The Question of Relevance

1.1 Would That the Holocaust Was Irrelevant

A personal word: many years ago, when we were first developing the United States Holocaust Memorial Museum, we struggled with the issue of how to end the permanent exhibit. We had come up with an appropriate beginning that would serve the function of taking visitors off the National Mall, taking them back what was then fifty years in time, moving them a continent away and introducing them to a European event that we knew they would be seeing primarily through American eyes. Responding ever so subtly to the question of what this event has to do with the American experience, we decided to begin at the end of the Holocaust with the American troops entering the concentration camps, encountering its survivors as well as its evil. It worked because we could conclude this transitional beginning by asking the question those troops who entered the camps asked: how this could have happened?

The rest of the Museum was a response to that question.

But how was the Museum to end?

What transition could we make between the capital of the United States and the world of the Shoah—what survivors and scholars of the Holocaust had named “l’ universe concentrationaire, the planet of Auschwitz,” what Elie Wiesel, who was deeply committed to maintaining, “that world is not our world… the Holocaust was a world apart,” often called the “Kingdom of Night?”.

I knew the ideal ending. We could simply say, “This is how twentieth century humanity behaved toward one another. We, however, do not behave this way, nor should we.” Unfortunately, that is not something we could say; it would neither be credible to our visitors nor to ourselves. Thus, we ended by presenting a lightly narrated film of survivors telling their stories—fragments of memory—to serve as a bridge between that world and our world. As survivors, they have lived in both, and they had made the transition between the two worlds. We had little interest in showing the transition that the perpetrators made from being staff at Auschwitz or from the killing fields of Ponar to living ordinary lives as post-war citizens of Germany, Austria and other perpetrator countries- even in the United States.

My dream today remains the same as it was then: that someday the Holocaust will become irrelevant and the people of that era could look back upon it as an aberration and a warning, a lesson in how individuals, societies and governments should not behave, the negative example par excellence. We could also learn from the all-too-few who lived through the Holocaust but, nevertheless, present a positive model of human behavior. My hope is that someday we can utter the words “Never Again” neither as a cliché nor with shame, but with a sense of achievement in a world transformed.

I am not alone in these sentiments. Speaking at the commemoration of the 75th anniversary of the liberation of Auschwitz at Yad Vashem, the President of Germany, Frank Walter Steinmeier, said:

I wish I could say that our remembrance has made us immune to evil.

But...the spirits of evil are emerging in a new guise, presenting their anti-Semitic, racist, authoritarian thinking as an answer for the future, a new solution to the problems of our age. I wish I could say that we [Germans] have learnt from history once and for all.

But I cannot say that when hatred is spreading.

Of course, our age is a different age. The words are not the same. The perpetrators are not the same. But it is the same evil.

And there remains only one answer: never again! Nie wieder!

As a religious but somewhat disbelieving Jew, the easiest affirmation that I make is that “this is a world that is not redeemed.” While the more pious, the more faithful, await the Messiah daily, I live in an unredeemed world, one in which the Holocaust still has abiding relevance. With the rise of antisemitism, racism, authoritarianism, and fascism in recent years, everyone in this field is challenged with the question, “What have we learned from the Holocaust?” In a polemical talk for the Tikvah (Hope) Foundation, Ruth Wisse, a Harvard Professor Emeritus of Yiddish, questioned the very necessity and utility of Holocaust education.

1.2 The Curse of Abiding Relevance

Still survivors and scholars of the Holocaust are routinely asked to comment on parallels between current events and the Holocaust. Non-sophisticated students often confuse analogies with equivalences as if comparing two events makes them identical. As we learned early on in our high school education, we must both compare and contrast; only when we do both can we understand the distinctiveness of each event. During the ongoing COVID-19 pandemic, survivors and scholars, myself included, were often asked what we can learn from the Holocaust that sheds light on the pandemic. Clearly the two events are dissimilar, but still there is something that can be learned.

Survivors, who spent years in hiding from an all too visible enemy, spoke of their experience with newly isolated and quarantining students and adults hiding from an invisible enemy-the virus. These students and adults wondered how survivors passed the time and dealt with the isolation and loneliness during the Holocaust, when they were without the use of the internet, email, television, telephone and Zoom, all of which have been readily available to this generation. The conversations were interesting, the engagement lively as one generation began to understand the other.

In the last months of 2020 and most especially after the infamy of January 6, 2021, many of us have been asked if we are living in 1931, 1933, or 1938. We are living in 2022, and the challenges of this age are unique to the tools of this age. The internet and social networks, multiple and often conflicting sources of news and information have led to disagreements about basic facts and even whether there is any type of objective truth. We face problems specific to this moment in time: the health crisis, the economic crisis, the social justice crisis, the leadership crisis and the climate crisis.

After the storming of the Capitol on January 6, 2021, analogies were made to the Reichstag Fire of February 1933 or Kristallnacht, the November 1938 Reich pogroms. Most people understand that the analogies are inexact; history does not quite repeat itself, not directly, but the past has echoes in the present and the Holocaust has by now assumed its place at the “Negative Absolute” (Berenbaum 2003, 46) of our age.

In a world of relativism, where facticity is challenged and truth often abandoned, the Holocaust has come to serve as a pivotal point of reference. We do not know what is good and what is bad, what is truth or fiction, but we do know that the Holocaust was evil, absolute evil, even the “gold standard” of evil. It is therefore the “go to event” when people want to call attention to a violation of human dignity or human rights, to mass murder, inhumanity, persecution, discrimination, racism, and genocide. It is for this reason that some want to deny the event, to purge that evil, while others, who seek to mimic it or repeat it, invoke its symbols, and provoke by using its iconography. And in times of crises, we hear echoes of the Holocaust again and again as fear, as a warning, and sometimes, sadly even as aspiration.

1.3 Science in the Service of Ideology, In the Service of Politics

Readers of this book certainly know that the judges at the Doctors’ Trial at Nuremberg established ten principles—perhaps Ten Commandments—which have served as a cornerstone of contemporary medical ethics. Among them are the right of the patient to be informed of their treatment and to consent to it, and the right of the patient to end treatment. These ten principles have been critical also in considering the ethics of human experimentation. So much has been learned from the Holocaust in the sphere of medicine—much, but not enough.

During the COVID-19 pandemic, we have seen the politicization of medical information, the falsification of medical data to advance a political agenda to the exclusion and even derision of scientific knowledge, the promotion of false information to satisfy the whims of political leaders, national and local. We have witnessed and been victimized by restrictions on publicizing information that could save human lives, as well as inform physicians in an ongoing medical emergency about best practices and what practices to avoid. We have seen the promulgation of needless optimism when realism and cautious restraint were necessary to protect human life. We have heard self-serving lies when truth would have been an important warning.

We have seen medical personnel affiliated with some of the great universities of the United States advance theories and policy recommendations contradicting the best medical advice available, subordinating themselves, their reputations, and exploiting their credentials to a political leader they supported. For example, Dr. Scott Atlas, a senior fellow at the Hoover Institution, a conservative think tank at Stanford University did not have a specialty in either infectious diseases or public health. Instead, his focus is on healthcare policy with a background in neuroradiology, which is the reading of X-rays, CT scans, and MRIs. He was given his position as a Special Coronavirus Adviser to President Trump not based on his medical qualifications but because he attacked those who challenged the President and offered without any known expertise in this area advice against lockdowns and masking (Romo 2020). Seemingly, this type of behavior, which is antithetical to the foundations of medicine, was without consequences in the medical community including discipline by medical boards or withdrawing of university affiliation or firings. At the same time, experts with the knowledge and skills to save human lives have been silenced. And others, responsible physicians such as Anthony Fauci and Deborah Birx, had to walk a tightrope, avoiding lies, saying just enough to inform the public but withholding unessential criticism and toning down their views in order to retain their jobs or not be sidelined. They knew that should that occur their successors would only be more ineffective and probably less honorable (Collins 2021).

The results have been that as of January 19, 2021, almost exactly one full year after the first case was confirmed in the United States, the nation surpassed 400,000 COVID-19 deaths (Crist 2021). Although accounting for only 3% of the world’s population, the U.S. had as of the inauguration of Joseph Biden as President of the United States almost 20% of the world’s COVID-19 cases, and the virus continued to surge throughout the country until the vaccine was widely distributed.

The scientific achievements of the vaccines, seemingly in remarkably record time, demonstrate what science can accomplish. The catastrophic handling of the pandemic by our leaders, empowered and legitimated by their medical enablers who subordinated their knowledge and talent to a manifestly political agenda—seemingly without professional consequences—demonstrates the perils of what can occur when medical personnel decide to be more faithful to politics, power, prestige, position, and fame than to medical knowledge and when that subservience directly contributes to the loss of life.

We have also witnessed the politicization of data collection. Some political leaders did not want to provide for adequate testing for fear the results would impose obligations to quarantine, to close bars and restaurants and businesses, even assembly lines at meat processing plants where a majority of workers got sick. Some also refused to release statistics for similar reasons or to support the perception—in the face of evidence—that the pandemic was under control. The former Governor of New York has been accused of requiring nursing homes to accept COVID-19-positive patients when New York’s hospitals were overflowing, and then, to hide data about deaths of nursing home residents to maintain credit for handling the virus properly (Cohrs 2021). This happened at state and local levels and not merely on the national scene. It occurred in the U.S: a democracy, not a totalitarian state.

We must realize that the subordination of scientific knowledge to the political agenda of the head of government—national, state and local—and his/her ideological enthusiasts was not restricted to Nazi doctors alone. It was also not restricted to medical personnel. This took place within a democracy with constitutional checks and balances and an independent judiciary. One can only imagine what could happen in authoritarian states or dictatorships where the consequences of opposing the dominant political position is imprisonment, exile and death, not just loss of position, prestige and political influence. The silence of international doctors who could have spoken up at the beginning of what was to become a global pandemic and their reluctance to share information in a timely fashion must be studied in the future.

These were observable violations of medical ethics. Over time we will come to understand that there were other significant violations as doctors and other medical personnel decided who shall live and who shall die, what priorities to give to treatment and who should be allowed to die by neglect. Others will write of the implications in new fields of genetics and the ability to attack certain diseases in vitro. The behavior of Nazi doctors should indicate that restraints need to be in place. Ethical norms need to be established, sustained, and defended-even in times of crisis.

Although the roll out of the vaccination program got off to a slower start than desired, there were a series of sustained, public, and serious debates as to who should get priority for receiving the vaccine and little dispute that the priorities are ethically valid, beginning with front line workers, then going to those in nursing homes and assisted living conditions, the elderly and those with underlying medical conditions before the general population. While these priorities have not been universally observed they make ethical sense and have properly enjoyed the support of the American public. We have also seen that minorities have been vaccinated less than others and among minorities, there is a greater suspicion as to the efficacy and safety of vaccines because of a greater distrust of government and of science (Recht et al. 2021).

Vaccine nationalism, now prevalent throughout the world, raises an interesting ethical dilemma since there has developed a gap between the wealthy nations and others. This is highly problematic because only global vaccination will lead to safety as borders are porous, and travel will spread contagion. The rabbinic sage Hillel admonished, “If I am not for myself who will be and when I am only for myself what am I? If not now, when?” This seems not only sound political advice, but the only policy that will starve the virus and return us to pre-pandemic normalcy.

1.4 Medicine in Extremis: Then and Now

As we have faced the greatest public health crisis of our time, what can we continue to learn from the Holocaust? Where is the relevance both to how we will judge our actions during the COVID-19 pandemic and prevent future social injustices related to health and medicine? To answer this question, let me turn to medicine in extremis. As I witnessed New Yorkers pausing at 7:00 PM each evening at the beginning of the pandemic and going out on their balconies to applaud for first responders, doctors and nurses, fire fighters and ambulance drivers, I thought momentarily of the doctors and nurses, pharmacists and other health care workers in the ghettos of German occupation, who, under increasingly dire conditions had to provide for their besieged Jewish populations.

I had been working on two books at that point, writing a review of Mark Smith’s The Yiddish Historians and the Struggle for a Jewish History of the Holocaust, and assisting in editing the English language translation of a Ph.D. dissertation on the Doctors of the Warsaw Ghetto by Maria Ciesielska. The Yiddish writers of the Holocaust were committed to writing about how Jews lived and not about-or at least, not only about how Jews were murdered. Following their example, rather than write about Nazi doctors and Nazi medicine alone, in this chapter I have chosen to give a brief overview about what happened inside the ghetto as Jewish doctors tried to practice medicine in extremis and the parallels we can draw in contemporary society.

Germany invaded Poland on September 1, 1939, from the West; the Soviet Union invaded from the East on September 17; Poland was thus divided. In the weeks before the war, the Polish Army was mobilized and physicians who had been part of the Polish Army were called up into their military units. That left many Polish hospitals understaffed, presuming that the military would bear the brunt of the casualties, but as fighting became fierce and the attacks on the civilian population widespread, the civilian hospitals’ abilities to handle the wounded overran the hospitals’ capacities. During the initial stages of the invasion, doctors throughout Poland had to practice triage in choosing their patients. This was due to the fact that the German army did not merely attack military targets but attacked civilian targets and the general population as well. They, therefore, had to balance treating military personnel, who required medical treatment and were also needed by the Armed Forces to return to battle, along with civilian casualties. They too operated with limited resources and inadequate supplies. Ill prepared, they had to practice emergency medicine without certitude as to when they would benefit from resupply. Given an emergency situation of unknown duration, it was all-hands on deck for the foreseeable future, a sprint was required to keep pace in what turned out to be a marathon, enduring throughout the war years.

In areas under German occupation, Jews were immediate targets of persecution and placed in ghettos. In retrospect, the ghettos were a place to contain the Jews until the Final Solution to the Jewish Problem became the operative priority of the German government and the infrastructure was built for their annihilation- death camps complete with gas chambers and crematoria. As a general principle under German occupation, there was no interest on the part of the occupiers in the general health of the Jewish population. There was only self-interest in preventing epidemics that could endanger German personnel or reach beyond the ghetto walls and afflict the Aryan population, which would in turn jeopardize the health of German troops and civilians.

German assistance to the hospitals of the ghettos was motivated solely by a desire to contain epidemics, specifically typhus, and not by a desire to care for the well-being of the captive Jewish population. Health care providers were thus working under conditions of deliberate depravation where the very act of obtaining medical supplies was contrary to the basic interest of the occupiers. During the COVID-19 pandemic, the entire world was faced with an unprecedented demand for medical necessities (e.g. personal protective equipment, ventilators, hospital space) that far outweighed the available supply. This is vastly different than the situation in the ghettos under German occupation, where the ability to provide medical care was present, but a deliberate choice was made not to do so.

Clearly, there are differences between the medical crises of the German occupied ghettos and our current experience with COVID-19. The Nazis manufactured a medical crisis to suit their own political and racial ideology, using science and medicine as a justification. The death and destruction caused by this medical crisis was linked to the second World War. COVID-19 is a global pandemic that has ravaged the world population, (mostly) independent of politics or international hostilities. Yet, there is still much to learn from medicine in the Holocaust, and the behavior of physicians in extreme circumstances in particular that can impact our response to the challenges we currently face. Stories of physicians who remained dedicated to healing and saving lives in any way possible prove that ethics, virtues, values and hope can prevail. These tales of Jewish physicians and righteous Gentiles who risked their lives to save others inspire a positive view of medicine and bioethics in which the power of the profession is harnessed for good, even in increasingly desperate circumstances. The lessons of the Holocaust- how the power and privilege of medicine can be used in both positive and negative ways- have informed our current situation as we have struggled to meet the challenge of COVID-19 in the most ethical manner possible.

1.5 Heroism and Self-sacrifice

Courage took many forms in the ghetto, not just armed resistance. On August 6, 1942, the Germans struck against the children’s institution in the ghetto. Dr. Janus Korczak, an extraordinarily well-regraded pediatrician and a radio personality in Poland, ran an orphanage in the ghetto. Well-respected and well connected with significant admirers among non-Jews in Poland, he knew that deportation meant death. He was offered an opportunity to escape, but when his contacts were unable or unwilling to rescue his children, he lined the boys and girls of his orphanage up in rows of four. The orphans were clutching flasks of water and their favorite books and toys. 192 children and 10 adults were counted off by the Germans. Korczak stood at the head of his wards, a child holding each hand. One child carried a double-sided flag. One side was a green children’s flag, like the one created by King Matt in the book King Matt the First. The other was white with a Star of David set in the center.

They marched through the ghetto to the Umschlagplatz (the deportation point), where they joined thousands of people waiting in the broiling August sun. There was no shade, shelter, water, or sanitary facilities. There were none of the cries and screams usually heard when people were forced to board the trains. The orphans walked quietly in their rows of four. One eyewitness recalls: “This was no march to the train cars, but rather a mute protest against the murderous regime…a process the likes of which no human eye had ever witnessed.”

Korczak was the teacher who would not abandon his students, the physician who accompanied his patients. He was with his children to the end. All were gassed at Treblinka.

Less dramatic but no less valiant were the acts of Dr. Halina Szencier-Rotstein, near the end of the Great Deportation in 1942:

On September 12 [one of the last days before the Deportation], all patients and remaining hospital personnel boarded the boxcars. Even those who had “tickets” and stayed in the hospital on Stawki Street to tend to their patients to the very end were also deported. Among them was Dr. Alina Szenicer-Rotstein who, despite being permitted to leave the Umschlagplatz, chose to accompany her patients. Dr. Adolf Polisiuk remembered that “she went to a wagon voluntarily, to be with those needing her help; this is how she understood her duty. To many such a gesture seemed abnormal, for the will to survive was so strong. Her behavior was very poignant in its heroism” (Ciesielska 2022, 227).

The cruel and corrupt Commander of the Jewish police was approached by a young nurse who timidly asked whether personnel had to accompany the children. “Korczak showed you the way,” he answered.

Noble doctors do not abandon their patients, clergy their congregants, teachers their students. Of course, not all doctors are noble, not all clergy brave, not all teachers self-sacrificing, but there are models to be emulated, brave upstanders giving all they had, all acting with integrity.

There are other reports from the Great Deportation of physicians who injected their patients to ease their pain, to facilitate their deaths, of doctors boarding the train voluntarily, knowing that they were taking leave of this world. Not every doctor or nurse can be a hero but when they are, we must remember their names, revere their deeds. They can—and should—serve as role models for future generations of the importance of promoting the ethical virtues of the profession.

There are reports from virtually every ghetto where records were available of doctors and nurses who committed suicide, some out of despair and some because they simply could not take it anymore. No stranger to death, with easier access to drugs and painkillers, suicide is a choice that doctors and nurses make when they can no longer cope with the unique pressures of their profession. Other medical personnel succumbed to the diseases of their patients. Lacking protecting equipment, engaging too closely, not taking sufficient precautions or simply because they were doing their jobs with dedication and commitment, they themselves became patients. And we have witnessed this again and again during the current pandemic: medical personnel committing suicide, medical personnel dying of the disease they were trying to cure.

1.6 Maintaining Dignity and Professionalism

Physicians and other medical personnel used quarantine signs, most especially from typhus, to protect individuals including themselves from being rounded up. German and Ukrainian forces and the Jewish police were reticent to enter an apartment if the sign on the door indicated a quarantine. Typhus did not obey Nazi racial laws, much like COVID-19 does not discriminate based on class or socioeconomic status. The Prime Minister of Great Britain, the Prince of Wales and even the President of the United States have all battled COVID-19 at various points during the pandemic.

A major example of self-help occurred in Warsaw with too few medical personnel to provide for the needs of the ghetto. As a form of resistance, the Jewish doctors of the Warsaw ghetto created courses for medical students, nursing students, pharmacy students and anyone who cared to attend the classes. It was how they partially alleviated the personnel shortage. It was also how they strengthened their sense of professional commitment and maintained their dignity under oppressive conditions. They modeled their curriculum on how they were taught and did it so well that Warsaw University honored their credits after the war. It seems incredible, but some physicians began their training in the ghetto and completed it at the University. Their ghetto professors were able to maintain their honor, professionalism and productivity even inside the confines of the ghetto walls. It shielded them from dehumanization.

I know that we will find parallels in the contrasting circumstances of the COVID-19 pandemic.

While Nazi doctors conducted research on prisoner victims without their consent or consideration of their well-being, Jewish doctors in the ghetto conducted research on the impact of starvation- research which they took care to include in the Oyneg Shabbes archives assembled by Emanuel Ringelblum so that, once again, the story of how Jews lived and struggled to survive under condition of oppression could be documented. The commitment to scholarship and research was another assertion of dignity and professionalism amidst the quagmire that was their existence. These are important positive models for how physicians can behave in extremis, which can bring out the best in some but surely not all. Unlike Nazi medicine, these research studies have proved invaluable over time.

There is no doubt that physicians have learned how to treat COVID-19 over time both from experience and the research of colleagues. They have learned what works and what does not. Medical personnel have learned how to heal when they could not cure, at a time of great isolation when families could not visit, loved ones could not say goodbye. They have been aided by technology which allows remote visits. The best of them, the most dedicated, have found ways not only to treat their patients but also their patients’ families who can no longer sit by the bedside of their loved ones. Those who do it well have diminished the anguish of the present moment. I know this first-hand having lost my beloved cousin to COVID during the first months of the pandemic, when a nightly call from a nurse was the only information we had and when a physician gave us important and most often dispiriting and disappointing information, accurately, intelligently, and kindly.

In extremis veritas, we learn much from the extreme. To return to my opening dilemma regarding the United States Holocaust Memorial Museum and how to create a transition between two worlds, i.e., that of the Holocaust and that of current society, maybe the answer to such a question can be found in what we can learn from our responses to the extreme.