By Dennis Sullivan, MD, MA (Ethics) Professor Emeritus of Pharmacy Practice Cedarville University Moral complicity, sometimes called “moral taint,” is the moral guilt attached to a person by their association with a moral wrong. Complicity requires that a person have some association with the act committed, even if they do not personally perform the deed.[1] However, complicity is complex. For many of us, the perception of cooperation with evil seems to diminish with the passage of time. For example, almost all physicians still recommend the vaccine against Rubella (“German measles”), even though tissue from aborted fetuses was used to develop the vaccine back in the 1960s. Nevertheless, the passage of time does not always “morally sterilize” an act. Consider the story of Eduard Pernkopf, a distinguished professor of anatomy who published his Atlas of Topographical and Applied Human Anatomy between 1933 and 1960. His atlas was a four-volume masterpiece of 800 detailed watercolor paintings of human anatomy. The atlas saw extensive use by medical schools in both Europe and the United States until the 1990s, when (as the story goes) an alert med student used a magnifying glass to examine the signatures at the bottom of the illustrations, many of which contained a swastika! After an extensive investigation, it turns out that the bodies of over one thousand wartime prisoners that died during the Nazi era had been delivered to the German Institute of Anatomy. Dissections of these bodies were likely used as models to create the detailed illustrations of the atlas. Indeed, many of the artists were members of the Nazi Party, and Pernkopf himself was a fascist and Nazi sympathizer. The Atlas of Topographical and Applied Human Anatomyhas now disappeared from all medical libraries worldwide because of the moral taint associated with its production. Complicity with Nazi evil had made any educational use of the Pernkopf atlas morally unthinkable, and nothing could be done to change this disgraceful legacy from the past. Dr. Kalyanam Shivkumar wants to change all that. A cardiologist and specialist in electrophysiology from UCLA, Dr. “Shiv,” as his friends call him, has been deeply moved by a very poignant ethical dilemma. Many of his colleagues praised the unmatched excellence of the Pernkopf opus, claiming that no other anatomical work has ever been its equal. Yet almost all medical educators, including Dr. Shiv, have deep revulsion at even opening its pages. So Dr. Shiv asked: “Could we be better?” and “Could we not be making something that’s completely untainted?”
Those questions have led to a passionate quest that has already lasted a decade and will most likely require many years more. The project is named ‘Amara Yad,’ from Sanskrit and Hebrew meaning “immortal hand.” Beginning with the heart, anatomists and illustrators are using cadaver models from generous recent donors, combined with modern sophisticated imaging, to create a new, highly detailed roadmap of the human body. The goal is to outshine Pernkopf entirely and to erase this historical taint from the study of anatomy.
At its core, medicine is a moral enterprise, in the words of Dr. Edmund Pellegrino. Among its many virtues is moral fortitude, the will to act courageously when facing adversity.[2] Correcting a moral wrong, as Dr. Shiv is attempting to do, requires such fortitude. In an LA Times interview, Dr. Shiv quotes a Buddhist source: “One who does good first does something hard to do … Truly, it is easy to do evil.”
What lessons might we learn from Dr. Shiv’s example? At the very least, he is an exemplar, a role model of moral fortitude in medicine. But we might wish to reflect more deeply as we contemplate the uncomfortable challenges of day-to-day healthcare delivery, full of systemic injustices large and small. At what point do we refuse to sigh and move on, and instead stop, dig in, and take a courageous stand? Will we act courageously to confront evil, or are we morally complicit in the face of it? All moral agents in healthcare must answer these profound questions for themselves.
[1]Portions of this essay first appeared in: Sullivan, D. M. and A. Costerisan (2008). “Complicity and Stem Cell Research: Countering the Utilitarian Argument.” Ethics & Medicine 24(3): 151-158.
[2] Pellegrino, Edmund D., and David C. Thomasma. Virtues in Medical Practice. Cary: Oxford University Press, USA, 1993, pp. 109–110.
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