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Holocaust and Genocide Studies in Nursing
Education: Nurse Practitioners as Critical
Intellectuals
Zvika Orr, PhD, MA; and Anat Romem, DNP, GNP, RN
Nazi Germany is a low point in the history of nursing,
as many nurses participated in programs of compul-
sory sterilization, “euthanasia,” and annihilation con-
ducted by the Nazis (Benedict & Shields, 2014; Shields et al.,
2022). Despite the importance of this era for understanding
processes that affect present and future nursing, Holocaust and
genocide studies are not part of the curriculum in most nurs-
ing school programs. Recently, there has been a call to include
this topic in health professions curricula (Chelouche, 2021;
Copeland, 2021; Horton, 2019, 2020; Roelcke et al., 2021;
Silvers et al., 2021). However, Holocaust and genocide stud-
ies usually are taught in medical and not nursing schools as an
elective course in undergraduate programs.
This article analyzes a unique Holocaust and genocide cur-
riculum for nurses and its effects on participants. This cur-
riculum is a requisite part of the graduate nursing degree and
nurse practitioner (NP) program. We contend that not only
can Holocaust and genocide studies help nurses and nursing
students internalize the medical-nursing ethics (Ben-Sefer &
Sharon, 2014; McKie, 2004) but also can lead nurses to adopt
an intellectual and critical approach on public issues and sup-
port marginalized patients and disadvantaged social groups.
LITERATURE REVIEW
Holocaust and Genocide Studies
for Health Professionals
Medical professionals played key roles in both develop-
ing and carrying out some of the most appalling crimes of the
Holocaust. Nazi doctors and nurses were not forced to partici-
pate nor did they act in an ethically free vacuum. More than
45% of German physicians voluntarily joined the Nazi Party,
and a code of medical ethics existed prior to World War II (Reis
et al., 2019). German nurses were just as complicit as German
physicians, and in larger numbers (Benedict et al., 2007, Bene-
dict & Shields, 2014; Shields et al., 2015). They were involved
in the identication, selection, and murder of vulnerable hu-
mans (Benedict & Shields, 2014; Copeland, 2021; Shields et
al., 2022). The few nurses who opted out of the genocidal pro-
grams were not punished (Ben-Sefer, 2006; Fernandes & Ecret,
2019).
Genocides have occurred several times since 1945, and in
some instances, killing and violence still continue. Some past
genocides and atrocities are still denied by states, such as the
Armenian genocide (Auron, 2003). However, the Holocaust
differs from other genocides due to the active participation of
health care professionals (Chelouche, 2008).
Despite widespread knowledge of the Holocaust, a 2018
study of millennials in the United States found 22% were not
sure they had ever heard of the Holocaust (Copeland, 2021).
The core requirements for university students in the U.S. gener-
ally do not specify Holocaust and genocide studies (Hurwitz,
ABSTRACT
Background: In most nursing schools, Holocaust and
genocide studies are not part of the curriculum. How-
ever, studying past horrors involving health care profes-
sionals is essential for forming a clear moral compass to
navigate future nursing practice. This article analyzes a
unique Holocaust and genocide curriculum for gradu-
ate nurse practitioner students and its effects on partici-
pants. Method: The students wrote reflective accounts,
which were analyzed using qualitative content analy-
sis. Results: The studies had a profound effect on the
students, who adopted a critical perspective and became
more sensitive to wrongdoing and social suffering, more
involved in current ethical and social issues, and more will-
ing to engage in social advocacy. The course strengthened
the moral responsibility of the students, transforming
them into critical intellectuals. Conclusion: Holocaust and
genocide studies enhance nurses’ humanistic approach
and help them confront dogma, challenge social denial,
and resist oppression, discrimination, and structural rac-
ism. [J Nurs Educ. 2022;61(11):624-632.]
Zvika Orr, PhD, MA, is a Senior Lecturer. Anat Romem, DNP, GNP, RN, is
the Head of the Graduate Programs. Both contributors are affiliated with
the Department of Nursing, Jerusalem College of Technology.
Address correspondence to Zvika Orr, PhD, MA, Department of Nurs-
ing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem
9548311, Israel; email: orr@g.jct.ac.il.
Grant: The Holocaust and genocide studies program was supported
by Israeli Hope in Academia.
Disclaimer: The funding source was not involved in determining any
aspect of the program.
Disclosure: The authors have disclosed no potential conflicts of inter-
est, financial or otherwise.
Acknowledgment: The authors thank Beth Zalcman and Michal
Zach for their research assistance and Israeli Hope in Academia for their
support.
Received: June 30, 2021; Accepted: April 20, 2022
doi:10.3928/01484834-20220912-04
624 Copyright © SLACK Incorporated
2007). A study in Australia on the prevalence of Holocaust stud-
ies in nursing, midwifery, and medical schools found little atten-
tion was given to the topic (Shields et al., 2015; Wynia et al.,
2015). Educators’ difculty in approaching the topic of genocide
competently is a real concern (Johnson & Pennington, 2018).
However, as the Galilee Declaration (Second International Con-
ference on Medicine in the Holocaust and Beyond, 2017) states,
it is essential “to encourage the study of the roles of health profes-
sionals in medical atrocities committed during the Nazi period…
and the many implications that this legacy holds for us for today.”
Studying past horrors is essential for forming a clear moral
compass to navigate future medical and nursing practice. This in-
cludes stigmatization, assisted reproduction, resource allocation,
obtaining informed consent, beginning- and end-of-life care,
genomics, and technology expansion (Reis et al., 2019). Study-
ing historical medical abominations can encourage health care
professionals to resist institutional racism, structural violence,
intolerance, and discrimination (Horton, 2019, 2020). It also can
help health care professionals be more aware of the inherent risk
factors in the medical profession that can lead to the abuse of
power, such as hierarchical power imbalances (Reis et al., 2019).
To avoid ethical transformation when the means subvert the
end, nurses must learn the importance of the ethics of responsi-
bility to bear witness and question authority (McKie, 2004). To
avoid empathetic erosion, nurses must be aware of the continued
need for compassion in the face of economic, social, and profes-
sional pressures. Nurses must learn to be truth tellers and whistle-
blowers, as being advocates for patients binds them to ethical
practice (Ben-Sefer, 2006; Fernandes & Ecret, 2019; McKie,
2004).
Social Advocacy in Nursing
The nursing profession has a long history of advocacy, which
has become part of its underlying professional ethos (Hanks,
2013; Thurman & Ptzinger-Lippe, 2017). Nursing advocacy is
dened as “nursing acting on behalf of others, such as patients,
families, groups, or society at large” (Hanks, 2013, p. 164). So-
cial advocacy is a type of nursing advocacy that “extends beyond
the patient-nurse dyad and the boundaries of institutional walls…
brings light to social justice issues and spurs nurses…to advocate
on the societal level for signicant changes related to the welfare
of the public” (Hanks, 2013, pp. 163, 167). Social advocacy is
included in the Code of Ethics for Nurses With Interpretive State-
ments (American Nurses Association, 2015). This code obligates
nurses to advocate against racism, discrimination, and injustice.
It states that nurses “must bring attention to human rights vio-
lations in all settings and contexts” (p. 33), including genocide,
abuse, and hate crimes. The American Nurses Association (2020)
also adopted a resolution on racial justice for communities of
color, stating that racism is a public health crisis. However, de-
spite these overarching statements on social advocacy, the major-
ity of the theoretical and practical frameworks in nursing have
remained focused on the individual patient-nurse dyad (Thurman
& Ptzinger-Lippe, 2017).
In recent years, nursing schools increasingly have incorpo-
rated issues of structural racism, discrimination, implicit bias,
and abuse of power in their curricula (e.g., Coleman, 2020;
Valderama-Wallace & Apesoa-Varano, 2019). The American
Association of Colleges of Nursing (AACN) (2021) integrated
these issues in its Essentials document that outlines required
curriculum content. According to the Essentials, “Academic
nursing must address structural racism, systemic inequity,
and discrimination in how nurses are prepared” (p. 6). Nurses
should understand their conscious and unconscious biases to
fulll their responsibility to enhance social justice. Similarly,
the National League for Nursing (2021) created the “Taking
Aim” initiative, which supports the training of nursing students
in topics such as diversity, equity, inclusion, and social justice.
Scholars also have developed various educational methods,
such as the Social Change Model, to promote leadership for
social change and health equity (Read et al., 2016), and teach
courses on advocacy ideas, emancipatory knowledge, civil
rights, and structural competency (Finkelstein & Orr, 2021;
Mohammed et al., 2014; Orr & Unger, 2020b; Orr et al., 2022).
The syllabi of nursing research courses often include readings
of ethical principles, such as the Belmont Report (National
Commission for the Protection of Human Subjects of Biomedi-
cal and Behavioral Research, 1979).
Despite the importance of these statements and initiatives
by nursing organizations, they have been criticized for largely
being ahistorical. According to Walker (2020), “Almost none
of the statements by major professional nursing organizations
acknowledged nursing’s long history and ongoing complicity
in upholding structural racism and white supremacy.” Further-
more, in many countries, including Israel, most nurses still
choose an “apolitical” approach, advocacy is largely restricted
to the individual patient level, and nurses rarely are involved in
public affairs (Alhassan et al., 2020; Orr & Unger, 2020a). This
has a justiable rationale: to make the hospital and clinic a safe
haven for all. However, it can lead to overlooking contemporary
structural violence. We suggest Holocaust and genocide stud-
ies can and should become a key element in the current efforts
to educate nurses toward social advocacy. This element is ef-
fective because it adds a contextualized and historical perspec-
tive that provides nursing students with lessons from one of the
darkest eras of the nursing profession’s history.
Critical Intellectuals
This article proposes that Holocaust and genocide studies
contribute to the socialization of nurses as critical organic intel-
lectuals. Edward Said (1994) asserted that the intellectual is a
person who represents, embodies, or articulates a view, an at-
titude, or an opinion to, as well as for, the public. Intellectuals
must belong on the same side with vulnerable, disadvantaged,
and unrepresented people. Their raison d’etre is to represent
people and issues routinely forgotten, denied, or neglected:
The intellectual does so on the basis of universal principles:
that all human beings are entitled to expect decent standards of
behavior concerning freedom and justice from worldly powers
or nations, and that deliberate or inadvertent violations of these
standards need to be testified and fought against courageously.
(Said, pp. 11-12)
Intellectuals cannot be easily co-opted by governments or
corporations, as their “whole being is staked on a critical sense,
a sense of being unwilling to accept easy formulas, or ready-
made clichés, or the smooth, ever-so-accommodating conr-
625
Journal of Nursing Education • Vol. 61, No. 11, 2022
mations of what the powerful or conventional have to say, and
what they do” (Said, 1994, p. 23).
Gramsci (1971) maintained that all persons are potential in-
tellectuals and viewed intellectuals not only as speakers or writ-
ers but also as those who build their society in practice. Gramsci
believed the participation of intellectuals could not be excluded
from any human activity—“homo faber cannot be separated
from homo sapiens” (i.e., man the maker and man the thinker)
(p. 9). Gramsci distinguished between traditional professional
intellectuals (e.g., literary or scientic) and organic intellectuals,
who represent subaltern social groups and challenge the hege-
monic common sense. A major role of the organic intellectual
is to facilitate intellectuality in others (Holmes, 2002). Accord-
ing to Racine (2021), Gramsci’s notion of engaged intellectuals
should be deployed to articulate nursing’s response to racism
and racialization.
Both Said (1994) and Gramsci (1971) conceptualized the
intellectual as a politically engaged person who aspires to af-
fect and transform the sociopolitical reality. However, health
organizations and professionals often prefer to adopt a depoliti-
cized approach in which “issues are driven outside the political
realm and actors minimize, avoid or conceal the political dimen-
sion of their action” (Louis & Maertens, 2021, pp. 5-6; see also
Barnes & Parkhurst, 2014, and Hunsmann, 2016). Ostensibly,
the politicization of the nurses in Nazi Germany was part of the
problem. However, Steppe (1992) showed the nurses’ apolitical
professional consciousness made it possible for the profession
to be subsumed into the larger political system. German nurses
were under the illusion that they were unaffected by the larger
sociopolitical change. Steppe argued that because nurses never
operate in a neutral context, they must engage in shaping socio-
political developments.
This article examines the Holocaust and genocide curriculum
at the Jerusalem College of Technology (JCT) and its effects on
graduate NP students, specically as social advocates and criti-
cal intellectuals.
METHOD
The Curriculum
Since 2019, the Holocaust and genocide studies are manda-
tory for all rst-year students in the integrated Master of Sci-
ence in Nursing and NP program in geriatrics or palliative care.
All of the students in this program are experienced nurses. The
curriculum has the following three elements: (1) an academic
course, (2) a study day at Yad Vashem—The World Holocaust
Remembrance Center, and (3) a study day at the Ghetto Fighters’
House Museum. These study days were held on-site in 2019 and
virtually during the coronavirus disease 2019 (COVID-19) pan-
demic. The course includes lectures, discussions, lm analysis,
survivor testimony, interactive peer learning, concept analysis,
and student presentations. Lecturers include nurses, physicians,
historians, social scientists, and a lawyer, from both JCT and
other universities. To date, 125 students have participated in the
full program, and other students and faculty have attended lec-
tures that were open to the entire JCT community.
The course began with a study day at the Holocaust
History Museum of Yad Vashem in Jerusalem, guided by Dr.
Shai Feuering. This multidisciplinary museum provided stu-
dents with the historical background for the course, focusing
on the development of the “Final Solution.” It also allowed
students to connect on an emotional level to the course top-
ics because the museum emphasizes the personal experience of
individual victims through original artifacts and survivor tes-
timonies (Yad Vashem - The World Holocaust Remembrance
Center, 2022). The aspects highlighted were related to health
care providers and introduced some of the issues that were elab-
orated later during the course. The curriculum examined four
main aspects of the Holocaust and genocide (Table 1).
Collaboration of health care professionals with the Nazi
regime. A central element in the curriculum was the collabora-
tion of health care professionals with the Nazi regime and the
decisive role these professionals played in perpetrating Nazi
crimes. This included a visit to the Ghetto Fighters’ House
Museum for the exhibition, “Deadly Medicine: Creating the
Master Race,” curated by the U.S. Holocaust Memorial Muse-
um (n.d.). The exhibition presents the Nazi’s “science of race”
and various activities from 1933 to 1945 meant to “cleanse”
the German society of people viewed as threats to the nation’s
“health.” The exhibition also traces the roots of this ideology
to the early 20th-century eugenics movement in other coun-
tries and explains how German physicians and nurses actively
engaged in the Nazi racial health policies that started with the
mass sterilization of “hereditarily diseased” people and ended
with the murder of millions of Jews and other populations
(Ghetto Fighters’ House Museum, n.d.). The students also par-
ticipated in the museum’s workshop about “healing by killing.”
Students learned about this process from scholars such as
Dr. Tessa Chelouche, who discussed “medical ethics” under the
Nazi regime (Bruns & Chelouche, 2017) and the connection be-
tween American Eugenics and Eugenical Sterilization and the
German Racial Hygiene. Dr. Chelouche analyzed the symbiosis
between health care professionals and the Nazi state, and these
professionals’ contribution to developing, legitimizing, and im-
plementing Nazi policies (Bruns, 2014; Lifton, 1986; Proctor,
1988). The case of nurses who chose to participate in the T4
“Euthanasia” program was discussed.
Social denial and bystander indifference. Students ana-
lyzed questions of social denial of contemporary horrors, the
indifference of bystanders, and the denial of past atrocities,
such as the Armenian genocide. Professor Yair Auron discussed
the Banality of Denial (Auron, 2003), including why Israel has
not recognized the Armenian genocide. Other genocides, such
as the ones in Rwanda, Bosnia, and Darfur, also were discussed
as well as the international reaction (or lack thereof) to these
genocides. The social denial theory in States of Denial (Cohen,
2001) helped analyze this phenomenon (e.g., the distinction be-
tween literal denial, interpretive denial, and implicatory denial).
Jewish medical professionals’ experiences during the
Holocaust. Students learned about the experiences of dedicat-
ed Jewish physicians and nurses during the Holocaust. These
medical professionals worked under subhuman conditions, in-
cluding disease, hunger, and lack of supplies, to provide health
care, maintain sanitation, and contain epidemics. Dr. Miriam
Offer shed light on the tremendous medical ethical dilem-
mas and conflicts that these professionals encountered, as
626 Copyright © SLACK Incorporated
well as the research and teaching that they insisted on continu-
ing in the ghettos (Offer, 2020). The course also examined the
role of non-Jewish medical professionals, such as prisoner doc-
tors, who offered assistance in the camps. One of these indi-
viduals saved the life of Rabbi Yisrael Meir Lau, the former
Chief Rabbi of Israel, who shared his story with the students.
Moreover, the students learned about leadership in times of cri-
sis. In Yad Vashem, Professor Dina Porat talked about Jewish
women leaders during the Holocaust. The students participated
in a workshop of the Ghetto Fighters’ House Museum on the
survivors’ testimonies at the Eichmann Trial. Dr. Sharon Geva
examined how Israeli society viewed women Holocaust survi-
vors over the years.
The perspective of Holocaust survivors. Dr. Laurie Glick
explained the types of physical and mental morbidity expe-
rienced during the Holocaust, as well as those that currently
characterize Holocaust survivors. Dr. Haya Raz illuminated the
experience of growing up in hellish conditions as well as the
long-term effects. The course also emphasized the resilience
and hopefulness expressed by Jews during the Holocaust and
by survivors. The nurses received professional tools to better
understand, communicate with, and provide nursing care and
support for Holocaust survivors and other traumatized patients
(Orr & Romem, 2021).
This article focuses on the rst two elements in the curricu-
lum, namely the collaboration of German health care profes-
sionals with the Nazi regime and bystander behavior, and how
learning these issues affected the graduate students.
Students’ Reflective Accounts
The program emphasizes the role of nurses as critically re-
ective practitioners (Schön, 1983; Thompson & Thompson,
2018). Reective practice ensures nursing work is informed by
a knowledge base that is open to scrutiny and challenge, and by
a clear value base (Thompson & Thompson, 2018). Students
were encouraged to be reective of their nursing practice, their
learning, and the connection between them. Students also were
encouraged to be involved in both reection-in-action and re-
ection-on-action (Schön, 1983).
Students wrote reective accounts during the course; they
were requested to write the reection throughout the course
rather than at one point in time. Students were instructed to
write shortly after their experiences (e.g., lectures, workshops,
museum visit, and professional experiences that reminded them
of what was learned in class) when the memory and experience
were still fresh in their minds. In addition, it was recommend-
ed that students take a break and return to their writing from a
more distant perspective. After writing the reective analysis on
different components of the course separately, students were in-
structed to attempt to examine the different components in a ho-
listic perspective as well. Most of the students handed in three
to eight pages of reection. Many of the students said the re-
ective writing helped them process the intense and emotional
learning experience, and view their routine professional praxis
anew. Students were invited to share their reections in class.
This method was interrelated to the contents of the course,
because, as Holmes (2002) argued following Gramsci (1971),
nurse educators can and should help those around them real-
ize their status as intellectuals by assisting them to recognize
their capacity for critical reection. As engaged intellectuals,
nurses should recognize and challenge their preconceptions and
accepted patterns of thought, behavior, and feeling (Holmes,
2002). Their reexivity should be used to critically examine is-
sues that may preclude the delivery of equitable nursing care
(Racine, 2021). Reection has been found to be an effective
method to develop nurses’ open-mindedness, critical aware-
ness, and doubt. Reection allows nurses to see what others
tend to overlook and promote social justice and human rights in
their practice (Bulman, 2013; Johns, 2017). These abilities are
particularly relevant to the present curriculum.
This article presents an analysis of the students’ reections.
This analysis allows for measuring whether and to what extent
students developed the perspective of critical intellectuals and
social advocates following the intervention, namely the course.
Student texts were coded and analyzed inductively using quali-
tative content analysis (Braun & Clarke, 2021). Following a
holistic reading of the raw data, open coding that included an
initial division of the data into many thematic categories was
conducted. Connections then were identied between these
initial categories, similar categories were combined, and other
categories were rened. Core categories were chosen that com-
prised the meaningful thematic clusters around which the nd-
ings were organized. Finally, after the conceptual descriptions
and explanations were formed, the raw data were reexamined
to conrm that the analysis did not lead away from the data.
Students’ texts were anonymized. Students consented to the
publication of quotes taken from their texts.
FINDINGS
The students’ reective writing revealed three main themes
(Table 2). First, following the course, the nurses attempted to
maintain a critical and independent point of view, to become
TABLE 1
Curriculum Elements and Resources
Element Resource
Historical background of
the Holocaust
Yad Vashem Museum
The role of physicians and
nurses in plotting and
executing Nazi crimes
Ghetto Fighters’ House Museum;
classroom
Apathetic bystanders, states
of denial, and indifference
to genocide and extreme
human suffering
Classroom
Jewish health care providers
during the Holocaust and
Jewish women’s leadership
Yad Vashem Museum; classroom
Holocaust survivors and
the current treatment of
survivors and patients who
are traumatized
Ghetto Fighters’ House Museum;
classroom
627
Journal of Nursing Education • Vol. 61, No. 11, 2022
more sensitive to wrongdoing and more committed to pre-
venting them, and to develop their advocacy skills. Second,
the Holocaust and genocide studies encouraged the nurses
to engage in current ethical and social issues, such as social
discrimination in the health care system and stigmatization
of individuals with disabilities. Third, the nurses became
more cognizant of states of denial and bystander indiffer-
ence, including their own indifference to contemporary
atrocities and structural violence, and they challenged this
prevailing social denial.
Maintaining a Critical Perspective
and Preventing Wrongdoing
In their reective reports, the participants emphasized their
surprise regarding the extent of nurses’ involvement in the
Nazi mass killings. Referring to the Nazi T4 program, one par-
ticipant said, “I was astounded and angered to learn that those
who performed the euthanasia were mostly nurses rather than
physicians.” The students tried to comprehend the process that
led the German nurses to become part of systematic annihila-
tion and asked the following questions:
1. What was the slippery slope that led nurses to cooperate
closely and ideologically with the Nazi regime?
2. What was it in the nurses’ professional worldview that al-
lowed this?
3. Could it happen again?
Many of the students gained a profound understanding of
their moral and social responsibilities, and their duty to take
a proactive role against evil. One participant said, “We are at
risk of becoming less sensitive. This is something I want to
be aware of in my daily work…to keep from becoming indif-
ferent, or worse yet, accepting and tolerating inhumane and
unacceptable acts.”
The participants also asked how they could use their author-
ity without harming the patient and maintain a critical perspec-
tive when facing situations that have become the norm. One
participant said:
Physicians who were supposed to protect human dignity
became so involved in the ideology that they actively partici-
pated in the murders.…What about me, with my daily work,
to what extent can I remain critical, maintain an independent
perspective, and not become part of the mainstream?...I want
to acquire knowledge so that I can confidently criticize things
that appear self-evident.
Many students expressed their desire to develop awareness
and sensitivity to wrongdoing and to prevent them. One stu-
dent noted that only through participation in this course did
she understand:
This is an extremely slippery slope.…Today, when we met
with [a holocaust survivor] and saw the number tattooed on
her arm, I vowed that no matter what happens, I will stay in the
lead and on guard, to protect…those who are helpless.
Another student who spoke of the importance of nurses ad-
vocating for their patients said, “I think that we, as the nurs-
ing team, see our patients and treat them in the most humiliat-
ing, painful, and critical moments; hence, we must maintain a
strong moral compass and be sure to advocate for the patients.”
A participant who described the concept of advocacy, as
well as leadership, after her experience in the course said:
I often feel the need to advocate for the patients when they
encounter the physician, taking a leadership role in the situa-
tion. More than once, I have found myself arguing with a physi-
cian and insisting on my opinions.
The same participant noted that after the course she was
more sensitive to ethical issues:
This week, I encountered a case in which the blood re-
sults of a 90-year-old patient were abnormal, and I asked
the physician to refer him to a dietitian. The physician’s re-
sponse, which was, ‘What for? He’s old,’ left me so angry.…
TABLE 2
Main Themes
Themes Sub-Themes
Maintaining
a critical
perspective
and
preventing
wrongdoing
Understanding the process whereby German
nurses played an active role in systematic
annihilation
Understanding the nurses’ moral and social
responsibilities;
How to use their authority without harming
the patient
Developing awareness and sensitivity
to wrongdoings and preventing future
wrongdoings; Identifying the slippery slope
The importance of nurses advocating for their
patients and being leaders
Understanding the danger of abusing
medicine’s power
Engaging in
contemporary
ethical and
social issues
Questioning the students’ own personal and
professional practices and ethics
Inquiring whether eugenics currently exists in
health care systems
Examination of current moral dilemmas
Rethinking issues of social discrimination
and unethical considerations in professional
decisions
Discerning and changing stigmatizing
attitudes toward people with disabilities
Challenging
social denial
Forms of denial and bystander indifference
during the Holocaust
Realizing that indifference characterizes
our world and society, which tolerate social
suffering
Understanding the students’ own indifference
to contemporary atrocities and structural
violence
Linking the horrors of the past to those of the
present
Attempting to prevent a situation of not
believing an atrocity exists
628 Copyright © SLACK Incorporated
Is it our place to dictate the patient’s quality of life or decide
when to end it?
The students noted the extreme power associated with medi-
cine and the devastating potential if that power is abused. They
spoke of the paternalism and hubris that characterize today’s
medical teams and the potentially dangerous implications of
this state of affairs. One student noted that she had a deeper
understanding of “how dangerous power can be, even when
granted to people who are supposed to heal us. Power can make
us arrogant and conceited.…This arrogance can lead to the loss
of human life.”
Engaging in Contemporary Ethical and Social Issues
Examining nursing practices during Nazi Germany raised
questions among the students regarding both their current per-
sonal practices and ethics, and those associated with the nursing
profession. One student, who was studying to become an NP in
the eld of palliative care, said:
They were transformed from representatives of healing and
compassion…to the willing and eager servants of the Führer.
Where do I come in?. . .What is my response when the family
asked if their relative should be disconnected from the feeding
tube? How easily I suggested that they give up.…Do I have a
sufficient understanding of the severity and responsibility my
words have at this crucial moment? Do I treat life as preciously
as I ought?
The participants wondered whether concepts such as eugen-
ics exist in today’s health care system. They gave a variety of
current examples that could be considered a type of eugenics.
One student said:
To what extent are we still at the top of the hill or have we
started to our descent down the slippery slope?. . .For example,
the extensive number of prenatal tests that Israeli women take
compared to women throughout the world.…Does such exten-
sive testing lead to a greater number of abortions of fetuses that
are at risk of having a defect or an illness?
Another student said:
As far as the scientific world is concerned, there is a race to
create the perfect human.…Has anything really changed? Al-
though today this is not accompanied by mass murders, there
are ideologies that, in some sense, have not changed. For ex-
ample, is it ethical to eliminate a fetus based on sex or eye color,
or to engineer fetuses according to the parents’ request?
For one student, the study of the past led her to a more
profound examination and understanding of today’s moral
dilemmas:
Without gaining an in-depth understanding, one might
think that eliminating defective genes could lead to a healthier
population…For example, as a nurse, I am sometimes angered
to hear that children are born with severe disabilities and are
unable to live a life of dignity…but things are not that simple.
After visiting the museum, I understood the enormity of the di-
lemma.
Studying this era in history led students to reconsider issues
of social discrimination that can cause unnecessary suffering.
One student said:
In my daily work, I see things that bother me on a conscien-
tious level: preferential treatment based on ethnic background
or social status, lack of proper end-of-life care, attitudes of dis-
missal toward patients with dementia and plain disregard of
their needs, [and] disregarding complaints of patients because
of their worldviews.
After learning about medical ethics during the Nazi era, an-
other student asked:
How will we make sure that our ethics have clear and stable
rules, and focus on the needs of the patient? Nowadays, is our
loyalty first and foremost to the patients, or do we involve organi-
zational, political, and financial considerations in our decisions?
Many of the students considered current attitudes toward in-
dividuals with disabilities. After discussing the topic with their
colleagues, they found that a large portion had stigma; some of
the colleagues said they would even consider it legitimate to
sterilize people with disabilities. One student said:
I was amazed to discover that when I spoke to people about
the idea of sterilization, some of them thought it legitimate…
We treat people with disabilities as second-rate. In hospitals, pa-
tients with mental illnesses are considered a nuisance, and the
staff doesn’t like to take care of them.
Challenging Social Denial
After learning about states of denial, the students applied this
theoretical knowledge to various scenarios that took place dur-
ing the Holocaust. Students were especially bothered by the in-
difference of the bystanders surrounding the ghettos and concen-
tration camps who saw, heard, and smelled the horrors but did
nothing. The students were equally disturbed by the realization
that indifference characterizes our society and that they them-
selves were indifferent to contemporary humanitarian disasters,
wars, and structural violence.
Regarding bystander indifference during the Holocaust, one
student said:
How is that even possible? I understand that we too demon-
strate indifference nowadays.…We see what’s going on in the
world, and there is no shortage of horrific events.…Although
I am shaken by such atrocities…I continue my daily life after
watching the segment on the news. In that sense, I am commit-
ting the same sin of indifference.
After visiting Yad Vashem, one student said:
It was a strong and shocking experience; I too am guilty.…
These things exist in today’s world as well. In various places
throughout the world, people…are being trampled by radical-
ized military forces.…The world remains silent, just as it did
then. Consider, for example, northern Ukraine, the Kurds in Syr-
ia, and other minority groups.
During their visit in Yad Vashem, students thought about the
horrors of the present. One student said:
I stood there facing caricature posters published by the Nazi
regime through the media, and right away I was reminded of the
present. The media brainwashes us incessantly.…Not every-
one has the wherewithal to stop and seek out the truth…that’s
scary.…In Russia, Putin is trying to take complete control of the
media.…In Syria, Bashar Hafez El Assad used chemical weap-
ons against the citizens of his country.…Why was the world si-
lent then, and why is it silent now?
Another student shared her feelings after watching Claude
Lanzmann’s documentary lm (2010), The Karski Report,
629
Journal of Nursing Education • Vol. 61, No. 11, 2022
which discusses the denial and indifference of the Western Al-
lies’ prominent leaders. The student referred to a quote pre-
sented in the lm:
Someone once asked Raymond Aron, who was exiled in
London at the time, if he had known about what was hap-
pening in Eastern Europe. He answered, “I knew, but I didn’t
believe it, and because I didn’t believe it, I didn’t know.”
(Lanzmann, 2010).
The student said, “This sentence…made me think about
situations in life in which we ‘choose’ to know but not to be-
lieve.” Consequently, this student said she developed “self-
consciousness and reection on what I can do and change in
myself to prevent a situation in which I choose to know but
not to believe.”
One student criticized the prevailing discourse in Israel that
often tolerates the social suffering of other people. The student
noted:
You might expect that the people that have suffered anti-
Semitism…[would] be more sensitive to the suffering of other
peoples; sadly, however, this is not always the case.…In our
country, we are experiencing a rift between people on the left
and the right…the left is viewed as undermining the nation.
DISCUSSION
Oftentimes, the lessons learned from Holocaust and geno-
cide studies pertain to medical ethics (Ben-Sefer & Sharon,
2014; Chelouche et al., 2013; McKie, 2004). However, these
studies also can have a broader effect on students’ habitus, fa-
cilitating a deeper socialization of nurses as organic intellec-
tuals (Gramsci, 1971) and critical intellectuals (Said, 1994).
Holocaust and genocide studies allow nurses to grasp their
moral responsibility as engaged intellectuals in the public
sphere, unearthing issues and people who are routinely si-
lenced or denied. These studies illuminate the signicance of
confronting dogma and questioning issues often considered by
society to be unquestionable, emphasizing nurses’ moral and
professional duty to represent disempowered groups exposed
to structural violence. Teaching the Holocaust and genocide in
nursing schools is highly effective in raising awareness of the
possible abuses of power in the health professions, equipping
nurses with a moral compass to navigate moral challenges,
building an ethic of responsibility and social involvement,
and teaching nurses to bear witness and become advocates
for their marginalized patients (Chelouche, 2021; Copeland,
2021; Shields et al., 2022; Silvers et al., 2021). These abilities
and moral-social commitment lie at the heart of the conceptu-
alization of the critical and organic intellectual (Said, 1994;
Gramsci, 1971).
This learning and socialization are especially meaningful
and effective because nurses in general and NPs in particular
have distinct professional characteristics that allow them to be-
come organic intellectuals who not only talk but also act, stand
by the disenfranchised, and provide critical analysis challeng-
ing the hegemonic common sense that has become transparent
for most people (Gramsci, 1971; Holmes, 2002; Racine, 2021).
Throughout this process, nurses can build on their tradi-
tional advocacy role (Hanks, 2013; Thurman & Ptzinger-
Lippe, 2017). Nurses’ professional ethos of advocacy for dis-
advantaged individuals and marginalized social groups is quite
similar to what Said (1994) called “a vocation for the art of rep-
resenting” (p. 13). Nurses’ unique professional position helps
them recognize bodily harm caused by sociopolitical injustices
and other structural forces (Pine, 2013). Nurses can use this po-
sition to act when they face injustices, in keeping with Florence
Nightingale’s legacy that nurses’ sociopolitical action is an ex-
pression of caring (Falk-Rafael, 2005). Holocaust and genocide
studies encourage nurses to move beyond advocating for the
individual patient and engage in social advocacy based on their
code of ethics (American Nurses Association, 2015).
Specically, NPs can play an essential role in challenging
the consensus. On one hand, given their professional authority
in the eld of nursing, they can serve as advocacy leaders. On
the other hand, in many countries, including Israel, NPs have
a liminal status in the health care system and their profession-
al status is debated and contested by physicians. To exercise
their authority, NPs often are forced to contest physicians and
institutional administrations that seek to maintain physicians’
professional monopoly and autonomy. Consequently, NPs can
nd themselves at the outer edges of the health care system, a
position from which they can view the state of affairs with fresh
eyes, identifying problems and issues that others who have be-
come part and parcel of the medical institution fail to see or rec-
ognize. This position allows them to recognize and react when
medical teams abuse their power.
Holocaust and genocide studies can be seen as a novel com-
ponent in the recent trend of incorporating issues of structural
racism, systemic inequity, discrimination, structural violence,
and implicit bias in the nursing curriculum (American Associa-
tion of Colleges of Nursing, 2021; National League for Nursing,
2021). These studies have the potential to add a much-needed
historical contextualization that is often missing in the current
efforts to increase the social responsibility in nursing (Walker,
2020). These studies also can help challenge the depoliticized
approach of the nursing profession prevalent in many countries,
including Israel, where nurses are underrepresented in the poli-
cy-making process (Alhassan et al., 2020; Orr & Unger, 2020b).
Learning the historical lessons of the Holocaust demonstrates
that nurses never operate in a politically neutral context, and
therefore they should engage in social-political issues (Steppe,
1992) in line with the conceptualization of the intellectual as a
socially and politically engaged person (Gramsci,1971; Said,
1994).
CONCLUSION
This article presented a requisite curriculum on Holocaust
and genocide studies for graduate nursing students. These stud-
ies can enhance the understanding of current ethical issues and
transform nurses, particularly NPs, into critical intellectuals
(Said, 1994) who strive to challenge social denial and resist op-
pression, discrimination, xenophobia, and racism. These studies
increased nurses’ responsiveness to injustice and human rights
abuses, strengthened their moral responsibility, and encouraged
them to question the uncontestable and become more sensitive
to social suffering. The students adopted a universalist and hu-
630 Copyright © SLACK Incorporated
manistic approach through the study of the Holocaust (Geva,
2017), which aligns with Said’s depiction of the intellectual and
departs from the narrow particularistic approach that focuses on
the link between the Holocaust and Jewish Israeli nationalism.
This program took place in Israel; thus, the participants
had previous knowledge of the Holocaust. In other countries,
there may be a need to familiarize students with the Holocaust.
Moreover, the Holocaust is a pivotal part of the Jewish-Israeli
collective memory, whereas most societies do not have similar
cultural ties to this history. Although this fact may make the
implementation of the present curriculum in other sociocultural
contexts more challenging, it also makes it more needed and
signicant. The two major centers for Holocaust education in
Israel, Yad Vashem and the Ghetto Fighters’ House Museum,
have excellent pedagogical infrastructure for experiential learn-
ing and offer distance learning for international audience.
Other educational institutions and museums in the U.S. and
in other countries offer an increasing number of online distance
learning tools, both synchronic and asynchronic, including we-
binars, online lectures, online exhibitions, virtual eld trips, and
PowerPoint® presentations for educators. The recent develop-
ment of online learning tools, which makes it easier to teach this
subject globally, may encourage more nursing schools world-
wide to include this subject in their curricula. Additionally, the
design of a local exhibition on this topic is recommend wher-
ever programs are established. Finally, this program also should
be accessible to nurses who have already completed their stud-
ies, possibly as part of their professional development.
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