Where we have been… Leprosy HIV/AIDS Eugenics Tuskegee Trials
Eugenics Late 19 th 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 Nature vs. Nurture “Biologic” Darwinism and “Social” Darwinism Targeting of specific “undesirable” populations Racism, Xenophobia, Anti-Semitism
Progressive Movement Role of government in determining “traits” within society “Science” as a cure to social ills GovernmentScience Cure to Social Ills
Public Policy Marriage Laws Forced Sterilizations IncarcerationEuthanasia 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 IncarcerationEuthanasia Death Camps
Sterilization Law (1933) (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.Congenital Mental DeficiencySchizophrenia Manic-Depressive InsanityHereditary EpilepsyHereditary ChoreaHereditary BlindnessHereditary Deafness (3) Any person suffering from severe alcoholism may be also rendered incapable of procreation. alcoholism 
“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 IncarcerationEuthanasia Death Camps
“Laws Against Dangerous Habitual Criminals” (1933) Beggars Vagrants Homeless Alcoholics Roma (Gypsy)
Nuremberg Laws (1935) Laws against racial mixing (sexual intercourse between races) Targeted mostly Jews
Law for the Protection of the Genetic H e a l t h o f t h e G e r m a n P e o p l e 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 IncarcerationEuthanasia 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.
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
“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 Hartheim Sonnenstein
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
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”