 Welcome everyone to the Center for Bioethics Research Ethics Consortium. My name is Becca Brandel. I am the director of the master in bioethics program and an associate director of the center. And it is my great pleasure to welcome my colleagues today on the topic of medical research in Nazi Germany, anatomy as example for changes from routine to murder. Before we get started and before I make introductory remarks, we have some housekeeping items to share with you on our next slide. We encourage you to submit questions at any time using the question and answer feature on the bottom of your screen. And you can answer, enter questions in any time we will have time for questions and answers following our three presenters who I'll introduce in a moment. We'll select those questions and discuss them and we encourage you also to keep the conversation going on social media using hashtag HMS bioethics. If you have any technical issues please use the chat feature to send a message to all panelists and a staff member will assist you in accessing the content of the presentation today. If you like this enjoy this presentation and feel that you've learned. Please subscribe to our newsletter bioethics dot HMS dot Harvard dot edu slash subscribe and encourage others in your community to join us as well. So perhaps now we can go back to the first slide, and I can introduce our speakers for today. Perhaps no era in in recent history, for sure, have brought up more issues about the conduct and practice of medicine and research than medical research in Nazi Germany. And today I'm so pleased to welcome three experts to join in a conversation started by our good colleagues to be Sabine Hildebrand. So, she will begin today with her presentation, followed by two discussants, then it's 80 and dominant call who I'll introduce more extensively prior to each of their remarks. And to get us started. Let me introduce you to Sabine Hildebrand who for all of us has taught us so much about the relevance of Nazi medicine and research for bioethics and for anatomical practice today. She's an associate professor of pediatrics in the division of general pediatrics and the department of pediatrics at Boston Children's Hospital and a lecturer on global health and social medicine at Harvard Medical School. Dr. Hildebrand received her MD degree from Phillips University Marburg in Germany. She teaches anatomy and history of anatomy at HMS and Harvard College. Her research interests are the history and ethics of anatomy, and specifically the history of anatomy in National Socialist Germany. Her educational approach integrates anatomy, medical history and medical ethics. Her book, The Anatomy of Murder, ethical transgressions and anatomical science during the Third Reich from Bergen books in 2016 is the first systematic study of anatomy during national socialism. The biography of Jewish physician refugee, Kat Butler was published by Hintek and Hintrek in 2019. She is currently researching the history of the anatomical institute as a member of the Historical Commission from 1941 to 1944. She is also co-editor of Recognizing the Past, Invent the Present, Medicine Before, During and After the Holocaust, published in 2021 and serves as co-chair of the Lancet Commission on Medicine and the Holocaust, historical evidence, implications for today and teaching for tomorrow. Please join me in welcoming Dr. Hildebrand to present the first paper. Thank you so much Dr. Brandl for this introduction. I will speak now about medical research in Nazi Germany and anatomy as an example here. And I will start with a very brief review of the key events of medicine in Nazi Germany between 1933 and 1945. In 1945, more than half of all doctors had joined the Nazi Party in much greater number than any other profession. From spring 1933 on, they tolerated or actively colluded in the dismissal and persecution of their Jewish and politically dissident colleagues, filling the resulting vacancies eagerly and without regret. The dismissed were then coerced to emigrate or risk imprisonment and death. Others than other healthcare professionals were involved in the development and implementation of Nazi policies that led to the extermination of population groups, not considered worthy of being part of the healthy Aryan germination including persons with developmental disabilities, psychiatric patients, those labeled as quote unquote racially inferior, and most of all Jews. The image you see here is of the title page of the official journal of the National Socialist Physicians League, and very clearly our colleagues back then declared here, we take the lead in the Nazi policies. Psychiatrist Ernst Rudin was instrumental in formulating the Nazi forced sterilization law that was passed on July 14, 1933, the so-called law for the prevention of offspring with hereditary diseases. Psychiatrists, neurologists, anatomists and others served on hereditary health high courts which passed sentences on forced sterilizations. About 300 to 350,000 persons were who were judged to be quote unquote genetically inferior and were sterilized between 1933 1945. Gynecologists honed their technical skills and published them with statistics and books that were read around the world. Just one example of such a book it made its way into a Brooklyn library it was published in 1936. In the same year the Nazi government actually decided to forbid any further publications of statistics to keep the whole event secret from the German population. In 1939 on psychiatrists and neuropathologists collaborated in the government authorized so-called euthanasia program, which occurred in several stages and resulted in the killing of 250 to 300,000 psychiatric patients and others in Germany and the occupied territories. Physicians, nurses and midwives reported patients to the authorities. They also served as personnel in the six centralized psychiatric killing centers. There were no negative repercussions if they did not participate, but many did so by a free choice and out of conviction. The image you see is of one of those killing centers hard time castle hospital, and you see smoke of rising from the crematory in 1940, where the victims of this murder program were burned. Patients were murdered by medication starvation and in gas chambers that were built specifically for this purpose. And the knowledge gained in these killings particularly in the gassing was unused in the creation of the extermination camps of the Holocaust with a transfer of health personnel and quote unquote technical expertise acquired in the euthanasia murders. In addition, Nazi laws and inhumane practices led to the increasing numbers of victims and their bodies in life and death were eagerly used by clinicians and medical scientists for teaching and research. They were often affiliated with German medical schools performed coercive and brutally experiments in camps as as Steve, highly highly him made prisons available for these experiments and you see here from work by Paul winding the UK medical historian and this group that the number of these experiments rose exponentially during the war here. Many of these experiments only became known to the wider world during the Nuremberg medical trials in 1946 47 of the 23 defendants 20 were physicians, and among the experiments investigated were the high altitude and low temperature and drinking of seawater experiments in the how the typhus and infectious Johnson experiments, then in Ravensburg, the cell phonomide bone grafting and cellulite experiments, and at not silent camp the mustard gas experiments. And in addition, other medical crimes were investigated there, the collection of skulls of Jews for stress book, and the so called use an easier program. The latest group found that there were many more experiments of unspeakable cruelty with many more victims, close to 30,000 of these victims have now identified in nearly 200 medical experiments. I will now actually talk about the background of the collection of skulls for Jews of Jews for stress book University. What happened in anatomy Nazi Germany. With Libertas house higher and how to shoot the boys. You see them here in the year 1935, a year before they were married. Libertas was a publicist and the German movie industry worked in Berlin, and her later husband have was an officer in a vice aviation ministry. Both of them were opposed against Hitler and very soon found themselves as part of a group of political dissidents that later became known as the so called red orchestra. The activities of these, this group were discovered in the summer of 1942. They were all imprisoned and put on trial. Libertas and how to have that trial on the 19th of December 1942, and were sentenced to death for high treason. After all prisoners on death row. She was Libertas was allowed to write a letter of farewell to her family on the 22nd of November, December 1942 just three days after her trial. She wrote in this letter to her mother, very clear ideas of what should happen to her body after a death. She wrote, as a last wish I have asked that my material substance be left to you. It is possible, burying me in a beautiful place, and it's sunny nature. However, this is not what happened. Instead, we learn from the reports of another young woman what actually happened. Charlotte Obama had just graduated from medical school. She was an aspiring anatomist and served as an assistant to Professor Hammond Steve, the chair of anatomy in Berlin. She remembered later in a letter to Libertas cousin on 22nd of December 1942 11 men were hanged and five women decapitated 15 minutes later they were laid out on the dissection tables in the anatomical Institute. And Libertas lay on the first table and on the third table the big lifeless body of her husband. I felt paralyzed and could hardly assist Professor Steve who as always carried out his scientific exploration with great care and uncommon diligence. The impressions of that night I resigned from my position. And whereas the young anatomist resigned from her position. Her boss remained chair of the Department of Anatomy until his death in the year 1952. This was possible without any interruption after the war, because he had never joined the NSDAP the Nazi Party. However, we know from his publications that he had used several hundred of the bodies of the executed Nazi victims for his research. And these were bodies of persons who were executed in the prison system after civilian and military trials. Back to 1920 had performed animal research on the influence of the nervous system and stress on the male and female reproductive system. And then in the 1920s, he started with a thought experiment. He realized that he could interpret the situation of death row inmates as the reflection of his animal experiments and that he saw the imprisonment and fear of execution as stressors on the prisoners systems. He performed research on the bodies of executed men. At the time in democratic Germany, women were not executed. That was however again the case under the Nazis and so from 1935 on Steve performed research on the effects of severe psychological trauma on menstruation patterns and the morphology of the reproductive organs. To understand what happened to Libertas and what happened with anatomists during Nazi Germany, we have to look at the various facets of anatomy during that time. We have to look at the interactions between anatomists and politics at the bodies that consisted in increasing numbers of Nazi victims were delivered to the anatomies and were used therefore anatomical education and science. And we see that the use of these bodies then led to very clear stages of an ethical transgression. And we need to talk about continuities and legacies from this history. The image you see here is a charcoal drawing by the medical illustrator Leopold Metzenbauer, when 1943 documented here the arrival of coffins with bodies of executed persons at Vienna anatomy. Anatomists in Nazi Germany had a state supporting the leading role in the state supporting science of so called race hygiene the German version of the then international leading science of eugenics. Foremost among them was Oregon Fisher the chairman of anatomy at Freiburg. And until 1927 when we became the founding director of the Kaiser Wilhelm Institute for anthropology, human heredity and eugenics in Berlin, and also served as president of the University of Berlin and you see me here in an official function at the university. These were trained as physicians at the time, and more than 80% of anatomists joined the Nazi Party. As physical anthropologists anatomists contributed to the scientific legitimation of Nazi policies through the ideas of race hygiene. They served as leaders and in research in this field and as leaders in racial theory. They served as teachers of race, race hygiene and as judges in the hereditary health courts. A Nazi ideologue was Edward Pernkopf an Austrian who in 1933 became chair of anatomy at Vienna University in the same year he had joined the Nazi Party and the stormtroopers groups that were actually still illegal in Austria at the time which had its own system of fascism. However, after the so called Anschluss the annexation of Austria into Nazi Germany he was made dean of the Vienna Medical School, and in this role oversaw the removal of 53% of the medical faculty for so called racial or political reasons. He also became president of the university and of course lost all these roles after the war and was imprisoned. And after the end of his imprisonment, he was allowed to finish the work on an atlas of topographical anatomy of man for which he became famous around the world. It was this book was published in four volumes between 1937 and 1960, and the first American edition among many translations came out in 1963. It became enormously popular among physicians, particular surgeons and anatomists around the world, because of the great detail it showed, and then new printing technique that allowed for such brilliant images as the site of the head and neck region. However, it was already after the publication of the American edition that questions came up about the political background of the atlas questions that were investigated by general physician, Gerald Weissman and medical illustrator David Williams in the 1980s. In the 1990s, a very loud public discussion came up around the very clear signs of Nazi sympathies that the illustrators had left in those images that had been published during the war years. In the 1990s, he signed with the swastika. Carl Endres had a double S in his name and use the SS rules during the war years, from Spartan normally it was number four like this, and then in 44 use the SS rules. The signs in these images led then in 1994 oral surgeon in New York or Howard Israel to contact general physician and medical historian Bill Sidleman in Canada to approach the Yad Vashem Mertah's authority in Jerusalem to send an official inquiry about the origins of the atlas to Vienna University, where the historical commission was launched that became known as the senatorial project. This confirmed the Nazi affiliation of Pernkopf and his illustrators. It also confirmed that bodies of more than 1300 persons who had been executed in the Vienna prison system of the civilian and military trials had been assigned to the anatomy department, and among them were seven Jewish persons. It is to this day unclear which bodies of which victims were used for which images. And this brings us to the changes and traditional anatomical body procurement during that time, which in Germany as elsewhere in the whole world before 1933 had relied on very traditional legal sources those were the unclaimed bodies. The bodies of bodies of persons who died in public institutions, and who are not claimed by their families for a burial. And in Germany as well as around the world, among those sources were at the time disease psychiatric patients, persons were committed suicide disease prisoners and among the deceased prisoners also executed persons. In the Nazis we see an increasing number of victims among these traditional sources. Among the deceased psychiatric patients we have persons that were killed in the euthanasia programs. Among the suicides we have increasing numbers of Jewish persons among the deceased prisoners, more political prisoners due to the Nazi laws, more violence, especially in the Gestapo prisons led to more deaths. In the camp prison system. We have a high number of so called natural deaths. And these are not only due to the camp conditions and violence in the centralized concentration camps, but also in the decentralized camps for forced laborers and prisoners of war. And finally we see a rising number of executions due to new Nazi legislation in a democratic Germany from 1919 to 33, we have all together 200 executions exclusively of men. And now under the Nazis, we have an exponential rise, especially during the war years of more than 30,000 executions after military and civilian trials. We have documented now women. We know that all anatomical departments use these bodies that were about 30 anatomical departments, and we have a documented number of bodies delivered of 3963. One of the anatomists who use these bodies were Hammond was Hammond Foss. He worked in Leipzig and leveraged his career in 1937 by joining the Nazi party so that he was made chair of a department in 1941. And this was the newly formed German University in occupied Poland in the city of Posen. And Hammond Foss Diary, which was published by Goetzali in 1987, how he acquired the bodies he needed for the new de-sectual course. He writes here in September 1941. Today I had a very interesting discussion with the chief prosecutor Dr Heiser about obtaining corpses for the anatomical Institute. People are executed here that there are enough for all three neighboring institutes, not just Posen, but also Greifswald and Breslau. A month later he writes, tomorrow the anatomical Institute will get its first bodies. 11 Poles are being executed. I will take five of them. The others will be cremated. This means Foss had more than enough bodies, more than bodies than he quote unquote could wish for. And later than he writes, the dissection of the organs of the executed persons were the loveliest I have ever seen in a dissecting room. Why were the dissections lovely in the eyes of the anatomical beholder, because they stemmed from young, healthy, Polish persons who had been executed for their resistance against the Nazi regime. The young persons bodies were also used in the production and sale of skeleton skulls and plaster cast masks that were sold to other collections and museums. This was documented by Ali and Margaret Berner, who is the curator of the osteological collection at the Museum of Natural History of Vienna. She showed me this page from the Acquisition Register from the day of the 22nd of June 1942. Under the headline skulls and plaster cast of Jews and Poles, you'll read here, Jews and the cranium that's a skull of a male person born on 15th August 1998 was bought for 25 Reichsmark. These are the Nazi victims were used for anatomical education for profit in this in their sale for the acquisition for museum collections for anatomical teaching collections, and they were used for research. This was not we actually know from studies that were published during the war years and for me the question came up. Was this a practice that was up to only in Germany. And was it actually occurring only during the Nazi period. And so I looked at anatomical journal articles published before during and after the Nazi period and compared the German language papers with the English language papers. And as you can see here, I saw a much higher number of the explicit mention of material from the executed in the German language papers 183 compared to two in the English language papers. When we look at the timeline we see that these papers were published already before 1933. The use of these quote unquote materials became something of a gold standard in German language anatomy because these these tissues were fresh quote unquote fresh as in life, and they were at the same time quite rare. So as soon as the Nazis increased their execution fragment frequency, we see that the anatomists eagerly use these new body materials, and we see an exponential rise during the war years. The busiest users of these bodies was Max Clara, the chair of anatomy in Leipzig and Munich, who published several studies where he used large numbers of human bodies of the executed in his research but not just the quantity changed it was also the quality and this has been first pointed out by my colleagues, Winckelmann and Noah in 2010 in the seminal paper on Max Clara. In this 1942 publication he speaks about the vitamin C distribution in human tissues. In the methodology section and for all the world to read. He wrote the material evaluated in the current study stems from 15 apparently healthy adult individuals of different ages, who without exceptional died of a sudden death after varying periods of imprisonment. 33 security year old male individual received one pill of CB and that's a vitamin C product by Mac four times daily for the last five days before his death. What had happened here. Clara had realized that he had access to the bodies of these prisoners before the execution, he could manipulate the tissues in vivo, then make the execution date part of his research design and investigate the tissues afterwards. And this Clara clearly clearly crossed the boundary of the traditional paradigm that is knowledge gain and anatomy to work with a debt to a new paradigm first identified by my colleague Hans Joachim long to work with a so called future debt that is human experimentation. This paradigm change, even more clearly in the activities of your own Paul creamer, Professor of anatomy in Münster and an SS officer, who in the fall of 1942 was detailed to Auschwitz until then he had performed animal research on the effects of hunger. In Auschwitz, he had two duties. One was to be present at the selections at the train ramp in Auschwitz Birkenau sending prisoners to the gas or to force labor, labor, or, and he had to perform selections on the prisoners sick words to the prisoners for execution. There he realized that he could now transfer his research from the animal system into the human system, asked for permission to select prisoners who were quote unquote interesting for him. And the company these prisoners to the execution chambers where he took their medical history, then awaited their murder by card intracardial phenol injection and then removed the tissues. We know this in such detail because throughout his life he kept a diary, and you see here the copy of a page from his time in Auschwitz. This diary was found by the British military after the war in creamers apartment, and it became the very first document that proved that the physician had performed in humane human experiments on prisoners in camps. He was put on trial then for murder in Poland and also accessory to murder in Germany. Now note that creamer had entered the camp without any plans for a research, but he there realized quote unquote his opportunity. We have, however, one anatomist who became the mastermind of work with the future dead. And that is August tilt. He was the chair of anatomy at the vice visitage transport in the outside that's over here in the occupied outside area, and he was an SS officer. He collaborated with the on an air by the SS organization that studied race in experiments on prisoners with poison gas and the strut of nuts by the concentration camp that was nearby. They had the special small gas chamber built there for these experiments. He planned a large anatomical anthropological study, a so called Jewish skeleton collection that was to complement an existing 19th century racial collection at the University of Strasbourg. For this purpose, he had prisoners selected over here in Auschwitz by the SS anthropologist Bruno Biga and Hans Fleischer in the summer of 1943. These prisoners bodies were then transported by train from Auschwitz to Nazi Weiler, and they're held personally gave the cyanide salts for the murder of these prisoners to the commander of Nazi Weiler. The first victims were killed in July and August 1943. Their bodies were immediately transferred to Strasbourg anatomy department where the work on the collection started but was never finished. So there is no collection. He was named during the Nuremberg doctors trial. He was not present at the time. He was also once again indicted for murder and absence and the SS in 1953, and only at that time did it become known that he had committed suicide in the summer of 1945. Now, we can all speculate why physicians in Nazi Germany worked in the way they did and what they were thinking. Here are some thoughts that I would like to share with you. Medical historian Gerd Bader said they believe their work was scientifically valid and thus justified. For them, the purity of the method was the only prerequisite for the compliance with ethics norms and medical historian Volker Röker says they saw the availability of Nazi victims as an opportunity in the methodologically correct sense but without care for the research we can say very clearly here the extreme cruelty of their methods and unbearable suffering of their victims did not affect their scientific reasoning. Now I believe there are many tangible and intangible legacies from this history I can only point to quite a few of them here, and I would like to title this part of my presentation books, bodies, bones and brains. Charlotte Obama remained the only voluntarily retired anatomist few German and Austrian anatomists lost their positions after the war. The old teachers were the new teachers, the old researchers and new researchers. The studies on bodies of Nazi victims were published in journals and books that were right around the world, and this knowledge is now integrated into the general canon of anatomy, you and I have used it. Most notably the perk of Atlas, and is often copied images are everywhere. Body's bones and brains of Nazi victims were used in German and Austrian anatomies for many years after the war as part of institutional quote unquote material and collections. Despite previous investigations more specimens from bodies of Nazi victims are still being found in ongoing investigations in institutional and private collections. Guidelines have been developed for the handling of remains, but the guidelines and at least until 2017 never had any visible input from the victims communities. And so in 2017 we met for a symposium at Yad Vashem in Jerusalem, where we discussed the question of what to do with Holocaust era human remains. We formulated their 10 recommendations and at the center of this these recommendations is the what we call the Vienna protocol, responsible by Rabbi Joseph Pollack on the question for to do when Jewish or possibly Jewish human remains are discovered. He speaks here from the Jewish traditional law with respect to medical ethics also. And I would like to point out that Rabbi Pollack is a childhood Holocaust survivor, and one of the few experts in the field of what to do with Jewish human remains from the Holocaust. He speaks here and this is important, not only about the use of physical human remains but also what to do with data from that were obtained unethically data such as the program of images. The Nazi history of anatomy shines a clear light on current critical questions and anatomy as unethical handling of anatomical bodies still exists. And he has just one example of body brokers in the United States that act in a great legal zone. They were extensively documented in a wider series of investigative reports. These are private organizations that have set up body donation programs where they essentially prey on the indigent by promising them inexpensive and dignified burial of their loved one's bodies. And these bodies then are ostensibly donated for medical purposes but really they are they are making a profit for these body brokers, they are used in often in postgraduate courses and you may have encountered them in in postgraduate teaching courses. So I would urge all of us to ask whenever we work with bodies and tissues in our wet labs, where do the bodies come from where do the tissues come from. And in times of online anatomy teaching that has increased exponentially so the pandemic, we have to ask, where do the images and data come from where does the knowledge come from. Some of you may be familiar with some of these 3d apps here for anatomy that are proliferating now. It's difficult to get any true information about where they get their data sets but if you ask long enough you will find out that they're using at least one data set that goes back to the old visible human project that the National Library of Medicine put in place in the 1990s. And that relies on a male data set from Joseph Paul Jernigan, a man who was executed for murder in Texas. And if you have any ethical questions about capital punishment or the vulnerability of prison populations then you will have ethical questions about this data set. At a minimum we need transparency about the provenance of our images. This is also true for our atlases. You see you see here on the right side here the perk of original of an image that was then copied after the war by Eric lapier the same illustrator the perk of was after the war employed by the supporter atlas editors, and he essentially copied the images from the perk of atlas for the supporter atlas, you will find these copies and many, many other atlases and they are not not dignified as coming from the perk of atlas. I believe that new 25th supporter edition is probably the first one that actually has an editors introduction to the history of the images and shows the prominence. I would like to end now with one more legacy, the legacy of eponyms. I know that eponyms and the use of them is currently hotly contested in the question of the colonization of the traditional medical history. I would, however, remind us that eponyms can be teaching moments in commemoration and I would like to end here with a commemoration of our former colleague Lucia Fai, a neuroanatomist and physiologist who was born in the blood lens as Timothy Snyder calls them. She was born in love when it was Polish it later became Ukrainian and then under the Nazi occupation in 1942. It became Lemberg ghetto, and she was killed either in the Lemberg ghetto or in Belsak death camp. She at that time she had already lost her husband, Marek Gottesman to the Stalinist purges in 1939. She had in 1923 published a paper on the gastritory sweating and flushing that is now known as the Frye syndrome. I would like us to remember Lucia Frye. Thank you very much. Thank you so much, Dr. Hildebrand for that incredibly thought provoking and comprehensive lecture regarding the many questions that we need to ask and will continue to need to ask as we as we think about the provenance of anatomical specimens and we think about the very nature of our knowledge and our ethical responsibilities. I know we'll have a lot of questions are already coming in to the question and answer and so we'll get to those in just a moment. But before we do we very much look forward to hearing the remarks and comments of Dr. Donesh Zady. We are particularly thrilled to invite him back to the research ethics consortium. He has a graduate of our first class in the MBE program and also at this consortium since really its origins in the very beginning. So let me tell you a little bit about him because it's quite extraordinary what he has accomplished in his brief career. Dr. Zady is a resident physician in the Department of Internal Medicine at Yale University School of Medicine and Yale New Haven Hospital. He completed medical school at Wake Forest, his master of bioethics at Harvard Medical School and his master of theological studies at Harvard Divinity School. His research interests are at the intersection of bioethics, cardiovascular disease and health policy. He has served on the board of the American Society for Bioethics and Humanities and was nominated in 2021 by the president of the American Medical Association to serve a three year term on the AMA Council of Ethical and Judicial Affairs where we've had the pleasure of working together. At Yale, he is on the faculty for the professional responsibility course for first year medical students. He is an inductee of the Gold Humanism Honor Society and a former participant in the fellowships at Auschwitz for the study of professional ethics. He's contributed more than 25 peer reviewed papers to the medicine and bioethics literature in his already prolific career and we are so delighted to welcome him to give his comments and Dr. Hildebrandt's paper. Welcome Dr. Zady. Thank you so much Dr. B and thank you Dr. Hildebrandt for that amazing and harrowing talk. I think this is like Dr. B was saying it leaves a lot to to consider. So I had some slides of my own. Can everyone see those. I think so. Perfect. To kind of jump off from where Dr. Hildebrand mentioned I think that it's important to ask why we turn toward Nazi physicians to understand ethics and the lack thereof in the practice of medicine. And I basically wanted to talk about parallels and pedagogy and why this, this case based format is helpful for the work that we do. And I want to start by, you know, a quote that is oftentimes said and and I benefited a lot from folks that I'll acknowledge later in the talk, we had a discussion very recently. You know, they're saying that comparisons to Nazism are fraud or comparisons to Nazism are problematic. Right. And there is some validity to that perhaps I think that there is definitely hyperbole and sort of the day to day practice of medicine particularly since 2020 and onward but the reality is, we must, I argue, think with creativity and humility to mitigate against immorality, and I think there are still lessons to be to be to be obtained from the study of Nazi physicians and there was a question in the chat about how 80% of physicians in Nazi Germany were participating in these sorts of experiments and how is it that such a, you know, large population of the workforce is contributing to sort of immoral practice of medicine and I think it's worth looking at things creatively and humbly to see if we can put ourselves in the shoes of those in the past. And when I talk about humility in particular I talk about the humility that it takes to identify with perpetrators of these crimes and atrocities, particularly in the work that they did, and then trying to draw the parallels in the work that we do today. Oftentimes, when I went on the trip to Auschwitz in Berlin with Faske the fellowship that Dr. B was mentioning in the first week, and even I think in reading about the Holocaust growing up, you know, oftentimes we say well how is this possible and then anybody speak up etc etc. But then you realize that there are a lot of things that were actually happening quite close to home that need to be unpacked and should cause us or should give us a moment to pause and reflect so I talk about symmetries. And I think that it's important to acknowledge symmetry with humility and look back at our own past and the American past specifically in terms of unpacking sort of why the practice of medicine can be so ethically flawed, even with good intentions. So for example, the forced sterilization lie Dr. Hoderbrand was mentioning six years before that in the United States. Kerry Buck and Emma Buck so on the left you see Kerry Buck and her mother Emma Buck, who both were considered immoral and promiscuous, the mother Emma Buck had actually had three children out of Webbock and was considered imbecile. And a case was brought to the Supreme Court about forced sterilization for Kerry Buck and that led to Buck v. Bell. And essentially, the Supreme Court at the time led by Oliver Wendell Holmes Jr allowed for forced sterilization that states could carry out in order to protect the health of the state. And I think that it's just very fascinating to me how we know so much about forced sterilization laws and sort of a late person understanding of Nazi physicians but it's important to look back at the parallels in the American context, and also the fact that Buck v. Bell and the circumstances around that case were actually used to perpetuate into draft and promote forced sterilization in Nazi Germany, some years later. Similarly, I was having a conversation not too long ago with Dr. Jay Malone who was one of my faculty members in the fellowship program at Auschwitz. And he was mentioning a very good point about how the Nuremberg Code, which was written as first line of the Nuremberg Code is the voluntary consent of human subjects is absolutely essential. Okay, this is published in 1951, sorry, in 1947. And so 1946, literally four years after that, Dr. Otto Gray at Hopkins did the cervical biopsy that subsequently led of Henrietta Lacks that subsequently led to HeLa cells and so without any consent. And it's interesting because the Nazi experiments and the Nazi process was at that point, public knowledge Nuremberg Code had been drafted for several years and yet in practice in America. Consent was not obtained for the obtaining a sample and then perpetuating it. So this is a wonderful picture on the left here of the grandchildren of Henrietta Lacks, who now 60 years plus after the biopsy of the cervical biopsy are now actually on a governing body that deliberates any sort of NIH funded research that uses HeLa cells. So I think it's just, well, obviously long overdue but once again it shows that there is a symmetry between what was happening across the pond and what was happening here. And it's important in the day to day process, when we're reflecting on the ethics of these things to acknowledge that there is symmetry. And that even though comparisons between Nazism and us may be fraught or maybe problematic, we still must have the humility to unpack the, the parallels between the two. So this is a just a really harrowing and haunting kind of image. Diana Barry, who's a professor sheet she wrote this wonderful article in the New York Times. A few years back about the slave trade and the cadaver trade and sort of on the right is another article that was in the Smithsonian that builds up upon what she had written where they talk about. Susan Harris, who was actually a slave purchased by the Medical College of Georgia, taught to read and write and then subsequently paid by the institution and was a free free person at that point, but was hired specifically as a grave robber, and as a body trader. And that was actually one of the reasons why the Medical College of Georgia had a robust attraction to folks who wanted to study anatomy and the reason why Grandson Harris was actually educated specifically was so that he could comb through funeral announcements, and unfortunately go specifically to particularly black graveyards, where there wasn't fencing where there was a protection to rob bodies and then use them and sell them to institutions. So I, the, the, the commodity the commodification of cadavers and bodies, as we saw in Europe had already been in practice and perpetuated in America, some centuries prior. I want to go back to Buck V bell and actually briefly read Oliver Wendell Holmes juniors Pete quote from his opinion so he's he talks about in again in justifying for sterilization for Kerry buck. He says we have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the state for lesser sacrifices to prevent our being swamped with incompetence. It's better for all the world if instead of waiting to execute degenerate offspring for crime or to let them starve society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover the cutting of fallopian tubes. And that crux that the rights of an individual patient can be infringed upon for the benefit of the greater good is a line that we balance on a day to day basis. And despite the fact that comparisons to Nazism might be fraud. We see those comparisons made day to day since particularly since 2020. Yes, there is like I acknowledge there is hyperbole to this and unfortunately there is a lot of politics now involved in the practice of day to day medicine. But if there is so much vitriol, we cannot be dismissive, we need to look back and think about what are the implications of the things that people are saying. And, and I'll kind of get to one of the particular piece there so so that's one piece I think is to acknowledge the humility to humbly acknowledge and identify with perpetrators in order to mitigate immorality in the practice. And then I think the second piece is what are creative ways to develop new pedagogy that emphasizes those symmetries in order to kind of learn from it. And so what what should we emphasize and I and and and Dr. Hildebrand mentioned this. And I think one of the pieces that is key is we need to emphasize the shared factors across, I would say both space and time but across time between Nazi physicians, and also physicians who are training and developing and practicing and and not just I would apply this broadly to the healthcare enterprise at large. So one of the pieces that I think is important to keep in mind is how medicine is practiced within a hierarchy, moral development is happening during medical training. We've all heard about the ideas of hidden curriculum and, and myself and some colleagues we wrote a paper on clerkship ethics, and one of the most challenging aspects of being a medical student for example, is not to deliberate who's going to get a heart transplant. It's to figure out whether or not you should laugh at a joke that comes at the expense of a patient. When a resident makes that joke and you have every incentive to laugh along because you're being evaluated because you are developing as a person who's who's who is going to internalize behaviors that you're seeing in leadership. So that has not changed the idea of a medical hierarchy and we see it in the military and we see it in medicine particularly and those two things I think are parallel between both between both Nazi physicians and today's situation. Macro skill factors like institutional policies and government, I think is also a very important piece to emphasize in these pedagogy. And I particularly emphasize the coven 19 visitor restrictions you know when you go back to those photos of people saying that we're not living in Nazi Germany. Hyperbolic dramatic. Yes, nonetheless the coven 19 visitor restrictions that were implemented in in in the best interest of the patient and understandingly with very limited data in real time. There was a recent paper that was published in the Journal of Hospital Medicine that basically acknowledged what we intuitively felt like we knew that visitor restrictions were not evidence based and that they ultimately ended up being detrimental to both patient and physician well being. So, being mindful of how how policies are enacted how they're implemented who is developing the policies. And then similarly government factors like care for the undocumented care for the undershirt there's things that are outside of the individual clinicians control to which they are still beholden in the practice of day to day medicine. And I think that is not changed from Nazi Germany to today. What policies sure, but the fact of the matter is we do not practice in a vacuum with practice within a system systems can be flawed. And one aspect that I think is also almost imperative to emphasize in these pedagogy is the idea of desensitization and compartmentalization. Robert lift and this fantastic book the Nazi doctors talks about the idea of psychological doubling that is used to blunt sort of emotion, and in order to practice medicine in a more objective way and he specifically talks about physicians who are missing in Nazi Germany, and looking at the conditions of the concentration camp and taking a step back, approaching things with a very scientific mindset, in order to, to blunt the atrocity that they're witnessing every day and we. I can only speak from experience. I see myself do that as well. And, you know, when you are implementing an MPO order on somebody who hasn't eaten and their procedure keeps getting delayed and delayed and delayed. What are these sorts of or when you see you're having to discharge folks to the street in the emergency room. There are all these atrocities and system errors and poverty that you are seeing a day and you have to blunt to an extent to protect your own psyche, but you can't do it to the extent that it ends up robbing the individual patient of their humanity. The last few factors that I think are important to emphasize are structural racism that's embedded and veiled in the objectivity of science. There was a paper that was published and not too long ago that talked about how many people in the lay population and unfortunately more than 50% of the survey population within the medical field had these flawed and not found it in science understandings of pain thresholds between white and black patients and they particularly talked about thicker skin than black patients, which obviously is not found in anything but that sort of mindset can then end up leading to bias downstream. And you sort of see a similar thought process in Nazi Germany where there was this mindset of painting Jews as a. A technology that only use but basically that there are flawed scientific understandings of the differences between one population and the other, which then permeates into into policy. And that's why I think it's incredibly important to emphasize representation in both the workforce and in leadership, and not only in medical practice but also in the development of policy. So who is writing guidelines, who is writing the code of medical ethics, right there was a very robust ethics curricula and Nazi Germany that's still accepted and conceded, unequal worth of human beings, who is writing the ethics literature you know, and we in our own past have had guidelines that were discriminatory against people from the LGBTQ community, there is I know that somebody in the chat mentioned something about abortion, the code of medical ethics of the AMA has a piece of abortion that is that discusses the law which is not really mentioned elsewhere in the code. There are things that we need to keep an eye out for and this is why DEI is so important. We need to have diversity and inclusion in all aspects of I think leadership, not just in the workforce but I think higher up because they will also contribute to a more just and more ethical application of policy. And so how do you emphasize it I think this is the challenge I think what we're doing right now is fantastic. There's obviously different programs that specifically are looking at Nazi Germany and learning about ethics or the lack there of there's fellowships Auschwitz that Dr. Brindel was mentioning that I was a part of the University of Colorado as the Silver's Fellowship I know at HMS they were also trying to start a program that was looking at the Holocaust. Like I said I think the reality is we need to figure out pedagogy that emphasizes the similarities, acknowledging the fact that there are fundamental and huge differences but we still need to emphasize the similarities with humility and creativity and whether that be case based whether that be through didactics, not every school can afford traveling to Germany so how can we bring that to us, and I think you know Dr. Hoderbrandt's talk of kind of walking us through how immorality can be perpetuated in the system. It is important for us to continue to reflect on that. And so I just wanted to acknowledge some folks, particularly a lot of these folks I met through the FASB program, which is one of the most it was one of the most professionally changing experiences of my life and I'm so grateful to have, you know, kind of had the chance to talk to you also thank you again and thank you again to Dr. Hoderbrandt for for a fantastic talk. Thank you doctors 80 and thank you in particular for pointing our attention to, I think, three piece parallels politics and pedagogy and calling on us all to recognize both the sources of our sources of our ethical beliefs the possibility for transgressions and how we use our humility to look at both to advance ourselves as as people and also as professionals within very complicated institutions and political structures. I know there are a lot of questions that came up during your comments as well but first, I am absolutely delighted to bring us to our final discussion. And who's going to, I understand, bridge us a little bit from the work we've just talked about continue the discussion of where we go in the future so let me introduce to you Dominic Hall, who's the curator of the Warren anatomical Museum in the Center for History of Medicine at Countway library, a position that he's held since 2007. He received his bachelor's degree in history from Colgate University and masters in museology from University of Washington, Seattle. He earned an additional MA in liberal arts and history from the Harvard Extension School. He's a curator, Dominic's responsible for both managing the historical anatomy and pathology collections of Harvard's legacy medical museum and developing the modern medical artifact collections associated with the center's manuscript and archival holdings. He is the primary point of contact for the museum and is responsible for its acquisitions, loans, collections management, research, outreach, and exhibition. One of his chief goals for the museum has been integrating it into the special collections environment at the Countway Center for the history of medicine, and orienting the mission of the historical specimen collection into the modern academic community, and for the appreciation by the general public. Before his appointment as the Warren curator, Mr Hall worked in Seattle's Museum of History and Industry, the Burke Museum of Natural History and Culture, and the South Count Country Museum in Rhode Island. He is a past president of the Medical Museum Association. Please join me in welcoming Dominic Hall to give his remarks. Thank you very much for that. So I am going to sort of orient us a little bit more to the present I think in that I sit in a modern anatomy or not modern historical and legacy anatomy and pathology collection. That is trying to make its way into a more ethical framework within the 21st century. And so it just sort of very briefly so the Warren atomic museum was founded in 1816 so it's it's quite old in terms of anatomy collections within the United States. This is the Warren in 1906. And so that is actually in the main administration building of Harvard Medical School in the top three floors of a very grand space. So very much oriented at the center point of the medical school at that time. So we had a tight to about 14,000 probably remains are in that hall. And it is very much a, but it is still very much a sort of pre war enterprise pre World War two enterprise in terms of teaching anatomy, and actually which sort of ties us into some of these earlier talks as the war actually I think sort of forms a both ethical and operational turning point for the collection. So the medical museum landscape in the United States train changes really dramatically in and around the war is that you start to see a real decline in the operational capacities of many museums in the United many anatomy and pathology museums in the United States and certainly true the Warren and a lot of this gets chalked up to educator educational technology changing the ability to actually view the interior of the body technologically through x-rays and other evolving technology technologies they're actually giants. It's a giant space user in space becomes more of a premium and so it's, it's space is always an issue in terms of the medical museum. And there's also probably the largest downward trend is push that pushes on things like the Warren Museum is this trend for macro anatomy to micro anatomy. And so the actual, your actual tissue needs at a medical school changes dramatically and that certainly impacts the war as well. One of the things I think it's under talked about, and this might be me more editorializing then, then looking at things that other people have written work on, is that it is really around this time that you find this really evolving bio ethical landscape in regards to human remains ideas of more informed consent ideas of what it means to be alive ideas of, you know what it means to do ethical research, really in some ways probably probably born from these analyses of what would happen in, in Nazi Germany. And I think that puts us further downward pressure where the, there's something in Congress about having three floors of remains in the main production building of your medical school. And at the same time, you're soliciting remains per the you know recently passed in 1968 uniform whole body gift act to have individual have donors donate their remains to your anatomy room. So, the war museum very much gets gets falls into this sort of compression that happens it loses its space it loses its floors, the anatomy department itself. Actually, in some ways he says to exist at Harvard Medical School. And then the war museum and its collection becomes sort of orphaned administratively and that's what ends up in the center for the history of medicine. And that's where we are sort of have been taking it and trying to figure out what's its place in this new, new world. And a lot of different things have sort of happened recently and I'm just going to highlight a couple of them that the war museum has sort of played a part in, or that the Coway's played a part in, and then I'll sort of give off for the, for the larger questions. Um, so Dr Hildebrand mentioned that the anatomous table there's an atomized table in the Coway library and this actually something to do the museum's historical collection. But we did actually write a lengthy proven on statement about the individuals in the museum or excuse me in that are whose images are in the anatomous table in Florida, in order to inform the user and you know give them the sort of they the user themselves to be looking for sort of informed decision about whether or not they want to use images of an executed, if an executed man to learn anatomy. You know probably the sort of chief ethical, ethical question in terms of the remains are actually for full body cadavers on the anatomous table, and the proven on statement goes through each one of the origins of each one of those cadavers and so the user can make an informed decision. It was also been already sort of mentioned in the chat that the Harvard has recently published a report on the human remains collections. They're at the university and that, you know, one of the larger holders is the war anatomical museum. This was brought on by the investigations of potentially enslaved individuals in museum collections that are held that they may have been held at the are held at the university. So for the first time, the university is a whole is taking on this issue of, you know, we will be acknowledging these individuals of figuring out and figuring out what the next steps are but also setting up mechanisms of redress in a sense a returns has been formed where to sort of deal with and to talk about and to discuss individuals in the remains who may no longer should should be no longer held by the university. The research committee has been informed to, you know, decide whether or not individuals remains that are in these museum or museum should be used for certain research projects. And so these are all part of this sort of again these sort of heritage collections being really interrogated in a transparent and operational way to try to figure out how we can take this historical legacy and bring it to the place that we wanted to ethically be. And sort of one of the things I just wanted to point out lastly and some earlier work I did was to look at the legacy overall in the United States and what has happened to our heritage medical museums or legacy medical museums and this is just the Albany College Medical that's one picture is from their course catalog in 1899 and the other is the space in 1915. And I'd found through my own research to looking at historical sources that I've been able to sort of I've been able to find about 76 historical anatomy and pathology museums that were once in the United States, and they are all largely gone. But I don't know if that really means gone. I mean, so I think that the same way that Dr. Hildebrand's work has taken her to find legacy collections from the Nazi anatomy that I wonder if more and more collections will surface in the United States from these heritage medical collections, and then we will, as a collective community have to work our ways through these opportunities of redress. And so I just wanted to quickly run through some of the things that are happening to the Warn as a legacy collection, and I look forward to the discussion that follows. Thank you so much for bringing the questions that Dr. Hildebrand raised into the present time and pointing out for us how much work we still have to do both not just in figuring out the provenance of the remains we know that exists but also finding the finding the remains where they may be and we've all heard many accounts of almost accidental discoveries with huge historical significance as well as significance for our ethics or morality or humanity. So thank you to our. Thank you to doctors Hildebrand and Zady and our museum curator Dominic Hall and let me now say that we have a lot of, we have a number of questions. And they go in a number of different directions. I'm going to we have about 20 minutes for discussion today so let me let me first acknowledge and thank our attendees who brought up the question of in some ways almost the ubiquity of ethical transgressions in medical biomedical research human subjects research that happen alongside many political determination so we've had some pretty a lot of engagement both questions about how this occurred both in Nazi Germany and in Japan studies that have been done in India and elsewhere. And then also bringing us really to the legacy in the United States of slavery and the systemic racism that ensued so those are all incredibly important questions and topics. I'm going to turn to focus us on two particular areas in the time that we have remaining. And the first really, they're related so we'll come back to the human remains and University Museum collections for the second question because that's really thinking about where we're from here. But let's start with a question that came in from Claudia Fernandez Perez who asked us what what approach would you recommend taking. If you find that some of the bodies or tissues you're provided for educational educational purposes or their images come from sources that you find to be ethically conflicting with your own values what do we do about that. What's our response. So we, we have this situation definitely in in the anatomy education at Harvard Medical School, where I certainly do not use Perncope images for example, unless I'm specifically talking about the history of the Perncope Atlas. Likewise, we still have at a minimum as I said, I would always declare to my students if I myself see an ethical problem for example we still have some some skeletons with unclear provenance. We only real human bones that we still have but the provenance is unclear. So we use them only in very specific cases and then we tell the students about the fact that we're unable to clear the provenance we're currently still using them. What we're not going to do in the future will will be seen. So I'm saying, you have to stay in discussion, not come with perfect answers because we usually don't have them, but be transparent and try to find out what you actually have in hand at a minimum you need to find out what you have. I don't emphasize that often enough I believe that Dominic Dominic calls a provenance statement on the another much table is probably worldwide the first one. So I think we just have to start in these small bits and pieces and actually talk about this. Yeah. Sure. Yeah I think. So first of all I think you should know that that is a very common occurrence and that you know you opening the cabinet door and finding a collection that you do not know the origins of, or if there are bits and pieces of information you may find some of that challenging. The legacy is those legacies of those remains legacies are still very much. I mean, and Sabina can definitely testify to this as well, or very much still with us and actually that the American Association Association of Association of anatomy is is working on guidelines for legacy for found legacy human remains collections. And so it's a problem or challenge to be met. And I, I think the first piece of advice I always give is, is for these kinds of things is not to close the door back. Right so you also are probably not the first person who's open. And then, you know, but there's several people before you have made the decision to close the cabinet again. So I think a lot of what people are talking about now and even just having a program like this is about how sort of the first step forward is, is to ask yourself the questions and then to just to start inventorying to start making a learning the provenance. So you can even make decisions about what the future of those remains are. So I think that's not what Dominic I just said, I would like to add, do not just close the door, but also don't throw them out, because that has been for decades, the, the activity that we see in, in definitely in German anatomical basically these human remains were essentially put to the side and not just forgotten but also taken out of the department nobody heard about them again. This has stopped that doesn't hope hopefully doesn't happen anymore but this also applies and I would like to say that what we've learned from this invest these investigations in Europe to certain degree is now repeated here in the United States is the greater awareness of the history of anatomy, and the history of human remains in the United States we see the true effort to learn the origins of the collections of the human remains and treat them as human and treat them as individuals that belong to a community. That is what we're all learning currently and there was a question in the chat do we know, are we dealing with for example, human remains from indigenous populations of. Yes, we actually that's the only community that was able to collaborate or get the government to actually pass a law on the return of human remains. It's a community that I'm aware of around the world where actually a law exists otherwise there are guidelines. But we're working on this all together in a concerted efforts on the local level at universities like just as Harvard has just now published the report, and has a commission on the return of human remains as well as a commission as a commission on what to do it when research applications are coming in so there we have that new research committee, but also we see it and nationwide in the various associations it's not just the American Association for me that has a task force for the formulation of guidelines it also has a task force on its history of systemic racism, and it's also the for example the American Association of physical anthropologists, which are to a certain degree are sibling associations. I've spoken enough now. Donna should I jump in on this or you want to wait for that. I know I agree with with what everyone said I think the most salient point there is to not throw throw away that the remains I think I think acknowledge this is a. This is a fascinating question that plays into the wider discussion of what do we do with our dubious past, right, do we erase it, do we learn from it, do we preserve it and put it in a where in a place that is less. I just think that's a very salient point. And I think the, the healer case is also a very interesting way to, to kind of look back and try to integrate the family of the folks who who were wronged and try to incorporate them so I think that similar stuff has happened kind of in the American Indian Native American space where the tribal lands upon which a lot of these institutions have been built. So I'm going to try to integrate those communities into the work that is now going on in the institution. So I think it's a similar parallel. Great, thank you for bringing us to the to recognize so many of the parallels within our own us history in particular. I'm going to go to we've been talking around a little bit. The University Museums collection report that Harvard released back in September. As usual, thank Dr Willie Lynch for asking, asking my question, formulating it much more clearly than I could have myself. So let me tell you what Willie's asking us really what parallels do each of you see between your work on human remains from the Nazi era, and as described within the Harvard report, primarily those from enslaved individuals. And we began that conversation the interested another interesting piece that he brings us for us is being particularly interested in views regarding questions of the proper disposition of remains that have been held. So two part question really getting at the heart both of the provenance and the past, the history of these remains but also the ongoing point. I just brought up about going forward, the respect for the humanity of these remains and perhaps creating a legacy of respect, and of a commitment to doing things differently in the future with with that respect for humanity at its core. Hard question. And Sabine on the spot because I put Dominic on the first question. I didn't want to jump in right away. But for me. So there's two things right. My learning of what was happening in in anatomy Nazi Germany has directly informed how I teach anatomy in the dissection with bodies of body donors. I, it informs, knowing about this history of abuse makes me stronger in approaching the humanity of, well, not just our donors, but truly also of our students and colleagues. And also of those people who donated their bodies and recognizing their connection with a former person that they were. And this something that we bring to the foreground in our anatomy, anatomy education approach, and that informs the atmosphere in the learning in our laboratories. So that's definitely something that is not just implicit but explicit in our educational concept. That's the first thing. Then secondly, in terms of what we should do with a human remains that's something we've extensively discussed with our anthropology colleagues also in the task force. They're really the binding in of that. So first of all, you need to do your research you need to find out to whom these human remains actually belong, then you have to locate the community of this individual, and find out what they want to do with these human remains and if you cannot find that out. So you probably have a duty of storage of these human remains and take the best care that you can, because you're currently the only community that these human remains have. So take these human remains seriously as belonging to an individual. Oh, go ahead. Sorry, Josh, go ahead. Oh, no, no, I was, I was going to echo Dr. Elder Brown was mentioning and and and something that I've seen in the chat to a couple of the Q&A's in terms of sort of services or acknowledgments or quote unquote funerals for for the donors in in these cadaver labs. There's so many interesting questions that come up with this I know at some institutions, for example, students are told about who the individual is what their story is what the social circumstances where what the pathology was, and in other circumstances they are not. And I think there are there is something interesting to be teased out there about having some degree of objectivity in the study of anatomy is also essential. And then in other circumstances understanding the sort of the cycles of the social aspect of things is interesting but one piece that I just wanted to briefly say, which I always found somewhat comforting is one of my mentors taught me that one way to view these individuals is as your first teachers, right, and in some respects, learning from their body, even after death because Dr. Hildebrand mentioned they had a life before right what was their life before and what is their life now so in some degree I think what it was in some some way, these people are immortal, right and I think it's I think that was a very fascinating way to kind of view the remains is that they have somehow achieved immortality, despite injustice injustice that was done upon them, in that you are learning from from them, and I just always I just wanted to mention that because I've always found that somewhat comforting. Down Nick you want to jump in on this before we move on to me one last question. Sure. I think in regards to, to Dr Lynch's question if I'm really thinking about some of the parallels. I do think that there is could be a, you know, when you're focusing on the individual's life. And that leads you back to their through their story to maybe some descendant community or linear descendants today. When you start you tell that story. I do think we can learn a lot from the many efforts that are going on right now so there's not. There's no there's no like one there seems to be a lot of different groups different really well meaning people trying to sort of work through a through this ground. I mean, usually when I listen to, to be in his talks I find of another effort somewhere in, you know, informally like German occupied Europe where they find something and then they're working their way through how, how to address how to, you know what to do next with these with the remains. And so I think if we start to look in the United States about this history of formerly enslaved individuals who might. Who might still be in museum collections or university collections. I think we can start to look other places, you know, we can learn from each other or vice versa, you know, it's a lot of new ground. And it's going to be emotional and fraught and their questions of morality and so seeing what everybody else is, you know, being a talking, I guess I don't know that seems a little too, but stuff like this sort of, I think helps and looking at each other to try to figure out the best practice because it's going to be very challenging to get it right. If there is a right. I mean, yeah. Right. Well I think you know one one of the key features that's come through about something that is a necessary component of getting it right or as right as we can is really maintaining a commitment and prioritizing a commitment to our fundamental shared humanity in this right both I think from the perspective of what Donis talked about and approaching this with humility. And that's really coming through to in the chat and in the question and answer that we can look at the atrocities of the Nazi period and of Nazi medicine and say that was then this is now. But if we do not think about the these fundamental conceptions of respect for humanity. We make small mistakes and big mistakes we see them in our own history and our own account, as well as in some ongoing practices that would benefit from additional attention. On that topic of the fundamental humanity I wanted to raise some ideas that had come out in the Q&A about how do we in practice show that kind of deep respect. One being through thinking about the paradigm of the burial of unknown soldiers those who have served us and give it made the ultimate sacrifice, whether voluntary or involuntary right are there ways that medical schools can establish a form of honor for unknown medical research remains and how might we go about that. And also a second comment really about how might we learn from religious traditions and conceptions of life in order to properly recognize the significance. So I'm going to stop talking there I'm going to give each of you we have about just about two minutes I'm going to each of you about a little just a little bit of time for a final comment and reflection and express my gratitude on behalf of the Center for Bioethics for really beginning beginning this important conversation in this particular space on an issue I know that we will come back to time and time again. I'm going I'm going to go. First I'll go to Dinesh then I'll go to Dominic, and then we will give Sabine the last the last word. And we have just about 30 seconds. Yeah, yeah, no I just want to echo what you said back to be I mean thank you to both Dominic and Dr elderburn for for letting me, you know, offer my, my response is, I'm very humble to kind of participate in the conversation and I think I think the crux comes back to what you all said I think it's important to continue to have these conversations. Be honest be humble, be be open to learning from the mistakes of the past and not forgetting about them. I think if we can at least take that step then we're at least on a better track than we were in the past. So thank you so much. Thanks, Dominic. In regards to the sort of the unknown soldier example which I think is interesting the that there is a decision that one has to make first when you're talking about medical remains that are in collections is that does this have we outlived and I'm not going to get underway on this but how we outlived how we outlived the research life of the remains in this collection. And that is, you know, and if you're treating you know you treat them as all, you know individual remains and that's a question that people have to answer first before they make that secondary decision. So, you know that's a way to question. But again, it's things like this talking about it. Maybe we can get us to those answers, and at least to somewhat quick way. Thanks. Thank you and thank you for leaving us as always or as almost always in these sessions with more questions than than answers perhaps. And to me, we'll give you the final word on our time here together today. I would like to add that being transparent about the history and the present of what we're doing in the anatomy labs in the anatomy education has served us all extremely well. Our students have become much more questioning, much more open and they have actually in our memorial service that they organize for our donors they have included the skeletons of unclaimed donors. So, we need to make this part this history needs to inform our education it needs to become a standard part of education. There was a question in the, in the chat about this we need to have a curriculum that is history informed. Great. Thank you so much. Thank you to the three of you for a conversation and raising the ethical questions that we will all be grappling with for a long time to come. It's a pleasure. Thank you so much. Thank you.