Care of the Medical Ethos: Reflections on Social Darwinism, Racial Hygiene, and the Holocaust

The core values of medicine-healing, relief of suffering, and compassion-have ancient roots and have been reiterated on countless occasions over the millennia. Most physicians have adopted these values and use them to guide clinical practice. However, these principles, which reflect the ethical priorities of medicine in most western societies, are vulnerable to distortion and subversion by various forces. The eugenics movement of the early 20th century, based on flawed and simplistic science, was one such force; it led medicine to adversely affect the lives of tens of thousands of persons in the United States, Great Britain, and elsewhere. The most egregious distortions of the medical ethos took place in Nazi Germany in the 1930s and 1940s, when state policies led German biomedicine to depart radically from the traditional values. Recent decades have seen heightened sensitivity to the idea that the medical ethos is not immutable; rather, upholding it requires concerned attention and ongoing care. Such views have been sharpened not only by reports of ethically flawed research but by striking inequalities in access to and quality of health care among socioeconomic and ethnic groups in the U.S. population. Specific efforts are needed to raise awareness of the central importance of the medical ethos as an active guide across the range of activities of biomedicine.