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Euthanasia, the Second Time Around
by Allan Carlson
Euthanasia, or “mercy killing,” has twice been an issue in the recent history of our common Western civilization: the first time, about three generations ago; and the second time, over the last 20 years. While there are certainly differences between these two episodes, I am more interested at this point in their similarities. The common features are three: (1) a shift in medical ethics brought on by leaders in the medical profession itself; (2) the dominance in public life and policy of an ethos that sees death as a positive instrument for progress; and (3) the linkage of mercy killing to economic gain or good business.
The first euthanasia episode emerged in the 1920s, as an adjunct to the eugenics campaign. “Racial improvement” stood at that time as a certified science, in America as in Europe. Professors of eugenics took posts in many prestigious universities, with the goal of improving the racial stock by encouraging the genetically “fit” to reproduce and by discouraging the so-called unfit from having children. Laws for the forced sterilization of these “unfit”—usually defined as the mentally ill, chronic alcoholics, epileptics, and persons with physical defects—enjoyed particular popularity in the United States. Indeed, experts saw the California law as the most progressive, a model of applied science devoted to “the public good.”
The same impulse emerged in Germany as well. In 1920, the prominent jurist Karl Binding and the distinguished psychiatrist Alfred Hoch published a book entitled (in translation) The Release of Life Devoid of Value. The volume described those “absolutely worthless human beings” held in psychiatric institutions and asylums for the retarded who had “neither the will to live or die” and “whose death is urgently necessary.” The book labeled these poor souls a vast army of “ballast existences,” outlined how a euthanasia program could be organized, and emphasized the financial economies to be gained.
These views, I hasten to add, were not those of cranks or cruel thugs. These judges, doctors, and scientists were leaders in their fields, progressives, self-styled “modernists,” who sought to apply the successful techniques of industry and the values of efficiency and cost-accounting to questions of healing, life, and death. They rejected the old, “discredited” Christian principle of “the sanctity of human life” in favor of a rational measure of utility, and a readiness to relieve suffering at any cost.
Turning to a personal example, let us examine the work of Dr. Paul Nitsche, director of the Dresden Psychiatric Hospital and a pioneer in various forms of progressive therapy. During the 1920s and 1930s, he and his colleagues worked to develop new psychiatric drugs and innovative methods of counseling and work therapy. Nitsche was also a leader in introducing to central Europe electroconvulsive shock and insulin therapy as putative cures for mental disease. As one historian explains, “Nitsche . . . maintained that for every disease there must be a therapy; euthanasia became the therapy for those judged incurable. . . . Healing and killing went hand in hand” (Proctor). This was progressive medicine, freed from “irrational” Christian restraints, and committed to efficiency and to the prevention of pain.
This broad shift in medical ethics toward a utilitarian measure of life—“is it useful?”—soon found a willing political partner. In a speech given in August 1929, the struggling politician Adolph Hitler said:
If Germany was to get a million [new] children a year and was to remove 700,000–800,000 of the weakest people, then the final result might even be an increase in strength. . . . As a result of our modern sentimental humanitarianism we are trying to maintain the weak at the expense of the healthy.
Hitler, of course, did come to power four years later, but on the euthanasia front, he moved cautiously. He feared possible negative reactions by the Christian churches within the Reich. The National Socialist government did approve a measure for the Prevention of Hereditarily Diseased Progeny on July 14, 1933. Modeled on the law of California, it led to 350,000 forced sterilizations over the next five years. The legalization of “mercy killing” would take more time; public opinion had to be softened first.
The Nazi SS did its part, willing as usual to be on the cutting edge of the new ethic. In its journal Das Schwarze Korps (The Black Corps), SS editors ran in 1937 an article praising a German farmer who had taken his son from a care center for the handicapped in order to shoot him. A week later, the same journal placed handicapped children below animals in a published chart showing the value of things in life.
Hitler directed his own Chancery staff to develop propaganda films pointing toward euthanasia as the solution to both pain and fiscal or financial stress. Documentaries, filmed in nursing centers selected for their lovely settings, included Die Sünden der Vater (The Sins of the Father), Erbkrank (Genetic Disease), and Alles Leben ist Kampf (All Life is Struggle). Each of these films celebrated a popularized kind of Social Darwinism, which saw human existence based on conflict and the survival of the fittest. The films displayed “hopeless” patients in lavish facilities speaking nonsense or attacking their conscientious doctors, next to scenes of healthy but poor and dirty German children living in urban slums. The films portrayed beautiful young nurses and handsome male attendants whose lives and “idealism” were being squandered caring for “idiots.”
The most influential of these films was a feature release, Ich klage an (I Accuse). Its clever, manipulative plot mixed three standard film clichés—a love triangle, noble pioneering doctors, and courtroom drama—to justify euthanasia (which was still illegal in Germany). The movie portrayed a young doctor, Thomas Heyt, whose beautiful wife, Hanna, develops multiple sclerosis. Another doctor, Lang, also an admirer of Hanna, is a convinced opponent of euthanasia. As Hanna declines physically, Heyt and Lang race to find a cure. Lang abandons his opposition to mercy killing when he comes across a child whose life he had saved as a baby but who has since grown into a hideously deformed creature. To end Hanna’s agony, Heyt gives her a fatal drug overdose, while Lang plays Mozart on the piano. The script reads:
Hanna: . . . I wish that was the end, Thomas.
Heyt: It is the end, Hanna.
Hanna: How I love you, Thomas. . . . [He weeps.] I wish I could give you my hand, Thomas.
Thomas Heyt is then arrested for murder, and a great public trial ensues, which results in Heyt’s acquittal. A retired Prussian major speaks for the jury. After pointing to the “luxury” care centers and the “pitiful creatures” kept there, he argues: “The state which demands from us the duty to die, must also give us the right to die. . . .”
Ich klage an found an audience of 18 million. While Christian leaders denounced it, the film was warmly received by the critics in Germany, Austria, and—interestingly—Sweden.
Death & Deceit
In late 1938, the National Socialist regime took another step. Using as a pretext the case of a seriously handicapped infant, Hitler secretly authorized the euthanasia of children. He commissioned his own personal doctor, Karl Brandt, and his office aides, Philip Bouhler and Victor Brack, to organize the killing operation. They set up front organizations to identify and transfer victims, recruit doctors, and build killing wards in various hospitals. During the first six months of 1939, the operation killed 5,000 handicapped children; “making angels,” the doctors called it. Parents were told that their children had died of natural causes; pneumonia was a favorite diagnosis.
The following summer, Hitler expanded his order to cover handicapped adults. Using the same management team, this project took over offices at No. 4 Tiergarten Strasse in Berlin; in consequence, the entire operation became known as T-4. Internal memos called this work gnadentod (“euthanasia”) and vernichtung lebensunwerten Lebens (“destruction of life unworthy of life”).
The T-4 group pioneered industrialized murder, developing techniques for the killing of the handicapped that would prove useful when the target victims became the Jews. T-4 managers invented the gas chambers and the crematoria able to kill and incinerate quickly large numbers of bodies. They also pioneered ways to lure victims into these chambers (such as disguising them as showers) and to process the corpses (including the extraction of gold from teeth) with maximum efficiency. As entrepreneurs, the T-4 managers also moved into the lucrative sale of bodies and body parts to research institutes and medical schools throughout Central Europe.
Between September 1939 and August 1941, 70,000 more German citizens received “mercy deaths.” But the operation then began to break down, as—in the words of historian Michael Burleigh—“the system of deceit became overloaded.” Families with but one relative in a care center received two ash urns. Letters reported that patients had died of appendicitis who had, in fact, had their appendixes removed years before. And hospital staff members drinking beer in the local Ratskellers hinted to outsiders about the sinister nature of their work. Legal and religious protests grew, culminating in an August 1941 sermon by the “ultra-conservative aristocrat” (Burleigh) Clemens August Count von Galen, the Catholic bishop of Munster. The bishop warned:
If one is allowed to kill the unproductive people, then woe betide the invalids who have used up, sacrificed and lost their health and strength in the productive process . . . woe to mankind, woe to our German nation, if God’s holy commandment ‘Thou shalt not Kill,’ which God proclaimed on Mount Sinai amidst thunder and lightning, which God our Creator inscribed in the conscience of mankind from the very beginning, is not only broken, but if this transgression is actually tolerated and permitted to go unpunished.
Amazingly, Hitler retreated and ordered the T-4 program to a halt. Even at the height of his power, the Führer feared the fitfully sleeping Christian giant in his land. As he grumbled to his close colleagues over dinner: “I am quite sure that a man like the Bishop von Galen knows full well that after the war I shall extract retribution to the last farthing.” But on this issue, Hitler was publicly beaten.
In private, though, the pause proved to be short-lived. As good managers, the T-4 project leaders altered their procedures, shipped the gas chambers east for new uses, and “decentralized” the mercy killing. Over the next three years, at least another 70,000 handicapped and chronically ill Germans (and perhaps twice that number) perished from injections or deliberate starvation before the collapse of the Nationalist Socialist regime brought an end to this experiment. Exposés of these atrocities at the Nuremburg trials shocked the world—but, as it turned out, only for a short time.
Animals & Babies
For the second episode of euthanasia began about 20 years later. As before, a revolution in values within the medical profession and among ethical leaders came first. Progressive physicians in the West, in the name of preventing suffering, sought to free themselves from the ethical confines of the ancient Hippocratic Oath. The flashpoint was abortion; the restraint on progress was the Christian insistence on the sanctity of all human life, from conception to natural death. The result regarding abortion is too well known for me to repeat.
Symbolic of this campaign’s move into areas touching on euthanasia was a short article, now fairly infamous, appearing in the July 1983 issue of Pediatrics, the official journal of the American Academy of Pediatrics, under the title, “Sanctity of Life or Quality of Life?” The author—Australian-born “ethicist” Peter Singer—wrote:
If we compare a severely defective human infant with a non-human animal, a dog or pig, for example, we will often find the non-human to have superior capacities, both actual and potential, for rationality, self-consciousness, communication, and anything else that can plausibly be considered morally significant.
Is the erosion of the sanctity-of-life view really so alarming? . . . Once the religious mumbo-jumbo surrounding the term “human” has been stripped away . . . we will not regard as sacrosanct the life of each and every member of our species. . . . [Instead], we may start to look at human life as it really is: at the quality of life that each human being has or can achieve.
Do these words sound familiar? They should, for the image of a healthy animal compared to a defective human child framed in Singer’s article is identical to that found in the 1937 issue of Das Schwarze Korps, the journal of the Nazi SS described above. (Dr. Singer, of course, has since gone on to assume a prestigious professorship at Princeton University).
Modern Utility & Strength
What has been the business side of this second episode? Here, we have only hints. But I can report one event in which I was directly involved. In 1996, a German patent attorney of casual acquaintance passed on to me evidence that Michigan State University had recently filed for a patent in Europe. The new product was, to quote from the application, for “euthanasia solutions, which use the anesthetic gamma-hydroxy-butramide (embutramide) as a basis for formulating the composition.” While intended initially for use with animals, the application added: “If it should ever become legal to use the compositions in human beings, the patent claims should encompass the use of the compositions of the present invention for this purpose.” It turned out that the research at the university for this new killing drug had been funded by a drug company whose name was carefully buried in the record. But I later learned the name of the firm: Hoechst, a global German-based pharmaceutical company (which, incidentally, had also manufactured the gas sometimes used during the first euthanasia episode).
When word of this patent became public through an article I wrote for The Detroit News, both the university and the firm said they would not actually sell the compound for human use. Perhaps so. And yet, one suspects that you simply cannot keep a good market opportunity down.
What has been the political side to this second euthanasia episode? Here, I only speculate. But I suggest that the answer is this: a revolution in public morals tied to the needs of the advanced welfare state. Put another way, once the “sanctity of life” ethos has been discarded, the very logic of the welfare state points to euthanasia as an adjunct or supportive policy.
First, there is the moral revolution, evident since the late 1960s: what the Belgian sociologist Ron Lesthaghe has labeled a “shift in the Western ideational system” away from the values affirmed by Christian teaching (such as “responsibility, sacrifice, altruism, and sanctity of long-term commitments”) toward a militant “secular individualism” focused on the pursuit of pleasure and the desires of the self. Sickness and suffering have no place in this new Western ethical universe because they challenge its “most precious and profound belief,” namely, the implicit assumption “that humanity has in fact become God” (Hauerwas). It becomes better to be rid of our medical failures than to be reminded of our all-too-human limitations and the absurdity of our presumptions.
Tied to this is the need for good public accounting. Even during the National Socialist euthanasia project, advocates stressed the enormous public expense of mental hospital and nursing home patients. These frail lives consumed vast resources and had no prospects for cure or future useful labor. They were, as one formulation had it, “useless eaters.”
Even more so in our time, the handicapped, the chronically ill, and the very old consume great resources. In contrast to the world of the 1930s, most Western nations have assumed complete responsibility for medical and long-term maintenance costs. Medical technology, moreover, has greatly improved since that time; it can now keep alive persons who would surely have died naturally under the National Socialists, but again, they are now maintained only at great expense.
The modern welfare state makes almost unlimited promises to citizens regarding security and care, yet it runs—inevitably—into limits on taxation and revenue. In the absence of any restraining “sanctity of life” morality, it becomes logical to reduce those expenditures going to non-productive, non-working persons. Indeed, the “quality of life” ethic carries an imperative to end their “useless,” often suffering existence. In one stroke, euthanasia both reduces “pain” and frees up resources for the young and healthy. As the nineteenth-century German nihilist philosopher Friedrich Nietzsche once queried: “As for sickness: are we not almost tempted to ask whether we could get along without it?” And, as a former Austrian corporal once explained: “The final result might even be an increase in strength” of the society. Many of our contemporary, ethical, medical, and political leaders clearly agree.
But the twenty-first-century advocates for euthanasia will immediately and angrily object to my comparison of the National Socialist program of the 1930s with their project. The Nazis, they will say, engaged in coercion. They eliminated the handicapped, the old, and the sick without their consent. We citizens of The Netherlands, Oregon, and Australia’s Northern Territory, on the other hand, rely on voluntary consent: Only those who have given their permission shall die.
Now, for the sake of argument, I will grant this point, even though there are many troublesome issues surrounding the matter of consent: subtle pressures, indirect coercion, a change of mind. Indeed, one official 1991 study in The Netherlands found that over half of the “euthanized” patients had not actually given their consent. All the same, I will admit that on this ground, our contemporary proponents of euthanasia are better people and more sensitive than the National Socialists.
On the other hand, the Nazi T-4 project had another quality: It was done in secret. Even given a Reichstag completely under the Führer’s thumb, the National Socialists never dared openly to seek legislative approval of the euthanasia project. Even at war’s end, true German law still prohibited euthanasia. The reservoir of Christian belief in “the sanctity of human life” was too great in the Germany of the 1930s and early 1940s, the churches too powerful, the church leaders—such as Bishop von Galen—too watchful, the German people too moral.
In contrast, the modern euthanasia project advances in the open, by democratic process, with popular support, approved by parliamentarians, public referenda, or by the courts. Where Hitler himself feared to tread, terrified by the latent righteousness of his own people, citizens of the twenty-first-century West boldly march forward under the banner of “Right to Die.” Viewing the issue from this angle, I ask: Who have been the better, more compassionate people, the ones more truly opposed to a “culture of death”? The Germans living under the Third Reich? Or we, the citizens of the new, “quality” driven moral order?
Michael Burleigh, “Euthanasia and The Third Reich,” History Today 40 (February 1990), 11–16.
Michael Burleigh, “Racism as Social Policy: The Nazi ‘Euthanasia’ Programme, 1939–1945,” Ethnic and Racial Studies 14 (October 1991), 453–473.
Henry Friedlander, “Step by Step: The Expansion of Murder, 1939–1941,” German Studies Review 17 (October 1994), 495–507.
Stanley Hauerwas, “God, Medicine, and Problems of Evil,” in R. J. Neuhaus, ed., Guaranteeing the Good Life (Ann Arbor, Michigan: Eerdmans, 1990), 213–228.
International Anti-Euthanasia Task Force, “Euthanasia in the Netherlands,”
Ron Lesthaghe and Dominique Meekers, “Value Changes and the Dimensions of Familism in the European Community,” European Journal of Population 2 (1986).
Robert N. Proctor, “Nazi Health and Social Policy,” in H. Friedlander & Sybil Morton, eds., Simon Wiesenthal Center Annual, Vol. 7 (Los Angeles: Philosophical Library, 1990), 145–163.
Peter Singer, “Sanctity of Life or Quality of Life?” Pediatrics 72 (July 1983), 128–129.
Allan Carlson Allan Carlson is President of The Howard Center for Family, Religion & Society in Rockford, Illinois (www.profam.org). His books include Conjugal America: On The Public Purposes of Marriage and The Natural Family: Bulwark of Liberty. He is married and has four children and is a member of the Evangelical Lutheran Church in America. He is a senior editor for Touchstone.