In the curriculum designed to help its students become the best that medicine has to offer, New York Medical College (NYMC) in Valhalla includes studying medical ethics, the history of medicine and exploring medicine at its worst as practiced in the past by its most evil participants.
“You have an expectation when you go to the doctor that you have a doctor-patient relationship, that you tell the doctor something and ask for advice and they give you advice that is in your best interest,” Dr. Edward C. Halperin, chancellor and CEO of NYMC told the Business Journal.
“We”™ve learned in history that sometimes there”™s somebody else in the room and you as the patient may not know that the other person”™s in the room. Maybe it”™s the doctor”™s desire to make more money; maybe it”™s the doctor”™s employer saying ”˜order more tests”™; maybe it”™s the government saying do something which is in the government”™s best interest and not in the patient”™s best interest.”
Halperin explained that in medical ethics the phenomenon is called “the third person in the room.” He said that the Holocaust perpetrated by Nazi Germany provided prime examples of medical professionals being ruled by something other than ethics.
“In the Holocaust, doctors promoted people being sterilized against their will. They executed by starvation children with congenital deformities. They executed in gas chambers psychiatric patients. They used that technology for the mass murder of people in concentration camps where doctors were willing executioners and they conducted unconsented medical experimentation on people,” Halperin said.
“That”™s all because they were serving the best interests of the state as the state perceived it, not of their patients. That is the logical consequence of the third person in the room gone off the rails. That”™s why medical students need to learn about the Holocaust, understand the consequences at its worst of not representing your patients”™ best interests but representing the perceived best interests of a third party in the room.”
Halperin said that The Nuremberg Code, created after World War II for the trial of Nazi doctors who committed war crimes, established 10 principles regarding medical experimentation on which modern medical ethics are built. These included: voluntary consent being essential; mental suffering and injury needing to be avoided; the results needing to be for the greater good of society; and the risks of a procedure never exceeding the benefits.
“The reason you need to see the worst is to understand from whence came the principles of medical ethics, which are now considered standard,” Halperin said. “In medical ethics sometimes you have to show people the clearest example of evil and then get them to work backward from that to understand from whence comes standards for behavior.”
Halperin said that about two-thirds of the medical schools in the U.S. teach medical history but with almost all of them it”™s an elective course. He said that NYMC is one of the few schools at which it”™s a requirement. All first-year students take the course.
In addition to examining what physicians did in Nazi Germany, the course delves into their role in the North American slave trade as well as medicine”™s role in anti-Semitism in Russia, Canada and elsewhere.
Halperin said that as part of the history of medicine course, students attend lectures, read about the topic and are given the option of writing a term paper such as a biographical study of someone in the history of medicine or interviewing a Holocaust survivor in Westchester and doing a term paper on the interview.
Halperin said that during the pandemic, the interviews had been taking place by Zoom. He said that students also visit the website of the American Holocaust Museum where there is material on medicine during the Holocaust.
Halperin said that he developed the Holocaust elements of the medical ethics effort against the background of his wife and an associate operating a speakers bureau that arranged appearances by Holocaust survivors and veterans at schools.
“I saw the impact on children and so when I started to think about how to teach medical students these values I had an example of what worked. There is nothing to substitute for firsthand testimony and I also realized time is not on my side,” Halperin said. “Survivors and veterans are dying and so if I was ever going to do it I needed to get about my business and do it.”
Halperin said that he contacted Millie Jasper, executive director of the Holocaust and Human Rights Education Center in White Plains and asked whether she had survivors who were willing to talk to medical students, which she did. Halperin said video recordings of Holocaust survivors that have been created can provide source material for students to use in the future.
A first-year medical student at NYMC, Margot Lurie, told the Business Journal that her Holocaust survivor interview lasted more than two hours. “We talked about everything from childhood, what it was like to grow up during the war, what it was like before and after the war as well.”
Lurie related that the Holocaust was not entirely new to her because when she was 10 years old her parents took her to Yad Vashem, The World Holocaust Remembrance Center, in Jerusalem.
“We were in an exhibit looking at documents and photographs from medical experimentations and that”™s something I”™ll never forget,” Lurie recalled. She said that the course at NYMC allowed her to understand the true extent of what had happened.
Lurie said that learning about medical history and ethics will help her better serve her future patients and make sure that they fully understand what is going on.
“The idea of informed consent and talking with them in a way that makes them feel most comfortable are some of the things that I”™ll take with me,” Lurie said. “My goals are to provide the best care that I can for my patients and for their families in a way that respects my patients and where they come from and what they believe in, making sure it”™s patient-centered care. Medical ethics definitely needs to be in the thoughts and thought processes of providers every day.”
“In the years that I have taught this course when the students fill out their end-of-the-year course evaluation it”™s very common that they”™ll use the expression ”˜transformative experience”™ from interviewing the survivor,” Halperin said.
“I also notice that it is extremely common that the students who choose to do this interview generally are not students who have any family experience with the Holocaust. They are not the grandchildren of survivors. It is very common that the students who elect to do these interviews are exploring territory which was otherwise theoretical for them.”
Halperin said that the motto of the Touro College and University System of which NYMC is a part of is that wisdom is at the intersection of knowledge and values.
“You can teach people an awful lot about biochemistry, pharmacology and physiology. That”™s knowledge. But you have to make sure that they have the right values in order to be a wise physician,” Halperin said
