This book presents an attempt to show that there indeed was something called medical ethics during the Nazi regime, something viewed with much skepticism by many of today's scholars. Florian Bruns makes his case by examining the works and deeds of some prominent medical leaders of the regime, ultimately focusing on three stalwart Nazi doctors: Bernward Gottlieb, Rudolf Ramm, and Joachim Mrugowsky. He places the lives of these men in the context of a medical field they felt determined to change along the lines of their Nazi creed.

Burns shows how much of medical practice during the century preceding the Nazi regime showed the imprint of Social Darwinism, stressing collective fitness by promoting the well-being of the well-to-do at the expense of those deemed to be “less fit.” To that end, Dalton's eugenics movement in Britain stressed the importance of increasing the birthrate of the former while minimizing that of the latter. Both found great resonance in Germany as well, evidenced, for example, by the success of such ardent promoters of collective fitness as Wilhelm Schallmeyer and Alfred Ploetz, who popularized their ideas in well-read publications.

World War I and the associated horrors of trench warfare, manifesting the pitfalls of trying to achieve collective fitness, did not lead to the kind of vigorous criticism of Social Darwinism and eugenics that might be expected in retrospect, definitely not in medicine. Quite the contrary, as Burns explains. Particularly members of the medical profession argued that the war favored the survival of the less fit and should be countervailed with appropriate health measures in the future. There were some critical voices, such as that of Julius Moses, appealing again for a more individualistically minded rather than collectively oriented medicine. They called, for example, for the protection of vulnerable patients from arbitrary treatment, often being unwitting subjects of dangerous experiments. As a result, the highest health council of the new Weimar government (Reichsgesundheitsrat) passed revolutionary guidelines requiring human subjects to give informed consent for experimental treatment in 1931. Those guidelines reappeared again in the language of the Nuremberg Code at the Doctors' Trial following World War II.

Bruns shows that with Hitler's assumption of power, an increasing number of physicians with Nazi affiliation forcefully advanced a new set of medical ethics into their professional associations, work places, and schools. Many viewed the regime as a new era of personal opportunities and joined the growing ranks of those eager to promote not only the Nazi cause but also their personal careers. Bernward Gottlieb made his career by joining the SS as a young physician and becoming a leading expert on German medical history. He tried to reveal its supposed race-based (völkisch) character, the presumed source of strength in overcoming adversity, including “Jewish infiltration.” And, like most other Nazi medical thinkers, he traced the beginnings of this history to Hippocrates. According to Gottlieb's reading, Hippocrates, too, had placed the health of the collective over that of the “destructive” individual. In 1941 Gottlieb became director of the newly founded Institut für Geschichte der Heilkunde beim Reichsarzt-SS in Berlin and, according to Bruns, the most important exponent of Nazi-based research on medical history in the Third Reich. Rudolf Ramm's career was similar, except for an early stint as Nazi deputy at the Reichstag. A prolific writer of medical articles, lecturer at the Berlin University, and author of the first authoritative textbook on forensic medicine in Germany, he played perhaps the most crucial role in spreading Nazi ideology in the medical profession by creating ethics courses that became part of the core curriculum for medical students at many universities. Joachim Mrugowsky, a professor (Dozent) at the Friedrich-Wilhelm-Universität in Berlin, advanced to become the chief hygienist of the Reich Physician SS. He was preoccupied with the havoc epidemics among German populations and military forces. Trying to find remedies, he became involved in performing fatal experiments on primarily Polish and Russian concentration camp inmates. He was one of the twenty-three defendants at the Nuremberg Medical Trial and received the death sentence.

All three men tried to base medical ethics on Nazi concepts. Primarily this meant, as Bruns points out throughout the book, that the general health of society (i.e., racial German society), preceded that of any individual member. The latter had to be sacrificed if it would endanger the health or survival of the former. For this reason, physicians were trained to be “medical soldiers” as well as healers. Bruns leaves no doubt that this simple equation hides enormous conceptual complexities, which he lays out, sometimes unwittingly, within the limits of a work kept too short for unraveling them. Nazi ethics, he argues, entails concepts not only of Social Darwinism and eugenics, but also Holism, Vitalism, and, which he mentions only as tangential possibilities, German Idealism and Existentialism. Many of these concepts seem to contradict each other irreconcilably (e.g., natural selection vs. holistic purpose). Also, their connection to medicine is assumed more than demonstrated and needs more clarification to be convincing. But the doors for further exploration have all been opened by this book. It is, after all, a doctoral dissertation that should not be judged by what its author did not try to do but by what he did try to do. The strength of the book lies in presenting a convincing argument that Nazi medical ethics had a coherent conceptual framework and method of application and constituted not merely the absence thereof, as is often argued. For readers who may see in this an objectionable step toward making Nazi medical ethics an acceptable, if not respectable, subject of investigation, the author leaves no doubt of his view that Nazi medical ethics ultimately was rooted in evil.