From Nazi Medicine to Informed Consent

Nazi Medical Facility at Hadamar
Inside the Nazi Medical Facility at Hadamar (Germany), Source: Author (2019)

Much has been written on the issue of Nazi medicine during the almost eighty years that have passed since Germany’s liberation from Nazism. It also has been eighty-five years since the most significant Nazi pogrom pushed Nazi medicine forward.

The anti-Semitic pogrom became known by its Nazi term Kristallnacht – a word coined by top-Nazi and SS-Brigadeführer Wilhelm Börger (1896-1962) when claiming, the Reichskristallnacht will enter history. Its anti-Semitism had also set Nazi medicine in motion.

Nazi medicine is a state-sanctioned mass murder and genocide. Next to more direct forms of industrial murder – and long before Auschwitz was established – Germany’s Nazis started to use medicine for genocidal purposes. And it was set to become one of the most abhorrent forms of evil.

Nazi medicine included forced sterilization legislation and these procedures were performed on between 310,000 and 350,000 victims who were labeled genetically inferior by Nazi ideology.

During the Nazi regime, at least 230,000 people with various mental, cognitive, and other disabilities – of whom lives were deemed unworthy of living – were murdered in euphemistically named euthanasia programs in Germany and the conquered territories. Under the Nazi language, the term used was lebensunwertes Leben – life unworthy of life.

Much of this was merely the precursor for what was to come. Code-named Operation Reinhardt, the Nazi plan was to exterminate all Jewish people living in German-occupied Poland.

This included the murder of 1.7 million Jews, and an unknown number of Roma and Soviet prisoners of war – overall, around 3 million Soviet prisoners of war “died” in German camps.

Yet, most did not simply “die”, but were humiliated, abused, beaten, starved, worked to death, tortured, or simply killed for Germany’s war effort and for profit-making German companies.

While Nazi medicine was part of all this, it did not occur in a vacuum: German medical scientists were part of international networks exploring and promoting eugenics and developing medical rationales for racist beliefs.

During the Nazi regime, Nazi doctors furthered their careers by – in some cases – simply eliminating Jewish medical professionals.

While in post-Nazi Germany, most Nazi doctors continued – undeterred. One should note that most health professionals involved in Nazi medical crimes were never prosecuted, and many continued their careers after World War II, sometimes reaching prominent medical positions.

This alone makes a mockery of Neiman’s hallucination that one should be Learning from the Germans when it comes to dealing with the Holocaust. What are we supposed to learn from the Germans?

Should one learn that you can murder thousands of innocent victims and after that continue with your medical career as if nothing had happened, while not being prosecuted and, in some cases, even protected by the German state?

In other words, Nazi medicine – and what followed in post-Nazi Germany – sharply contradicts Neiman’s assertion that:

The Image:                        Germany has become good;

Denazification:                the country has successfully dealt with its Nazis via prosecution and trials;

Financial Aid:                   Germany is a marvel for its financial Wiedergutmachen – literally made good again;

History:                             the country has worked through its Nazi past – Aufarbeitung; and,

A Role Model:                   we should be Learning from the Germans.

In reality, Germany produced people like Nazi party member Eugen Fischer (1874-1967) – a leading proponent of German race hygieneRassenhygiene – and a racial anthropologist.

Worse, German Rassenhygiene, racial anthropology, and Nazi medicine signified the point were Genghis Khan joined hands with Eugen Fischer – mass murderer meets medicine.

However, Nazi party member Eugen Fischer was not alone. By 1945, 50%-65% of German physicians had joined the Nazi party, a much higher proportion than in any other academic profession. Meanwhile, Jewish doctors were removed from the profession and public life.

To defend all that, Nazi propaganda used the depiction of male Jewish doctors as sexual predators seeking to exploit vulnerable so-called Aryan women. Worse was to come: most German and Austrian Jewish doctors who did not emigrate were murdered during the Holocaust.

Virtually all of this was a direct result of the Nazi’s obsession with race and heredity. This is also why medicine came to occupy such a significant place in Nazi Germany. Much of this meant that the creation of a Nazi version of medical ethics was part of this endeavor.

In Nazi ideology, medical ethics was linked to the so-called race hygiene – Rassenhygiene – and to Herbert Spencer’s idée fixe of the survival of the fittest.

Furthermore, it linked Nazi medicine and Rassenhygiene to the Nazi concept of the Aryan Volksgemeinschaft.

Such a Nazi Volksgemeinschaft has never been simply a people’s community. Instead, the Nazi Volksgemeinschaft is to be understood as a purified “Aryan” community – to the total exclusion of political opponents, Jews, and other minorities like gays, Roma, and Sinti.

Nazi ideology also sought to merge British scientist Francis Galton’s idea to further evolution with what German physician Alfred Ploetz saw as race hygiene. To achieve Rassenhygiene for a pure Aryan Volksgemeinschaft, Nazi medicine advocated eugenic policies such as forced sterilization. On this, one might call a spade a spade:

The sterilization law introduced in Nazi Germany in 1933 was partly based on a model law that had been drafted by US educator and eugenicist Harry Laughlin and was subsequently adopted and modified over several decades in the USA.

In Nazi Germany, this meant the forced sterilization of people suffering from so-called feeblemindedness – an “elastic” category under which ultimately, 50%-60% of all forced sterilizations in Germany were done.

Yet, the excuse used by Nazi medical staff that if they had not done it, they would be punished, falls foul of the fact as there are no known documented cases of negative consequences resulting from such failure to comply with sterilizations.

What supported all this were the infamous Nuremberg Race Laws. Noteworthy is the reality that several medical journals reported on the promulgation of these laws and even welcomed them as important steps to safeguard the racial purity of the German people.

Meanwhile, race hygiene became a compulsory subject in the medical curriculum of Nazi Germany. At the same time, something even more sinister occurred. Medical “ethics” were now considered important by the Nazis. However, much of this thought,

encompassed a Nazi version of medical ethics, making Nazi Germany, paradoxically, one of the first countries in the world to have mandatory courses in medical ethics … the central principle of this version of medical ethics was that the flourishing of the Volk as a collective should take precedence over all other considerations.

In the twisted minds of Nazi ideologues, this meant that what was now “ethical” covered the annihilation of life unworthy of living, which in this context meant killing people with severe and chronic mental illnesses and physical and cognitive disabilities – ballast lives as the Nazis call it.

It is still worth remembering that none of the victims of these programs volunteered to be killed. Notably, no psychiatrist was forced to participate in these killing programs – and some actually declined to do so without apparent repercussions.

Perhaps Goldhagen’s argument that there were plenty of Hitler’s Willing Executioners may have merit after all.

One of the most willing and horrific Nazi executioners was Josef Mengele (1911-1979) – probably the most notorious of all Nazi physicians who perpetrated medical atrocities.

Mengele’s research practices were marked by extreme brutality and a complete disregard for the humanity of the people forced to participate in his gruesome acts.

Like the aforementioned SS-Brigadeführer Wilhelm Börgerwho survived until 1962, the Nazi party member and race-hygienist Eugen Fischer who lived until 1967, The Angel of Death – Josef Mengele – only died in the year 1979, long after he was able to escape Germany to South America and live under various names, without once having been brought to justice for his crimes.

So, does Learning from the Germans mean that you can commit the most horrific crimes and live untouched until you die?

Meanwhile and beyond all that, four themes were the central drivers of the so-called scientific studies and Mengele-style experiments during the Nazi period:

  1. supporting the war effort,
  2. achieving German economic autarchy,
  3. spatial expansion towards the east, and,
  4. the idea of building and maintaining a healthy and strong German race.

Without a sense of irony or a shred of guilt, data from Nazi medical investigations were used in aviation medicine after the war.

Moreover, Nazi scientists connected to the experiments were recruited for the development of US’ space medicine.

In a closely connected case, Julius Hallervorden, Berthold Ostertag, Hans Joachim Scherer, Heinrich Gross, and others studied victims’ brains and published their results in academic journals, even decades after their beloved Nazi regime was eliminated.

Meanwhile, many inhumane medical experiments with thousands of victims were also left aside in post-Nazi court cases and trials, partly because the full extent of the atrocities was not yet known at the time.

One wonders why? Why didn’t the miraculously denazified post-war Germans investigate this so that Neiman’s mirage of Learning from the Germans could become possible?

Worse, many medical crimes – including most patient murders – were never investigated, few medical perpetrators were convicted, and many of these perpetrators continued their careers in clinical practice or academia despite the official commitment to denazification.

Over and over, one is forced to think of Neiman’s Learning from the Germans and how we cannot and probably should not learn from the Germans.

Those thoughts continue when realizing that by 1946, most German and Austrian doctors who had been involved in Nazism were back in their jobs and practices.

The same goes for the aforementioned Julius Hallervorden (1882-1965) who personally removed the brains of victims immediately after they had been gassed at the T4 killing center in Brandenburg.

Hallervorden continued his career largely unhindered in post-Nazi Germany. The list of Nazi doctors – never denazified – also includes Eduard Pernkopf (1888-1955) who used his unrestricted access to the bodies of executed Nazi victims for his famous Pernkopf atlas.

The story of non-denazification in post-Nazi Germany continued well into the new century. Germany did not recognize the 1933 sterilization law as unconstitutional until 2007, and compensation for the surviving victims of forced sterilizations was only introduced in 2011.

The families of the people killed in the patient-murder programs have never received any compensation.

On the other side of the coin, the deadly altitude and hypothermia experiments in Dachau were shared with the US aviation industry.

Several of the scientists involved in this research – including Nazi doctors Siegfried Ruff and Hubertus Strughold – were recruited immediately after the war by the US Army Air Forces. Strughold had a high-profile career in the US Space Program, and has been praised as the Father of space medicine.

All this continues with Heinrich Gross (1905-2005), who was one of the physicians involved in the killings. Later, the Austrian justice system did not put him on trial for murder until 2000, when Gross managed to evade prosecution by pleading unfitness to stand trial – unfortunately, a rather typical case.

Yet, medical ethics and professionalism were not dismissed under the Nazi regime as fundamentally incompatible with the goals of Nazism.

Rather, they were radically transformed in lockstep with broader developments in Nazi Germany, and turned into instruments of a brutal dictatorship and its eugenic and racist agenda.

Norms and values shifted to the point that health professionals could persuade themselves that it was ethically justified to prioritize the purported interests of the Volk – conceived as the national body, and defined in biological and racist terms – above all else, even the most fundamental aspects of humanity.

Perhaps even more important is the fact that despite all the factors mentioned, health-care professionals in the Nazi era had agency.

A range of behaviors remained available to them, and while some health-care professionals assumed leading roles in mass murder, others quietly declined to recommend patients for forced sterilization or worse, or pursued active resistance against the regime.

Yet – and this is also because of Nazi medicine – what we can really learn from all this is that reflecting on Nazi medicine has forced the world to develop, for example, the Nuremberg Code.

This is the first and most elaborate code for medical ethics. Most importantly, the ethics code include the requirement of voluntary consent based on sufficient knowledge and comprehension of the subject matter.

Given all this, a roadmap for teaching the history of medicine, Nazism, and the Holocaust should be put in place. This needs to include learning modules, curriculum development, and pedagogies.

In the end, what we can really learn from the Germans is that too many perpetrators of Germany’s Nazi medicine got off the hook scot-free. Nazi medicine and Germany’s post-Nazi history shows that Germany’s post-Nazi medical apparatus is more like what has been outlined by Gallant and Gallant in their recent book, Nazis All The Way Down.

Nevertheless, Nazi medicine shows that the medical profession – perhaps even more so than many other professions – needs to remain vigilant in the face of authoritarian regimes that put their dehumanizing ideology above humanity.

In the harsh light of what has been revealed about Nazi medicine, the teaching of medical ethics according to the guidelines of the Nuremberg Code – including the informed consent of patients – remains imperative.

Born on the foothills of Castle FrankensteinThomas Klikauer is the author of over 950 publications including a book on Alternative für Deutschland: The AfD – published by Liverpool University Press.

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