Nightingale Alliance® Euthanasia Opposition - Resources, End of Life Alternatives

Ja Emerson Vermaat, ?Euthanasia? in the Third Reich: Lessons for Today? 18 Ethics & Med. 21 (2002).

Sixty years ago the Nazis occasionally used similar arguments as today?s humane and sincere advocates of euthanasia. Karl Brandt, the head of Hitler?s euthanasia program, claimed at his trial after the war: "The underlying motive was the desire to help individuals who could not help themselves and were thus prolonging their lives of torment." However plausible or humane this may sound, the reality was far from humane. Indeed, the Nazis went far beyond killing the incurably sick, and few of the "individuals" Brandt had in mind actually made a request that "their lives of torment" should not be prolonged.

"Euthanasia" in the Third Reich was even a prelude to the Final Solution (Endlösung). Euphemistic terminology and covering up was the rule. Hitler?s Euthanasia Decree (Erlass) of 1 September 1939 ordered his personal physician Dr. Karl Brandt and Reichsleiter Philip Bouhler, head of the Reich Chancellery, "to enlarge the authority of certain physicians to be designated by name in such a manner that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death (Gradentod)." Hitler?s decree was written on personal letterhead ("Adolf Hitler. Berlin") and highly secret. It was never made law, even when pressure was brought to bear to do so. The official bureaucracy was largely bypassed.

Nazi practices of euthanasia did not appear out of the blue. They were preceded by Social Darwinism and the debate on "eugenics." Racial and social hygiene and sterilization of inferior and worthless life were dominant themes in the Twenties. This was referred to as Schädlingsbekämpfung ("pest control"). In July 1949 Leo Alexander, Chief U.S. Medical Consultant at the Nuremberg Crimes Trials, published his essay "Medical Science Under Dictatorship." The Nazi rule in Germany was preceded by "a propaganda barrage directed against the traditional compassionate nineteenth-century attitudes towards the chronically ill," Alexander writes:

"Sterilization and euthanasia of person with chronic diseases was discussed at a meeting of Bavarian psychiatrists in 1931. . . . Nazi propaganda was highly effective in perverting public opinion and public conscience in a remarkably short time. In the medical profession this expressed itself in a rapid decline in standards of professional ethics."

The crimes which the Nazis would commit later had their origins in prior subtle changes as stated in the following:

"The beginnings at first were a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as 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 social unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans."

Leo Alexander?s findings are still valid today. It would be wrong to assume that the decline of medical standards and ethics in the Third Reich is completely irrelevant to contemporary bioethical debates. Writing about the "Nazi Doctors and Nuremberg," Pellegrino points out:

"So obvious these moral lessons seem now, and so gross the malfeasance, that it seems redundant to revisit them. Certainly we do not need to study such gross moral pathology that could never happen again. That is a dangerous conclusion. Moral lessons are quickly forgotten. Medical ethics is more fragile than we think. Moral reasoning based on defective premises tends to recur in new settings."

Euthanasia was recently legalized in The Netherlands. There is, of course, a wide gap between Nazi thinking on medical ethics and the mood of the Dutch medical community of today. But laws are made and subsequently eroded by practice. Shortly after the new euthanasia law was passed in the First Chamber of Dutch Parliament, Health Minister Els Borst suddenly widened the debate in a highly controversial interview. If old people who are "tired of life" (levensmoe) would take a suicide pill ? the so-called "Drion-pill" ? she, the Health Minister, would not object." She said that this issue must be a matter of public debate. One month later the NVVE (the Dutch pro-euthanasia movement) announced a public debate on the suicide pill, which it hopes will be legalized after its conclusion. A TV-documentary is being prepared to arouse public awareness to the issue.

Of course, there is not the slightest resemblance between the Dutch euthanasia movement and crude Nazis or their ideology. But the ghosts of the past will some day haunt those who proclaim principles like "there is such a thing as life not worthy to be lived." The lessons from the past can only be ignored at our peril.

Posted on June 25, 2004.