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

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 19^th 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.