Serena Yu argues that incorporating culturally and geographically diverse examples of medical atrocities into medical school curriculum helps train students to be ethically vigilant in ways that are respectful of forgotten histories.

__________________________________________

Medical professionals swear an oath to save lives, but throughout history some have also committed the most horrendous crimes against humanity. It is imperative to turn these historical atrocities into moral lessons, especially for medical professionals in training, in order to build their ethical vigilance. The recently published Lancet report on medicine, Nazism, and the Holocaust brought to light the crimes committed by healthcare professionals during the Nazi-era, and advocated for the integration of this part of history into medical education. While Nazism is a well-known instance of medical involvement in transgressions against vulnerable groups, equally significant war crimes committed by the Unit 731 of the Japanese Imperial Army in the Pacific War, receive significantly less attention and coverage, despite being no less inhumane than those witnessed on the European continent.

Photo Credit: Wikimedia Commons. Image Description: A building situated at the location of the former Harbin bioweapon facility of Unit 731 in China.

Unit 731, a covert biological warfare research team, conducted heinous human experiments in Northern China between 1936 and 1945. Vivisection, intentional infection, and live weaponry testing were inflicted upon thousands of prisoners of war and villagers. Despite the undeniable violation of medical ethics, this chapter of history has been omitted from medical education in most parts of the world. Indeed, to fully grasp the breadth of ethical transgressions in medical history, medical education has to address not only the history of the Holocaust but also a wider array of major incidents such as those perpetrated by Unit 731.

The almost monistic focus of medical ethics education on the Holocaust raises concerns about selective memory – the unconscious tendency to focus on specific narratives while neglecting others. A reform of the medical history curriculum is timely with the contemporary world’s turbulent landscape marked by war, persecution, and various human rights crises. However, an incomplete incorporation of historical perspectives, especially those that do not align with the Eurocentric narrative, may lead to the underrepresentation of marginalized groups, aggravating historical silences that fuel injustices against victimized groups.

It is, therefore, imperative to acknowledge Unit 731 in the moral education roadmap of medicine worldwide, alongside the discussion of Nazism and the Holocaust. The inclusion of diverse teaching examples serves as a safeguard against ethical exceptionalism. Focusing solely on one historical event risks perpetuating the myth that Nazi crimes were singular isolated events, happening only in a specific context among a particular people, at a particular time period. The inclusion of Unit 731 in the educational paradigm serves as a stark reminder that immorality within medicine can transcend borders and cultural boundaries, hence reinforcing the importance of moral awareness universally.

Moreover, medical students can benefit from learning cultural sensitivity from diverse examples, a skill essential for their work in the globalized healthcare landscape. While war crimes committed by Unit 731 and the Nazis shared comparable brutality, their socio-medical contexts differed in geographical and cultural settings, leading to nuanced variations in the nature of their experiments, ideology, and power structures. Understanding how Western and Asian societies differ in remembrance practices adds complexity to the cultural cues surrounding the reflection of these histories.

Historical reflection is particularly important for medical students because it forms the scaffold of their professional identity formation. The teaching imparted during ethics education helps guide and rationalize students’ future actions as doctors. Ethics education is tremendously powerful, so much so that it can drive doctors to serve humanity, or in the worst cases, commit immense malevolence. Contrary to common misconception, medical ethics was compulsory and rigorously taught at every medical school in Nazi Germany, propagating ideologies of racial purity and eugenics. While there is scarce documentation regarding the medical ethics education curriculum within the Japanese army during WW2, it is evident that participating healthcare professionals believed fervently that their work was ethically justifiable.

Rather than dismissing the Holocaust and Unit 731’s evils as acts of insanity or blind conformity of deranged individual doctors, it is crucial to acknowledge that both instances were meticulously designed and executed with organized leadership. To prevent the weaponization of medicine in torture and genocide in the modern day, incorporating seminal wartime examples is timely and imperative, so as to instill in future doctors a moral compass based on humanity and compassion. While these examples are extreme manifestations of misconduct, they prompt medical students to critically reflect upon their moral and professional obligations, and the need to uphold these duties even in the face of prevailing immorality.

An inclusion of culturally diverse historical examples of medical ethics violations, such as Unit 731, alongside Nazism and the Holocaust, not only more comprehensively illustrates to medical students how crucial it is to build ethical reflexivity, but it also serves the profound purpose of acknowledging victims of less-documented moral transgressions. Each crime of medical brutality is ladened with historical, political, and moral complexities; each holds unique value of examination and remembrance.

__________________________________________

Serena Yu is a Master of Science student in Bioethics at Harvard Medical School, and an MBBS III student at the University of Hong Kong.