Bioethics History Holocaust Medicine

Eugenics and involuntary euthanasia

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts.) These will appear at least twice a day while I’m gone (and that will probably leave some leftover for Christmas vacation, even). Enjoy, and please feel free to comment. I will be checking in from time to time when I have Internet access to see if the reaction to these old posts here on ScienceBlogs is any different from what it was when they originally appeared, and, blogging addict that I am, I’ll probably even put up fresh material once or twice.

i-30480cfb1997bc2a9b883717cf304758-EnthanasiePropaganda.jpgAs longtime readers know, I’ve had a longstanding interest in the Holocaust. A precursor to the mass killings that occurred during the Holocaust was known as the T4 euthanasia program. This was a program in which as many as 200,000 people deemed “useless eaters” or “life unworthy of life” were “euthanized” (a euphemism for “murdered,” actually) by a variety of means, including starvation, overdoses of narcotics, poisoning, and early prototypes of gas chambers later used to to such lethal effect in the death camps used to exterminate Jews and others that the Nazis considered enemies of the Reich or otherwise “undesirable.” The T4 program, which ran from 1939 to 1941, when Hitler ordered a temporary halt to the program due to protests from churches and the victims’ families, provided the development and proving grounds for methods of mass murder that would later be expanded to the industrialized killings of millions from 1941 until the end of the war. Indeed, Josef Mengele himself learned his trade in this program. Of course, even this “temporary halt” was nothing of the sort. The program continued in secret.

A recent article got me thinking about the T4 program again. Why it did so will become apparent in a moment, but first I would like to list a few quotes from the article. They are quotes justifying the “euthanasia” of the “feebleminded” from around the appropriate time period:

    1. But I am in favor of euthanasia for those hopeless ones who should never have been born – Nature’s mistakes.
    2. So the place for euthanasia, I believe, is for the completely hopeless defective: nature’s mistake; something we hustle out of sight, which should never have been seen at all. These should be relieved the burden of living, because for them the burden of living at no time can produce any good thing at all. . . . For us to allow them to continue such a living is sheer sentimentality, and cruel too; we deny them as much solace as we give our stricken horse. Here we may most kindly kill, and have no fear of error.
    3. …to release the soul from its misshapen body which only defeats in this world the soul’s powers and gifts is surely to exchange, on that soul’s behalf, bondage for freedom.
    4. A third variety of reaction results from an accusing sense of obligation on the part of the parents towards the defective creature they have caused to be born. The extreme devotion and care bestowed upon the defective child, even with sacrifice of advantages for its normal brothers and sisters is a matter of common observation. This position is understandable, but to the impersonal observer may appear to partake of the morbid. Disposal by euthanasia of their idiot offspring would perhaps unbearably magnify the parents’ sense of guilt.
    5. It is submitted that the state of mind of the parents of an idiot may as fairly become a subject of psychiatric concern as the interrelationships in the families of psychotic patients, and the unwholesome reactions stand as much in need of correction in one case as in the other.
    6. It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified. Parents who have seen the difficult life of a crippled or feeble-minded child must be convinced that, though they may have a moral obligation to care for the unfortunate creature, the broader public should not be obligated…to assume the enormous costs that long-term institutionalization might entail.

    Here’s an interesting question for you. What is the source for each of those quotes? They are all consistent with the rationales that Nazis used to argue for “euthanasia,” namely not wasting society’s resources and the supposed “mercy” that killing such children would be. They all date to the 1930’s and early 1940’s. They all sound as though they came from Third Reich eugenicists.

    All but one of them didn’t come from the Third Reich, however. Here are the sources:

    1. Kennedy, F. (1942) The problem of social control of the congenital sterilization, euthanasia. Am. J. Psychiatry, 99, 13-16.
    2. Ibid.
    3. Ibid.
    4. Anonymous (1942) Euthanasia. Am. J. Psychiatry, 99, 141-3.
    5. Ibid.
    6. Pamphlet published by Dr. Heilig, representative of the Nazi Physicians’ League. From: Robert N. Proctor, Racial Hygeine: Medicine Under the Nazis, Harvard University Press, Cambridge, 1989, p. 183

    Yes, the first five quotes come from Americans, the first three from neurologist Foster Kennedy, in an article based on a speech he gave to the American Psychiatric Association in May 1941. The fourth and fifth quote come from an editorial published in the same issue and seem to be considering parents who might object to the killing of their “feeble-minded” children as being worthy of “psychiatric concern.” These are all discussed in a fascinating article that appeared a recent issue of History of Psychiatry. (Found via Autism Diva and Mind Hacks.)

    Also appearing in the same 1942 journal was an editorial against the killing of the “feebleminded” written by Leo Kanner. Yes, that Leo Kanner, the one who published the first major work describing the condition now known as autism in 1943. Indeed, as part of his argument against involuntary euthanasia of such children, he correctly invoked the Nazis, asking rhetorically, “Shall we psychiatrists take our cue from the Nazi Gestapo?” He did, however, comment that “sterilization is often a desirable procedure” for “persons intellectually or emotionally unfit to rear children,” although he did object to sterilization performed “solely on the basis of the I.Q.” Even though there was a “point-counterpoint” sort of debate in this journal, it should also be remembered that the journal itself came down on the side of Kennedy, not Kanner.i-56b64497335bc582e8ff4df97a4affc8-Wir_stehen_nicht_allein.jpg

    When looking back at the atrocities of the Nazi regime in the name of eliminating undesirables from the volk, it is important to realize that the ideas the fueled their quest to kill those deemed burdens on society were not unique to Germany. Far from it. As this 1942 journal shows, advocacy of various types of eugenic measures was widespread in the U.S., including among the most elite physicians in the nation. True, no one was advocating selective breeding or the killing of “lesser races” in the service of producing a “master race,” as the Nazis were, but there was a disturbing similarity in the thinking of the medical elite in the U.S. with that of Nazi advocates of racial hygeine. As the History of Psychiatry article points out:

    It is surprising that a debate on murder could have appeared in the most prominent psychiatric journal in the USA at the time. But as historians have noted, eugenic sterilization was legally sanctioned in the USA long before the Nazi sterilization law of 1933. The logical progression from sterilization (killing presumed genes) to ‘euthanasia’ (killing presumed gene carriers) occurred much more slowly in the USA, but accelerated in the early 1940s under German influence. The progression from sterilization to killing is ‘logical’ because, once it has been established that the state should actively participate in preventing the reproduction of ‘genetically undesirable’ people through compulsory sterilization, it eventually seems more ‘efficient’ to wipe out the alleged gene carriers themselves. In a chilling and prophetic statement in 1923, Swedish Member of Parliament and sterilization opponent Carl Lindhagen asked, ‘Why shall we only deprive these persons, of no use to society or even for themselves, the ability of reproduction? Is it not even kinder to take their lives? This kind of dubious reasoning will be the outcome of the methods proposed today’.

    How prophetic were Lindhagen’s words!

    It was only the postwar revelation of all the atrocities the Nazis committed in the name of eugenics and racial hygeine that utterly discredited this sort of thinking in the U.S. Yet, at the eve of our entry into the war, in the most prestigious psychiatric journal in the U.S., prominent physicians were debating, in essence, whether the Nazi approach to dealing with severely disabled children was the correct one, with at least as many prominent neurologists and psychiatrists arguing that it was as arguing that it was not. (Indeed, early in his regime, Hitler himself spoke approvingly of the compulsory sterilization programs that had been implemented in several states in the U.S. by the 1930’s.) We should not forget that, particularly in an era in which the genetic basis of psychiatric diseases are being discovered, lest history repeat itself.

    This post originally appeared on the old blog on October 10, 2005.

    By Orac

    Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

    That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

    DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

    To contact Orac: [email protected]

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