Doctors’ Dilemmas during a Crisis: Historical Perspective

‘There is within us some hidden power, mysterious and secret, which keeps us going, keeps us alive, despite the natural law...’ Chaim Kaplan, March 10, 1940

This post was prompted by a Facebook post I recently happened to see. Glaring in its inaccuracy, using a desperate situation for making cheap political points, the post claimed that in Italy the elderly are simply left to die, with no treatment. The implication being that this is a result of certain kind of medicine and lack of care. This is very upsetting; Italy is right now the hardest hit by the crisis to which no country is well-prepared. It seems cruel and unnecessary to make points whilst medical staff in Italy is working very hard under desperate circumstances. The same situation may well be repeated in many other nations – no one is prepared.

Thinking of this, I immediately remembered the dilemmas of doctors during the Holocaust. The Holocaust was a unique period in history with no comparison. Writing, as a historian  rather than a medical doctor, I would like to bring up some of those 1940’s dilemmas, which do not sound unlike those some doctors will face today and tomorrow.

What comes to mind is the Warsaw Ghetto. Following the German occupation of Warsaw (September 1939), it was decided in October 1940 that a Jewish District, that is, the ghetto would be created. It would cover roughly 2% of Warsaw city territory whereas the Jews were over 20% of its population. All Jews were supposed to move into the ghetto by mid-November 1940. Warsaw Ghetto was the largest of all Holocaust-era ghettos with about half-a-million people. This means that people were living in extremely crowded conditions, which of course would have a bearing on spread of disease.

There was a German policy that contributed to people dying in droves. This was the policy of withholding food and medicine including vaccines. Of course, there was the always present violence and possibility of an arbitrary death, too. It has been calculated that on average a person in the Warsaw Ghetto might have received 180 daily calories. This would also have an effect on existing medical conditions. Historians speak about Ghetto Disease. People died of hunger, sickness and cold in such numbers that for instance between October 1940 to July 1942 about 100 000 people perished.

Under these horrific conditions, Jewish doctors were still active. First of all, in the Warsaw Ghetto of all places, there was a functioning Medical School. The School functioned for about fifteen months. Some of its students ultimately survived the Holocaust and became physicians. This is something the above citation of Chaim Kaplan would refer to, as the mysterious power, no? Also, Jewish doctors in the ghetto -unbelievably- conducted a study on effects of hunger. The study was started in February 1942 and it included studying psychological and physiological aspects of hunger (cardiovascular system for instance). Eventually, the study was smuggled to a Polish doctor. It was later published in several languages.

Medical doctors in Warsaw, as well as in many other places, faced huge ethical and moral dilemmas. When medicine was withheld by the Nazis and hunger was ever-present, what could a doctor offer? If a limited amount of medicine was available, on which basis would he give it? Was it to be given to the person with best chances of survival or to the person who needed it the most? Would a child take precedence over an adult? Or would a doctor give some aspirin, should he have it, and reassure the patient despite knowing the bitter truth? What were ethics in a situation where there were only choiceless choices – a term frequently used in Holocaust studies to describe a situation with no real or good choices.

Throughout the world, watching the situation unfolding in Italy, these questions resonate. If hospitals are overwhelmed; if there are not enough beds or medicines or doctors, what is going to be done? Let us hope we do not need to face these questions.

In summer 2016, a special march took place in the city of Warsaw. This march was organized to honor the medical doctors, nurses and other medical staff that valiantly performed their duties in the chaos and misery of the 1940’s. The marchers wanted to show their respect. It came late but is nevertheless a recognition.

If a doctor had nothing to offer what could he do during the Holocaust? Would it have been better to tell the truth? Would it have been right to just abandon the patients? If there was no medicine what could he give to the patient? What do we know about this aspect?

From survivor accounts, by Jewish doctors as well as by their patients, we do know that they were able to offer the precious commodity of hope. Words of reassurance by a medical doctor became hope. When patients were not abandoned by the doctors, despite everything, some of them survived.