Arthur L. Caplan, "Misusing the Nazi Analogy" (2005)

Sixty years ago, Allied forces brought an end to Adolf Hitler's dream that Germany would rule Europe and dominate the world. The death of Nazi Germany gave birth to a charge that still haunts the scientific community--what might be called "the Nazi analogy." In ethical or policy disputes about science and medicine, no argument can bring debate to a more screeching halt then the invocation of the Nazi comparison.
> Whether the subject is stem cell research, end-of-life care, the conduct of clinical trials in poor nations, abortion, embryo research,<br> animal experimentation, genetic testing, or human experimentation involving vulnerable populations, references to Nazi policies or
> practices tumble forth from critics. &quot;If X is done, then we are on the road to Nazi Germany&quot; has become a commonplace claim in contemporary bioethical debates. <br> Sadly, too often those who draw an analogy between current behavior and what the Nazis did do not know what they are talking about. The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine. Because its misuse diminishes the horror done by Nazi scientists and doctors to their victims, it is ethically incumbent upon those who invoke the Nazi analogy to understand what they are claiming.

A key component of Nazi thought was to rid Germany and the lands under German control of those deemed economic drains on the state--the mentally ill, alcoholics, the "feeble-minded," and the demented elderly. They were seen as direct threats to the economic viability of the state, a fear rooted in the bitter economic experience after the First World War. The public health of the nation also had to be protected against threats to its genetic health. These were created when people of "inferior" races intermarried with those of Aryan stock. Threats to genetic health also included, by their very existence, genetic degenerates--Jews and Roma. Theories of race hygiene had gained prominence in mainstream German scientific and medical circles as early as the 1920s.

What is important to keep in mind about these underlying themes that provided the underpinning for Nazi euthanasia and eugenic practices is that they have little to do with contemporary ethical debates about science, medicine, or technology. Take, for instance, the case of Terri Schiavo, a massively brain-damaged patient who was kept alive by means of artificial feeding for more than a decade. When congressmen and religious leaders in the United States commented on her situation during the weeks leading up to her death on 31 March 2005, soon after her feeding tube was removed, they described it as analogous to what the Nazis had done to Jews in concentration camps--a complete misuse of the Nazi analogy. Whatever one thought about the ethical issues raised by the decision to allow the removal of a feeding tube from this woman, the decision had nothing to do with the belief that her continued existence posed a threat to the economic integrity of the United States or that her racial background posed a threat to America's genetic health. The fight over her fate was about who best could represent her wishes so that her self-determination could be respected--a moral principle not afforded those killed by deliberate starvation in the Nazi euthanasia programs.

Similarly, when critics charge that allowing embryonic stem cell research permits the taking of innocent life to serve the common good, and then compare it to Nazi research in concentration camps, the claims of resemblance are deeply flawed; moreover, they demean the immorality of Nazi practices. Concentration camp prisoners were used in lethal experiments because they were seen as doomed to die anyway, were seen as racial inferiors, and, given the conditions of total war that prevailed, they were considered completely expendable in the service of the national security of the Third Reich.

There are many reasons why a practice or policy in contemporary science or medicine might be judged unethical. But the cavalier use of the Nazi analogy in an attempt to bolster an argument is unethical. Sixty years after the fall of the Third Reich, we owe it to those who suffered and died at the hands of the Nazis to insist that those who invoke the Nazi analogy do so with care.

Arthur L. Caplan is chair of the Department of Medical Ethics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.