Back in 1930s Germany, the eugenicists and government propaganda continued to soften the ground for the eventual killing of “useless eaters.” One task remained before implementation could commence: that the medical profession had to reject the Hippocratic requirement that its sole loyalty is to be to each and every individual patient. “Between 1933 and 1945, German physicians did not take the Hippocratic Oath,” Dr. Franzblau told me. “Instead, they took an oath to the health of the state, known as the Gezuntheit. Thus doctors had a dual loyalty, to their patients yes, but their first loyalty was to Germany.”37
German doctors, to recall Dr. Hufeland’s warning, were now among society’s most dangerous members. Many physicians accepted wholeheartedly the eugenics-based theories, reinforced by Nazi racial ideology, that disabled people, mentally retarded people, and, of course, Jews, Gypsies, and others were life unworthy of life. At the same time, their first loyalty shifted to the state, away from their individual patients. Forced sterilization of the “unfit” had become commonplace and popularly accepted. Physicians and midwives voluntarily reported every child born with disabilities to authorities. Binding and Hoche’s notions of killing as a “healing” practice were accepted widely as ethical and moral. Dr. Karl Brandt, who Hitler had placed in charge of promulgating euthanasia bureaucratic procedures, had a plan of implementation firmly in place. The table was now set for the mass murder of hundreds of thousands of disabled people—the opening overture of the Holocaust.
Disabled infants became the first to suffer medical cleansing when Hitler signed a secret executive order in early 1939 permitting infanticide based on disability. No doctor was forced to kill patients. However, illustrating how effectively the Hippocratic tradition and the belief in the equality of all human life had been undermined over several decades in Germany, many physicians (as well as nurses and midwives) enthusiastically supported the policy, either directly by killing patients or indirectly by referring disabled babies to “health centers.” “The tragedy is that these doctors were not ogres,” Dr. Franzblau told me. “They were mainstream physicians who were exquisitely trained in German medical schools, which at the time were the best in the world. They went utterly wrong, in my judgment, because they no longer perceived these [disabled] patients as fully human.”38 Thus the German medical establishment participated in the euthanasia Holocaust, not because they were Nazis—although many had joined the Party—but because they had convinced themselves that they were performing, in Binding and Hoche’s words, a “healing” service for the child, the family, and the Reich.
Hitler and Brandt were so pleased with the success of their infanticide program that Hitler next issued an executive order expanding the categories of those to be medically cleansed to include disabled and mentally retarded adults. The order stated simply: “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 [Signed,] Adolph Hitler.”39 This was the infamous “T-4 Program,” named after the address of the German Chancellery, Tiergarten 4. “Killables” included people with epilepsy, polio, schizophrenia, senile diseases, paralysis, and Huntington’s disease. As with the infanticide program, T-4 was officially a secret; death certificates listed phony causes of death.
Adult euthanasia victims were sent to specially designated hospitals that had been converted into centers of mass murder. Like the later Jewish genocide, T-4 was highly bureaucratized. Government workers “coldly and calculatingly organized the murder of thousands of people” and kept meticulous records of what they were doing. Secretaries, for example, “shared their offices with jars of foul-smelling gold-filled teeth, listening to dictation which enumerated ‘bridge with three teeth,’ ‘a single tooth,’ and so on.”40 With so many people involved in the killing, it wasn’t long before much of Germany became aware of what was going on. There were some public protests. Catholic Archbishop Clems August Graf von Galen even preached openly against the euthanasia policy,41 and dared the Gestapo to arrest him, stating that he would meet them in full regalia. Even some Party members objected, assuring themselves that the Führer must not know.42 Himmler soon recognized that the jig was up and pronounced euthanasia “a secret that is no longer a secret.”43
Because of public pressure, Hitler rescinded the T-4 program, although not the infanticide directive. Nevertheless, German doctors continued to murder disabled and ill infants and adults in a process known as “wild euthanasia” until stopped by the Allies at the end of World War II. The death toll is estimated to have been about 250,000 people. Every one of these deaths “required a physician’s review and order to determine that the individual’s life was not worth living.”44 Among those who participated in the killing programs were Dr. Ernst Wetzler, ironically the inventor of an incubator for prematurely born children, and Dr. Hans Joachim Sewerling, who was elected in the 1980s to the presidency of the World Medical Association but forced to resign due to the efforts of Dr. Franzblau and the American Medical Association. Neither German doctor ever expressed remorse. Indeed, Dr. Wetzler called his participation in the murder of disabled infants as “a small contribution to human progress.”45 Dr. Sewerling sought refuge in anti-Semitism, claiming his political troubles were the result of a “Jewish conspiracy.”46 Rather than receiving the calumny of his peers, after being forced to resign as president of the WMO Dr. Sewerling was named an honorary member of the German Medical Association’s board of trustees.47
IMMORAL MEDICAL EXPERIMENTS
Adding to the infamy of German medicine were the SS physicians who engaged actively in genocide and human medical experimentation. For example, at Auschwitz, doctors helped create “the murderous ecology” of the camp. They performed selections and supervised the killing in the gas chambers. They determined when all of the gassed victims were dead. Doctors lethally injected debilitated inmates and helped work out details of body disposal.48
A few SS doctors also carried out inhumane “medical” experiments on people in concentration and death camps, during which inmates, almost all of them Jewish, were subjected to horrible crimes of bodily violation. The horror of this is impossible to overstate: women had their cervixes injected with caustic substances in an attempt to invent sterilization-by-injection; men were subjected to intense X-ray exposures of their genitals to induce sterilization, with later castration to study the damage radiation caused to the testes; inmates were intentionally exposed to typhus contagion to determine the efficacy of various sera. At Auschwitz, Joseph Mengele engaged in a sadistic study of identical twins, including children who he physically examined over several months, measuring every part of their body and taking their blood, and then lethally injected them prior to dissection.49 “German physicians in the name of science,” Dr. Franzblau has stated, “froze people to death, asphyxiated them by denying them oxygen at high altitudes, forced them to drink seawater to the point of serious illness, injected them with tubercle bacilli, cut off arms and legs of war prisoners and attempted [tissue] grafting, and perfected the use of Zyklon B gas, the preferred method of death in the concentration camps.”50
CRUCIAL LESSONS LEARNED
The depth of depravity to which some German physicians sank seems unthinkable to us today. But it was unthinkable when it happened, too. How could German doctors, of all people, have gone so far astray? To exclusively blame the Nazis is to miss the mark and give us false comfort about our own flirtation with unethical health policies. Adolph Hitler did not blaze the road to medical depravity. He just goose-stepped with full fascist regalia down the boulevard already paved by Binding and Hoche with their advocacy that there is such a thing as a human life unworthy of life. Permission to Destroy Life Unworthy of Life gave the imprimatur of the academy to a subjective measurement