If the physician presumes to take into consideration in his work
whether a life has value or not, the consequences are boundless and the
physician becomes the most dangerous man in the state.(1)
A Personal Statement
I am the author of By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich.(2) I am a historian; I am also a severely disabled person, a polio quadriplegic. As such, I am interested in the evolution of social attitudes and assumptions towards disabled people. It is my conviction that the underlying assumptions that made possible the killing by physicians of upwards of two hundred thousand disabled German citizens in the 1930s and 1940s are still widely held, not just in Germany but throughout the Western industrialized world. The purpose of this article, as of my book, is to make the reader aware of these assumptions and of the evil that can arise from their careless application.
Aktion T-4 Euthanasia: Summary of Program
In the late 1930s and throughout World War II, physicians of Germany's medical establishment, acting both with and without the acquiescence of the Nazi government, systematically killed their severely disabled and chronically mentally ill patients. These people were said by their doctors to be "useless eaters"--persons with "lives not worth living."
The officially sanctioned killing program was authorized by Hitler in 1939 at the request of leading figures of the German medical establishment. The program was under the direction of the Fuhrer's personal physician, Dr. Karl Brandt. It was called "euthanasia," although most of its victims were neither terminally ill nor in unbearable pain, nor were they anxious to die. The program's proponents advanced various arguments for its justification: compassion, eugenics, economics, racial purity. The official program was halted by Hitler in the summer of 1941 in the face of a rising wave of protests from people with disabilities, their families and friends, and religious officials. Even so, many doctors, acting largely on their own counsel, continued killing patients in hospitals and institutions throughout Germany.
Over the course of the official program and the unofficial so-called runaway euthanasia that followed it, more than two hundred thousand German citizens met their death at the hands of their physicians. The mass murder techniques developed in the euthanasia hospitals were later utilized against the jews.
As part of the official program, the medical establishment was informed of the Aktion T-4 operation at secret briefings held across the country. At these meetings the psychiatrists, physicians, and medical professors were fully informed on euthanasia. Euphemisms were used to describe the program: "negative population policies" was mass killing; refractory therapy cases" were the disabled people targeted for killing; "specialist children's wards" were children-killing centers; and "final medical assistance" was, of course, murder. There was never a doubt as to what was being discussed. These men were told the euthanasia program was part of the "breakthrough campaign" necessary to obtain the new medicine of the Third Reich. This held that medical attention and money should go, on a cost-benefit analysis, to those who could be brought back to full productive health, while the chronically disabled would be removed from society, as, said Dr. F. Klein, "I would remove the purulent appendix from a diseased body."(3)
In both the minutes of the "State Committee for the Scientific Registration of Severe Illness due to Heredity or Predisposition"--a high-level physicians'committee that met regularly with the Reich Chancellery--and in the reports of the briefing meetings with rank-and-file physicians, it was fiercely argued that the radical modernization of therapeutic activity could not be achieved without, and, in fact, must go hand-in-hand with, the elimination of these "refractory therapy cases. …