UofTMed Alum: On the Holocaust's Lasting Lessons

My family has always lived in the shadow of the Holocaust.

My paternal grandmother’s parents and most of her siblings were murdered by the Nazis in the death camps. My mother’s mother also lost both of her parents and several of her siblings in the Holocaust — including her three-year old brother, whom I’m named after.

I am forever in awe and forever grateful to them for living through hell on earth and rebuilding their lives on the other side, raising happy families and establishing supportive communities. But they and their children and grandchildren could never fully escape the traumatic legacy of the Holocaust. 

When I was 16, I travelled to Poland to witness the death camps for myself. Confronted by horror after horror, I could hear my peers all around me repeating the same phrase: “How inhuman!”

But the Holocaust wasn’t inhuman. It wasn’t a natural disaster. This, the largest mass killing in history per the UN Convention on Genocide, was the purposeful, planned, carefully executed work of people. Among the most instrumental in justifying, planning, and carrying out these murders were well-meaning doctors.

As a Jewish person and grandchild of survivors, the Holocaust places me in the role of victim, reminding me that I am always vulnerable to the pernicious destruction of Anti-Semitism; but as a doctor, I must grapple with my own profession’s complicity and participation in this horrific atrocity. Instead of dismissing them as simply “bad doctors” and “evil people”, I believe that by confronting physician atrocities head-on, by trying to understand how those committed to helping people could justify hurting people so badly, by acknowledging the shameful parts of our profession’s history, we can learn lessons that help us reflect on the ways we might be inadvertently dehumanizing others.

More than 11 million people were systematically murdered during the Holocaust: six million Jews, 250,000 people with disabilities, 200,000 Roma, thousands of Jehovah’s Witnesses, gay men, Black people, and political opponents, as well as millions more Eastern European civilian non-combatants. And at every step along the way, doctors were there, helping to make it possible. 

In 2019, Dr. Richard Horton published an article in The Lancet entitled “Medicine and the Holocaust — It’s Time to Teach” in which he extolled medical schools to integrate Holocaust education into their curricula.

“Teaching medical students about the Holocaust would instil lessons about the equal worth of human beings, the limits of human experimentation, the importance of ethical regulation of research and practice, and the balance between notions of public health and the duty of health professionals to the welfare of individuals,” Horton wrote.

It was a call to action that U of T’s Vice Dean of Medical Education Patricia Houston (MD ’78, PGME ’83, M.Ed. ’00) took up passionately, tapping Ethics and Professionalism Curriculum Lead Dr. Erika Abner (MEd ’98, PhD ‘06) to pursue the development of a learning module in the MD program. Dr. Abner then recruited me, along with Dr. Ayelet Kuper (MD ’01, PGME ‘06, PGME ‘07, MEd ’07), Shayna Kulman-Lipsey, and two student representatives, Jordynn Klein and Jane Zhu, to help guide the creation of a new lecture focused on Holocaust Education.

And so, a few weeks ago, I found myself preparing to speak to the class of second-year MD students on  Physicians, Human Rights, and Civil Liberties: Lessons from the Holocaust.

The lessons from the Holocaust are not broadly taught in medical schools, despite being eminently relevant to 21^st century medicine. In fact, many of the central ideas that make up modern medical ethics, social justice and the psychology of trauma emerged from the literature and the legacy of the Holocaust.

More than anything, I wanted the students participating in the lecture to recognize that the horrors of the Holocaust are not ancient history, and they aren’t just a sad story. They are exceptionally relevant and meaningful to our conduct as human beings and as physicians today.

In preparing for the talk, I learned that more than half of all German physicians joined the Nazi party early and voluntarily. They supported and led mass sterilizations of hundreds of thousands of people with hereditary diseases. Later, they systematically euthanized children with physical disabilities and people living with mental illness.

Doctors were also key figures in the Holocaust’s death camps — selecting which prisoners would be sent to be murdered, overseeing the gas chambers, and performing cruel medical experiments on non-consenting subjects.

Shockingly, these doctors often saw no contradiction between their actions and their Hippocratic Oaths. They justified them through a twisted interpretation of “the common good.” Jews and other “undesirables” had been so villainized and dehumanized in society, that in the minds of these doctors, their murderous removal from society was akin to the removal of a gangrenous appendix from the body. This teaches us that it isn’t enough to follow our own definition of “do no harm”— we have to constantly reflect on our beliefs and actions, continually questioning our assumptions, biases, power, and privilege.

What does it mean to apply the lessons of the Holocaust to the practice of medicine? It’s more than simply promising not to commit genocidal acts. Dehumanizing discourse is a significant problem in Canadian hospitals, as certain groups of people are cast as less valuable than others or at fault for their misfortune, including the homeless, Black and Indigenous individuals, those with addictions, and those who don’t speak English.

We must cultivate our moral courage and denounce dehumanizing discourse on a large scale and in our daily practice. We must use our privilege as physicians to stand up against unethical behaviour, discrimination, and hate. We must create cultures where each of us can speak out without fear of reprisal when confronted with ethically challenging situations.

Two weeks after I delivered the Holocaust education lecture, our daughter was born. We named her after my grandmother, who survived the Holocaust because she was strong, but who thrived afterwards because despite the incredible hardships she faced in her life, she maintained a profound kindness and generosity towards everyone, and always sought to understand and care for others. Despite the challenging times that face us, I know that by remembering the lessons of the past, we can forge a brighter future.

Dr. Ariel Lefkowitz (PGME ’18, M.Ed ’20),  is an internal medicine specialist practicing as a clinical associate at Sunnybrook Hospital and Mount Sinai Hospital, as well as a lecturer in the Temerty Faculty of Medicine’s Department of Medicine.