A second fundamental lesson of the euthanasia Holocaust is that doctors must never allow themselves to be seduced into accepting dual loyalties. Subject to the rules required in protecting public health, the welfare of each individual patient—not that of society, the patient’s family, the finances of health insurance companies, government mandate, or the doctor’s individual pocketbook—must be each physician’s unequivocal concern. For doctors to place other agendas before the welfare of their patients is to expose those in their care to significant danger of exploitation and oppression.
Finally, let us heed the words of Dr. Leo Alexander, who served as an investigator in the Nuremberg trials and became one of the world’s foremost experts on the medical aspects of the Holocaust. In 1949, Dr. Alexander attempted to summarize what he had so painfully learned through years of investigation. In the New England Journal of Medicine, he wrote:
Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of physicians. It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.53
Dr. Alexander then issued a prophetic warning:
In an increasingly utilitarian society these patients [with chronic diseases] are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated . . . has developed. This is probably due to a good deal of unconscious hostility, because these people for whom there seem to be no effective remedies have become a threat to newly acquired delusions of omnipotence. . . . At this point, Americans should remember that the enormity of the euthanasia movement is present in their own midst.54
In today’s enlightened world, we soothingly tell ourselves that the spirit of Binding and Hoche has been exorcised. But that is self-deception. In fact, it still lurks in hospital corridors, university seminars, medical school classrooms, legislative cloakrooms, and most particularly in the depth and breadth of bioethics advocacy. This is not to say, of course, that today’s bioethicists are similar to Nazi doctors. (But then, Binding and Hoche weren’t Nazis either.) Nor is it to say that Western health policies are the same as those of fascist Germany. But we are heading in a very wrong and dangerous direction. There are, after all, many ways to fall off an ethical cliff.
Neglecting Disabled Infants to Death: In 1972, Life magazine reported that Mrs. Phyllis Obernauer gave birth to a daughter with Down syndrome. The girl’s condition was complicated by heart problems and an intestinal blockage, the latter a common occurrence with Down’s babies. The Obernauers decided they didn’t want a disabled baby and ordered their doctors not to perform surgery to clear up the intestinal blockage. Their intent was that their baby would die by starvation. The doctors refused to deprive the child of life’s basic necessities, and the baby lived.55
Beginning at about the time of the Obernauer case—a mere fifty years after the publication of Permission to Destroy Life Unworthy of Life—some of the world’s most respected doctors and philosophers began to again suggest openly that it should be ethical to kill or neglect disabled babies to death. Many of these death advocates were among the cream of the scientific community. For example, Harvard professor and Nobel laureate James D. Watson, the co-discoverer of the genetic makeup of DNA, reacting to the emergence of new reproductive technologies argued, “we have to reevaluate our basic assumptions about the meaning of life.” Analogizing to the ancient practice of exposing disabled infants on hills, Watson further declared, “No one should be thought of as alive until about three days after birth,” adding that parents would then “be allowed the choice” to keep their baby or “allow” their child to die.56 Similarly, another Nobel laureate involved in the discovery of DNA, Francis Crick, declared in 1978 that “no newborn should be declared human until it has passed certain tests regarding its genetic endowment and that if it fails these tests it forfeits the right to life.”57
Demonstrating the prescience of Dr. Alexander’s 1949 worries about American medical ethics, such advocacy took root. In 1982, Baby Jane Doe’s doctors engaged willingly in the very medical neglect that Baby Obernauer’s doctors refused to countenance only ten years before. Like the Obernauer infant, Baby Doe was born with Down syndrome and an intestinal blockage. Routine surgery to clear the blockage could have saved the baby’s life. But the mother’s ob-gyn told Jane’s parents that they could refuse surgery. Deciding that she—and they—would be better off if she died, Jane’s parents refused consent to surgery and ordered the doctors to withhold food and fluids for their child, dooming her to death by dehydration.
When the news broke that Baby Jane was being neglected to death because she was disabled, several couples came forward asking, even begging, for the opportunity to adopt her. But Jane’s parents wanted their baby dead, not adopted. They refused to allow others to intervene. The matter was brought to court, where a judge sided with Jane’s parents and against Jane’s equal moral status as a human being. She died six days after her birth. If a “normal” child were neglected to death in this way, the parents and doctors would be brought to the docket for child abuse. But because Jane was disabled, she was made to die and no legal sanctions were applied against either the parents or the participating doctors, this despite that on her way to death, she became parched, dried out, and spit blood.58
Similar cases have occurred elsewhere in the United States, England, Canada, and the Netherlands. In England, a woman gave birth to a Down’s baby who did not have an intestinal blockage. Upon learning that her baby was disabled, she said, “I don’t want it, Ducks.” Despite the fact that the child had no physical abnormalities other than the genetic condition that causes Down’s, she ordered the doctors not to feed the baby. Dr. Leonard Arthur ordered the baby to be given morphine but not fed. The baby died at the age of four days. Dr. Arthur wasn’t tried for homicide but paradoxically for “attempted murder.” Several of Dr. Arthur’s medical colleagues testified that such medical neglect directed at babies born with significant abnormalities is “normal medical practice.” Sir Douglas Black, president of the Royal College of Physicians, told the jury that he thought it ethical for a “rejected child” to be put “upon a course of management that would end in its death,” declaring “it is ethical that a child suffering from Down syndrome . . . should not survive.” After only two hours, the jury decided the doctor was not guilty to sounds of rejoicing in the courtroom.59
Babies with spina bifida have suffered similar fates. Spina bifida is a condition in which the spine is exposed at birth, with hydrocephalus (water on the brain) a frequent accompanying malady. The proper treatment for the condition is to close the wound in the back and drain the fluid from the brain with a shunt. Babies with spina bifida generally are disabled by paralyzed legs and are sometimes incontinent.
Dr. John Lorber was once a leading proponent of treating babies with spina bifida. At some point, he had a change of heart and became a leading advocate for nontreatment, developing protocols for deciding which spina bifida babies to care for and which to abandon to death by neglect. He subsequently traveled to the United States and Canada, urging pediatricians not to operate on these helpless infants. His justification?
Humanity demands that such badly affected infants should not be put through such constant and severe punishment. Criteria had to be found, preferably on the first day of life which could reliably separate those infants who may die early but even more importantly those who would live but would suffer from severe multi-system handicaps and would be unable to live an independent and dignified existence in spite of the best possible treatment. . . . [In such cases,] nothing should be done to prolong life.60