The German experiment with euthanasia provides salutary lessons for the debate in the early 21st

century.

During the Nazi's T-4 programme, an estimated 250,000-350,000 Germans were put to death. It
is not commonly known that the gas chamber technology used by the Nazi's in the war years was
developed when the large number of adult and child euthanasia cases required more efficient
means than narcotics and starvation. Gas chambers were, in many cases, constructed on hospital
grounds.

The killing ended with the surrender in May, 1945 and the leading doctors were put on trial at the
Nuremberg War Crimes Trials.

Leo Alexander, an American psychiatrist, was a consultant to the Secretary of War and serving
with the office of the Chief Counsel for War Crimes in Nuremberg during 1946 and 1947. In his
"Medical Science under Dictatorship", published in the New England Journal of Medicine, July,
1949, Dr Alexander observed: "Whatever proportions these crimes finally assumed, it became
evident to all who investigated them, that they started from small beginnings. The beginnings at
first were merely a subtle shift in emphasis in the basic attitudes of physicians."
It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such
a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely
with the severely and chronically sick.

"Gradually the sphere of those to be included in this category was enlarged to encompass the
socially unproductive, the ideologically unwanted, the racially unwanted, and finally all nonGermans."

"The small beginnings"

By the end of the nineteenth century in Germany, scattered voices could be heard calling for
euthanasia in the name of personal choice and mercy, using arguments identical to those heard
today.

The extraordinarily high death rate from mass starvation in German mental hospitals during
World War I, was an early warning signs of the deadly shift official attitudes could take toward
the mentally ill when resources were strained.

Before Adolf Hitler came to power and issued the executive order for the T-4 programme to be
implemented, the ideological ground had been thoroughly prepared.

Years before in 1920, two eminent German academics: Karl Binding, a law professor and Alfred
Hoche, a doctor, published their seminal work: "Permission to Destroy Life Unworthy of Life".

They argued that first it was acceptable for an outside agency to define what individual life was
worthless, and second that in effect, an individual had to justify his existence according to
criteria imposed from outside. This means proving to the agency that one's life was worthwhile.

Two cultural factors unique to Germany at the time ensured that the book had immediate
influence in the medical establishment and the social sciences. These factors were the ethos of
social Darwinism and eugenics.

Social Darwinists applied Charles Darwin's theories of natural selection to human society. Social
progress depended on the fittest and most powerful surviving and the weakest elements being
culled to prevent infecting their betters.

Eugenics envisaged a hierarchy of human beings, the lower levels being the mentally
handicapped and the disabled.

Binding and Hoche set out to undermine the Hippocratic Oath tradition. They argued that the
criteria for medical practice should be utilitarian. People were valuable in terms of their
contribution to society. Their "quality of life" should be the determining factor in medical
treatment.

In contrast, the Hippocratic Oath assumed that an individual did not have to prove their worth.
The sanctity and value of each individual human person was sacrosanct.

Binding and Hoche placed people in categories and deemed that certain individuals were
"unworthy" of life: those with terminal illnesses, the disabled (including children) and the
mentally ill.

There were two benefits for German society if these categories could be eliminated: racial purity
and re-directing medical resources and funds to those "worthy" of support.

Such sentiments were readily accepted by influential doctors, the intelligentsia and soon wider
German society. Ten years after the publication of Mein Kampf, 45 percent of German doctors
had joined the Nazi party. Thus when the Nazis came to power in 1933, determined to create a
new Aryan Master Race, many Germans were ready to be persuaded on the merits of "merciful"
euthanasia.

The legalization of voluntary euthanasia was a Nazi priority and the public were supposed to be
reassured by a raft of safeguards. However the proposals were vigorously opposed by the
churches and the Nazis retreated to wait for a more opportune time.

Within six months, "Heredity Health Courts" were established to sterilize those in the targeted
categories. An estimated 350,000 Germans were sterilized under this programme, until May,
1945.

Propaganda used to persuade

Propaganda minister Joseph Goebbels, marshalled the resources of the state-controlled media to
persuade Germans that euthanasia was a humane social policy, the foundation for building the
Master Race. Graphic pictures portrayed mentally ill and disabled "subhumans" in a series of
powerful and popular films, to reinforce the message.

In the popular film "I Accuse", an attractive woman suffering from multiple sclerosis was gently
killed by her loving husband.

German school children studied math problems and calculated how many services, how much
bread, jam, and other necessities of life could be saved by killing people - the chronically sick
and crippled - who were a "drain on society."

The Hippocratic Oath replaced

Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm"
clause. The Oath required that a doctor's first duty is to his patient.

The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi
state. Thus a German doctor's first duty was now to promote the interests of the Reich.

Infanticide: the first legal killings

Once German doctors accepted social eugenics, the forcible sterilization of the "unfit" became
widespread. The next step was infanticide, which required the willing cooperation of doctors and
midwives, who reported every birth of a child with disabilities to the authorities.

The child was sent to an institution - supposedly for treatment. A brief report on the child was
then sent to Berlin where three doctors judged the child, in almost every case to be "unworthy of
life." After killing the child (with the usual cause of death' listed as pneumonia), the body was
delivered to the family, minus the brain.

Hitler appointed Dr Karl Brandt (later hanged following the Nuremberg War Crimes Trials) to
head the bureaucracy and implement the infanticide programme, following a secret directive
issued in 1939.

Thousands were killed at psychiatric institutions and pediatric clinics by being spoon-fed lethal
medicines and drugs. From infants, the categories were extended to those between three and
seventeen years old. Some of the victims were non-mentally ill children whose behavior was
deemed abnormal or anti-social.