Medical research and practice under Germany's National Socialist regime (1933–1945) has come to serve as an archetype for the immoral uses to which science and technology can be applied. In many instances appeals to science were used to justify evil actions, and independent reflection failed to criticize unethical research protocols and medical interventions. Without diminishing the horrors that resulted, it is nevertheless important to place such actions in context in order not to so distance them that they offer no lessons from which others might learn.
Genetics and related eugenic claims were at the heart of Nazi racial ideology that ultimately led to genocide in Europe during World War II. Although the study and application of eugenics did not begin with National Socialism, it was in Nazi Germany that eugenics became a central component of state policy. The same academic and research institutions that were so critical in the development of modern medicine, medical science, and medical education were also directly complicit in the most massive program of human destruction in history.
Henry Friedlander (1995) nevertheless cautions that the murderous application of eugenic and racial principles by German physicians must be understood in terms of the motivations of other professions. German physicians were professionals who, like all professionals, sought financial security, career advancement, and professional recognition. Motives certainly varied, but these physicians were all German nationalists who generally subscribed to the racist and eugenic components of National Socialism. While providing a rationalization for their actions, ideology was nevertheless probably not the primary motivation for most physicians.
Studies by Michael H. Kater (1989) reveal that German physicians tended to be more closely associated than other professionals with Nazi Party organizations such as the National Socialist Physicians' League, the SA (Sturmabteilung, the military arm of the Nazi party founded in 1921, but disarmed and neutralized by Hitler in 1934) and the SS (Schutzstaffel, initially recruited from the SA in 1923 as Hitler's personal bodyguard, and the embodiment of Nazi racial ideology that developed into a vast police, military, and economic empire). About a third of all physicians were members of the National Socialist Physicians' League, and by 1939, almost 45 percent of physicians in Germany were members of the Nazi Party, figures substantially higher than those of other professions (such as lawyers [25%], teachers [24%], and musicians [22%]). Moreover, 7 percent of all physicians in Germany were members of the SS. Their professional needs seemed to find relatively more satisfaction within the context of the growing power of the SS and its extraordinary role in matters of life and death.
Under National Socialism, German medical science soon identified individual Germans considered by the state to be inferior and expendable. Acknowledging the influence and experience of American eugenicists and compulsory sterilization laws in the United States, the Nazis on July 14, 1933, enacted the Law for the Prevention of Progeny of Sufferers from Hereditary Diseases. Hundreds of thousands of Germans and, later, Austrians were sterilized without their consent after being medically diagnosed with conditions deemed hereditary and undesirable. These conditions included "feeblemindedness," schizophrenia, and manic-depressive disorder, among others.
The genocidal policies of the Nazi regime commenced shortly after the outbreak of war in September 1939, with the decision to exterminate the handicapped in Germany. Friedlander identifies the first victims as disabled children and adults who were in institutions. Under the euphemism of euthanasia, the killers described their task as "destruction of life unworthy of life." Hitler's Chancellery, with the support of the health division of the Ministry of the Interior, directed the killings. It established various front organizations, headquartered in Berlin at Tiergartenstrasse No. 4, and known as T4. Physicians and psychiatrists, hospital directors and bureaucrats, directed the T4 killings and served as medical experts in the selection of victims they never saw. In addition to starving some patients to death, these physicians murdered patients with overdoses of Luminal (a sedative) and Veronal (sleeping tablets), and also morphine-scopolamine.
In the spring of 1941, the T4 killings were expanded to include concentration camp prisoners. This new task was designated Special Treatment 14f13. In late 1941 and 1942, T4 methods and technology were transferred to the east where the SS established extermination centers at Chelmno, Auschwitz, Treblinka, Belzec, Sobibor, and Majdanek, modeled on the T4 centers, for the extermination of Europe's Jews and Gypsies. There, physicians supervised the registration of the arriving victims, administered the gas, pronounced the victims as dead, and participated in looting the corpses. Besides extracting gold teeth for the Reich treasury, physicians performed countless autopsies on the bodies of their victims in order to provide younger physicians with training and academic credit, as well as to recover organs, especially brains, for scientific study at medical institutes.
SS physicians tolerated unhygienic conditions, inadequate food, and inhuman working conditions in the camps. Moreover, they were complicit in inhuman corporal punishment when they certified that prisoners were healthy enough to undergo beatings. SS physicians also participated in the murder of prisoners in most camps, using lethal injections and other medications to kill their victims.
At Auschwitz-Birkenau, with its assembly line methods of killing, medical officers selected those destined for the gas chambers. In addition, most SS physicians at Auschwitz participated in cruel and unethical medical experiments on human beings. Many were young and inexperienced physicians who wanted to learn, and who did these experiments in order to obtain degrees or to secure some publications. SS physicians performed the function of both concentration camp medical officer, a position that had existed since the early 1930s, and extermination center physician, a position that materialized early on in the war as part of the T4 operation.
In the end, the T4 physicians and SS physicians at Auschwitz volunteered for their positions. They could have refused to participate but did not. There is general agreement among scholars that they became murderers because they were consumed with ambition while remaining, at the same time, more or less loyal to the racist ideology of Hitler's regime.
American military courts conducted a series of twelve trials at Nuremberg between December 1946 and April 1949, which included the trial of a group of twenty-three Nazi physicians and members of the German medical establishment for T4 ("euthanasia") killings and medical experiments. These trials generated an in-depth search for ethical rules to be observed before initiating experimental therapy with human beings. Beginning with the creation of the Nuremberg Code in 1947, which condemned medical abuses in experimentation on human beings, a body of ethical guidelines has accumulated over the years.
The Nazi medical establishment also produced some good science, according to Robert N. Proctor (1999), within the larger eugenic and racial context of Nazi medicine and its agenda of systematic murder of the handicapped, Jews, and Gypsies. Under National Socialism, German epidemiology was probably the most advanced in the world. Before World War II, for example, German medical science established the relationship between tobacco use and lung cancer. This reflected the regime's goal of improving the overall public health of the German people, of which its racial hygiene policies constituted a significant part. As Proctor concludes, the campaign against tobacco provides a compelling insight into the complex nature of the racially based public health initiatives of Nazi Germany, responsible as they were for both better nutrition and forced sterilizations, for both genocide and campaigns against smoking.
William E. Seidelman (2000) has written that the legacy of Nazi medicine included an amnesia that conditioned the postwar German and Austrian medical establishments until the late twentieth century particularly with regard to the continued use of the fruits of Nazi medical practice. The links between Nazi ideology, the cruel and exploitative medical experiments that German physicians conducted on the victims of that ideology, and the sterilization, euthanasia, and extermination policies conducted by physicians under Nazi authority, raise questions that have immediate relevance to contemporary controversies over the nature and course of research in human genetics and biotechnology.
FRANCIS R. NICOSIA
Burleigh, Michael. (1994). Death and Deliverance: "Euthanasia" in Germany, c. 1900–1945. Cambridge, UK: Cambridge University Press. Links the Nazi mass murder of the Jews, Gypsies, and the handicapped by revealing the redeployment of "euthanasia" personnel to the mobile killing units and the extermination camps after 1941.
Friedlander, Henry. (1995). The Origins of Nazi Genocide: From Euthanasia to the Final Solution. Chapel Hill: University of North Carolina Press. Traces the rise of racist and eugenic ideas in Germany and elsewhere in the early twentieth century, their contribution to the Nazi "euthanasia" program beginning in 1939, and to the policy of extermination of Jews and Gypsies beginning in 1941.
Kater, Michael H. (1989). Doctors under Hitler. Chapel Hill: University of North Carolina Press. Focuses on the institutional framework of the medical profession in Nazi Germany and examines how German physicians participated in crimes against Jews and other victims.
Lifton, Robert Jay. (1986). The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic. Demonstrates how many German physicians were transformed from healers to murderers, and the overall role they played in Nazi genocide.
Nicosia, Francis R., and Jonathan Huener, eds. (2002). Medicine and Medical Ethics in Nazi Germany: Origins, Practices, Legacies. New York: Berghahn Books. Six distinguished scholars consider the various ways in which German physicians and the German medical establishment were complicit in crimes against humanity, and the disturbing legacy they left in post-Holocaust Germany and Austria.
Proctor, Robert N. (1999). The Nazi War on Cancer. Princeton, NJ: Princeton University Press. Focuses on the discovery of the link between tobacco smoking and lung cancer in Nazi Germany, and demonstrates how the positive health activism of the Nazis derived from the same roots as their medical crimes against humanity.
Seidelman, William E. (2000). "The Legacy of Academic Medicine and Human Exploitation in the Third Reich." Perspectives in Biology and Medicine 43(3): 325–334. Examines the continued use in post-World War II Germany and Austria of some of the results of Nazi medical experiments during World War II.