People in favor of assisted suicide pose four compelling arguments:
1. Compassion – Assisted suicide is a matter of compassion. No one should suffer needlessly when a doctor's injection ends it quickly.
2. Dignity – Euthanasia is necessary to preserve the dignity of a dying person.
3. Better good of society – End-of-life care is expensive and drains the health care system. Sometimes we have to make hard choices for the greater good.
4. Checks and Balances – Euthanasia can be carefully controlled through a system of checks and balances.
These four arguments are hard to refute, which is why the Nazi leadership was able to present them so effectively in the era before World War II.
These four arguments enabled Adolph Hitler and his followers to convince German doctors to perform euthanasia on first the terminally ill, then retarded and deformed babies, then institutionalized children, and then insane, retarded, sick and otherwise incapacitated adults.
The Argument for Compassion
Just as today's filmmakers produce books and movies like "Million Dollar Baby," "One Flew Over the Cuckoo's Nest," "Whose Life Is It Anyway?" and a multitude of TV shows with similar plots about mercy killings, Nazi filmmakers and writers did the same.
"I Accuse" remains a powerfully emotional German movie from the era. It tells the story of a doctor whose wife is terminally ill. As she cries in pain and begs him to end her life, he tearfully gives her a lethal injection. When he goes on trial for her murder, he wins over the jury for an acquittal, after he says, "Would you, if you were a cripple, want to vegetate forever?" (F-1)
Dr. Karl Brandt, who was Hitler's personal physician, explained himself like this: "The underlying motive was the desire to help individuals who could not help themselves and were thus prolonging their lives in torment. To quote Hippocrates today is to proclaim that invalids and persons in great pain should never be given poison. ... I never intended anything more or believed I was doing anything but abbreviating the tortured existence of such unhappy creatures." (F-2)
The compelling argument for compassion appeared in works of literature, scholarly journals, newspapers, and books, just as it does today.
The Argument for Human Dignity
Psychiatrist Dr. Alfred Hoche and attorney Karl Binding wrote a groundbreaking book in 1920 called, "The Permission to Destroy Life Unworthy of Life." The Nazis used this work over and over to convince doctors that killing is a form of healing. The two authors argued that when people become terminally ill, hopelessly insane or mentally handicapped, they become "empty shells of human beings" who no longer have the dignity of human beings. They are "life unworthy of life" and require "death assistance" from doctors.
Dr. Hoche and Binding were among the first to develop the concept of "brain dead" or "mental death," as they called it. Since "brain dead" patients cannot decide to end their lives, their doctors must decide for them. Destroying "life unworthy of life" is "the work of healing" (F-3) and "such killing is compassionate and consistent with medical ethics." (F-4)
Little Gerhard Kretschmar, born blind, missing an arm and a leg and seemingly retarded, was the first German child to be euthanized. His parents wrote to Hitler and asked him to end the child's life. Dr. Brandt killed the five-month-old baby himself, and the story circulated Germany as an act of compassion that relieved his parent's suffering.
Similar arguments circulated today when the case of Terri Schiavo was being debated.
For the Greater Good of Society
The Nazi propagandists used medical metaphors to convince the medical establishment that euthanasia helped society. The argument was that just as a doctor has to remove a cancerous tumor or inflamed appendix to keep a patient alive, so doctors have to remove those drains on society in order for it to survive.
Dr. Hoche again: "The state organism is a whole with its own laws and rights, much like the self-contained organism, which, in the interest of the welfare of the whole, as we doctors know, must abandon and reject parts or particles that have become worthless or dangerous." (F-5)
Arguments made today in Europe and the United States are similar. As the cost of health care skyrockets, the medical establishment must ration it to those who can benefit from it the most.
Checks and Balances
Assisted suicide is now legal in Oregon, Washington, and the Netherlands, but you require a panel of doctors and experts to "sign off" on each case before any doctor can assist a suicide. The Nazis did the same thing.
Dr. Brandt wrote: "We are stern on constructing a careful medical sequence of evaluation before any patient is put to death." He and others devised a system that required a doctor, a lawyer, and a psychiatrist to review each case file and make sure death was "compassionate and consistent with medical ethics." (F-6) The panel of three had to make a unanimous decision after reading each file. A plus mark (+) meant death; a minus mark (-) meant life, and a question mark (?) meant postponement.
The Death with Dignity Act in Oregon requires the okay of an attending and consulting physician and in some cases, a psychological evaluation. (F-7)
The Netherlands law requires that oversight of the suicide be provided by three experts: a legal specialist, a physician and an expert on ethical or philosophical issues. (F-8)
Nazi doctors assured themselves that they could select the proper candidates "with 100% certainty"(F-9) because their check and balance system was foolproof.
What Happened with Legal Euthanasia in Nazi Germany
The terminally ill and very elderly were among the first to die. Nursing homes became "Hungerhauser" or starvation houses for the elderly, where they were neglected and given no food. (F-10)
Also among the first to die were deformed and mentally handicapped infants and children under three. The Nazis gradually moved the age up to 16 years old. At first these were children in institutions, later the Nazis took them from their parents on various pretenses such as a child's "need for surgery." The children drank tea laced with luminal and went into fatal comas. To better hide what they were doing, doctors and nurses simply starved "the cases with the plus marks" and then cremated the bodies. Medical personnel told themselves that by allowing children to starve, they were only letting "nature take its course." By 1941, over 5,000 children were dead.
The T4 Program involved killing adults in institutions for the mentally retarded, insane, criminally insane, deaf, epileptic, paralyzed and senile. The Nazis were particularly interested in killing young, physically healthy people who were facing a lifetime of expensive care. People rode buses with blacked-out windows to one of six centers, where they died in gas chambers. At Nuremberg, nurses told accusers that they struggled with the ethics of the procedures, but they genuinely believed they were relieving patients of suffering.(F-11)
By 1945, the Nazis had killed over 200,000 people in their euthanasia program and went on to kill over six million. The grim process actually started a few decades before when well-meaning educated people argued for compassion, dignity, careful selection, and the highest good for all.
Today doctors in the Netherlands have already moved from assisted suicide of the terminally ill to the euthanasia of seriously sick infants.(F-12)
Jane St. Clair has worked as a production staff member of the television program Sesame Street in New York City, at Channel 11/PBS-TV in Chicago, and as a newspaper reporter/photographer for the Louisville-Courier Journal and weekly papers in rural Indiana and Appalachian Kentucky. She has published over fifty children's short stories and adult fiction in literary magazines such as Thema, QWF, and Red Rock Review. Her stories also appear in four literary anthologies, including Times of Grace, Times of Sorrow published by the University of Nebraska. She is the 2007 winner of the True Life Story contest, 2006 first-place winner of The Writers Network contest, American Accolades, Hollywood's Next Success, and 2005 winner in television writing for Scriptapalooza. She has also authored two nonfiction books and hundreds of web articles. Her series on financial literacy for children won a national award and has had over a million " hits." Her first novel, Walk Me to Midnight, was published by OakTara. www.janestclair.net
F-1. Lifton, Robert, The Nazi Doctors: Medical Killing and the Psychology of Genocide, (New York: Basic Books, 1986) page 49.
F-2. Mitscherlich, Alexander and Mielke, F. The Death Doctors, (London: Elek,1962) pp. 264-265.)
F-3. Lfton, op cit, pg. 46.
F-4. Ibid, pg. 47.
F-5. Ibid, pg. 45.
F-6. Ibid, pg. 47.
F-7. Oregon Death with Dignity, State of Oregon website at http://www.oregon.gov/DHS/ph/pas/faqs.shtml
F-8. Holland's Euthanasia Law at http://www.internationaltaskforce.org/hollaw.htm
F-9. Lifton, op cit, pg 47.
F-10. King, PJ "Lessons from History, " posted at http://www.pregnantpause.org/euth/nazieuth.htm F-11. Benedict, Susan (RN). "Nurses' Participation in the Euthanasia Programs of Nazi Germany," Western Journal of Nursing Research, Volume 21, Number 2, pages 246-263 (1999).
F-12. Netherlands Grapples With Euthanasia of Babies," Associated Press, November 30, 2004, posted at MSNBC at http://www.msnbc.msn.com/id/6621588/ . See also Aiken, Kirsten, "Dutch doctors admit infant euthanasia," ABC News, May 25, 2005, at http://www.abc.net.au/pm/content/2005/s1377030.htm.