&)ud�U}/1/ NAZI EUTHANASIA, 1939-1945

�

HEATHER

er

"The rose that does not bloom will be pulled up and tossed in the fire, and the gardener will chop down the tree that bears no fruit."

- Walter Gross, 1933

he history of National Socialist rule in Germany is, in many ways, a history of atrocities. Hitler and the men and women who supported him sought to fashion a new ethnic identity based on self-sacrifice, unwavering allegiance, and the radical exclusion of undesirable groups. In the process, the Nazi machine systematically annihilated millions of individual lives considered to be of no, or negative value to the Volk. While much atten­tion has been duly paid to the destruction of Jewish lives in the Holocaust, new scholarship has emerged over the last two decades to shed light on the concurrent program of Nazi euthanasia, which aimed at cleansing the ethnic body politic from within. In the quest to create a strong and healthy racial state, it was not only necessary to rid Germany of foreign elements like Jews and Gypsies, but also to cleanse the Aryan ranks of the unfit - those mentally or physically handicapped individuals whose existencethreatened the strength and health of the Volk as a whole. As Hitler wrotein Mein Kampf, ''.A stronger race [must] drive out the weak" and replace"the so-called humanity of individuals" with "the humanity of Naturewhich destroys the weak to give his place to the strong." 1 In a society thatdemanded that the interests of the Volk be placed above the interests ofal!)I individual, destroying those who could neither care for themselves norcontribute to society became a kind of moral imperative - an act ofdevotion for the greater good.

‘8 CPFThe euthanasia program began in the fall of 1939 with a secret de

cree, issued on Hitler’s personal stationary, which charged Dr. Karl Brandtand Phillip Bouhier with recruiting doctors to grant “mercy death[sj” tohandicapped patients who were cnnsidered “incurable.”2 Under the direction of the administrative headquarters established at Tiergartenstrasse4 (14), approximately 5,000 children and 70,000 adults met their deathsat the hands of physicians and nurses in German Idifing centers between1940 and August 194l. Thousands more died during the period of “wildeuthanasia” that followed Hider’s 1941 halt order, which had put an endto the gassing of institutionalized patients in special centers, but not tothe starvation diets and lethal injections that could be carried out on anindividual and less public basis in any institution.4

Viewed within the limited context of other atrocities, like the concentration camps and Einsatz,gruppen sweeps, the euthanasia programmight only be seen as another example of a peculiarly Nazi disregard forhuman life. But the devaluation of individual life was not peculiar to theNazi power of 1933-1945. It was, rathei an integral facet of a eugenicsand racial science movement, which predated the Nazis by decades, andgained increasing influence among German psychiatrists and anthropologists from 1900 on. Furthermore, the tendency to devalue individuallife and create a hierarchy of worth based on one’s ability to contributeto society grew out of the visceral and intellectual response of manyEuropeans to the devastating loss of life suffered in World War I. Whenearly advocates of euthanasia asked their readers how one could justifythe maintenance of “worthless” lives in institutions while the healthydied en masse at the front,5 they posed a question, which had alreadycrept into the subconscious of many Germans’ minds: Were individuallives not of relative value in an age in which millions were sacrificed inthe name of a higher cause? When Hitler backdated the euthanasia order signed on October 1, 1939 to the outbreak of the war in September,he played on an association between war and sacrifice, which Germanshad accepted for years.6

What was peculiar to the Nazis was the transformation of thoughtinto radical action. In the hands of the T4 administration, a pre-existing inclination toward euthanasia and theoretical discussions of its meritsbecame a concrete program for the destruction of “life unworthy of life”on a mass scale.7 This transformation of theory into practice was madepossible by three principle factors: a government-sponsored bureaucracyspecifically devoted to euthanasia, which compartmentalized tasks andcreated an environment of “free-floating responsibility;”6 the training andindoctrination of medical staff in the rhetoric of eugenics and racial science prior to and during their participation in the euthanasia program;and the natural tendency of the perpetrators to create mechanisms fordistancing themselves from the reality of unpleasant, or difficult tasks.Through an examination of the above factors, this essay attempts to

HEATHER COOPER

CPF I9

derstand how it was possible tojustif)ç commit, and deny responsibility forthe murder of almost 100,000 handicapped children and adults between1939 and 1945.

Historical interest in racial science and euthanasia in Nazi Germanyhas increased over the last two decades, as historians have sought to understand the origins of Nazi violence and the Final Solution, the racial hierarchy of the Third Reich, and the psychology of perpetrators in variousprograms of radical exclusion. The work of Henry Friedlander, MichaelBurleigh, and RobertJay Lifton has been particularly valuable in addressing these topics. Friedlander’s The Origins ofNazi Genocide: From Euthanasiato the Final Solution argues that euthanasia was one stage along a continuumof exclusion, which first sought to exclude undesirables from future generations and then to eradicate them from the present one through systematic extermination. His work is primarily concerned with examining theways in which the T-4 administration and bureaucracy sewed as a modelfor the Final Solution, which followed. Burieigh provides a different context for the euthanasia program in his books, Ethics and Extermination andDeath and Deliverance, when he considers the ways in which eugenics, racialscience, and changes in psychiatry before 1933 created an environmentthat made organized euthanasia possible under the Nazis.° Finally, Lifton’spsychohistorical study in The Nazi Doctors introduces some valuable questions about the psychological mechanisms employed by perpetrators inthe “medicalized killing” operations of the Third Reich.’°

Most of what we know of the Nazi euthanasia program is from thetestimony and documentation of the post-war trials, which have given aface to the perpetrators and a shape to the T-4 administration that necessitated their crimes. All the books mentioned above, and many others nottouched upon here, culled their evidence from similar sources and utilizeda common outhne of perpetrators, victims, and administration in their examinations of euthanasia. What separates them is the context in which thatbasic outhnc has been placed and the questions which each author hasasked of those sources. The research presented in this essay is obviouslyconsiderably more limited than that of Lifton, Burleigh, or Friedlander —and, yet, it still works with the same basic oudine of information relatingto perpetrators, victims, and the T-4 administration. I have attempted toplace the Nazi euthanasia program within the context of an caner eugenics and race hygiene movement, which frequently devalued individual life,in order to establish that an environment conducive to euthanasia was already forming in Germany prior to the Nazi rise to power. By examiningthe T-4 administration and organization, indoctrination and training ofmedical stafi and distancing mechanisms of perpetrators, I hope to offera tentative and partial answer to two questions central to the historiography of this topic: How did the Nazis transform theoretical discussions ofthe merits of euthanasia into a systematic program for the destruction of“life unworthy of life?” And how was it possible for the men and women

Radical Exclusion: Nazi Euthanasia, 1939-1945

20 CPFresponsible for tens of thousands of deaths to deny their responsibilityjustify their actions, and separate themselves from the physical and moralmeaning of what they did?

PRELUDE TO EUTHANASIA:Eugenics and Psychiatry before 1939

The first steps toward creating a hierarchy of the valued and valueless in German society were taken in the name of eugenics. Inspired byDarwin’s theories of natural selection and survival of the fittest. eugenicists applied those same principles to man and began to see the successesand failures of their society as biological matters of selection, counter-selection, and hereditary fitness. At the same time, individuals were reducedto “aggregates of ‘negative’ or ‘positive’ biological materials” whose valuewas determined by their contribution to, or hurden on society; such a contribution was understood both in terms of hereditary traits and capacityfor production and

Alfred Ploetz and William Schailmayer were two of the foremostGerman eugenicists in the late nineteenth and early twentieth centuries.Despite their early resistance to notions of scientific racism, the Naziswould later credit their work with creating the biological foundations ofthe Nazi racial state.’2 In 1895 Ploetz published the book, The Efficiencyof our Race and the Protection of the Weak, which argued that genetic healthensured national efficiency and that welfare and modern medicine werecounter-selective forces that protected inferior genetic elements at thenation’s expense. He coined the term “racial hygiene” to describe the process of cleansing and strengthening the national body’3 Schafimayer wassimilarly concerned with collective health and efficiency and argued thatan individual’s primary function was to contribute to the regenerationof society by producing healthy offspring. He seemed to foreshadow theNazi ideal of devotion and self-sacrifice when he wrote that the “law ofnature, the total subservience of the interest of the individual to that ofthe species, must also hold true for human development.”4 Yet neitherPloetz nor Schallmayer advocated negative eugenics measures like forcedsterilization, or euthanasia. They were, rathei primarily concerned with apositive eugenics that would encourage genetically compatible marriagesand increase the reproduction of healthy offspring.’5

Other scientists of this period perceived a dire threat to the healthof the nation, which could not be silenced by positive eugenics alone. In a1904 hook entitled The Riddle of Ljfe, zoologist Ernst Haeckel specificallyadvocated euthanasia of the handicapped when he wrote:

What profit does humanity derive from the thousands ofcripples who are horn each year, from the deaf and dumb,fmm eretins, from those with incurable hereditary defects etc.

HEATHER COOPER

©PF 2I

who are kept alive artificially and then raised to adulthood?How much of this loss and suffering could be obviated, if

one finally decided to liberate the totally incurable from theirindescribable suffering with a dose of morphia.’6

Later advocates of euthanasia would couch their arguments in strikingly similar terms, emphasizing both the burden on society represented by anever-growing population of “cretins” and the “indescribable suffering” thatmade their eradication an act of mercy In an influential treatise published in1920, Karl Binding and Alfred Hoche considered the merits of euthanasiafor those incurable individuals whose lives were “not only completely worthless but [were] of negative value.”7 In language that turned the intended victims of euthanasia into inhuman agents of degeneration and the would-beperpetrators into victims and heroes, Binding and Hoche called on Germansto consider the necessity of relieving themselves and the handicapped of theburden of nonproductive lives. While they insisted that euthanasia shouldonly be permitted when the person involved viewed it as a “release,” thisstandard was only applicable to individuals with a terminal disease, such ascancer.’8 In contrast, the incurably insane were said to “have neither the willto live nor to die” and, therefore, euthanasia could be carried out without“clash[ingl with any will to live which would have to be broken.”9

Binding and Hoche’s Ferrnession for the Destruction of Worthless Life didnot meet with immediate approval in all psychiatric circles, but it certainlyprovoked discussion. It was, in fact, a very topical subjectjust two years afterthe end of the twentieth century’s most devastating war to date. Germanysuffered unprecedented military and civilian casualties in WWI and theselosses created an environment in which the worth of an individual life hadto be weighed against the hundreds of thousands who were already dyingand the millions who lived on because of their sacrifice. Germany’s psychiatsic institutions felt the ravages of war just as the general populationdid. Accounting for normal peacetime mortality rates, Michael Burleighestimates that nearly 72,000 patients died in institutions 1914-1918 as aresult of hungei disease, or neglect.2° In his 1920 address to the GermanPsychiatric Association, chairman Karl Bonhoeffer seemed to suggest thatBinding and Hoche’s call for “a higher morality” which would “ceaseimplementing the demands of an exaggerated concept of humanity” wasalready being ansvcred.’

It could almost seem as if we have witnessed a change in theconcept of humanity I simply mean that we were forced bythe terrible exigencies of war ... to get used to watching ourpatients die of malnutrition in vast numbers, almost approving of this, in the knowledge that perhaps the healthy could bekept alive through these sacrifices.22

Many of the psychiatrists who were faced with limited resources duringthe war believed that they must acknowledge a hierarchy of human valueand be willing to take from the weak in order that the strong might survive.After the war, the principle of relative worth continued to be applied.

Radical Exclusion: JVazi Euthanasia, 1939-1945

2

Armcd with a new concept of individual worth, in the 1920s psychiatrists equated one’s ability to contribute to society with one’s physicaland mental health. following the example of Hermann Simon, an asylumdirector at Gutersloch, occupational therapy became widespread in German asylums and offered a means for classifying patients according to thetasks they were capable of performing.23 Burleigh estimates that by theend of the 1 920s, up to 80 percent of institutionalized patients were doingsome form of work, ranging from basic manual labor and weaving to gardening, office work, and factory labor.24 The full significance of productivity as a measure of worth would be felt after 1939 when productive capacity became one of the criteria for deciding which patients to include in theeuthanasia program.25 In the meantime, occupational therapy provided afree labor pool to institutions for their own maintenance and came closeto realizing racial hygienist Ignaz Kaup’s 1910 vision of a “work colony”in which worthless lives could “repay the money spent on them.”26 As stateexpenditures on asylums fell, patient labor became critical to make up forthe food and staff shortages, which institutions faced.

But by insisting on productivity as a sign of health and worth, occupational therapy created an environment in which those who were unable to work, or to advance beyond the more basic skill sets, were considered incurable and, therefore, inherently inferior. Such individuals were,as Binding and Hoche suggested, “not only completely worthless butof negative value.”27 Given the burden that their care placed on societyand the risk that their diseases posed to the nation’s gene pool, incurablepatients were increasingly labeled “degenerates” because of their allegedrole in the degeneration of the VoUc. In what amounted to a wave of racialhysteria, eugenicists feared that a declining birth rate among the healthyand the uncontrolled reproduction of degenerates would eventually leadto a society in which inferior elements outnumbered the genetically desirable.28 The solution to this crisis not only involved government programsto educate the public about racial hygiene, create genetically compatiblecouples, and increase the reproduction of healthy offspring, but also acompulsory sterilization program to prevent the hereditarily ifi from reproducing additional burdens.

The sterilization program, initiated in July 1933 under the Law forthe Prevention of Offspring with Hereditary Diseases, was responsible forthe sterilization of 200,000-400,000 people.n The sterilization programcannot be adequately treated in this essay, but it is necessary to note certainconsistencies between its organization and that of the euthanasia programthat followed. The Sterilization Law named those diseases which were tobe considered hereditary, including congenital feeblemindedness, schizophrenia, manic-depression, hereditary epilepsy, hereditary Huntington’schorea, hereditary blindness and deafness, severe hereditary physical deformity, or severe alcoholism.30 After being reported by health officialsand having their cases heard in Genetic Health Courts, individuals with

HEATHER COOPER

IPF 23

these conditions could be forcibly sterilized under the law3’ A similar listof hereditary and, therefore, “incurable” diseases was used to classify andselect patients for the euthanasia program. While euthanasia never operated publicly in the way that sterilization did, it nonetheless relied on thedecision of medical experts similar to those in the health courts to decidethe fates of patients who were reported by local officials. Both programsrelied on the cooperation of government bureaucracy and medical professionals in order to exclude the handicapped, first from future generationsand then from the existing one.32

When one considers the atrocities that followed the outbreak of warin 1939, one is confronted by events so sweeping and utterly destructivethat they seem to almost stand outside of time. Yet it would be wrong toconsider the horrors of the ghettos, extermination camps, and 1-4 Itiffingcenters without acknowledging the historical context which made thempossible. The Nazi euthanasia program was not a random developmentdriven by the whims of a madman. It was, rather, the final stage in adecades-long movement toward the devaluation of individual life by thescientific community Understanding the development of the eugenicsmovement in Germany and the significance of radical changes in psychiatry prior to 1939 is necessary for any informed understanding of whatfollowed. Now one must ask, if euthanasia was the next point on a continuum of radical exclusion, how did the Nazis make that leap possible?

ADMINISTRATING DEATH:T-4 Operations

The creation of a government-sponsored administration specificallyresponsible for euthanasia was a critical development in the process oftransforming theoretical discussions into a concrete program of radicalexclusion and annihilation for the handicapped. By compartmentalizingtasks and creating an environment of “free-floating responsibility”33 the 1-4 administration made it possible for men and women to participate in thedestruction of lives deemed “not worth living.”34 In 1939, the administrative headquarters for the euthanasia program were established in Berlinat a seized Jewish property located at Tiergartenstrasse 4. Hider’s secretdecree had granted authority for overseeing the program to Karl Brandtand Philip Bouhier, both of whom would delegate various responsibilitiesto lower authorities and functionaries once the 1-4 organization was established. The euthanasia program was primarily under the direction ofthe Chaneellory of the Führer EKdF), but its various tasks were ofren carried out in coordination with the Reich Ministry of the Interior (RividI).As head of the KdF, Philip Bouhler placed the euthanasia program under the direction of Victor Braek in Central Office II. Brack assignedthe children’s euthanasia program to Hans Hefelmann and Richard von

Radical Exclusion: Waei Euthanasia, 1939-1945

24 CPFHegener of Office JIb, while he continued to oversee the general operations of adult euthanasia himself35 From their central headquarters, thesemen and the one hundred on-site staff memhers who supported themorchestrated the reporting, selection, transport, murder, and death recordsof patients chosen for euthanasia.36 An examination of the process ofselecting, transporting, and killing patients in the children’s and adult euthanasia programs will reveal the degree to which T-4 compartmentalizedtasks and established hierarchies of shifting responsibility

The first stage in the euthanasia program was collecting informationabout prospective victims and making judgments as to who was capableof recovery and who was not. In 1939 RMdI issued a decree to stategovernments requiting that midwives and doctors report the births ofnewborns suspected of having idiocy, mongolism, microcephalie, severehydrocephalus, deformities, or paralysis. Doctors were also required toreport all children under the age of 3 with such conditions.37 In July of1941, a new order was issued requiring doctors, midwives, and medicalpersonnel to report all minors, up to the age of 17, who were known tohave crippling handicaps. Even teachers were called on to report studentsin their charge who suffered from various hereditary ailments. Doctorsand midwives faced a fine, or month-long imprisonment for failure to report appropriate eases to the authotities,35 but received 2RM for each casethey did report.39

It was Richard von Hegener’s responsibility to review the reports onchildren as they came in and choose those eases in which he felt euthanasia was necessary Triplicate copies of the selected children’s reports weremade and distributed to the members of the Reich Committee for theScientific Processing of Serious Genetic Diseases, which was composed ofthree doctors appointed by Karl Brandt. Once the committee discussedthe ease and informed Brandt of their approval, his signature sealed thefate of the child concerned.45

The adult euthanasia program utilized a similar means of reporting and selection. On September 21, 1939 Department IV of RMdI issued a circular to state governments requiring them to report all clinicsand institutions in their jurisdiction in which “mentally ill, epileptics, andthe feeble minded are cared for on a long-term basis.”4’ Philip Bouhler,Werner Heyde, and Ftiedtieh Nietsehe drafted questionnaires to send toeach of the reported institutions in order to collect information on theirpatients.42 These were forwarded to the institutions on October 9, l939under the auspices of the Reich Committee for the Scientific Registrationof Severe Hereditary Ailments, the T-4 front organization responsible fordata collection.45 Institutions were not informed of the purpose of theforms and, early in the program, generally assumed that they were forstatistical purposes only In most eases, they were given 2-3 weeks to complete questionnaires on hundreds of patients. When T-4 was not satisfied

HEATHER COOPER

PF 25

with the speed or accuracy with which institutions completed the forms,it dispatched a team of experts to do the job themselves. Thus, in somecases, patients were classified and reported by inexperienced medical personnel totally unfamiliar with their history43 The staff of the Schönbrunnasylum described a visitation from one of the T-4 teams as the “spreadingof a burial shroud over the asylum.”

The questionnaires were single-page forms with fill-in-the-blankspaces to answer specific questions regarding the condition of each patient. Most questionnaires required the following information: name andaddress of asylum, patient name, birthplace, citizenship and race, diagnosis, detailed statement of the nature of employment, length of time in asylum, whether a criminal patient and what offenses if so, address of nextof kin, whether patient was regularly visited, whether patient has relatives,address of legal guardian, and who was responsible for asylum costs.47Institutions were required to report all patients who could not performmore than basic tasks and were suffering from schizophrenia, epilepsy, senility, paralysis, feeble-mindedness, encephalitis, or Huntington’s chorea;in addition, patients who had been continuously confined in institutionsfor more than five years, or who had been confined as criminal lunaticswere also reported.° Thus the criteria for selection were largely based onthe categories of hereditary diseases established under the sterilizationprogram of 1933, along with an added emphasis on the patient’s productive capacity, which was in keeping with the eugenics thought of thelast several decades. By 1941, productive capacity had become an evenmore critical factor in selection, as T-4 decided to eliminate all patientswho could not work, “not only those who are mentally dead.”49 Statistical analyses of those who were eventually killed reveals that most of thepatients chosen from state hospitals were designated as schizophrenics,while those from church-affiliated institutions were more often diagnosedas feeble-minded, or epileptic.

Upon completion, the questionnaires were returned to Dr. HerbertLinden at RMdI. Photostats were made and forwarded to four expertschosen from among ten to fifteen doctors on an expert medical panel organized by T-4.3’ These junior experts marked a corner of the form with ared + sign to signal inclusion in the euthanasia program and a blue — signto designate exclusion.52 Then Drs. Heyde or Nictsche, as chief experts,reviewed the decisions of the junior experts, made a final judgment regarding the patient, and informed Dr. Linden so that he might arrange forthe patient’s transfer to a killing center.53Junior experts received hundredsof questionnalres at a time and were paid according to the speed withwhich they processed them: lOORMs for 500 forms per month, 200RMsfor up to 2,000, 300 RMs for 3,500, and 400RIvIs for over 3,5O0. Dr.Hermann Pfanmdller, ajunior expert and head of the children’s euthanasia center at Egffing-Haai testified that he received at least 159 shipmentsof 200-300 questionnaires each before August 194

Radical Exclusion: Nazi Euthanasia, 1939-1945

26 PFAfter patients were chosen for euthanasia, they had to he trans

ferred to facilities designed for that purpose. In the case of the children’s program, parents were generally consulted and informed thatsince all traditional therapies had failed, it was necessary to transfertheir child to a special center where more intensive therapies couldbe tried. Parents were told that their children might be “healed” inthe new setting, but also ran the risk of death from complicationsof the treatment.56 Made to feel that no hope existed in the current setting and a cure might be possible if the risk was taken, manyparents consented. In a twisted manipulation of the truth, doctorsinterpreted parents’ permission for intensive therapy as consent forthe murder of their children.57

Relatives were not consulted for the transfer of adult patients.Another of T-4’s front organizations, the Charitable Foundationfor the Transport of Patients, Inc., contacted institutions with a listof patients who were to he moved to an undisclosed location. Mostlists contained the names of 50-100 patients and institutions wererequired to prepare their medical records and personal belongingsfor the trip.56 Patients were generally assigned a number at the timeof transfer so that they could be readily identified later; in one case,numbers were written in ink on their wrists.59 Patients were often sedated before the trip in order to calm their fears about where theywere going and make them compliant for the staff who accompaniedthem to the killing centers.60 The surrendering institutions were toldnot to inform relatives of the transfer or location of patients.6’ Shortlyafter the patient’s death, which usually occurred within hours of arrival at the killing center, his or her relatives received a notificationof transfer from the receiving institution, which informed them thatno visitation was possible at that time “for reasons connected with thedefence of the Reich.”62 After waiting a period of 10 days or more,a second notice was sent informing relatives of the patient’s suddendeath and subsequent cremation.63

The final stage of the euthanasia program took place in the actual killing centers and wards designed for the elimination of patients. Children were generally transferred to special pediatric wardswithin existing institutions, where they were observed for a fewmonths prior to being killed by slow starvation, or overdose.64 Themethod of killing for children was left somewhat to the preference ofthe head physician at each ccntec Dr. Pfanmuller of Eglfing-Haar,for instance, preferred the more “natural” method of starvation torid Germany of its “living burdens.”65 Other doctors preferred usingprogressively high doses of Luminal until a child “lapsed into continual sleep” and died.66 In some cases, the parents would be contactedbefore the administration of the drug, informed that their child wasgravely ill, and given the opportunity to visit him or her before she

HEATHER COOPER

PF 27

died.67 In other cases, they simply received a condolence letter afterthe fact, which listed a fictitious cause of death and asked them toconsider that their child’s death had been a release from “great andincurable suffering.”60

Adults who were transferred to killing centers during the first phaseof euthanasia went through a very different process than the children whodied in pediatric wards. Six killing centers were established in Germanyby 1941, although only four were in operation at any one time; they wereknown by their locations at Brandenburg, Grafeneck, Hartheim, Sonnenstein, Bernburg, and Hadamar. Patients were generally taken to anundressing room upon arrival and instructed to undress so that they couldbe bathed and deloused prior to being shown to their beds. Their clothesand belongings were put in a pile, labeled, and numbered so that personaleffects could either be returned to relatives after death, or confiscated bythe Charitable Foundation for Institutional Care.69 The Charitable Foundation was another of T-4’s front organizations, which was responsible forcollecting payments for the care of patients up to, and sometimes beyond,the time of their death. In addition, it occasionally confiscated the morevaluable property of victims for its own use. 70 Patients had to open theirmouths so the staff could see whether they had any gold teeth and thosethat did had a four-digit stamp pressed against their chests so the teethcould be extracted after death.

Patients were then led into an examination room where a doctorchecked to make sure that their medical records were complete and considered a reasonable cause of death to list on the death certificate for eachof the patients before them. At some sites, doctors marked patients at thistime who were considered of scientific interest so that their bodies couldbe set aside for autopsy later. 72 Some patients were also given a small doseof sedative at this time.73 They were then led into a separate room wherethey were photographed while naked in order to preserve their images foranthropological research.74

Following this, patients were led into the gas chamber, which wasdisguised as a “shower room” complete with a tiled flooo tiled walls, anda row of showerheads attached to the ceiling.70 Anywhere from 20 to 150patients might be gassed at one time.76 It was the responsibility of thephysician-in-charge to turn the lever that released gas into the chamberthrough an overhead pipe. The advocates of euthanasia considered carbon monoxide poisoning a humane killing method because it supposedlyallowed the victim to “simply fall asleep under the gas and feel nothing more.”77 However, more objective witnesses remembered watchingthrough the peephole as men and women died, “semi-collapsed, otherswith their mouths terribly wide open, their chests heaving.”75 Patientswere generally unconscious in five minutes and dead in ten. After a fewhours of ventilation, their bodies were dragged from the chamber by stok

Radical Exclusion: Wad Euthanasia, 1939-1945

28 PFcr5, who extracted gold teeth as needed, cremated two to eight bodies ata time, and ground down the bones that did not burn with a mill.79 Approximately 3kg of bonemeal was used to fill each urn to be sent to thepatient’s relatives.86

Each killing center had its own Special Registry Office in which official causes of deaths were chosen and recorded.8’ T-4 provided doctorswith a list of sixty-one possible causes of death, their corresponding symptoms, and the merits and demerits of using it for patients of differentsexes, ages, and conditions. Pneumonia, for example, was listed as “anideal cause of death for our action” because the public regarded it as asudden and critical illness and it could occur at any age in both sexes. AtHadamar, the Registry Office used a map and colored pins to plan thetiming of death notifications so that no single area would receive a largebatch of condolence letters at one time. Alternatively, they might sendthe information for patients killed at Hadamar to another killing centerso that the death notices could be sent from there; in this way, publicsuspicions regarding the nature of Hadamar could be kept at bay.82 Onceall these details had been arranged, the condolence department in eachcenter prepared a relatively generic letter for the patient’s relatives notifying them of his or her death, the fact that the body had already beencremated, and instructing them as to how to collect the urn.83

The program of “wild euthanasia,” which followed Hider’s August1941 halt order maybe seen as distinct from the organized efforts of theT-4 administration prior to that date. Wild euthanasia continued in thespirit of T-4, but was based more on the initiative of individual institutions and medical staff than on a formal program of selection issuingfrom Berlin. In 1942, the directors of Bavarian asylums held a conferenceat the Ministry of the Interior to discuss the need “for the asylums to dosomething themselves” now that gas chambers were unavailable for themurder of the handicapped. They decided on a method of starvationusing a “special diet” with no fat, meat, bread, or carbohydrates for thosepatients who were incapable of workY4 Many institutions in Germanyintroduced a similar program of starvation, which gradually eliminatedpatients. In other cases, patients were given medication orally, or by injection, which caused them to lose consciousness and eventually die.85 Despite its less organized nature, the wild euthanasia program still managedto compartmentalize tasks and shift responsibility. Different nurses withinthe same killing ward had responsibility for different tasks, so that theperson who handed out drugs was not the person who administered them,or the person who disposed of the bodies.86 Nurses who gave injectionsfocused on the task before them rather than on its consequences, so thatgiving sedatives to children became a matter of calming the “impaired”and “restless” rather than an act of murder.87 Furthermore, most nursesfelt that they were relieved of responsibility because they were simply following the instructions of the doctors they were trained to serve.86

HEATHER COOPER

ePF 29

It is unsettling to consider how few people were necessary to bringabout the deaths of neady 100,000 individuals in the five years of euthanasia operations. As already stated, approximately 100 staff worked atT-4 headquarters in Berlin.39 Approximately 60 physicians may have beeninvolved at some level of selection. Each killing center was manned by onephysician-in-charge and one or two assistant physiciansY° In addition, killing centers had a small staff to handle patient transportation, disposal ofbodies, administrative duties, and facility maintenance; Hadamar managed all this with only 25 workers.91

Friedlander describes the bureaucratic process of killing carried outby this relatively small number of men and women as “assembly line massmurder.”92 The T-4 administration contributed to the process of mechanized killing by placing individual perpetrators at one point on the assembly line and assigning them specific, compartmentalized tasks. Differentdepartments at T-4 headquarters were responsible for the reporting, selection, transport, and death notifications of patients. Doctors at institutions completed questionnaires,junior experts who had neither visited theinstitution nor met the patient marked the questionnaires and preparedthem for review by a senior expert. Different staff members greeted thepatients at different steps in the killing process — from the time of transport, to the undressing room, to the examination room, to the gas chamber, and finally to the crematotia. The death records for patients killed atone institution might be completed and processed at another. Those whoautopsied the bodies were not necessarily those who had released the gasinto the chamber and killed them. As other researchers of the Nazi bureaucmcy have noted, the compartmentalization of tasks often created atendency in the perpetrators to see only the task before them and operatewith “moral blinders” as to the larger process at work.93

The compartmentalization of tasks not only made it possible for perpetrators to deny, or ignore the larger significance of their actions, but alsocreated an environment of “free-floating responsibility” in which no singleperpetrator felt responsible for the ultimate fate of patients because his orher actions were only one part of a larger process.94 On the one hand, thisis an example of the well-known protest of perpetrators that they were justfollowing orders.” On the other hand, it was a very real process of disassociation, ivhich made it possible for individuals’ technical responsibility tothe administration to eclipse any moral responsibility to fellow human beings.95 A focus on compartmentalized tasks and disassociation from moralresponsibility were two of the principle means by which perpetrators distanced themselves from the full meaning and significance of their actions.

Radical Exclusion: Nad Euthanasia, 1 939-1945

3o

MAKING BIOLOGICAL WARRIORS:Staff Training and Indoctrination

One of the principle questions under consideration by historians ofNazi euthanasia is how it was possible for doctors and nurses who had swornto protect life to willingly participate in a “medicalized killing” operation designed to eradicate itY6 While there can be no definitive answer to this question, a partial explanation may be offered by considering the training andindoctrination that doctors and nurses went through ptior to and duringtheir participation in the euthanasia program. By teaching the principles ofeugenics and racial hygiene, instilling the values of individual sacrifice andservice to the Vo&, and dehumanizing the handicapped, medical educationunder the Nazis trained doctors and nurses to be “biological soldier[s]” whocared for the health of the nation before that of the individual.97

As already discussed, eugenics and racial hygiene gained growinginfluence in German scientific circles from 1900 on. By the 1920s, thesestudies were fundamental components of psychiatry, medicine, and anthropology By 1932, over forty courses in race hygiene were offered at Germanuniversities.98 By 1936, race hygiene was considered an obligatory coursefor the medical profession in many universities and was incorporated intothe medical exams required of students prior to graduation and actualpracticeY° Training continued after graduation in various formats. The1935 Physicians’ Ordinance required that all physicians under the age ofsixty attend a three-week course on recent medical developments in racialhygiene; by 1936, 5,000 doctors a year were receiving specialized trainingin this field.’05 As one of the premier research centers for racial science andeugenics, the Kaiser Wslhelm Institute for Anthropology had trained over1,000 doctors in “genetic and racial care” by l934.’°’ The Office of RacialPolitics, headed by Walter Gross, trained medical professors as well as political educators in the importance of racial hygiene and offered dozens ofmedical seminars each year in which young doctors received lectures on“liberating’ the ethnic community from its ‘undesirable’ elements.”52

Most of the physicians who came to be involved in the euthanasiaprogram were relatively young’°3 and had either gone to medical schoolduring the 1930s heyday of eugenics education, or practiced medicineduring a time when the medical community embraced concepts of racialhygiene, degeneracy, and “worthless” lives wholeheartedly. Much of themedical profession was drawn to the Nazi party, which seemed to placenew importance on their particular knowledge and skills in its creation ofa biological and racial state. By 1942, approximately half of the doctorsin Germany had joined the Nazi party’°t By 1940, 45 percent of all physicians had joined the National Socialist Physicians’ League, which was devoted to the promotion of racial hygiene, racial science, and

HEATHER COOPER

PF 3’]As medical personnel, nurses were subject to similar efforts of indoc

trination. As early as 1933, nurses were being instructed that their primaryduty was to “secure and promote a genetically sound, valuable race” and“not to expend an exaggerated effort on the care of genetically or raciallyinferior people.”°6 Some psychiatrists suggested that nurses should begiven early experience with incurable patients so that they might understand the seriousness of the burden represented by their lives and beginto recognize the negative eugenics measures of the state as a virtue for thegreater good.’°7 Furthermore, their roles as obedient servants to doctorscontinued to be emphasized, with an added obligation of obedience to thewishes of the Führer. n

A fundamental component of the training and indoctrination ofdoctors and nurses was the dehumanization of the handicapped. The Office of Racial Policy made documentary films of the handicapped andfeeble-minded, which were seen by 20 million people a year, includingmedical personnel.’°9 These films painted an animalistic and degradedpicture of the handicapped with images of “a shaven-headed youtheating handfuls of grass” and footage of the handicappedjuxtaposed withthat of criminals and the physically deformed. In the traditional languageof racial hygiene, these films referred to the handicapped as “beings’,‘creatures’, ‘existences’, ‘idiots’, ‘life unworthy of life’, [and] ‘travesties ofhuman form and spirit.””° Trained to see the handicapped as worthless,bestial, and dangerous, many doctors and nurses were able to deny thehumanity and rights of those whose lives they took.

In some cases, the training and indoctrination of medical staff continued during their participation in the euthanasia program. Alfons Klein,supervisor of the Hadamar Itiffing center, recalled that lectures were offered at the killing center to explain the merits and necessity of the euthanasia operation.”’ Another participant in the program recalled that in order “to relieve [theirj consciences,” medical staff was given frequent talkson the economic significance of euthanasia. Such lectures demonstratedthe positive uses to which money could be put if it was not required for thesupport of the incurable in institutions. Doctors and nurses were assuredthat euthanasia was necessary for the well-being of the nation and that“the method of elimination was the most humane imaginable.”2

It seems unlikely that many doctors and nurses would have activelyparticipated in euthanasia without the training and education in racialhygiene, which took place prior to and during their involvement in theprogram. Medical education under the Nazis not only imbedded theprinciples of eugenics and racial hygiene in its students, but created anenvironment in which those principles were regarded as the only properstandard. Doctors and nurses may have sworn an oath to protect life, butfor those who practiced medicine in the I 930s or latei that oath had become virtually meaningless given the larger context of Nazi medicine.

Radical Exclusion. Yazi Euthanasia, 1939-1945

PFOther oaths were also sworn in allegiance to Hitler, or to the goals of theeuthanasia program itseW”3 and these oaths ultimately exercised moreinfluence on those who took them. In a 1933 lecture, Walter Gross hadcalled for “a revolutionary professional ethic that mandates medical carefor the Vol/c and not for the individual.”4 In this context, destroying the“gangrenous appendix” of the national body became a new kind ofmoral imperative that destroyed the Nazi doctor’s former obligations. Inan utter reversal of values, it was the refusal “to kill valueless life [that] wasconsidered immoral and evil.”6

DISTANCING MECHANISMS

In addition to a medical training that prepared them for an environment in which the lives of the handicapped were devalued, the perpetrators of euthanasia were served by distancing mechanisms that allowedthem to deny, or ignore the full significance of their actions. Doctors,nurses, and other T-4 staff separated themselves from the reality of killingand saw their actions as distinct from, or insignificant in the larger contextof organized mass murder. This process of disassociation took a varietyof forms, including a focus on the compartmentalized nature of tasks, theuse of a language of falsehood and euphemisms, and the conviction thateuthanized patients were spared a more painful fate.

The T-4 administration and its division of labor and responsibilitywas, in itself; a distancing mechanism for many of the men and womenwho committed and facilitated murder. In post-war testimony, perpetrators repeatedly seemed incapable of recognizing the connection betweentheir specific duties and the larger program of murder to which they contributed. Irmgard Huber, the chief nurse at Hadamai denied any responsibility for the euthanization of tubercular Russians and Poles nearthe end of the war. As she put it, “I did nothing to the Russians and thePoles, and I do not feel any guilt. The transport was there already and ithad to be received. It was already standing in front of the door.” In thiscase, Huber’s moral responsibility seems to have been supereeded by her“technical responsibility” to the institution of r.1 a She felt an obligation to fulfill her assigned task and emphasized that other forces, presumably larger than herself; had already brought the Russians and Polesto her door. likewise, Edith Kloster, a nurse at one of the killing centers,insisted that she could “find no connection at all between the requiredtransport of patients into the examination room and any kiffing that mighttake place later.”9 Pfanmuller who personally oversaw the murder ofchildren at Eglfing-Haar and acted as a junior expert for patient selection,denied responsibility for choosing patients for death — one of his specificresponsibilities because his opinion was not the final decision in thecase. He insisted that that was done by a “higher echelon” of authority’25

HEATHER COOPER

PF 33In a letter to his wife, Dr. Friedrich Mennecke described the task of selecting thousands of patients for death at Buehenwald as “purely theoreticalwork.”2’ After the war he said, “It was not my duty to shorten the livesof the insane persons, it was my duty to act as a medical Inall these eases, a focus on the compartmentalized nature of their tasksallowed perpetrators to deny responsibility for the final product of theeuthanasia program. Whether they were unable to see, or simply refusedto admit the full significance of their actions is impossible to know.

The language of euphemisms and falsehood employed by the euthanasia program may also have contributed to disassociation in perpetrators,as it hid the darker reality of euthanasia beneath a façade of positive programs and actions. Hence, “murder” became “special treatment,” “therapy,” or “cleansing”23 “Disinfection” might stand in for “murdei” or for theprocessing of bones into ash by the stokers who manned theThe Reich Committee issued orders to kill as orders to “treat” even in secret documents.’25 The insistence on calling the destruction of handicappedllfe anything but that is evident in Dr. Ernst Ludemann’s irritation when anasylum director referred to patients who were to be “killed,’ as he insisted onputting it” rather than those who were to be treated or cleansed.’26

One wonders whether the fact that T-4 departments operated under a set of front organizations that existed in name only may also havecontributed to disassociation. Under this system, the Reich Cooperativefor State Hospitals and Nursing Homes, Charitable Foundation for Institutional Care, Charitable Foundation for the Transport of Patients, Inc.,Central Accounting Office for State Hospitals and Nursing Homes, andReich Committee for the Scientific Registration of Severe Hereditary Ailments stood in for the offices responsible for registering victims, hiringperpetrators, transporting patients to their deaths, collecting payment forthe care of patients already murdered, and orchestrating the euthanasiacampaign against What’s more, the physicians who selectedpatients for euthanasia and signed their death certificates used one ormore pseudonyms to disguise their identities on documents relating to theprogram. Thus, Ernst Baumhard, the leading physician at Grafeneek andHadama; became Dr. Jllger; Irmfried Erbel, a physician at Brandenburgand Bernberg, became Dr. Schneider or Dr. Meyer, depending on whichinstitution he was at; and Klaus Endruweit, of the Sonnenstein killingcenter, became Dr. Bader.’28 It seems likely that working in a setting inwhich one’s tasks were carried out under a false identity for an organization with a false name and purpose would have made ft possible to distance oneself from the moral responsibility for such tasks and the truth ofthe organization’s goals.

Some perpetrators acknowledged that they were taking life, butclung to the belief that euthanasia really was a “mercy death” for patients,especially in wartime. Hannah Arendt suggests that the most powerful

Radical Exclusion: Nazi Euthanasia, 1939-1945

34 CPFmanipulation of language in the euthanasia program was Hitler’s originalorder, which replaced “murder” with the phrase “to grant a mercy death.”This transformation created an environment in which “the unforgivablesin was not to kill people hut to cause unnecessary pain.”29 One euthanasia doctor expressed astonishment at those who had reservations aboutgranting mercy deaths, but could stand by and watch their patients starveas rations were cut in wartime:

They refuse to eod the suffering of their patieots by administering drugs but they are happy to accept the fact that patients, who are by then really famished and emaciated, Willone day take the road which could earlier have been made somuch easier for them by a little

Nurses and doctors might be disturbed by the actions they were asked tocarry out, but they saw it as a matter of “releas [sng] unfortunate creaturesfrom their suffering”3’ This reasoning went back to some of the earliest arguments for euthanasia, which had always emphasized the mindlesspain of those suffering from incurable diseases and made it the doctor’sduty to “release” them.’32

CONCLUSION

In 1932, Julius Moses, a Jewish physician and politician, saw clearlywhat the evolution of German medicine was leading to and the radicaltransformation of ethics, which Nazism was making possible. One yearbefore Hider’s fateful appointment as Chancellog he issued a warningto the medical eommunit); which would soon include him in its radicalpolicy of exclusion:

Everything that was considered until now as the holiest obligations of medicine - to care for the sick without paying attention to their race, to deal in the same way with all diseases,to help ill men everytvhere and ease their pain all this isviewed by the National-Socialists as sheer sentimental stuffwhich should be thrown away. The only matter of importancein their eyes is leading a war of annihilation against the lessworthy (Minderwertige) — the incurable patients. ... If thisline of thought will win the upper haod the German medicalprofession will lose its ethical norms [..j’ the physician willact as a killer, the doctor will become a murderer.n

Moses would eventually die in Theresienstadt, but not before his awful premonition had been realized in the organized murder of nearly one hundredthousand handicapped children and adults.

This paper has attempted to understand the fransfonnation of what wasonly an inclination toward euthanasia in 1932 into a concrete program forthe destruction of “worthless lives” after 1939. A partial explanation has beenoffered by placing euthanasia in the context of an earlier eugenics and racialhygiene movement and examining the role played by the T-4 bureaucracy,training and indoctrination of medical staff, and the creation of distancing

HEATHER COOPER

epF 35mechanisms in that radical transformation. Yet somehow questions persistabout the meaning of the Nazi euthanasia program for our world. The Naziatrocities and subsequent investigations into the “banality of evil” have ledmany to question what separates us from the men and women who orchestrated death on a mass scale from 1939 to 1945. As Arendt famously wrote,“The trouble with Eichmann was precisely that so many were like him, andthat the many were neither perverted nor sadistic, that they were, and still are,terribly and terrifyingly normal.”34

if it tvas possible to convince ordinary Germans to cooperate in an unprecedented campaign of destruction against the helpless, how easily mightthe ordinary citizens of other nations have been drawn into a similar enterprise? Certainly Germany was not alone in its devaluation of individual lifeand ostracism of the handicapped. The United States was a model of eugenics in the first half of the twentieth century; 45,127 people were sterilized inorder to cleanse American society of the unfit between 1907 arid l945.’One of the first proposals of euthanasia came from the American scholas;W. Duncan McKim in 1899, who suggested that euthanasia was a meansof “improving the human race” and providing a “sweet death” to the unfit.’36 In 1935, the French-American Nobel Prize winner Alexis Carrel wrotethat criminals and the handicapped should be “humanely and economicallydisposed of in small euthanasia institutions supplied with proper gases.”37In 1935, British physicians formed the Voluntary Euthanasia LegalizationSociety and submitted bills before the House of Lords for the legalization ofeuthanasia for the terminally ifi. Just one year before Hitler signed the decreefor euthanasia in Germany, WG. Lennox spoke at Harvard regarding theneed for physicians to acknowledge “the privilege of death for the congenitally mindless and for the incurable sick who wish to die.”°5

Clearly, the fear of racial degeneration and the advocacy of radical measures were not unique to Germany. Yet perhaps it is Germany that must becredited with making those fears and ideas taboo. It was not until the Nazistook the radical step of transforming theoretical discussions of euthanasia’smerits into an actual program of annihilation that other nations recognizedthe terrible path they had been wandering for decades, Just as the Holocaustseemed to make anti-Semitism unthinkable after 1945, the euthanasia program made eugenics and its hierarchy of human worth into a symbol of theperversion of truth and science for future generations.

From this distance, it seems almost impossible to imagine a womi inwhich the government and scientific community could cooperate in the destruction of tens of thousands of lives. But that is to deny the world in which1-4 administrators, doctors, and staff lived and worked. The Nazi racial statecreated an environment in which the interests of the individual were subservient to those of the Vo& and radical sacrifices were demanded to ensure thesafety and health of the ethnic body politic. Within this context, the bureaucracy of T-4, the indoctrination of medical stall and the creation of psychological distancing mechanisms allowed men and women to justify, commit,

Radical Exclusion: Nazi Euthanasia, 1939-1945

36 eIPFand deny responsibility for mass murder of the handicapped. The scientificcommunity in Germany did not heed Julius Moses’ 1932 warning, but theterrible legacy of that failure continues to stand as a harrowingwarning to thegenerations that followed.

NOTES

Adolf Hitler, Mein Kampf trans. Ralph Manheim (Boston & New York: HoughtonMiflhinCompan 1971), 132.2 Document 740, Hitler’s order for euthanasia, signed October 1939, dated September1, 1939. In Foreign Potig War and Racial Extermination. Ed. J. Noakes and G. Pridham. Vol 3of Nazism 1919-1945: A Documentary Reader (Exeter: University of Exeter Press, 1997), 1021.[Hereafter Noakes].Henry Friedlander, The Ongins of Mxo Genocide: From Euthanasia to the Final Solution(Chapel Hill & London: The University of North Carolina Press, 1995), 61; 112..Ibid., 151.Document 716, Excerpt from Binding & Hoche’s 1920 book, Permi.ssion for theDestruction of Worthless Lj/i its Extent and Form. In Noakes, 998.

6 Friedlander, The Origins of Nazi Genocide, 67.Ibid., 14.Zygcuunt Bauman, Modermtv and the Holocaust (Ithaca, New York: Cornell UniversityPress, 1989), 163.Michael Burleigh, Death and Deliverance: ‘Euthanasia’ in Germany c 1900-1945 (NewYork: Cambridge University Press, 1994); Michael Burleigh, Ethics and Extermination: Reflectionson Nazi Genocide (Cambridge: Cambridge University Press, 1997).

‘ RobertJav Ufton, The Nazi Doctors: ?,.frdical Killing and the Psychology of Genocide (NewYork: Basic Books, 1986), 15.Michael Burleigh and Wolfgang tVippermann, The Racial State: Gmnanr 1933-1945(Cambridge: Cambridge University Press, 1991), 32.

2 Robert Proctor, Racial Hygiene: Medicine Under the Nazis (Cambridge & London:Harvard University Press, 1988), 27-28.‘ Burleigh and Wipperman, The Racial State, 32.4 Sheil faith Weiss, Race Hygiene andNational Efficiency: The Eugenics of Itiizelm Schailmayer(Berkeley: University of California Press, 1987), 79.‘° Ibid., 86-87.I6 Burleigh and Wipperman, The Racial State, 30-32.Document 716, Excerpt from Binding & Hoche’s 1920 book, Permission for theDestruction of Worthless L)/i, its Extent and Form. In Noakes, 998.

IS Ibid.‘ Document 718, Excerpt from Binding & Hoche’s 1920 book, Permission for theDestruction of lthethleos Life; its Extent and Form. In Noakes, 999.25 Burleigh, Death and Deliverance, II.21 Document 719, Excerpt from Binding & Hoche’s 1920 book, Permission for theDestruction of Il’orthless Lfo its Extent and form. In Noakes, 1001.22 Burleigh, Death and Deliverance, II.23 Ibid., 30-33.24 Burleigh, Ethics and Extermination, 116; Burleigh, Death and Deliverance, 32.Document 730, Questionnaire for euthanasia program issued on October 9, 1939. InNoakes, 1012.

26 Sheila faith Weiss, “The Race Hygiene Movement in Germany,” Osith 2, no. 3(1987): 210-Il.27 Document 716, Excerpt from Binding & Hoche’s 1920 book. Permission for theDestruction of llirthless Life, its Extent and Form. In Noakes, 998.

HEATHER COOPER

PF 37128 Paul ‘,\‘kindling, Health, Race and German Politics between National Unification and Mizum,

1870-1945 (Cambridge: Cambridge University Press, 1989), 338-42.29 Ufton, 27; Weiss, ‘The Racial Hygiene Movement in Germany,” 230; Friedlander,

The Origins ofNazi Genocide, 30. According to Ufton, 200,000-300,000 were stenhzed; accordingto Weiss, as many as 400,000; according to Friedlander, 375,000 or more.

° Friedlander, Tlte Origins of]’[azi Genocide, 26.

St Robert Proctor, “Nazi Doctors, Racial Medicine, and Human Experimentation,” inThe Nazi Doctors and the ]‘furemberg Code: Human Rights in Human Experimentation, eds. George J.Annas and Michael A. Grodin (New York & Oxford: Oxford University Press, 1992), 21.

32 Friedlander, The Origins ofNazi Genocide, 26.Bauman, 163.

4° Proctor, “Nazi Doctors, Racial Medicine, and Human Experimentation,” 24.friedlander, The Origins ofMcvi Genocide, 39-40.

36 Peter Delius and Hurst Dilling, “The End of the Strecknitz Asylum at Lfibeck — aContribution to the Social History of Psychiatry During National Socialism,” ed. Andreas Hill,Histoyy of Psvchiaty 6, no. 3 (1995): 269.

Document 724, Reich Interior 1vlinistiy circular issued to staie governments, 1939. InNoakes, 1006-7.

38 Proctor, Racial Hjgiene, 188.4° Burleigh, Death and Deliverance, 99.4° Gtitz My et. al. Cleansing th€ Fatherland: Na.ti Medicine and Racial Hygiene, trans. Belinda

Cooper (Baltimore: TheJohns Hopkins University Press, 1994), 189.4t Noakes, lOll.42 Affidavit of Victor Brack, Nuremberg Trials Transcript of the Proceedings, United

States of America v. Karl Brandt, et. al. In Medical Experiments on Jewish Inmates of ConcentrationCamps, ed. John Mendelsohn. Vol. 9 of The Holocaust (New York: Garland Publishing, Inc.,1982), 1-5. [Hereafter Mendelsohn, Vol. 9]

4° Noakes, 1011.4° friedlander, The Origins of Nazi Genocide, 44.See, for example, Document 734, RMdI to Neuendettelsau Asylum, 2 September

1940 and Document 735, Dc Rudolf Boeckh, Director of Neuendeuelsau Asylum to ReichInterior Ministrs; Not: 7, 1940. In Noakes, 1015-16.

4° Budeigh, Death and Deliverance, 138.4° Document 730, Reporting forms for patients, issued October 9, 1939. In Noakes, 1012.48 Document 731, Instructions for reporting forms. In Noakes, 1013.“ Document 737, March 10, 1941 meeting to set criteria for patient elimination. In

Noakes, 1017.° Weindling, 549.5t Affidavit of Victor Brack, Nuremberg Trials Transcript of the Proceedings, United

States of America v. Karl Brandt, et al. In Mendelsohn. Vol. 9, 4-5.Friedlander, The Origins ofMizi Genocide, 83.

4° Affidavit of Victor Brack, Nuremberg Trials Transcript of the Proceedings, UnitedStates of America t: Karl Brandt, et al. In Mendelsohn. Vol. 9, 9.

4° Burleigh, Death and Deliverance, 129.Trials of war criminals before the Nuernberg Military Tribunals under Control

Council law no. 10, Nuremberg, October 1946-April 1919, Vol. 1: “Medical Case” (Washington,DC: USGPO, 1949-1953), 800.

56 Testimony of Viktor Brack, Official Transcript of the American Military Tribunal inthe matter of the USA against Karl Brandt. In Mertdelsohn, Vol. 9, 124.

4° friedlander, The Origins ofNazi Genocide, 60.Document 742, Letter informing institution of patients to be transferred. In

Noakes, 1022-23.4° Document 743, Description of transfer frojestetten asylum. In Noakes, 1023-24.Friedlander, The Origins uf Nazi Genocide, 94.Ibid., 85.

4° Document 748, Letter to relatives informing of transfec In Noakes, 1028.

Radical Exclusion: Nazi Euthanasia, 1939-1945

3863 Friedlander, The Origins of]’fozi Genocide, 103-4.64 Ibid., 57; My, 190-9 I.65 Document 727, Description of visit to Egelfing-Haar asylum on Feb. 16, 1910. In

Noakes, 1008.66 lifton, 55.

65 Testimony of Viktor Brack, Official Transcript of the American Military Tribunal inthe matter of the USA against Karl Brandt. In Meodelsohn, Vol. 9, 125.

68 Document 749, Letter to relatives informing of death. In Noakes, 1028.69 Document 744, Account of a burner at Hartheim. In Noakes, 1026.° My, 176-77 and 182-83.Description of a gassing given after war by a participant. In The jThd liars: A

Documentary His/op’ ed.Joachim Remak (Englescood Cliffs, NJ: Prentice-Hall, 1969), 138-3972 Budeigh, Death and Delicerance, 149.Affidavit of Pauline Kneissler, Nuremberg Trials Transcript of the Proceedings,

United States of America v Karl Brands, et. al. In Meodelsohn, Vol. 9, 13.‘ Friedlander, The Origins of J’/azi Genocide, 95,See Figure 6.4: Gas chamber of the Bernberg psychiatric hospital. In Budeigh and

Wsppermann, The Racial State, 151.76 Friedlander, The Origins of Nazi Genocide, 96.Document 746, Participant recollection. In Noaken, 1026.

78 Friedlander, The Origins of sVazi Genocide, 97; Document 747, Employee witness to gassing. In Noakes, 1027.

Friedlander, Vie Origisu of Js”azi Genocide. 97.85 Document 744, Account of a burner at Hartheim. In Noakes, 1026.9° Lifton, 75.82 Burieigh, Death ondDeliverance, 150.83 Document 749, Letter to relatives informing of death. In Noakes, 1028.04 Burleigh, Death and Deliverance, 240.to Burieigh, Death and Deliverance, 246; Bmnss’yn Rebekah McFariand-Icke, Mines in Vazs

Germans’: Moral Choice in Hutsp’ (Princeton, NJ: Princeton University Press, 1999), 214.06 McFarlaod-Icke, 238.05 Ufton, 57.88 ?sicFarland-Icke, 227-28.Delius and Dilling, 269.

9° Friedlander, The Origins of]Vazi Genocide, 300.9° Burleigh, Death end Deliverance, 147.92 Friedlander, The Origins of Jtiozi Genocide, 300.9° Fred F. Katz, “Implemenation of the Holocaust: The Behavior of Nazi Officials,”

in The “SinaI Solution:” The Imftlesnentarion of Mass Murder, Vol. 2, ed. Michael R. Marcus, Vol. 3of The sVari Holocaust Historicalalrtieks on the Destnscrion of the European Jews (Westport & London:Meckler, 1989), 355.

° Bauman, 163.9° Ibid., 101.96 Lifton, 15.Ibid., 30.Friedlander, The Origins of Nazi Genocide, 13.

9° Proctor, Racial Hsgiene, 79-81.55 Ibid., 82.Ibid., 42.

102 Claudia Koouz, The Nazi Cosunence (Cambridge, MA & London: The Belkoap Pressof Harvard University Press, 2003), 126.

53 Burleigh, Ethics and Extermination, 124; Friedlander, The Origins of Nazi Genocide, 216.

HEATHER COOPER

ePF 39N. Proctor, “Racial Hygiene: The Collaboration of Medicine and Nazism,”

in Medicine, Ethics, and the Third Reiclis Historical and Contemporayy Issues, ed. John J. Mtchalczyk(Kansas City MO: Sheed & Ward. 1994), 36-40.

Proctor, Racial Hygiene, 65.° Susanne Hahn, “Nursing Issues during the Third Reich,” in Medicine, El/oct and the

Third Reic/c Historical and Contemporaiy Issues, ed.JohnJ. Michalczyk (Kansas City, MO: Sheed &Ward, 1994), 143-44.

07 Mcfarland-Icke, 13 1-32.° Burleigh, Ethics and Extermination, 124; 157-59.09 Koonz, 125.I0 Burleigh, Death and Deliverance, 192-94.Testimony of Alfons Klein, Evidence for the Defense, in Trial of A(Tons Klein, Adoff

lbihlmwtn, Heinrich Roof Karl lVittgi Ado(( Merkle, Irmgard Hides, and Pltihpp Blum (The HadamarTrial), ed. Earl W Kintner, Vol. IV of Wtsr Crimes Trials (London: ‘oVilliam Hodge and Company,Limited, 1949), 93. [hereafter Hadamar Trialj

‘‘2flocument 746, Participant recollection. In Noakes, 1027.tl3 Testimony of Mfons Klein, Evidence for the Defense, in Hadamar Trial, 90.wKoonz, 112.“5Ufton, 16.“6James M. Glass, “Lj/i Unworthy of Ljfei”Rarial Phobia andMass Murder in Hitler’s Germany

(New York: Basic Books, 1997), 156.IS Testimony of Irmgard Huber, chief nurse at Hadamar. In Hadamar Trial, 119.t8Bauman 101.IS Mcfarland-Icke, 238-39.Testimony of Dr. Herman Pfanmueller, taken at Nuremberg, Germany, 1435-1630 5

September 1945. In Mendelsohn, Vol. 9,28-30.Mennecke to Wife, 26 November 1941, 7:50 pm. In My, 254.

122 Friedlander, The Origins of.Yasi Genocide, 80.23 Glass, 61.I24 friedlander, The Origins of Yas,i Genocide, 98.25 Ibid 57.26 My 33-34. Italics added by author.27 Friedlander, The Origins of]’fai Genacide, 73-74.‘2oTable 5.2: The Euthanasia Killing Center Physicians and Their Pseudonyms, in

Friedlander, The Origins of,N’azi Genocide, 103.129 Hannah Arendt, Eichmann in Jerusakin: A Report on the Banality of Evil (New York:

Penguin Books, 1977), 108-109.3tBenno Muller-Hill, Murdeioizs Science: Elimination by Scientific Selection of Jews, Gypsies, and

Others, Germany 1933-1945, trans. George R. Fraser (Oxford: Oxford University Press, 1988), 64.‘ Burleigh, Ethics and Extermination, 122-23.32 Document 716, Excerpt from Binding & Hoche’s 1920 book, Permission for the

Destruction of Worthless Life, its Extent and Form. In Noakes, 998.133 Daniel Nadas; “Sterilization, ‘Euthanasia,’ and the Holocaust—The Brutal Chain,”

in Medirine Ethics, and the Third RAe/is Historical and Contemporayy Issues, ed.JohnJ. Michalczyk(Kansas Cits; MO: Sheed & Ward. 1994), 42.

34 Arendt, 276.35Koonz, 105.Enzo Traverso, The Origins of J’[azi Iialence, trans. Janet Lloyd (New York: The New

Press, 2003), 122.137 Proctor, “Nazi Doctors, Racial Medicine, and Human Experimentation,” 24.‘° Proctor, Racial Hsgiene, 179-80.

Radical Exclusion: Xazi Euthanasia, 1939-1945