Jewish Medical Ethics: Moral Dilemmas Faced by Jewish Doctors During the Holocaust

At a conference concerning Jewish medical responses during the Holocaust sponsored by the YIVO Institute for Jewish Research and the New School for Social Research in November, 1996, one of the speakers, Dr. Ralph E. Yodaiken, described how in September 1942 a 22 year old Jewish senior medical student, Adina Blady Szwajger, gave lethal doses of morphine to several elderly patients and about fifteen infants and children in order to spare them ignominious, certain death at the hands of the Nazis. While she could hear screaming downstairs as the German and Lithuanian guards were taking the sick from the wards to the trucks, the older children were told that the medicine would make their pain go away. They quickly fell asleep, but since Doctor Szwajger had to flee, it's uncertain whether all of the patients died as a result of the morphine.

Dr. Swajger escaped the ghetto and joined the Polish Jewish resistance. In order to prevent detection because of the noise of infant cries, she had to perform several abortions. Another time, she put to death a girl who had gone berserk and was running in the street, again, in order to save the lives of others. The doctor survived the war and for forty years continued her work as a pediatrician, but because of her previous actions always felt unworthy to be a doctor. Tortured by her secret, she delayed publishing her memoirs until forty-five years later. Dr. Swajger died of cancer in Lodz in 1993.

The Jewish tradition teaches the paramount importance of life. Both homicide and suicide are heinous crimes, but there may be extenuating circumstances. Rabbi Shimon Efrata, formerly the rabbi of Bendery (Bessarabia) was deported to Siberia during the war and after the collapse of Germany, was appointed rabbi of the surviving community of Warsaw. During his tenure there, he was asked whether a Jew hiding from the Germans in a ghetto bunker must repent for inadvertently smothering a crying infant to avoid detection? His responsum, published in 1961, concluded that halakhah does not require that the infant be killed; rather, it is optional. If one chooses to die rather than to kill the child, they shall be called holy. However, the individual who did inadvertently suffocate the child should not have a bad conscience for he acted lawfully to save Jewish lives.

No doubt Rabbi Efrati was influenced by the fact that his own brother had been hiding in a bunker during such a search when a baby burst out crying. The rabbi ordered that no one should risk harming the child and, as a result, all twenty people were discovered and murdered by the Nazis. In another modern responsum, Rabbi Ephraim Oshry permitted a man faced with torture to commit suicide, but did not allow it to be published lest the ruling would undermine the commitment to life of other Jews in the Kovno ghetto.

At the YIVO conference, Dr. Yodaiken explored whether or not there was justification for this well-meaning, but desperate homicidal act by a physician sworn to preserve life. He concluded "I believe that Swajger, looking into the well of life and death in the Warsaw ghetto, knowing what she knew, made the only possible decision on behalf of the ones she loved.....(She) gave her patients a dignified death. Hers was the ultimate act of resistance -- she denied the willing executioners the satisfaction....of slaughtering her charges at their leisure in the spirit of an animal hunt."

But was Dr. Yodaiken being too sympathetic with Dr. Swajger? Given the leisure of hindsight and safety, it is easy to cast aspersions, but it's also tempting to contrast her behavior with that of the martyred pediatrician, Janusz Korczak who declined several opportunities to escape from the Warsaw ghetto in order to accompany and comfort the two hundred orphans in his charge when they were transported in cattle trains to their deaths at Treblinka. Surely that was an unparalleled act of defiance and courage, a paradigm of "death with dignity", whatever that overused expression may mean.

In her memoirs, Dr. Swajger described how only a few days after she had seen Korczak lead his orphans to the Umschlagplatz, she attempted suicide by swallowing an overdose of sleeping pills and vodka. Unsuccessful and in a continued state of despair, she returned to work and it was only about three weeks later that she administered the morphine to the hospitalized patients.

Some of the children asked Dr. Swajger to stay with them. She did not. Faced with a similar choice, Korczak said, "One does not leave a sick child in the night, and one does not leave children in a time like this."

About two years after Dr. Swajger's action, the Germans invaded Hungary and among the thousands shipped to Auschwitz was a Jewish pathologist, Miklos Nyiszli. There, he was selected by Dr. Mengele to direct the infamous medical experiments and dissections performed on prisoners. Dr. Nyiszli survived the war and several decades later wrote his memoirs, but perhaps more illuminating than the doctor's own self-serving account, was the forward to his book by the famous Viennese psychoanalyst, Bruno Bettelheim, himself a camp survivor, and recently the subject of considerable criticism.

Bettelheim noted that Dr. Nyiszli's is the only report written by one of the many prisoners who volunteered to collaborate, in effect, to become a tool of the SS to stay alive. In order to be able to justify his choice of life through collusion, the doctor concentrated on his professional work itself and not on the purpose for which it was used; he took pride in his professional skill irrespective of its moral implications. Bettelheim suggested that this attitude which enabled Dr. Nyiszli to volunteer his help to Mengele and the SS, only led to a moral inertia and physical passivity which made the Germans' job easier.

Indeed, Bettelheim suggested that the near universal glorification of the Anne Frank story only proves how much we all wish to subscribe to a business-as-usual philosophy. All the Franks wanted to do was to carry on their lives as usual, but had they split up, taken chances, perhaps some may have escaped. They were a family who could not believe in the reality of Auschwitz. To the end, Anne Frank held to her belief that all men are basically good. But, according to Bettelheim, when the world goes to pieces and inhumanity reigns supreme, man cannot go on with business as usual. In such a circumstance one has to take a stand based on the new reality, a firm stand, and not one of retirement.

Although Bruno Bettelheim favored pro-active response, one of his moral heroes was Janusz Korczak whom he considered to be one of the thirty-six unknown righteous ones who live on earth at any one time. Like the Frank family, Korczak's approach with his orphans in the Warsaw ghetto also was to carry on business-as-usual. The children were taught Hebrew. Their schooling was continued. Even when they were preparing to march to the Umschlagplatz, their teachers were instructed to tell them that they were going to the country for a "treat." The motives for deceiving the children were benevolent and, as it turned out, their heroism helped to galvanize the remnants of the Warsaw ghetto to action. It was as if for the first time the remaining Jews recognized that they would be next. Three weeks later, their armed resistance began. Until the end, Korczak lived according to the rabbinic precept, "When everyone acts inhuman, what should a man do? He should act more human."

Still another model of medical heroism was Lucie Adelsberger. A Berlin allergist, she was offered a faculty position at Harvard in 1933, but declined to leave her paralyzed mother who was a stroke victim and unable to obtain an exit visa. She contemplated "liberating" mother by euthanasia, but was unable to carry out the act for as she explained, "I, who had spent her whole life struggling to save each and every human life, was I supposed to kill my mother, the person most dear to me in all the world? May a person who trusts in a higher power ever deliberately end a life, be it her own or that of another? I couldn't do it."

Dr. Adelsburger eventually was shipped to Auschwitz where for two barbaric years she worked as a prison doctor in Birkenau's women's hospital under the supervision of Dr. Mengele. With pathetic medical supplies and under the ubiquitous shadow of the chimneys she persevered and did whatever she could to relieve misery: "Death was as close and familiar to us as the landscape in which we were born and raised." Many years later, Dr. Adelsburger concluded her poignant memoir with these words, "The dead were strong; in their destruction they displayed a strength bordering on the colossal. Can the living afford to be any weaker?"

The closing passage of Robert Liften's classic book, The Nazi Doctors: Medical Killing and the Psychology of Genocide, cites still another Jewish doctor who survived Auschwitz: "At a certain point, he and a few other prisoner doctors were overwhelmed with moribund patients, with suffering people clamoring for relief. They did what they could, dispensed the few aspirin they had, but made a point in the process of offering a few words of reassurance and hope. He found, almost to his surprise, that his words had effect, that "in the situation it really helped.' He concluded that by maintaining one's determination to try to heal, even under the most extreme conditions, 'I was impressed with how much one could do.'"

Bettelheim's scorn for business-as-usual notwithstanding, it was out of the very banality of caring for their patients, by not abandoning them even when the results would be futile, from small acts of kindness that some heroic Jewish physicians were able to achieve a triumph of the spirit amidst a world that had gone mad. Others were not up to the task.

So how might Doctors Korczak, Adelsburger, Nyiszli and Swajger be compared on a moral score-card, albeit the circumstances they faced differed? All would agree that Janusz Korczak was extraordinary, but is it reasonable to expect others to have performed up to his exemplary standard? Dr. Adelsburger may not have faced the same excruciating choices as the others and was able to survive two years at Auschwitz with her integrity unscathed. Dr. Nyiszli was a reprehensible individual who ingratiated himself with his masters in order to save his own skin. Perhaps the most morally ambiguous of the four was Dr. Swajger. Distraught and acting under enormous stress, she did what she understood to be the right thing. She intended to spare her patients from suffering, but acted without their knowledge or consent and foreclosed any slight possibility that they might survive. Dr. Swajger is an entirely sympathetic figure, in many respects heroic, but later admitted that she had crossed a moral threshold and was burdened by a guilty conscience for most of her life.

Admittedly, it is easy to be judgmental from a safe distance, but nevertheless, considering the nuanced choices encountered by individuals such as these four Jewish physicians not only is an instructive exercise, but in some instances is inspirational.

References

• Ralph Yodaiken, MD, MPH. “The Ethics of Agonizing Decisions.” Presented at the conference: “Medical Resistance During the Holocaust”, YIVO and The New School for Social Research, November 5, 1996.
• Adina Blady Szwajger. I Remember Nothing More. The Warsaw Children's Hospital and the Jewish Resistance. (New York: Pantheon Books, 1988).
• Robert Kirschner. Rabbinic Responsa of the Holocaust Era. (New York: Schocken Books, 1985).
• Miklos Nyiszli. Auschwitz. A Doctor's Eyewitness Account. With a foreword by Bruno Bettelheim. (New York: Frederick Fell Inc., Publishers, 1960).
• Bruno Bettelheim. “Janusz Korczak: A Tale for our Time.” In Freud's Vienna and Other Essays. (New York: Vintage Books, 1991).
• Lucie Adelsberger. Auschwitz. A Doctor's Story. (Boston: Northeastern University Press, 1995).
• Robert Jay Lifton. The Nazi Doctors. Medical Killing and the Psychology of Genocide. (New York: Basic Books, Inc., Publishers, 1986).

Sources: Jewish Medical History—Chevra/SIG