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| By Sheldon
Rubenfeld, M.D. |
On a typical
day at Auschwitz, train after train filled with Jews arrived at the camp's
ramp, where a medical doctor met them. The doctor then made a "selection,"
choosing those who would be sent directly to the gas chambers and crematoria
and those who would be spared for work, medical experimentation, or other
services to the Nazis in the camp.
The overwhelming majority of Jews were sent directly to the gas
chambers, where, according to eye witnesses quoted in Robert Jay Lifton's The
Nazi Doctors: Medical Killing and the Psychology of Genocide, another doctor
ordered "how many [pellets] of gas should be thrown in these holes from the
ceilings, according to the number of people, and who should do it." The doctor
"observed through the hole how the people are dying." "When the people were
dead...[the doctor] gave the order to open the gas chamber, and [the doctor]
came...with a gas mask into the chamber." The doctor signed a form confirming
that "the people are dead...how long it took." After that, the doctor "observed
the teeth extraction from the corpses."
Jews selected for work were sent to
the gas chambers when they were no longer able to work; doctors also made these
"selections." If inmates became sick, the doctor rode with them directly to the
gas chambers in an ambulance marked with a large red cross. Doctors designed
and supervised inhumane medical experiments and selected the prisoners they
needed for these experiments. As one survivor of Auschwitz put it, "A doctor
was not a doctor. A doctor was the selection. That was what the doctor was-the
selection."
Hundreds of physicians willingly participated in all of these
genocidal activities. Indeed, one can imagine an "on-call schedule" with
different physicians assigned to ramp selections, gas chambers, crematoria,
work selections, medical experiments, and so on at each of the many Nazi
concentration camps. Physicians and other medical personnel rarely refused to
participate in these atrocities. Exactly how did physicians, sworn to protect
and care for their patients, wind up as Hitler's henchmen?
One answer to this question begins in
1859, with the publication of Origin of Species, Charles Darwin's evolutionary
theory of "natural selection." Francis Galton, building on Darwin's theory in
1883, coined the term "eugenics" which, according to The New Shorter Oxford
English Dictionary, is defined as "the science [sic] dealing with factors that
influence the hereditary qualities of a race and with ways of improving these
qualities, especially by modifying the fertility of different categories of
people." German social Darwinists responded to these two theories with their
own theory of "racial hygiene," which would promote the welfare of the human
race as well as that of the individual.
In the view of German racial
hygienists, negative eugenics or negative racial hygiene discouraged the
transmission of less desirable genetic traits while positive eugenics or
positive racial hygiene encouraged the transmission of more desirable genetic
traits. In practical terms, racial hygienists discouraged inexpensive medical
care for the inferior races and encouraged procreation for the superior races.
Medical societies and journals supporting the pseudoscience of racial hygiene
arose during the 1920's and expanded rapidly from 1933-1945, the years of the
Third Reich.
German racial hygienists originally included Jews among the
superior races of the world because European Jews were "more Aryan than
Semitic." There was, however, a definite anti-Semitic current in the mind of
right wing hygienists, which drew them to the Nazi philosophy of "applied
biology." Fritz Lenz, one of Germany's most prominent racial hygienists,
praised Hitler in 1930 as "the first politician of truly great import who has
taken racial hygiene as a serious element of state policy." Others lauded
Hitler as the "great doctor of the German people." Himmler, one of Hitler's
closest associates, spoke of the leader's task as being "like the
plant-breeding specialist who, when he wants to breed a pure new strain from a
well-tried species that has been exhausted by too much cross-breeding, first
goes over the field to cull the unwanted plants."
Robert Jay Lifton describes the Nazi
philosophy of applied biology as one of "absolute control over the evolutionary
process, over the biological future. Making widespread use of the Darwinian
term 'selection,' the Nazis sought to take over the natural functions of nature
(natural selection) and God (the Lord giveth and the Lord taketh away) in
orchestrating their own 'selections,' their own version of human evolution. In
these visions, the Nazis embraced not only versions of medieval mystical
anti-Semitism but also a newer claim to 'scientific racism.' Dangerous Jewish
characteristics could be linked with alleged data of scientific disciplines, so
that a 'mainstream of racism' formed from 'the fusion of anthropology,
eugenics, and social thought.' The resulting 'racial and social biology' could
make vicious forms of anti-Semitism seem intellectually respectable to learned
men and women."
Physicians supported Hitler. In 1929, a group of 44 physicians
formed the National Socialist Physicians' League to coordinate Nazi medical
policy and "to purify the German medical community of the influence of Jewish
Bolshevism." By the time Hitler came to power four years later, 2,786 doctors
or 6 percent of the entire German medical profession had joined the league.
Nearly 40,000 physicians, 45 to 50 percent of all German physicians, had joined
the league by 1942. Michael Kater describes physician participation in Doctors
Under Hitler this way: "With over two-thirds of all physicians in Germany
admitting to some connection with the [Nazi party] or its derivatives, the
medical profession surely emerges as one of the most highly Nazi-oriented
occupational strata in the Third Reich."
Robert Proctor asks, in Racial Hygiene: Medicine
Under the Nazis, "How could such ideas come to dominate a community of scholars
and physicians dedicated to serving and preserving life?" He offers several
explanations:
- German
racial hygienists modeled their science on movements in other countries,
imploring their fellow Germans to follow these examples, lest Germany be
surpassed in racial purity. Racial hygienists drew upon the examples of
restrictive immigration, sterilization, and miscegenation laws in the United
States to formulate their own policies in these areas.
- The
Nazi's willingness to "medicalize" a host of social problems, including
criminality, alcoholism, and homosexuality, may be one of the primary reasons
Nazism appealed to physicians. Nazi racial programs were seen as public health
programs, involving the participation of doctors in state policy on an
unprecedented scale. It may even be true that under the Nazis the medical
profession achieved a higher status than in any other time in
history.
- Central
to the medical code of ethics was, and is, that physicians should stand up for
one another, especially in the face of criticism or adversity. Proctor wonders
whether an ethic that encouraged criticism might not have served the profession
better.
- With the
collapse of the German economy from 1929-1932, there was severe competition for
jobs, especially among younger physicians. Eliminating Jewish physicians, who
accounted for 13% of all German physicians, created opportunities for financial
advancement, especially for younger physicians, who were most enthusiastic in
the support of the Nazis.
- Jewish
physicians accounted for an even higher percentage of all German physicians in
large cities and, especially, in academic medical institutions. Eliminating
Jewish physicians created opportunities for professional advancement for German
medical scientists, whose credentials and prestige influenced many of their
colleagues.
- The Nazis
gave new meaning to the idea of sacrifice in the time of war. Alfred Hoche, the
author of The Destruction of Lives Not Worth Living, lost his first and only
son in World War I, and used this to argue that if the healthy could make such
a sacrifice, then why should the sick and inferior not make similar sacrifices?
The destruction of German's "less fit elements" was defended as a measure that
would balance the counterselective effects of World War I and free up beds for
the German war effort. The cloak of war also provided the secrecy necessary for
the massive programs of human destruction.
When
Hitler came to power, he quickly called upon physicians to implement a policy
he had written about in Mein Kampf: "Whoever is not bodily and spiritually
healthy and worthy, shall not have the right to pass on his sufferings in the
body of his children." In 1933, the Nazi government passed the Law for the
Prevention of Genetically Diseased Offspring or the Sterilization Law. In 1934,
181 Genetic Health Courts and Appellate Genetic Health Courts were established
to administer the Sterilization Law. Each court was presided over by two
doctors and a lawyer, one of whom had to be an expert on "genetic
pathology."
The
Sterilization Law required doctors to register all of their patients with
genetic illnesses, such as feeble-mindedness, schizophrenia, manic-depressive
insanity, genetic epilepsy, Huntington's chorea, genetic blindness, deafness,
and severe alcoholism with their local genetic court. The German Medical
Association founded a journal, The Genetic Doctor, to help physicians "select"
who should be recommended for sterilization and to describe the latest
sterilization techniques. Genetic courts, whose proceedings were secret, then
reviewed the recommendations and, in over 90 percent of cases, ordered
sterilization. Between 1933 and 1939, approximately 350,000 to 400,000 men and
women were sterilized.
The Nazis found support for their sterilization laws in the
United States, where Indiana passed the first sterilization law in the world in
1907. In the mid-1920's, when 28 states had sterilization laws on the books,
the United States Supreme Court ruled that sterilization was constitutional,
declaring: "Three
generations of imbeciles is enough."
The Nazi government also promoted positive eugenics,
passing legislation that took women out of universities and the workplace and
returned them to the home, where they were to have as many children as
possible. Hitler established the Honor Cross of German Motherhood, awarded in
bronze for four children, silver for six, and gold for eight. At a time when
forced sterilization and abortion were legalized for individuals with
undesirable genetic traits, sterilization and abortion for "healthy" German
women were declared illegal and punishable as a "crime against the German
body."
In 1935,
the Nuremberg Laws excluded Jews from citizenship-Jews were already excluded
from practicing medicine on non-Jews in 1933- and prevented marriage and sexual
relations between Jews and non-Jews. A further measure, the Marital Health
Laws, required couples to submit to medical examinations before marriage at one
of 700 Reich health offices to see if "racial pollution" might be involved. The
Nuremberg laws were considered public health measures and were administered
primarily by physicians, who profited financially as instruments of racist Nazi
policies.
Once
again, German racial theorists cited American actions in support of their
policies. The Germans were particularly taken with the 1924 Immigration
Restriction Act, which cut annual immigration to the United States by 90%, and
by American miscegenation legislation. One of Germany's racial hygiene journals
reported that the University of Missouri had refused to admit black students
and that the American Medical Association refused to admit black physicians to
its membership.
In
May of 1939, Hitler implemented the concept of "extermination of lives not
worth living" when he instructed his personal physician, Karl Brandt, to
appoint a committee to prepare for the secret "mercy killings" of deformed and
retarded children. Jewish children were originally excluded from this program
on the grounds that they did not deserve the "merciful act" of euthanasia.
Doctors were required to register any child born with congenital
deformities-the reporting requirement was eventually extended to cover children
up to 17 years old-with local health authorities. After the reports were filed,
physicians on the Committee for the Scientific Treatment of Severe, Genetically
Determined Illness sorted the infants and children for possible "selection," a
euphemism for death by medical means.
The killings occurred in 28 institutions, including
some of Germany's most prestigious hospitals, administered by pediatricians and
medical authorities. The head of the euthanasia program of Brandenburg Hospital
emphasized that only physicians should perform euthanasia, saying, "The needle
belongs in the hand of the doctor." Children were killed by a variety of
methods, including morphine injections and gassing with cyanide or chemical
warfare agents. Some institutions starved the infants and children to death so
that they died of "natural causes."
The child euthanasia program was not voluntary.
Parents of the selected children were told that transportation to one of the
hospitals was necessary to improve treatment for their child. A standard letter
was then sent to parents, saying that their child had died suddenly and
unexpectedly of a contrived cause and that, owing to the danger of an epidemic,
their child's body was cremated immediately. More than 5,000 children were
killed in the child euthanasia program.
In October of 1939, Hitler issued a
Fuhrer decree, which read: "Reich Leader Bouhler and Dr. Brandt are charged
with the responsibility for expanding the authority of physicians, to be
designated by name, to the end that patients considered incurable according to
the best available human judgment of their state of health, can be granted a
mercy death." This "T4" program, which took its name from the Tiergarten 4
address of Hitler's Chancellery in Berlin, involved virtually the entire
psychiatric community and large segments of the general medical
community.
Under
the guise of a statistical survey, questionnaires were sent to psychiatric
institutions and homes and hospitals for the chronically ill, Physicians,
usually psychiatrists, evaluated the responses and placed either a red "+,"
indicating death, or a blue "-," indicating life, in the lower left-hand corner
of the form. Those marked for death were then transported, for "war-related
measures," in buses with blackened windows to one of six main killing
centers.
Physicians killed patients with injections of poisons or by
gassing with carbon monoxide. For each patient, physicians falsified the death
certificate by inventing a cause of death that could have some medical
credibility. In this and many other ways, physicians participated in the vast
deception involved in spiriting away patients, killing them, and then
pretending that they died of something else. By August of 1941, when Hitler
called an end to the T4 program, 70,000 adult patients had been
murdered.
Although
T4 officially ceased as a program, widespread killing continued in a second
phase of adult euthanasia, sometimes-called "wild" euthanasia. Doctors were
encouraged, if not directed by the regime, to act on their own initiative to
exterminate "lives not worth living." The killings continued until, and in some
cases even beyond, the demise of the Nazi regime. Indeed, there are stories of
Allied troops liberating surviving patients from their physicians at
gunpoint.
When
Hitler called an end to the T4 program, the gas chambers were dismantled and
reassembled in concentration camps in what was called Operation or Special
Treatment 14 f13. The goal of Operation 14 f 13 was to murder, by gassing, all
concentration camp prisoners who were unwilling or unable to work. In the
spring of 1941, hundreds of experienced psychiatrists from the T4 program were
sent to the camps, charged with the tasks of selection, deportation, and
execution of appropriate subjects. While Aryans were required to have a medical
examination to determine their eligibility for this program, Jews were selected
merely on the basis of their "racial inferiority." The stage was set for the
"Final Solution" of the Jewish problem.
The horrors, crimes, and abuses of
biomedicine in the Third Reich seem unbelievable. Millions of innocent people
were tortured, mutilated, starved, and murdered as threats to the state. Babies
were killed only because of their race, religion, or mental or physical
disability. There is no doubt that these acts were immoral, but those who
carried out mass murder, sterilization, and cruel experiments did so for
reasons they believed were moral.
In When Medicine Went Mad: Bioethics and the Holocaust, Arthur
Caplan states that it is comforting to "believe that only madmen, charlatans,
and incompetents among doctors, biomedical scientists, public health officials
and nurses could possibly have associated with those who ran the Nazi party. It
is comforting to believe that health care professionals who have pledged an
oath to 'do no harm' could not kill babies or conduct brutal, often lethal,
experiments on starving inmates in concentration camps. It is comforting to
think that it is not possible to defend involuntary euthanasia, forced
sterilization, and genocide in moral terms. It is comforting to believe that
anyone who espouses racist, eugenic ideas cannot be a competent, introspective
physician or scientist. Nazi medical crimes show that each of these beliefs is
false."
Nonetheless, after the war, at the Nuremberg Doctors' Trial
known as The Case Against the Nazi Physicians, only 23 defendants were charged
with "murders, tortures, and other atrocities committed in the name of medical
science." In reality, there were thousands of physician perpetrators and
accomplices, the overwhelming majority of whom escaped justice. Indeed, many
were restored to positions of prominence and respect among the German medical
community.
The
average German physician was content to forget the wartime period and organized
medicine, often infiltrated with former Nazi doctors, collaborated to cover up
the past. In 1946, the West German Physicians' Chambers asked Alexander
Mitscherlich, a young lecturer in psychiatry, and Fred Mielke, a medical
student, to report on the Nuremberg Doctors' Trial. Ten thousand copies of
their book, Doctors of Infamy, were printed and sent to the West German
Physicians' Chambers. The book was not reviewed in any medical journal and the
fate of the ten thousand copies is unclear.
We conclude with a tale told by Dr. William Seidelman
in When Medicine Went Mad: Bioethics and the Holocaust about "a timeless symbol
of medicine and the ethical spirit of the profession: the Greek Island of Kos.
On Kos, there exists the remains of a major temple to the Greek god of
medicine, Aescelapius. Kos is also the mythical birthplace of Hippocrates, who
created the paradigm, perhaps mythical as well, of the ethical physician. An
oft-visited site in the town of Kos is an ancient plane tree where, legend has
it, Hippocrates taught under its branches. Seeds from the plane tree of
Hippocrates have been distributed around the world as part of an effort to
disseminate the Hippocratic spirit.
"In the summer of 1944, Kos was occupied by the
German military. On July 23, the 120 Jews of Kos were assembled at the harbor,
near the plane tree of Hippocrates. A small vessel arrived to pick them up,
afterward joining other vessels containing the last Jews of Rhodes. From there,
they were transported to the Greek mainland and from there they were conveyed
by train to Auschwitz.
"Upon arrival at the rail siding in the Birkenau complex, the
Jews of Hippocrates' birthplace were met on the ramp by the professional
descendants of Hippocrates. Those licensed SS physicians who had been selected
to select made a diagnosis on each of the Jews of Kos that he or she was a
'useless life' and should receive the 'Great Therapy of Auschwitz,' which was
death in 'The Central Hospital.' There, they all perished."
"Today the island of Kos and the empty
synagogue of Kos, which adjoins the plane tree of Hippocrates, symbolize the
spiritual crisis of medicine arising from the Holocaust; a crisis that medicine
has failed to recognize, let alone resolve."
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