In Europe, the publication date fell on November 9, the date of the radical pogroms against Jews 85 years ago, during which tens of thousands of them were imprisoned, abused, and murdered in Germany and Austria. A new comprehensive report in the globally influential journal “The Lancet” summarizes the medical crimes of National Socialism, citing nearly 900 publications. The report involves 20 researchers, including Herwig Czech from the Medical University of Vienna, recently confirmed as a professor of the history of medicine.
“The medical atrocities of the Nazis are among the most extreme and well-documented examples of doctors’ involvement in human rights violations in history,” emphasizes pediatrician and medical historian Sabine Hildebrandt of Harvard Medical School in the USA, who, like Czech, is a co-chair of the commission. The report makes it clear that the atrocities were not committed solely by a few doctors who were forced to do so; crimes against humanity were supported by numerous institutions.
The medical profession had the highest proportion of members in Nazi organizations, highlighted Czech during the report presentation in Vienna, attended by the editor of The Lancet. Physicians contributed to developing, implementing, and endorsing the discriminatory and dehumanizing ideologies and policies of the Nazis, such as those related to “racial hygiene” to protect the “Aryan race,” which included the expulsion, deportation, and murder of many Jewish colleagues. “It is often surprising how limited the knowledge about Nazi medical crimes in the medical community is today, perhaps apart from a vague notion of Josef Mengele’s experiments in Auschwitz,” said Czech. “Our report aims to change this.“
German physician and anthropologist Josef Mengele is one of the most notorious war criminals from the Nazi era. In the Auschwitz concentration camp, he conducted cruel experiments on inmates, including Jews, Sinti and Sintizze, and Roma. Less known is his search for proteins in the blood to distinguish human “races”—a core point of Nazi ideology now understood to lack biological basis, as ethnicities genetically differ little for the justification of the concept of race.
“Mengele’s research practices were characterized by extreme brutality and complete disregard for the humanity of the individuals forced to participate,” the report states. The horrific conditions in Auschwitz were ruthlessly exploited, allowing “a person in power to inflict endless suffering and death on others.”
Mengele later escaped via the so-called ratline to South America. Others were charged in a subsequent trial following the famous Nuremberg Trials. In the Nuremberg Doctors’ Trial from 1946 to 1947, out of the 19 doctors—one female doctor, one lawyer, and two administrators—a total of seven individuals were acquitted, four sentenced to ten to 20 years, five to life imprisonment, and seven received the death penalty.
Among the executed were Karl Brandt, a key figure, Lieutenant General of the Waffen-SS, Reich Commissioner for Health, and Euthanasia Commissioner. He led the “Euthanasia” programs, under which at least 230,000 disabled people were murdered during World War II, both children and adults. At least 310,000 individuals classified as “genetically inferior” were sterilized.
In the so-called T4 program for the murder of patients, gas killed 70,000 people within three years, the majority of whom were from psychiatric institutions. Here, the Nazis tested killing methods later used in Polish extermination camps in showers disguised as gas chambers. Victims included those from the Vienna Spiegelgrund (now Baumgartner Höhe): At the “Am Steinhof” institution, at least 789 disabled children were killed. The psychiatrist Heinrich Gross, also a member of the NSDAP, played a leading role.
Lack of Accountability
Like him, many continued their careers after World War II, concealing their involvement in these medical atrocities to varying degrees. Gross prepared brain preparations from many murdered patients for later research. The anatomical atlas of the physician and fervent Nazi Eduard Pernkopf from the University of Vienna (which then included the medical faculty) is now considered ethically problematic. The illustrations, considered exceptionally detailed in professional circles, used the bodies of victims of the Nazi regime, including political detainees.
Images from the Pernkopf atlas were partially used as a template for further illustrations without clearly indicating their context. Even today’s knowledge of hypothermia and the consequences of tobacco or alcohol consumption, in part, originates from research conducted during the Nazi regime, without clarifying the circumstances of this research. “Accountability for and recognition that crimes were committed in the name of medicine in the Nazi era and during the Holocaust remains woefully inadequate,” says Shmuel Pinchas Reis of the Hebrew University of Jerusalem in Israel, also a commission chair.
While the report mentions numerous perpetrators and victims, it also emphasizes that one should not focus solely on centrally known figures. Political theorist Hannah Arendt made it clear in her “Banality of Evil” during the trial against SS-Obersturmbannführer Adolf Eichmann: behind the cruel Nazi crimes were not only malignant monsters but mainly “ordinary people” fulfilling their assigned duties and collaborating.
“While it is tempting to view the perpetrators as incomprehensible monsters,” says medical historian Hildebrandt, “ the evidence put forward by the Commission demonstrates how many health professionals were capable of committing ethical transgressions and even crimes against their patients under certain conditions and pressures.” Particularly in the healthcare sector, it is crucial to “develop and preserve a strong moral agency” as it involves caring for especially vulnerable individuals.
Campaign Against Discrimination
Therefore, the commission advocates for education about medical crimes during National Socialism, particularly in this professional group but also generally. These crimes are not isolated incidents but evidence that members of the medical community were involved in crimes against humanity and human rights, including anti-Semitism, racism, discrimination, and genocide. However, the crimes committed during the Nazi regime are among the most extreme, well-organized, and well-documented cases.
The investigation of Nazi crimes took a long time and only became a topic in medicine and history in the 1980s. One of its pioneers was the Viennese historian Gerhard Baader, who died in 2020. Yet, medical history and especially medical atrocities are hardly part of the curricula for aspiring doctors and medical personnel in Austria today, criticizes Czech, whereas the situation is better in Germany.
The report shows how this could be improved, also through positive examples of doctors in concentration camps and ghettos who showed moral courage under difficult conditions. The guilty doctors in the Third Reich did not question the cruelty of their actions and did not consider the human rights of their victims, emphasized Hildebrandt during the report presentation. Instead, they prioritized scientific knowledge to a deadly extent. “We must speak out against antisemitism, racism, and other forms of discrimination, uphold and advocate person-centred, human rights-based medicine, protect the vulnerable, serve the marginalised, and acknowledge the humanity and dignity of each and every patient.”
Many current debates show how medicine and science are linked to politics, personal beliefs, and socioeconomic factors – such as “the question of who should be cared for in a catastrophic event, end-of-life healthcare, and up to new developments in genetics,” emphasizes medical historian Czech. Professionals in relevant fields must be aware of these influences and their own responsibility. “Today’s health professionals operate in systems and structures that do not benefit all patients equally.” Making decisions is not easy here. However, knowledge of historical extreme cases can help in dealing with ethical dilemmas in medicine.