On Holocaust Remembrance Day, UCLA event confronts one of medicine’s darkest chapters

As communities around the world marked the beginning of Holocaust Remembrance Day - known in Hebrew as Yom HaShoah - on the evening of April 13, experts in medicine and public health came together at UCLA for soul-searching and urgent conversation at the nexus of history, medicine and moral responsibility.

The event, moderated by Felicia Marie Knaul, a distinguished professor of medicine at UCLA and a global health leader, centered on the findings of The Lancet's Commission on Medicine, Nazism and the Holocaust, a landmark 2023 journal report examining the role of physicians and medical institutions in one of history's greatest atrocities - and how the lessons of that history can guide the ethical development of medical students and health professionals today.

The evening began not with data or analysis but with memory, as Knaul shared her deeply personal reflections with the professors, doctors, medical students, staff and invited guests at the David Geffen School of Medicine's Iris Cantor Auditorium.

"This is a particularly important day in my life every year, and actually almost every day that I have lived since as long as I can remember," she said. "I am the daughter of a Holocaust survivor who was branded in Birkenau at the age of 15."

'To bear witness'

Knaul's father survived five years in Birkenau and other Nazi concentration camps but lost his parents and nearly his entire family in Auschwitz. He escaped just days before Dachau was liberated. He chose not to give up on life, Knaul said, in order "to bear witness" to the Nazi horrors for the rest of humanity.

Felicia Marie Knaul on how the Holocaust has affected her.

She and her partner, UCLA Chancellor Julio Frenk, then read a haunting poetic dialogue written by Knaul's father - a stark exchange between "Mankind" and "Survivor" that gives voice to the psychological devastation left in the wake of genocide. (Read the full poem at the bottom of this page.)

Mankind: You live!

Survivor: I exist.

Mankind: You survived!

Survivor: No, I am dead!"

Mankind: You are alive.

Survivor: My flesh is intact; my soul and spirit died in the ditch.

Nazi doctors: How medical healers became murderers

The Lancet commission report offers one of the most comprehensive examinations of how medical professionals in Nazi Germany helped design, justify and carry out policies rooted in antisemitism, racism and eugenics - a slippery slope that began with the forced sterilization of hundreds of thousands of German citizens deemed genetically inferior, continued with the medicalized mass murder of hundreds of thousands more considered to have various disabilities, and ultimately led to the systematic slaughter of millions of Jews and others considered to be a "disease" in the body of the German nation.

Chancellor Frenk, whose father and grandparents fled Nazi Germany in the 1930s for Mexico due to rising antisemitism, connected the history of Nazi medical atrocities to the present, warning of the consequences when science becomes married to racist ideology and untethered from ethics.

"We are here to reflect on one of the darkest chapters in human history - and one dimension of this history that is particularly unsettling," Frenk said. "During the Nazi era, physicians and researchers reduced human beings to categories: They stripped them of their dignity and their lives. Professionals who normally exemplify healing and humanity turned into terrible instruments of harm and hatred."

One of the authors of the commission's report, Dr. Matthew Fox, a radiologist and medical historian and ethicist at Ben-Gurion University of the Negev in Israel, emphasized the scale of the medical profession's complicity. Mass murder was not the work of a few individuals but a systemic failure of institutions, he said. Doctors and nurses were not peripheral - they were central to the regime's machinery.

"There's a deeply rooted misconception that these atrocities were the isolated acts of a few radicalized individuals," he said. "In truth, the involvement of the medical establishment was vastly more extensive."

Fox noted that by the early 1940s, 50% to 65% of German physicians had joined the Nazi Party and the affiliated SS - a higher proportion than any other academic profession - and that many actively participated in policies that excluded Jewish colleagues from medical practice, promoted sterilization laws and ultimately facilitated genocide.

"Physicians voluntarily and even enthusiastically joined," he stressed. "Healers systematically became killers."

Lessons of the Holocaust: Health professionals and morality

"How could distortion of ethical norms go so far as to define the murder of the most vulnerable as not only acceptable and morally justified - but as an imperative?" Fox asked.

That question lies at the heart of not only of ongoing historically inquiry but of efforts today to strengthen and protect the moral grounding of health practitioners and medical students. The Nuremberg Code - a blueprint for physician-patient interactions that is now foundational to modern biomedical ethics - grew out of the postwar prosecution of Nazi doctors, pinpointing how deeply the profession had failed. But incorporating day-to-day instruction is crucial.

Both Fox and Hedy Wald, also a commissioner on the Lancet report and a professor of family medicine at Brown University's Warren Alpert School of Medicine, are actively weaving lessons from the Holocaust into their instruction for students and practicing physicians. The goal, they said, is to influence the culture, values and unspoken norms that shape how medicine is practiced.

That process, Wald said, begins with recognizing the ethical dilemmas that exist, whether they're related to the informed consent of patients for clinical trials, competing loyalties between doctors and insurance companies or hospital administrators, or simple, everyday doctor-patient interactions.

"We need the two pockets of the white coat," she said, "one being the technical skills and knowledge and other being moral fortitude."

To instill that moral fortitude, Fox and Wald have taken physicians to Nazi death camps in Europe, encouraged students and doctors to reflect in writing on their ethical dilemmas, and presented examples of moral courage on behalf of patients by both Jewish and non-Jewish practitioners.

Wald, Fox and Knaul all expressed hope that similar approaches in curricula will be adopted more widely by medical schools going forward.

"If we want future physicians to act ethically under pressure, we have to give them more than rules," Wald said. "We have to give them a deep, reflective understanding of how medicine has failed before - and the courage to recognize early warning signs."

Why it is important for universities too

Frenk, in his comments, drew a direct line from the history of Nazi Germany to the present moment, highlighting the threat of antisemitism and other forms of hatred to American universities.

"In the 1920s and '30s, universities in Germany had the position of global preeminence that American universities occupy today," the chancellor said. "Antisemitism corrupted the soul of the university by replacing evidence with pseudoscience. We must guard against antisemitism, racism and every other form of discrimination and hate. It is essential not just because it is the right thing to do. It is essential for the very survival of the university."