Comment
Why health-care learners and professionals should want to
learn about medicine, Nazism, and the Holocaust
Published Online The report by the Lancet Commission on Medicine,
November 8, 2023
https://doi.org/10.1016/
Nazism, and the Holocaust1 provides a comprehensive
S0140-6736(23)02317-6 and incisive review of the most relevant medical acts,
See The Lancet policies, and beliefs, before, during, and after the Nazi
Commissions page 1867
regime and the Holocaust. Valuable lessons are also
drawn from this history, with the Commission setting
out the implications for present health-care practices.
Additionally, a new pedagogical approach is described
for bioethics and professional identity formation
education as measures to accomplish global goals of
improving health-care practice.1
The Student Advisory Council to this Commission
was created to enrich its generational, interdisciplinary,
and global perspectives. As members of the Student
Advisory Council, we support the call of the Commission
to teach this history and its implications in all health
professions education programmes. We also appeal to
fellow learners to recognise the importance of learning
from this history as part of our individual history-
informed professional identity formation.1–3 Learners
must take agency and insist we are educated in this
Panel: Ten actions for learners to promote education on the history of medicine, Nazism, and the Holocaust
1 Increase your knowledge by participating in relevant
conferences, events, or activities, especially if educational
resources are absent in your institution.
2 Request your institutional library to purchase books and
online resources on this history.
3 Prepare a short lecture as part of a journal club session in the
department where you are doing your clinical rotation.
4 Use biographies of health-care personnel related to this
history and discuss their beliefs, actions, choices, and
dilemmas. You can choose to discuss various perspectives,
such as perpetrators, victims, and Righteous Among the
Nations. This can be done in several ways, including
professional conferences and seminars, courses and
workshops, journal clubs, peer groups, written reflections,
academic mentorship meetings, ethics courses, and research
groups, online or in person. Exemplary biographies can be
found in the Commission’s report.1
5 Conduct a survey to determine the level of interest,
knowledge, and perspectives your peers have towards
learning of this history.
6 Create a poster or a small exhibition about a specific topic
from this history and ask your library or faculty to present it
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topic to help develop the moral tools we acquire during
our studies.
As an international group of learners from ten countries
and four continents, we are aware of the challenges
of assimilating and responding to recommendations
of this Commission in different regions. Although we
acknowledge that the Student Advisory Council lacks
representatives from some parts of the world, and are
mindful of these limitations, we are also aware of the
opportunities this discussion holds and the global need
for education on history-informed professional identity
formation. Integrating this history in medical education
can be a way of framing ethical and professional identity
education through the recounting and analysis of extreme
historical moral transgressions. Parallels can be drawn
to local histories and current concerns, so that moral
dangers can be recognised in the present. Examples of
such parallels can be found in challenges such as resource
allocation; competing loyalties; the capacity to cause harm;
paternalism; antisemitism, racism, LGBTQX+ phobia,
and other discriminatory practices; triage; beginning-of-
in an appropriate place. For example, create a poster
explaining the importance of using proper medical terms.
Give examples of Nazi eponyms that are still being used,
such as “Clara cells”. You can also leave a blank space so
more learners can add examples, or for them to reflect on
whether a change of terms is required.
7 Reach out to course directors and professors and advocate
to incorporate lectures and other educational activities
about topics in medicine, Nazism, and the Holocaust related
to their course. For example, a lecture about Pernkopf’s
anatomy atlas in an anatomy course, or a lecture about
eugenics in a genetics course.
8 Arrange a seminar, webinar, or workshop on ethics and
medicine, Nazism, and the Holocaust, inviting local experts if
possible, or foreign experts if local ones are unavailable.
9 Organise a meeting with survivors, or, if not possible, with
their descendants, providing an experiential learning
opportunity.
10 Organise a group viewing of online lectures, seminars,
webinars, or documentaries about this history and have a
follow-up group discussion. Relevant and vetted materials
can be found on the Commission’s website.
www.thelancet.com Vol 402 November 18, 2023

life and end-of-life care; showing compassion despite
burnout; advocacy; and dedication. These topics are
relevant to health-care practice irrespective of location,
and despite variations in discourse. Reflecting on choices
made in extreme situations can inform us about our own
values, strengths, and principles, while also exposing our
own biases and challenges.
Traditional medical education often falls short of
preparing learners for the ethical challenges inherent
in daily and future practice, as was evident during
the COVID-19 pandemic when there were many
ethical struggles and moral injuries for health-care
professionals.4,5 There are various contributing factors
to the shortcomings of bioethics education, including
an already packed curriculum, difficulties in delivering
bioethics education due to insufficient interest, and
challenges of preparing learners for every moral decision-
making process.6,7 Education about medicine, Nazism,
and the Holocaust uniquely supports the development
of learners’ moral compass. The extreme examples from
this history compel the learner to focus and reflect on
the decision-making processes, the conflict of values,
and the context of the dilemma. Such education
challenges learners’ misguided belief that they would
never do harm—an attitude that can prevent learners
from identifying with the dilemmas presented in ethics
studies. This history exposes why it is crucial to constantly
reflect on ethical perceptions, while also using critical
thinking, especially in times of media disinformation.
Every conceptualisation of ethics should be based on the
core agreement that all human beings are born equal,
are deserving of dignity, autonomy, and equity, and are
entitled to be treated with empathy and respect.8
The moral lessons of medicine, Nazism, and the
Holocaust were called upon on Oct 7, 2023. Hamas, an
internationally recognised terrorist organisation, attacked
Israel, murdered over 1400 people, and kidnapped
more than 200 civilians, including children, women,
and older people;9 this is the highest single-day loss of
Jewish life since the Holocaust.10 Some reactions to this
massacre, including in health-care facilities, academia,
and the media, show that antisemitism is still prevalent
in certain settings and poses threats to Jewish people
everywhere. Humanitarian acts are vital to uphold the
rights of all civilians and should include the immediate,
safe return of all Israeli hostages held in Gaza as it is a
humanitarian act protecting Jewish people’s right for life.
www.thelancet.com Vol 402 November 18, 2023
Comment
Israel has the right to protect its citizens against terror,
but with tight adherence to international laws and with
respect to the lives of innocent civilians in Gaza. All share
the responsibility to protect innocent lives, Israeli and
Palestinian, at all costs.
In addition to our duty to stand up against wrongful
deeds, we believe learners can also act in the educational
arena and propose ten ways for them to advance the
education of medicine, Nazism, and the Holocaust
(panel). Most of the educational interventions proposed
in the Commission’s report are aimed at educators.
Creating a course or a curriculum is daunting, might
not be feasible for some learners, and can be difficult
to accomplish without a supporting infrastructure
and experience with teaching this or related topics.
Therefore, based on our experience, we recommend that
learners start with small educational projects (panel)
and expand their activities later. Local perspectives are
important and need to be part of any plan. Whenever
possible, such educational activities should be done in
collaboration with peers and academic officials sharing
similar goals and values, since this is likely to improve the
chances of success. The Commission’s report describes
the most relevant history, its implications, and how
this knowledge can be used to direct history-informed
professional identity formation. Yet this Commission
is only the first step to acquiring knowledge in this
field. We encourage learners to start with it, and by
implementing small educational tasks gain experience
and expertise to advance medical education in this area.
Learning about medicine, Nazism, and the Holocaust
is crucial for all health-care learners to help shape moral
beliefs and behaviours and develop professional identity
informed by history. Understanding of this history
facilitates a cascade of impacts, including remembering
and respecting victims and vulnerable populations,
increasing awareness of our ability of doing harm, facility
in ethical reflection, and prevention of future atrocities
through human rights promotion and acknowledgment
of the ethical dimensions of practising health care.
The Student Advisory Council was created by the Lancet Commission on Medicine,
Nazism, and the Holocaust, and participated in some of the Commission’s
activities. SL, MAA, CBR, SGL, CJI, YJ, CJ, GL, DM, EN, MP, MS, and RV received
financial support from the Commission to attend its in-person meetings and
events. CJI, DM, and MP received financial support to attend the Commission’s in-
person meetings and events from Institut für Geschichte der Medizin Gießen,
Oakland University School of Nursing, and Österreichische HochschülerInnenschaft
Medizin Wien (ÖH Med Wien), respectively. SGL has applied for a patent for
monitoring patients with chronic obstructive pulmonary disease, is International
and National Course Coordinator on Bioethics and Human Rights, WMA
1815
 Comment
Cooperating Centres, formerly part of UNESCO Haifa, and is a student
representative of the Internal Quality Assurance cell of his university; an
International Steering Member and Student Coordinator at Department of
Education, Bioethics, WMA Cooperating Centers; the State Joint Secretary for the
Indian Medical Association, Junior Doctors Network, Maharashtra, India; the
Coordinator for Bioethics Student’s Unit for all Indian and International Medical
Associations; and a member of the Organizing Committee for ETHOS International
Conference on Bioethics and has published a book, Human Values and Professional
Ethics. YJ’s research, studies, and living costs are supported by a grant from JST
SPRING. GL received a grant from the Leventis Foundation for her PhD study and
payment for academic work as well as financial support for travelling from Cyprus
University of Technology, HTWG Konstanz, Deree-the American College of Greece,
University College of Dublin (UCD), and University of Hannover. GL was the Chair of
the External Ethics Advisory Board, ARETE EU funded project, UCD; Ethics Expert to
the Ethics Advisory Board, Impact EdTech EU project, European Schoolnet,
Brussels; and Ethics Expert, Ethics and Deontology Committee of University of
Patras, School of Medicine. GL is Ethics Advisory Board member, augMENTOR EU
funded project, Unisystems GR; Head of the Executive Committee of Cyprus
Bioethics Unit, International Chair in Bioethics; board member of the E.LE.FI
Hellenic Society of Pharmaceutical Medicine responsible for ethics and deontology
concerns ethics contributor, team member of Trustworthy AI Lab under the
supervision of Professor Roberto Zicari; ethics researcher, Hellenic Association of
Political Scientists, Greece; ethics adviser, Frankfurt Big Data Lab/AI Ethics,
Frankfurt University, Germany; Ethics Mentor, Postgraduate Bioethics Committee,
Oxford University, UK; Ethics Research Associate, Applied Philosophy Research
Laboratory, National and Kapodistrian University of Athens; and Ethics Research
Associate, Cardiovascular Epidemiology & Genetics Research Lab, CUT. CR is a
member of the Medical Society of Virginia; American Medical Association; HOPES
Clinic Board of Directors; Dr Lorna Breen Heroes Foundation Medical Student
Coalition; and RESOLVE advocacy. CR worked for Embody Inc as an intern before
joining the Student Advisory Council of this Lancet Commission. RV was a member
of UNESCO Chair in Bioethics Students’ Association International in 2020–21.
SL, CJ, and RV were employed by this Lancet Commission to perform logistic and
administrative tasks. The funders had no role in preparation of this Comment.
We thank the Co-Chairs of the Lancet Commission on Medicine, Nazism, and the
Holocaust for the opportunity to be part of the unique work process of the
Commission. Working with the Commission members was a valuable lesson and
an exceptional learning opportunity for scholarly work, collaboration,
dedication, and what it means to be completely devoted to a cause. We also
acknowledge Abigail Leibowitz who was our fellow Student Advisory Council
member who could not participate in the writing of this Comment.
*Shani Levany, Muhammad Athallah Arsyaf,
Cristina Bejarano Roma, Shubham Gupta Lalbabuprasad,
Chinyere Jennifer Igwe, Yimeng Jin, Clemens Jobst,
Georgia Livieri, Dali Majeed, Emma Nalianya,
Mercedes Prodromou, Catherine Read, Max Stone,
Rounak Verma
shanilevany@gmail.com
Statement on the Lancet Commission on Medicine, Nazism,
and the Holocaust
Published Online The report of the Lancet Commission on Medicine,
November 8, 2023
https://doi.org/10.1016/
Nazism, and the Holocaust1 was accepted for publication
S0140-6736(23)02461-3 before the massacre in the south of Israel on Oct 7, 2023,
See The Lancet when Hamas terrorists killed an estimated 1400 Israelis,
Commissions page 1867
which included Jews, Arabs, women, men, children, and
older people, and also foreign nationals. More than
200 people were taken hostage and removed to Gaza.
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Joyce and Irving Goldman Medical School, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Be’er-Sheva 8410501, Israel (SL); Faculty
of Medicine Universitas Indonesia, Jakarta, Indonesia (MAA); Faculty of
Medicine, Autonomous University of Madrid, Madrid, Spain (CBR); Dr D Y Patil
Medical College, Hospital and Research Centre, Kolhapur, India (SGL); Philipps-
University Marburg, Faculty of Medicine, Marburg, Germany (CJI); Graduate
School of Systems Life Sciences, Kyushu University, Fukuoka, Japan (YJ);
Medical University of Vienna, Vienna, Austria (CJ, MP); Cyprus University of
Technology, Cyprus International Institute for Environmental and Public
Health, Faculty of Health Sciences, Limassol, Cyprus (GL); School of Nursing,
Oakland University, Rochester, MI, USA (DM); Kenyatta University Teaching,
Referral and Research Hospital, Nairobi, Kenya (EN); Eastern Virginia Medical
School, Norfolk, VA, USA (CR); Schulich School of Medicine and Dentistry,
London, ON, Canada (MS); London School of Hygiene & Tropical Medicine,
London, UK (RV)
1 Czech H, Hildebrandt S, Reis SP, et al. The Lancet Commission on medicine,
Nazism, and the Holocaust: historical evidence, implications for today,
teaching for tomorrow. Lancet 2023; published online Nov 8. https://doi.
org/10.1016/S0140-6736(23)01845-7.
2 Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical
education to support professional identity formation. Acad Med 2014;
89: 1446–51.
3 Wald HS. Professional identity (trans)formation in medical education:
reflection, relationship, resilience. Acad Med 2015; 90: 701–06.
4 Muñoz-Quiles JM, Ruiz-Fernández MD, Hernández-Padilla JM,
Granero-Molina J, Fernández-Sola C, Ortega-Galán ÁM. Ethical conflicts
among physicians and nurses during the COVID-19 pandemic: a qualitative
study. J Eval Clin Pract 2023; 29: 117–25.
5 Robert R, Kentish-Barnes N, Boyer A, Laurent A, Azoulay E, Reignier J.
Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care 2020;
10: 84.
6 Safuan S, Ali SH, Kuan G, Long I, Nik Hassan NN. The challenges of bioethics
teaching to mixed-ability classes of health sciences students. Educ Med J
2017; 9: 41–49.
7 Giubilini A, Milnes S, Savulescu J. The medical ethics curriculum in medical
schools: present and future. J Clin Ethics 2016; 27: 129–45.
8 UN General Assembly. Universal Declaration of Human Rights. 1948.
https://www.un.org/en/about-us/universal-declaration-of-human-rights
(accessed Sept 9, 2023).
9 Saidel P, Deng C, Lieber D. Hamas took more than 200 hostages from Israel.
Here’s what to know. The Wall Street Journal. Oct 31, 2023. https://www.
wsj.com/world/middle-east/hamas-hostages-israel-gaza-41432124
(accessed Oct 31,2023).
10 The Economist. Hamas’s attack was the bloodiest in Israel’s history.
The Economist. Oct 12, 2023. https://www.economist.com/
briefing/2023/10/12/hamass-attack-was-the-bloodiest-in-israels-history
(accessed Oct 28, 2023).
We condemn these crimes against humanity in the
strongest terms, and we denounce the perpetrators’
use of their own people (including patients and staff in
health-care facilities) as human shields.
This antisemitic attack by Hamas has unleashed
immense and ongoing suffering in Israel and beyond.
It has led to a reality in Gaza in which health-care
www.thelancet.com Vol 402 November 18, 2023