Medicine has never been completely and totally science. Those of us who practice this profession know it as "the art and science of medicine." Although there is a scientific foundation to medicine, the art comes from applying science to human beings. Pure science has no inherent ethics or morals. It is the application of testing to theories to confirm hypotheses, and in doing so provides explanation for how things work. The proven hypothesis becomes a scientific fact and may then be used to direct further efforts at shaping ourselves and our world. In medicine, it is the application of those facts to living, breathing people that is the art, and the art requires moral judgment.
When people do not have a system of moral judgment other than the one they construct for themselves, moral relativism results. What I consider moral may not be the same as what you consider to be moral. And what is tragic is when moral relativism infuses the art of medicine. Throughout history, people in all societies have held a special regard for their healers. Few things are more terrifying than to have a broken body, and the people with the knowledge to heal are elevated in the minds of the public. Although it is human nature to be suspicious of those things that we do not understand, when we find that a science that is incomprehensible to many can cure illness and disease, that suspicion is often replaced with awe and respect. This leads many to accept and obey the pronouncements of scientists and doctors as dispensers not only of healing but truth itself. (Of course, as a doctor, I kind of like it that way myself.)
We have been looking at Germany in the first half of the twentieth century and developments in that society as the Jews were defined as "sub-human", capable of great evil and seen as the greatest threat to that nation. Decades of teaching and reinforcing this notion led to it being widespread in German thought. Even before Hitler rose to power, there was the "Jewish problem," and much debate was carried forth on how to address it. Hitler and his Nazis brought this to the forefront of national consciousness, with much resulting abuse of the Jews. We left off our discussion in 1938, following the terrible Kristallnacht, but for today we will turn our attention to another Nazi program, Aktion T4. To do that, we will need to follow scientific thought from the turn of the century.
Charles Darwin published The Origin of the Species in 1859, and in it he described how species developed over time with continual improvement due to the natural selection of superior species. A good deal of his thought had derived from his study of the breeding of animals. It was actually his cousin, Francis Galton, who developed the notion that societies could actually improve its members by artificial selection, choosing those with the best genes. This led to Galton coining the term eugenics (from the Greek, "eu-", meaning "good" and "genos", meaning birth). Over the next many decades, eugenics looked not only at choosing the best members of society breeding with each other but eliminating the most undesirable elements from breeding. In the United States, many states in the early 1900's had forcible sterilization laws for the mentally disabled or epileptic. For over fifty years in this country, more than 60,000 people were sterilized because someone had deemed them "unfit." You must remember, for states to carry out these laws, someone had to be invested with the power to decide who was "fit" and who was "unfit."
The notions of eugenics were a large part of Nazi ideology and the idea of racial superiority. But simply preventing the less desirables from breeding was not enough. Hitler was very much interested in eliminating those undesirables directly. The Nazi party promoted the idea of euthanasia throughout the 1930's. Requests for mercy killing from parents with deformed children were funneled directly to Hitler's office. And in 1939, a child that was born with congenital defects was chosen to be the first to be eliminated. Eugenics, "good birth," had now become Euthanasia, "good death" (eu = good, thanatos = death).
Hitler's personal physician, Karl Brandt, was put in charge of developing the program of euthanizing infants. A large medical bureaucracy was created, with a system put in place to process these killings. The program was later known as Aktion T4, with the "T4" being an abbreviation for Tiergartenstraβe 4, the address of the "Charitable Foundation for Curative and Institutional Care." Initially parental consent was needed for these killings, but that was eventually dropped. Doctors and midwives were ordered to report any defective babies at birth, and although originally decisions were made after examining the infant, simply filling out a questionnaire was sufficient to make the decision to euthanize. Six centers were set up around Germany to handle these children, first infants and then the older ones. Parents were told that their child was going to a special center, and then after the child was euthanized, they would receive a phony death certificate and cause of death. The parents were often suspicious of these reports, especially if their child who had no appendix supposedly died of appendicitis.
It didn't take long for the Nazis and their physicians to realize that they could eliminate disabled adults as well. The "mercy killings" soon became a way to exterminate all undesirables from the German gene pool. The mentally ill and retarded, the epileptic and schizophrenic, those with dementia or any illness that required prolonged institutional care were deemed candidates for euthanasia.
Initially, people were put to death with injection, but this was slow and costly. It was much more efficient to use carbon monoxide gas, and gas chambers were set up at the killing centers. The bodies were cremated. This process of gas execution and cremation would later be utilized on an industrial scale during the Holocaust. There was one huge difference between the Nazi euthanasia program and the slaughter of the Jews, however. The euthanasia program was kept secret.
This was necessary because Hitler knew that the German people would be outraged at the state-sanctioned killing of German citizens. In fact, when word finally got out, the German people protested to the point where the program was officially ended only two years later in 1941. However, it continued unofficially until the end of the war. Over 70,000 Germans were euthanized.
Several points need to be taken in here. The "science" of eugenics and its cold calculations of genetic inferiority and racial superiority were translated into the "art" of killing, a machine for assassination carried out by the German medical profession. Someone somewhere had to make a decision that you were "fit" to live or were "unfit"; you did not make that decision yourself. The science was divorced from an objective God-given morality and coupled with a man-made morality, where it was seen as morally desirable to execute the undesirable. Finally, it was a "medical procedure" that made it all possible, first injection and then the more efficient gassing.
All of these lessons learned by the Nazis from the murder of children would enable them to exterminate millions of Jews. The striking difference was that the German public objected to the forced deaths of other German "humans." There would not be the same outrage at the elimination of Jewish "non-humans", nor any need to keep those programs secret. After only a few generations of being taught that the Jew was not a human were necessary to remove them from the conscience of the German country. Next week we will look at the Holocaust itself, and how Germany developed the "Final Solution" to the "Jewish Problem".
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