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Historical lessons for an aspiring physician
Alexa Kanbergs, a member of Tigard High School's class of 2009, currently is studying at the Warren Alpert Medical School of Brown University. But some things can't be taught and fully absorbed inside of a classroom — so Kanbergs took part in a medical ethics program that brought her to some of the most harrowing sites in world history.
Kanbergs returned last week from a trip through Germany and Poland, where she visited the Holocaust Memorial in Berlin, Auschwitz-Birkenau concentration camp in Poland, and other sites related to the Holocaust, during which six million Jewish people were killed under Hitler's rule of Nazi Germany.
She was one of 15 medical students chosen to take part in the two-week program, which is facilitated by Fellowships at Auschwitz for the Study of Professional Ethics. When visiting each historical site, students would attend classes and hold discussions about medical ethics, particularly in relation to the Holocaust.
"There are so many things that happened in the Holocaust, and we (physicians) were the transgressors," said Kanbergs, who received her master's in bioethics at Albert Einstein College of Medicine in New York before attending Brown. "It was really powerful learning about how, essentially, we think we're going to be doing so much good in the world, and so quickly it turned. That was probably the biggest takeaway from that program, that it happened to people who were just regular physicians, and they did some of the most heinous acts committed in the Holocaust."
During the Holocaust, German physicians conducted medical experiments on concentration camp prisoners. Though they were done in the name of science, Kanbergs said they amounted to nothing more than torture. Physicians also evaluated incoming prisoners, deciding which ones should be killed and which ones were healthy enough to keep alive and force into labor.
These were especially horrific acts, Kanbergs said. But physicians who did not participate in Nazi activity, yet failed to speak out about it, also were in breach of medical ethics.
"I consider our profession to be more than just your duty to one patient," she said, adding that population health is just as important.
Though the Holocaust is perhaps the most striking historical example of physicians acting unethically, it is hardly the only one. Between 1932 and 1972, the Public Health Service and medical researchers at Tuskegee University in Tennessee misled hundreds of impoverished African American men who had syphilis. The men were not told they had the disease, nor were they made aware of the penicillin cure when it became available in the 1940s. This was done for the sake of medical research.
"That wasn't that long ago — the '70s was when that trial wrapped up," Kanbergs said. "And it wasn't physicians who stopped it. It was a whistle-blower who wasn't even a medical professional. That's horrific."
Kanbergs wants to work with incarcerated populations after receiving her medical degree, as she sees that as one of the major medical ethical issues of the day. She pointed out that there are some similarities between the United States' modern prison system and Holocaust concentration camps, including the forced labor element. Idaho potatoes often are farmed by prisoners, she said, and Victoria's Secret lingerie used to be made by prisoners.
"I have an issue working within a system that I think is so broken," Kanbergs said about the U.S. prison system. "But then there's also the side of me who's feeling like that's one way to make a difference, one way to have an impact on a broken system is to at least get my foot in the door so I can help individuals."
In addition to incarceration, Kanbergs said that many hot-button issues today have strong medical ethical implications, the most obvious one being the Republican Party's efforts to overturn the Affordable Care Act and replace it with a bill that would insure far fewer Americans. According to the Congressional Budget Office, 22 million people would lose insurance if the current Senate bill were to become law.
"It's a huge medical ethical issue in itself," she said. "How we allocate resources in a society where medical resources are scarce."
She said LGBTQ rights also are a major medical ethical issue, as members of the queer community often have medical needs that differ from straight, cisgender patients. Kanbergs said that LGBTQ people statistically have, "less access to health care. They're less likely to receive adequate health care and preventative screenings, and are more likely to commit suicide."
In April, the state of Arkansas attempted to execute eight death row inmates in 11 days, before its lethal drug supply expired at the end of the month. The state ended up executing just two men in that time, with other inmates taking legal action to appeal their sentences. Kanbergs has strong feelings about the death penalty, saying that it is a physician's duty to speak out against it.
"Even the idea of having a physician who writes an order for kill prescriptions, and the pharmacist who fills that… any role you play in that is an issue of justice and compromised professionalism, and doing harm," she said.
Kanbergs is not sure whether she will work directly with incarcerated patients after graduation, or work for an advocacy group on their behalf. But she said she's glad she joined the Fellowships at Auschwitz for the Study of Professional Ethics program this summer, as it helped to round-out her medical education.
"Medical school and medical training is so challenging, and I think there's a pretty big absence in ethics training in medical school, even though without ethics, we're practicing bad medicine," she said. "Knowing how to approach an ethical dilemma was something I thought was incredibly valuable.