'Euthanasia' in the Third Reich: Lessons for today? (Schiavo?)

‘At this stage I do not feel that I am going to die, but I don’t want to die away later with my body being reduced to a little more than a lump. Please, promise to help me before this moment comes.’ Today, many physicians are familiar with incurably ill patients requesting them to end their lives because of unbearable suffering. In the case of the above quote the request for euthanasia is not made by a desparate twenty-first century patient. One finds it in the Nazi film Ich Klage an (I Accuse) which was produced in 1941. The message of the the two hour long film was that doctors who submit to an incurable patient’s death wish act legally and morally.¹

Hanna, the beautiful young wife of professor Thomas Heyt, is suffering from multiple sclerosis. Her husband, the newly appointed director of the Anatomical Institute of Munich University, knows that there is little hope for his wife. Hanna first asks her personal physician and family friend Bernhard Lang to end her life should the moment of unbearable suffering occur. Lang refuses and says: ‘I am your best friend, but I am also a doctor, and as such I am a servant of life. Life must be preserved at any cost.’

Hanna then approaches her husband Thomas in a very emotional way: ‘You must help me. I want to remain your Hanna till the very end, I don’t want to become somebody else who is deaf, blind, and idiotic. I wouldn’t endure that. Thomas, if you really love me, promise that you will deliver me from this beforehand.’

Hanna’s medical condition rapidly deteriorates. Thomas and Bernhard realize she has only a few weeks to live. One day they are together at Hanna’s bedside. Hanna kindly asks Bernhard to leave the room. She wants to be alone with Thomas. Bernhard goes to the piano in the living room where he starts to play. While the piano music can be heard in the bedroom Thomas fetches a bottle containing a sedative and poors a fatal dose into Hannna’s glass. Before passing away Hanna says, ‘I feel so happy, I wish I were dead.’ Thomas replies, ‘Death is coming, Hanna.’ Hanna responds, ‘I love you, Thomas.’ ‘I love you, too, Hanna,’ says Thomas.

Bernhard is furious when Thomas informs him what has happened. Domestic servant Bertha then accuses Thomas of murdering his wife and takes him to court. At issue is: can a doctor be allowed to cause the death of a terminally ill patient after that person explicitly requested him to do so? One of the witnesses is Bernhard. He says that he initially also opposed Hanna’s request, but now he sees things from a different perspective. ‘Thomas, you are not a murderer!’ he says loud and clear in the courtroom. Thomas himself then accuses (‘I accuse!’) those doctors and judges who by adhering to strict rules fail to serve the people. ‘Try me! Whatever the outcome, your judgment will be a signal to all those who are in the same position like me! Yes, I confess: I did kill my incurably ill wife, but it was at her request.’

From a propagandistic point of view the film was a success. The Gestapo, the secret state police, reported that the film received much attention in the whole Reich.² A Dutch woman living in Düsseldorf at the time told me in an interview: ‘All my colleagues were impressed by the film. They suddenly understood the dilemma of a doctor who is confronted with an incurable disease.’³

Hitler’s ‘Euthanasia Decree’
This remarkable propaganda film presents a case and a logic with which today’s medical profession is quite familiar. It is not the crude Nazi ideology of killing ‘worthless life.’ Rather it makes a smart plea for a terminally ill patient’s right to a ‘humane’ way of dying. Sixty years ago the Nazis occasionally used similar arguments as today’s humane and sincere advocates of euthanasia. Karl Brandt, the head of Hitler’s euthanasia program, claimed at his trial after the war: ‘The underlying motive was the desire to help individuals who could not help themselves and were thus prolonging their lives of torment.’⁴ However plausible or humane this may sound, the reality was far from humane. Indeed, the Nazis went far beyond killing the incurably sick, and few of the ‘individuals’ Brandt had in mind actually made a request that ‘their lives of torment’ should not be prolonged.

‘Euthanasia’ in the Third Reich was even a prelude to the Final Solution (Endlösung).⁵ Euphemistic terminology and covering up was the rule. Hitler’s Euthanasia Decree (‘Erlass’) of 1 September 1939 ordered his personal physician Dr. Karl Brandt and Reichsleiter Philip Bouhler, head of the Reich Chancellery, ‘to enlarge the authority of certain physicians to be designated by name in such a manner that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death (Gradentod).’⁶

Similar criteria were later found in Ich Klage an: Mercy killing (Gnadentod is in Nazi language synonymous to Erlösung) for those whose suffering could not be prolonged. However, the decree did not refer to the need for a specific request by the patient, in most cases persons with mental disorders. Karl Brandt later said in Nuremberg that ‘incurably sick persons’ primarily meant ‘insane persons.’⁷

Hitler’s decree was written on personal letterhead (‘Adolf Hitler. Berlin’) and highly secret. It was never made law, even when pressure was brought to bear to do so. The official bureaucracy was largely bypassed. Even Franz Gürtner, the Reich Minister of Justice, initially knew nothing about Hitler’s secret legalization of euthanasia, which by 1941 was practiced on a rather wide scale.

When Evangelical-Lutheran pastor Friedrich von Bodelschwingh, head of the large hospital and nursing-home ‘Bethel,’ confronted Gürtner with mass killings in nursing homes and mental institutions, the latter was upset.⁸ While Nazi law provided for forced sterilization (Sterilization Act of July 1933) of those having congenital disceases, euthanasia itself had never been officially legalized.⁹ Gürtner also received telegrams and letters from bishops who protested the killings. He then raised the matter with Philip Bouhler from the Führer’s Reich Chancellery and Interior Minister Wilhem Frick who both seemed to know more about the matter. When finally in 1940 a representative of Bavarian governor Franz Xaver von Epp showed up in Gürtners’ office and asked him to do something about certain Gestapo actions in mental institutions and subsequent disappearance of mentally ill patients, Gürtner sounded resigned. ‘My hands are tied,’ he said. ‘I can’t do anything about it, go to Mr. Bouhler at the Führer’s Chancellery Office, he can tell you from whom originated the order.’¹⁰

Operation ‘T-4’
The Nazi euthanasia program was code-named T-4. This referred to Tiergartenstrasse 4, the headquarters of the newly created bureaucratic apparatus. It was an insider’s group bound to strict secrecy rules. The Führer’s euthanasia decree was implemented through a number of instructions and administrative arrangements. Mercy killings took place in nursing homes and mental institutions. There were special questionnaires regarding a person’s health. On the basis of these documents an ever growing number of individuals was selected for T-4 action. Heads of establishments who were not initiated into T-4 practice and procedures were often tricked into believing that a number of their patients had to be transferred to better equipped treating centers. Not everyone was tricked, however. Pastor von Bodelschwingh, for example, suspected widespread abuse of medical standards and successfully sabotaged attempts to transfer patients under his care.¹¹

Abuse was beyond von Bodelschwingh’s worst suspicions. Operation T-4 centers were places of brutal medical experiments and mass killings of unwanted people considered a burden to society. They were Totungsanstalten (killing institutes). There were six of them: Grafeneck, Hartheim, Brandenburg, Sonnenstein, Bernburg, and Hadamar. In these special T-4 establishments nearly 9,000 people were gassed in the first half of 1940.¹² The total number of killings problably exceeded 100,000. The killings provided know-how for the subsequent gassing of the Jews in extermination camps. Indeed, under the name of Sonderaktion 14 f 13, T-4 even extended its activities to concentration camp inmates. More than 3,000 deformed children also fell victim to the T-4 frenzy.¹³

Doctors and medical staff involved in T-4 and other killing operations generally performed their duties with devotion and zeal. They sometimes even presented their actions as ‘humane.’¹⁴ According to Menges, ‘It is incomprehensible that doctors lent themselves to such things. Even more incomprehensible is this: they did their job often with great enthusiasm, sometimes they were even excited about its scientific value.’¹⁵ On the other hand, their duties could turn into routine, especially in the concentration camps. Sonderaktion 14 f 13, according to Menges, ‘marked a new stage which would eventually lead to the destruction of all undesirables. Doctors were part as an extra: their role was to give the action ethical legitimacy.’¹⁶

These hideous crimes were still called ‘euthanasia,’ which was synonymous with the elimination of unworthy life. They had nothing in common with the humane kind of voluntary euthanasia which the Nazi filmmakers and the leadership wanted to portray as reality in a film like Ich Klage an. Yet, this portrayed reality, too, was part of the multifaceted Third Reich. Only a minority of doctors participated in mass killings. Many others did not know about them or acquiesced as soon as rumours could no longer be denied. However, euthanasia proper as portrayed in Ich Klage an was also practiced. The fact that some bureaucratic elements pushed for official legalization¹⁷ (in vain, however) is an indication that ‘normal’ euthanasia was practiced on a rather wide scale. In cases of euthanasia death certificates invariably mentioned different causes of death than the real one. The film Ich Klage an shows that such euthanasia practices were a topic of debate among physicians. The Security Service (SS) reported that younger doctors were less inclined to oppose voluntary euthanasia than their older colleagues.

Protests
In general the medical profession was conspicuously uncritical about the Nazi euthanasia programme.¹⁸ Instead, abuse of human life by leading scientists and university professors was widespread. ‘Every university anatomical institute in Germany was the recipient of the cadavers of Nazi terror.’¹⁹ Nazi ideological thinking on racial superiority and eugenics pervaded the whole profession. As Shevell notes, ‘a perversion of medicine occurred in the more traditional settings of the medical clinic, the chronic care institution, the university hospital and academia among the mainstream of physicians.’²⁰ However, a number of doctors did protest or sabotage the euthanasia programme, particularly in the Rhineland. Menges decribes the case of a ‘Professor C’ who through his contacts in Berlinhad been briefed about the gassing of mental patients. He informed all the Rhineland mental institutions which then took measures of obstruction. Consequently T-4 actions in the Rhineland utterly failed.²¹

Others protested and sabotaged, too, particularly people with a church background. We have already mentioned Pastor von Bodelschwingh’s intervention with Justice Minister Gürtner. Lothar Kreyssig, a judge from Brandenburg/Havel also informed Gurtner on what was going on. He did so in a letter dated 8 July 1940:

About two weeks ago an acquaintance told me about rumours of numerous mental patients having recently been transfered by the SS from their clinics and nursing homes to intitutions in southern Germany where they were killed. . . . The issue of the meaning of these lives actually touches on the very issues of existence. It leads directly to the question of God. . . .Destroying ‘worthless life’ is a serious matter of conscience. Life is a mystery of God. . . . It is man’s incredible rebellion and arrogance to think he can terminate life because his limited judgment tells him that such life does not or does no longer have any meaning.²²

Dr. Kreyssig was a member of the ‘Confessing Church,’ a vocal anti-Nazi movement within the mainstream German Evangelical Church (DEK). It was clear that his religious conviction prompted him to voice his concern. Evangelical-Lutheran Landbishop Theofil Wurm (Württemberg) was also very concerned. Grafeneck, one of the Totungsanstallten, was in Württemberg and Wurm had noticed that a crematorium had recently been built there. Wurm saw and heard that great numbers of sick people were transfered to Grafeneck many of whom died soon after. The continuous dark smoke emenating from the crematorium’s chimney could be seen clearly from far away. The bishop, who had previously performed pastoral duties in a health and nursing asylum, was well aware of what was going on Grafeneck. He knew that some Nazi doctors lied about the real causes of death on death certificates. On 19 July 1940, Wurm wrote a letter to Interior Minister Wilhelm Frick protesting the way death certificates were falsified and criticizing attempts to hush everything up (Geheimnistuerei). ‘Destroying the life of feeble and helpless people, not because they pose a threat to us, but because we are weary of feeding and nursing them, is against the commandment of God.’²³

Protests from the Catholic clergy had more effect. While Protestant leaders largely confined themselves to letters of protest or visits to officials and ministers, some Catholic clergymen raised the matter in public. Most vocal among them was Bishop Clemens August Graf von Galen (Münster). On August 3, 1941, Bishop von Galen preached fire and brimstone in the church of Saint Lamberti—and he made history.

It is a terrible theory which wants to justify murdering the innocent, which practically legalizes the violent killing of disabled people who are no longer able to work, the crippled, the incurably sick and the decrepit ones. . . . When one upholds and practices the principle that “unproductive” fellow human beings may be killed, woe then unto us all when we ourselves will be old and weak! When unproductive human beings may be killed, woe then unto the disabled who gave, sacrificed and lost their strength and healthy bones in the production process!²⁴

It was not the first time that Bishop von Galen raised his voice, nor would it be the last time. According to Menges ‘the protests of the Catholic clergy were a powerful factor which contributed to the suspension of the “euthanasia action” in August of 1941.’²⁵ What was suspended, however, was the official euthanasia action, unofficially ‘euthanasia’ practices continued. For example, in a special clinic near Düsseldorf ‘euthanasia’ was practiced as late as the Summer of 1943.²⁶

Hitler was furious at Bishop von Galen. Letters of protest could be handled bureaucratically, public protests were quite something else. Himmler wanted to arrest the influential church leader straightaway, but Hitler, fearing further confrontations with the church, preferred to wait till the war was over.27 The Gestapo was ordered to monitor the bishop’s movements and sermons. After the assassination attempt of 20 July 1944 on the Führer, Bishop von Galen was sent to the concentration camp of Sachsenhausen. He survived the camp, but he died in March 1946, shortly after the Pope had made him a Cardinal.

Thus, it is clear that the Nazi’s failed to keep their euthanasia programme secret. Things were happening at too large a scale, too many people were involved, both as killers and as victims. As early as November 1940, William Shirer, the noted American correspondent in Berlin, knew interesting details about the ‘mercy killings’ in special asylums and about Philip Bouhler’s leading role.²⁸

The Nazi’s Rationale for the ‘Mercy Killings’
Those involved in the Euthanasie Aktion sought rationalizations of all sorts. Although a number of Jews were also subjected to ‘mercy killing’ the basic intent of the ‘action’ was not ideological or racial. Hitler’s political, social, and racial ideas were a hotchpotch. He detested people like chief ideologist Alfred Rosenberg for creating some sort of coherent Weltanschauung.²⁹ Most victims of the mercy killings belonged to the ‘superior’ Aryian race, Germans that is. Shirer believes that the killings ‘were simply the result of the extreme Nazis deciding to carry out their eugenical and sociological ideas.’³⁰ On the other hand, Stephen Saetz argues that ‘the Euthanasia Programme was instituted for pragmatic reasons which bore no relation to eugenics.’³¹ In my view, the main impetus of the euthanasia programme was the view that for the sake of man’s own preservation the weak and the strong cannot live and survive together. Hitler clearly pointed this out in Mein Kampf:

This preservation is bound up with the rigid law of necessity and the right to victory of the best and the stronger. Those who want to live, let them fight, and those who do not want to fight in this world of eternal struggle do not deserve to live.³²

In time of war there is no place for the weak and the incurably sick, and euthanasia was the best way of getting rid of them. As Hitler formulated it in 1935: ‘In the event of war he would take up the question of euthanasia and enforce it,’ and ‘solve the problems of the asylums in a radical way.’³³ Church leaders would be less inclined to opppose him in times of war than in times of peace, Hitler reasoned. And patients in need of long and continuous care were only a burden on society. The German economy did not have the resources for a long war, that is why the concept of Blitzkrieg (sudden and quick victories) was introduced in Nazi military thinking.³⁴ It was not accidental that Hitler’s Euthanasia Order was officially given on the very first day World War II. But the order really dated from October 1939, and had been backdated to 1 September. Thus, the Nazi euthanasia drive was inseparably linked to the needs of ‘the best and the stronger’ in war, the weak and defenseless were a nuisance and had to be eliminated.

An additional problem was that there were not sufficient physicians to provide for adequate health care. Especially ordinary health insurance patients did not have easy access to their doctors and to hospitals. Only too often, waiting lists were long. With the outbreak of war many doctors joined the military and hospital beds were diverted for military use. ‘The civilian population as a whole was deprived of medical services by comparison with the army,’ writes Grunberger. He adds, ‘But the reluctant shortage was partly made good by means of the Euthanasia Programme.’³⁵

The ‘Slippery Slope’ Debate
Nazi practices of euthanasia did not appear out of the blue. They were preceded by Social Darwinism and the debate on ‘eugenics.’ Racial and social hygiene and sterilization of inferior and worthless life were dominant themes in the Twenties.³⁶ This was referred to as Schädlingsbekämpfung (‘pest control’). For example, in 1925, Robert Gaub, Professor of Psychiatry at Tübingen University, delivered a lecture on ‘The Sterilization of the Mentally and Morally Sick and Inferior.’ Also, in Hitler’s address to the 1929, Party Rally at Nuremberg he calls for the removal of 700,000 to 800,000 of the weakest children, ‘the end result will then even be an increase of strength.’

In July 1949 Leo Alexander, Chief US Medical Consultant at the Nuremberg Crimes Trials, published his essay ‘Medical Science Under Dictatorship.’³⁷ It is still considered a classic piece of research. The Nazi rule in Germany was proceeded by ‘a propaganda barrage directed against the traditional compassionate nineteeth-century attitudes towards the chronically ill,’ Alexander writes. ‘Sterilization and euthanasia of persons with chronic illnesses was discussed at a meeting of Bavarian psychiatrists in 1931.’³⁸ Alexander’s main concern was the shift in medical ethics and attitudes after January 1933 when Hitler was appointed Reichchancellor: ‘Nazi propaganda was highly effective in perverting public opinion and public conscience in a remarkably short time. In the medical profession this expressed itself in a rapid decline in standards of professional ethics.’³⁹

The crimes which the Nazis would commit later had their origins in prior subtle changes as stated in the following:

The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.⁴⁰

At medical facilities the principle that physicians must fight for the life of their patients in accordance with the Hippocratic Oath came under attack. In Alexander’s view this did not happen overnight, it happened gradually. This slippery slope concept has been criticized by Hanauske-Abel. He studied the contents of leading German medical journals from late 1932 to late 1933. ‘The evidence for a “snowballing involvement” of physicians in 1933, “that had started from small beginnings” is scant at best.’⁴¹ ‘The medical crimes against humanity presented at the doctor’s trial in 1946, were the result of changes in German medicine that did not evolve gradually over several years but happened largely within a distincly brief period during early to mid-1933.’⁴²

Hanauske-Abel primarily limits his investigation to one year. On that basis he claims that ‘the German medical community set its own course in 1933. In some respects this course even outpaced the new government.’⁴³ Things were not right from the very start and there was no ‘sudden subversion’ of medical ethics. But Alexander never uses the term sudden subversion. When he claims there was ‘a rapid decline in the standards of professional ethics’ he does not specify the word rapid. Was it one year, or three, or five? Even a change in five years can be called rapid—if we are discussing fundamental changes in medical standards, that is. Alexander points out that ‘by 1936 extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an article in an official German medical journal.’⁴⁴ But he only refers to one journal. And ‘openly accepted’ is not the same as generally accepted. Even as late as 1940/1941 euthanasia was still a matter of debate in the medical community as the film Ich Klage an clearly shows. The film was not only aimed at convincing the general public but also (dissident) sections of the medical community. Hanna’s own husband is a doctor who clashes with Bernhard, another doctor and also his best friend, over the question whether ending the life of terminally ill Hanna is acceptable or not. After long hesitation Bernhard changes his mind—in court finally. At that time there were still doctors who opposed euthanasia under all circumstances.⁴⁵ Formally, the law was on their side, but pressure to conform was enormous. The majority of doctors acquiesced or had changed their mind.

Alexander’s slippery slope theory cannot be contested on the basis of what happened in one year only (1933) when the whole medical community supposedly went berserk. Alexander ‘s observations about ‘small beginnings’ and ‘subtle shift’ refer to an ‘early change in medical attitudes’ and ‘a propaganda barrage even before the Nazis took open charge.’ The notion ‘that there is such a thing as life not worthy to be lived’ marked the starting point. This was before the Nazis came to power. Alexander fully recognizes that the year 1933 was crucial as he mentions the effectiveness of Nazi propaganda early on. The coming to power of the Nazis in 1933 accelerated things and culminated six years later in Hitler’s Euthanasia Decree which was deliberatey couched in cautious language (in practice it gave a free reign to those who practiced mass killings).

After quoting Hanauske-Abel’s paper Edmund Pellegrino points to the importance of ‘the ethical values of the larger community.’ ‘In Germany this support system was weakened well before the Holocaust and the experiments at Auschwitz.’⁴⁶ This observation does not at all not contradict Alexander’s finding that the proportions which the Nazi crimes ‘finally assumed’ had small beginnings.

Relevance for Today
Leo Alexander’s findings are still valid today. His essay was reprinted in 1996 and positively reviewed in an editorial in Medical Sentinel.⁴⁷ It would be wrong to assume that the decline of medical standards and ethics in the Third Reich is completely irrelevant to contemporary bioethical debates. Writing about the ‘Nazi Doctors and Nuremberg,’ Pellegrino points out:

So obvious these moral lessons seem now, and so gross the malfeasance, that it seems redundant to revisit them. Certainly we do not need to study such gross moral pathology that could never happen again. That is a dangerous conclusion. Moral lessons are quickly forgotten. Medical ethics is more fragile than we think. Moral reasoning based on defective premises tends to recur in new settings.⁴⁸

A pharisaical attitude like ‘I thank Thee, O God, that I am not like all those evil men’ (cf. Luke 18:11) will not help to widen the gap between past and present.

Euthanasia was recently legalized in The Netherlands. The debate in parliament attracted world wide attention. Leading proponents of the new euthanasia law argued that it bore no similarity whatsoever to the Nazi past. Senator Jacob Kohnstamm rejected any comparison between Nazi practices and contemporary Dutch euthanasia rules: ‘As if a murderous and destructive system like that in Nazi Germany would care at all about a legal regulation as proposed here!’⁴⁹

There is, of course, a wide gap between Nazi thinking on medical ethics and the mood of the Dutch medical community of today. Moreover, Hitler himself opposed attempts to legalize euthanasia (his secret decree was never made law) while today’s euthanasia advocates seek legalization and legislation. Even if there would have been an official euthanasia law in Nazi Germany, it would have only served to legitimize widespread killings. The Nazis never really cared about legal regulations and Kohnstamm may be correct that they would have only laughed at laws like the new Dutch euthanasia law. Or, maybe some Nazis would have not laughed. For example, after receiving many complaints about crude euthanasia practices Reich Justice Minister Franz Gürtner and some high ranking officials wanted an euthanasia law, but they were stopped by Hitler. The euthanasia law (there, in fact, were several drafts) they had on mind contained a number of guarantees against abuse (Sicherungsgarantien), like euthanasia only in the case of incurably ill patients whose suffering could no longer be prolonged, and at their own request. One draft of the laws even stipulated that a commission of doctors and judges be appointed as an overseeing body.⁵⁰ A similar suggestion was made by in the euthanasia film Ich Klage an. The director of the film, Wolfgang Liebeneier, stated after the war that his film was intended to prepare the ground for official legalization.⁵¹

The new Dutch law specifies criteria of careful medical practice (‘zorgvuldigheidseisen’) which must be fulfilled before euthanasia can be agreed to.⁵² Requests for euthanasia must be voluntary; well-considered and persistent; made by patients who are experiencing unbearable suffering without hope of improvement; at least two physicians must be involved in the decision; and all cases must be reported to regional committees composed of a lawyer, physician, and ethicist/philosopher and be report to the Public Prosecutor. The role of the Public Prosecutor is significantly reduced by these ‘committees’ whose decisions are mandatory.

Another problem is that Dutch culture is one of tolerance. Laws are made and subsequently eroded by practice. Vocal advocates of euthanasia will contribute to this erosion by making further demands. Shortly after the new euthanasia law was passed in the First Chamber of Dutch parliament, Health Minister Els Borst suddenly widened the debate in a highly controversial interview. If old people who are ‘tired of life’ (levensmoe) would take a suicide pill—the so-called ‘Drion-pill’—she, the Health Minister, would not object.’⁵³ She said that this issue must be a matter of public debate. Prime Minister Wim Kok immediately distanced himself from Borst’s statements saying it was not cabinet policy, but the damage was done. One month later NVVE announced a public debate on the suicide pill, which it hopes will be legalized after its conclusion. A TV-documentary is being prepared to arouse public awareness to the issue.⁵⁴

During the parliamentary debates Senator Egbert Schuurman, a leading opponent of the new euthanasia rules, had predicted precisely this: ‘Advocates of euthanasia will add new criteria, for example “being tired of life.”’⁵⁵ Nobody paid attention then. This is undeniably a slippery slope trend, starting from the small beginnings described by Leo Alexander. It is this very trend that Professor Schuurman, a leading culture philosopher in The Netherlands, is worried about. Of course, there is not the slightest resemblance between Senator Kohnstamm or Minister Borst—both prominent in the Dutch euthanasia movement (NVVE)—and crude Nazis or their ideology. But the ghosts of the past will some day haunt those who proclaim principles like ‘there is such a thing as life not worthy to be lived.’

It should be kept in mind that the propaganda film Ich Klage an started a similar public debate in Nazi Germany in 1941 as people who lived at the time told me. Again, the film did not show the crude ways in which the Nazis often conducted their euthanasia programme. On the contrary, it told a very sentimental story about human feelings and love, and finally about the decision of a man who killed his own wife because he loved her so much. Hanna had explicitly requested euthanasia. These lessons from the past can only be ignored at our peril. ‘What experience and history teach is this - that peoples and governments never have learned anything from history or acted on principles deduced from it.’⁵⁶ E&M

References
1 For more details on Ich Klage an, see: Courtade, Francis, and Cadars, Pierre, Geschichte des Films im Dritten Reich (Munich: Wilhelm Heyne Verlag, 1975): 138-143. The author is in possession of a copy of Ich Klage an (director: Wolfgang Liebeneiner). The film was based on the novel Sendung und Gewissen by Helmuth Unger.

2 Heinz Boberach, Meldungen aus dem Reich. Die geheime Lageberichte des Sicherheitsdienstes der SS 1939-1944, vol. 9: 3175 (Herrsching: Pawlak Verlag, 1984): ‘Der Film hat im ganzen Reichsgebiet stärkste Beachtung gefunden.’

3 Author’s interview with Mrs. G. Benit, Hilversum: 17 May 2001.

4 Karl Brandt, statement in Nuremberg, in: Mitscherlich, Alexander/Mielke, Fred, Medizin ohne Menschlichkeit. Dokumente des Nürnberger Ärzteprozesses (Frankfurt am Main: Fischer Taschenbuch Verlag: 1985): 206.

5 Menges, J., op cit.: 70-72.

6 Trials of War Criminals, Vol. 2 (Washington, DC: US Govenrment Printing Office, 1949): 196.

7 Ibid., Vol. 1: 893.

8 Menges, J., op. cit.: 102.

9 Ilse Staff, Justiz Im Dritten Reich (Frankfurt am Main: Fischer Taschenbuch Verlag, 1978): 52-53 (Sterilization Act); Rudolf Echterhölter, Die Deutsche Justiz und der Nationaalsozialismus, Vol. 2 (Stuttgart: Deutsche Verlags-Anstalt, 1970): 321.

10 Heinrich Schmid, Apokalyptisches Wetterleuchten. Ein Beitrag der Evangelischen Kirche zur Kampf im Dritten Reich (Munich: Verlag der Evangelisch-Lutherische Kirche in Bayern, 1947), 400.

11 J. Menges, op. cit.: 101-104.

12 Israel Gutman, (Ed.), ‘Enzyklopädie des Holocaust’ (Munich/Zurich: Piper, 1995): 424.

13 Hermannn Weinkauff, and Albrecht Wagner, Die Deutsche Juistiz und der Nationalsozialismus, Vol. 1 (Stuttgart: Deutsche Verlags-Anstalt, 1968): 198.

14 Henry Dicks V, Licensed Mass Murder. A Socio-Psychological Study of some SS Killers (London: Heinemann and Sussex Universty Press, 1972): 143-177, 231.

15 J. Menges, op. cit.: 49.

16 Ibid.: 52.

17 J. Menges, op. cit.: 6.

18 Israel Gutman, op. cit.: 424.

19 William E. Seidelman, ‘Medicine and Murder in the Third Reich,’ Dimensions. A Journal of Holocaust Studies, 1999; 13, Number 1 (http://www.adl.org/braun/dim_medicine_murder.html).

20 Micahel I. Shevell, ‘Neurosciences in the Third Reich: from Ivory Tower to Death Camps,’ Can J Neurol Sci. 1999; 26: 132-38.

21 J. Menges, op. cit.: 92, 93

22 Full text of Lother Kreyssig’s letter in: Staff, Ilse, op. cit.: 112-115.

23 Full text of Bishop Wurm’s letter in: Denzler, George, and Fabricius, Volker, (Eds.), Die Kirchen im Dritten Reich, Vol. 2: Documents (Frankfurt am Main: Fischer Taschenbuch Verlag, 1984): 193-198.

24 Full text of Bishop von Galen’s sermon in: Klee, Ernst, (Ed.), Dokumente zur “Euthanasie,” Frankfurt am Main: Fischer Taschenbuch Verlag, 1985): 193-198.

25 J. Menges, op. cit.: 137.

26 Author’s interview with Mrs. G. Benit, Hilversum: 17 May 2001.

27 Henry Picker, Hitlers Tischgespräch e im Führerhauptquartier (Stuttgart: Seewald Verlag, 1976): 416.

28 Williame L. Shirer, Berlin Diary. The Journal of a Foreign Correspondent 1934-1941 (New York: Galahad Books, 1995): 569-575.

29 Henry Picker, op. cit.: 213. Hitler was highly critical of Rosenberg’s Mythus des XX. Jahrhunderts which he did not consider ‘an offical party book.’

30 Ibid.: 574, 575.

31 Stephen B. Saetz, ‘Eugenics and the Third Reich,’ The Eugenics Bulletin, Winter 1985 (http://www.eugenics.net/papers/3rdreich.html.

32 Adolf Hitler, Mein Kampf (London: Radius Book/Hutchinson, 1972): 262.

33 Jeremy Noakes, and Geoffrey Pridham, Documents on Nazism, 1919-1945 (London: Jonathan Cape, 1974): 613, 614.

34 Ibid.: 631.

35 Richard Grunberger, The 12-Year Reich. A Social History of Nazi Germany 1933-1945 (New York: Holt, Rinehart and Winston, 1971): 221, 230. Much of my information on health care in the Third Reich is based on Chapter 15 (‘Health’) of this study.

36 Ernst Klee, Euthanasie im NS-Staat, op. cit.: 29-33. Much of my information here is based on Klee.

37 Leo Alexander, ‘Medical Science Under Dictatorship,’ N Engl J Med. (1949); 241: 39-47.

38 Ibid.: 39.

39 Ibid.: 39.

40 Ibid.: 44.

41 Hartmut Hanauske-Abel, ‘Not a Slippery Slope or Sudden Subversion: German Medicine and National Socialism in 1933,’ Br Med J. 1996; 313: 1453-1463.

42 Ibid.: 1454.

43 Ibid.

44 Alexander, op. cit.

45 J. Menges, op. cit.: 88-100.

46 Edmund D. Pellegrino, ‘The Nazi Doctors and Nuremberg; Some Moral Lessons Revisited,’ Ann Inter Med. 1997; 127: 307-308.

47 Miguel A. Faria, ‘Euthanasia, Medical Science, and the Road to Genocide,’ Medical Sentinel 1998; 3:79-83; see also: Michael I. Shevell, op. cit.: 132-138.

48 Edmond D. Pellegrino, op. cit.: 307.

49 Handelingen Eerste Kamer, 9 April 2001 (26): 1221.

50 Lothar Gruchmann, ‘Euthanasie und Justiz im Dritten Reich,’ Vierteljahreshefte für Zeitsgeschichte, 1972; 20: 247-250; Ernst Klee, Dokumente zur Euthanasie op.cit.: 86.

51 Emerson Vermaat, De nazi’s en de euthanasie (Utrecht: De Banier Publishers, October 2001).

52 H. Jochemsen, ‘Update: The Legalization of Euthanasia in The Netherlands,’ Ethics & Medicine 2001;17 (No. 2): 9, 10.

53 Interview Minister Els Borst, NRC Handelsblad, 14 April 2001.

54 Trouw, 17 May 2001 (‘Nu zelfdoding ter disccussie’).

55 Handelingen Eerste Kamer, 9 April 2001 (26): 1223.

56 G.W.F Hegel, The Philosophy of History (New York: Dover Publications, 1956): 6.

JA Emerson Vermaat, MA, studied law at Leyden University. He is a senior television reporter in Hilversum, The Netherlands, and specializes in international affairs and European history. He is the author of a book about international crime networks Het criminele web: De globalisering van de misdaad (De Banier Publishers Utrecht, 2000), and is currently preparing a book about Euthanasia in the Third Reich.

This article appeared in Volume 18:1 of Ethics & Medicine.

http://www.npr.org/programs/disability/ba_shows.dir/index_sh.html

The Black Stork: Newspaper Controversy

The following are excerpts from newspaper interviews and editorials from 1915-6 that comment on Dr. Haiselden's controversial position on the treatment of newborns with disabilities. They are reprinted here courtesy of Martin Pernick.

From "Dr. Baruch Praises Doctor who let Doomed Baby Die" from the New York Sun, November 21, 1915:

Reporter: It has been stated that Dr. Haiselden could have saved the baby's life if he had performed some operation. Would you mind stating the character of the operation?

Baruch: I am glad that you asked this question, since this very important point has been lost sight of in the hysterical discussions. It really has greater bearing upon this question than appears on the surface . . . You may note what many sentimental folk disregard, how much depends upon the individual doctor's judgment of emergency.

The causes, progress and termination of congenital defects are not fit subjects for the lay reader, many of whom are already too much interested in medical subjects, the knowledge of which can be of no earthly service to them. Indeed, the type of deformity involved in the Chicago case is usually so revolting that the description in the news columns in the Chicago case has added to the hysteria of the public.

I may say, however, that in this instance, Dr. Haiselden had to deal with what is called a monstrosity, not only a defective or malformed baby.

What difference is there, the doctor was asked, between these defects as they influence the action of a physician?

Baruch: A monstrosity, or obvious defective, always demands more serious consideration. No physician would presume the responsibility of destroying the life of such a child although he may realize that it will never be anything but the semblance of a human being. It is doubtful if the Spartan law will ever become operative in the present state of so-called civilization. What suffering the saving of a defective baby even may involve is graphically described in one of the city papers today with the headlines, Love for Defective Child Has Ruined This Family--Father Made a Bankrupt and Mother a Physical Wreck Caring for a Boy Born Unsound Mentally and After All Their Sacrifices He is Now in An Institution.

While monstrosities are exceedingly rare and deformities not infrequent, what is called the stillborn baby comes under observation of every physician in even moderate obstetric practice.

In my personal experience, I have observed but one monstrosity. The mother was under the care of a specialist in obstetrics, and I was present as the family physician. When it was discovered that the baby was a monstrosity of a worse type than the Chicago child, it was left alone and died. If Dr. Haiselden was correct in his diagnosis of the Bollinger baby, then I am quite in sympathy with the stand he took.

John Kingsbury, Commissioner of the Department of Public Charities, from the Independent, November 11, 1915:

In my work in connection with this particular department of the city's administration, I have had to know of many cases similar in a way to that of the infant that has provoked all of this recent discussion. I have felt strongly that little ones of this sort were better out of the world than in it, but I am free to say I have nothing to offer in the way of a public solution to the problem. Each case has its individual factors. And no one law would suffice for a rule of conduct. I do feel, however, that no conscientious physician should be saddled alone with the responsibility of deciding whether a woefully abnormal child should be helped to live or be left to die agreeable to nature's manifest intent. No, I do not believe that a board or commission of any sort would be the answer to this social puzzle, for after all, the question is fundamentally a social one, and it is not for a committee of physicians or lawyers to dispose of it. It more intimately concerns the home first and the general public next, and the parents must inevitably be the real arbiters.

John Kingsbury, from "Dr. Baruch Praises Doctor Who Let Doomed Baby Die," New York Sun, November 21, 1915:

I believe that the only really sane and satisfactory procedure would be for the parents and the attending physician to decide the fate of the little one--always assuming that nature is intent upon making the infant's days brief and that the society of medicine or surgery alone could change this. ...If the choice is to let nature prevail, then I am reasonably satisfied that the best interests of all concerned would thus be served.

Just as justice should be tempered by mercy so should the science of the healing art be willing to forego a mere physical triumph and consider the possible aftermath of blighted human existence--indeed more animal than human. It is only when we have an aggregation of these unfortunate creatures that we realize perhaps what Dr. Haiselden had in mind when he courageously refrained from using the knife that might possibly have made the Bollinger baby's days longer.

How many dwellers in this city have ever journeyed to Randall's Island? Relatively few, and really the sight is not a cheerful one. We have there 2,000 feeble minded and some of these are distressing cases, indeed this hardly expresses it. In one whole ward, the poor creatures are quite incapable of helping themselves. They have to be dressed and fed like helpless infants. There are others that are deformed and utterly devoid of any human instincts.

....On the other hand, it does seem that the wise and reputable physician cooperating with the parents, should be the best advisor, and that the ultimate decision, after he has presented the case with full professional knowledge, should rest with the parents, the desire of the mother prevailing. This broad question should not be evaded. Public discussion should be encouraged and after all the seemingly untimely end of that poor child in Chicago may be the means of a doing a world of good. This is eugenics in the concrete.

From "Was the Doctor Right?" The Independent, January 3, 1916:

The letters commending the doctor's course in letting the crippled baby die are four times as many as those that condemn him... Every letter except one bearing a minister's name answers our question.

"Was the doctor right?" Yes, I emphatically approve of the attitude of the mother and the physician. Of the many questions involved the important one is the eugenic question. In fact the chief significance of the event lies in the recognition that the vitality of the human race must be duly considered. I hope the time will come when it will be commonplace that the interests of the race are paramount. Irving Fisher, New Haven Connecticut, Chair, Department of Political Economy, Yale.

In my judgment it was not only biologically wise, but normally right from the highest ethical standards, to make no effort to preserve the life of the Chicago baby....This infant could never develop into anything even approaching a normal human being....This and like cases, however, should be regarded each on its own individual merits and not be made the basis of far reaching generalizations. Raymond Pearl, Orono, Maine, Biologist in charge of the Maine Agricultural Experiment Station.

The little child should mercifully be allowed to die. The child with a good brain, however crippled otherwise, should be saved. Franklin Giddings, Department of Sociology, Columbia University.

In successful social species the functions of the individual must be subordinated to the best interest of the race. If surgical interference in a case will be to the detriment of society, such interference would be antisocial. If the progress of surgery is to be used to the detriment of the race... it may conceivably destroy the race. Charles B. Davenport,Director of the Carnegie Station for Experimental Evolution and of the Eugenics Records Office.

Handicapped from birth to death, what but pain, shame, humiliation and distress awaits them. Edward Berwick.

A natural death is its natural right. Edward Clapham, Fulton, New York.

As a Christian and a Socialist, I believe and hope the day of the parasite who eats his bread without earning it will soon pass whether he be mentally or physically incompetent or not. J.C. Howell, M.D., Orlando, Florida.

If we love our friends or relatives, why should we wish them to suffer needlessly? ...If this case had come up a hundred years ago, as it undoubtedly did...death would have followed birth because there was no way of preventing such an outcome.

Science has divinely given rights, but these rights are only for good and merciful ends, and cannot rightly be exercised to prolong human misery needlessly, or to cause unnecessary suffering. Benjamin Walker Saunders, Pastor Congregational Church Prairie du Chien, Wisconsin.

The most conscientious may at times decide from high ethical reasoning that extraordinary measures are not justified in prolonging life in a being who is destined to misery and suffering and who may be a positive menace to society. Lillian Wald, Henry St. Settlement.

I think all monstrosities should be permitted to die, but I do condemn the physician for making such a public ado about the matter. He has done nothing more than many physicians have done but done more wisely, and this publicity will prompt others less wise to go farther in this matter than they should. Frank Roberts, President of New Mexico Normal University.

Between extinction and sterilization the difference seems rather of degree than of kind. Those who advocate sterilization must surely approve of the course taken in this extreme case. I believe however that a matter of such vital importance should not be left to the decision of one man, but that some form of collective or legalized action should be required. Alexander Johnson, Field Secretary on Provision for the Feeble Minded.

She had chosen this doctor and HE FAILED HER! Had she been allowed to keep her child, to nurse it, to care for it, and lavish the love of her heart upon it, her life would have been broadened, bettered, purified, for with such suffering comes the purification of character. Willie May Reddin, Jamesville, Wisconsin.

I believe that the Constitution of the United States was right in guaranteeing that no person shall be deprived of life, liberty, or property without due process of law. Paul Kayser, Milwaukee, Wisconsin.

We cannot help congratulating ourselves and the world at large that in the past so utilitarian a standpoint as regards defective lives was not taken. For we would then never have had the songs of Fanny Crosby or read of the wonderful transformation in the life of Helen Keller--P. Smith, Detroit, Michigan.

So far at least as I know we have no courses in our medical colleges as yet which teach how to judge when a patient's life may be of no service to the community...physicians may thank God that we are not yet the licensed executioners of the unfit for the community, and some of us know how fallacious our judgements are even with regard to the few things we know. Dr. Walsh, Catholic physician

From "Noted Men and Women Differ on Ethics of Letting Baby Die." From the Washington Post, November 18, 1915:

This child as well as every other child should be kept alive as long as possible. It is not for me to decide whether a child should be put to death. If it is a defective it should be treated as such, and be taught all it can learn. The law states that only a judge has the power to decide who shall die, and then only in case of crime. Jane Addams.

As a eugenicist and a philanthropist, I would let the child die, perhaps as a parent I would let it live. I doubt though, if it is possible to tell whether a baby is mentally defective when it is only 5 days old. Dr. Harvey Wiley, M.D.

If the child would be a helpless idiot, what purpose is served by keeping it alive? Katherine Davis.

A doctor has one enemy, Death, and should fight him to the last ditch. Royal Copeland, M.D.

This case should give an impulse to the national movement for birth control and prevention of defectives. Benjamin Lindsey, Judge.

Tomorrow's Children Highlights

Evidence Highlights Index, 1870 - 1930

The Black Stork: Movie Ads

The Black Stork, a feature film from 1917, dramatically expresses the anxieties people had about medicine and disability during this period: disability was equated with disease, doctors claimed absolute authority. Dr. Martin Pernick discusses The Black Stork in Tomorrow's Children, an excerpt of which is available here on RealAudio. Other material relevant to the film is available at the Tomorrow's Children Highlights page.

The film was inspired by the sensational case of Dr. Harry Haiselden, a Chicago surgeon who convinced the parents of a newborn with multiple disabilities to let the child die instead of performing surgery that would save its life. In the film, Haiselden actually plays himself, a wise doctor who attends the birth of a child born with congenital syphilis -- incurable at the time and a major cause of congenital disabilities. Two other doctors interfere, out of personal pride and misplaced benevolence, and try to convince the woman to save the child's life. The woman is forced to choose.

She dreams a tormented dream of her child's probable future: He grows up physically, mentally, and morally deformed. He becomes a criminal, and fathers a brood of disabled children. He isn't allowed to enlist in the Army ("Uncle Sam won't take anybody who's not perfect"). Aware that he is entirely different from others, despised and angry, he returns to kill the doctors who performed the operation that saved his life.

After this vision the woman decides to accept the doctor's advice and lets the infant die.

Haiselden's activities brought forth a storm of public controversy in which all of the currently popular attitudes toward disability were expressed. Many prominent thinkers, including Clarence Darrow and Helen Keller, argued that physicians had the right and the duty to decide whether a life was worth living. Although it was widely accepted that doctors should make these decisions and act on them in their private practices, it was rare that the subject was argued in public.

A conversation with Martin Pernick about the Black Stork

from the Chicago Herald, April 1, 1917

from Motography, April 14, 1917

from Exhibitors' Trade Review, March 10, 1917

The Black Stork Movie Stills

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