Death as Deliverance: Euthanatic Thinking in Germany ca. 1890-1933

A recurring theme in the encyclicals of John Paul II has been the necessity that we harness freedom to truth. Speaking from the vantage-point of one who has had intimate acquaintance with political tyranny, John Paul addresses those of us who live in a "free" society by reminding us that the wedding of democratic pluralism and moral relativism constitutes a thinly-veiled totalitarianism. Indeed, the historical record would seem to vindicate the pontiff: the century immediately behind us constitutes a sobering reminder that freedom is capable of annihilating itself; this occurs when human freedom is no longer tethered to moral principle.

When moral vision fails, the door is open for the totalitarian option. This "option," it needs to be stressed, requires preparation - preparation that is facilitated by a reconfiguration of the way people think about life and death, moral agency and personhood. What sort of world our children and our children's children inherit is inextricably linked to this reconfiguration. For this reason, Christian involvement in the public square cannot be overemphasized. What sort of cultural climate our children inherit depends to a great extent on present Christian participation in the great ethical debates of our day.

Perhaps because I married into a German family and spent the early years of marriage living in (former West) Germany, where our first child was born, I am particularly sensitive to the moral atrocities that lie in the recent past. My own experience and close identification with German culture doubtless have created a greater sensitivity than I otherwise would have known to recent history and to the character of moral atrocities that lie in the not-too-distant past. In contemplating lessons to be learned, I am struck by several observations - foremost among these: (1) the beginnings of scientific and medical depravity are small, marked by subtle shifts in the way personhood is defined and law is defined; (2) given the fact that scientific "progress" invariably outpaces our ability to reflect ethically on that progress, it is critical that the church not remain silent in the face of present or potential evil. Part of the ethical task, then, is to discern and expose utilitarian ethics when it surfaces.

The Euthanatic Mindset: Prelude

While it is commonly assumed that the moral atrocities associated with the Holocaust were the exclusive domain of Adolf Hitler and his loyal henchmen Joseph Goebbels, Hermann Goering, Heinrich Himmler and Albert Speer, this was only the final act, as it were, of a narrative whose beginnings are traceable to the turn of the century. Indeed it would appear, as authors as diverse as Alexander Mitscherlich, Robert Jay Lifton, Michael Burleigh, and Wesley Smith have documented, that the path to medical evil was prepared "long before Nazism was even a cloud on the German horizon." One of the tragic legacies of social Darwinism, rooted in the presupposition of biological determinism, is that it assisted in giving justification--frequently couched in the language of "compassion"--to the elimination of lebensunwertes Leben, life that is unworthy of living, or, in the language of Darwinists, life that is simply unfit.

In addition to the ascendancy of biological determinism, an important step in legitimizing the killing of the weak, the infirm, the terminally ill, and the incompetent was the shift in ethos among medical doctors and psychiatrists several decades prior to WWII. Historian Robert Proctor has argued persuasively that the Nazi experiment was rooted in pre-1933 thinking about the essence of personhood, racial hygienics and survival economics and that physicians were instrumental both in pioneering research and in carrying out this program. In fact, Proctor is adamant that scientists and physicians were pioneers and not pawns in this process. By 1933, however, when political power was consolidated by National Socialists, resistance within the medical community was too late. Proctor notes, for example, that most of the fifteen-odd journals devoted to racial hygienics were established long before the rise of National Socialism.

Few accounts of this period are more thoroughly researched than Michael Burleigh's Death and Deliverance: 'Euthanasia' in Germany ca. 1900-1945. Particularly important is Burleigh's discussion of psychiatric reform and medical utilitarianism during the Weimar period. During the years of WWI, it is estimated that over 140,000 people died in German psychiatric asylums . This would suggest that about 30% of the entire pre-war asylum population died as a result of hunger, disease or neglect. Following the war, evidence indicates that a shift in the moral climate had begun. In the Spring of 1920, the chairman of the German Psychiatric Association, Karl Bonhoeffer, testified before Association members at the GPA annual meeting that "we have witnessed a change in the concept of humanity"; moreover, in emphasizing the right of the healthy to stay alive, which is an inevitable result of periods of necessity, there is also a danger of going too far: a danger that the self-sacrificing subordination of the strong to the needs of the helpless and ill, which lies at the heart of any true concern for the sick, will give ground to the demand of the healthy to live.

According to Burleigh, Bonhoeffer went on in the 1930s to offer courses that trained those who in time would be authorized with implementing sterilization policies introduced by the National Socialists.

Already in the 1890s, the traditional view of medicine that physicians are not to harm but to cure was being questioned in some corners by a "right-to-die" ethos. Voluntary euthanasia was supported by a concept of negative human worth--i.e., the combined notion that suffering negates human worth and the incurably ill and mentally defective place an enormous burden on families and surrounding communities. It is at this time that the expression "life unworthy of being lived" seems to have emerged and was the subject of heated debate by the time WWI had ended.

One notable "early" proponent of involuntary euthanasia was influential biologist and Darwinian social theorist Ernst Haeckel. In 1899 Haeckel published The Riddle of the Universe, which became one of the most widely read science books of the era. One of several influential voices contending for the utility of euthanasia, Haeckel combined the notion of euthanasia as an act of mercy with economic concerns that considerable money might thereby be saved.

Further justification for euthanasia in the pre-WWI era was provided by people such as social theorist Adolf Jost and Nobel-Prize-winning chemist Wilhelm Ostwald. According to Ostwald, "in all circumstances suffering represents a restriction upon, and diminution of, the individual and capacity to perform in society of the person suffering." In his 1895 book Das Recht auf den Tod ("The Right to Death"), Jost set forth the argument--an argument almost forty years in advance of Nazi prescriptions--that the "right" to kill existed in the context of the higher rights possessed by the state, since all individuals belong to the social organism of the state. Furthermore, this was couched in terms of "compassion" and "relief" from one's suffering. Finally, the right to kill compassionately was predicated on biology, in accordance with the spirit of the age: the state must ensure that the social organism remains fit and healthy.

Putting Euthanasia in Perspective: The Preparation of an Idea

In 1933, with the accession of the National Socialists to power, two developments that had reached their critical mass were promptly codified into law. One was the long-discussed sterilization program, which had been debated but had not achieved majority support. The second was authorized euthanasia. The proposal, issued by the German Ministry of Justice, was reported on the front page of The New York Times and stated:

"It shall be made possible for physicians to end the tortures of incurable patients, upon request, in the interests of true humanity." Moreover, the Ministry ensured, "no life still valuable to the state will be wantonly destroyed."

Andrew C. Ivy, M.D., asked in 1946 by the Board of Trustees of the American Medical Association to serve as a consultant at the Nuremberg trial of Nazi physicians who had been indicted for "crimes against humanity," reflected on his difficult experience with the following observation:

It was inconceivable that a group of men trained in medicine and in official positions of power in German governmental circles could ignore the ethical principles of medicine and the unwritten law that a doctor should be nearer humanity than other men... [W]e had assumed that the sacred aspects of medicine and its ethics would certainly remain inviolate.

Although, according to Ivy, "fewer than two hundred German physicians participated directly in the medical war crimes," it became clear to Ivy that these atrocities were only "the end result" of the "complete encroachment on the ethics and freedom of medicine" by those in positions of influence.

Two generations removed, this utilitarian strain of thinking, perhaps dormant for several brief decades, is once again dominant as we stand before scientific breakthroughs. Utilitarian thinking about ethics is ubiquitous; it is the air we breathe, propagated by ethicists, health-care practitioners, social theorists, and sundry consultants, all of whom weigh the value of personhood against the economics of health care and the cumulative "burden" on society. Lacking any strong commitment to the sanctity of life, utilitarian ethicists and practitioners adopt a "quality-of-life" ethic. The inevitable question that follows is this: At what point does an individual no longer have a "quality of life" that is "worthy of life" itself? With justification bioethicist Leon Kass has warned: "There is the very real danger that what constitutes a 'meaningful life' among the intellectual elite will be imposed on the people as the only standard by which the value of human life is measured."

Historian Robert Proctor has argued that the primary impetus for forcible euthanasia in the 1930s was economic; assisted death was justified as a kind of "preemptive triage" to free up beds. Persons who were considered a burden on German society included handicapped infants, the mentally ill, the terminally ill, the comatose, and the criminal element. By 1941, euthanasia had become part of normal hospital routine. This disposal or "disinfection" of human lives, however, was to be done "humanely and economically." But let it be emphasized that most of the people advocating assisted death at this time were, relatively speaking, ordinary, good, hard-working and loyal people who, surely, thought of themselves as engaged in the service of mankind through a philosophically-neutral practice of science and medicine.

Writing in 1989, the late Cardinal John O'Connor of New York City, an ardent pro-life advocate, predicted that euthanasia would "dwarf the abortion phenomenon in magnitude, in numbers, in horror." When one considers the sheer number of abortions that are performed each year and that have been performed over the last two decades, this statement borders on fantastic. But Cardinal O'Connor's are not the words of someone given to exaggeration. While there is nothing inevitable about human predictions, O'Connor's words are haunting. What is it that can hinder this "prophecy" from coming to pass?

Such, I dare say, will be the true test of our moral vision in the days ahead.

Editor's note: The following commentary was taken from a forthcoming CBHD paper of the same title. The expanded, referenced paper will include sections on the medical, legal, compassion, and economic arguments used to further euthanatic thinking in pre-WWII Germany.