Jake Keller
December 10th, 2015
Final Paper
Healing by Killing
I stumbled into the Healing by Killing elective. In all honesty, I originally chose
the elective because it worked into my schedule and I wanted the credit points. To be
fair, I am an MS1 and we tend to make decisions this way with our immature brains. On
the other hand, it did not take long for me to be drawn in to the lectures and material of
the course. My shallow decision seemed to be the right one after all. I found myself
excited to come to lecture, reading material outside of the course, and coming home to
discuss that day’s topic with my wife. My wife is a social worker, so she was able to
give me an interesting and different perspective on some of the ideas I struggled with.
One lecture in particular stuck with me for weeks. I unfortunately do not
remember the lecturer’s name, but I remember that the topic was on euthanasia in Nazi
Germany. He (or she) described the progressive institutionalization of euthanizing
individuals seen as unfit. The lecturer informed the class about the asylums where
children were taken from their parents and euthanized, while the parents were told that
their children were being cared for by the state. It was clearly emphasized that doctors
were leading this eugenics movement, and medical professionals were helping
determine if individuals were fit to remain alive. I was taken aback by the callousness
and the evil inherent in these men’s actions, but I still felt removed from the euthanasia
and eugenics issues as a whole. These doctors were Nazis! Of course they committed
atrocities, but they were not like regular people of today.
The lecturer finished the historical portion of his talk and began bringing up
examples of euthanasia today. He discussed the organization that offers drug addicts
and alcoholics money to become sterilized. He continued on to the sterilization of
prisoners in the United States as recent as 2010. I cannot remember the other modern
examples, but I do remember the feeling of horror and disgust that this had been
occurring in my backyard.
The lecture ended a few minutes early, and there was silence in the auditorium.
This was not unusual following a lecture in this course, and there was usually 2 minutes
of silence before anyone thawed enough to ask a question. On this occasion, Dr.
Rubenfeld took the stage. He presented a hypothetical situation where I was a medical
student delivering a child who was born with severe birth defects. He made sure to
preface that my attending or resident was not available as a crutch, and I was going to
have to speak to the parents regarding their child. Instead of asking the correct
approach to this situation, Dr. Rubenfeld asked how I would feel when I first saw the
severely deformed infant. This caught me off guard since I was used to answering with
facts and protocol in my courses, and it became apparent that many of my classmates
were in the same boat.
The initial answers to Dr. Rubenfeld’s question all sounded like the right answer,
but not the real answer. Students talked about how they would feel compassion and
sympathy for the parents and would do everything they could to reassure the parents
about their child. Many people commented on how they would feel remorse for the
child. I agreed with the sentiment of what everyone was saying, but I knew that my
initial reaction upon first seeing that severely deformed infant would not be sympathy
and remorse. I had seen photos in our embryology lectures of children with severe
deformities, and I found myself turning away in disgust when many of those images
were first displayed. Finally, someone had the courage to voice this opinion of fear,
disgust, and disconnect. Dr. Rubenfeld took that response and ran with it, saying that
this emotions and reactions are completely normal for the layperson. He actually
expected most of us to have this visceral reaction to such an upsetting site. He went on
to say that the first answers, the feelings of compassion, sympathy, and remorse, were
learned over years of practicing medicine. After that, the lecture was over, and the
lecture hall had its characteristic silence.
Later that evening, I talked with my wife about the question that had been posed
and my initial response. I still felt guilty, but I did not fully understand why. During our
dinner discussion, we came to the conclusion that I was unconsciously drawing
similarities between my response and those of the doctors who were proponents of
euthanasia in Nazi Germany. I distinctly remember her asking me if I would terminate
the severely deformed child if given the choice. My honest response was that I did not
know.
This internal conflict and guilt stayed under the surface for the next week or so,
but it was brought to the surface in another elective I am taking this term, Compassion
and the Art of Medicine. On a particular Friday, the Compassions lecture was covering
prenatal testing in potential Down Syndrome pregnancies. I had always assumed that
Jaimie (my wife) and I would have prenatal testing done when we decided to have
children, and I also assumed that we would terminate any embryos with severe genetic
or birth defects. It seemed that much of the US population was ideologically similar with
me, with one review from Prenatal Diagnosis showing a 92% termination rate following
prenatal diagnosis of Down Syndrome.
The lecturer directly challenged this idea by presenting a survey study published
in The American Journal of Medical Genetics. The study had directly surveyed people
with Down Syndrome and their families and was looking at their perceptions of the
syndrome. Here are some of the statistics:

99% of people with Down syndrome are happy with their lives.

97% of people with Down syndrome like who they are.

99% of parents said they love their child with Down syndrome.

5% of parents felt embarrassed by their child.

97% of brothers/sisters, ages 9-11, said they love their sibling.

Source: Brian G. Skotko, Susan P. Levine, Richard Goldstein, “Self Perceptions
from People with Down Syndrome.” American Journal of Medical Genetics Part
A 155 (2011) 2360-2369
He went on to discuss how many people in the Down Syndrome community consider
the high termination rate a genocide of their people. I could not help but see the ideals
of the Nazi doctors of the past inherent in the prenatal selection process in the present.
This was just one instance of how the Healing by Killing course has challenged
me on many levels. Today, I am still struggling with the idea that I have the potential to
commit atrocities as a medical professional. Fortunately, I have had the opportunity to
learn about those who made terrible mistakes before me. The Healing by Killing course
has led me to much introspection, and it has led to some quite bizarre dinner table
discussions. I will gladly recommend this course to any medical student coming in, and
I hope to further challenge myself in a similar course in the future.