Euthanasia in Germany
Where we have been…
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Leprosy
HIV/AIDS
Eugenics
Tuskegee Trials
Eugenics
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Late 19th century – Rise of Nation-States
Limited resources and economic hardship
Conflict on a global scale
State ownership of disabled
Eugenics
• “Disabled”, and the cost of care for the disabled,
became increasingly the task of government
bureaucrats.
• What is the financial worth of a disabled person to
the state?
Best for the state
Best for the individual
Eugenics
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Nature vs. Nurture
“Biologic” Darwinism and “Social” Darwinism
Targeting of specific “undesirable” populations
Racism, Xenophobia, Anti-Semitism
Progressive Movement
Government
Science
Cure to
Social Ills
• Role of government in determining “traits” within
society
• “Science” as a cure to social ills
Public Policy
Marriage
Laws
Forced
Sterilizations
Incarceration
Euthanasia
Death
Camps
“Permission for the Destruction of Life
Unworthy of Life” (1920)
Alfred Hoche – Psychiatry
from Saxony
Karl Binding – Lawyer
from Heidelberg
“Life Unworthy of Life” – Medical
Argument
• Physicians and Nurses are called to make life and
death decisions commonly, and are immune from
prosecution.
• Separated two groups – those born disabled vs.
those who acquire disability
• Hoche criticizes the "modern endeavor" that has
blocked "our German duty", which wants to "keep
the weakest of all alive" and "has blocked attempts
at preventing the mentally dead at least from
procreating" and he speaks of "elements of less
value", "weaklings" or "ballast existences".
“Life Unworthy of Life” – Legal
Argument
• Suicide is not illegal
• Therefore, assisting a suicide should not be
illegal
• “Painless” death in such cases is a substitute for
a life of hardship and a “painful” death
• Three groups of patients under consideration of
physician-assisted death or euthanasia
Three groups : “Life Unworthy of Life”
• Mortally wounded or disabled patients requesting
assistance in dying
• “Incurable mentally ill” – those without a will to live
or die. “Living pointless lives and are a burden of
their families and society”
• “Mentally Healthy” people who have suffered an
injury that renders them unconscious
Mechanics of Government Sanctioned
Euthanasia
• Committee of three – physician, psychiatrist, and
lawyer
• Cases heard in a court
• Patient defends him/herself, or the mother may
speak on the patient’s behalf
• A decision for death must be unanimous among
all three members of the committee
• Death must be painless
Marriage
Laws
Forced
Sterilizations
Incarceration
Euthanasia
Death
Camps
Sterilization Law (1933)
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(1) Any person suffering from a hereditary disease may be rendered
incapable of procreation by means of a surgical operation
(sterilization), if the experience of medical science shows that it is
highly probable that his descendants would suffer from some serious
physical or mental hereditary defect.
(2) For the purposes of this law, any person will be considered as
hereditarily diseased who is suffering from any one of the following
diseases: – (1) Congenital Mental Deficiency, (2) Schizophrenia, (3)
Manic-Depressive Insanity, (4) Hereditary Epilepsy, (5) Hereditary
Chorea (Huntington’s), (6) Hereditary Blindness, (7) Hereditary
Deafness, (8) Any severe hereditary deformity.
(3) Any person suffering from severe alcoholism may be also
rendered incapable of procreation.[2]
Sterilization Law : “We Do Not Stand
Alone”
“Genetic Health Courts”
• Hearings and Appeals
• 400,000 sterilizations over the course of the Nazi
era
• “You are sharing the load”
“Laws Against Dangerous Habitual
Criminals” (1933)
Marriage
Laws
Forced
Sterilizations
Incarceration
Euthanasia
Death
Camps
“Laws Against Dangerous Habitual
Criminals” (1933)
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Beggars
Vagrants
Homeless
Alcoholics
Roma (Gypsy)
Nuremberg Laws (1935)
• Laws against racial mixing (sexual intercourse
between races)
• Targeted mostly Jews
• Couples must submit to medical examinations
before marriage to see “if racial damage” might
be involved.
• Genetically ill persons were permitted to marry
other genetically ill persons, but only after
being sterilized.
• Since it was feared many Jews had converted
to Christianity, religion alone was no longer a
reliable measure of one’s race.
Euthanasia - Priming of German
Society
Marriage
Laws
Forced
Sterilizations
Incarceration
Euthanasia
Death
Camps
Role of Propaganda
• “Das Erbe” (The Inheritance) A young woman
and a professor discuss racial purity. A “financial
burden” is also discussed.
• “Opfer der Vergangenheit” (Victims of the Past)
showed shocking images of asylum and
described the cost analysis of maintaining the
lives of the mentally insane.
http://www.youtube.com/watch?v=LiO_
c5-6_Hw
Euthanasia – “Good Death”
• Historian Seutonius remarking
on the death of Emperor Augustus :
“Dying Painlessly”
• Francis Bacon Management of suffering
Act of Commission versus Omission
• Gerhard Herbert Kretschmar (20 February 1939
– 25 July 1939)
• Severely disabled, blind, missing limbs, mentally
retarded
• Petition on behalf of the family directly to Hitler for
permission to euthanize
• Hitler’s personal physician (Dr. Karl Brandt) was
dispatched to make an assessment
• Infant was killed while nurses were on coffee
break at University of Leipzig Pediatric Ward
Creation of a state program for the
killing of disabled children
• “Reich Committee for Scientific Registering of
Serious Hereditary and Congenital Illnesses”
• Compulsory registration on a state and national
level of children under the age of 3 with idiocy,
Down’s syndrome, microcephaly, hydrocephaly,
spasticity, and physical deformities.
Reich Committee for Scientific
Registering of Serious Hereditary and
Congenital Illnesses (1939)
• Nurses, teachers and midwives paid by the state
for registering infants and toddlers with these
conditions
• Cases were reviewed by a Panel in secret and
under the guise of “best medical care”.
• Euphemisms – “Treatment”, “Cleansing”,
“Disinfection”, and “Therapy”
• 28 facilities were created
• Families were assured that the child was getting
the best medical care.
Committee Decisions
• “Live”, “Delay”, or “Die”
• Families not involved in the decision-making and
routinely were misinformed about the process at
hand
Inventing the Mechanics of Killing
• Omission – starvation and cold exposure
• Systematically reporting to the parents that the
child died of “natural causes”, “suddenly”, of
“appendicitis”, etc.
• Parents informed that the body had to be
immediately cremated to avoid epidemic infection
• By 1941, failure by nurses, doctors, and medical
personnel to register eligible infants and minors
was punishable by a fine or imprisonment of four
weeks.
Inventing the Mechanics of Killing
• Children were killed using injectable morphine,
cyanide, and chemical agents known from
warfare.
• More than 5,000 children were killed in this
manner.
• Interestingly, Jewish children were excluded from
this program because they did not deserve this
“merciful act” by the state on their behalf.
Extending the Euthanasia Program
• By October 1939, war had erupted and Hitler
empowered Dr. Brandt to expand the program to
adults.
“Reichleiter Bouhler and Dr. Brandt are charged
with responsibility to extend the powers of specific
doctors in such a way that, after the most careful
assessment of their condition, those suffering
from illnesses deemed to be incurable may be
granted a mercy death.”
T-4 Program – a state secret
• Tiergartenstrasse 4 – an address with a name
“Charitable Foundation for Cure and Institutional
Care”
Creation of a Bureaucracy for Killing
• Reich Working Party for Mental Asylums
Registry of victims, manage their effects,
assign fake causes of death
• Community Patients’ Transport Service
Transport victims to holding asylums and
extermination centers
• Community Foundation for the Care of
Asylums
Run the extermination camp, execute the killing,
recycle the gold
• Victor Brack
key technician of the Holocaust
executed at Nuremburg
• Dr. Karl Brandt
personal physician to Hitler
• Philip Bouhler
studied philosophy
committed suicide
First adult killings under the guise of
war…
• January 1940, Poland – killing of Polish victims in
mental asylums by systematic execution.
• Studies and organization around large-scale
killing
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“I was ordered by Brack to participate in the first euthanasia trial run in
the Hospital at Brandenburg, near Berlin. It was in the first part of January
1940 that I traveled to the hospital. Special apparatus had been
constructed for this purpose at this hospital. A room, similar to a shower
with tile floor, had been set up, approximately three by five meters and
three meters high. There were benches around the edge of the room, and
on the floor, about ten centimeters above the ground, there was a water
pipe approximately one centimeter in diameter. In this tube there were
small holes, from which the carbon monoxide gas flowed. The gas
containers were outside the room and were already attached to one end of
the pipe...In the hospital there were already two crematoria ovens ready to
go, for burning the bodies. At the entrance to the room, constructed
similar to that of an air-raid shelter, there was a square peep hole through
which the behavior of the subjects could be observed. The first gassing
was administered personally by Dr. Widmann. He operated the controls
and regulated the flow of gas. He also instructed the hospital physicians
Dr. Eberl and Dr. Baumhardt, who later took over the exterminations in
Grafeneck and Hadamar...At this first gassing, approximately 18-20 people
were led into the
“showers” by the nursing staff. These people were required to undress in
another room until they were completely naked. The doors were closed
behind them. They entered the room quietly and showed no signs of
anxiety. Dr. Widmann operated the gassing apparatus; I could observe
through the peep hole that, after a minute, the people either fell down or
lay on the benches. There was no great disturbance or commotion. After
another five minutes, the room was cleared of gas. SS men specially
designated for this purpose placed the dead on stretchers and brought
them to the ovens...At the end of the experiment Victor Brack, who was of
course also present (and whom I’d previously forgotten), addressed those
in attendance. He appeared satisfied by the results of the experiment, and
repeated once again that this operation should be carried out only by
physicians, according to the motto: ‘The needle belongs in the hands of
the doctor.’ Karl Brandt spoke after Brack, and stressed again that
gassings should only be done by physicians. That is how things began in
Brandenburg.”
Killing Centers
• Gas chamber at Grafeneck
• Bradenburg Euthanasia Center
• Bernburg
• Hadamar
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Hartheim
• Sonnenstein
http://www.youtube.com/watch?v=Ww8
00PzlJ6Y
T4 Gassing Program
• After 70,000 murders, the program was abruptly
halted by a verbal order from Hitler in August
1941.
• The program may have been halted because of
the public outcry and protests by the clergy,
including Cardinal Von Galen.
“Wild” Euthanasia
• While a formal program in government-sponsored
euthanasia ended in 1941, widespread killing
continued to be permissible and even encouraged
under the Nazi rule.
• Physicians continued to be the regular
instruments of euthanasia, participating and
advocating for death by starvation or injection.
• 70,000 more disabled persons were killed in this
way from 1941-1945.
T4 doctors move on to pursue other
things.
• T4 gas chambers are uprooted and moved to
concentration camps and expanded.
• T4 physicians, nurses, and technicians followed
and came to instruct the SS in the “selection” of
victims
• These same physicians, nurses, and technicians
came to operate the mass killing of millions of
victims in concentration camps.
• Operation 14f13 – a file number used for the
killing of prisoners in T4 centers, was adopted by
the concentration camps.
• “Special treatment” was the euphemism for killing
A Pause, ….and what have we learned
German Euthanasia
• Did not happen behind closed doors and
depended heavily of support from society (and
propaganda)
• Was a results of a progression of ideas
(Progressive movement, Social Darwinism)
• Was subject to “mission creep”
• Involved “science” in supporting its ideas
• Involved MDs and nurses in performing these
heinous acts.
A Different Paradigm
• “Life” as a natural right or privilege rather than
something to be earned or established based on
worth.
On the role of nurses and doctors….
“The needle belongs in the hand
of the doctor”