I noticed in the “News from the College Section” of the December 2019 issue of ACEP Now that ACEP applauds the United States District Court for the Southern District of New York for rejecting the HHS rule that would shield health professionals who refuse to deliver care or medical services based on religious belief or moral conviction.

It astonishes how quickly we have forgotten the lessons of the recent past. A former governor of Colorado stated that for financial reasons, and the greater good, it was the “duty of the elderly to die.” 

It should be sadly remembered that the German 1930 sterilization law was largely modeled on a draft written by Harry Laughlin at the Eugenics Record Office in Cold Spring Harbor, New York. After Hitler’s rise to chancellor in 1933, a radicalized eugenics program emerged in Germany, and its first victims were 70,000 Germans deemed “feebleminded.”¹

The euthanasia program was initially organized and carried out by German physicians. These physicians were encouraged to move from doctoring individuals to doctoring the nation. Dr. J. Barondess observed in the Annals of Internal Medicine “that physicians in Germany did not simply acquiesce; rather they accepted, supported, and were instrumental in the application of the policies.”¹

Former U.S. Surgeon General Dr. C. Everett Koop stated, “At greatest risk are the poor, elderly, disabled, disadvantaged, and others without access to good medical care for whom the ‘choice to die’ could become ‘a duty to die.’” The frightening echoes of the concept of “lives not worth living” loudly resound.^{2, 3}

I have witnessed authorized and approved hostile demonstrations against Jews and also Catholics by regimes in other countries. We cannot ignore that both Papa Doc Duvalier, Haiti, and Che Guevara, Cuba, were physicians, and they were known for their brutality. As physicians, we are not automatically immunized against inhumanness, and it appears that we can be changed by state dictates, personal agendas, career advancement, profit incentives, and personal biases.

Physicians, like any citizen, must have the right to refuse or provide treatments deemed not moral or unethical based on religious or moral conviction. As R. Orr, MD, director of clinical ethics at Loma Linda University, stated: “Become involved or the reprehensible will become the standard, and the standard of care will ultimately become your obligation.”⁴

References  

1. Barondess J. Care of the medical ethos: reflection on social Darwinism, racial hygiene, and the Holocaust. Ann Int Medicine. 1988;129(11):891-898. 
2. Koop CE, Johnson T. Let’s Talk. Grand Rapids, MI: Zondervan; 1992:46.
3. Barondess JA. Medicine against society. Lessons from the Third Reich. JAMA. 1996;276(20):1657-1661.
4. Orr RD, Biebel DB. Why doctors should not kill. Christ Med Soc J. 1993;24(1):10-14.