Sunday, 27 January 2013

Holocaust Memorial Day – Let’s not forget the key role doctors played

The millions of Jews and others killed during the Holocaust have been remembered in services today across the UK, as part of Holocaust Memorial Day.

Candles have been lit at ceremonies in London and Staffordshire's National Memorial Arboretum, 68 years after Auschwitz was liberated.

More than one million people, mostly Jews, died at the Nazi camp before it was liberated by allied troops in 1945.

But the horrific genocide of six million Jews was only the final chapter in the story.

What is far less well known is the role of doctors in the process.

Twenty-three physicians were tried at the so-called Nuremberg Doctors' Trial in 1946 (picture above), which gave birth to the Nuremberg Code of ethics regarding medical experiments.

Many others including some of the very worst offenders never came to trial (see full list here).

What ended in the 1940s in the gas chambers of Auschwitz, Dachau and Treblinka had much more humble beginnings in the 1930s in nursing homes, geriatric hospitals and psychiatric institutions all over Germany.

When the Nazis arrived, the medical profession was ready and waiting.

Germany emerged from the First World War defeated, impoverished and demoralised.

Into this vacuum in 1920 Karl Binding, a distinguished lawyer, and Alfred Hoche, a psychiatrist, published a book titled ‘The granting of permission for the destruction of worthless life. Its extent and form'.

In it they coined the term ‘life unworthy of life’ and argued that in certain cases it was legally justified to kill those suffering from incurable and severely crippling handicaps and injuries. Hoche used the term ballastexistenzen (‘human ballast’) to describe people suffering from various forms of psychiatric disturbance, brain damage and retardation.

By the early 1930s a propaganda barrage had been launched against traditional compassionate 19th century attitudes to the terminally ill and when the Nazi Party came to power in 1933, 6% of doctors were already members of the Nazi Physicians League.

In June of that year Deutsches Arzteblatt, today still the most respected and widely read platform for medical education and professional politics in Germany, declared on its title page that the medical profession had ‘unselfishly devoted its services and resources to the goal of protecting the German nation from biogenetic degeneration’.

From this eugenic platform, Professor Dr Ernst Rudin, Director of the Kaiser Wilhelm Institute of Psychiatry of Munich, became the principle architect of enforced sterilisation. The profession embarked on the campaign with such enthusiasm, that within four years almost 300,000 patients had been sterilised, at least 50% for failing scientifically designed ‘intelligence tests’.

By 1939 (the year the war started), the sterilisation programme was halted and the killing of adult and paediatric patients began. The Nazi regime had received requests for ‘mercy killing’ from the relatives of severely handicapped children, and in that year an infant with limb abnormalities and congenital blindness (named Knauer) became the first to be put to death, with Hitler’s personal authorisation and parental consent.

This ‘test-case’ paved the way for the registration of all children under three years of age with ‘serious hereditary diseases’. This information was then used by a panel of ‘experts’, including three medical professors (who never saw the patients), to authorise death by injection or starvation of some 6,000 children by the end of the war.

Adult euthanasia began in September 1939 when an organisation headed by Dr Karl Brandt and Philip Bouhler was set up at Tiergartenstrasse 4 (T4) (pictured right) The aim was to create 70,000 beds for war casualties and ethnic German repatriates by mid-1941.

All state institutions were required to report on patients who had been ill for five years or more and were unable to work, by filling out questionnaires and chosen patients were gassed and incinerated at one of six institutions (Hadamar being the most famous).

False death certificates were issued with diagnoses appropriate for age and previous symptoms, and payment for ‘treatment and burial’ was collected from surviving relatives.

The programme was stopped in 1941 when the necessary number of beds had been created. By this time the covert operation had become public knowledge.

The staff from T4 and the six killing centres was then redeployed for the killing of Jews, Gypsies, Poles, Russians and disloyal Germans. By 1943 there were 24 main death camps (and 350 smaller ones) in operation.

Throughout this process doctors were involved from the earliest stage in reporting, selection, authorisation, execution, certification and research. They were not ordered, but rather empowered to participate.

Leo Alexander, a psychiatrist with the Office of the Chief of Counsel for War Crimes at Nuremberg, described the process in his classic article 'Medical Science under Dictatorship' which was published in the New England Medical Journal in July 1949.

‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in 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.’

The War Crimes Tribunal reported that ‘part of the medical profession co-operated consciously and even willingly’ with the ‘mass killing of sick Germans’.

Among their numbers were some of the leading academics and scientists of the day; including professors of the stature of Hallervorden (neuropathology), Pernkopf (anatomy), Rudin (psychiatry/genetics), Schneider (psychiatry), von Verschuer (genetics) and Voss (anatomy). None of these men were ever prosecuted while of the 23 defendants at Nuremberg, only two were internationally recognised academics.

It is easy to distance ourselves from the holocaust and those doctors who were involved. However, images of SS butchers engaged in lethal experiments in prison camps don’t fit the historical facts; the whole process was orchestrated through the collaboration of internationally respected doctors and the State.

With the advantage of hindsight we are understandably amazed that the German people and especially the German medical profession were fooled into accepting it. The judgement of the War Crimes Tribunal in 1949 as to how they were fooled was as follows.

'Had the profession taken a strong stand against the mass killing of sick Germans before the war, it is conceivable that the entire idea and technique of death factories for genocide would not have materialized...but far from opposing the Nazi state militantly, part of the medical profession co-operated consciously and even willingly, while the remainder acquiesced in silence. Therefore our regretful but inevitable judgement must be that the responsibility for the inhumane perpetrations of Dr Brandt (pictured left)...and others, rests in large measure upon the bulk of the medical profession; because the profession without vigorous protest, permitted itself to be ruled by such men.' (War Crimes Tribunal. 'Doctors of Infamy'. 1948)

A 2010 article in American Medical News covered the United States Holocaust Memorial Museum’s exhibition on medicalised killings under the Nazis. It concluded:

“‘The misguided scientific ideas of physicians and scientists were integral to Nazis' crimes against humanity and should serve as a reminder to doctors to put patients before political ideology ... As evil as these actions appear in retrospect, they arose out of a highly sophisticated German medical culture... More than half of the Nobel Prizes that were awarded in science through the 1930s went to Germans ... 'These doctors became killers, not despite their training but in the name of their science and training… All doctors and medical professionals need to know and understand this material.'"


  1. The only thing necessary for the triumph of evil is that good men do nothing. (See also Pastor Niemoeller's famous quote).

    On the other hand, Stanley Milgram's work showed us that it is remarkably easy to persuade human beings to readily comply with the apparent torture (possibly even execution) of other human beings. Having read Milgram's book, I feel far from certain that if placed in his experiment, I wouldn't comply. I feel moderately certain that if I lived in a country like Nazi Germany (and had no means of escape), where I considered the lives of my family and children to be threatened by the state for my non-compliance, I would do anything I was told, in order to ensure their safety. I think for any of us to pretend otherwise is naive.

    What happened in Nazi Germany is but one example (among dozens) of how one group of human beings has visited untold suffering on another group of human beings. It is not special; it just has the advantage of having been recent enough that eyewitness accounts and reliable photographic documentation have survived to allow us to scrutinise what happened. The fact that some of those human beings who perpetuated the suffering were doctors doesn't surprise me in the least. I dare say quite a lot of them were also Christians.

    Doctors are people. Like all people, most are compassionate, decent and kind, but some are cruel, selfish and wicked.

    If the German medical profession had taken a stand against the Nazis, it might indeed have slowed them up a bit. However, I tend to think it would simply have slightly lengthened the queues for the ovens, as they were all rounded up, family by medical family.


  2. You're missing the point, mate. I think what Peter is trying to say is that the medical profession LED with the changes, they did not merely "comply".

    Ergo, your conclusion that it would have simply lengthened the queues for the ovens is wrong. This was about incremental extension. Once people get used to disabled and other "unworthy" lives being extinguished (at the instigation of the medical profession, no less), then it is the start of a slippery slope. The point is that the slope would likely never have been reached, were it not for these doctors "paving the way" by their previous actions wrt the physically disabled and the mentally ill.

    1. Fair point, James, but I disagree.

      Eugenics was pretty sexy in the early 20th century, not just in Germany but in the UK and the US. Plenty of scholars and philosophers and doctors seemed to think it was a spiffing idea. So why didn't those other countries start herding gypsies and Jews into gas ovens? Because they weren't being run by Nazis. It wasn't the doctors who were driving it forward, but the state. Some prominent doctors got involved, but I bet most ordinary German doctors kept their eyes (and their mouths) firmly shut, knowing that if they spoke up they and their families would be executed. That's almost certainly what I would do in the same circumstances.

      Why did everybody vote for Saddam Hussein? Or Robert Mugabe? Because if you don't vote for the dictator, his hoods will torture your children. Why did doctors support National Socialism? Some of them, undoubtedly, because they agreed with it, but most of them, probably, because they felt they had no reasonable choice. The heroism required to stand up to this level of state brutality is to be expected in the few, not the many, and those who did not show it are not to be blamed by we who have not been similarly tested.

      I think many people cling to the cosy notion that another Holocaust could never happen again. "We just wouldn't allow it!"

      I believe that most of us (doctors or not) would be horrified to discover what cruelty we are capable of, if forced by circumstances. Some of us might even find we are quite good at it. Though this thought upsets and troubles me, that doesn't diminish the truth of it.


  3. Aidan,

    And yet again you miss the point.

    The whole idea of the "final solution" STARTED with eugenics - it didn't start out as ovens for gypsies and jews, it started out as killing machines for the disabled and the "unworthy".

    Eugenics as a philosophical idea may have been "sexy" in the Europe and USA of the early 20th century, but the fact remains that it wasn't actually put into practice, definitely not on a significant scale, except in Germany.

    None of this takes away from the brutality of the Nazi regime, and the fear factor you keep banging on about (yes, of COURSE millions complied out of fear - that goes without saying. But it has no relevance to this particular discussion). Or the fact that ordinary individuals are capable of great evil, under the "right" circumstances.

    Since this is one of the rare occasions when I actually agree with Peter, I'm surprised and disappointed he doesn't back me up :)


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