Chapter 5 The Nazi Eugenics Programs

The economy of Germany was in shambles at the end of World War I. The population was decimated. The government-this was the Weimar Republic, which was in power from 1919 until 1933-looked to popular eugenic theories for ways to restore and improve the health and physical wellbeing of the populace.

In 1932, inspired in part by Laughlin's Model Eugenics Law and other writings in the United States, the Weimar government drafted a plan for sterilizations of individuals with "hereditary illnesses." Many people were living in institutions, and they were costly to the country. Sterilizing them would prevent them from having children; some might then also be able to leave the institution and live on their own. The plan involved those to be sterilized (or their guardians) in decisionmaking, requiring prior consent to the procedure.

The next year, the National Socialists-Nazis-took control of Germany. On July 14, 1933, the new government issued its "Law for the Prevention of Progeny with Hereditary Diseases." This law was far more directive than the Weimar government's plan. People with so-called hereditary illnesses had to be sterilized, even if they objected. And the list of persons classified as hereditarily ill included those suffering from "congenital feeble-mindedness, schizophrenia, manic depression, hereditary epilepsy, Huntington's chorea, hereditary blindness, hereditary deafness, and serious physical deformities." People with chronic alcoholism could also be sterilized. The law established some 200 Genetic Health Courts at which teams of lawyers and doctors would subpoena medical records in order to choose candidates for sterilization. The Court proceedings were secret, and the decisions could rarely be reversed.

Throughout Germany, doctors were being trained in "race hygiene." They were identifying and zealously reporting those in their communities who had any of the so-called genetic diseases and would be candidates for sterilization. The Nazis and Nazi doctors also were promoting the eugenics strategy of "selective breeding" as a way to rebuild the nation's population, specifically its Aryan population.

In the six years before World War II, the Nazi doctors sterilized some 400,000 people, mostly German citizens living in asylums. Hitler's Rassenhygiene-race hygiene-program was in full swing. "The 'racial' health of the German people took precedence over the health of any given individual." (See included JAMA article.)

By the late 1930s, the Nazi government was using propaganda movies to persuade the public that those who were hereditarily ill and, therefore, dangerous to the health of the nation should be exterminated rather than kept alive as "neutered beings." The targets for extermination were objectified as "beings of lesser worth," "life unworthy of life," "ballast existences," "useless eaters."

In the autumn of 1939, Hitler approved the Aktion T-4 program, which authorized specific doctors and officials to carry out mercy deaths-euthanasia-of those the state deemed unworthy of life. Fifty volunteer physicians coordinated the program from its headquarters in a villa in Berlin located at number 4 Tiergarten Street (hence the name T-4). Again, physicians at hospitals and psychiatric institutions throughout Germany identified and recommended candidates for euthanasia.

At first, in accordance with the T-4 program, the physicians murdered 5000 congenitally deformed children. The children were given lethal injections or were starved to death at six special asylums that had been remodeled to accommodate the killings. Then, the T-4 program expanded to include adults, who were taken to killing asylums as well. Death certificates were sent to families of those who were killed, falsifying the reasons for their relatives' 'sudden deaths.'

Eventually, church groups and the general public raised objections to the T-4 program. In response, Hitler called a halt to the program. But, by then, August of 1941, almost 70,000 people had been killed under T-4. And, although Aktion T-4 stopped, the killing did not.

Doctors and nurses around the country continued to select and kill people and cover up their actions. Physician historian Edzard Ernst writes that Aktion T-4 "turned out to be nothing less than a 'pilot project' for the extinction of millions in the concentration camps." Most of the health care practitioners involved in T-4 simply transferred their "technology for killing on an 'industrial scale'" to the Aktion 14f13 program. Through this next program, six million Jews were exterminated in the gas chambers of the concentration camps as well as millions of political prisoners, Gypsies, the handicapped, those too ill to work, Jehovah's Witnesses, homosexuals, Afro-Europeans, and Soviet and Polish prisoners-of-war.

Hitler's race hygiene program relied on and succeeded because of the enthusiastic collaboration of people in the medical community. Wrote Ernst: "German physicians had been involved at all levels and stages. They had developed and accepted the pseudo-science of race hygiene. They were instrumental in developing it further into applied racism. They had evolved the know-how of mass extinction. Finally, they also performed outrageously cruel and criminal experiments under the guise of scientific inquiry. The aim of generating pure Aryans had taken precedence over the most fundamental ethical issues in medicine." Under the Nazi medical system of routinized killing, writes physician historian Michael Burleigh, "no one was safe in the presence of the carers."

German physicians conducted numerous 'medical' experiments in the concentration camps between 1941 and the end of the war. Karl Brandt, Hitler's personal physician, suggested that the camps would be the perfect "laboratories" for their experiments. Experimentation was pivotal for race hygiene, and killing could be rationalized and "treated not as murder but as healing-as a therapeutic imperative aimed at preserving the health of the one racial community which really mattered."

The physicians considered the people in the concentration camps to be the "living dead." If they served as objects of medical research, their useless lives might have some utility. If they died, nothing was lost. They were destined for death anyway, being unworthy of life.

The concentration camp doctors perfected techniques for sterilization and euthanasia. Did high doses of radiation bring about sterilization? What about new surgical techniques? They injected people with gasoline and shocked them with electricity to see if these procedures would kill them. They took away the prisoners' food and watched to see how long it took them to starve to death.

The camp doctors used twins in many of their experiments, because twins provided a perfect built-in 'control' for each study. One twin would be injured, infected, or treated in some way and then let die. Then, the other twin was killed, so that their bodies could be compared. The Nazis also were interested in twins because, if they could figure out how to produce more twins, the population could be restored faster.

When the doctors wanted to complete a skeleton collection at the Reich University in Strasbourg, they selected 112 healthy Jewish prisoners, photographed them, measured them, and murdered them. They studied their bones and tissues and then sent the bodies to Strasbourg, where the flesh was removed and the skeletons put on display.

The eugenics-based horrors of the Holocaust were influenced by political, economic, social, and military factors. But it was the added factor of the Nazis' total disregard for the rights and dignity of human beings that made the Holocaust possible.

Included References

JAMA 1996 November 27; 276(20): 1657-1661.
Journal of the Royal Society of Medicine 1997 June; 90(6): 342-346.
British Medical Journal 1996, 313(7070): 1445-1449.
American Journal of Medicine 1996 May; 100(5): 579-581.

Additional Resources

Video: The Long Way Home
Video: Selling Murder: The Killing Films of the Third Reich
The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation. George Annas & Michael Grodin, eds., Oxford University Press, New York, 1992.
Death and Deliverance: 'Euthanasia' in Germany 1900-194
Michael Burleigh, Cambridge University Press, Cambridge 1994.
When Medicine Went Mad: Bioethics and the Holocaust, Arthur Caplan, ed.. Humana Press Totowa, New Jersey, 1992.
JAMA 2000 March 15; 283(11): 1486-1487, Hannah Decker. Book review of "Death of Medicine in Nazi German: Dermatology and Dermatopathology Under the Swastika," by Wolfgang Weyers.
Experimentation with Human Beings, Jay Katz, Russell Sage Foundation, New York, 197
See "Experimentation without Restriction," 283, 292-297.
Nurses in Nazi Germany: Moral Choice in History. Bronwyn Rebekah McFarland-Icke, Princeton University Press, Princeton, New Jersey 1999.

Aims

Students should understand the following:

Eugenics policies from the United States influenced the German eugenics programs
The Third Reich took eugenics one step further-to euthanasia
Hitler's race hygiene programs were aimed at creating a 'pure' Aryan race and wiping out all others
The Nazi programs devalued human life and worth
Many doctors and other medical professionals in Germany participated in the eugenics and euthanasia programs of the Nazis
The Doctors' Trial led to the development of universal ethical guidelines for human subjects research

Topics for Discussion/Written Assessment

Some nurses in Germany denied that they were responsible for the deaths of their patients, arguing that they did not personally participate in the killings. Discuss the notion of complicity. When is someone morally responsible for an action or situation? What factors absolve an individual of moral responsibility?
People raise concerns about the Human Genome Project in the light of what happened during the Holocaust. As human genes are mapped and connected to specific conditions and diseases, the specter is raised that eugenic-style discrimination, sterilizations, notions of a hierarchy of human worth, and so on, might once again come into being. Are these concerns legitimate? How can society respond to them? What additional concerns do gene identification experiments raise?
Explicit international ethical guidelines for how research involving human subjects should be conducted were crafted after World War II. Based on what you know about the experiments that were carried out on humans during the Holocaust, what would you have included in such guidelines so as to protect subjects of future medical research? What sorts of safeguards, review systems, and so on would you have insisted on to prevent cruel experimentation from occurring again?
The Nazi's racial hygiene program enjoyed support from the German medical profession from the very beginning. By January 1933, 2,800 doctors (6% of the whole medical profession in Germany) had joined the Nazi Physicians' League. Bioethicist Art Caplan points out that this rate of allegiance was 3 times greater than the rate for the general population and 15 times greater than the membership rate for judges. Historian Michael Biddiss cites overwhelming evidence that "physicians became Nazified more thoroughly and much sooner than any other profession." By 1936, at least 50% of German, non-Jewish doctors were Nazi Party members. The rate stayed at this level until 194
What motivates people to become doctors? How might this account for (or not) the ready acceptance of doctors to support and enact the Nazi eugenics and euthanasia programs?
Not all physicians participated in the Nazi's extermination program. A small group of medical students at the University of Munich founded the "White Rose" resistance organization in 194
In 1943, the members of the group were arrested as enemies of the Reich and executed. What motivates people to resist authority? What personal characteristics are found in people willing to risk their lives for a cause? What causes or rights would you be willing to risk your life to defend?
One experiment done in the camps involved using prisoners as "hosts" for the organism that causes typhus. People were "deliberately infected with typhus with the sole purpose of keeping the typhus virus alive and generally available in the bloodstream of the inmates." In this experiment, the people were treated like test tubes or other inanimate objects. How does such 'objectification' help researchers carry out cruel experiments? What safeguards might be put in place in human experiments so that researchers do not fall into this trap as they carry out their experiments?

Extension Questions for Additional Research

The Nazi euthanasia policies wiped out entire towns and villages. Find out what happened in one of these towns. What was the town like before the war? Who lived there? What is the history of the village? What did the Nazis do in that town and when were the town and its people destroyed? Check the website of the United States Holocaust Memorial Museum (http://www.ushmm.org) for the names of these towns.
After the war, 23 key Nazi doctors went on trial in Nuremberg for committing crimes against humanity. The "Case Against the Nazi Physicians" ended on August 20, 194
Fifteen were found guilty; seven were found not guilty; one was acquitted. Find out about the trial, the charges leveled against the physicians, and what happened to each of the doctors after the verdicts were in.
What codes toward ensuring human rights in the future came directly out of the Nuremberg trial? What guidelines are contained in the Nuremberg Code, the Declaration of Helsinki, and the Universal Declaration of Human Rights?
Go to the Illinois Institute of Technology's website, which posts online many codes of ethics in health care (http://csep.iit.edu/codes/health.html). Choose one code from a profession that interests you. What ethical duties does it list for practitioners? Which of these duties did the health care professionals who participated in the Aktion T-4 program and the later euthanasia programs violate?
Harry Laughlin's theories about eugenics greatly influenced policymakers in Germany. In 1936 he received an honorary doctorate in Germany for his contribution to race hygiene. Consider the theories of Laughlin and the Nazis regarding improving the health and population of a nation through selective breeding. How did the theories support the slippery slope evolution of Nazi 'programs' from eugenics to sterilizations to euthanasia to mass extermination?
Find out about other medical experiments not already mentioned that the Nazi doctors conducted in concentration camps. What did the doctors suggest were the purposes of the experiments? How did they conduct them? How many people did they injure or kill in their experiments? How valid are the studies?
Josef Mengele was the Nazi doctor who conducted many experiments on twins. What were some of his experiments? How did he select and treat the twins (mostly children) who participated in his studies? Why was he given the nickname "Angel of Death?"
Discuss the Holocaust with a family member, friend, or neighbor who was alive during World War II. What memories of that time period does the person have? What did the person know about the Holocaust while it was happening? What, if anything, did the person do during that time that was directly related to the situation? Write this interview up as a feature story for a newspaper.
What was Japan's eugenics program during the 20th century? How did it resemble the programs in the United States and in Germany? How was it different? What adaptations did the eugenics advocates in Japan have to make to the racist policies developed in the United States and Germany in order to make them work for Japan?
At the Doctors' Trial, the defense lawyers argued that Germany did not have explicit rules governing the conduct of research on humans during the Nazi era. But, in fact, in 1900, the Prussian minister for religious, education, and medical affairs had issued detailed regulations concerning non-therapeutic research and later additional guidelines were released, including 'guidelines for new therapy and human experimentation' by the Nazi government. Read the attached article from the British Medical Journal. What were the regulations that actually were in existence at the time? What was the Neisser case? How did Neisser's disregard of the rights of his subjects lead to the regulations? Find out what positive contributions Neisser made to medical science during his career.

Topics for Teacher Preparation

Hitler's race hygiene programs
Early eugenics programs in Germany
Complicity in the race hygiene programs by a majority of Nazi doctors
Social, political, and economic factors that contributed to the Holocaust
Experiments carried out by the Nazi doctors in the concentration camps
The Neisser case and subsequent regulations in Germany