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Munich: face to face with evil…but never blinking

Sixty-one years ago, in the ruins of a war-ravaged city, Dr. Donald Seldin came literally face-to-face with evil, and didn’t blink.

The year was 1947.

The place was Munich.

The evil was personified in the form of a Nazi physician who had conducted dozens of liver biopsies on healthy prisoners in the infamous Dachau death camp, killing many of them in the process.

Seldin, although still a young man of 27, had been called as an expert witness in the Munich tribunal of Nazi doctors.

At the time a US Army captain in the Medical Corps, holding the position of chief of medical service at the Munich-based 98th General Hospital, he was cross-examined by the Nazi doctor himself, who acted as his own lawyer.

The defendant-lawyer tried to establish that there were legitimate medical reasons for conducting the lethal biopsies at Dachau; that they were somehow elevated above the monstrous examples of Nazi quack science which other Reich doctors had conducted.

Cool, calm and already professionally knowledgeable about the human liver and the contemporaneous science associated with it, Seldin answered every question put to him by the Nazi.

In answer after answer, he told the court that there was no possible therapeutic value associated with such procedures — that they constituted war crimes of the worst order.

The court was convinced by Seldin. The Nazi lost the case and was, as Seldin would say years later, “appropriately punished.”

Seldin, who went on to a brilliant medical career, including a decades-long tenure at the University of Texas Southwestern Medical School (where four of his students would earn Nobel Prizes), considers the Munich trial a pivotal point in his life.

It reinforced, he told the IJN last week, a personal interest in biomedical ethics that had already started before WW II, and strengthened and clarified that interest throughout his long and illustrious career.

His lifelong interest and expertise in the subject was well illustrated in Denver last week, as Seldin conducted the inaugural lecture and led a panel discussion for the Holocaust in contemporary bioethics program at CU’s Center for Bioethics & Humanities.

Speaking to the IJN after the presentations, Seldin indicated that while knowing the difference between right and wrong is crucial for the entire human race, it is even more critical – and considerably more complex – for doctors, who are entrusted with the ultimate power of life and death.

Nothing showed that more clearly, and horrifically, than the Holocaust.

Seldin, who served in Germany from 1946-48, knew well before going to Europe what had happened at Dachau and the other death camps, including the often fatal experiments and questionable procedures carried out by Nazi doctors.

He is modest now in describing his role as an expert witness at Munich, claiming that most American doctors had already returned to the States by 1947, resulting in his appearance in court, despite his age.

Still, he had already done extensive work in internal medicine and was prepared when the defendant Nazi led him through a series of tough questions on liver procedures.

“I was able to answer his questions,” Seldin says 61 years later, “because I had a good background.”

The testimony during that portion of the trial was highly technical, about medical procedures, and didn’t delve into the ethical dimensions of what the Nazi doctor had done, since the court had already established parameters, Seldin says.

If the work of the Dachau physician had any medical value or hope for therapeutic result, then murder charges against the physician would be dropped. If no such medical value could be established, the murder charges would stand.

Seldin’s testimony that liver biopsies on healthy persons had no such practical value was instrumental in the court’s ultimate decision to convict the Nazi physician of multiple murders.

There is a bit of irony in the nature of his testimony, Seldin reflects. Although he had been interested in philosophy and medical ethics before joining the Army, his testimony in Munich – arguably, one of the last century’s most crucial examinations of medical ethics – was limited to the hard science of medical knowledge.

Today, however, he is more than willing to debate some of the ethical implications that were raised by Nazi medical practices.

Seldin is asked whether the data collected by Nazi doctors – without the patients’ consent and very possibly at the cost of patients’ lives – should be used in modern medicine if the medical impact of that data was established to be very valuable.

“We have to be very careful about that,” he replied after giving the question a moment’s thought. “That’s a tricky question.

“In other words, suppose a Nazi doctor had discovered the cure for tuberculosis or cancer and done it in a perfectly illegal, immoral, vicious way. Should the results be used?

“I think that’s benefit analysis. If the thing that he discovered was trivial, I would ignore it. But if it’s of monumental benefit to mankind, I would use it because the benefits outweigh, in a certain sense, the recognition that this discovery was done in perfectly immoral ways.

“From an ethical perspective, therefore, Seldin concludes that it’s quite fortunate that virtually all of the medical research conducted under Nazi authority produced “absolutely worthless” results.

It’s difficult to weigh on an ethical scale the atrocities of Nazi medicine against virtually anything happening in the medical profession today, Seldin acknowledges.

“I don’t think anything unique can be drawn now, that I know of. Informed consent is well in place. Institutional review boards are well in place. Monitoring is well in place.”

But that doesn’t mean that modern medicine cannot learn lessons from the darkest days of Nazi medicine.

Seldin feels that modern physicians – in some ways, like the German physicians of the 1940s – are facing ethical challenges not from within the medical profession but from without.

“The thing that impresses me, and which I tried to get across today, was that there is pressure from outside medicine into medicine,” he says. “All sorts of things. Some of them are quite legitimate, but others begin to constrain the ability of the physician reasonably freely to exercise ethical principles.”

One example cited by Seldin has to do with federal mandates on hospitals, and the lack of support to fulfill such mandates.

“Supposing I say that you have to treat every patient that comes into your emergency room, on pain of going to jail. And then it turns out that the money I give you is totally inadequate to do that. It puts you in an awkward position.

“How can you function with a full panorama of those requirements, and you have to get rid of that patient because you see a lot of patients? In other words, the social system is imposing certain constraints on you, no matter how conscientious you are.”

Taking the question of medical ethics into a broader forum, Seldin is asked whether the modern American health care system can be described as ethical.

Again, he cites influence from outside the realm of medical practitioners.

“A lot of this is in the political domain,” he says.

“I personally feel that the health care system in the United States is a broken system. Not everybody agrees. This is part of the presidential choice we have. It’s very hard in the United States to institute reforms in the health care system that everybody agrees on.”

It is a “social question,” he says, to ask whether the system is ethical.

“Is it ethically justifiable to allow 47 million people to go without health insurance? I would say that’s to be ethically criticized.

“Is it unethical to under-fund emergency rooms all over the place and yet require emergency treatment. I’d say that’s ethically unattractive.

“But these are quasi-social questions,” he says, explaining that issues of medical ethics have to be weighed along with other considerations – how to pay for medical care, for example, and whether increasing insurance or taxes might impact negatively on the very people healthcare reform is meant to help.

“These are complicated questions of social engineering and the American public has not come to any consensus on this.”

Although daunting ethical questions, they do not compare with the black-and-white absolutes characteristic of Nazi medicine. In that case, the influence of the government not only challenged the ethics of the medical profession, it utterly destroyed them.

“The Nazi era says to me that when the government becomes increasingly coercive and threatening, the opportunities for the physician to operate with a full role of medical-ethical principles becomes compromised.”

And that lesson may be needed again, Seldin warns, as medicine moves ever deeper into the complex and largely uncharted territory of genetic research, the drive to eliminate inherited diseases and to “enhance” the human condition through genetic engineering.

New and challenging medical ethical questions have already arisen, and have yet to be settled to the satisfaction of medical practitioners, ethicists and religious leaders:

When does the lack of detectable brain activity justify the withdrawal of life support from a terminally ill patient?

When is it justified to perform an abortion when the presence of a genetic disease has been detected in a fetus still within the uterus?

“It’s very complicated,” Seldin agrees, but hastens to add that he has ultimate trust in the wisdom of humanity, and the medical profession, to arrive at the best ethical conclusions possible on all of these issues.

“We will blunder here and there,” he says, “but I think that there will always be an attempt to get it right.”

“But,” he adds, waving a finger of caution and hard-earned experience, “we should be very careful.”

Copyright © 2008 by the Intermountain Jewish News

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