On Thursday November 9th, the 79th Yahrzeit of Kristalnacht, I had the honor of participating in a panel discussion addressing lessons that can be drawn from the Holocaust which might be relevant to healthcare today. The discussion emanated from the well-known and horrifying facts about the active role of healthcare professionals, especially physicians and nurses, in the Nazi murder of those considered unfit to live and a threat to the purity of the Aryan nation.
The historical facts discussed included the disproportionately high percentage of physicians who joined the Nazi party, in comparison to other professions, and the role of physicians in devising the method of murder and administering these terrible operations. One of the most important lessons to be learned includes the fact that medical staff behaved according to what they came to believe was ethically and morally correct, as the ethical codex was not abandoned, but subverted to Nazi ideology. Lessons for education of current medical staff and the need to find ways to include and highlight ethical aspects in their already-overloaded curricula were addressed.
I chose to focus on the problems that still exist regarding accessibility of palliative and pain relief care. As it has been pointed out in the recent Lancet Commission report, published in October 2017, there are still often highly charged disagreements among health professionals about the use of palliative care and pain relief at the end of life, even in high-income countries where good health services exist, and even where palliative and pain relief services are available. I argued for the importance of clear guidelines that guard against personal prejudice and misinformation about the difference between palliative care and “euthanasia”, and for accountability frameworks such as bioethics committees in hospitals. Such committees should be multi-disciplinary and easily accessible to patients and their loved ones, so they can step in to assist patients, family members and healthcare providers during the desperate moments in the face of extreme suffering at end of life.
This was a spectacularly enriching discussion, and I hope to continue working to educate healthcare providers and the systems in which they work about inherent risks for dehumanization of patients, even by generally well-intentioned individuals in the helping professions. It is our duty as a society and as healthcare providers to learn the difficult lessons from the Holocaust, and from medicine in the Holocaust: none of us are above the processes that might lead to dehumanization of others, but as a society we have to strive to transcend these dangers by being aware of them and putting the appropriate investments and attention to preventing them.
Irit Felsen
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