Killing While CaringKilling While Caring

Nursing in the Nazi “Euthanasia” ProgramNursing in the Nazi “Euthanasia” Program

Susan Benedict, CRNA, DSN, FAANSusan Benedict, CRNA, DSN, FAAN

Medical University of South CarolinaMedical University of South Carolina

First, the language of disability:First, the language of disability:

People with disabilities…People with disabilities…People with developmental People with developmental

disabilities…disabilities…Many terms used are those Many terms used are those

of the time and are not of the time and are not acceptable today.acceptable today.

““A history of mental illness”…A history of mental illness”…

is as non-specific as “a is as non-specific as “a history of physical illness”.history of physical illness”.

Anna G: Accused of killing 150 Anna G: Accused of killing 150 patients…patients…

““When giving the [lethal] When giving the [lethal] medicine, I proceeded with a medicine, I proceeded with a lot of compassion. I took them lot of compassion. I took them lovingly and stroked them lovingly and stroked them when I gave the medicine. when I gave the medicine. They were not to be tortured They were not to be tortured more than necessary.”more than necessary.”

Steps to the “Final Solution”Steps to the “Final Solution”

Devaluation and Devaluation and generalizationgeneralization

SterilizationSterilizationEuthanasiaEuthanasiaConcentration campsConcentration camps

How could this happen?How could this happen?

EugenicsEugenics

Passed in 1922, the US Model Passed in 1922, the US Model Eugenical Sterilization Law Eugenical Sterilization Law

applied to applied to

Feeble-minded Insane (including the psychopathic) Criminalistic (including the delinquent and wayward) Epileptic Inebriate (including drug users) Diseased (including the tuberculosis, the syphilitic, the

leprous, and others with chronic, infections, and legally segregable diseases

Blind (including those with seriously impaired vision) Deformed (including the crippled) Dependent (including orphans, ne’er-do-wells, the homeless,

tramps and paupers.

Eugenics also popular in USEugenics also popular in US

Courses taught atCourses taught at Columbia UniversityColumbia University Brown UniversityBrown University Northwestern UniversityNorthwestern University Harvard UniversityHarvard University Cornell UniversityCornell University University of WisconsinUniversity of Wisconsin

In 1925, in “Mein Kampf” Hitler In 1925, in “Mein Kampf” Hitler wrote…wrote…

““Those who are physically Those who are physically and mentally unhealthy and and mentally unhealthy and unworthy must not unworthy must not perpetuate their suffering in perpetuate their suffering in the body of their children.”the body of their children.”

July 1933: Germany’s July 1933: Germany’s sterilization law passedsterilization law passed

Hereditary epilepsy Schizophrenia Mental deficiency Huntington’s chorea Hereditary blindness and deafness Certain malformations Severe alcoholism

1934 - 19391934 - 1939More than 350,000 More than 350,000 people were sterilized in people were sterilized in GermanyGermany

Examples in textbooksExamples in textbooks Courses in nursing and medical schoolsCourses in nursing and medical schools Racial hygiene a component of all Racial hygiene a component of all

educationeducation

EducationEducation

1935 Textbook1935 Textbook

Problem 95Problem 95

The construction of an insane asylum The construction of an insane asylum requires 6 million RM. How many housing requires 6 million RM. How many housing units @ 15,000 RM could be built for the units @ 15,000 RM could be built for the amount spent on insane asylums?amount spent on insane asylums?

SocializationSocialization

Posters depicting people with handicapsPosters depicting people with handicaps MoviesMovies

Sterilizaton to “Euthanasia”Sterilizaton to “Euthanasia”

Binding and Hoche, 1920:Binding and Hoche, 1920: The right to live must be earned.The right to live must be earned. Destroying “lives not worth living” Destroying “lives not worth living”

would be humane.would be humane. Elimination not a crime but Elimination not a crime but

permissible and beneficialpermissible and beneficial

Applied toApplied to

People with terminal illnessesPeople with terminal illnesses ““Incurable lunatics”Incurable lunatics” Those who had sustained an illness or Those who had sustained an illness or

injury and would awaken to a “nameless injury and would awaken to a “nameless misery”misery”

Three phases of killingThree phases of killing

The children’s “euthanasia” The children’s “euthanasia” programprogram

The T4 “euthanasia The T4 “euthanasia programprogram

““Wild euthanasia”Wild euthanasia”

The Children’s “euthanasia” The Children’s “euthanasia” programprogram

1939 – 19451939 – 19455,000 – 7,000 children killed5,000 – 7,000 children killed

All children with the following All children with the following had to be reported:had to be reported:

Idiocy and Mongolism (particularly if blindness or deafness were also present

Microcephalie [sic] Hydrocephalus Deformities of every kind, in particular

the absence of limbs, spina bifida, etc. Paralysis including Little’s disease

(Spastics)

The midwifeThe midwife

Received a fee of 2 Reichsmark “in return Received a fee of 2 Reichsmark “in return for her trouble”for her trouble”

3,000 – 5,000 children were 3,000 – 5,000 children were murderedmurdered

T-4 “Euthanasia” ProgramT-4 “Euthanasia” Program

GrafeneckGrafeneck BrandenburgBrandenburg HartheimHartheim

SonnensteinSonnenstein BernburgBernburg HadamarHadamar

T-4 “Euthanasia” ProgramT-4 “Euthanasia” Program

Began with this letter: 1 September 1939Began with this letter: 1 September 1939 Reichleiter Bouhler andReichleiter Bouhler and Dr. med BrandtDr. med Brandt are charged with the responsibility to extend the are charged with the responsibility to extend the

authorization of certain physicians designated by authorization of certain physicians designated by name in order that patients who must be name in order that patients who must be considered incurable on the basis of human considered incurable on the basis of human judgment be granted the mercy death after a judgment be granted the mercy death after a critical evaluation of their illness. critical evaluation of their illness. Adolf Hitler Adolf Hitler

The planThe plan

to kill 60,000 -to kill 60,000 -70,00070,000

The victims of T-4The victims of T-4

Persons with developmental disabilitiesPersons with developmental disabilities Psychiatric patientsPsychiatric patients EpilepticsEpileptics Persons with inherited diseases or Persons with inherited diseases or

conditionsconditions Persons with family histories of disease, Persons with family histories of disease,

alcoholism, antisocial behaviorsalcoholism, antisocial behaviors

HadamarHadamar

14f1314f13

T4 endedT4 ended

August 1941August 1941Killings had become public Killings had become public

knowledgeknowledgeChurches objectedChurches objectedNo objections from nursing No objections from nursing

or medical organizationsor medical organizations

70,273 adults were killed 70,273 adults were killed in the T4 programin the T4 program

““Wild euthanasia”Wild euthanasia”

Roles of nurses in the Roles of nurses in the “euthanasia” programs“euthanasia” programs

Reported newborns and children with Reported newborns and children with disabilitiesdisabilities

Selected patients for killingSelected patients for killing Accompanied the transportsAccompanied the transports Killed patientsKilled patients Aktion ReinhardAktion Reinhard

Consequences for the nursesConsequences for the nurses

Why did nurses participate?Why did nurses participate?

Belief in National Socialism and its goals:Belief in National Socialism and its goals:

““I swear to Adolf Hitler, my FI swear to Adolf Hitler, my Führer [leader], ührer [leader], unswerving loyalty and obedience. I unswerving loyalty and obedience. I commit myself to every assignment that I commit myself to every assignment that I am placed in and to fulfill my task as a am placed in and to fulfill my task as a National Socialistic nurse, loyal and National Socialistic nurse, loyal and conscientious in the service for the people, conscientious in the service for the people, so help me God.”so help me God.”

ObedienceObedience

To governmentTo government To administratorsTo administrators To physiciansTo physicians To superior ranking nursesTo superior ranking nurses

Lack of supportLack of support

From colleaguesFrom colleagues From professional organizationsFrom professional organizations

Duress?Duress?

Some were sworn to secrecy.Some were sworn to secrecy. Some were threatened verbally.Some were threatened verbally. In over 50 years of post-war testimony, no In over 50 years of post-war testimony, no

instance has been found of anyone being instance has been found of anyone being shot, harmed, or sent to a concentration shot, harmed, or sent to a concentration camp for refusing.camp for refusing.

EconomicsEconomics

Housing was tied to the job.Housing was tied to the job. Jobs were hard to find.Jobs were hard to find. Bonuses were paid for working in the Bonuses were paid for working in the

killing units.killing units.

In their words:In their words:

Helene W. (killed several hundred):Helene W. (killed several hundred):

““I only did my duty, and I did everything on I only did my duty, and I did everything on the order of my superiors.the order of my superiors.

Luise E. (210)Luise E. (210)

““I would consider it a release if a physician I would consider it a release if a physician or a person acting on direction of a or a person acting on direction of a physician would give me a dose releasing physician would give me a dose releasing me from my suffering…I didn’t do it with a me from my suffering…I didn’t do it with a light heart but only after serious inner light heart but only after serious inner fights I obeyed the orders.”fights I obeyed the orders.”

Anna G.: (150)Anna G.: (150)

““I would never have committed a theft I would never have committed a theft because I know one isn’t allowed to.”because I know one isn’t allowed to.”

Martha W. (150):Martha W. (150):

““The only explanation I can give is that I The only explanation I can give is that I didn’t have enough time to think about it at didn’t have enough time to think about it at that time because the nurses were put that time because the nurses were put under a lot of stress.”under a lot of stress.”

Erna D.:Erna D.:

““I can’t say why I didn’t refuse.”I can’t say why I didn’t refuse.”

Margarete T. (150):Margarete T. (150):

““I saw the act of giving medicine, even in I saw the act of giving medicine, even in order to kill mentally handicapped order to kill mentally handicapped persons, as an obligation I wasn’t allowed persons, as an obligation I wasn’t allowed to refuse. In case of refusal, I always to refuse. In case of refusal, I always imagined my dismissal from the job of imagined my dismissal from the job of nurse and civil servant, which is why I nurse and civil servant, which is why I didn’t refuse.”didn’t refuse.”

Meta P.Meta P.

““Among the nurses, there was strict Among the nurses, there was strict discipline and every subordinate nurse discipline and every subordinate nurse was obliged to strictly execute the orders was obliged to strictly execute the orders of the superior.”of the superior.”

Edith B.:Edith B.:

““I didn’t see anything wrong I didn’t see anything wrong with it.”with it.”

Margarete Maria M.:Margarete Maria M.:

““If I had refused to execute her [another If I had refused to execute her [another nurse’s] orders, I would have been nurse’s] orders, I would have been dismissed. I could have quit the job, but at dismissed. I could have quit the job, but at that time I was obliged to support my that time I was obliged to support my grandparents in Mesertiz.”grandparents in Mesertiz.”

Gertrude F.:Gertrude F.:

““I was the youngest nurse I was the youngest nurse on our ward. Still today, I on our ward. Still today, I haven’t completely become haven’t completely become aware of my wrongdoing.”aware of my wrongdoing.”

The killings of the The killings of the “euthanasia” programs led to “euthanasia” programs led to

the murders in the the murders in the concentration camps.concentration camps.

Lessons for today:Lessons for today:

Remember the victims.Remember the victims. Be vigilant against marginalization.Be vigilant against marginalization. Avoid generalizations about groups; i.e., Avoid generalizations about groups; i.e.,

the “mentally ill”, the “disabled”.the “mentally ill”, the “disabled”. Consider the “slippery slope” of assisted Consider the “slippery slope” of assisted

suicide and euthanasia.suicide and euthanasia.