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The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow (acesso a versao pdf)
The Holocaust, the systematic, state-sponsored persecution and murder of 6 million Jews by the National Socialist (Nazi) regime and its collaborators, is arguably the most extreme instance of crimes against humanity and genocide in history. During its reign of terror, the Nazi regime committed innumerable acts of violence against Jews, Sinti and Roma, people with disabilities or psychiatric illnesses, political prisoners, prisoners of war, and others. A distinctive and disturbing feature of these atrocities is the important role that health professionals played in formulating, supporting, and implementing inhumane and often genocidal policies. After World War 2, these crimes were important factors that contributed to the establishment of contemporary health professional ethics. Learning about, and reflecting upon, this history can have various benefits for learners and practitioners of health sciences, and the patients and communities they serve. Health sciences curriculums, however, rarely cover this topic. This is why Richard Horton, The Lancet’s Editor-in-Chief, convened the Lancet Commission on Medicine, Nazism, and the Holocaust.
Nearly 80 years after the defeat of Nazi Germany and the end of World War 2, references to Nazi medical crimes remain common—the surge of Nazi tropes deployed in anti-vaccination propaganda during the COVID-19 pandemic provides striking examples. All too often, such references are based on fragmentary knowledge of the facts, simplified assumptions, and serious misconceptions. This Commission aims to provide a reliable, up-to-date compendium of medicine’s and medical professionals’ roles in the development and implementation of the Nazi regime’s antisemitic, racist, and eugenic agenda, which culminated in a series of atrocities and, ultimately, the Holocaust. On this basis, we posit implications for the medical field and for society more broadly, and outline a roadmap for integration of this history into health sciences curriculums worldwide.
Medical crimes committed in the Nazi era are the bestdocumented historical example of medical involvement in transgressions against vulnerable individuals and groups. What happened under the Nazi regime has farranging implications for the health professions today, and virtually every debate about health professional ethics can gain from an understanding of this shameful history—from questions regarding the beginning and the end of life, to health professionals’ roles as economic actors or as agents of the state. This history shows the potential for health professionals to harm their patients, but also, when necessary, to stand up to power and protect the most vulnerable.
One of the goals of this Commission was to develop, informed by assessment of existing medical curriculums, educational approaches that promote ethical conduct, moral development, and the formation of a professional identity based on compassion through education about medicine, Nazism, and the Holocaust. As a result, we offer here a new educational paradigm, which we term history-informed professional identity formation. It integrates frameworks from health sciences education with the Commission’s specific objectives for the training of health-care professionals. We also propose a concrete roadmap to implement recommended mandatory curriculums on the history of medicine, Nazism, and the Holocaust and its implications in all health sciences education. This roadmap explores pedagogical approaches, questions of curricular design, assessment, and faculty development. Importantly, beyond an informational level of learning, education centred on this history can also result in learning on the formational and transformational levels—through prompting reflection on contemporary implications, for example. The aim is to support the development of morally conscious and self-critical, yet courageous and resilient health professionals— independent thinkers who are capable of upholding professional values in the face of pressure and who will, when needed, act as agents of change.
Contemporary health professionals and societies globally have been confronted with multiple crises: the COVID-19 pandemic; a rise in overt antisemitism, antiimmigrant sentiments, and other forms of racism and discrimination; climate change; the Rohingya genocide; and wars, such as in Israel, Gaza, Syria, Ukraine, and Yemen. It is our conviction that the study of medicine, Nazism, and the Holocaust can help to prepare medical professionals to stand up against antisemitism, racism, and other forms of discrimination, and to embrace and defend our shared humanity in their professional roles and as global citizens. It is only through understanding and reflecting upon history that we can fully understand the present and shape a better future.
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