A new book has just been published,titled "Bioethics and the Holocaust: A Comprehensive Study in How the Holocaust Continues to Shape the Ethics of Health, Medicine and Human Rights." It is a free download from the Maimonides Institute for Medicine Ethics & The Holocaust.
The uncomfortable reality is that the physicians who executed these crimes were of the conviction that their actions were morally and scientifically right (Caplan 2010). These were not incompetent, insane physicians from the fringes of the profession. Many were distinguished, experienced professionals from mainstream German medicine, which was considered to be the most progressive of the time (Aly et al. 1994; Weiss 2005). The German physicians were not coerced to join the Nazi Party, but did so on their own initiative and in greater numbers than any other free profession (Kater 1989). Among them were university professors and experienced physicians who, like Rudolf Ramm, took it upon themselves to inculcate future generations of physicians precisely due to the fact that they believed that what they were practicing and preaching was ethically and morally right (Bruns and Chelouche 2017). In Ramm’s words: “So this book should be a companion and a guide to the student of medicine and to the young physician for his established goal and an adviser to the young person in his choice of profession.”
...Nazi Germany became the first country in the world to hold mandatory ethics classes in medical schools.
Antisemitism was an inherent feature of Nazi medical ideology. One of the first steps taken in the newly formed Nazi regime was the removal of Jews from medical practice, both academic and clinical. In reading the textbook we realize the extent to which the Nazi physicians internalized and embraced antisemitism as inherent to, and acceptable with, medical and ethical norms. Ramm praises the new antisemitic directives: “One of the first measures of the National Socialist Physicians leadership was the cleansing of the profession of politically unreliable and racially foreign elements, so long as the medical benefit for the Volk population was not endangered” “Cleansing the profession” refers to the expulsion of the Jewish physicians from medicine in 1938, whose licenses were revoked and who were no longer considered doctors, but rather healers permitted to treat only fellow Jews. “One can however today already grasp the blessings which are important to life and to our Volk in the offices of the states that have emerged after the forceful expulsion of the Jews from the profession” He rationalizes the self-righteous persecution and marginalization of Jewish physicians: “It was the Jew who forced some German doctors into a crass materialistic employment of professionally unworthy methods of competition; the Jew who endangered the German Volk, and the one who through extension of his souls-poisoning ideas, enabled the destruction of germinating life while generating the impression, through his methods of advertising in wide circles of the population, that he was indispensable as a medical researcher and medical practitioner…Today no full-blooded German would allow himself to be treated by a Jewish doctor”. Although these passages read as blatant racist propaganda, they are in essence what was deemed morally right to teach medical students in Nazi Germany.
The chapter goes on to discuss sterilization, eugenics and euthanasia as all being placed in an ethical framework.
Ramm's medical ethics manual created a framework that was 'ethical" in the sense that it had an ethical basis - the importance of the Volk and the nation, ensuring that the most fit people would lead the nation in the future. Those who would be deleterious towards that goal should be marginalized and ultimately eliminated. It is monstrous, but it is a self-consistent ethical framework that appealed to the medical professionals in Germany of the day.
[E]thics instruction does not ensure future virtuous medical practice. In addition, the existence of codes and directives and in this case, ethical textbooks, does not assure moral integrity. In fact, Ramm’s work shows us just how training and education can be used deleteriously.