Lessons from History:
Euthanasia in Nazi Germany

However, if we look back to German society of the twenties and thirties, we find a civilized culture not so unlike our own. As a nation, Germany took pride in its art, its culture, and its science. People engaged in business, went shopping, enjoyed their families, followed the news. Genocide did not seem a likely development. But the seeds had already sprouted, though few foresaw into what kind of twisting vines they would soon grow.

In 1920 was published a book titled The Permission to Destroy Life Unworthy of Life, by Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig. They argued in their book that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. The conditions were spelled out, and included the submission of the request to a panel of three experts, the right of the patient to withdraw his request at any time, and the legal protection of the physicians who would help him terminate his life. Binding and Hoche explained how death assistance was congruent with the highest medical ethics and was essentially a compassionate solution to a painful problem.

Death assistance, according to the authors, was not to be limited to those who were able or even willing to ask for it. They would have such mercy extended as well to "empty shells of human beings" such as those with brain damage, some psychiatric conditions, and mental retardation, if by scientific criteria the "impossibility of improvement of a mentally dead person" could be proven. The benefits to society would be great, they said, as money previously devoted to the care of "meaningless life" would be channeled to those who most needed it, the socially and physically fit. Germans needed only to learn to evaluate the relative value of life in different individuals.

An opinion poll conducted in 1920 revealed that 73% of the parents and guardians of severely disabled children surveyed would approve of allowing physicians to end the lives of disabled children such as their own. Newspapers, journal articles, and movies joined in shaping the opinion of the German public. The Ministry of Justice described the proposal as one that would make it "possible for physicians to end the tortures of incurable patients, upon request, in the interests of true humanity" (reported in the N.Y. Times, 10/8/33, p. 1, col. 2). And the savings would redound to the German people if money was no longer thrown away on the disabled, the incurable, and "those on the threshold of old age."

A 1936 novel written by Helmut Unger, M.D., further assisted the German people in accepting the unthinkable. Dr. Unger told the story of a physician whose wife was disabled by multiple sclerosis. She asks him to help her die, and he complies. At his trial he pleads with the jurors to understand his honorable motive: "Would you, if you were a cripple, want to vegetate forever?" The jury acquit him in the novel. The book was subsequently made into a movie which, according to research by the SS Security Service, was "favorably received and discussed," even though some Germans were concerned about possible abuses.

With the public now assenting, the question turned from "whether" to "by whom" and "under what circumstances."

The first known case of the application of this now-acceptable proposal concerned "Baby Knauer." The child's father requested of Adolph Hitler himself that his son be allowed death because he was blind, retarded, and missing an arm and a leg. Surely, in his condition, he would be better off dead. Hitler turned the case over to his personal physician, Karl Brandt, and in 1938 the request was granted.

Over the next few months, a committee set out to establish practical means by which such "mercy deaths" could be granted to other children who had no prospect for meaningful life. The hospital at Eglfing-Haar, under the direction of Hermann Pfannmuller, M.D., slowly starved many of the disabled children in its care until they died of "natural causes." Other institutions followed suit, some depriving its small patients of heat rather than food. Medical personnel who were uncomfortable with what they were asked to do were told this was not killing: they were simply withholding treatment and "letting nature take its course."

Over time Pfannmuller set up Hungerhauser (starvation houses) for the elderly. By the end of 1941, euthanasia was simply "normal hospital routine."

In the meantime, no law had been passed permitting euthanasia. Rather, at the end of 1939, Hitler signed this letter:

"Reichleader Bouhler and Dr. Med. Brandt are responsibly commissioned to extend the authority of physicians to be designated by name so that a mercy death may be granted to patients who, according to human judgment, are incurably ill according to the most critical evaluation of the state of their disease."

Brandt, testifying at his trial in Nuremburg after the war, insisted:

"The underlying motive was the desire to help individuals who could not help themselves and were thus prolonging their lives in torment. ... To quote Hippocrates today is to proclaim that invalids and persons in great pain should never be given poison. But any modern doctor who makes so rhetorical a declaration without qualification is either a liar or a hypocrite. ... I never intended anything more than or believed I was doing anything but abbreviating the tortured existence of such unhappy creatures."

Decide for yourselves whether parallels can be drawn between Germany in the thirties and forties and the world scene in the nineties.

Written 3 March 1996.
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Copyright 1996 by P J King. Used with permission.