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Usually, physicians are regarded as the guardians of health and lives, but what happens when healing conflicts with larger state aims? How do physicians reconcile their Hippocratic oath with a mandate of genocide? Like many other professional groups, doctors are simultaneously members of the social elite and public servants. As such, ruling authorities sometimes use them as agents to provide a legitimizing framework for actions taken by the state. At the same time, doctors are human beings, and as members of a particular society, they are equally susceptible to that society's prevailing social mores and climate. When a state adopts an exclusionary policy of hyper-nationalism, all of its citizens, doctors included, can find themselves on both sides of the divide. Whether as willing participants or as reluctant accomplices, physicians have become involved in the planning and implementation of mass murder in numerous countries.

In 1915 Ottoman Turk physicians conducted medical experiments, participated in mass deportations, and promoted a genocidal ideology that led to the widespread death of the Armenian population. Less than two decades later physicians in Nazi Germany perpetrated similar atrocities in a system that culminated in the Holocaust. Carnage also occurred when Hutu doctors turned against Tutsi patients during the Rwandan genocide. Similarly, an international tribunal charged Serbian doctors with war crimes for their role in ethnic cleansing in Bosnia and Kosovo. Even in situations not necessarily intended as full-scale genocides, doctors have lent their medical expertise in an effort to remove or restrict "undesirable" elements of the population. Medical personnel in Argentina, Bolivia, Chile, Iraq, and elsewhere participated in the torture and death of dissidents and enemies of the state. Additionally, in Britain, the United States, Norway, and Sweden physicians helped to carry out involuntary sterilizations as part of their country's eugenic policies.

Four theories offer differing perspectives to explain how physicians could come to endorse programs so seemingly at odds with their role as healers. The first theory argues that doctors do not abandon medical ethics to follow eugenic or genocidal policies; rather, they reinterpret those ethics to coincide with the dominant and prevailing agenda. Generally, this involves placing the health of the collective ahead of that of the individual. Doctors then become charged with cutting out socalled cancerous elements of the population the same way they would remove cancerous tumors from a sick individual. Physicians are often aided in their actions by state-sponsored propaganda campaigns. The Nazis were particularly effective in promoting this approach through films for public consumption, such as Victims of the Past (1937) and Existence without Life (1940–1941). These films were designed to convince the population that the elimination of mentally and physically disabled people was not only in their collective best interest, but actually merciful, and furthermore, as in the case of the film I Accuse (1941), often the desire of the patients themselves.

The second theory promotes the idea of participation via the "slippery slope," whereby transgressions of the medical, ethical, and societal moral codes begin on a small scale, gradually build on themselves, and eventually spiral out of control. For example, doctors do not start out by killing individuals for the purpose of medical experimentation. Rather, by first defining certain people as inferior and then subhuman, it eventually becomes acceptable to use them as scientific specimens without regard for their rights as human beings.

A third theory argues that physicians participate because they cannot find a way to excuse themselves from such activities without suffering grievous personal, professional, or bodily harm. Their actions are motivated by a fear of losing their license, profession, social standing, or even life. For example, according to one source, Iraqi doctors under Saddam Hussein's regime were ordered to cut the ears off torture victims or suffer the same fate themselves. In another case, doctors during the Third Reich often faced internment in a concentration camp if they failed to comply with state rules. This theory raises questions about individual agency and choice. Why, when faced with identical situations, do some physicians find a way to circumvent such rules, while others, seemingly, cannot?

Whereas the first three theories are predicated on the idea that (some) physicians accept, or at least do not actively resist, involvement in such programs, a final theory argues that other doctors aggressively seek to participate in genocidal or eugenic programs. Their motivations range from an opportunistic desire for personal or professional gain to an entrenched belief in the advocated exterminationist ideology. Such was the case with National Socialist physician Leonardo Conti. His early membership in the Nazi Party (he joined the SA in 1923) qualified him as a member of the Old Guard. Conti rose through the system to eventually become the senior ranking medical officer in the Third Reich. Additional Nazi physicians who found scientific opportunity in the suffering of others included: Karl Brandt, who, along with Phillip Bouhler, headed the euthanasia program known as T-4; Gerhard Kujath, whose film A 4½-Year-Old Patient with Microcephaly (1936–1937) was a product of the regime's euthanasia program for children; Josef Mengele, best known for his infamous twin experiments; Sigmund Rascher, who conducted hypothermia and cold-water testing in Dachau; Heinrich Berning, who starved numerous Soviet prisoners of war in the name of famine experimentation; Carl Clausberg, known for his sterilization and castration experiments; and Kurt Gutzeit, who injected Jewish children at Auschwitz with hepatitis.

SEE ALSO Eugenics

Lynne Fallwell