Our query about whether an ethic of "do no harm" can be reconciled with physician-assisted suicide was intended to frame, not resolve, the issue. Dr. Schnaper's readiness to put patient suffering into the Equation is certainly legitimate. But this concern must be weighed against the potential for abuse. The German experience clarifies why physicians must never administer a lethal injection, however quick and painless, as capital punishment. It also suggests why physicians should be wary of recent legislative attempts to sanction their direct assistance in bringing about their patients' death.

Nazi eugenics, as Dr. Gelles notes, did borrow from U.S. eugenicists, some of whom were physicians. He is also correct in citing the pervasive role that racism has played, and continues to play, in U.S. medicine. Indeed, Gelles might have mentioned the infamous Tuskegee experiment [1] or other examples of unethical experiments done on black persons [2]. Nevertheless, we still believe that a distinction must be drawn. In Nazi Germany, when confronted by a racist political doctrine that explicitly contradicted and challenged its basic ethical tenets, the medical profession utterly collapsed. Physicians participated in the systematic expulsion of Jewish medical school faculty, the killing of terminally ill and psychiatric patients, gruesome experimentation, and, ultimately, the mass murder of millions of Jews. Although U.S. physicians have been sorely remiss in rectifying racial inequities in medical education and practice, they do not have this exceptionally shameful legacy to confront.