Commentary: The Third Reich—German physicians between resistance and participation

Abstract

To evaluate the role of the medical profession in the Third Reich is a delicate and difficult task. Its participation in major atrocities was, to a large extent, hushed up and recent reports of medical opposition may, in many cases, be exaggerated. Much of the evidence has been destroyed or is not easily accessible. Furthermore, an objective view is potentially clouded by a number of issues related to the past or outlook of the evaluator. Finally, when looking at history with hindsight, there is the danger of arrogance in those who have not actually lived through it. The following account therefore makes no claim to be either objective or complete. It is a personal analysis of a (non-Jewish) German physician who was born after the war and struggles to understand what happened. In the second half of the 19th century, ‘Social Darwinism’ had spread throughout Europe. This theory assumed that nations, like animal species, fight for the survival of the fittest. The fittest nation would be the one that is genetically the ‘purest’. German proponents of Social Darwinism were to expand the theory significantly: Alfred Ploetz coined the term ‘race hygiene’ (Rassenhygiene), Ernst Haeckel was the first to consider the killing of ‘weaklings’,1 and the physician Fritz Lenz formulated his concept of racial inequality which directly influenced Hitler.2 Binding and Hoche finally lobbied for the extinction of ‘life unworthy of living’3 suggesting that this could be a curative measure (Heilbehandlung) not necessarily requiring consent from its victims. Growing anti-Semitism and ‘Social Darwinism’ added together resulted in ‘race hygiene’. As the word implies, ‘race hygiene’ was essentially a medical issue. Hitler frequently referred to the Jewish race in medical terms, as a ‘bacillus’, ‘parasite’ or ‘disease’. His followers adopted these medical analogies. In their minds, the ‘biological body of the German people’ (Volkskörper) was threatened by the Jews. Actions against Jews were promoted as acts of defence (Notwehr-Antisemitismus) in the all-deciding struggle for survival. On 15 September 1935, a law was passed that made marriages and extra-marital intercourse between Aryans and Jews illegal. It was termed ‘Law for the Protection of German Blood and Marriages’.4 The German medical profession bore and promoted the belief that curing patients was one thing but to heal the nation was incomparably more important: ‘The maintenance of a genetically homogeneous and healthy stock of the German people is the main duty of the German physician’.5 The vast majority of the German medical profession were willing to adopt the ideas of race hygiene; many even went further and perverted them into applied racism. Race hygiene had been initially developed by and was later entrusted to the German medical profession. To a large degree, the medical profession was not politicized but politics were medicalized. To stop the ‘contamination’ of the German people by ‘inferior’ blood, forced sterilization was legalized on 14 July 1933, soon after Hitler took power in January 1933, through the ‘Law for the Prevention of Genetically Diseased Offspring’ (Gesetz zur Verhütung erbkranken Nachwuchs). The quick move had been possible because of much preparatory work during the Weimar Republic, initiated not least by the medical profession.6 The law provided that (allegedly) handicapped individuals were to be identified, examined by a jury of ‘experts’ and subsequently sterilized. Some 200 ‘Genetic Health Courts’ were instituted. They ordered the involuntary sterilization of approximately 400 000 individuals. In 1934 alone, 28 286 men and 27 958 women thus became the victims of involuntary sterilization.7 The overwhelming majority of the medical experts' reports were later found to be of unacceptable scientific quality; almost all had recommended sterilization.6 It is estimated that 50 000 women were forced into eugenically directed abortion performed by German gynaecologists8 while, at the same time, the laws against voluntary abortions were tightened and the total number of abortions therefore declined. Through accepting the role of experts in these juries, physicians had assumed an executive position within the National Socialist (NS) state.9 Leading proponents of race hygiene, however, believed that involuntary sterilization did not go far enough. In their view it generated human ‘ballast’ and an economic burden which had to be eliminated by other means. Thus, the concept of involuntary medicalized killing, wrongly termed ‘euthanasia’, was developed. The NS euthanasia programme secretly started in specialized medical departments in 1939. In theory, the programme was aimed at disposing of children suffering from idiocy, Down's syndrome, hydrocephalus and other abnormalities.10 Even though this programme was not specifically directed against Jews, it was sufficient for physicians to fill in the diagnosis ‘Jew’ to issue what in essence was a death sentence.11 At the end of 1939, the euthanasia programme went into its second stage by being extended to adults ‘unworthy of living’. Almost 100 000 (predominantly psychiatric) patients became its victims.12 The programme disposed of an estimated four-fifths of all psychiatric patients, and psychiatrists started wondering whether there would be enough patients left to keep their speciality alive.13 ‘Action T4’ (named after the address of its Berlin headquarters in Tiergartenstrasse 4) was the organizational centre of the programme which was run by some 50 physicians. They sent out questionnaires to psychiatric and other hospitals urging doctors to name candidates for euthanasia. These patients were then transported to specialized centres where they were gassed or poisoned and subsequently cremated.14 Others were executed through lethal injections or starvation in psychiatric hospitals. Hitler himself discontinued the programme on 24 August 1941, following increasing opposition from both the general population and the clergy.11 The medical profession's protest to these activities (see below) was minimal and ineffective. Despite Hitler's official decree, the programme continued as ‘wild euthanasia’ without official authorization. Even in 1944 (i.e. shortly before the collapse of the NS state), the directors of psychiatric institutions received an appeal to relieve the pressure on beds by disposing of (Beseitigung) their patients.15 ‘Action T4’ amounted to medically supervised murder. Its true significance, however, lies in the fact that it was a pilot project for the ‘Final Solution’.13,14 ‘Without psychiatry, the holocaust would probably not have taken place’.16 The technical know-how of ‘action T4’ provided the basis for the anticipated total extinction of all Jews within the (then) expanding Reich. The link between ‘T4’ and the Final Solution was ‘Action 14f13’ termed after the file-number it obtained in the official files. ‘Action 14f13’ was initially designed to kill all handicapped and insane prisoners in the concentration camps.17 It grew into an elaborate programme of killing all individuals of Jewish or other non-Aryan blood. The diagnosticians who decided over life and death within this monstrous project were, according to Himmler's wish, experienced psychiatrists. Almost without exception, those physicians who had gained experience in ‘action T4’ took charge of the Final Solution.11 The strategy for the anticipated extinction of the Jewish race was decided on 20 January 1942 at the Wannsee-Conference:... ‘in the course of the Final Solution, Jews should be brought... to work in the East... a majority will doubtlessly drop out through natural decimation... The eventual rest... will have to be treated accordingly...’.18 To be ‘treated accordingly’ meant to be killed. Jews from all parts of the Reich were transported to one of numerous concentration camps. Those who had survived the transports were ‘selected’. The choice was either to go to the gas chambers immediately or to be exploited as labourers until too weak to carry on. This, in turn, also meant death through gassing. The ‘selection’ was strictly a medical task, performed by teams of SS-doctors who formed an essential part of each camp. One of the camp doctors later stated: ‘There were the various officers, the doctor in charge and the unit commander. He had the task of making sure that everything remained orderly. I only saw it twice myself. The Kapos (camp inmates—criminals, political prisoners, and later, Jews—used by the Nazis to head the labour squads) would carry out a large pre-selection of children, very old women, and old men. There were additional selections carried out by certain personnel, after which the doctor had to decide. Now a lot depended on the size of the transport. If it was very large, the selection process was very superficial. If it was a normal-size transport, then things were done more thoroughly. The transports came at night, and if you had your normal duties during the day and then had to work extra at night, well...’19 While the pilot project (action T4) had killed thousands, the Final Solution eliminated millions under the trained guidance and supervision of physicians. Many camps also engaged in medical research. At this stage misguided science (Social Darwinism) had been perverted into pseudo-science (race hygiene) which, in these research centres, was further degraded into criminal science. Typically the projects were run by SS-doctors with some affiliation to German medical schools. Often the research questions were determined through the ‘necessities of war’: What is the best way to survive in cold water? How can one survive on drinking seawater? How can one stop bleeding after injury? How can certain dangerous infectious diseases be prevented? Other research focused on the ‘purification’ of the German race. This included practical methods of sterilization and mass killing.20-22 Altogether there were over 60 different research projects carried out in the camps.23 The hallmark of all of the experiments was their unspeakable cruelty, unprecedented in the history of medicine. The heads of research were often apparently normal SS-doctors with few signs of overt psychological pathology.24 The motivation of working for a ‘higher aim’ (e.g. for the best interest of the German nation) was a central theme which, in their minds, freed them from ethical obligations and humanitarian medical traditions. Many of the experiments were designed such that the ‘object’ would die at its conclusion—if only so that (s)he could be further investigated by the pathologist. ‘It is also a sign of cowardice, of lack of moral courage when Aryan German doctors ignore this prosecution of Jewish doctors’.25 Indisputably, there has been relatively little effective German opposition against the horrors of the Third Reich. It has been estimated that, between 1933 and 1945, some 800 000 individuals (15%–20% women) were imprisoned for resistance to the regime.26 The succession of evil, as outlined above, remained largely unaffected by this opposition. Amongst the resistance that did emerge, only a small part was driven by the medical profession. Why? Should doctors, through their Hippocratic oath, not have been the ideal and natural profession to oppose? And should they not have been aware of what was going on? Several reasons are usually offered to explain this apparent contradiction. Lack of courage, as quoted above, may be a contributing element but is unlikely to be a major factor. Doctors joined the NS party in higher percentages than any other profession. About 45% of doctors were party members (among teachers about 20% were members), 26% were SA members (about 11% teachers) and 7.3% were SS members (0.4% teachers).26 Germans have often been characterized through their sense of duty, their patriotism (before 1945), their need for law and order and their high level of obedience. These qualities do not readily lend themselves to resistance against a dictatorship. Yet such arguments do not explain why German doctors offered less resistance than other professions (see below). Doctors might simply not have been aware of what was going on. Clearly not everyone knew everything and some may indeed have known very little. But generally speaking, the profession as such was in an excellent position to realize at least some crucial facts, particularly as not a small proportion was being published in official German medical journals. If doctors did not know, it must have been because they did not want to know. With hindsight, the most plausible reason for the scarcity of medical opposition is the fact that any emerging resistance was radically crushed in its earliest stages. Within weeks after Hitler came to power in 1933 the German medical system was hierarchically structured with high rank positions being occupied by ‘trustworthy’ SS men.27 Most professional bodies, particularly those in natural opposition to fascism like the ‘Verein were doctors in positions had to go through a programme at the of of the German in were forced into or sent to the concentration camps. At the of for some of all medical were after the NS of in the first of the Third no less than and medical were from German 1933 and 1939, some from and to the Those who remained in were so and that in a at the of one were to all the of and them on one of a and the on the which do you would the this most effective of it may even that any opposition at of opposition or resistance may be and to be protest or through (see from to from to and a few of these were by The of resistance against the Third Reich can be as into a One is before 1933 has a different and than resistance at a when the collapse of the Third Reich was is personal for reasons must be from one driven by political (e.g. being a or which is different from resistance on (e.g. that the war was into The of the resistance also Clearly resistance against the of a Jewish is a different from opposition against sterilization or euthanasia of psychiatric patients or resistance against further is provided by the fact that different lend themselves to different of and for these it is that a may have one and in (see below). of the of scarcity of on the one and of on the other the following will on an selection of both and resistance in some of its At various of the Third that more or less the NS and its in die and To the best of the only medical to opposition was the The was in 1934 and published until 1939. It was the official of the an of the Socialist Its believed that is the end of by they published reports on Hitler's It is many German doctors the or what its true the a and of In was of the at the Berlin of and In this many who were by the NS for political or racial In came into with the a name coined by the NS to the of this This was a of individuals with different and of its members were activities from the of to and became the of the and of the Third Reich. He was in and for and executed in on Several other German psychiatrists were to the of as a within the euthanasia Leading were and was head of the of at an that was by the He against involuntary euthanasia and to in it. In even a for against the was in the protest against euthanasia that to stop its official part (see He to the protest of the profession but in this Other psychiatrists by an Several resistance during the Third (see and the These may have had some medical but was the only one related to it was an of medical Its came from a was in the NS He had through a of with this but soon became with it. In with other and his to which was on moral and ethical The was joined by and who were all medical they also to medicine. In 1942 the to to of in and word that from Hitler's is a The also of the through the Jewish and why an people could all this was The a of but they grew On and were in the The of the is by the fact that, by and and were to death and executed the same more death after a second The had with in The was in About of its members were in 1944 and were Other centres had been in Berlin and This is by some as one of the NS doctors, that certain issues of the In his and can be as of large of the German medical profession. many doctors of that time, was a and a at was of what as the NS to and At the same was to certain of National His and provided with and personal with men in the of Hitler courage in directly the NS SA from the on the of his He or offered to Jewish doctors like who had been his second in the when about his and motivation to It was at that people could He also his for about Hitler during the of the Third or about the of NS politics on medical against euthanasia in and was a of the an of that was later illegal. On the other became a willing of the NS in many His and the doctors of the was an to the that German in and its task in He also NS like the of the for the and the of of the German The NS his to and for their There is little that was aware of this fact and it or even from In it is to that was on a of the NS He to certain at the same himself to be in many most to do more to the as a for the of German medical under in the best and On 20 August the the against the of against in the has no in medical were and for life were received Fritz and further doctors were of and were not The found at this were the known and at the the and estimated that a total of doctors had In the of this probably a The more is that the German medical profession as a made these To it in the of of the (see the The medical profession's process of to with the participation in the medical of in the history of is complete. and account of the was to be at the of German Doctors in Almost the of 000 issues before took the following the that within German much had the Many of the were only Many doctors with a history of with a criminal were to carry on working in their some in high official In almost all the remained in or their The Jewish who were forced to their were many the of NS was an it remained so until the recent of German that believed that the process of the past had not even in the the first German physicians of the started the of NS they were as their few of their had indeed the to understand that such an is essential for their In the the German finally published a of on in the Third Its in the of the had a of had the of being The German professional body of took until to issue an official to the victims of NS patients who were during the Third Reich have been as victims. was on the that, at the time, forced sterilization was Some German psychiatrists even sterilization after the In a medical to of the German the profession could of it doctors many had a of with the to fill the in the of a The same who became the German medical official in that a of German doctors had the of of to understand what had and it was to the German medical profession the of into a This of in the of Even after the Third are with a of when to research the the was no the German medical profession everything on a few within their on a basis has so far not taken very few the the between 1933 and have influenced medical in and even German medical the view that go on for The have and the German medical by and large, has an from its The participation in the of had a basis within the German medical profession. the the could not have even against the most was minimal and was not by physicians. the Third the profession the of NS into a this was no it promoted the that the atrocities were performed by a of To the the German medical profession has or Some of the questions that could have been in this What are the for such atrocities to How can they be in there any In what way was the of 1933 of medical is the between a to an and to are the of ethical the medical profession have too little for the human How can this through medical What are the essential of a between the medical profession and the

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