Skip to main content

Advertisement

How Ethics Failed — The Role of Psychiatrists and Physicians in Nazi Programs from Exclusion to Extermination, 1933–1945

Public Health Reviews volume 34, Article number: 8 (2012) Cite this article

Article metrics

  • 4771 Accesses

  • 6 Citations

Abstract

Background: Disregard of Hippocratic medical ethics by major leaders in the Public Health establishment and the leadership role played by physicians during the Nazi era in Germany (1933–1945) pose continuing challenges for later generations to investigate and disclose. Aims: We review the history of evolution from humiliation of mental patients, other ill and disabled individuals and targeted ethnic groups to humiliation, sterilization, and “involuntary euthanasia” (a euphemism for medical murder). We focus on the role played by psychiatrists and neurologists during the Nazi period in Germany; we discuss the ethical norms of universal dignity, compassion and responsibility and we propose concrete steps to prevent recurrence of medically supported genocide. Methods: We explored the history of psychiatry of the period leading up to, including and immediately after the Nazi era in order to analyze the ethical standards and practices of psychiatrists and neurologists. Results: Psychiatrists, and neurologists, were guilty leaders and participants in the implementation of the Nazi programs, which escalated from humiliation and classification of their victims to the exclusion of the mentally ill and disabled, to devaluation and forced sterilization, to medical murder, then finally to the industrialized mass murder of millions, named the “Final Solution”. Discussion: This process was driven by a dangerous mix of failure of medical ethics, racist ideology and individual ambition. Radicalized myths of racial and genetic purity and 19th century technology of industrial production transformed into a technology driven industry of mass murder; motivated by calculated ambitions and desire for individual career advancement. Post war, the Nuremberg Trials and later The Universal Declaration of Human Rights defined standards of ethical framework for the medical profession everywhere. Outlook: Each generation should be made aware of these events through awareness, education and communication to prevent recurrence of medical professional criminality.

References

  1. 1.

    Bonhoeffer D. Letters and Papers from Prison. London: SCM Press; 1971.

  2. 2.

    Beck C. Sozialdarwinismus, Rassenhygiene, Zwangssterilisation und Vernichtung “lebensunwerten Lebens”. Eine Bibliographie zum Umgang mit behinderten Menschen im “Dritten Reich” — und heute. Bonn: Psychiatrie Verlag 1995. [In German]

  3. 3.

    Burleigh M, (editor). Death and Deliverance: “Euthanasia” in Germany, 1900–1945. Cambridge: Cambridge University Press; 1994.

  4. 4.

    Friedlander H. The Origins of Nazi Genocide. From Euthanasia to the Final Solution. Chapel Hill, NC: University of North Carolina Press; 1995.

  5. 5.

    Klee E. “Euthanasie” im NS-Staat: Die “Vernichtung lebensunwerten Lebens”. Frankfurt: Fischer Verlag; 1983. [In German]

  6. 6.

    Geiderman JM. Ethics seminars: physician complicity in the Holocaust: historical review and reflections on emergency medicine in the 21st century, part I. Acad Emerg Med. 2002;9:223–31.

  7. 7.

    Geiderman JM. Ethics seminars: physician complicity in the Holocaust: historical review and reflections on emergency medicine in the 21st century, part II. Acad Emerg Med. 2002;9:232–40.

  8. 8.

    Alexander L. Medical science under dictatorship. New England J Med. 1949;241:39–47.

  9. 9.

    Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York, NY: Basic Books; 1986.

  10. 10.

    Fischer BA. Maltreatment of people with serious mental illness in the early 20th century: a focus on Nazi Germany and eugenics in America. J Nerv Ment Dis. 2012;200:1096–100.

  11. 11.

    Schneider F. Psychiatry under National Socialism: remembrance and responsibility. Eur Arch Psychiatry Clin Neurosci. 2011;261:S111–8.

  12. 12.

    Von Cranach M, (editor). Psychiatrie im Nationalsozialismus. Munich: Oldenbourgh; 1999. [In German]

  13. 13.

    Evans RJ. The Third Reich at War. New York, NY: Penguin Group; 2008.

  14. 14.

    Nicosia FR, Huener J, (editors). Medicine and Medical Ethics in Nazi Germany. Origins, Practices, Legacies. Vermont: Berghahn books; 2002

  15. 15.

    Cohen MM, Jr. Genetic drift. Overview of German, Nazi, and Holocaust medicine. Am J Med Genet A. 2010;152A:687–707.

  16. 16.

    Westermann S, Wiesing U. Von der Pravention bis zur “olympiareifen” Belegschaft—Konfliktlinien und Argumentationsfiguren zur Genetik in der Arbeitsmedizin in historischer Perspektive. [Genetic testing in occupational medicine—conflicts and arguments within a historical perspective]. Medizinhist J. 2011;46:51–82. [In German]

  17. 17.

    Rotzoll M, Hohendorf G. Krankenmord im Dienst des Fortschritts? Der Heidelberger Psychiater Carl Schneider als Gehirnforscher und “therapeutischer Idealist”. [Murdering the sick in the name of progress? The Heidelberg psychiatrist Carl Schneider as a brain researcher and “therapeutic idealist”]. Nervenarzt. 2012;83:311–20. [In German]

  18. 18.

    Strous RD, Edelman MC. Eponyms and the Nazi era: time to remember and time for change. Isr Med Assoc J. 2007;9:207–14.

  19. 19.

    Strous RD. Psychiatric genocide: reflections and responsibilities. Schizophr Bull. 2010;36:208–10.

  20. 20.

    Von Cranach M. Ethics in psychiatry: the lessons we learn from Nazi psychiatry. Eur Arch Psychiatry Clin Neurosci. 2010;260:S152–6.

  21. 21.

    Bloch F. Medical scientists in the Nazi era. Lancet. 1986;1(8477):375.

  22. 22.

    Bauman Z. Modernity and the Holocaust. Cambridge: Polity Press; 1989.

  23. 23.

    Foucault M. The History of Sexuality. Vol. 1: An Introduction. London: Allen Lane; 1979.

  24. 24.

    Sofair AN, Kaldjian LC. Eugenic sterilization and a qualified Nazi analogy: the United States and Germany, 1930–1945. Ann Intern Med. 2000;132:312–9.

  25. 25.

    O’Mathuna DP. Human dignity in the Nazi era: implications for contemporary bioethics. BMC Med Ethics. 2006;7:E2.

  26. 26.

    Broberg G, Roll-Hansen N. Eugenics and the Welfare State: Sterilization Policy in Denmerk, Sweden, Norway and Finland. East Lansing, MI: Michigan State University Press; 1996.

  27. 27.

    Kevles DJ. The Name of Eugenics: Genetics and the Uses of Human Heredity. New York, NY: Knopf; 1985.

  28. 28.

    Baron JH. The BMJ’s Nuremberg issue. Compulsory sterilisation of defective people was legal in several countries besides Germany. BMJ. 1997;314:440.

  29. 29.

    Braun K, Herrmann, SL, Brekke O. Zwischen Gesetz und Gerechtigkeit. Staatliche Sterilisationspolitiken und der Kampf der Opfer um Wiedergutmachung. Kritische Justiz. 2012;3. [In German]

  30. 30.

    Adams MB. The Wellborn Science: Eugenics in Germany, France, Brazil, and Russia. Oxford: Oxford University Press; 1990.

  31. 31.

    Longerich P. Politik der Vernichtung. Eine Gesamtdarstellung der nationalsozialistischen Judenverfolgung. Munich: Piper; 1998. [In German]

  32. 32.

    Broszat M. Hitler und die Genesis der “Endlösung”. Vierteljahreshefte für Zeitgeschichte. 1977;25:739–75. [In German]

  33. 33.

    Mommsen H. Die Realisierung des Utopischen: “Die Endlösung der Judenfrage im Dritten Reich”. Geschichte und Gesellschaft. 1983;9:381–420. [In German]

  34. 34.

    Gütt A, Rüdin R, Ruttke F. Gesetz zur Verhütung erbkranken Nachwuchses vom 14. Juni 1933 nebst Ausführungsverodrnungen. 2nd ed. Munich: J. F. Lehmanns; 1936. [In German]

  35. 35.

    Rölcke V, (editor). Wissenschaft im Dienst des Reiches: Ernst Rüdin und die Deustche Forschungsanstalt für Psychiatrie. Berlin: Metropol; 2008. [In German]

  36. 36.

    Herbst L. Das Nationalsozialistische Deutschland 1933–1945. Frankfurt: Suhrkamp Verlag KG; 1996. [In German]

  37. 37.

    Hansson N, Peters A, Tammiksaar E. Sterilisierungsoperateur und Forscher: Leben und Karriere Benno Ottows (1884–1975). [Sterilization surgeon and researcher: life and career of Benno Ottow (1884–1975)]. Medizinhist J. 2011;46:212–37. [In German]

  38. 38.

    Übersicht über die Durchführung zur Verhütung erbkranken Nachwuchses, R18/5585 (1934). [In German]

  39. 39.

    Ernst E. Commentary: The Third Reich—German physicians between resistance and participation. Int J Epidemiol. 2001;30:37–42.

  40. 40.

    Blecker J, Jachertz N, (editors). Medizin im Dritten Reich. Cologne: Ärzteverlag; 1989. [In German]

  41. 41.

    Binding K, Hoche A, (editors). Die Freigabe der Venichtung lebensunwerten Lebens. Ihr Mass und ihre Form. [Allowing the Destruction of Life Unworthy of Living. To What Extent and in What Form]. Leipzig: Meiner; 1920. [In German]

  42. 42.

    Hudson L. From small beginnings: the euthanasia of children with disabilities in Nazi Germany. J Paediatr Child Health. 2011;47:508–11.

  43. 43.

    Beddies T, (editor). Wenn Kinder “der Wissenschaft dienen”. Die Kinderklinik der Charité in der Zeit des Nationalsozialismus. Paderborn: Ferdinand Schöningh; 2008. [In German]

  44. 44.

    Rürup R, Schieder W, (editors). Die Kaiser-Wilhelm-Gesellschaft im Nationalsozialismus. Göttingen: Wallstein; 2000. [In German]

  45. 45.

    Rotzoll M, Hogendorff G, Fuchs P, et al., (editors). Die nationlsozialistische “Euthanasie”-Aktion “T4” und ihre Opfer. Paderborn: Schöningh; 2010. [In German]

  46. 46.

    Rotzoll M, Fuchs P, Richter P, Hohendorf G. Die nationalsozialistische “Euthanasieaktion T4”: Historische Forschung, individuelle Lebensgeschichten und Erinnerungskultur. [Nazi action T4 euthanasia programme: historical research, individual life stories and the culture of remembrance]. Nervenarzt. 2010;81:1326–32. [In German]

  47. 47.

    Frewer A, Clemens E, (editors). Euthanasie und die aktuelle Sterbehilfe-Debatte. Die historischen Hintergründe medizinischer Ethik. [“Euthanasia” and the Current Debate on Assisted Suicide. The Historical Background to Medical Ethics]. Frankfurt: Campus; 2000. [In German]

  48. 48.

    Blessing T, Wegener A, Koepsell H, Stolberg M. The Wurzburg Anatomical Institute and its supply of corpses (1933–1945). Ann Anat 2012;194:281–5.

  49. 49.

    Schmuhl HW, (editor). Rassenhygiene, Nationalsozialismus, Euthanasie: Von der Verhütung zur Vernichtunh “lebensunwerten Lebens”, 1890–1945. Göttingen: Vandenhoeck & Ruprecht; 1987. [In German]

  50. 50.

    Zeidman LA. Neuroscience in Nazi Europe part II: resistance against the third reich. Can J Neurol Sci. 2011;38:826–38.

  51. 51.

    Hühn M, (editor). Das Schicksal der jüdischen Patienten im Nationalsozialismus. Berlin: Edition Heinrich; 1988. [In German]

  52. 52.

    Hohmann J. Geschichte der Zigeunerverfolgung in Deutschland. 2nd edition. Frankfurt: Campus Verlag; 1988. [In German]

  53. 53.

    Hohmann JS. Robert Ritter und die Erben der Kriminalbiologie: “Zigeunerforschung” im Nationalsozialismus und in Westdeutschland im Zeichen des Rassissmus. Studien zur Tsiganologie und Folkloristik. Frankfurt: Peter Lang; 1991. [In German]

  54. 54.

    Goldhagen DJ. Hitler’s willing executioners. New York, NY: Alfred A. Knopf; 1996.

  55. 55.

    Strous RD. Nazi euthanasia of the mentally ill at Hadamar. American J Psychiat. 2006;163:27.

  56. 56.

    Von Cranach M. The killing of psychiatric patients in Nazi Germany between 1939–1945. Isr J Psychiatry. 2003;40:8–18; discussion 19–28.

  57. 57.

    Von Cranach H. [Euthanasia of mental patients in Germany during World War II]. Ann Med Psychol (Paris). 1985;143:352–60. [In French]

  58. 58.

    Müller-Hill B. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Others, Germany 1933–1945. Oxford: Oxford University Press; 1988.

  59. 59.

    Süss W. Der “Volkskörper” im Krieg. Gesundheitspolitik, Gesundheitsverhältnisse und Krankenmord im nationalsozialistischen Deutschland 1939–1945. Munich: Oldenbourth 2003. [In German]

  60. 60.

    Kogon E, Langbein H, Rückler A. Nationalsozialistische Massentötungen durch Giftgas: Eine Dokumentation. Frankfurt: S. Fischer Verlag; 1983. [In German]

  61. 61.

    Faulstich H. Die Zahl der “Euthanasie”-Opfer. Frankfurt: Campus; 2000. [In German]

  62. 62.

    Gabriel E, Wolfgang N. Von der Zwangssterilisierung zur Ermordung. Vienna: Böhlau; 2002. [In German]

  63. 63.

    Mader ET. Das erzwungene Sterben von Patienten der Heil- und Pfegeanstalt Kaufbeuren-Irse zwischen 1940 und 1945 nach Dokumenten und Berichten von Augenzeugen. 2nd. ed. Blöcktach: Verlag an der Säge; 1985. [In German]

  64. 64.

    Strous R. Extermination of the Jewish mentally-ill during the Nazi era—the “doubly cursed”. Isr J Psychiatry Relat Sci. 2008;45:247–56.

  65. 65.

    Lifton RJ. Medicalized killing in Auschwitz. Psychiatry. 1982;45:283–97.

  66. 66.

    Zeidman LA. Neuroscience in Nazi Europe part I: eugenics, human experimentation, and mass murder. Can J Neurol Sci. 2011;38:696–703.

  67. 67.

    Siemen H-L. Menschen blieben auf der Strecke. Psychiatrie zwischen Reform und Nationalsozialismus. Gütersloh: Paranus; 1987. [In German]

  68. 68.

    Kersting F-W, Schmuhl, H-W, editors. Quellen zur Geschichte der Anstaltspsychiatrie in Westfalen. Paderborn: Schöningh 2004. [In German]

  69. 69.

    Hohendorf G, Rotzoll M, Richter P, Eckart W, Mundt C. Die Opfer der nationalsozialistischen “Euthanasie-Aktion T4” Erste Ergebnisse eines Projektes zur Erschliessung von Krankenakten getoteter Patienten im Bundesarchiv Berlin. [Victims of Nazi euthanasia, the so-called T4 action. First results of a project at the German Federal Archives to disclose records of killed patients]. Nervenarzt. 2002;73:1065–74. [In German]

  70. 70.

    Alexander L. The molding of personality under dictatorship; the importance of the destructive drives in the socio-psychological structure of Nazism. J Crim Law Criminol. 1949;40:3–27.

  71. 71.

    Andorno R. Global bioethics at UNESCO: in defence of the Universal Declaration on Bioethics and Human Rights. J Med Ethics. 2007;33:150–4.

  72. 72.

    Thomasma DC. Proposing a new agenda: bioethics and international human rights. Camb Q Healthc Ethics. 2001;10:299–310.

  73. 73.

    Beyleveld D, Brownsword, R. Human dignity in bioethics and biolaw. Oxford: Oxford University Press; 2001.

  74. 74.

    Andorno R. Human dignity and human rights as a common ground for a global bioethics. J Med Philos. 2009;34:223–40.

  75. 75.

    Nordenfelt L. The varieties of dignity. Health Care Anal. 2004;12:69–81; discussion 83–9.

  76. 76.

    Giubilini A, Minerva F. After-birth abortion: why should the baby live? J Med Ethics. 2013;39:261–3.

  77. 77.

    Thom A, Caregorodcev GI. Medizin unterm Hakenkreuz. Berlin: VEB Verlag Volk und Gesundheit; 1989. [In German]

  78. 78.

    Hohendorf GM, Magull-Seltenreich A. Von der Heilkunde zur Massentötung: Medizin im Nationalsozialismus. Heidelberg: Wundehorn; 1990. [In German]

  79. 79.

    Pury CLS, Lopez SJ (editors). The Psychology of Courage: Modern Research on an Ancient Virtue. Washington, DC: American Psychopathological Association; 2010.

  80. 80.

    Kidder RM. Moral Courage. Taking Action When Your Values are Put to the Test. New York, NY: William Morrow; 2006.

Download references

Author information

Affiliations

  1. Protestant University of Applied Sciences Ludwigsburg, Paulusweg 6, 71638, Ludwigsburg, Germany

    • Jutta Lindert PhD, MA

  2. Hebrew University — Hadassah Medical Center, Jerusalem, Israel

    • Yael Stein MD

  3. Founder, Foundation Guggenheim, Boston, United States of America

    • Hans Guggenheim PhD

  4. Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland

    • Jouni J. K. Jaakkola MD, DSC, PhD

  5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    • Rael D. Strous MD

Authors

  1. Search for Jutta Lindert PhD, MA in:

  2. Search for Yael Stein MD in:

  3. Search for Hans Guggenheim PhD in:

  4. Search for Jouni J. K. Jaakkola MD, DSC, PhD in:

  5. Search for Rael D. Strous MD in:

Corresponding author

Correspondence to Jutta Lindert PhD, MA.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lindert, J., Stein, Y., Guggenheim, H. et al. How Ethics Failed — The Role of Psychiatrists and Physicians in Nazi Programs from Exclusion to Extermination, 1933–1945. Public Health Rev 34, 8 (2012) doi:10.1007/BF03391660

Download citation

Keywords

  • Psychiatry
  • Nazi euthanasia
  • sterilization
  • medical ethics
  • genocide
  • the Final Solution

Public Health Reviews

ISSN: 2107-6952

Contact us