'Slapping up spastics': the persistence of social attitudes toward people with disabilities.

• Author: Gallagher, Hugh Gregory

If the physician presumes to take into consideration in his work

whether a life has value or not, the consequences are boundless and the

physician becomes the most dangerous man in the state.(1)

A Personal Statement

I am the author of By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich.(2) I am a historian; I am also a severely disabled person, a polio quadriplegic. As such, I am interested in the evolution of social attitudes and assumptions towards disabled people. It is my conviction that the underlying assumptions that made possible the killing by physicians of upwards of two hundred thousand disabled German citizens in the 1930s and 1940s are still widely held, not just in Germany but throughout the Western industrialized world. The purpose of this article, as of my book, is to make the reader aware of these assumptions and of the evil that can arise from their careless application.

Aktion T-4 Euthanasia: Summary of Program

In the late 1930s and throughout World War II, physicians of Germany's medical establishment, acting both with and without the acquiescence of the Nazi government, systematically killed their severely disabled and chronically mentally ill patients. These people were said by their doctors to be "useless eaters"--persons with "lives not worth living."

The officially sanctioned killing program was authorized by Hitler in 1939 at the request of leading figures of the German medical establishment. The program was under the direction of the Fuhrer's personal physician, Dr. Karl Brandt. It was called "euthanasia," although most of its victims were neither terminally ill nor in unbearable pain, nor were they anxious to die. The program's proponents advanced various arguments for its justification: compassion, eugenics, economics, racial purity. The official program was halted by Hitler in the summer of 1941 in the face of a rising wave of protests from people with disabilities, their families and friends, and religious officials. Even so, many doctors, acting largely on their own counsel, continued killing patients in hospitals and institutions throughout Germany.

Over the course of the official program and the unofficial so-called runaway euthanasia that followed it, more than two hundred thousand German citizens met their death at the hands of their physicians. The mass murder techniques developed in the euthanasia hospitals were later utilized against the jews.

As part of the official program, the medical establishment was informed of the Aktion T-4 operation at secret briefings held across the country. At these meetings the psychiatrists, physicians, and medical professors were fully informed on euthanasia. Euphemisms were used to describe the program: "negative population policies" was mass killing; refractory therapy cases" were the disabled people targeted for killing; "specialist children's wards" were children-killing centers; and "final medical assistance" was, of course, murder. There was never a doubt as to what was being discussed. These men were told the euthanasia program was part of the "breakthrough campaign" necessary to obtain the new medicine of the Third Reich. This held that medical attention and money should go, on a cost-benefit analysis, to those who could be brought back to full productive health, while the chronically disabled would be removed from society, as, said Dr. F. Klein, "I would remove the purulent appendix from a diseased body."(3)

In both the minutes of the "State Committee for the Scientific Registration of Severe Illness due to Heredity or Predisposition"--a high-level physicians'committee that met regularly with the Reich Chancellery--and in the reports of the briefing meetings with rank-and-file physicians, it was fiercely argued that the radical modernization of therapeutic activity could not be achieved without, and, in fact, must go hand-in-hand with, the elimination of these "refractory therapy cases."(4)

There can be no doubt the existence and operation of the euthanasia program was general knowledge within the medical community of the wartime Reich.

Throughout the life of the program--whether death came by injection, starvation, or poison gas shower--it came at the hand of a physician. It was program administrator Viktor Brack's firm and oft-stated belief that "the syringe belongs in the hand of a physician."(5)

Philip Bouhler, chief of Hitler's Chancellery, was insistent that a way of death be found that would be not only painless, but also imperceptible to the patient. He did not want to frighten the patients, nor make them uncomfortable. These things must be "done according to his orders, and in a dignified and not a brutal fashion."(6)

The original regulations envisioned a "conservative" program with careful review procedures. In operation, the program became a matter of killing in wholesale lots. The psychological reasons physicians were willing to participate in these killings are, no doubt, complex. There is, however, an aspect of the structure of the program that made it easier: There was no single point of responsibility--no place in the procedure at which it was possible to say, Here is where the patient receives his death warrant; no point where it could be said, This physician is responsible for this patient's death.

The local practicing physician simply filled out questionnaires, as he was required to do. The members of the assessing committee simply gave their individual opinions on each case. Nothing more would happen unless the members were in substantial agreement. The senior review physician simply went along with the committee or else expressed an objection. He was expressing a medical opinion, nothing more. Neither the assessors nor the review physicians ever saw the patient. The transportation staff was involved in transporting patients, but it was no business of theirs where or why the patients were being moved. The staffs that ran the centers were simply doing their jobs. Even the physician whose job it was to operate the gas chamber was not responsible for the death of the patients. After all, he played no part in their selection; he knew nothing of their cases. He was only following the procedures laid down by his superiors--carrying out the policy of his government as advised by the most eminent members of the medical profession.

The official, centralized euthanasia program lasted from 1939 through the summer of 1941. After two years of operation, the program's existence was widely known. The churches had raised strong and vocal objections. There had been public demonstrations in opposition to the killings. The German army was deep in the Russian campaign, and Hitler had no wish for public unrest at home. Accordingly, the Fuhrer, in a conversation with Dr. Brandt, without ceremony or discussion, ordered a halt to the euthanasia program. This did not, however, bring an end to the killing of disabled and insane persons. Physicians across Germany continued to administer "final medical treatment" to patients they considered as having "lives not worth living." The killings continued, but the decisionmaking and the criteria used in these decisions became those of the immediate doctor, rather than the assessor committees and the review professors. The "children's campaign," by which retarded and deformed infants were put to death, proceeded unabated. Even after...