented more than 30 euthanasia centers for children. The history of the move to euthanasia from sterilization, its cruelty and efficiency, and its impact on the progression to the Holocaust is well documented in Michael Burleigh’s dense and disturbing book, Death and Deliverance (1994).
The Nazi euthanasia campaign was publicly justified with four main arguments. First, ridding Germany of the unfit was simply “good science.” Who better to determine what constituted good science than German physicians, who were already the best in the world? The experts knew what was best for the German body.
Second, euthanasia was deemed humane. Since it was supported and implemented by a profession with a long tradition of healing and caring, the argument was even more persuasive. Pediatric euthanasia was often supported by many parents of disabled children for this reason; yet, with mixed motivation, for many wanted to avoid the strong stigma of having a disabled child. This conflict of interest shows how medical culture can influence the ethics of both individuals and society at large.
Karl Brandt, the infamous Nazi doctor, gave this worryingly persuasive defense at Nuremberg—a defense I still challenge my students and faculty with:
The human beings who cannot help themselves and whose tests show a life of suffering are to be given aid. This consideration is not inhuman. I never felt that it was not ethical or was not moral. But one thing seems necessary to me—that if anybody wants to judge the question of euthanasia he must go into an insane asylum and he should stay there with the sick people for a few days. Then we can ask him two questions: the first would be whether he himself would like to live like that, and the second, whether he would ask one of his relatives to live that way—perhaps his child or his parents.
This was no “monster’s defense.” But if Brandt’s words are persuasive, we must have a remedy—both intellectual and experiential—to rebut it.
Still, Dr. Brandt’s challenge combines the “humaneness” justification with a third. Especially in the case of children and the mentally disabled, euthanasia was deemed “rational,” that is, if they could only choose it themselves under “a veil of ignorance,” to reference the terminology of one postwar moral philosopher, they would. It should be noted that physicians at the time were more concerned about the “legality,” not the morality of euthanasia, and many insisted that euthanasia was a “private matter” between patients and doctors.
Finally, killing through euthanasia was justified independently on the premise that it was good for the racial state. That “good” eclipsed the good of this individual being. It should be fairly obvious that there are strong parallels between these reasons and contemporary arguments in favor of euthanasia today. While a full accounting of these parallels is beyond the scope of this essay, readers should note professor Peter Singer’s justifications for euthanasia, and Michael Burleigh’s sharply critical response in Death and Deliverance.
By the end of the “T4” program to euthanize disabled adults and children, between 70,000 and 100,000 persons had lost their lives; stigma against the vulnerable in attitude and language had become codified in law. According to Proctor, these three programs—forced sterilization of the “unfit,” the Nuremberg Laws, and the euthanasia laws—were the primary means the Nazi physicians and scientists used to accomplish “racial hygiene,” and led directly to the technological and medical surge responsible for genocide at the death camps.
But degradation and death was not limited to the clinical aspect of medicine. Research abuses by physicians and scientists, conducted in hospitals as well as in the camps, ranged from the scientifically frivolous (injecting prisoners with typhus) to the malevolent (amputation of limbs and “transplantation” onto other bodies), and are well documented elsewhere. Physicians were held in such high esteem, and thought to be of such high moral character, that experimentation was justified in that it benefited society, added to a burgeoning body of knowledge (a good in itself), and often (but not always) benefited the patient. It should come as no surprise that other populations (such as African-Americans in the USA, and prisoners of war in Japan) were also subjected to grotesque and unethical human experimentation during this period, and beyond.
In 1942, and as a direct result of a deep-seated tradition of anti-Semitism within the German medical community, the Christian churches, and Europe in general, the “Final Solution” was proposed—the murder of the entire European Jewish population. Nazi medicine, through what can only be called, in modern terms, “advocacy,” had a profoundly negative effect on culture. Physicians, dressed in white coats, gave the imprimatur that indeed, those that were to be gassed were not human persons at all:
At every turn, the annihilation procedures were supervised—and, in a perverse sense, dignified—through the presence of medical staff. … We may say the doctor standing at the ramp represented a kind of omega point, a mythical gatekeeper between the worlds of the dead and the living, a final common pathway of the Nazi vision of therapy via mass murder.
The killing of 6 million Jewish persons and 9 million “others”—could only have been accomplished through a buy-in into a twisted philosophical anthropology. Science alone could not accomplish this destruction, because science never stands alone. So, although we may not kill persons, we may kill animals, vegetables, and subhumans. What the Nazis needed was a philosophy to define out of lives inconvenient to the goals of the Race, and then science to do the killing. This is why the Holocaust can be deemed a “bioethical assault” on human personhood.
Nearly two decades ago, the late Edmund Pellegrino, M.D., one of the fathers of modern bioethics and my own mentor, gave us a starting point for procuring valuable, enduring lessons after Nuremberg:
We see here the initial premises that law takes precedence over ethics, that the good of the many is more important than the good of the few ... The lesson [from the Holocaust] is that moral premises must be valid if morally valid conclusions are to be drawn. A morally repulsive conclusion stems from a morally inadmissible premise. Perhaps, above all, we must learn that some things should never be done.
Pellegrino was correct. The Holocaust is not merely a lesson in history, it is an enduring lesson in philosophical ethics. These lessons are perhaps more important to remember today, as personal memories of the Shoah fade, survivors and liberators themselves become a part of history, and young physicians graduate medical school with less empathy and moral resilience than when they began.
The physicians who actively aided the Holocaust believed that they were practicing “good science.” But scientific truth alone does not “grasp” the reality of life, and if we believe it so, we are further on the road to what the late Jean Bethke-Elshtain called “scientific fundamentalism.” Physicians and health care professionals must, therefore, remember the Holocaust, but remember, as Pope John Paul II said on his visit to Yad Vashem, to “remember with a purpose.” I will briefly articulate five lessons of the tragedy of Nazi medicine that we must remember and integrate into our medical practice, if medicine is to survive as a profession of healing.
As a physician, you must serve the patient exclusively—not some abstracted idea of ‘society.’
First, and perhaps most fundamentally, we must affirm a strong personalism. This anthropology has been described briefly above, and extensively elsewhere, by Maritain, but it also has adherents as diverse and important as Mohandas Gandhi, Martin Luther King Jr.,and the late philosopher Karol Wojtyla (Pope John Paul II). Personalism posits the ultimate unit of value of human life is the individual person herself. Society is and ought to be built around this value. In short, society is created for the person, not the person for society, and hence the dignity and integrity of the person and her freedom cannot be sacrificed for the sake of society. No contingent factor—race, religion, economic status, disability, or actions of the past, present or future—can rob a person the dignity she is owed. Integrating this kind of rigorous, universal philosophical anthropology is an antidote to the corruption of medicine, and vital for the prevention of future genocides.
However, disturbing parallels in our contemporary medical, academic, and social culture now argue, for example, for abortion as a form of eugenics and crime reduction; the coerced sterilization of prisoners; pre-implantation genetic diagnosis as a way of promulgating “good genes”; and tours of Auschwitz as a “learning experience” for supporters of euthanasia. Targeted abortion for unborn children with genetic conditions such as trisomy 21 and cystic fibrosis have reduced populations by more than 90%, and are justified on utilitarian grounds. But if a person is the fundamental unit of value of our society, then no “other good” can eclipse her. Politically, legally, and medically, this would mean an expansive and firm definition of person, for it is a far smaller risk to give protection to an entity where personhood is possible, than to destroy the life a person who in the end deserved our protection. Practically, this must mean the end of physician involvement in state-sponsored torture, capital punishment, euthanasia, and eugenically motivated sterilization and artificial reproductive technologies.
Second, we must have rigorous conscience protection for physicians and health care providers. Contemporary literature in bioethics favors the removal of conscience protection laws particularly on “hot button issues” such as abortion, contraception, sterilization, and now euthanasia. Yet, a physician’s oath to her patient is only as strong as her conscience; allow (or even force) her to break it, and we have forgotten: One day, it may be our turn to stand against the tide. On this issue of conscience protection in medicine, of which volumes have been written, eloquent defenses (while still in the minority) made by Dan Sulmasy and others make clear the point that conscience is an active, driving force that is part of who we are as persons, and warn of the danger of a positivistic bioethics.
A medical student once asked me what was the most important lesson I wanted them to know. My answer was this: Between good and evil, there is no “safe space” to stand. There is no neutral void from which a physician can escape his ethical duties, referring it to another. In the time of the Nazis, courageous leaders from opposite ends of the spectrum—Cardinal von Galen, Dietrich Bonheoffer (tortured and murdered), and the Association of Socialist Physicians (whose leaders were arrested or exiled in 1933, and many murdered in Austria and Czechoslovakia in 1938)—would not stay silent. Bonheoffer’s words still challenge us today:
We have been silent witnesses of evil deeds: we have been drenched by many storms; we have learnt the arts of equivocation and pretence; experience has made us suspicious of others and kept us from being truthful and open; intolerable conflicts have worn us down and even made us cynical. Are we still of any use? What we shall need is not geniuses, or cynics, or misanthropes, or clever tacticians, but plain, honest, straightforward men. Will our inward power of resistance be strong enough, and our honesty with ourselves remorseless enough, for us to find our way back to simplicity and straightforwardness?
If morality does not assert its dominion over the law, the reverse shall happen, and radical positivism, with its morally inadmissible premises, will reach its equally inadmissible conclusions.
The third lesson to be learned from the study of medicine and the Holocaust is this: Science is not a “god.” Science relies on hypothesis, experiment, and validation or falsification of the hypothesis to progress. But it is science’s own methodology that also highlights its limitations. Science cannot answer of itself—using its own empirical methodology—whether a particular medical practice is morally good. It must rely on philosophy to do so. Moral philosophy extracts truths from reality based on reason and “lived experience.” The ethical enterprise is therefore both objective (rational) and subjective (experiential). Albert Einstein once said that:
And certainly we should take care not to make the intellect our god; it has, of course, powerful muscles, but no personality. It cannot lead, it can only serve; and it is not fastidious in its choices of a leader. This characteristic is reflected in the qualities of its priests, the intellectuals. The intellect has a sharp eye for methods and tools, but is blind to ends and values. So it is no wonder that this fatal blindness is handed from old to young and today involves a whole generation.
Fourth, as physicians and health professionals we must resist the desensitization to dehumanization that is so prevalent in medicine’s culture. Every clinician can tell you about the terms used to describe patients behind closed doors: “vegetable” (comatose); “P.O.S.” (piece of sh*t); “squirrel farm” (neonatal intensive care unit); “breeder” (a woman with more than 2-3 children); “useless”; “parasite”—the list could go on. For it is far easier to kill a “vegetable” than a human person; to not resuscitate a “squirrel” than a little baby; to feel no pang of conscience for disrespecting a “P.O.S.” or a “parasite” than a poor drug addicted person.
The medical literature supports these widespread anecdotal references. Omar Haque and Adam Waytz (2012) discuss causes of dehumanization alluded to previously: empathetic erosion and moral disengagement in training and practice. There is also another that particularly rings true: dissimilarity between physician and patient. Dissimilarity “manifests in three primary ways. First is through dissimilarity in illness—patients, by their very nature of being ill, become less similar to one’s prototypical concept of human. Second is the labeling of the patient as an illness, rather than as a person who has a particular illness.
Whatever the reason—dissimilarity or something more sinister—language alters perception, and perception affects our ethical calculus. For example, to build support for euthanasia of the disabled, Nazi filmmakers deliberately altered lighting on the faces of the disabled, to make them more “inhuman” in their appearance. Purposeful and dramatic dehumanization has the same ultimate outcome on our perception as slow, chronic dehumanization. Simple gestures—such as standing up against such language publicly when people dehumanize or showing personalistic leadership through examples of patience and even tenderness at the bedside—will do much to begin reversing this narrative.
Finally, a fifth lesson to be learned is that, as a physician, you must serve the patient exclusively—not some abstracted idea of “society.” Physicians and health professionals in the Holocaust decided that the good of the racial state took precedence over the good of individual persons. “Nazi doctors hailed a move ‘from the doctor of the individual to the doctor of the nation.’” The justification for the euthanasia program, in large part, was couched in economic terms—a cost-saving measure for society in a time of scarcity.
Today, we seem to be losing more of our commitment to the individual patient—for there are other “gods” in medicine. “Quality of life,” “public health,” or even “patient satisfaction” have become ends in themselves, not a means to an end. Physicians and mental health professionals in this century have (and continue to be) complicit in torture, in racial discrimination, and in capital punishment. In all of these examples, the physician obscures the value and dignity of the person for some other goal—some even laudable ones, perhaps (security, order, public health, etc.) Yet, the power of the “white coat” demands, if we are to fulfill our obligations of trust, that we do not serve the state (and its economic interests), nor the patient’s family (however compassionate our motivations), nor any other “just cause” or goal, including our own.
The white coat derived its significance in the last century from the physician as laboratory scientist, surgeon, and hospital doctor—but ultimately, its power rests in its symbolic value of the physician as healer. As black’s opposite, which often signified darkness and death, the white coat conveys the pull towards light, and life. This is not to ignore the controversies surrounding the white coat and its contemporary use, misuse, or disuse; it is only to point to a reality of the physician: that our profession was meant to always uphold the life and dignity of the human person, even if we could not preserve it.
Adapted from ‘Nazi Medicine and the Holocaust: Implications for Bioethics Education and Professionalism,’ by Ashley K. Fernandes in ‘Nazi Law: From Nuremberg to Nuremberg’ edited by John J. Michalczyk, with permission of the editor. Footnotes were removed for readability.
Nuremberg CodeOn August 19, 1947, the judges of the American military tribunal in the case of the USA vs.
[UNITED STATES HOLOCAUST MEMORIAL MUSEUM NOTE]
Karl Brandt et. al. delivered their verdict. Before announcing the guilt or innocence of each defendant, they confronted the difficult question of medical experimentation on human beings. Several German doctors had argued in their own defense that their experiments differed little from previous American or German ones. Furthermore they showed that no international law or informal statement differentiated between legal and illegal human experimentation. This argument worried Drs. Andrew Ivy and Leo Alexander, American doctors who had worked with the prosecution during the trial. On April 17, 1947, Dr. Alexander submitted a memorandum to the United States Counsel for War Crimes which outlined six points defining legitimate research. The verdict of August 19 reiterated almost all of these points in a section entitled "Permissible Medical Experiments" and revised the original six points into ten. Subsequently, the ten points became known as the "Nuremberg Code." Although the code addressed the defense arguments in general, remarkably none of the specific findings against Brandt and his codefendants mentioned the code. Thus the legal force of the document was not well established. The uncertain use of the code continued in the half century following the trial when it informed numerous international ethics statements but failed to find a place in either the American or German national law codes. Nevertheless, it remains a landmark document on medical ethics and one of the most lasting products of the "Doctors Trial."
[FROM TRIALS OF WAR CRIMINALS BEFORE THE NUREMBERG MILITARY TRIBUNALS UNDER CONTROL COUNCIL LAW NO. 10. NUREMBERG, OCTOBER 1946–APRIL 1949. WASHINGTON, D.C.: U.S. G.P.O, 1949–1953.]
PERMISSIBLE MEDICAL EXPERIMENTS
The great weight of the evidence before us is to the effect that certain types of medical experiments on human beings, when kept within reasonably well-defined bounds, conform to the ethics of the medical profession generally. The protagonists of the practice of human experimentation justify their views on the basis that such experiments yield results for the good of society that are unprocurable by other methods or means of study. All agree, however, that certain basic principles must be observed in order to satisfy moral, ethical and legal concepts:
1. The voluntary consent of the human subject is absolutely essential.
This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment.
The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.
2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.
3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment.
4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.
5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.
7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.
8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.
9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.
10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probably cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.
Of the ten principles which have been enumerated our judicial concern, of course, is with those requirements which are purely legal in nature — or which at least are so clearly related to matters legal that they assist us in determining criminal culpability and punishment. To go beyond that point would lead us into a field that would be beyond our sphere of competence. However, the point need not be labored. We find from the evidence that in the medical experiments which have been proved, these ten principles were much more frequently honored in their breach than in their observance. Many of the concentration camp inmates who were the victims of these atrocities were citizens of countries other than the German Reich. They were non-German nationals, including Jews and "asocial persons", both prisoners of war and civilians, who had been imprisoned and forced to submit to these tortures and barbarities without so much as a semblance of trial. In every single instance appearing in the record, subjects were used who did not consent to the experiments; indeed, as to some of the experiments, it is not even contended by the defendants that the subjects occupied the status of volunteers. In no case was the experimental subject at liberty of his own free choice to withdraw from any experiment. In many cases experiments were performed by unqualified persons; were conducted at random for no adequate scientific reason, and under revolting physical conditions. All of the experiments were conducted with unnecessary suffering and injury and but very little, if any, precautions were taken to protect or safeguard the human subjects from the possibilities of injury, disability, or death. In every one of the experiments the subjects experienced extreme pain or torture, and in most of them they suffered permanent injury, mutilation, or death, either as a direct result of the experiments or because of lack of adequate follow-up care.
Obviously all of these experiments involving brutalities, tortures, disabling injury, and death were performed in complete disregard of international conventions, the laws and customs of war, the general principles of criminal law as derived from the criminal laws of all civilized nations, and Control Council Law No. 10. Manifestly human experiments under such conditions are contrary to "the principles of the law of nations as they result from the usages established among civilized peoples, from the laws of humanity, and from the dictates of public conscience."
Whether any of the defendants in the dock are guilty of these atrocities is, of course, another question.
Under the Anglo-Saxon system of jurisprudence every defendant in a criminal case is presumed to be innocent of an offense charged until the prosecution, by competent, credible proof, has shown his guilt to the exclusion of every reasonable doubt. And this presumption abides with the defendant through each stage of his trial until such degree of proof has been adduced. A "reasonable doubt" as the name implies is one conformable to reason — a doubt which a reasonable man would entertain. Stated differently, it is that state of a case which, after a full and complete comparison and consideration of all the evidence, would leave an unbiased, unprejudiced, reflective person, charged with the responsibility for decision, in the state of mind that he could not say that he felt an abiding conviction amounting to a moral certainty of the truth of the charge.
If any of the defendants are to be found guilty under counts two or three of the indictment it must be because the evidence has shown beyond a reasonable doubt that such defendant, without regard to nationality or the capacity in which he acted, participated as a principal in, accessory to, ordered, abetted, took a consenting part in, or was connected with plans or enterprises involving the commission of at least some of the medical experiments and other atrocities which are the subject matter of these counts. Under no other circumstances may he be convicted.
Before examining the evidence to which we must look in order to determine individual culpability, a brief statement concerning some of the official agencies of the German Government and Nazi Party which will be referred to in this judgment seems desirable
Die Gemeinwirtschaft. Untersuchimgen über den Sozialismus, Ludwig von Mises
Zweite umgearbeitete Auflage, Jena 1932
Marx und Engels haben es nie versucht, ihre Gegner mit Argumenten zu widerlegen. Sie haben sie beschimpft, verspottet, verhöhnt, verdächtigt, verleumdet, und ihre Nachfolger stehen darin nicht zurück. Ihre Polemik richtet sich nie gegen die Darlegungen, immer gegen die Person des Gegners. Solcher Kampfweise gegenüber haben die wenigsten Stand gehalten.Nur wenige, sehr wenige haben sich gefunden, die den Mut aufgebracht haben, dem Sozialismus mit jener Kritik gegenüberzutreten, die überall rücksichts los anzuwenden Pflicht des wissenschaftlich Denkenden ist. Nur so ist es zu erklären, daß das Verbot, mit dem der Marxismus jede nähere Besprechung der wirtschaftlichen und gesellschaftlichen Verhältnisse des sozialistischen Gemeinwesens belegt hat, von Anhängern und Gegnern des Sozialismus streng befolgt wurde.
Marx and Engels never tried to refute their opponents with arguments. They have insulted, mocked, mocked, suspected, slandered, and their successors are not behind. Your polemics are never directed against the statements, always against the person of the opponent. Only a few, very few have found each other who have found the courage to confront socialism with the criticism that is the duty of the scientist of thought to be ruthlessly applied everywhere. This is the only way to explain that the prohibition with which Marxism imposed every detailed discussion of the economic and social conditions of the socialist community was strictly observed by supporters and opponents of socialism.
Socialism: An Economic and Sociological Analysis
Second reworked German edition, Jena 1932
|Declaración del Director General
de la OMS sobre la reunión del Comité de Emergencia del Reglamento
Sanitario Internacional acerca del nuevo coronavirus (2019-nCoV)
30 de enero de 2020
Buenas tardes a todas las personas que nos acompañan en esta sala y a las que nos siguen por internet.
En las últimas semanas hemos presenciado la aparición de un agente patógeno desconocido hasta el momento, que se ha ido extendiendo hasta causar un brote sin precedentes ante el cual se ha aplicado una respuesta inédita.
Como he afirmado en repetidas ocasiones desde mi regreso de Beijing, debemos felicitar al Gobierno de China por las medidas extraordinarias que ha tomado para contener el brote, a pesar de las graves consecuencias sociales y económicas que esas medidas están acarreando entre la población del país.
Si no hubiese sido por la labor del Gobierno de China, y por los avances logrados en la protección de su población y de la población mundial, ya se habrían producido muchos más casos, y probablemente muertes, fuera de China.
No tengo palabras para describir la rapidez con la que el país detectó el brote, aisló el virus, secuenció su genoma y compartió esa información con la OMS y con el mundo: ha sido realmente impresionante. Igual que el compromiso que ha asumido con la transparencia y con el apoyo a los demás países.
En muchos sentidos, China está marcando un nuevo nivel de respuesta ante los brotes. No es una exageración.
Quiero además manifestar mi profundo respeto y agradecimiento a los miles de valientes profesionales sanitarios, y a todas las personas encargadas de la respuesta en primera línea, que, en pleno Año Nuevo Lunar, están trabajando las 24 horas del día para tratar a enfermos, salvar vidas y controlar este brote.
Gracias a su trabajo, el número de casos en el resto del mundo se ha mantenido relativamente bajo hasta la fecha.
Actualmente hay 98 casos confirmados en 18 países fuera de China, incluidos 8 por transmisión de persona a persona en cuatro países: Alemania, el Japón, Viet Nam y los Estados Unidos de América.
Hasta el momento no se ha notificado ninguna muerte fuera de China, algo por lo que todos debemos estar agradecidos. Aunque esas cifras todavía son relativamente pequeñas en comparación con el número de casos en China, debemos actuar de forma inmediata y coordinada para limitar la propagación del brote.
La mayoría de los casos fuera de China habían viajado a Wuhan, o venían de esa ciudad, o habían estado en contacto con alguien que había viajado a Wuhan, o que venía de esa ciudad.
Desconocemos el tipo de daños que el virus podría ocasionar si se propagase en un país con un sistema de salud menos robusto.
Debemos actuar inmediatamente para ayudar a los países a prepararse ante esa posibilidad.
Por todas esas razones, declaro que el brote mundial por el nuevo coronavirus constituye una emergencia de salud pública de importancia internacional.
La razón principal de esta declaración no es lo que está ocurriendo en China, sino lo que está ocurriendo en otros países.
Nuestra mayor preocupación es que el virus se propague en países con sistemas de salud menos robustos y poco preparados para enfrentarse a esta amenaza.
Déjenme ser claro: la presente declaración no implica que estemos retirando nuestro voto de confianza a China. Al contrario, la OMS sigue confiando en la capacidad del país de controlar el brote.
Como ustedes saben, estuve en China hace unos días y me reuní con su Presidente Xi Jinping. He vuelto plenamente convencido del compromiso que el país ha contraído con la transparencia y con la protección de la población mundial.
Deseo mandar un mensaje a los ciudadanos de China y a todos aquellos en el mundo que se han visto afectados por este brote: «no lo olviden, el mundo está con ustedes». Estamos trabajando intensamente con asociados a nivel nacional e internacional en materia de salud pública para controlar el brote lo antes posible.
Hasta la fecha se han confirmado en el mundo 7 834 casos, de los cuales 7 736 en China, es decir, casi un 99% del total. Han fallecido 170 personas, todas ellas en China.
Debemos recordar que estamos hablando de personas, no de números.
Más importante que la declaración de emergencia de salud pública son las recomendaciones del Comité para prevenir la propagación del virus y para que la respuesta sea proporcionada y se base en datos probatorios.
Me gustaría resumir esas recomendaciones en siete puntos principales.
Primero: no hay motivo para aplicar medidas que obstaculicen innecesariamente el comercio y los viajes internacionales. La OMS no recomienda limitar el comercio ni el movimiento de personas.
Hacemos un llamamiento a todos los países para que tomen decisiones coherentes y basadas en datos probatorios. La OMS puede proporcionar consejos a todo país que esté estudiando qué medidas adoptar.
Segundo: debemos apoyar a los países con sistemas de salud menos robustos.
Tercero: hay que acelerar el desarrollo de vacunas, tratamientos y pruebas de diagnóstico.
Cuarto: es necesario luchar contra los rumores y la información errónea.
Quinto: necesitamos revisar planes de preparación, descubrir las posibles carencias y definir los recursos necesarios para detectar, aislar y tratar casos, y para prevenir la transmisión de la infección.
Sexto: debe comunicarse información, conocimientos y resultados a la OMS y al mundo.
Y séptimo: el único modo de superar este brote es que todos los países colaboren juntos de forma solidaria. Esto nos afecta a todos, por lo que solo podremos superarlo juntos.
Es la hora de la acción, no del miedo.
La hora de la ciencia, no de los rumores.
La hora de la solidaridad, no de los estigmas.
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Bat research and study
World Health Organization declared that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern (PHEIC)
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