Medicine As Instrument of Power

The news cycle now revolves so rapidly that even highly hyped issues can recede from view – and from memory – in no time. If you missed the wall-to-wall coverage of the “March for Science” recently, not to worry – it will be back. The narrative is just too useful to retire: brave souls defending science from antediluvian forces – until an enlightened politician can restore it to its “rightful” place.

Near peak frenzy, the following headline appeared: “The Perils of Trumping Science in Global Health.” It could come from almost anywhere – the Washington Post or the New York Times, MSNBC, NPR – right? It came, alas, from that erstwhile bastion of science, the New England Journal of Medicine (NEJM).

The authors are Stanford MDs and their complaint is a tired, flimsy one: the lack of contraceptives and the discontinuation of U.S. funding for abortion abroad are recklessly unscientific propositions that endanger health.

Articles like these convey an interest not in objective outcomes but in advancing a politically motivated cause – often the destruction of one class of persons or another. Not a good premise for an argument, scientific or otherwise. In support of that contention, let’s turn not to the Catechism but to another article in the NEJM.

It begins bluntly by stating: “Science under dictatorship becomes subordinated to the guiding philosophy of the dictatorship.” It identifies the guiding philosophical principle, one of “rational utility,” as Hegelian in nature and laments that it has “replaced moral, ethical, and religious values.”

That’s not normally something you can get away with saying. How then do we reconcile these radically different entries – in the same medical journal?

Well, I guess I should mention the latter came from 1949. Its title was: “Medical Science Under Dictatorship.” Written by Dr. Leo Alexander, a contributor to the Nuremberg Code, it was a reflection on his investigation into the complicity of the medical profession (“community” not yet being a thing) in the horrors of WWII.

Alexander stressed the astonishing rapidity of decline in professional ethics, manifested in the wholesale extirpation of the useless, unwanted, chronically sick, and disloyal. Medical “science” at that time found diagnoses such as “inveterate German hater” to facilitate their liquidation.

The overall medical research program was fixated on “destroying and preventing life.” Indeed, Alexander refers to this kind of enterprise as the “science of annihilation.” The conclusion that it’s good to be an enemy of “science” in such a context would seem to be a moral imperative.



He even coins the term “ktenology” for this science of killing; it may not be in everyone’s dictionary, but with all the means of riding roughshod over life we employ today – and seek tomorrow – some sort of term should be in common usage. (“Culture of death” may come closest).

Abuses by the Nazi regime obviously reached massive proportions, but what became evident to investigators like Alexander was that “they had started from very small beginnings.” They began with just a subtle shift in attitude – an acceptance of the basic premise of the euthanasia movement that some lives are a meaningless drain. Better off dispatched.

Not everyone caved. (Occupied) Dutch physicians saw through innocuous-sounding appeals, resisted cajoling, and endured brutal crackdowns – but did not participate in euthanasia or sterilizations. The Third Reich is long gone today, yet the Netherlands has since become euthanasia’s ground zero, which suggests that ideas the Nazis embraced – at least their “cold-blooded” utilitarianism – have triumphed, much like Soviet-like rule lives on in the domineering absurdities of political correctness.

Alexander’s article recounts many disturbing episodes, but is nevertheless edifying due to its clear-headedness. Reading it is akin to watching an old black and white movie that has aged well. Or to anything that induces a feeling of exile. Borders may not have changed, but the landscape of ideas has – to such a seismic extent that the present rather than the past, as they say, has become a foreign country.

The very “same” NEJM caused a bit of stir last month, in giving space to MD-turned-politician Ezekiel Emanuel’s view that “professional societies should declare conscientious objection unethical.”

Emanuel is talking about objecting to various means of destroying, preventing, or mutilating human life that fall under his warped rubric of “care” – means that Alexander had pilloried when Nuremberg was a painfully fresh memory. So you read that right: Emanuel says it should be unethical to object to these things; his apologia amounts, as Wesley Smith succinctly put it, to a demand that pro-lifers get out of medicine.

Drawing parallels to Nazi atrocities can at times be overwrought. But Alexander’s insights into the attitudes that brought about disaster do seem quite applicable to the mentality of Emanuel and his ilk. They sure seem to be attempting what Himmler demanded and ultimately got: the cooperation of physicians and German medical science in patent monstrosities deemed necessary to advance a larger (and obviously unscientific, inhumane) agenda.

Emmanuel is seeking to revive the intimidating tactic Alexander decried: “any hint of faintheartedness or lack of enthusiasm for the methods of totalitarian rule is considered a threat to the entire group.” Like those preceding him in ignominy, Emmanuel intuits that the one who won’t kill is a threat to the designs – and bad consciences – of those who will.

That “scientists” such as Emanuel want a kind of “progress” that abandons the ethos of the Nuremburg Code should clue us all in. What Emmanuel and company are interested in is, to paraphrase C. S. Lewis, power exercised by some men – such as themselves – over other men, with “science” as its instrument. They are ultimately bent on the final conquest Lewis envisaged: The Abolition of Man.

That is what we should be marching against.

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.