CHAPTER II

MENGELE'S PROFESSIONAL ETHICS

German society of the early twentieth century was considered enlightened and civilized.

Yet in this educated society the systematic extermination of millions was enabled, and chief among these facilitators was the medical profession.

Close analysis of the German medical ideal of 'lebenswurten lebens', or life unworthy of life, allows a picture to form as to how the medical community encouraged the establishment of camps such as Auschwitz.

The total number of men, women, and children murdered by the Third Reich was not strictly limited to European Jews.

The entire figure more likely approached "--- 21 million men, women, handicapped, aged, sick, prisoners of war, forced laborers, camp inmates, critics, homosexuals, Jews, Slavs, Serbs, Czechs, Italians, Poles, Frenchmen, Ukrainians, and so on"

It is estimated that this number includes roughly one million children.

The true number could easily be higher, and this killing environment emerged through the collaboration of doctors and legislators.

The evolving ethics of the German medical profession led to a frigid environment where the life of the patient no longer mattered.

Before Josef Mengele was authorized to conduct an experiment, he was obligated to submit a classification report detailing his study and categorizing the nature of each trial.

The two classifications were state-sponsored and educational research.

The state sponsored category was well regulated and quite limiting in its scope.

The second, and more dangerous, did not have the same structures and parameters as the state-sponsored experiment.

Even though the state sponsored research carried with it a strict set of guidelines, Mengele was not confined to its regulations.

Mengele's research fell within the educational parameters, and therefore he did not have to present any findings to an oversight board.

As a fellow doctor in Auschwitz would later write, Mengele's method "--- was descriptive, the amassing of data, and I know of no evidence that he had any significantly original scientific ideas"

Mengele marked his research as educational by arguing that the data-generating would be useful to future researchers.

Therefore, any non-scientific research was not identified and prohibited.

As a result, the only superior he was responsible to was von Verschuer, who encouraged Mengele to utilize the Auschwitz children.

The grouping of Josef Mengele's research by educational criteria meant that any government oversight was nonexistent, and Mengele's desire to out-research his colleagues led him to bend the rules of acceptability.

"All personal feelings should be forgotten in consultations, the good of the patients ought to be the chief and only consideration"

In each case during this period, the German state superseded the patient, oftentimes to the detriment of the infirmed.

Furthermore, the demarcation of another set of guidelines removed any oversight.

These guidelines were as follows:

--- distinguished explicitly between therapeutic and nontherapeutic research.

Without exception, nontherapeutic studies could be conducted only with the subject's formal informed consent.

Therapeutic research, however, was possible without consent in a medical emergency and if deemed in the patient's best interest.

These categorizations were open for interpretation by the researchers.

Josef Mengele ensured the categorization of his research as therapeutic, thereby eliminating the necessity of informed consent.

By arguing the research was for the betterment of the German state in general and that his findings would ease the pain of the German people, Mengele was roundly supported by the Nazi government.

The categorical language was ambiguous specifically so that it would be interpreted by the practitioner in a manner that best suited the experiment.

The Hippocratic maxim of 'do no harm' seemingly would invalidate Mengele's Auschwitz research.

It is vitally important, however, not to impose the professional ethics of modern society on research conducted seventy years ago.

To Josef Mengele, 'do no harm' was quite applicable to Auschwitz.

The overriding German anti-Semitism which existed promoted treating the Jews not as human beings, with the requisite respect for the person, but rather as an infestation or disease.

"Out of respect for human life, I would remove a purulent appendix from a diseased body. The Jew is the purulent appendix in the body of Europe"

This sentiment is mirrored by many physicians who participated in the Holocaust, who were questioned on how they justified these actions.

Illustrating the common mentality, historian Ihor Kamenetsky quietly responded with "When you find diseased appendix, you must remove it"

Ultimately, the categorization of a race as subhuman removes any concern regarding what is considered murder.

Legislative actions passed in prior years, specifically those enacted against the Jewish populations, allowed for such an environment.

The mass killing [of] the Jews was more akin to pest extermination than to killing human beings.

Evolving professional medical ethics did not allow for even a paternalistic protection of the so-called subspecies.

This mind frame is difficult to understand today, but the current ethical code would be equally foreign to Josef Mengele.

Despite the subhuman categorization, the Nazi doctors still sought professional justification for the Auschwitz research.

This was not a result of some altruistic concern for the patient.

Rather, it was a front to show the Red Cross that each examination and experiment was ethically conducted.

Even selection was administered in such a way that it appeared medically legitimate.

"Since no medical examinations [at the selection ramp] were done and no medical skill was required for this function, the Nazis apparently sought to invest it with medical authority and represent it as a medical procedure"

Even more than simply appealing for Red Cross validity, there was a practical reason for this behavior as it prevented prisoner revolt.

Whereas the inmates inside the barbed wires had been systematically stripped of humanity, and likewise their resistance, the captives emerging from the cattle cars were slightly healthier and could be physically able to resist.

While not at their peak strength, owing to several days in the transport cars, these inmates could reasonably become volatile once aware of the camp conditions.

"After the selection, the same SS doctor would enter the ambulance-like vehicle with a red cross and together with the SDG (a medical technician) --- ride to the gas chamber. At the gas chamber, the gas would be administered under the doctor's technical supervision"

The charade continued to the very end; inmates were permitted to log their suitcases and personal effects in preparation for retrieval.

After the gas chamber doors were locked, the sonderkommando would enter and remove all personal items to "Kanada", the location where the contents were catalogued and valuables dispersed throughout Germany.

The twisted truism of 'do no harm' seems to be the ultimate maxim under which the Nazi medical leaders operated.

The war provided the front by which the social disease was removed to better the life of the German people and the Reich.

"Another more significant level of medicalized killing was the idea of killing as a therapeutic imperative"

Years of economic depression and disruption led to unrest, and it became a healing mechanism to blame, and ultimately murder, the Jews for their culpability.

It is important to note that Josef Mengele believed his actions to be ethical and, under German law, he committed no actual crimes in Auschwitz.

Nazi dogma viewed the changing landscape and the coming victory in the Second World War as the advent of a new civilization, and this revolution would forever change the medical profession.

"Away with all that is unfit to live, for the restoration of a sound and healthy people. Away with all the biologically inferior, forward to a new biological superiority"

The elimination of those unworthy of life would help create a new Aryan world order in which physician approved legislation would determine who is fit to live.

The Nazis were notorious for selecting key passages from ethical codes and amending each as justification for Auschwitz.

There was a mercy killing dimension in all this, a kind of pseudo-Nietzschean expression of will toward asserting the most powerful and strong elements in the race while getting rid of the weak elements.

Josef Mengele's experiments were not simply a singular crime rooted in anti-semitism or psychosis.

His ethical construct was the result of an education strengthened in German universities, where he was introduced to the ethics of racial hygienics.

Ingrained in Mengele was more than simply eradicating a world pest, it was a noble stand of defiance.

The Jews held high ranking positions in industry and banking, but it was theorized that this success would still not satisfy the voracious Jewish appetite for power.

The Protocols of Zion mandated a new Jewish global leadership, and Mengele was taught that this revolution would begin with the eradication of the German intelligentsia.

"The Nazi doctors blamed the victim in many ways. They blamed the Jews for being non-human, for being the threatening factor"

Mengele saw that unlocking the programmability of twin reproduction as paramount in preventing the German demise.

Another unethical means by which the Auschwitz doctors killed was the refusal of treatment.

With the imprisonment of over one hundred thousand malnourished and ill treated persons, communicable diseases decimated the population.

An outbreak of cholera or typhus, of which several occurred, could not only wipe out the slave labor supporting the war effort, but also could threaten to disrupt the camp's infrastructure.

"Doctors also conducted a form of murderous epidemiology by wiping out wards or people when they became ill with an epidemic condition like typhus"

Josef Mengele successfully charted a strategy and its implementation prevented an outbreak of typhus in the women's camp.

His method, unfortunately, called for eliminating one entire bunk of women captives.

Mengele ordered for roughly three thousand women to be immediately gassed.

The bunk was cleaned, and after delousing, residents of a separate bunk took in their new residence.

The vacated bunk was cleaned and freshly deloused prisoners were moved in and the process continued.

By ordering the gassing of a few thousand innocent women, Josef Mengele received a commendation for his efforts.

In the presence of close family and friends, Mengele could be loving and tender.

Moreover, he exhibited normal benevolent professional behavior in the camp by providing chocolates to the children and aiding a pregnant prisoner through a tough labor.

Conversely, when agitated, Mengele exhibited characteristics of psychotic doubling.

"On the one hand, Mengele had normal human feelings. He had befriended this inmate doctor, he would save a drowning gypsy, give him medication, keep him alive only the next moment to send him to the gas chamber"

Whatever his mental state, the deadly actions were still, by German law, ethical practices.

The evil face of Mengele's killing personality was cognizant of the era's legislation.

Simply put, Mengele was acutely aware of the new role of ethics in his profession.

He previously helped to develop legislation built upon the ethical foundations he learned in German universities.

Historian Paul Weindling thoroughly researched the complicity of the medical profession in Nazi war crimes, and "---insists that there were never any protests from highly compromised medical elite against such atrocities, and that after the war careers continued with no sense of having violated medical ethics"

It is inaccurate to assume the Nazi physicians discarded long held ethical beliefs in Auschwitz.

Each trial and study was well within the state mandated guidelines.

An SS colleague of Mengele's was quoted as saying that "--- ethics was not a word used in Auschwitz. Doctors and others spoke only about how to do things most efficiently, about what worked best"

A cold and emotionless medical environment came to dominate Germany and within the confines of Auschwitz this setting became normal.

A difficulty in applying ethics to Josef Mengele is avoiding the temptation of utilizing constructs which were not available prior to 1945.

Any attempt to retroactively analyze Mengele's experiments in such a way would be disingenuous.

However, there are four main ethical principles of which Josef Mengele most likely had intimate knowledge.

These four main principles are:

1. Nonmaleficence: from the Hippocratic writings we have retained the maxim.
"First of all, do no harm"
This remains an important principle, though it is well recognized that virtually no treatment options are free from potentially harmful side effects.

2. Beneficence: we should do what is in the patient's best interests.

3. Autonomy: patients have a right to make their own decisions about medical treatment.

4. Justice: we should treat patients without favoritism or discrimination.
Thus, if two patients have a similar condition, we should offer the same recommendations and treatments to them rather than giving preference to one or the other based on status or our potentially biased assessment of them.

The Nazis altered the nonmaleficence ethics of bullet point number one by posturing that allowing the Jewish race to live would be doing irreparable harm to the global society.

However, Nazi dogmatic ideals cannot validate experiments with bullet points two through four.

It is not in a child's best interest to remove pre-pubescent testicles or to be injected with typhus.

The Auschwitz children did not have the autonomy to research and authorize any experiment, nor did their guardians.
Finally, Mengele operated with extreme degrees of favoritism and preference.

A child emerging from the transport car who was not part of a set of twins was selected to go directly to the gas chamber.

Moreover, as seen with Joe Rosenblum, Josef Mengele would protect any child if they provided a valuable service.

Professional ethics has strong roots in the Golden Rule.

The logical result of practicing the Golden Rule is an increase in the overall societal good.

Realistically, it is too simplistic to label the Holocaust as unethical in this prism.

Through the eyes of the German public, who had endured an embarrassing defeat in World War I and suffered through the economic wasteland that was the Weimar Republic, blame fell entirely to the Jews.

In Nazi Germany in the 1930s and 1940s, it would have been inconceivable to apply the Golden Rule to European Jews.

Furthermore, the Golden Rule could not apply to Jews as they were not legally considered human.

Another foundation for medical ethics is ideal care for the individual.

Using the Jews as research subjects only causes injustice to the patient.

The patient's best interests were not being identified and protected in Auschwitz, as Jewish inmates were routinely denied proper medical care.

These necessities were refused not because of an actual crime, but because of Nazi racism.

"On this view, determining that someone should not receive care because species-typical functioning cannot be achieved for them would be to deepen the injustice. On this basis, it would be discriminatory"

Again, eliminating the Jews protected the state, and the German state was of the utmost importance.

One principle goal of medicine is to prevent disease.

Each physician has an almost sacred duty to combat all known causes of death.

Yet in Auschwitz many known causes of death were permitted to flourish.

Overworked and malnourished, Auschwitz prisoners went through their daily routine of back breaking labor, poor sanitation, and severe beatings at the hands of the SS.

No aid was administered to a prisoner who contracted typhus or dysentery.

Likewise, no aid was administered in the event of a broken bone or other physical malady.

The inmate was typically executed and another prisoner inserted into the role.

Informed consent requires attention to two "--- basic components: the nature of the study, the procedures to be administered, the risks and potential benefits (if any), alternatives to participation, and the right to decline or withdraw participation without penalty. Second, subjects must voluntarily agree to participate under these conditions"

Mengele did not provide his test subjects with the opportunity to research his test, nor did he obtain signed informed consent from a guardian.

Mengele also did not arrange to provide suitable accommodations for post surgery recovery and failed to provide adequate trial information to even his closest colleagues.

Furthermore, there are several key provisions which protect involvement in a clinical study, as follows:

These include procedures to protect privacy and confidentiality, monitoring the condition of research subjects to assure their safety, terminating study participation in the case of adverse events, and informing enrolled subjects about risks and benefits discovered in the course of research.

The camp's children were not treated in a manner consistent with these provisions.

Even the camp infirmary was commonly referred to as the waiting room for the gas chamber.

Nazi racial hygienics would argue that these provisions have no bearing on Jewish subjects.

Due to the passing of several race laws, Jews were not treated as humans, and "--- once a human being has been stripped of his human and given a paranthropoid identity, the normal moral impediments cease to operate"

Again, viewing Jews as subhuman was not a new idea.

The belief was reinforced over many years and this belief was deeply ingrained in German society, but this categorization prevented the ethical treatment of Jewish patients.

Josef Mengele's professional aspirations drove him in Auschwitz, as he saw the opportunity to autopsy fresh corpses as the medical breakthrough he needed.

Mengele, and his contemporaries, were "--- attracted to the Nazi party by promises that the National Socialists will remove the Jewish predominance from the profession (60% of the physicians in Berlin were Jewish) and restore the prestige, honor, and dignity of the Aryan physicians"

By eliminating professional colleagues, Mengele's could now apply for many different open positions which were previously unavailable.

Therefore, his professional ambitions could more easily be realized.

The war-crimes trial in Nuremberg highlighted a disconcerting reality regarding the medical profession.

Testimony showed that the medical profession lacked a written charta, a statement of principles professing its traditional ethos, which had been deemed self-understood and sufficient.

Prior to the establishment of the Declaration of Geneva in 1948, German physicians were free to operate by whatever ethical code best suited the experiment.

It was common to see these codes amended depending on the study.

The change in philosophy meant that the Nazi state was infinitely more important than the individual.

"One of the more influential factors was a significant shift in perspective from the emphasis on the care and cure of the individual and the community to the treatment of the body politic --- as a whole"

German physicians eagerly modified their practices to align with this new paradigm.

In doing so, German research is fostered not by the paternalistic care and protection of subhumans, but rather by utilizing Jews as a disposable commodity in improving Aryan life.

The "--- [Nuremberg] Tribunal acknowledged that scientists justified human experiments on the basis that they yield results for the good of human society that could not be produced by other means of study"

The ascension of German academia to global esteem would be borne on the back of human test subjects.

These subjects would allow for immeasurable research and a new enlightened era would emerge.

This fundamental emotive change in German society is paramount.

The new Aryan-German citizen was hard working and tough.

Generosity and compassion for others had fostered a weak society unable to emerge victorious from World War I.

Full devotion to the Aryan platform and callous disregard for outsiders became commonplace.

The snowballing fanaticism was not exclusive to the German military; it also permeated the medical field.

"Whereas physicians generally perceive the preservation of life as their prime goal, death had become a core value in their overall belief system"

Death had become synonymous with progress, and experimenting on the inmate children was only the means to an end.

"Complicating the issue was the fact that there existed no international consensus among doctors about the use of humans in experimental research"

This resulted in an unfortunate environment of promoting the state's needs to the detriment of the patient's best needs.

The cultural shift resulted from decades of war failure, economic devastation, anti-Semitism, and fear mongering.

As Germany struggled to recover, the race laws enacted by Hitler mirrored societal trends.

Certain rights were restricted by the government, which was allowed to overstep its bounds by a frustrated public.

In times of war government modifies its sovereignty by overriding the legal system and exerting power on human beings who cease to be citizens protected by civil rights and are now seen as biological units.

Under extreme duress, national governments are often allowed to take an increased role in a citizen's life, even to the detriment of civil rights.

Josef Mengele's experiments, while unacceptable, did ultimately lead to the international establishment of a professional code of ethics.

There have been substantive measures taken to ensure another medical Holocaust is prevented.

The experiment must be scientific, not a random game of trial and error.
It must be based on a sound protocol with the area of inquiry, the hypothesis and the nature of the clinical tryout so well defined that the need for using human subjects is demonstrated.
Normally, this means that earlier scientific investigation, including tryouts on animals, as preceded clinical research on human subjects.

The Declaration of Geneva was the important first step in protecting patient's rights.

The current ethical landscape owes its strictness to physicians such as Josef Mengele, however disturbing it is to give him a certain modicum of credit.

As for the dilemma on whether to use Mengele's research, Stephen G Post concludes in the most appropriate manner when he writes that by using "--- the data without the consent of those who were violated is to violate the violated anew"

Furthermore, many Jewish historians and survivors have commented on this ethical predicament.

As representatives of those most directly affected by the Holocaust, each is an important voice into answering this very question.

Baruch Cohen, a lawyer, best summarizes these thoughts by writing:

The issue of whether to use the Nazi data is a smokescreen from the reality of human suffering.
Instead of the word "data", I suggest that we replace it with an Auschwitz bar of soap.
This horrible bar of soap is the remains of murdered Jews.
The image sensitizes and personalizes our dilemma.
Imagine the extreme feeling of discomfort and the mortified look of horror upon discovering that one just showered with the remains of murdered Jews.
The ghastly thought of Nazis melting human beings (and perhaps even one's close relatives) together for a bar of soap precludes any consideration of its use.
How could any civilized person divorce the horror from the carnage without numbing one's self to the screams of the tortured and ravaged faces of the Holocaust?
Indeed it is only with this enhanced sensitivity to the suffering that one can accurately deal with the Nazi data.

With that position in mind, I contacted a post-doctoral research assistant in Virology at Princeton University.

I conducted a brief interview with Stuart McGregor Dallas, who earned his Master's Degree from the University of Edinburgh, Scotland and his Ph.D from Cambridge University.

Below I have included an excerpt from our conversation.

1) Please describe your educational background, your doctoral thesis, and your present day research.

I obtained my undergraduate degree with honors in Medical Microbiology & Infection from The University of Edinburgh.
Subsequently, I spent a year doing research towards my Masters degree in Infectious Disease Research at The University of Edinburgh examining the mouse immune response during infection by a persistent mouse herpesvirus, known as MHV-68, which is commonly used as a model for the pathogenesis of the human herpesvirus Epstein-Barr virus (EBV) which is the causative agent of infectious mononucleosis and Burkitt's lymphoma.
I then did my PhD at The University of Cambridge and spent three years examining the molecular aspects of Human Cytomegalovirus latency and the mechanisms by which the virus establishes a life long persistent infection of its host. I have just recently moved to America to start a lecturing and research job at Princeton University.
My research here will also concentrate on examining the pathology, molecular biology and pathogenesis of the human herpesviruses that infect and cause varying degrees of illness in such a large number people worldwide.

2) As a Virologist, is there a code of ethics you are mandated to follow?

As a research scientist I am obliged to obtain ethical approval and consent when carrying out any work that involves animals or donated tissues.
It is my reasonability to not use more animals than is necessary to obtain the data I require and to perform my experiments in a manner that does not cause any waste of life, any excess harm or any undue distress.

3) Would you welcome the opportunity to conduct research on identical twins?
Would it affect you if they were not willing participants, even though the research was approved?

I would in no instance be ethically willing to conduct any experiments upon any individual or obtains samples from any individual without their full consent.

4) Would you research on children? Why or why not?

I think it's very important to do research on children especially when there are so many genetic conditions that effect many children from a young age and potentially decrease their quality of life and in some cases shorten their life expectancy.
The research done on children must be carried out with extreme prejudice and in an extremely careful manner.
As always, this should be done in a manner that in not overtly invasive, does not harm the child and in a way that does not cause distress or excess stress to the subject which may affect the outcome of their condition.
In my view, there must also be very strict controls upon what procedures can be carried out, vigorous examination of the ethical nature of the work, informed consent from the legal guardians and a strong basis that the research will eventually lead to a greater understanding of the disease that will directly result in an improved quality of life for those afflicted.

5) How do the doctors in your field view Josef Mengele and his research?

I think there is a common opinion that although a brilliant soldier and a decorated field medic that his conduct would not be one that many could call professional or acceptable. His 'scientific research' is widely frowned upon and not considered to have been of any benefit to our understanding of human genetics or medical science, but simply a waste of human life.

6) Given the same political and racist impetus, could you imagine yourself researching at the Auschwitz Concentration Camp?

The scientific world is one that is very strong driven my competition and lead by individuals who often strive, at all costs, to find an answer to a question.
Even in this modern age there are many people who still conduct their science in an unethical manner, most notably and most commonly those scientist conducting their research on human stem cells.
I think for many people in science there is a great temptation to do just about anything in order to achieve 'greatness', given the same impetus as existed during the Nazi era I think many people would have willingly been involved in this type of research.
I like to think that I am not one of those people due to my upbringing and my personal feelings about preventing human suffering.

7) Do you believe that the physician's actions can be justified in any way?

I'm not sure we can judge Mengele by our own modern standards.
His research was at the extreme end of what can be considered ethical, however there were many medical practices that were conducted up until the late 1960's that would in this modern age be equally condemned.
There are many people who currently object to research involving animals, however I think the important justification that has to be made (prior to any experiments being undertaken) is whether the research and discoveries made justify the lives of those sacrificed, be they human or animal.
In the past they commonly did not, which is why we must strive to control the practices undertaken in the name of medical science.
For that simple reason I don't think Mengele actions can be justified under any circumstances due to suffering that was caused to his subjects.

8) Is it ever right to take away someone's autonomy? (Would you adhere to a court order?)

I think this is very difficult to answer due to the various ways and reason for which a court might decide to take away someone's rights to govern their own medical care.
In most cases this will be due to mental illness or an inability to make conscious or conscientious decisions regarding what is 'best' for them.
I think that in only a very small number of instances that this results in the most beneficial outcome for the individual, however this is a grey area that is often clouded by multiple factors and never an easy thing to decide.

9) Should we completely discount Mengele's research as useless, or could there be something gained from it?

I do not believe that there is anything to be gained from the work that Mengele carried out at Auschwitz and that since that time far more credible work has been carried out under far better conditions, using more informed practices and far more ethical techniques.
This work alone has been able to further our understanding of genetics and hereditary illnesses.
It has proven Mengele's approaches to be misguided in many ways and simply irrelevant.

10) When should a physician step in to stop a cultural practice?

In my opinion it is the responsibility of a physician to protect the health of their patient whilst observing their wishes and beliefs.
I think the only stage at which there should be any form intervention is when it becomes clear that a cultural practice may cause harm, prolonged suffering or the death of a patient.
This topic is a minefield and should therefore be governed by an informed ethical committee in my view, however I think the patient's wishes should for the most part be observed, even when euthanasia is being considered.