Nazi Medicine

The Murder of Handicapped

• 1 September 1939

• Reich leader Philip Bouhler and Dr. Brandt are charged with responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment of their state of health, can be granted a mercy killing.

• A. Hitler

Philip Bouler

Karl Brandt

T-4 Program

• Within a few months, the T-4 program (named for Berlin Chancellory Tiergarten 4, which directed it) involved virtually the entire German psychiatric community.

• A new bureaucracy, headed by physicians, was established with a mandate to "take executive measures against those defined as 'life unworthy of living.'“

• Life Unworthy of Living• Useless Eaters

• • A statistical survey of all psychiatric institutions,

hospitals, and homes for chronically ill patients was ordered. At Tiergarten 4, three medical experts reviewed the forms returned by institutions throughout Germany, but did not examine any patients or read their medical records. Nevertheless, they had the power to decide life or death.

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Killing Centers• Patients whom it was decided to kill were transported to six

killing centers: • Hartheim, • Sonnenstein • Grafeneck • Bernburg, • Hadamar • Brandenburg.

The members of the SS in charge of the transports donned white coats to keep up the charade of a medical procedure.

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Three Stages of Killing

– Starvation– Injections of lethal doses of sedatives – Gassing– Cremation

• Fifteen to twenty people were killed in a chamber disguised as a shower. The lethal gas was provided by chemists, and the process was supervised by physicians. Afterwards, black smoke billowed from the chimneys as the bodies were burned in adjacent crematoria.

Informing the Family

• Families of those killed were informed of the transfer. They were assured that their loved ones were being moved in order to receive the best and most modern treatment available. Visits, however, were not possible. The relatives then received condolence letters, falsified death certificates signed by physicians, and urns containing ashes. There were occasional lapses in bureaucratic efficiency, and some families received more than one urn. They soon realized something was amiss.

Refusal to Cooperate

• A few doctors protested. • Karl Heinrich Bonhoffer, a leading psychiatrist, worked

with his son Dietrich, a pastor who actively opposed the regime, to contact church groups, urging them not to turn patients in church-run institutions over to the SS (Dietrich Bonhoffer was executed by the SS just before the end of the war.)

• A few physicians refused to fill out the requisite forms. • Only one psychiatrist, Professor Gottfried Ewald of the

University of Gottingen, openly opposed the killing.

Opposition

• AUGUST 3, 1941CATHOLIC BISHOP DENOUNCES EUTHANASIABy 1941, the supposedly secret "euthanasia" program is generally known about in Germany. Bishop Clemens August Graf von Galen of Muenster denounces the killings in a public sermon on August 3, 1941. Other public figures and clergy also raise objections to the killings.

Cancelling the Program• AUGUST 24, 1941

HITLER OFFICIALLY ORDERS END TO "EUTHANASIA" KILLINGSMounting public criticism of the "euthanasia" killings prompts Adolf Hitler to order the end of the program. Gas chambers in the various "euthanasia" killing centers are dismantled. By this time, about 70,000 German and Austrian physically or mentally impaired patients have been killed.

• Although the "euthanasia" program is officially ended, the killing of physically or mentally impaired people continues in secret in individual cases.

Evolution of Murder

• Mobile Killers – Stationary Killing Centers• Mobile Gas Vans – Yugoslavia• Stationary Killing Centers

Prefiguration of the Holocaust

• The killing centers to which the handicapped were transported were the antecedents of the death camps.

• The organized transportation of the handicapped foreshadowed mass deportation.

• Some of the physicians who became specialists in the technology of cold-blooded murder in the late 1930s later staffed the death camps. All their moral, professional and ethical inhibitions had long been lost.

• During the German euthanasia program, psychiatrists were able to save some patients, at least temporarily, but only if they cooperated in sending others to their death. No consequences to refusal.

• In the Jewish communities of the territories later conquered by the Germans, Judenrat leaders, Jews appointed by the Germans to take charge of the ghettos, had to make similar choices. They acted under duress. They were personally responsible.

• If they objected, or refused to cooperate, they paid with their lives.

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• Gas chambers were first developed at the handicapped killing centers. So was the use of burning to dispose of dead bodies. In the death camps the technology was taken to a new level: thousands could be killed at one time and their bodies burned within hours.

• The staff that killed thousands transitioned to kill millions.

Medical Experimentation

Four Categories of Medical Experimentation

• Facilitating Survival of Military Personnel• Testing of Pharmaceuticals• Experiments to Advance Racial Ideology• Sterilization

Survival of Axis Personnel

At Dachau, Air Force Physicians • High-altitude experiments, using a low-

pressure chamber, to determine the maximum altitude from which crews of damaged aircraft could parachute to safety.

• Freezing experiments using prisoners to find an effective treatment for hypothermia.

• Making seawater potable

Drug Testing• At Sachsenhausen, Dachau, Natzweiler, Buchenwald, and

Neuengamme, • Immunization compounds and sera for the prevention and

treatment of contagious diseases, including malaria, typhus, tuberculosis, typhoid fever, yellow fever, and infectious hepatitis.

• At Ravensbrueck camp was the site of bone-grafting experiments

and experiments to test the efficacy of newly developed sulfa (sulfanilamide) drugs.

• At Natzweiler and Sachsenhausen, prisoners were subjected to phosgene and mustard gas in order to test possible antidotes.

Racial Ideology

• Josef Mengele MD, PhD. at Auschwitz• Medical experiments on twins. – More rapidly reproduce the Master Race

• He also directed serological experiments on Roma (Gypsies), as did Werner Fischer at Sachsenhausen, in order to determine how different "races" withstood various contagious diseases.

• The research of August Hirt at Strasbourg University also intended to establish "Jewish racial inferiority."

Sterlization

• Air force physician Dr. Horst Schumann at Auschwitz.

• Rationale: If enemies of the state could not reproduce, genocide would be but a matter of time. The elimination of the unwanted could be more passive and less bloody.

– X-Rays– Castration

Doctor’s Trial: Ten Principles

• 1. The voluntary consent of the human subject is absolutely essential.

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• 2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

• 3. The experiment should be so designed and based on the results of animal experimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment.

• 4. The experiment should be so conducted as

to avoid all unnecessary physical and mental suffering and injury.

• 5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.

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• 6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.

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• 7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

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• 8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

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• 9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.

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• 10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.