Jewish doctors Jewish doctors

Wrestling with medical-ethical dilemmas during WWII

In Culture
Written by  Graziella Runchina Wednesday, 01 April 2015 12:37

On 2 April at Maastricht University, Hannah van den Ende will defend her thesis titled ‘Don’t forget that you're a doctor: Jewish doctors in the Netherlands in 1940-1945’. She studied the experiences of 534 Dutch-Jewish doctors who had to work under extreme conditions during WWII, which also caused them to struggle with many ethical dilemmas. “During peacetime, making a healthy person sick was out of the question, but in times of war it seemed absolutely justified.”

 

“Don’t forget that you're a doctor”, is how Hannah van den Ende’s thesis begins. These were the wise words that a father imparted to his son when the two were forced to separate because of Nazi persecution. “The father was referring to both the privileges of being a doctor as well as the duties of the profession”, explains Van den Ende, a doctor herself, on the eve of her PhD defence.

Privilege and duty

“The Jewish physicians were definitely privileged, which is apparent by their relatively high survival rate. They also tried to fulfil their medical duties as well as they possibly could, often under appalling conditions. “With only themselves to rely on, doctors during the German occupation were faced with many new ethical dilemmas. Often they attempted to use medical means—which were sometimes very unorthodox— to offer another kind of help as an act of resistance. Misdiagnoses, invented diseases, incorrect prescriptions and operations on healthy individuals frequently had the ultimate goal of acting in the best interest of the patient.

“Medical sabotage to rescue people from being boarded on a train and sent to a death camp—that's what it came down to”, says the researcher. “The fact that the unorthodox methods they used went very far supports the stories of the doctors Van den Ende encountered. “Chest X-rays were falsified by putting a piece of metal on the chest when the X-ray was taken, blood was injected into the bladder so they could later show blood in the urine, and there are examples of interventions such as making an incision in the abdomen and stitching it up so it looked like an appendectomy had been given. Because the Germans had initially promised not to deport sick patients, this approach was successful in many cases”, describes Van den Ende.

Guilt

As a medical student, Van den Ende came across the story of Elie Aron Cohen, a Jewish doctor who had survived Auschwitz and suffered from a massive amount of guilt because he thought that, as a doctor, he should have done more for others. “It fascinated me, so after my medical degree and my master's in medical history, I started to collect the stories of other Jewish doctors. It soon became clear that these doctors were faced with particular ethical dilemmas: Should I cut into a healthy body to make someone ‘unfit for transport’? Should I perform euthanasia or an abortion because of the threat of deportation? Do I need to treat people who have attempted suicide because of a deportation threat, or let them die? During peacetime, these options were obviously out of the question: to make a healthy person sick, let alone to kill or to let someone die, but under these new circumstances everything was called into question.”

Own safety

Doctors had to make the choice on a regular basis of: “Should I stay with my patients to the bitter end or should I choose for my own safety?”. Van den Ende explains, “What I have seen is that the Hippocratic Oath remained an important guide in their life and in their work. Although they were privileged because of their profession, they were persecuted as much as non-physicians, which also made them very vulnerable. So it's almost like being a ‘captain of a sinking ship’ to want to stay with your patients. This balancing of duty versus personal safety was particularly evident in the spring of 1943 when many doctors themselves were deported. If we look at the survival rates, we see that one in three doctors survived in the concentration camps, compared to only one in 22 other people.”

Experiments

What struck her in her research is that the conduct of the Dutch-Jewish doctors was completely different from that of the German Nazi doctors. “They did experiments on healthy people who could have died from the experiments. They saw the state as their ‘patient’ and completely neglected the importance of the individual, in contrast to the Dutch-Jewish doctors, who often had to make major medical-ethical concessions in order to keep their political standing, but who did that while focusing on the importance of the individual patient.”

“I find the sense of duty that these doctors felt very inspiring. They tried to do something for others under precarious conditions and sometimes even at the risk of their own lives. The fact that certain pre-war standards were violated and sometimes totally abandoned is relevant, also for current times. I hope that this study is also inspiring for the current generation of doctors, because it's never wrong to ask yourself what you would do in a similar situation.”

Hannah van den Ende (1983) graduated from the University of Groningen in 2008, with a medical diploma (artsenbul) and an associate’s degree in history. She went to work as a doctor, but also followed the master's programme in medical history at the VU University Amsterdam. Her thesis on the medical department of the Jew Council (Joodsche Raad) led to her PhD research on the experiences and moral dilemmas of Dutch-Jewish doctors during the Second World War. On 2 April, she will defend her thesis as an external PhD candidate at Maastricht University with Prof. Dr E. S. Houwaart from the VU and Prof. Dr J. Th. M. Houwink ten Cate from NIOD. She has also worked as a doctor, from 2009 to 2014 for the Youth Health Care (JGZ) branch of the Public Health Service (GGD) of Amsterdam, and as a teacher of public health. ‘Vergeet niet dat je arts bent’ Joodse artsen in Nederland 1940-1945 was published by Boom publishers

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