Faculty of Medicine
Memorial University of Newfoundland
William Osler
The recent (November 1996) Annual Conference of Educating Future Physicians for Ontario (EFPO) underscored a basic philosophy: medical education --- from the first day of medical school to the last day of practice --- must be responsive to societal needs. Since its foundation in 1986, a major plank in EFPO's programme has been directing attention to physician roles. These were decided on from surveys on what the public wants to see in its doctors. Aside from the well-appreciated professional and scientific roles, others include communicator, healer, gatekeeper, and health advocate; all these roles are under discussion in the proposed CanMeds 2000 program of the Royal College of Physicians and Surgeons, as well as now being part of the medical school curriculum at Memorial.
Of course, a danger exists in focusing attention on individual roles alone, since searching questions about the social responsibility of the medical profession as a whole may be pushed aside. A widely held opinion, that the history of the medical profession's social responsiveness leaves much to be desired, hardly discourages this view. Although the activism and social concerns of individual physicians are often highlighted, this is sometimes to contrast their lives with the conservatism of the profession at large; the popular story of Canadian physician Norman Bethune comes to mind.
Concerns over the medical profession's social responsibility (or lack of it) have been highlighted in recent months through the 50th anniversary of the Nuremberg trials. The "Nuremberg issue" of the British Medical Journal (Dec. 7 1996) is recommended reading. One article argues that the German medical profession did not become involved in eugenics following Nazism, as is generally viewed, but set its own course in 1933 through the scientific study of race and health as a service to the state. The profession "even outpaced the new government, which had to rein in the profession's eager pursuit of enforced eugenic sterilisations."
The same author states that, after 1939 when eugenic sterilisation of patients was halted and a euthanasia program instituted for adult and pediatric patients clinically classified as futile or terminal cases, "the medical community [on a large scale took] 'part in the acquisition of human specimens' from the plethora of 'material' produced by the killing hospitals, death camps, and executions to serve teaching and research."
These horrendous acts are perhaps brought "home" by a current small medical school exhibit of volumes of Eduard Pernkopf's Anatomy from the Health Sciences Centre library. It is generally accepted that the first edition (1943) was based, in part, on specimens obtained from killing in hospitals and the like. The exhibit shows illustrations from the first edition with Nazi symbols (swastika and SS) incorporated in artists' signatures. In the current (1989 edition), two illustrations by Entresser still incorporate the SS symbol. One writer (1995) has stated "Pernkopf worked on the publication of an anatomic atlas, which contained material from children killed in a Viennese hospital. His Institute of Anatomy also used the corpses of executed persons for teaching purposes; part of this material is believed to be still in use at the university."
Unquestionably, this adds to an ethical debate in recent years. To what extent, if at all, should data from unethical experiments and from victims of eugenic "experiments" continue to be utilized in science and education?
It is a long stretch between the EFPO program and the behavior of the medical profession during the Nazi regime; however, together they remind us that professional responsibility is not just listening to and responding to society's concerns--as essential as that is--but in also taking public and activist positions on social issues. For instance, while many individuals are concerned about trends in medical genetics, little collective debate takes place within the medical profession.
Last updated 18 Jun 1997 by 