“The medical crimes of the Third Reich were the result of a dynamic triad involving the state, the medical profession, and an academic enterprise comprising the universities and the research institutes.” (Seidelman, Perspectives in Biology and Medicine, 2000)
Germany was the birthplace of modern medicine in the early 20th century. The vocabulary of medicine is replete with the names of distinguished German physicians whose discoveries bear their names. The German university served as a model for medical education and thousands of physicians flocked to Germany to complete their scientific medical training. Many Nobel Prize winners in medicine and chemistry of that period were German scientists. So it is all the more shocking that the medical elite played a critical role in subverting the moral tradition of Hippocratic medicine.
Germany’s medical leaders set in motion the downward spiral of medicine from its lofty heights as a healing profession that values the individual person, to a profession obsessed with racial hygiene and obsessed with demonstrating Aryan superiority by denigrating other segments of humanity as inferior subhuman. Medical doctors first classified mentally disabled children and adults as genetically inferior, followed by Jews and gypsies. The designation “inferior” was not merely humiliating, it escalated methodically into industrialized mass murder and genocide.
These crimes – later judged as “crimes against humanity” – were given the seal of legitimacy by Dr. Alfred Hoche, Professor of Psychiatry, and Karl Binding, Professor of Law. They advocated the “destruction of life unworthy of living” employing pseudo-science and pseudo-law. (Lindert J, Stein Y, Guggenheim H, Jaakkola JJK, von Cranach M, Strous RD. How Ethics Failed – the Role of Psychiatrists and Physicians in Nazi Programs From Exclusion to Extermination, 1933-1945. Public Health Reviews, 2013)
“German universities and research institutes played a decisive role in the dehumanization, exploitation, and destruction of human life during the Hitler period.” (William Seidelman. . Whither Nuremberg? Medicine’s Continuing Nazi Heritage, Medicine and Global Survival, 1995)
Prominent academic physicians at Germany’s elite universities and research institutes provided the “scientific” rationale to legitimize an eugenic racial-ethnic hierarchy; they crafted the selection criteria for the racial hygiene laws and the directives for their implementation. They were in the forefront who embraced racial hygiene to define humans; they legitimized the professional designation of human beings as “subhuman,” “life without value,” “useless eaters,” “useless life,” “ballast.”
The pivotal factor that led German physicians to become murderers was the usurpation of the medical profession’s traditional commitment to healing, and serving the best interest of the individual patient – with preventive medicine which focuses on the application of interventions aimed at preventing and eliminating suspected genetic defects and disease for the presumed “greater good” of society.
Another factor that is rarely acknowledged, is described in detail by Dr. Michael Grodin, a psychiatrist and American medical ethicist at Boston University:
“physicians are experts at compartmentalization, who deal with life and death every day and whose profession carries a sense of power. The motivation for choosing a career as a physician is often a fantasy of power, either sadistic or voyeuristic, as medicine gives license to look, touch, and control. Doctors medicalize and dehumanize their patients so that they can more easily process what they have to do…using science to objectify their work, they heal by attacking and killing disease with surgery or therapy or whatever tools they have available.”
“Medicine as a profession contains the rudiments of evil, and some of the most humane acts of medicine are only small steps away from evil.”
“During the Holocaust, the paradigm of the Nazi Doctor was Josef Mengel [who] often assumed a dual role with his victims—acting like a parent, playing games, and giving sweets before brutally killing children in his twin experiments…fixating on cleanliness and perfection in his experiments even when the patients [.. ] would shortly be consigned to death.”
For the doctors in the Nazi party, omnipotence merged with sadism – they took pleasure in domination and control…In the mental struggle to maintain their professional identity, Nazi doctors medicalized, technicalized, and professionalized their activities…they became absorbed in the technical aspects of medical work, examining inmates as a criterion for sending them to the gas chambers…identifying themselves as part of a larger machine working to ‘heal’ society…
SS doctors would kill and then have a meal, flog and then dress for dinner, torture and then listen to the opera and return to the camp.
Table 5.2 Why Physicians are Vulnerable to Becoming Perpetrators:
- Tendencies toward sadism, voyeurism
- Healing through hurting
- Use of science to objectify violence
- Use of metaphors and euphemisms
- Justifying and rationalizing
- Medicalizing Narcissistic grandiocity
Through these justifications within the larger social context of ‘political medicine,’ Nazi doctors were able to mentally transform murderous acts into acts of healing. ” (Grodin, “Mad, Bad, or Evil: How Physician Healers Turn to Torture, Murder and Genocide From the Nazi Doctors to Abu Ghraib” in Medicine After the Holocaust: From the Master Race to the Human Genome and Beyond, Edited by Sheldon Rubenfeld, MD 2010)
Of all the professions in Germany, physicians had the highest ratio of Nazi party membership – 50% to 65% of the physicians in Germany voluntarily joined the Nazi Party; and physicians joined the SS seven times more than teachers or average male employees. But not only physicians who were members of the Nazi party conducted experiments meeting the definition of torture. (Volker Roelcke, MD, “Academic Medicine During the Nazi Period and Implications for Creating Awareness of Professional Responsibility Today” in Medicine After the Holocaust, 2010)
Doctors became the unseen generals in Hitler’s war against the Jews and others deemed inferior. Doctors created the science, devised the eugenic formulas, wrote the legislation, and even hand-selected the victims for sterilization, euthanasia and mass extermination. Hitler’s deputy, Rudolf Hess, coined a popular adage in the Reich, “National Socialism is nothing but applied biology.”
The entire German health care system was mobilized: selection for forced sterilization was a medical procedure; physicians registered patients with “genetic illness” just like they register births and deaths. High ranking medical academics submitted written “expert medical opinions” attesting to individual’s disability was due to a “genetically determined” disease. Final authorization for forced sterilization was made by Hereditary Health Courts—made up of two physicians and a judge.
“the [sterilization] law must be looked upon as an expression of loving care for the coming generations, and as an act of altruism. The elimination of defective genes is not of itself sufficient to keep our nation healthy and energetic, for this purging of the common gene palmist must be complemented by positive population measures” (Deutsches Arzteblatt [Journal of the German Medical Association], 1933 in “Not Slippery Slope” by Dr. Hartmut Hanauske-Abel, 1996)
The Sterilization Law served as a model for all subsequent Nazi eugenic legislation.
Venerable Academic Research Institutions
In 1911, the Kaiser-Wilhelm organization gave rise to the most prestigious and influential scientific and academic institutes in the world, encompassing a wide scope of scientific disciplines. But as William Seidelman, MD reports,
“Three of its institutes that were beneficiaries of the Rockefeller Foundation [K-W Psychiatry (Munich); K-W Brain Research (Berlin-Buch); K-W Anthropology, Genetics, Eugenics (Berlin-Dahlem)] played an important role in the development, implementation and exploitation of the racial programs of the Third Reich including murderous experiments and the exploitation of the dead. Kaiser-Wilhelm scientists joined with the Nazi state in pursuit of the goal of improving the people’s health (Volksgesundheit), the major emphasis being on eugenic and racial purification.
The resulting collaboration between science and the Nazi state not only legitimized the policies and programs of the Hitler regime but it resulted in the exploitation and mutilation and murder of untold thousands of innocent victims by physicians and scientists associated with some of the world’s leading universities and research institutes. The participation of scientists associated with the Kaiser-Wilhelm Society enhanced the credibility of the Nazi state’s program of scientific terror and murder.” (William E. Seidelman, MD. Science and Inhumanity, 2001)
Leading academic institutions and rank and file practicing physicians were active participants who developed the medical means for mass sterilization, surgical mutilation, and murderous initiatives — T-4 — all of which aimed at forcibly preventing life and exterminating the living on a massive scale. The medical establishment supported and actively participated in the debasement of German medicine and are responsible for the medical atrocities — whose first victims were handicapped infants and children, followed by institutionalized mental patients, followed by Jews, Gypsies and other prisoners in Nazi concentration camps. And they exploited Nazi executions to obtain endless supplies of human body parts for research and education.
“Not a Slippery Slope or Sudden Subversion: German Medicine and National Socialism in 1933,”is powerful, myth shattering article by Dr. Hartmut Hanauske-Abel. It was published on the 50th Anniversary of the Nuremberg Doctors Trial, in the BMJ and in Medicine & Global Survival, Vol. 3 (1996). Dr. Hanauske-Abel challenges the “slippery slope” and “sudden subversion” explanations for the atrocities perpetrated by German physicians. The “slippery slope” and “sudden subversion” –i.e., rape –explanations are a perversion of the truth; implying the inevitability of small missteps leading to unintended consequences, whereas the overwhelming evidence proves the physicians’ enthusiastic culpability.
[“Slippery slope”] connotes a gradual slide over infinitesimal steps until, suddenly, all footing is lost; the second conveys forced take over of the profession’s leadership and values. Both concepts imply that the medical profession itself became the victim of circumstances. The slippery slope concept is a prominent figure of argument in the current debate on bioethics. The evidence presented here, however, strongly suggests that the German medical community set its own course in 1933. In some respects this course even outpaced the new government, which had to rein in the profession’s eager pursuit of enforced eugenic sterilisations.
The damning evidence Dr. Hanauske-Abel presents is in the form of primary documents which provide the professional context for the cataclysmic degeneration of medicine. He provides excerpts from original articles published in leading German professional medical journals in 1932–1933. [To avoid selection bias, he excludes excerpts from Nazi medical journals — even though they were widely read by physicians. The English translations are not his own.]
The excerpts attest to the medical establishment’s enthusiastic support of Hitler immediately following his political take-over; and they attest to the pivotal role that the medical establishment assumed voluntarily in the formulation and enforcement of racial hygiene policies. (Read Journal Excerpts)
German physicians were attracted to Nazism for its adoption of biological interventions as a national cure for societal problems and for elevating medicine as the preeminent academic discipline. Under the Third Reich, 30% of all university faculty were in medical disciplines; racial hygiene, a newly established scientific medical discipline, assumed great importance.Between 1933 and 1945, 59% of university and college presidents were medical doctors. [Seidelman, 1995]
Forced sterilization galvanized German physicians’ enthusiasm for the Nazi party
By 1936, 45% of the physicians in Germany had joined the Nazi Party — the highest ratio of any profession; and physicians joined the SS seven times more than teachers or average male employees. At German universities Nazi membership was even higher; for example, 81% of the Jena Medical Faculty were Nazi party members, and 31% were members of the SS. (Zeidman, MD, Stone MD, Kondzella MD, PhD. New Revelations, 2013)
Racial hygiene for the improvement of national health (Volksgesundheit) became the moral imperative overriding individual rights. Evidence of enthusiastic collusion by the German medical establishment with the Hitler administration is evident in the medical journal literature of the day. That collaborative partnership was pivotal for the radical transformation of German society and the transformation of medicine into a lethal weapon for mass destruction.
“In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.” (Hartmut Hanauske-Abel “Not Slippery Slope”, 1996)
Professor Volker Roelcke, MD, PhD (University of Geisen, Germany) is a world renowned scholar focused on medical ethics and medicine during the Nazi era and the relevance for both the medical profession and the broader public about the importance of ethics in human subjects research. He stresses the importance of including “systematic historical reflection in present day ethical debates on human subjects research…[for example] the legitimacy of research involving human embryonic stem cells, clinical trials in the third world…”
He notes that bioethicists who contend that Nazi medicine bears no relevance to today’s research involving human subjects “lack awareness of the historical dimensions implicit in today’s value preferences.” He faults bioethicists for relying on “deficient, faulty, or misconceived secondary or tertiary literature, often ignoring more recent historical analyses that call into question earlier interpretations.”
Roelcke argues that German medical science stood in the mainstream of western medical scientific research in accordance with the field of specialty:
“Nazi scientific research, he argues, must be seen as “normal” in so far as it simply obeyed the basic imperative of all scientific research, which is the pursuit of a scientifically defined truth.
“all researchers followed the intrinsic logic of their scientific disciplines and used the legally and ethically unrestricted access to human beings created by the context of the political system and the conditions of war.
Rather than being the result of a coercive state, Nazi medicine illustrates how medical researchers and their representative bodies co-operated with and even manipulated a totalitarian state and political system relying on expert opinion, in order to gain resources for the conduct of research without any moral and legal regulation.” (Twentieth Century Ethics of Human Subjects Research: Historical Perspectives, Edited by Volker Roelcke MD, PhD and Giovanni Maio, MD, PhD , 2004)