Can one breach medical ethics to save lives?

By Paul Ngurari

I was watching a medical drama a while ago set in the United States involving a female Jewish gynecologist. The medic, who we shall call Sarah, was an evacuee from Hitler’s Nazi Germany in the height of the holocaust. After painstakingly settling down in the US, Sarah applied to the American medical board to be licensed to continue with her medical carrier. 

There were serious odds stack against Sarah. She needed to appear before the board for an interview. Prior to the interview, the board had invited members of the public who had anything they could say about Sarah. A dozen people, mainly drawn from her fellow Jewish evacuees, forwarded numerous memoranda regarding her.

Apparently, as detailed in the various memoranda, her practice during the Nazi war had a mixture of experiences. 

There was what looked like obvious ethical questions on her part. Firstly, in addition to her medical training, Sarah had a natural talent that she would deploy to assist mothers during delivery. It mostly came in handy in emergency situations. She would be called in, at times in the middle of the night, to assist with emergencies.

This special talent was not a recognized medical procedure. Some of her colleagues felt it was unorthodox but they would invite her nonetheless when faced with emergency situations. Many women liked her for the relief her procedure brought and this made her very popular even among German women. Elite Germans were said to consult her in secret. She would offer her services to them for a reasonable fee. 

When Jews were finally put in concentration camps, Sarah was allowed to continue her medical practice albeit in an unregulated environment. Nazi camp administrators would pick her up to assist their pregnant women in the cover of darkness. Besides she provided free medical services to her fellow Jews often going beyond her specialty. 

 The Nazi administration had put in place strict rules for women in the camps. Among the rules, they were not supposed to get pregnant. Those who broke this rule and got pregnant were often shot dead. They would be picked up in the full view of their fellow Jewish hostages and taken to an open ground and shot dead instantly. Pregnancy was an automatic death sentence for Jewish women. Many of them met their deaths in the camps as a result.

Sarah had a better idea to beat the death trap. She assisted pregnant women to abort on her own volition. She would encourage the women to abort before authorities got wind of their pregnancies. In total Sarah was accused to have helped procure 1000 abortions. The abortions were offered free of charge. The women hardly developed complications as a result of the abortions.

During the board hearings, these issues came up. She was hard pressed to provide answers. It was obvious the interviewing panel had all the ammunition to deny her a license. Sarah occasionally broke down during the interviews. But she was forthright nonetheless. She admitted to helping many women abort. This act in the US was untenable and amounted to murder. Sarah spent many agonizing nights as she relieved the harrowing experiences in the Nazi camps and how these experiences had come back to haunt her.

In one of the hearings, Sarah got defensive. It had been put to her by one of the panelists that what she did amounted to committing murder of 1000 innocent children. She retorted that in the contrary, she had saved more than a thousand lives through the abortions. According to her, she saved 1000 women who were faced with execution. The women, she said, would later give birth to many more children.  

In tears, a distraught Sarah implored the panelists to see the good side of her actions. She explained that saving lives is the cardinal principle of medicine and appreciated that fact better than anyone. But they were as hard as a stone.   

There was one woman who had gotten wind of the ugly turn of events against Sarah. She, like Sarah, had settled and gotten married in the US. Her marriage had rewarded her with three children. Sarah had helped her abort in the Nazi camp. She approached Sarah and volunteered to testify in her favour but Sarah declined the offer saying this was contrary to professional ethics. She had already defended herself enough and felt that the medical board could do as they wished. 

But the woman had other ideas. She decided not push Sarah further but worked on a plan to walk into the venue of the next hearing uninvited. While the panel sat to read their verdict the woman walked into the room to the surprise of everyone. Sarah was perplexed. She did not want to appear to be canvassing among fellow evacuees for support. The panelists looked at each other and you could tell they were perturbed by the turn of events.

The woman told them she was not invited by anyone to the hearings. She said she thought that what she had to say could help the panel make an informed decision on the matter in question. Without giving the panel time to respond she stepped forward and started narrating how Sarah convinced her to abort and eventually saved her life. She told a harrowing account how fellow Jewish women whom she knew were executed in cold blood. In her own words, Sarah not only saved her life but also gave her the opportunity of having three wonderful children.

After the woman’s submission, the panel asked to be given time to go in camera for consultations. The matter, they said, was weighty and needed wider consultations in view of the new developments. They were gone for about half an hour. When they emerged they said that after much consideration and wide consultations the board had decided to give Sarah a license to practice medicine without any conditions.

Sarah was overjoyed. She could not believe it. She shot to her feet and hugged everyone, tears of joy rolling down her cheeks. She was full of gratitude to the panel and to the woman witness. She vowed to help millions of women deliver safely and with joy.

Be the judge. Did Sarah get away with murder? Is what she did professionally acceptable? Between her actions and the professional ethics she professed, what was on the side of life? At what point do professional ethics cease to apply?