How Ethics Failed - the Role of Psychiatrists and Physicians in Nazi Programs from Exclusion to Extermination, 1933-1945

By Lindert, Jutta; Stein, Yael et al. | Public Health Reviews; Rennes, January 1, 2012 | Go to article overview

How Ethics Failed - the Role of Psychiatrists and Physicians in Nazi Programs from Exclusion to Extermination, 1933-1945


Lindert, Jutta, Stein, Yael, Guggenheim, Hans, Jaakkola, Jouni J. K., Strous, Rael D., Public Health Reviews; Rennes


"We have been silent witnesses of evil deeds: we have been drenched by many storms; we have learnt the art of equivocation and pretense; experience has made us suspicious of others and kept us from being truthful and open; intolerable conflicts have worn us down and even made us cynical. Are we still of any use? What we shall need is not geniuses, or cynics, or misanthropes, or clever tacticians, but plain, honest, straightforward men. Will our inward power of resistance be strong enough, and our honesty with ourselves remorseless enough, for us to find our way back to simplicity and straightforwardness?"

Dietrich Bonhoeffer1

INTRODUCTION

Prior to and during the National Socialist German Workers' Party, commonly known as the Nazi Party, regime in Germany (1933-1945), physicians were influenced by Social Darwinism, ideas of racial and genetic purity, and by the mythology of a superior race, and so abandoned their traditional medical ethical standards and fell into the seductive ideals of the eugenics movement.2-5 There can be no doubt about the role played by the medical profession in the planning and execution of the eugenics programs in Germany, and that opportunities for professional advancement played a major role in their participation. A body of scholarly work has been published about the complicity of physicians during the Nazi era,6-13 but the specific roles played by physicians and medical institutions during this period still demand in-depth investigation.10,14 In contrast, the criminal role of many physicians and health scientists was mixed with other work in epidemiology, public health, preventive medicine, public health policy, screening, and occupational health law throughout the Nazi era.15,16 While Nazi Germany was rampaging throughout Europe perpetrating mass slaughter, some health professionals were working on innovative health and prevention interventions promoting life. At the same time many of their colleagues were working on destroying life. Psychiatrists deceived their patients and patients` families. Physicians were complicit in forcing their patients to be sterilized, arranged their deaths, used them as test subjects for research, performed "involuntary euthanasia" and participated in the Final Solution.17 The question remains unanswered: how could such an enormous criminal conspiracy and shift in cultural values occur among highly educated and trained physicians in a "society" who were well aware of Aristotelian Ethics and the Hippocratic Oath, and how can such a tragedy be avoided in the future?

In order to better understand what occurred, we aim to review the history of devolution from humiliation and classification of mental patients, other ill and disabled individuals and different ethnic groups, leading to their exclusion, sterilization, and finally to "involuntary euthanasia" (a euphemism for medical murder); discuss the ethical norms of universal dignity, compassion and responsibility; and propose concrete steps of action for preventing medical rationalizations that promotes the participation of the psychiatric and public health community in crimes of mass atrocity or other assaults on humans and human moral values.15

THE IDEAL OF RACIAL AND GENETIC PURITY AND STAGES OF HUMILIATION, EXCLUSION, AND EXTERMINATION

The fantasy of an "ideal" society with "ideal" individuals, the paradigm of eugenics was a movement in many countries in the late 19th and early 20th century,21 primarily influenced by scientific developments such as Darwinism and the Mendelian and Lamarckian theories of heredity. The origins of eugenics can be traced back to classical times, to the Spartans, who appear to have been among the first to systematically regulate marriages and to kill the mentally ill, the diseased and the disabled. Modern Eugenicists sought control over the range of physical and mental characteristics they deemed acceptable for people22,23 in order to create societies free of individuals considered to have undesirable hereditary characteristics, and to keep these persons from reproducing. …

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