The Holocaust in Bioethical Discourse

In bioethical contexts the Holocaust often is invoked as a form of moral approbation. The development of the Nuremberg Code in the wake of the Holocaust was the clear precursor to the emergence of modern protection measures for human subjects and therefore often is referenced legitimately (Caplan). However, the Holocaust-Nazi analogy also is invoked regularly to condemn a wide range of practices (e.g., abortion, physician-assisted suicide), healthcare strategies (e.g., managed care, age rationing), and even people (e.g., by opponents of the work of philosopher Peter Singer). Sometimes the analogies are so overblown as to be easily dismissed, for example, when the breast implant controversy was referred to at an Institute of Medicine meeting as the "silicone holocaust" (Ault). However, it is instructive to look at a number of cases in which the use of Holocaust metaphor or imagery is employed to make a bioethical argument in a professional or public forum.

ANIMAL RIGHTS. Animal rights activists have called fur farms Buchenwalds for animals and have likened animal experimentation to the human medical experiments of the

Nazi doctor Josef Mengele. A best-selling book in the animal rights movement called Eternal Treblinka (Patterson) argues that there are many parallels between animal exploitation and the Nazi exploitation of people and points out that the slaughterhouse was the model for the death camps. In 2003 People for the Ethical Treatment of Animals (PETA) mounted a graphic campaign and exhibit called Holocaust on Your Plate, which placed 60-square-foot panels displaying gruesome scenes from Nazi death camps side by side with disturbing photographs from factory farms and slaughterhouses. One exhibit shows a starving man in a concentration camp next to a starving cow. The campaign, which highlighted medical research using animals along with other forms of animal exploitation, used the slogan "To animals, all people are Nazis" (Specter). Jewish leaders, as well as many others, objected strongly to the exhibition.

AIDS. AIDS activists often use the slogan "silence equals death" to liken the purported indifference among bystanders in the face of the epidemic to the inaction of those who let the Holocaust occur. It also has become common for activists to refer to AIDS as the "Gay Holocaust" (Bamforth). At the 2000 AIDS summit in South Africa delegates accused drug companies of a "holocaust against the poor" for refusing to provide Africans with inexpensive AIDS drugs (Smith). Used in tandem with the slogan about silence, that phrase is an implicit rebuke of the claimed unwillingness of the drug companies and others to dedicate the resources and attention to its eradication that the activists believe AIDS deserves.

ABORTION AND EMBRYONIC STEM CELLS. In the abortion debate and more recently in the human embryonic stem cell (hES) debate both sides have made use of Holocaust metaphors to defend their positions. The pro-life and anti-hES movements commonly refer to the destruction of embryos as "the American Holocaust" and use symbols and images from the Holocaust as a primary metaphor in their literature (Neustadter). When he was surgeon general of the United States C. Everett Koop warned of a progression "from liberalized abortion ... to active euthanasia ... to the very beginnings of the political climate that led to Auschwitz, Dachau, and Belsen" (quoted in Novick, p. 241). At a Senate Labor and Health and Human Services Appropriations Subcommittee meeting in April 2003 Senator Sam Brownback of Kansas likened embryo research to Nazi research on Holocaust victims.

Conversely, the pro-choice side often argues that state control of women's bodies is the first step toward state ownership of people and ultimately toward genocide. The Holocaust thus is also used to argue against state involvement in reproductive freedom. Pro-choice advocates point out that abortion was illegal in Nazi Germany and that the state prominently expressed an interest in controlling women's reproduction through antimiscegenation and compulsory sterilization laws.

END-OF-LIFE ISSUES. Public discussions about end-of-life options, from disconnecting life supports to physician-assisted suicide, inevitably raise comparisons to the euthanasia campaign in World War II, especially in Germany (Kottow, Spannaus et al.). In a Hastings Center Report commentary, the Village Voice columnist Nat Hentoff compared Dan Callahan's argument in Setting Limits (in which Callahan argued that some categories of people, notably the elderly, should not be entitled to the same access to healthcare as others) to the Nazi policy of lebensunwertes leben, "life unworthy of life." Hentoff also stated that the Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying would have been welcomed by defense attorneys for Nazi doctors. Although the respondents, including Callahan, addressed some of Hentoffs arguments against Callahan's points, the responses focused predominantly on the appropriateness of the Nazi analogy. Ironically, the epithet also was hurled from the other side of the issue as Jack Kevorkian assailed doctors who were not willing to help patients die as Nazis (New York Times).

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