Medical Science Under Dictatorship

Arthur H. Gale, MD
Article Type: 
November/December 1998
Volume Number: 
Issue Number: 

Dear Dr. Faria,

Your review of Dr. Leo Alexander’s article, “Medical Science Under Dictatorship,” (“Euthanasia, Medical Science, and the Road to Genocide,” Medical Sentinel 1998;3(3):79-83) which [initially] appeared in The New England Journal of Medicine in 1949 was both stimulating and timely.

When I first read this article several years ago I too was moved. A particular section of the essay aroused my curiosity. Like most American doctors, I had never heard of the bravery of the Dutch medical profession during World War II in resisting German orders to send physically and mentally handicapped Dutch citizens to killing centers. The resistance of the Dutch medical profession was probably the most courageous act in history ever committed by any group of medical professionals.

Because of my interest in learning more about this historic event, I invited Dutch physician-historian Professor Joseph Weerts to the United States to give two lectures on this subject to the medical staff of the Jewish Hospital of St. Louis.

Dr. Weerts made some very interesting comments about the actions of the Dutch medical profession in the 1940s. I will mention just a few which are especially germane to our present period of medical crisis.

The Dutch Medical Association equivalent to the AMA Principles of Medical Ethics proclaimed the government had no right to interfere with the patient-doctor relationship. The 90 percent of physicians who belonged to the Dutch Medical Association understood the patient-doctor relationship claimed superiority to any government edict. Thus, there was already in place a common cultural bond among Dutch physicians to resist government interference — even the interference of an all-powerful enemy that occupied their homeland. The contrast between the position of the Dutch medical profession in the 1940s towards government interference with the patient-doctor relationship was in striking contrast to the position of their next door neighbors — the German medical profession. Similarly, the primacy of the patient-doctor relationship in the Netherlands fifty years ago is quite different from what is happening to that relationship in the United States today.

Although some Dutch physicians were incarcerated in concentration camps, none were executed for their opposition to euthanasia of the handicapped. There was one Dutch physician who was executed. When this physician was asked whether he had treated a downed British airman who had parachuted in the vicinity of his office, he retorted that he never revealed to any authority matters pertaining to his patients. This was a natural response for Dutch physicians of that era. This response cost him his life. Contrast this physician’s reverence for Hippocrates’ dictum of the privacy of the patient-doctor relationship with the lack of protection of confidentiality of medical records so prevalent today in the U.S.

The resistance to the Nazis was generally from persons who held simple but strong notions of what was morally right and wrong. The leaders of the Dutch Medical Association’s resistance were obscure general practitioners. Contrast the physician leaders of the resistance in the Netherlands with the Nazi doctors. The latter were often professors or would-be professors who sought to advance their careers by joining the Nazi party. Careerism and opportunism were rife in the German medical profession, once the most respected in the world. Whereas about 1 percent of the Dutch physicians joined the Dutch National Socialist party, 45 percent of German doctors joined the German National Socialist party.

After the war ended, physicians who were members of the Dutch medical resistance organization, known as Contact, were awarded a medallion. The inscription on this medallion reads: “Only a free man can be a good physician.” Contrast this notion of what constitutes a good physician with today’s managed care concept of the physician as a provider who must work under imposed financial incentives to withhold care and who must report to clerks before tests, procedures, and referrals can be ordered for the patient. Or, contrast this concept of freedom with the Orwellian Newspeak that crowned the gates of most Nazi concentration camps: Arbeit Macht Frei, “work makes one free.”

The lessons to be learned from the experience of the Dutch physicians in World War II are self-evident. They are the flip side of the lessons to be learned from the example of the German medical profession during the same period. In this vein, the comments of Dr. Weerts on the Alexander article (which he had not read until I sent it to him) are worth noting. He stated that Dr. Alexander’s analysis of the success of the Dutch medical profession’s resistance was accurate. Resistance to totalitarian control of the medical profession must occur swiftly and decisively, “before the first step is taken,” if it is to succeed at all.

It is an irony of history that the descendants of the courageous Dutch doctors who resisted Nazi demands that they transport their handicapped patients to killing centers are in the vanguard today of the assisted suicide and euthanasia movements.

Dr. Gale practices internal medicine in St. Louis, Missouri. His address is Overland Medical Center, 2428 Woodson Road, St. Louis, MO 63114-5497, (314) 427-2424, Fax (314) 427-7787.

Originally published in the Medical Sentinel 1998;3(6):219-220. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).







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