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The Philosophy of Medicine in the Third Reich

Joseph R. Fitchett

Imperial College School of Public Health, London

Joseph.fitchett@doctors.org.uk

Context

The genocidal atrocities committed by the Nazis, mainly directed at millions of Jews

throughout Europe, are of an unparalleled evil. Deeply disturbing for the medical

profession is the role that doctors played up until the end of the Second World War,

especially

in

human

experimentation,

compulsory

sterilization

and

involuntary

euthanasia. The following article provides an overview of the political climate at the

time, the eugenics movement worldwide in the 1930s and the unsettling past, only 65

years ago.

“For ever let this place be a cry of despair and a warning to humanity where the Nazis

murdered about one and a half million men, women and children, mainly Jews from

various countries of Europe.”

Memorial Tablet at Birkenau Concentration Camp

Historical Background

Following defeat of the First World War in 1918, the recently united Germany was left

isolated and facing severe sanctions. Germany signed the Treaty of Versailles and as a

consequence lost over 10 per cent of its territory, all overseas colonies, set to pay

crippling sanctions, prohibited to annex neighbouring states and had the size of its army

greatly capped. The Weimar Republic, a liberal democracy, was instilled in 1919 to

govern Germany. It was difficult, however, to reach a single party majority with its

system of proportional representation, resulting in coalition governments that found it

near impossible in its early years to control left and right wing extremism, attempted

coup d’états, rampant inflation and economic meltdown. Despite the “Golden Era” from

the

mid-1920s,

political

instability

within

Germany

and

the

crisis

of

the

Great

Depression worldwide contributed to the strengthening of popularity of the National

Socialist German Worker’s Party (the Nazi Party) with many Germans still humiliated

by

the

terms

of

the

Treaty

of

Versailles.

The

Nazi

Party,

promoting German

nationalism, was racist, anti-communist and anti-capitalist, with its leader Adolf Hitler

aspiring to establish a “New Order” of Aryan supremacy in Europe. In 1933, president

Paul von Hindenburg appointed the increasingly popular Adolf Hitler as Chancellor for

another

coalition

government

in

an

attempt

to

keep

him

under

close

control.

Ultimately, following more turmoil including a devastating fire at the Reichstag

(German Parliament building) blamed as a communist plot, Hitler swiftly began

dismantling restrictions of power and expanding his command and German territory,

eventually leading to the Second World War.

The Eugenics Movement

The eugenics movement of the early 20 th Century was not a phenomenon exclusive to

Nazi Germany. The aim was to improve the human species by controlling birth and

offspring. Compulsory sterilization was a key mechanism to reach this end. Eugenics

inevitably raises concerns violating human rights, namely the right to life, privacy and

freedom from discrimination, however it was at the time justified in both utilitarian and

Darwinian terms. Controversy over eugenics and the Nazi desire for “racial hygiene”

and extermination of certain distinct population groups is highlighted by the fact that

other countries applied eugenic policies to differing degrees. The United States of

America, Britain, Sweden, Belgium, Canada, Australia and others enforced, in different

degrees, compulsory sterilization based on criteria such as mental health, social class,

sexuality, and crime. It was in this controversial climate that the Nazi Party began

outlining its increasingly severe interpretations of the eugenic movement of the 1930s

and applying it to an unparalleled scale for “Volkwerdung”, or becoming a master race.

Hitler increasingly began to see society as a “biological organism” and became fixated

on promoting what he believed to be healthier elements [1]. The “common good”

began

to

carry

more

importance

than

the

“individual

benefit”

and

economic

justification

was

increasingly

used.

A

slippery

slope

towards

fulfilment

of

“Volkwerdung” led to an expansion in involuntary euthanasia. Inspired by a 1920s

treatise entitled “Release through the Annihilation of Life Unworthy of Living”,

involuntary euthanasia was initially confined to the asylums but soon expanded into

hospital practice. The next step, genocide, is extreme but was central to the “racial

hygiene” sought by the Nazi Party [2]. The spectrum from compulsory sterilization to

involuntary euthanasia and to genocide is broad and chronologically apparent in the

Third Reich. Supervised by doctors, they are a chilling reminder to those in the

healthcare profession of the importance of a patient-centred relationship for the

protection of those most vulnerable.

Nazi Human Experimentation

Enforced scientific experimentation by the Nazis is shocking simply in its nature and

compounded by the fact that doctors, respected as protectors of life, carried out the

research

in

labour

and

concentration

camps.

Experiments

included

genetics,

experiments on twins, exposure to extreme conditions (include freezing temperatures

and high altitudes), infectious diseases and pharmacology. Many experiments were done

in the aim of understanding the conditions a soldier may encounter during the Second

World War. Freezing experiments for the Luftwaffe (Nazi air force) would therefore

involve a simulation of harsh conditions followed by an attempt at resuscitation. The

experimental subjects would then be subjected to very hot temperatures, such as in a

bath, which they could succumb to. Further experiments for pilot survival included

analysing the effects of drinking seawater.

Some prisoners were subjected to mustard

gas in an effort to investigate treatment of their wounds. Other prisoners were

deliberately infected with malaria. Dr Josef Mengele, a physician and Schutzstaffel (SS)

officer, was the notorious medical officer at Auschwitz and chief medical officer at

Birkenau. Particularly interested in experimentation on identical twins, Mengele initially

treated his subjects well. However, from around 3,000 twins only 52 are known to have

survived Auschwitz [3]. Mengele was even referred to as the “White Angel” as he

inspected the new arrivals to Auschwitz and Birkenau concentration camps, directing

them either to the right or to the left, indicating their immediate fate: hard labour or the

gas chambers.

Nuremberg Trials and the Nuremberg Code

Following the end of the war, the allies (France, the United States of America, the Soviet

Union and the United Kingdom) put on trial suspected war criminals. Political

differences between the allies at the end of the Second World War resulted in diplomatic

difficulties over continuing to use the International Military Tribunal that had operated

in 1945-46. Instead, 12 trials were held before United States military courts in the city of

Nuremberg in the American-occupied zone. The Doctors’ Trial, December 1946 to

August 1947, brought 23 defendants to trial facing accusations on four charges, namely

1) Conspiracy to commit war crimes and crimes against humanity, 2) War crimes, such

as performing medical experiments without the subject’s consent, 3) Crimes against

humanity, and 4) Membership of a criminal organisation, such as the Schutzstaffel.

Prosecutors concentrated on the experimentation within the camps and seven were

acquitted, seven sentenced to the death penalty (including Karl Brandt, Hitler’s personal

physician) and the remaining nine received sentences of imprisonment. The trial led to

the Nuremberg Code – a set of biomedical research ethics principles addressing non-

therapeutic experimentation on human subjects, with the first principles emphasising

that the “voluntary consent of the human subject is absolutely essential” [4]. The impact

of the Nuremberg Code on medical ethics can be felt to this day with subsequent

statements such as the 1964 Declaration of Helsinki [5] and 1978 Declaration of Alma

Ata [6] emphasising ethical principles for human experimentation and promoting health

as a human right, respectively.

Reflections

The Auschwitz camp complex, including the Birkenau extermination centre, stands

today as a poignant reminder to prevent exploitation of those most vulnerable. It feels

almost impossible to comprehend how such atrocities could take place. The fact that

human beings are capable of the most inhumane of thoughts and actions is unsettling.

Patients trust their doctors and healthcare professionals often at times of great despair.

Accordingly, doctors have an unparalleled responsibility to protect the individuals they

treat and care for, and must respect their patients’ autonomy, always seek their consent

and do them no harm. Through experimentation, hard labour and murder, the

prisoners in the Nazi concentration camps were dehumanised and subjected to the

gravest violations of their human rights. The presence of a medical professional can

often be seen to justify a procedure, particularly relevant to this day with accusations of

supervised torture. Acknowledging and protecting an individual’s fundamental rights

and never treating them merely as a means to an end are two of the most important

principles we must all actively promote throughout our lives to safeguard humanity.

“A destruction, an annihilation that only man can provoke, only man can prevent”

Elie Wiesel, Holocaust survivor and Nobel Laureate

Poem extract from Primo Levi’s “If This Is a Man” [7]

Consider if this is a man

Who works in mud,

Who knows no peace,

Who fights for a crust of bread,

Who dies by a yes or a no.

Consider if this is a woman

Without hair, without name,

Without the strength to remember,

Empty are her eyes, cold her womb,

Like a frog in winter.

References

For further reading, see references 8, 9, 10 & 11.

1 Biddiss M. Disease and dictatorship: the case of Hitler’s Third Reich. Journal of the

Royal Society of Medicine. 1997;90:342-6

2 Annas G, Grodin MA. The Nazi Doctors and the Nuremberg Code. Oxford University Press,

1995

3 Lagnado LM, Dekel SC. Children of the Flames. Penguin, 1991

4 The Nuremberg Code. Trials of War Criminals before the Nuremberg Military Tribunals under

Control Council Law No.10, Vol.2, pp.181-2. US Government Printing Office. Washington

DC, 1949

5 World Medical Association. Declaration of Helsinki – Ethical principles for medical research

involving human subjects. Helsinki, 1964

6 World Health Organisation. Declaration of Alma Ata. International Conference on

Primary Health Care. Alma Ata, 1978

7 Levi P. If This Is a Man. Abacus (English translation 1958), 1947

8 Caplan A (editor). When Medicine Went Mad. Bioethics and the Holocaust. Totowa, Humana

Press, 1992

9 Special Issue on the Nuremberg Doctors’ Trial. British Medical Journal. 7 December

1996

10 Proctor RN. Racial Hygiene. Harvard University Press, 1988

11 Weindling P. Health, Race, and German Politics, 1870-1945. Cambridge University Press,

1989