How Healing Becomes Killing

Nazi Germany has been described as a biological state where official policy was based on an extreme form of the pseudo-science eugenics – one that “justified” the murder of millions of “undesirable” individuals.

At a Nazi Party rally in 1938, Joseph Goebbels laid out the National Socialist strategy: “Our starting point is not the individual, and we do not subscribe to the view that one should feed the hungry, give drink to the thirsty or clothe the naked.... Our objectives are entirely different: We must have a healthy people in order to prevail in the world.”

The theory of creating such a “healthy society” was not invented by the Nazis. Their policy drew from eugenic principles laid out in the 19th century which became increasingly popular in many countries. When Charles Darwin introduced his theory of evolution, scientists and politicians were eager to believe they found the key to counteract what was considered the genetic deterioration of the people and the social problems caused by it. In the early 20th centuries, these theories gained influence even in the mainstream. Eugenic societies and research centers came into existence in many countries.

In the United States, the Eugenic Record Office (ERO) at Cold Spring Harbor Laboratory, founded by Charles B. Davenport, was the most important institution representing this theory. ERO had two general goals: to carry out research on human heredity, especially the inheritance of undesirable social traits, and to educate politicians on how to implement the conclusions of this research into public policy, or in other words, how to introduce “rational social planning.” Eugenicists considered themselves as reformers proposing biological solutions to social problems. They propagated that a “healthy” society could – and should – be created by “breeding” people. The reproduction numbers of “valuable” individuals, therefore, had to be increased, while the “invaluable” had to be prevented from having progeny.

Individuals with mental illnesses were particularly viewed as a threat to this projected “healthy people body,” in addition to being a burden on society. Surgical sterilization became the primary proposal for preventing these “inferiors” from reproducing and for saving on costs of their special care and education. In his book “Eugenics: The Science of Human Improvement by Better Breeding,” published in 1910, Davenport wrote: “This three or four percent of our population is a fearful drag on our civilization. Shall we as an intelligent people, proud of our control of nature in other respects, do nothing but vote more taxes or be satisfied with the great gifts and bequests that philanthropists have made for the support of the delinquent, defective classes? Shall we not rather take the steps that scientific study dictates as necessary to dry up the springs that feed the torrent of defective and degenerate protoplasm?”

Until World War I, the German eugenics movement paralleled that of the United States – brain measurements were used to determine intelligence, Social Darwinism was widely accepted, populations were divided into superior and inferior, and proponents hoped to safeguard the nation’s “genetic heritage” while viewing degeneration as a threat. After Germany’s defeat in 1918, during the Weimar Republic, eugenic thinking gained even more influence and was supported by the majority of the political parties, also by the left and progressive.

In 1920, two distinguished German scholars, the law professor Karl Binding and the medical doctor Alfred Hoche, wrote the crucial work “The Permission to Destroy Life Unworthy of Life” (Die Freigabe der Vernichtung lebensunwerten Lebens). The Binding-Hoche study reflected a fear in Germany following the first world war, arguing that the best young men (including Hoche’s son) and their genes had perished on the battlefield, leaving only the “inferior” (those unable or unwilling to fight) to proliferate freely. This “unbalance” would inevitably cause the degeneration of the German people and society, they claimed. The study proposed that eliminating these “inferior elements” would restore the balance. In addition, and this was not without resonance at a time of economic depression and hyperinflation during the Weimar Republic, it would free society from the tremendous financial burden imposed by the care for this “human ballast.”

Binding’s and Hoche’s study influenced Adolf Hitler, who read the book while imprisoned in Landsberg prison in 1924. It was there that Hitler wrote his “bible” called “Mein Kampf,” laying out the principles of the Nazi ideology. In his vision of the “new Germany,” of creating the “master race,” there was no place for the perceived “alien blood” – Jews, gypsies and others – but equally not for the genetically “inferior” of his own people.

When Hitler seized power in 1933, “biological enemies” were destined for elimination to make this vision reality. New marriage and reproduction laws were issued; and mental hospitals were encouraged to neglect their patients. Their funds were increasingly reduced. The mentally ill were portrayed as repulsive, animal-like creatures to the general public.

The first measure taken was the “Law for the Prevention of Hereditarily Diseased Offspring,” issued on July 14, 1933, implementing a program of forced sterilization. It fulfilled the long-held dreams of eugenicists. Individuals with any of the nine conditions assumed to be hereditary were destined to be sterilized: genetic feeble-mindedness, schizophrenia, manic-depressive disorder, genetic epilepsy, Huntington’s chorea, genetic blindness, genetic deafness, severe physical deformity and chronic alcoholism. The law took effect on January 1, 1934 and was effective until the end of the war. Within this 12-year period, an estimated 400,000 Germans were forcibly sterilized.

Nazi Germany was not the first country to sterilize the “unfit.” Before the Nazis, the United States had led the world in policies of compulsory sterilization. In 1907, Indiana became the first state to enact a sterilization law, and by the 1930s, more than half of the states had passed laws that authorized the sterilization of inmates of mental institutions and others.

In 1927, a Virginia law reached the U.S. Supreme Court. The case involved a woman diagnosed with feeble-mindedness and whose mother and infant daughter had been classified the same way. In that case, Justice Oliver Wendell Holmes, speaking for the eight-man majority of the court, justified upholding the Virginia law: “We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the state for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes….Three generations of imbeciles are enough.”

Although the Nazis later defended their sterilization program in the Nuremberg trials by referring to the United States, and although sterilization rates climbed in the United States during the depression, the U.S. program was nowhere near the mass scale of the Nazis', nor was sterilization a forerunner to state-sponsored mass murder.

It was only Nazi Germany that made the step from preventive eugenic measures to the physical destruction of the victims, to the mass murder of the mentally and physically ill. Two hundred thousand people – men, women and children – were murdered throughout the “euthanasia” program at the hands of doctors. Those who were entrusted with life and care of patients became those who destined them to die.

Six killing centers were created for the systematic murder of the mentally and physically ill. Here, physicians and other medical personnel developed the technology for gassing and cremating large numbers of people – “skills” that were then transferred to the concentration camps, thus making the “euthanasia” program the experimental field for the “Final Solution.”

These six centers – Grafeneck, Brandenburg, Hartheim, Sonnenstein, Bernburg and Hadamar – were the focus of Holocaust Museum Houston’s 2007 exhibition and catalog under the theme “Medical Ethics and the Holocaust: How Healing Becomes Killing: Eugenics, Euthanasia and Extermination.” Together, they present the story of the indispensable and enthusiastic participation of physicians and biomedical scientists in the murder of their patients seen as “lives not worth living.”

It is a story that should not be forgotten in these times when exciting scientific feats like the Human Genome Project have once again revitalized interest in such topics as biological determinism and eugenics.

We must take care to consider the choices we make in coming years on issues of modern medical, ethical, scientific, legal and public health policy in light of mankind’s so obviously poor choices of the past.

Susan Myers
Executive Director
Holocaust Museum Houston
Houston, Texas

Medical Ethics and the Holocaust

Shelley Rubenfeld

Series Moderator
Sheldon Rubenfeld, M.D, F.A.C.P, F.A.C.E., created “Medical Ethics and the Holocaust” and served as chairman of its Steering Committee. He also served as moderator for The Michael E. DeBakey Medical Ethics Lecture Series.

A clinical professor of medicine at Baylor College of Medicine, he has taught “Healing by Killing: Medicine During the Third Reich” for three years and “Jewish Medical Ethics” for seven years. 

An endocrinologist in private practice, Rubenfeld is known for pioneering the fine needle
aspiration biopsy of the thyroid gland. He is the published author of multiple publications about endocrinology, including the first and second editions of "Could It Be My Thyroid?"

Rubenfeld is the founding chair of the Maimonides Society of Houston and of the Texas Hadassah Medical Research Foundation. He serves on the advisory board of Houston Medicine

In 1998, Rubenfeld was the recipient of the Thyroid Society for Education & Research’s “Dr. Robert Graves Award.” His peers selected him as the “Top Endocrinologist” in Houston in both editions of the “Guide to Top Doctors” published by the Center of the Study of Services, as one of America’s “Top Doctors for Cancer” in 2005, and as a “Texas Super Doc” from 2005 through 2007.

Rubenfeld is originally from Brooklyn, New York and is certified by the American Board of Internal Medicine in endocrinology and metabolism and in internal medicine.

Steering Committee
Dr. Sheldon Rubenfeld, Chair
Peter N. Berkowitz
Melissa Brunicardi, R.N.
Nancy S. Dinerstein
Kelli Cohen Fein, M.D.
Walter Hecht
The Honorable Manuel D. Leal
Leo Linbeck III
Cheyenne Martin, Ph.D., R.N.
Eric Pulaski 
Anna Steinberger, Ph.D.
Dr. John Thrash
Ileana Trevino
Susan Myers, Museum Executive Director

Advisory Committee
Charlotte Berkowitz, Ph.D.
Baruch Brody, Ph. D.
C. Thomas Caskey, M.D.
Seth Chandler, J.D.
Thomas R. Cole, Ph.D.
Mary A. Daffin
Ralph D. Feigin, M.D.
David Fine
Donald J. Foss, Ph.D.
O. Howard Frazier, M.D.
Richard A. Gibbs, Ph.D.
Ron Girotto
Anthony M. Gotto Jr., M.D., Ph.D.
Jean Herzog, Ph.D.
Rabbi Samuel E. Karff
Joan Krause, J.D.
David Leebron, J.D.
John Mendelsohn, M.D.
Ferid Murad, M.D., Ph.D.
Carol Quillen, Ph.D.
Stanley G. Schultz, M.D.
Marc J. Shapiro
Ira Shephard, LL.B.
Patricia Starck, D.S.N., R.N.
Jay H. Stein, M.D.
John D. Stobo, M.D.
Richard E. Wainerdi, Ph.D.
Thomas M. Wheeler, M.D.
James T. Willerson, M.D.
Dr. Zbignew J. Wojciechowski
Daniel J. Wolterman

Program Sponsors
The William & Margaret Alkek Foundation
Dr. Milton and Laurie Boniuk
The Boniuk Center for the Study and Advancement of
  Religious Tolerance at Rice University
Continental Airlines
Jack and Nancy Dinerstein
Martin and Dr. Kelli Cohen Fein
Morris and Amanda Gelb
Lyondell Chemical
Walter and Punkin Hecht
Barry and Rosalyn Margolis
John Mendelsohn, M.D.
Lufthansa Airlines
Nodus Solutions
William Osher, M.D.
Park Plaza Hospital and Medical Center
Pierpont Communications, Inc.
St. Luke’s Episcopal Health System
David and Charis Smith
Emil Steinberger, M.D. and Anna Steinberger, Ph.D.
Corby and Barbara Robertson
Texas Children’s Hospital
University of Houston
University of Texas Health Science Center Houston
University of Texas Medical School at Houston
University of Texas School of Nursing 

Exhibit and Catalog Sponsors
Gateway Logistics Group, Inc.
Lufthansa Airlines
Dr. Sheldon Rubenfeld and Linda Rubenfeld

DeBakey Lecture Series Sponsors
Aquinas Corporation
EMD Serono, Inc.
Fulbright & Jaworski L.L.P.
Huffington Foundation
The Jewish Federation of Greater Houston
The Maimonides Society
Memorial Hermann
David, Ira and Mindy Mitzner
Eric and Karen Pulaski
The Methodist Hospital
Torah Outreach Center of Houston (TORCH)
University of Houston’s Elizabeth D. Rockwell
  Ethics and Leadership Lecture


Holocaust Museum Houston Morgan Family Center, 9220 Kirby Drive, Suite 100, Houston, TX 77054, Tel: 713-942-8000, E-mail: Powered by Nodus Solutions