On The 60th Anniversary Of The Liberation Of Auschwitz - 27 January 2005

The following is chapter 11 from my book, The Edge of Life - Dying, Death and Euthanasia.

The Nazi Holocaust

The Nazi Holocaust is a shameful subject.  It is probably the biggest blot on the history of twentieth-century medicine - its only rival could be the worldwide legalization and practice of abortion.  The relevance of the Nazi Holocaust to twenty-first century euthanasia is two-fold.  First, ethically, it marks the formal introduction of the concept that some people can be regarded as having ‘lives not worthy to be lived’.  Second, practically, it reveals the origins of a national policy of euthanasia, which was both doctor-driven and publicly-approved.

Everybody knows that the Holocaust happened, some know how it happened, but few know why it happened.  Shelffuls of books have been written about it, but few accounts are as moving as Michael Burleigh’s 1994 book, Death and Deliverance: ‘Euthanasia’ in Germany 1900 - 1945.  As well as being a masterly piece of historical research, it manages to convey the sheer ordinariness of the people and events - this is what makes the book, and, needless to say, the Nazi reality, so chilling.  Borrow the book, read it, and be moved.

11.1 The euthanasia plan developed
So how and why did the Holocaust develop?  History can often be exceedingly complex, but by grasping just a few major threads, it is possible to weave together some of the events and motivating forces that eventually led to the Holocaust. 

One of these threads emerged during the nineteenth century.  Germany had, at that time, developed into the focal point of much of the world’s most exciting medical research and practice, as exemplified by innovative specialisms, like neurology and biochemistry.  But new-fangled disciplines can challenge old ethical assumptions, and there is a human tendency to cut loose and explore beyond traditional boundaries.  One presupposition to be contested was the old Hippocratic oath’s, ‘do no patient any harm’.  Nor was this challenge simply cerebral, it was also practical - some doctors, under the pretext of medical progress, began to get involved with hastening dying and causing the premature death of their patients, especially among the poor and vulnerable, the incurably ill and the mentally disabled.  To be sure, some aspects of medicine were getting out of hand.  Euthanasia was beginning to lose its wholesome Greek meaning.  One man who foresaw the potential dangers of these activities and who predicted the ensuing slippery slope, was the German doctor, Christoph Hufeland.  His far-sighted statement (Journal der praktischen Ärzneykunde und Wundärzneykunst, 1806, 23:15-16) has already been quoted (section 3.6), but it bears repetition, plus some extension, here, ‘The doctor should and must not do anything other than preserve life.  Whether it is happy or not, valuable or not, that is none of his business.  If he once permits such a consideration to influence his actions the doctor will become the most dangerous person in the State.  Once this line is crossed, and the doctor believes that he is entitled to decide upon the necessity of life, then it is only a matter of logical progression before he applies the criteria of worthy, and unworthy, in other situations.’ 

During the 1890s, with a blatant disregard of such forewarnings, the German polemicist, Adolf Jost, redefined the concept of euthanasia to include the two additional notions of ‘the right to die’ and ‘human worthlessness’.  The former phrase introduced the idea of a voluntary category of euthanasia.  The latter phrase, since it was particularly directed at the mentally and incurably ill, launched the idea of an involuntary category of euthanasia.  Then came Ernst Haeckel.  He was the professor of zoology at the University of Jena, an enthusiastic exponent of Darwin’s ideas, and a theologically-confused Monist.  Perhaps then, it is not surprising that some of his ideas were crackpot, and they were not helped by his often-unsubstantiated speculations and his carelessness over factual details - there is no doubt that he was a shoddy scientist.  Nevertheless, his thoughts and opinions captivated the German intelligentsia throughout the first half of the twentieth century.  Haeckel was eager to espouse his approval of infanticide and his opinion that euthanasia was ‘an act of mercy’, which would, he claimed, be a cost-effective policy against the unproductive.  These two men, together with several others, were the forefathers of the German euthanasia programme.  They were the ideas’ men. 

Their ideas were picked up again in 1920, when another two Germans, Karl Binding, a retired expert in jurisprudence, and Alfred Hoche, a professor of psychiatry, published what was to become a most provocative pamphlet entitled, The Sanctioning of the Destruction of Lives Not Worthy to be Lived (Die Freigabe der Vernichtung lebensunwerten Lebens. Ihr Mass und ihre Form).  In it, after some considerable beating about the bush, they dared to pose this ominous question, ‘Is there human life which has so far forfeited the character of something entitled to enjoy the protection of the law, that its prolongation represents a perpetual loss of value, both for its bearer and for society as a whole?’  It was philosophical dynamite. 

Binding and Hoche maintained that indeed there were people with ‘lives not worthy to be lived’ and they were to be found predominantly among three groups of people.  First, there were the terminally ill and the mortally wounded, who were familiar sights throughout Germany after the Great War.  These might voluntarily express a wish to die, to be euthanized.  Second, there were the mentally healthy, who, through battle or accident, were now unconscious and therefore incompetent in terms of consenting to euthanasia.  Third, there were the ‘incurable idiots’, especially those who resided in psychiatric hospitals.  To these latter people, Binding and Hoche drew special attention, not only because of the emotional and financial burdens that they were putting on their families and communities, but also because the care of these so-called ‘full idiots’ was costing the German State huge sums of money each year. Binding and Hoche actually did the economic sums to prove their case.  Alongside these ideas was some talk among medical professionals about throwing overboard the ‘Ballastexistenzen’, or ‘dead ballast’, from the ‘ship of fools’.  In reality, what was developing among the medical and academic elite was a deliberate denial that the weak and the vulnerable were real human beings.  And if they were not human beings, then why should they not be treated according to the rules of the farmyard and the abattoir? 

Thus, in post-Great War, pre-National Socialist Germany, some of the philosophical and ethical threads of the euthanasia movement were being interwoven.  The fabric contained social threads too.  There was, for example, the harsh aftermath of the First World War. Millions had died in the fighting, and for the survivors in Germany, economic hardship and hunger had begun to set in.  These warps and wefts consisted of post-war depression among a defeated people, the realities of deprivation and suffering, a weakened Christian church that had largely forgotten its powerful Reformation roots, the decoupling of Christian doctrine and practice, the eugenic ‘solutions’ propagated by social Darwinian ideology, and the eagerness of psychiatrists to improve their social status and function.  And there were the physically and mentally handicapped people, who had now become stigmatized as being both unproductive and costly.  Of all of these factors, two were paramount.  First, there was a person’s racial fitness.  This was a peculiarly German concept that historically had symbolized a person’s acceptance by, and usefulness to, the State.  Second, there were the prevailing financial privations.  Eugenics and economics had met again.  These threads were decisive in fabricating the unthinkable - a national policy of euthanasia. 

A final thread, probably the last straw, came from the best-selling author, Ernst Mann, also known as Gerhard Hoffman.  In one of his books, Moral der Kraft, he had previously called upon war veterans to perform one ‘last heroic deed’ and kill themselves in order to spare the German State the expense of their pensions.  Evidently, Mann was not a man to dither, or mince his words.  In 1922, he suggested to the Reichstag, that in addition to the advantages of ‘mercy-killing’ for the terminally ill, those who were mentally ill should also be exterminated, and that even children, who were crippled and incurably ill, should be killed too.  He considered that a combined plan of eugenics and euthanasia would bring about a double benefit for Germany - it would be seen as an act of mercy, and it would be financially sound.  In 1922, Mann’s ideas were considered by the vast majority of the Reichstag’s politicians and Germany’s general public to be far too extreme, way beyond the pale.  But wait - just a decade later, they had become official German policy!

11.2 The euthanasia plan implemented
The euthanasia programme was thus laid and hatched. It began to be implemented in July 1933, six months after Adolf Hitler came to power, when the Law for the Prevention of Hereditarily Diseased Progeny was published.  This eugenic plan authorized the compulsory sterilization of those with congenital defects, schizophrenia, manic depression, epilepsy, severe alcoholism, and a variety of other conditions.  Between 1934 and 1945, some 400,000 people, or about one per cent of the child-producing German population, were sterilized. 

The slippery slope was all too evident.  Hufeland was right - the doctor could become ‘the most dangerous person in the State’.  Six years later, in 1939, it became compulsory to report the births of all physically and mentally disabled children.  Many parents agreed to send their special-needs children to asylums for what they thought would be specialized care.  Once there, a committee of three would meet secretly and decide, usually without even seeing the child, who should live and who should die.  The latter children were sent to special clinics and given overdoses of barbiturates, or, more cost-effectively, they were deliberately starved to death.  Parents would then receive a letter explaining the cause, picked randomly from a standard list, of their child’s sudden death - sometimes appendicitis was given as the reason, even though the child may have already have had his appendix removed! 

So, first, there was compulsory eugenic sterilization of adults, then second, there was non-voluntary euthanasia for children.  But there was worse to come.  The child euthanasia plan was but the forerunner of the adult euthanasia programme.  This systematic plan to exterminate all psychiatric patients throughout Germany was called, Aktion T-4. It began in 1940.  Its code name was derived from its administrative head office at Tiergartenstrasse 4 in Berlin.  Under its auspices, residents of State institutions could be euthanized if it was considered that they could not be ‘rehabilitated for useful work’.  Therefore the mentally disabled, psychotics, epileptics, the old and senile, those with infantile paralysis, Parkinson's disease, multiple sclerosis, brain tumours, even bed-wetters, and those with poorly-formed ears, were killed because they were considered to be ‘useless’ and a ‘burden on society’. 

This adult euthanasia plan was responsible, first of all, for the destruction of some 275,000 German, non-Jewish, institutionalized patients.  They were human ‘guinea pigs’, killed in experimental gas chambers in the drive to perfect the methods and to train the technicians to be used for the later Jewish exterminations in concentration camps, the so-called Final Solution.  That horror of mass involuntary euthanasia accounted for the destruction of some six million Jews.

11.3 After the Holocaust
After the Second World War, the Allies felt compelled to take steps to ensure that the Holocaust would never be repeated.  One such measure was the Nuremberg doctors’ trial of 1946 and 1947.  The twenty-four doctors and public health officials, who were accused of being war criminals, were shown to have been willing collaborators with the Nazi regime.  Indeed, half of all German academic biological scientists at that time were members of the Nazi party.  These scientific personnel knew exactly what they were doing. Many of their experiments were conducted under the pretext of respectable health initiatives, such as, screening for tuberculosis, free gynaecological examinations, or anti-smoking campaigns. But behind such façades of human decency and medical progress, there lurked something unquestionably more deadly, the execution of this immense euthanasia programme.  The Nuremberg trial ended after 149 days of hearings and the submission of 11,500 pages of transcripts.  Seven of the accused were hanged, five received life sentences, four were given sentences of between ten and twenty years, and eight were acquitted.  Most of those imprisoned were released within ten years.  Few of the Holocaust survivors, or the victims’ families have ever been compensated.

11.4 The lessons to be learned
Here then is a bit of history with its own frightening momentum.  It began with a little novel science, a few academic treatises, several political mavericks, some seemingly-outrageous ideas, a number of popular articles, various economic hardships and numerous emotional challenges.  It ended up as the Nazi Holocaust. Its essential fabric had been woven and largely accepted by a society within a relatively short time-span - perhaps as little as twenty years. 

But perhaps the most frightening aspect of this cheerless episode it this - it was not just the crazy Führer and a few of his more madcap henchmen, who devised and carried out these atrocities, but rather it was educated, professional men and women, who planned and implemented the whole thing.  There was a clearly discernable pattern of personal involvement.  Moral philosophers and politicians first raised some controversial issues.  Then the medical and scientific professionals, especially some doctors and others, including psychiatrists, followed.  Once medicine, its ethics and practice, had been corrupted, the law and its practitioners formulated the necessary legal provisions.  Next, there was acceptance by the general public, and finally, the ‘open door’.  Can you discern the uncanny progression?  We have witnessed similar patterns elsewhere, have we not? 

Above all, it was the German medical profession that failed the ethical challenge - they had turned their backs on Hippocratic-Christian medicine.  They had assumed that proper medicine and Nazi ideology were compatible.  Driven by eugenics and economics, they had compounded such erroneous thinking into a programme of euthanasia.  While upholding the apparently unassailable idea of Aryan purity, they considered that the mentally and the physically disabled, together with homosexuals, gypsies, Jews, and others were sub-standard, non-persons with ‘lives not worthy to be lived’.  Consequently, they considered them to be expendable, and that the implementation of such an enterprise would be for the social and economic good of the State.

So where were the German protesters?  Where were those who cherished and protected all human life?  There were some opponents, who spoke of Christian truth and charity, who argued against such gross utilitarianism, and who warned of the dangers of embarking down such a slippery slope.  But they were relatively few in number, and generally ineffective in their opposition.  The vast majority of doctors and nurses were apparently easily persuaded to work within these euthanasia programmes.  Scientists became yes-men.  Lawyers and judges acquiesced.  Perhaps most appallingly, ministers of religion generally turned a blind eye, or even worse, actually colluded in these policies.  In fact, about half of those killed in the first phases of the euthanasia programme actually came from asylums funded and administered by the German churches! 

And think, all this happened just seventy years ago, about 700 kilometres away from Britain - trifles in time and space.  Can you believe that?  Here was a society that had forgotten its historic Christian roots - the land of Luther and the emergence of the Reformation, no less.  A people, who had forgotten that they, and all others, bore the imago Dei.  A medical profession, which had forgotten the Hippocratic oath and its basic tenet, ‘do no patient any harm’, as well as the Christian commandment of Matthew 22:39, ‘Love your neighbour as yourself.’  It started with a denial of the specialness and inviolability of all human life, and it ended with the acceptance of the slogan that people could have ‘lives not worthy to be lived’.  Once that Rubicon had been crossed, then all forms of human abuse began to be justified.  This was an indisputably authentic slippery slope.  Two generations on, nothing much has changed.  The parallels are all too obvious.  Today’s international calls for the implementation of programmes of euthanasia are just as menacing. 

Yet, understand this if you can.  After all the film clips, newspaper reports, personal testimonies of the survivors and of the victims’ families, the records of the liberating armies, the physical evidence of the gas chambers and the camps, some people, moreover, some highly-intelligent people, are still denying that the ghastly events of the Holocaust ever occurred.  They are still trying to deny the incontestable horror of it all, they are still suppressing the truth.  Despite all the evidence to the contrary, for some, it simply never happened. Matthew 15:14 is as true as ever, ‘Leave them; they are blind guides. If a blind man leads a blind man, both will fall into a pit.’

For us, the Holocaust should be the wake-up call.  It should shatter any remaining ideas we may have about the innate goodness of man, and the inevitability of human progress, kindness and decency.  I shudder every time I read this chapter - few narratives can move me to tears so readily.  As has been rightly said of the Holocaust, ‘All who live after it must confront it.’  The lessons of history are there to be learned.  Many of the very same philosophical, ethical and social threads that were present in the 1930s, are still with us in the 2000s, still prowling around.

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