Complementary and alternative medicine History Hitler Zombie Holocaust Medicine Quackery World War II

Arthur Caplan finds the Hitler zombie in bioethics

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgVacation time! While Orac is gone recharging his circuits and contemplating the linguistic tricks of limericks and jokes or the glory of black holes, he’s rerunning some old stuff from his original Blogspot blog. This particular post first appeared on July 25, 2005 . Although the Undead Führer himself has made only one appearance, but the concept is there, and this forms the basis for what the monster became. Enjoy!

As for all the Hitler Zombie reruns, don’t worry. I decided to do that over the weekend, and now I’ll change to reposts of different topics for a while.

In the most recent issue of Science, bioethicist Arthur Caplan points out how common flawed and overblown Hitler or Nazi analogies are during debates about stem cell research, end of life care, and clinical trials:

Sadly, too often those who draw an analogy between current behavior and what the Nazis did do not know what they are talking about. The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine. Because its misuse diminishes the horror done by Nazi scientists and doctors to their victims, it is ethically incumbent upon those who invoke the Nazi analogy to understand what they are claiming.

I couldn’t have said it better myself. (Of course, Arthur Caplan does this kind of thing for a living and I don’t; so it would be shocking if he couldn’t say it better than I.) The Hitler zombie will not be pleased by his words, as biomedical debates have proven a fruitful hunting ground for him to find brains to snack on, and not just in the debate about thimerosal and autism. there are also the issues of stem cells, human clinical trials, genetic engineering and gene therapy, and end of life issues.

On a more serious note, let’s look at one example in particular that Dr. Caplain mentioned, the Terri Schiavo case. How many times did you hear that the way authorities were rushing to “execute” Terri was reminiscent of Nazi Germany or even a step onto the “slippery slope” to a new Holocaust? There was apocalyptic imagery of “jack-booted” Gestapo coming to end her life. Indeed, it makes me wish I had come up with the concept of the Hitler zombie a few months before I did, as he would have had a field day with this case. Here’s one example:

As Schiavo starves to death, we are entering a world last encountered in Nazi Europe. Prior to the genocide of Jews, Gypsies, and Poles, the Nazis engaged in the mass murder of disabled children and adults, many of whom were taken from their families under the guise of receiving treatment for their disabling conditions. The Nazis believed that killing was the highest form of treatment for disability.

And this article about Schiavo:

It was also used in Auschwitz, Bergen-Belsen, Treblinka and the Soviet gulags. Stalin used starvation as a means of control. Nazi doctors experimenting on unwilling “patients” adopted all kinds of cruel techniques. One of those techniques was starvation and dehydration. It is recorded in the records of the Nuremberg Trials.

And this one:

Even before the rise of Adolph Hitler’s Third Reich, the way for the gruesome Nazi holocaust of human extermination and cruel butchery was being prepared in the 1930 German Weimar Republic through the medical establishment and philosophical elite’s adoption of the “quality of life” concept in place of the “sanctity of life.” The Nuremberg trials, exposing the horrible Nazi war crimes, revealed that Germany’s trend toward atrocity began with their progressive embrace of the Hegelian doctrine of “rational utility,” where an individual’s worth is in relation to their contribution to the state, rather than determined in light of traditional moral, ethical and religious values.

Yet another article about Schiavo invoking the Nazis:

Because evil has no reason, we once again see its ugly head in the shameful decision by people dressed in black like the Gestapo of Nazi Germany, giving way to the execution by starvation without a jury trial, required in all capital death cases.

And, finally, of course, such a discussion would not be complete without the gratuitious, outrageous, and overblown dropping of the H (for Hitler)-bomb (Mary Labyak apparently runs the hospice where Terri Schiavo was being cared for):

While Mary Labyak is not a leader of armies of soldiers and is not known to be targeting ethnic groups as Hitler did, she is actively involved in making hospice a place where the severely disabled can be eliminated, with government approval. Hitler also targeted the severely disabled, killing over “200,000 handicapped, mentally ill and other institutional patients who were deemed physically inferior” and used his government to accomplish that goal. Labyak uses her hospice to accomplish the same goal.

Labyak sits on the board of national level policymaking organizations which decide the future of hospice and health care. Labyak agrees with Hitler that there is a rationale for intentionally ending the lives of the NON-terminal, severely disabled and is pushing that agenda. Labyak sits on the board of an organization (Partnership for Caring) with DIRECT historical roots in the Euthanasia Society of America, founded in 1938 in New York, during the HEIGHT OF THE NAZI agenda of killing off the disabled, mentally ill and other ethnic groups, shortly thereafter to become THE HOLOCAUST!

If you do a Google search, you can easily find thousands of articles making or discussing that analogy (although at least one pointed out how dubious it was). And, indeed, if you don’t know a lot about Nazi Germany and its euthanasia program it can all sound pretty persuasive. The problem is, it doesn’t add up, as Dr. Caplan points out, and I’ll try to expand upon a bit.

Nazis justified the T4 euthanasia program on two main grounds. The first and foremost purpose of the program was eugenic, to remove undesirable genetic traits from the Volk. Consequently, the Nazis killed the deformed, the disabled, and particularly the mentally retarded or those with mental illnesses. They used multiple methods, including starvation, intentional overdose with narcotics, lethal injection, and then ultimately gas chambers to achieve this end. (Of course, given that genetics was in its infancy, the Nazis not infrequently misidentified conditions as being genetic when in reality they weren’t, one example being cerebral palsy, which is often due to birth trauma or cerebral anoxia.) Consistent with this vision was the mandatory sterilization of adults deemed to have “undesirable” genetic traits, a group that expanded to include Jews and other “racial undesirables,” who as groups later became the victims of mass murder during the Holocaust. The second justification was to eliminate what the Nazis perceived as drains on the Volk in order to “free up hospital beds,” “increase the food supply,” and “free up personnel for the war effort,” among other specific reasons they would group under this rubric. Indeed, some of the terms for the disabled the Nazis would use to justify this killing were “life unworthy of life” and “worthless eaters.” Removing them by killing, according to Nazi ideology, would allow the “healthy” members of the Volk to devote themselves to pursuits that would contribute to society and the war effort, rather than “wasting” their efforts caring for the disabled.

Consider this in relationship to the Terri Schiavo case. What was at the very core of the arguments made by those advocating removing her feeding tube? Personal autonomy and the right to self-determination, about as un-Nazi-like a justification as you can make! (Indeed, referring to such analogies, one commenter in a blog said sarcastically about such comparisons: “Yep: Adolf Hitler, famous advocate for patient autonomy.”) In essence, the state of Florida spent nearly a decade and millions of dollars trying to determine what it was that Terri herself would have wanted for herself if she ever fell into a permanent coma or the persistent vegetative state she found herself in, and even ordered the feeding tube reinserted when an appeal was made. Implicit in that search was the accepted right of an competent human adult to refuse medical care. Nowhere in the arguments for letting Schiavo die were appeals to wasted resources being used to keep her alive or threats to the genetic health of the nation. Consider further, then: What would the default have been if Michael Schiavo had failed to convince the courts that he was not lying when he reported that Terri’s wishes were not to be kept alive in a coma or persistent vegetative state? It would have been to continue to keep her alive, as she had been kept alive for years before that. In contrast, in Nazi Germany, the justification for letting Terri die would have been that she was a drain on the Volk, and not a second thought would have been given to withholding food and water or even helping her along with a lethal injection as soon as it became clear that she was never going to recover.

Besides being a bad analogy, such arguments rely on a logical fallacy, that of the “slippery slope.” In essence, this logical fallacy seeks to convince one that, if the proposition in question occurs, then it will set into motion a chain of causality that will lead to something truly horrific; in this case, if Terri Schiavo is allowed to die, it will lead to widespread involuntary euthanasia of the disabled. The reason that the slippery slope is almost always a logical fallacy is that the chain of causation is usually vague and it is not proven that if the disputed proposition were to become reality that the feared outcome would have a high probability of resulting. Given that the very basis for letting Terri Schiavo die is not anything like the justifications the Nazis used for involuntarily euthanizing the disabled, there is no strong evidence or reason to conclude that allowing her to die would move the United States towards the horror of the widespread involuntary “mercy killing” of the disabled, as some advocates of the disabled have claimed.

Does this mean that all Nazi analogies in the realm of bioethics are dubious? No, but I would argue that the vast majority are. I’ve addressed this issue before with respect to bad Holocaust/Nazi/Hitler analogies in politics, and I’ll paraphrase what I said before for biomedical Nazi analogies: Whenever someone makes a Hitler or Nazi comparison, be it “Bush=Hitler” or “killing Schiavo=Nazi euthanasia” or a questionable Holocaust comparison, don’t just accept it. Pin down the person making the analogy. Make him justify the analogy with history, facts, and logic. Ask him what historical events lead him to make that analogy. At least 95% of the time, you’ll get either no answer (and you’ll hopefully make the idiot making the analogy very uncomfortable); a meaningless answer or an obviously fallacious answer. The other 5% of the time you may actually get an answer that makes you wonder. In any event, when examining a particular bioethical issue, what should determine whether such an action is ethical or not should be the facts and ethics of the case, not any distorted Nazi analogy.

As Arthur Caplan argues:

There are many reasons why a practice or policy in contemporary science or medicine might be judged unethical. But the cavalier use of the Nazi analogy in an attempt to bolster an argument is unethical. Sixty years after the fall of the Third Reich, we owe it to those who suffered and died at the hands of the Nazis to insist that those who invoke the Nazi analogy do so with care.

I wish I could have put it so succinctly. When considering a bioethics issue, to determine what is and is not ethical should rely on the facts of the case and the ethics of the policy, not a bad analogy to a historical event.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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