Euthanasia” Programs
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1 IV. THE “MEDICALIZATION OF MURDER”: THE “EUTHANASIA” PROGRAMS Part 1: The Children’s “Euthanasia” ProGram Professor Susan Benedict UT Health Science Center Houston, Texas, USA 77030 [email protected] 001-713-500-2039 Purpose of the Module: The PurPose of this module is to describe how the “euthanasia” ProGram in Germany beGan with the murder of children with disabilities. Suggested Reading: 1. BurleiGh, M. (1994). Death and Deliverance. CambridGe, UK: CambridGe University Press, P. 93-129. 2. Friedlander, H. (1995). The OriGins of Nazi Genocide. Chapel Hill: University of North Carolina Press, P. 39-61. 3. Gallagher, H. (1990). By Trust Betrayed. ArlinGton, VA: Vandamere Press, P. 88-104. 4. Proctor, R. (1988). Racial HyGiene. CambridGe, MA: Harvard University Press, P. 177- 222. 5. Benedict, S., O’Donnell, A., Shields, L. (2009). Children’s “euthanasia” in Nazi Germany. Journal of Pediatric NursinG, (246), 506-516. Suggested Video: HealinG by KillinG, Part I. Objectives: 1. To identify the major historical factors leadinG to the children's euthanasia ProGram 2. To describe the major beliefs of the German PeoPle and the German culture consistent with the develoPment of the children's euthanasia ProGram 3. To sPecifically apPraise the roles of Physicians and nurses in these killinGs 4. To analyze the connections between the killinG of disabled children and the apPlication of racial hyGiene Policy 5. To identify your feelinGs and thouGhts about the value of the individual and society's resPonsibility to Protect vulnerable GrouPs 6. To discuss the relevancy of this module to contemPorary Practice Discussion Points: 1. What was the role of German Government and Policy in decidinG who was "worthy" of continued life? 2 2. What were the socio-cultural and Political factors that led to the children's euthanasia ProGram? Could there have been a different outcome in this Place and time? 3. At what Point is the "line crossed" when makinG decisions about the termination of life and who has the riGht to make these decisions? 4. What is the inherent value of human life irresPective of mental and Physical conditions? 5. What is the relevancy between the children's euthanasia ProGram and contemPorary ethical issues you face today? Synopsis: The word “Euthanasia” means an easy death. The killinG of the disabled and handicapPed of Germany and Austria durinG National Socialism was anythinG but easy for the victims. It was involuntary, deceitful, cruel, unforGettable, and unforGivable. It beGan with the killinG of the most vulnerable: children with disabilities. There is not a sinGle factor that led to the killinG of 3,000 – 5,000 of these children. There was the stronGly held belief by the German PeoPle, and esPecially the German medical Profession, in euGenics. A stronGer and healthier race was to be created throuGh the elimination of “inferior” PeoPle. HandicapPed children were seen as Positive Proof that some PeoPle were Genetically or hereditarily “inferior”. There was the humiliatinG and financially devastatinG Treaty of Versailles which left Germany in desPerate economic straits, thus drastically cuttinG the resources to care for institutionalized children and adults. There was the beGinninG of World War II which necessitated reallocation of economic resources to the war effort and a call to free hosPital beds and staff to care for the wounded. There was the belief that severely handicapPed were livinG “lives unworthy of life” and to eliminate their existence was releasinG them from sufferinG and removinG a diseased Part from the healthy Volk. And 3 Perhaps the Greatest influence came from the Führer himself who had lonG advocated the elimination of the “weaker elements” of society. An imPortant event in the develoPment of the German euthanasia ProGrams was the Publication in 1920 of a book entitled Die FreiGabe der VernichtunG lebensunwerten Lebens (The sanctioninG of the destruction of lives unworthy to be lived). 1 Written by Alfred Hoche, a Professor of Psychiatry at the University of FreiburG, and Karl BindinG, a German judGe and former President of the Reichsagericht, the hiGhest criminal court,2 this book advocated the killinG of PeoPle who were “mentally ill or mentally defective”. It was within this book that the term “euthanasia” was used for the killinG of PeoPle with mental illnesses who could not Give consent.3 Hoche and BindinG asserted that the riGht to live must be earned and justified and that those who had no capacity for human feelinG were livinG lives not worth livinG and their destruction would be humane. 4 BindinG ProPosed that three GrouPs of Patients should be killed: 1) Patients with a terminal illness who were mentally comPetent and who exPressed a wish to die, (2) the “incurable lunatics” who had neither the will to live nor to die, and (3) PeoPle who were formerly mentally healthy but who had sustained a illness or injury that would make them either Permanently comatose or who would “awaken to a nameless misery” 5 Binder and Hoche stated that the elimination of those who are mentally comPletely dead is not a crime, not an immoral act, not brutal, but a Permissible and beneficial act.6 However, by German law, this “elimination” was a crime. 4 In a Nazi Party rally held in NuremberG on AuGust 5, 1929, Hitler stated the following: If Germany was to Get a million children a year and was to remove 700,000 - 800,000 of the weakest PeoPle then the final result miGht even be an increase in strenGth. The most danGerous thinG is for us to cut off the natural process of selection and thereby Gradually rob ourselves of the Possibility of acquirinG able PeoPle...As a result of our modern sentimental humanitarianism we are tryinG to maintain the weak at the exPense of the healthy. It Goes so far that a sense of charity, which calls itself socially resPonsible, is concerned to ensure that even cretins are able to Procreate while more healthy PeoPle refrain from doinG so, and all that is considered Perfectly understandable. Criminals have the oPPortunity of ProcreatinG, deGenerates are raised artificially and with difficulty. And in this way we are Gradually breedinG the weak and killinG off the stronG.7 It has been lonG rePorted that the imPetus for the children’s euthanasia ProGram came from a request to Hitler’s Chancellery by the father of a severely handicapPed child by the last name of Knauer8,9,10,11 to have the child killed. The child was described as beinG born blind, missinG one leG and Part of an arm, and Possibly an “idiot”12. More recently, Ulf Schmidt identified the child as Gerhard Herbert Kretschmar. He was born on February 20, 1939 in Pomβen. His Parents were rePorted to be ardent Nazis.13 The infant’s father, Richard Gerhard Kretschmar, contacted Dr. Werner Catel, the director of the University Children’s Clinic in LiPziG, to have the child “Put to sleeP” because Richard was concerned about the effect the child was havinG on the mother. Catel refused, believinG it was illeGal; however, the father, or accordinG to BurleiGh14, the child’s Grandmother, Petitioned Hitler to Grant Permission to have him killed. The Petition of the Kretschmar family was not unique. In fact, one official rePorted that two thousand such requests reached the Chancellery each day.15 5 However, this Particular request did catch Hitler’s attention and he sent Dr. Karl Brandt to LeiPziG to investiGate. Brandt was authorized by Hitler to allow the child to be killed if all agreed that the infant was as described. Thus the Kretschmar [Knauer] child became the first known victim of the Nazi euthanasia ProGram.16 TestifyinG in November 1960, Dr. Hefelmann of the Führer’s office stated Brandt told me later about the Knauer case. Hitler had Given him unrestricted authority to let the euthanasia take Place...at least Brandt told me that the child was Put to sleeP by Catel. I seem to remember that Brandt said that the euthanasia was done with tablets. Whoever undertook the actual euthanasia, Brandt or Catel, or a different Physician altoGether or even a careGiver is hard to say. I am quite certain that the euthanasia occurred at the University Clinic in LeiPziG.17 Subsequent requests for euthanasia were also dealt with at the Kanzlei des Führer and were considered “secret state action”. This children’s euthanasia ProGram was disGuised under the title of “The Reich Committee for the Scientific ReGistration of Serious Hereditary- and ConGenitally-based Illnesses” [Reichsausschuss zur wissenschaftlichen ErfassunG von erb- und anlagebedinGten schweren Leiden], known simPly as the “Reich Committee”.18 A Goal of the Reich Committee was to determine the number of newborns with Problems or conditions and to initiate the killinG of these children alonG with those children with disabilities who were already institutionalized.19 6 Photo courtesy of Judy Lott. 7 In 1939, a Ministry of Justice commission ProPosed the followinG: Clause 1: Whoever is sufferinG from an incurable or terminal illness which is a major burden to himself of others can request mercy killinG by a doctor, Provided it is his exPress wish and has the apProval of a sPecially emPowered doctor. Clause 2: The life of a Person who, because of incurable mental illness, requires Permanent institutionalization and is not able to sustain an indePendent existence may be Prematurely terminated by medical measures in a Painless and covert manner.20 On AuGust 18, 1939, the State Ministry of the Interior mandated that all Physicians and midwives rePort all newborns with observable Physical and/or mental disabilities: RE: The duty to rePort deformed births etc. 1. In order to clarify scientific questions in the field of conGenital deformities and intellectual under-develoPment [sic], it is necessary to reGister the relevant cases as soon as Possible.