The Beginning of the Ending
By Eamon Doohan, The Catholic World Report, March 1997
The spiritual ancestry of the right-to-die movement can be traced directly to Nazi Germany
The light dims. The members of the audience settle comfortably into their seats. The movie begins.
The film's plot involves a beautiful young woman who develops multiple sclerosis - a slowly progressive neurological disease for which there is no cure. She becomes more and more debilitated. Greatly handicapped by her condition, humiliated by her helplessness, she is a pathetic shadow of her former self. She asks her husband, a doctor, to end her suffering. Years of his life have been devoted to research in a vain effort to find a cure for her, the love of his life. Finally, after wrestling with his conscience, he gives in to her expressed wish and administers a fatal overdose.
A team of three doctors would decide who was to live and who was to die. They were paid on the basis of numbers of forms they passed as suitable for extermination.
The plot is familiar. Essentially the same plot can be seen in dozens of the pro-euthanasia films which have been produced in recent years. However this film, Ich Klage An (I Accuse), premiered in 1941 in Nazi-controlled Vienna. It was produced by the Ministry of Propaganda, under the patronage of Joseph Goebbels The movies director, Wolfgang Liebeneiner, collaborated closely with the Chancellery of the Führer in matters of nuance, language, and scenes. The Chancellery was the office which dealt with matters of particular interest to Adolf Hitler. And the termination of the lives of what were called "useless eaters" was an issue which interested the Führer greatly
The termination of lives of what were called "useless eaters" was an issue which interested the Führer greatly.
Racial cleansing
In the film, the story of the woman with multiple sclerosis was twinned with a story of a child who has become blind, deaf, and retarded as a result of meningitis. The former tale was designed to make the case for consensual euthanasia, to end the suffering of those who had come to find life burdensome. The story of the retarded child made the case for non-consensual euthanasia - the ending of lives which were judged "worthless" not by the individuals themselves but by the society around them. These twin policies were reflected in the draft law on euthanasia which was drawn up in late 1939. This draft law followed an order authorizing euthanasia, signed by Adolf Hitler himself in October of that year:
Reichsleiter Bouhler and Dr Brandt are charged with the responsibility of expanding the authority of physicians who are to be designated by name, to the end that patients who, in the best available human judgment after critical evaluation of their condition are considered incurable, can be granted Cuadentod. (mercy death) Adolf Hitler
Health policy in Nazi Germany (what was called at the time "hereditary and racial hygiene") looked forward to a national socialist Volksgememeinschuft or national community, where there would be a recognized common obligation to "cleanse" the German people of diseases and disabilities. Nazi propaganda promoted the sterilization of the "inferior" and the elimination of "unnecessary eaters." Films, radio programs, and articles in the widely-read Nazi press including Der Sturmer and the Volkischer Beobachter promoted euthanasia as both merciful and logical.
This policy was not the sole preserve of the Nazis, nor were they the first to promote it. In 1921 the noted liberal Karl Binding, professor of criminal law in Leipzig, and Alfred Hoche, a Freiburg psychiatrist, produced a landmark work, Destruction of Worthless Life: its Extent and Form. This and other liberal efforts to undermine the traditional recognition of an inherent right to life provided the intellectual framework for the later Nazi drive to Gnadentod.
The Nazis came to power after the 1933 general election. The hereditary - disease prevention law was introduced the same year. On October 6, 1935, a law was published ordering abortions "when necessary to safeguard hereditary health." That chilling statement of policy is unhappily not just a historical artefact; the same attitude is also reflected in the barbarity of our own age, when in Western countries pregnant women are routinely screened using blood tests, amniocentesis, and ultrasound in the attempt to diagnose genetically transmitted conditions like spina bifida, hydrocephalus, and Down's syndrome; an offer to terminate the pregnancy invariably follows a positive diagnosis. Non-consensual euthanasia is also practiced today in cases where fluids and nutrition are withheld from patients who are diagnosed as being in a persistent vegetative state.
Working within a consensus
By the time Hitler signed his Euthanasia Authorization, an organization to implement the order had already been set up, and in fact had been functioning for some months. It was based in offices at 4 Tiergartenstrasse in Berlin. It was known officially as the Reich Association of Mental Health, or more commonly, from its address, as Aktion T4. Philip Bouhler - the head of the Führer's Chancellery, and the man to whom Hitler's Euthanasia Authorization was addressed - was assisted there by SS Oberfuhrer Victor Brack, SS Oberfuhrer Werner Blankenberg, and the psychiatrists Herman Paul Nitsche and Werner Heyde. Those leaders presided over a larger bureaucracy.
Processing of patients in psychiatric institutions began almost immediately. A questionnaire was sent out by the Reich Ministry of the Interior to various mental hospitals. These questionnaires solicited details of the patients' illness and, most importantly, their ability to work. A team of three doctors at T4 would decide who was to live and who was to die. They were paid on the basis of numbers of forms they passed as suitable for extermination. They soon set a target of 65,000-70,000 who were to be killed under the auspices of Aktion T4. In the end they exceeded their own target.
The questionnaires were completed and returned. A few weeks later, a list of patients to be "transferred" would arrive at the asylum. Initially the transferred patients were taken directly to the killing camps. These were Schloss Grafeneck near Stuttgart, Schloss Hartheim near Linz, Brandenberg an der Havel, Sonnenstein outside Dresden, Hadamar near Limburg, and Bernberg near HalIe.
Later, patients were detoured to intermediate asylums. This was done for two reasons: on the one hand, the more complicated transfer helped to cover the tracks of the missing patients; on the other hand, the extra step allowed strong-willed relatives an opportunity to intervene to protect their kin if they wanted to do so. It is remarkable to notice the degree of consensus which the Nazis achieved. No doctor or nurse was forced against his will to work at the euthanasia institutes; no family which objected to a transfer was punished for intervening. The end result of a transfer was never openly stated. When after a few weeks, word of the death of a relative was communicated to the family, it was often accepted as a natural event. No questions were asked; no lies were told.
"Should a child with a hereditry defect be born in a case in which abortion was not ordered, alternatives are available through the Reich Committee."
Prelude to the Holocaust
On August 18, 1939, the Reich Committee for the Scientific Processing of Serious Genetic Diseases was created. Its function was to collect information of "deformed, etc., newborns." From that point it was only a short time before babies with Down's syndrome, cerebral palsy, and other handicaps were being dispatched to be killed in what were euphemistically called pediatric departments. Viktor Brack, a T4 staff member pointed out darkly in an internal memo, "Should a child with a hereditary defect be born in a case in which abortion was not ordered, alternatives are available through the Reich Committee."
In the summer of 1940, all Jewish mental patients were the subject of a fatal "transfer order" from the Reich Ministry of the Interior, delivering them into the hands of the staff at T4 at the euthanasia institutes.
In April 1941, a murder campaign parallel to that sponsored by Aktion T4 began in the concentration camps. This effort was called Aktion 14f13; its aim was to gas all prisoners who were unable to work because of sickness or starvation, or whom the camp guards judged disruptive or hostile. This program was run by T4 personnel, and it claimed the lives of some 20,000 camp inmates. Aktion 14f13 was the forerunner of the Final Solution.
The mechanism of gassing was perfected first in the euthanasia institute. In this way, euthanasia became the midwife at birth of Shoah.
T4 operatives, over one hundred in number, started the Aktion Reinhard, the SS group that ran the Belzec, Sobibor, and Treblinka extermination camps. The original commandants of these camps all came from the Reich Association of Mental Health and were on its payroll. The mechanism of gassing was perfected first in the euthanasia institutes. In this way, euthanasia became the midwife at the birth of the Shoah.
The underground campaign
By August 24, 1941, the euthanasia campaign had claimed the lives of 70,023 people. The campaign was officially suspended on that date in deference to mounting public criticism in particular from the Catholic Bishop Calen of Münster, who had preached a courageous sermon condemning the policy.
The euthanasia program continued, however, albeit in greater secrecy - and in greater scope. In 1942, T4 turned its attention to old-age homes, exterminating patients who suffered from various degrees of dementia, immobility, or disability. The extra beds that thus became available were to be devoted to refugees fleeing from bombed cities. Some old peoples' homes were turned into convalescent homes for wounded soldiers.
In that same year the Reich Committee for the Scientific Processing of Serious Genetic Diseases - whose brief had to that point been limited to killing handicapped children up to 14 years old - was authorized to target 14-17-year-olds as well. The Reich Committee's euthanasia program differed from T4 in that the cases reported to the committee were received by three pediatricians. The handicapped children who were to be exterminated were transferred to a "pediatric department;" usually these departments were housed in a mental hospital, but some also were in children's hospitals. There the children would be killed individually by specially authorized and trained doctors. By the time Nazi Germany had been defeated, the Reich Committee had received some 100,000 reports on handicapped children of whom some 5,200 were sent for "treatment" (killing).
| Euthanasia Institutes | Dates of Operation | Deaths |
|---|---|---|
| Grafeneck | Jan - Dec. 1940 | 9,839 |
| Brandenberg | Feb -Sept. 1940 | 9,772 |
| Bernberg | September 1941 | 8,601 |
| Hahamar | Jan - August 1941 | 10,072 |
| Hartheim | Jan - May 1940 | 18,269 |
| Sonnenstein | June 1940- Aug. 1941 | 13,720 |
Among psychiatric patients, the killing method was not limited to gassing or the injection of lethal drugs. Specially conceived starvation diets were designed to minimize the expenditures on lethal drugs. In the conquered territories of the east, Einsatzgruppen - Nazi killing units operating behind the front line - were employed to liquidate Jews and other "inferiors." They began to shoot asylum inmates by the thousands in occupied Poland and then in the border provinces of the German Reich, Pomerania and East Prussia.
Vindicated by history?
Euthanasia, then as now, is a twin-edged sword. If it becomes legally acceptable to accede to a patient's request to be killed, or to assist that patient's efforts to kill himself, how can it not also be legally acceptable to kill a patient who cannot ask to be killed, but whose quality of life is judged to be so poor that "he would be better off dead?" In other words, how can the acceptance of consensual euthanasia fail to open the door to non-consensual euthanasia? There is no moral gulf, no ethical chasm between these two. As so often in life one evil leads, often imperceptibly, to another.
And where are we now, more than 50 years after the defeat of Nazism? In her penetrating biography of Albert Speer, Gitta Sereny asks a contemporary of Speer for his views on euthanasia. The man's name was Theo Hupfauer and in 1941 he was commandant of the Ordensberg Sonthofen, an elite college for Nazi political education on whose curriculum racial hygiene and the Volksgemeinschaft would have featured prominently. His response suggests that, in his view, the West is merely adopting those same ideas. He said:
How can the acceptance of consensual euthanasia fail to open the door to nonconsensual euthanasia? There is no moral gulf, no ethical chasm between these two.
Euthanasia, I'm not against it. You can see that the whole world is slowly moving in that direction now. The question is only how and to what degree. Is there really such a difference between the early pregnancy tests done as a matter of routine with the idea of termination if the fetus is abnormal, not to mention the number of abortions now being performed for all sorts of reasons, and what was done here (in Germany) forty years ago? The light dims.
Eamon Doohan is an Irish physician with a large private practice.