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Killing While Caring Nursing in the Nazi “Euthanasia” Program

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1 Killing While Caring Nursing in the Nazi “Euthanasia” Program
Susan Benedict, CRNA, DSN, FAAN Medical University of South Carolina Thank you for inviting me to Cincinnati/

2 First, the language of disability:
People with disabilities… People with developmental disabilities… Many terms used are those of the time and are not acceptable today. An article I wrote was posted on the Internet and I heard from an advocate for people with disabilities who took issue with my use of terms such as “the handicapped”, “the disabled”.

3 “A history of mental illness”…
is as non-specific as “a history of physical illness”. He cautioned against the use of non-specific language and the use of generalizations: i.e., “the handicapped”. As non-specific as the “Catholics”, the “Jews”, the “Gypsies”, etc.

4 Anna G: Accused of killing 150 patients…
“When giving the [lethal] medicine, I proceeded with a lot of compassion. I took them lovingly and stroked them when I gave the medicine. They were not to be tortured more than necessary.” This presentation is a historical study of nurses’ participation in the Nazi “euthanasia program”. Data were obtained from archives in Germany, Austria, Poland, and the US. Trial documents including testimonies and depositions were the data sources.

5 Steps to the “Final Solution”
Devaluation and generalization Sterilization Euthanasia Concentration camps To put this into perspective, I want to emphasize a continuum that began with devaluation and ended in the Nazi death camps.

6 Eugenics How could this happen?
You have heard of the German’s plan to create a master race. This was built on the pseudo-science of eugenics. Beginning in 1869, Francis Galton, a cousin of Charles Darwin postulated that “incompetent, ailing people” were a threat to society because their children were “impoverished, sick, and miserable.” He introduced the term “eugenics” in 1881. In 1985, a German eugenicist published a book in which he stated that “the protection of the weaker members of society was threatening the quality of the race. In the same year, another person, Jost, wrote that the ill should be able to choose to live or die. In cases of mental illness, the right to decide reverted to the state.

7 Passed in 1922, the US Model Eugenical Sterilization Law applied to
Feeble-minded Insane (including the psychopathic) Criminalistic (including the delinquent and wayward) Epileptic Inebriate (including drug users) Diseased (including the tuberculosis, the syphilitic, the leprous, and others with chronic, infections, and legally segregable diseases Blind (including those with seriously impaired vision) Deformed (including the crippled) Dependent (including orphans, ne’er-do-wells, the homeless, tramps and paupers. The eugenics movement gained strength in the US and Europe. In 1907 the state of Indiana passed the world’s first compulsory sterilization law. It applied to “confirmed criminals, idiots, rapists, and imbeciles” who were in state institutions. The 1922 Model Eugenical Sterilization Law became the basis for US and German sterilization laws.

8 Eugenics also popular in US
Courses taught at Columbia University Brown University Northwestern University Harvard University Cornell University University of Wisconsin

9 In 1925, in “Mein Kampf” Hitler wrote…
“Those who are physically and mentally unhealthy and unworthy must not perpetuate their suffering in the body of their children.”

10 July 1933: Germany’s sterilization law passed
Hereditary epilepsy Schizophrenia Mental deficiency Huntington’s chorea Hereditary blindness and deafness Certain malformations Severe alcoholism

11 Textbooks and posters were used to inflame sentiments against people with handicaps.

12 More than 350,000 people were sterilized in Germany

13 Education Examples in textbooks Courses in nursing and medical schools
Racial hygiene a component of all education

14 1935 Textbook Problem 95 The construction of an insane asylum requires 6 million RM. How many housing 15,000 RM could be built for the amount spent on insane asylums? A high school mathematics problem was used to demonstrate how money could be better spent on the needs of the well rather than those with disabilities.

15 Socialization Posters depicting people with handicaps Movies

16 Another very popular poster depicting a strong and healthy German man supporting two people with disabilities. Notice how they are portrayed.

17 From a 1937 book.

18 Depiction of people with handicaps eventually outnumbering “the fit” in 120 years.

19 Sterilizaton to “Euthanasia”
Binding and Hoche, 1920: The right to live must be earned. Destroying “lives not worth living” would be humane. Elimination not a crime but permissible and beneficial A very influential book was published in 1920 and convincing argued for killing people with disabilities on both the grounds of humanitarianism and on the need for making a contribution to society.

20 Applied to People with terminal illnesses “Incurable lunatics”
Those who had sustained an illness or injury and would awaken to a “nameless misery” Binding and Hoche defined people who had “lives not worth living” as those who Had a terminal illness and who were mentally competent and who wished to die. “Incurable lunatics” who had neither the will to live nor to die. People who were formerly healthy but who had sustained an illness or injury that would make them permanently comatose or who would “awaken to a nameless misery.

21 In 1935, Hitler described his plan to initiate euthanasia in the event of war. He planned it to coincide with the war for 2 reasons: People would be distracted by the war effort. People would see the need to divert money from people in institutions to soldier s and the war effort.

22 Three phases of killing
The children’s “euthanasia” program The T4 “euthanasia program “Wild euthanasia” The children’s euthanasia program started by a request from a father to Hitler’s office to have his handicapped son killed. Hitler sent his personal physician to validate the case and the child was, in fact, killed.

23 The Children’s “euthanasia” program
1939 – 1945 5,000 – 7,000 children killed

24 All children with the following had to be reported:
Idiocy and Mongolism (particularly if blindness or deafness were also present Microcephalie [sic] Hydrocephalus Deformities of every kind, in particular the absence of limbs, spina bifida, etc. Paralysis including Little’s disease (Spastics) Children with handicaps were identified by midwives, nurses, and physicians and were reported. It was often a community nurse who went to the home and promised that the child would be placed in an environment of free and excellent care if the parents would relinquish the child. If the parents refused, often the mother was conscripted into a job leaving the family without child care and thus necessitating the placement of the child in an institution. Once in an institution, the child was evaluated on the basis of a questionnaire and a decision was made about life or death. The physician evaluators did not see the child.

25 The midwife Received a fee of 2 Reichsmark “in return for her trouble”
The midwives were paid for reporting the child. This is about 80 cents.

26 3,000 – 5,000 children were murdered
3 -5 thousand children were murdered in institutions. Often they were kept sedated with Luminal (phenobarbital) while they starved and developed pneumonia. It took about a week for a child to die in this manner. In other cases, the child was given a lethal injection of morphine.

27 This depiction of the cost of caring for school children with handicaps appeared in a 1933 eugenics journal.

28 T-4 “Euthanasia” Program
Grafeneck Brandenburg Hartheim Sonnenstein Bernburg Hadamar The organized euthanasia program was called T-4 because of its location on Tiergartenstrasse 4 in Berlin. There were 6 killing center although not all were operational at the same time. Brandenburg was the first and the first gassings were done there on January 4, Brandenburg functioned until September Grafeneck opened next and was operational from January through December Hartheim, in Austria, and Sonnenstein near Dresden also operated during Hadamar and Bernburg opened later.

29 T-4 “Euthanasia” Program
Began with this letter: 1 September 1939 Reichleiter Bouhler and Dr. med Brandt are charged with the responsibility to extend the authorization of certain physicians designated by name in order that patients who must be considered incurable on the basis of human judgment be granted the mercy death after a critical evaluation of their illness Adolf Hitler This statement was actually written in October but was backdated to coincide with the beginning of the war and the invasion of Poland. This action was never a law.

30 The plan to kill 60, ,000 The plan was to kill 60,000 – 70,000 patients. This number was calculated by determining how many of those institutionalized were capable of performing some sort of useful work.

31 The victims of T-4 Persons with developmental disabilities
Psychiatric patients Epileptics Persons with inherited diseases or conditions Persons with family histories of disease, alcoholism, antisocial behaviors Inpatients who were unable to do any type of work were the first to be killed. Those who were able to work in the hospital’s gardens, kitchens, or do sewing were spared a little longer.

32 Patients within the 6 killing centers were killed and others were bused in from outlying institutions to be gassed at the killing centers. Buses, with their windows painted over, were loaded with patients and accompanied by nurses. Patients were told to pack their belongings, the patients were tagged, and given a box lunch.

33 Upon arrival at one of the killing centers, the bus pulled into a specially build unloading area that was screened from the outside. The patients and their belongings were unloaded and escorted by the nurses to a room where they were undressed. A physician was present who briefly looked them over to determine an appropriate cause of death to be listed on each death certificate. Care was taken, for example, to look for appendectomy scars so acute appendicitis was not given as the cause of death. Patients who had particularly interesting characteristics were marked on their backs with a big X so their bodies could be picked out from the others and autopsied. This is a photo of Hadamar as it looks today.

34 Inside one of the wards of Hadamar.

35 The nursing staff of Hadamar in 1945.

36 Hadamar Inside the gas chamber. Note the mirror on the back wall so the observer could make certain that all were dead.

37 The gas chambers at the killing centers became the prototypes for the “showers” of the concentration camps. The patients were killed with carbon monoxide.

38 Grafeneck, a former castle, was the site of 9,839 murders.

39 Bernburg, near Weimar, as it looks today
Bernburg, near Weimar, as it looks today. Like Hadamar, it is still an active psychiatric hospital.

40 This is the gas chamber of Bernburg.

41 14f13 Before the gas chambers were built at the concentration camps, inmates who were unable to work were transported to the euthanasia centers to be killed in the gas chambers. This action was named 14f13.

42 As smoke billowed from the chimneys of the institutions and the special buses made frequent trips, people in nearby areas became suspicious. Children would even taunt each other with “be good or you’ll be put on a bus and sent up the chimney”.

43 Killings had become public knowledge Churches objected
T4 ended August 1941 Killings had become public knowledge Churches objected No objections from nursing or medical organizations Several factors probably brought an end to the T4 program. Not the least of which was that the planned number of 70,000 had been killed.

44 70,273 adults were killed in the T4 program

45 “Wild euthanasia” However, the killings did not end, just the method changed. The gas chambers were dismantled and taken to the death camps of Treblinka, Belzac, and Sobibor along with some of the nursing staff. In the institutions, people were killed individually, usually with injections of morphine and scopolamine. The physicians selected those to be killed usually, although sometimes the nurses selected them. Those to be killed were then overdosed by the nurses. The killings killed until the last few days of the war when the allied forces came upon the institutions.

46 When the Russians came upon Meseritz Obrawalde, one of the most deadly of the wild euthanasia institutions, now in Poland, and heard what had been happening, they made the head nurse Amanada Ratacjek re-enact the killings and then they shot her on the spot.

47 Roles of nurses in the “euthanasia” programs
Reported newborns and children with disabilities Selected patients for killing Accompanied the transports Killed patients Aktion Reinhard

48 Consequences for the nurses
Several male nurses were hanged. Several female nurses went to prison. Even more were acquitted because they were “just following orders”. Trials went on for years. The 14 nurses of Meseritz were not tried until 1964 – a full 20 years after the fact. Even today new trials are beginning.

49 Irmgard Huber, the head female nurse of Hadamar was sentenced to 25 years in prison by the US military tribunal. Her sentence was reduced to 12 years and she was released in Three other Hadamar nurses were sentenced to 4 years, 3 years 6 months, and 3 years 1 month each.

50 Why did nurses participate?
Belief in National Socialism and its goals: “I swear to Adolf Hitler, my Führer [leader], unswerving loyalty and obedience. I commit myself to every assignment that I am placed in and to fulfill my task as a National Socialistic nurse, loyal and conscientious in the service for the people, so help me God.” The allegiance to Hitler was not specific to the NS nurses. Even the Red Cross nurses and the Diaconess nurses (protestant nurses) swore an oath of allegiance to Hitler.

51 Obedience To government To administrators To physicians
To superior ranking nurses Obedience was a trait greatly admired in German women and one strongly emphasized within nursing.

52 Lack of support From colleagues From professional organizations

53 Duress? Some were sworn to secrecy. Some were threatened verbally.
In over 50 years of post-war testimony, no instance has been found of anyone being shot, harmed, or sent to a concentration camp for refusing. In trials, few reported fear of reprisals for refusing to kill. Several nurses did ask for and receive transfers without consequence. Other nurses married, got pregnant, moved away, or quit their jobs to either avoid or get out of the killings.

54 Economics Housing was tied to the job. Jobs were hard to find.
Bonuses were paid for working in the killing units.

55 In their words: Helene W. (killed several hundred):
“I only did my duty, and I did everything on the order of my superiors.

56 Luise E. (210) “I would consider it a release if a physician or a person acting on direction of a physician would give me a dose releasing me from my suffering…I didn’t do it with a light heart but only after serious inner fights I obeyed the orders.”

57 Anna G.: (150) “I would never have committed a theft because I know one isn’t allowed to.”

58 Martha W. (150): “The only explanation I can give is that I didn’t have enough time to think about it at that time because the nurses were put under a lot of stress.”

59 Erna D.: “I can’t say why I didn’t refuse.”

60 Margarete T. (150): “I saw the act of giving medicine, even in order to kill mentally handicapped persons, as an obligation I wasn’t allowed to refuse. In case of refusal, I always imagined my dismissal from the job of nurse and civil servant, which is why I didn’t refuse.”

61 Meta P. “Among the nurses, there was strict discipline and every subordinate nurse was obliged to strictly execute the orders of the superior.”

62 “I didn’t see anything wrong with it.”
Edith B.: “I didn’t see anything wrong with it.”

63 Margarete Maria M.: “If I had refused to execute her [another nurse’s] orders, I would have been dismissed. I could have quit the job, but at that time I was obliged to support my grandparents in Mesertiz.”

64 Gertrude F.: “I was the youngest nurse on our ward. Still today, I haven’t completely become aware of my wrongdoing.”

65 The killings of the “euthanasia” programs led to the murders in the concentration camps.
The euthanasia program was the precursor to the Final Solution in several ways: The medicalization of the killings – murders done by doctors and nurses in the euthanasia program, physicians doing the selections for the gas chambers in the camps. The generalization and then the stigmatization of groups – the disabled, the handicapped, the Jews, the Gypsies The development of the technology – the gas chambers. The transference of personnel – dismantling the gas chambers at the killing centers and taking them, and related personnel, to the concentration camps.



68 Lessons for today: Remember the victims.
Be vigilant against marginalization. Avoid generalizations about groups; i.e., the “mentally ill”, the “disabled”. Consider the “slippery slope” of assisted suicide and euthanasia. Was the continuum of eugenics to mass murder a “slippery slope”? What about genetic testing today? Will people who have certain genetic traits face discrimination? Will they experience eventual persecution? Will they be compelled to undergo sterilization? Will assisted suicide lead to a desensitization to death? Will it lead to euthanasia? Is it too a slippery slope or are enough safe guards in place? When contemplating these issues, it is vital to keep in mind the lessons of the so-called euthanasia program.

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