Eugenics and the modern euthanasia movement: an essay

The Wall Street Journal recently published the results of a worldwide survey on people's attitudes towards Judaism, Jewish people and a comparison with attitudes to the other world religions. Most revealing was this statement:Younger people were significantly less aware of the Holocaust than older people. While 61% of those over 50 years old knew about the tragedy, only 48% of people under 35 were aware of it. That trend is expected to continue with the fading of the generation that lived through the Holocaust, which ended nearly 70 years ago.

It is oft said that there's nothing new under the sun; that what seems essentially to be a new fad or agenda is, at its roots, something as old as Adam but dressed up in modern or post-modern language.

One potent example is Malthusianism. Based on the notion of an English cleric, Thomas Robert Malthus, that the earth could only sustain a certain level of population and that, therefore, population growth needed to be curtailed. He said, in his 1798 Essay on the Principle of Population. "The power of population is indefinitely greater than the power in the earth to produce subsistence for man" This idea surfaces, it would seem, in every second or third generation in the post-war era in some form or another. It will always have its supporters.

We saw its most potent revision in the work of Paul Ehrlich in 1968 with his book The Population Bomb. I well recall how seriously the world took Ehrlich's doomsday warnings of impending global famine and catastrophe if we failed in our duty to the planet and to humanity by curtailing our breeding dramatically.

The first edition of the book opened with:

The battle to feed all of humanity is over. In the 1970s hundreds of millions of people will starve to death in spite of any crash programs embarked upon now. At this late date nothing can prevent a substantial increase in the world death rate.

In recent years the Green movement has adopted yet another variation on poor old Malthus' flawed thesis. The Green movement is seemingly not as concerned about humankind as it is about the planet itself; some arguing that humanity itself is the threat.

I mention this population argument because it is also subtlety connected to the eugenics movement - if not intrinsically, then at least because there are some similarities in their programs. Eugenics, by definition, seeks to improve humankind through either breeding out unwanted traits or breeding in desirable traits. An argument for reducing population growth can very easily be linked to selective breeding or non-breeding.

Just as there will always be sons and daughters of Malthus, we are likely always to find those who support the idea of eugenics. Though the principal example of a pogrom of eugenics in the 20th century gave the whole idea a very 'bad rap' there are those about who still seek to rehabilitate the notion.

Does that reality mean that those people have a wicked intention? I don't believe so. I ask you to keep the possibility that those who push such matters and those who willingly follow may not be themselves evil nor have an evil intent in the forefront of their minds.

But intention, while important, is not the full story; we need to judge outcomes and potential outcomes objectively and with one eye to history.

Of course, there will always be those whose intent is decidedly malicious. Those who can either channel or adapt the zeitgeist with chameleon-like craft to a sinister end whilst adopting and promoting propaganda that would seem to be entirely wholesome and worthy. Again, it is important to recognise this because their goals are reached incrementally and, like boiling the frog in the pot, those who do not know the lessons of history, never see it coming.

This notion of improving humanity by culling population generally or by eliminating 'poor character traits' particularly has been around a long time.

And so, I want to take a look at the first half of the 20th century and the characteristics of the eugenics movement, how they found their expression at the time, the effects that have had lasting resonance and what, if anything, we can find in the modern debate about euthanasia that, at the very least, holds similarities to nearly a century ago.

In 1920, two German academics published a two–part treatise entitled: Permitting the Destruction of Life Unworthy of Life. Karl Binding was a lawyer and Alfred Hoche, a psychiatrist. Much of the literature about these men and their book suggests that they simply wanted to present this idea from an academic perspective, but they were certainly not neutral to the matter at hand; as evidenced by Hoche's characterization of people suffering from psychiatric problems, brain damage or retardation of any kind as 'ballastexistenzen' or human ballast.

Nor were they the first to raise the subject of eugenics in that era. Already over the preceding two decades, 17 US states had enacted eugenic laws that focused on the sterilization of mentally incapacitated persons. An Indiana law for the sterilization of mentally incompetent people stood on the statute books until 1974. In fact, it was claimed by one of the USA's early eugenicists, Dr Paul Polenoe that Hitler's 1933 'Law for the Prevention of Genetically Diseased Offspring' act - one of his first - was modelled on the Californian eugenics Law.

Of course, Hitler was already of the belief that eugenics could provide a benefit to the Aryan nation. In 1925 he wrote in Mein Kampf, that the destruction of the weak and sick is far more humane than their protection.

It is worthy of note that, also in that same year of 1925, a survey of parents of disabled children in Germany found that 74% were actually in favour of euthanasing their children. So while Hitler's programs were sinister and objectively evil, such sentiments were clearly already part of the Zeitgeist.

So we can see that this kind of eugenics thinking was already evident in some form in the USA, in Britain (though no program was ever developed) and in Europe. The ground was fertile.

Initially at least, the 1933 Nazi law for the sterilization of 'genetically diseased offspring' included a requirement that a doctor examine and report on the patient and that the Heredity Health Courts would sanction any action. Doctors' support was crucial, not only in this initial action, but also in subsequent Nazi death programs.

Binding and Hoche had put the discussion on eugenics on an academic plane. But without the cooperation of German doctors it would have been likely that their work would not have progressed as it did. Even before Hitler grabbed power in 1930, it was estimated that 6% of German doctors were already members of the Nazi Physicians League. The later programs, which we will come to shortly, were actively supported by doctors - there was no need for conscription to the killing.

The Nazi War Crimes Tribunal was chronicled in a 1948 report called: Doctors of Infamy. It condemned the behaviour of the German profession:

'Had the profession taken a strong stand against the mass killing of sick Germans before the war, it is conceivable that the entire idea and technique of death factories for genocide would not have materialized...but far from opposing the Nazi state militantly, part of the medical profession co-operated consciously and even willingly, while the remainder acquiesced in silence. Therefore our regretful but inevitable judgement must be that the responsibility for the inhumane perpetrations of Dr Brandt...and others, rests in large measure upon the bulk of the medical profession; because the profession without vigorous protest, permitted itself to be ruled by such men.'

So, the killing actually began from that point in 1933. At this early stage it was most often carried out in nursing homes, geriatric hospitals and psychiatric institutions all over Germany. The early focus was on German citizens.

At that time, Professor Ernst Rudin, director of the Kaiser Wilhelm Institute began a sterilization campaign across Germany with such enthusiasm for the eugenic program of the Third Reich that 300,000 Germans were sterilized in only four years. Rudin also helped develop Hitler's sterilization laws in the first instance (writing its commentary) and was also understood to have been a significant influence upon the thinking of a young student named Josef Mengele.

In this environment and radicalized German culture the sterilization program became a direct killing program in 1939. The Nazi regime had at this time already been receiving requests for 'mercy killing' from relatives of severely handicapped children and, in that year, Hitler himself signed off on the killing of the first child named Knauer with the consent of the parents.

Wesley Smith, commenting on Dutch child euthanasia in 2006, referred to the Knauer case:

The key test came in late 1938 when the father of "Baby Knauer," an infant born blind and missing his leg and part of his arm, wrote Hitler requesting permission to have his child "put to sleep." As described by Lifton and other historians, Hitler was quite interested in the case and sent one of his personal physicians, Karl Rudolph Brandt, to investigate. Brandt's instructions from his Führer were to verify the facts of the baby's condition and, if found to be true, to assure the child's doctors and his parents that if he was killed, no one would face punishment. The doctors in the case who met with Brandt agreed that there was "no justification for keeping the child alive." Baby Knauer soon became one of the first victims of the Holocaust.

It was thereafter mandated that all children under the age of three with 'serious hereditary diseases' were to be registered with the authorities. This information was then used for an assessment by a 'panel of experts' - including medical professors - who actually never saw the patient, and who signed off on the death by lethal injection or death by starvation of 6000 such infants by the end of the war.

The Nazi euthanasia program was given the code name Aktion T4; T4 referring to the principle place of operation at Tiergartenstrasse 4 which was also known euphemistically as the "Charitable Foundation for Curative and Institutional Care". Its principals were the infamous personal physician of Hitler, Dr Karl Brandt and SS-Obergruppenführer, Philipp Bouhler. Brandt was hanged for his involvement in human rights atrocities in 1948 while Bouhler committed suicide whilst in prison in 1945. Brandt had earlier come under the influence of Alfred Hoche, the co-author of the 'life unworthy of life' book and adopted his code of medical ethics.

In October 1939 Hitler signed a "euthanasia decree" backdated to 1 September 1939 that authorized Phillipp Bouhler and Karl Brandt to carry out the programme of euthanasia. It read, in part:

"Reich Leader Bouhler and Dr. med. Brandt are charged with the responsibility of enlarging the competence of certain physicians, designated by name, so that patients who, on the basis of human judgment , are considered incurable, can be granted mercy death after a discerning diagnosis." So said the decree.

All state institutions were required to report on patients who had been ill for five years of more and were unable to work. Chosen patients were gassed and incinerated in one of six centres operating at the time. False death certificates were issued with diagnoses appropriate for age and previous symptoms and payment for 'treatment and burial' was collected from surviving relatives. Remember, until 1941, this operation was covert; the patient's relatives were under the impression that T4, or whatever they knew the program as, was essentially a treatment facility.

In 1941 the T4 program was abandoned. Some reports suggest that it was due to the public awareness of what was actually happening, however, it was also likely that the program had largely achieved its objectives, part of which ultimately became the development of the gassing techniques for multiple homicides which were then deployed in Treblinka, Auschwitz or the other death camps (24 main ones and 350 smaller ones). T4 staff were redeployed thereafter to continue their work in these death camps.

Reports on the numbers vary; one analysis recording 400,000 total sterilizations and 275,000 total deaths under the T4 program in three years.And the killing of the disabled continued along with the extermination of Jews, Gypsies, homosexuals and other 'undesirables' as we well know. Whereas Jewish people were required to be identified by wearing a gold coloured Star of David, those with a disability who were heading for the same grizzly fate were required to wear a Black Triangle patch which identified them under the euphemism of 'arbeitsscheu' or simply 'workshy'. The Black Triangle remains a potent symbol that is still in use today by disability groups across the globe.

Though the horrors of what occurred in these death camps was beginning to be known around the world at the time, it was, of course, only afterwards that the full extent of the Nazi program became evident. But even as the work was beginning to be known, there remained still, in places outside Germany, support for the regime and the mass genocide.

One important example of this support came from a Lothrop Stoddard, an American eugenicist and colleague of Margaret Sanger, who spent some time in Germany in 1939 and 1940 as a news reporter. He was favoured highly in his access to Nazi officials - even Hitler himself - and was popular with Joseph Goebbels (Reich Minister for Propaganda) because his (Stoddard's) works on the 'racial question' were featured in Nazi school textbooks.

After visiting the Hereditary Health Courts in Charlottenburg that authorized sterilizations, Stoddard observed that the law was, "being administered with strict regard for its provisions and that, if anything, judgments were almost too conservative", and that the law was "weeding out the worst strains in the Germanic stock in a scientific and truly humanitarian way". Stoddard later reported in 1940 that 'the Jew problem' is "already settled in principle and soon to be settled in fact by the physical elimination of the Jews themselves from the Third Reich."

Post-war, due to the 'Nazi stench' associated with Stoddard, Margaret Sanger renamed her organisation originally called The Birth Control League - of which Stoddard was a board member, Planned Parenthood. The 'stench' attached to the word 'euthanasia' was also responsible, in part, for the change in focus of such US groups as The Hemlock Society away from euthanasia to the slightly more palatable 'assisted suicide'.

Now I want to focus on the outcomes that, by any reasoned analysis, we can rightly say were intrinsically evil. That is to say, whether motivated by murderous and evil intent or not, the genocide of 6 million Jews and other 'undesirables' as well as an estimated 700,000 persons living with disability stands condemned by history and by every right-thinking person.

My British colleague, Dr Peter Saunders, in his writing on this subject, focusses intentionally upon the role of doctors during the Nazi regime. He concludes that there was no need to conscript doctors to take part in any level or operation of the Nazi extermination programs; that they were, more often than not, willing participants. I want to look a little more broadly than that at these questions as they may relate to the discussion on euthanasia today.

But, as a bridge between this brief historical overview and my further observations, Leo Alexander, a psychiatrist with the Chief Counsel for the Nuremberg War Crimes Tribunal made the following observations in the New England Medical Journal in 1949:

'The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in 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 non-Germans.'

Noted American intellectual, George Weigel spoke recently at a forum in Rome where he referred to Binding and Hoche and the idea of 'Life not worthy of life', saying that: "The result of this denial of the first of human rights, the right-to-life, was the same under both German National Socialism and Marxism-Leninism: the result was genocide."

He added that it's "something of a mystery" that Western democracies forgot the lessons of these 20th century totalitarian states.

"It must be said, and it must be said without hesitation: the desperately false idea that some human lives are worth less than others, and thus have less claim on cultural and legal protection than others, is at the root of the abortion license in our countries, and is now infecting public policy toward the elderly, at the other end of the life spectrum."

Referring again to my admonition concerning intention and outcome, I want to stress once more that I do not attribute malicious intent to anyone in the pro-euthanasia movement in these further observations. I don't doubt that, even if simply as an observation of some statistical predictor, that there are those with such intent, but I believe that these people would be few and, in any case, charity demands better of us than to condemn.

Whereas the eugenics movement as played out in and through the Nazi regime was focussed on the elimination of those determined undesirable and not worthy of life, the modern euthanasia movement, whilst being something of a chameleon in terms of its rhetoric, still holds to something that I, at least, have cause to identify with the basic tenets of eugenics.

What it seeks to eliminate is suffering itself. But isn't that something we all would aspire to? Certainly, but not at the demise of the sufferer as a means to that end.

This was brought home to me in a truly shocking way in Brussels last November during a debate between my colleague, Alex Schadenberg and two pro-euthanasia Belgian academics. The first outed himself from his very first words as a Malthusian; but then that's hardly surprising. The second, Professor Etienne Vermeersch, one of the architects of the original Belgian legislation, during question time raised himself with the kind of fervour that immediately reminded me of Da Furher himself at the Nuremberg rallies and declared, "We need more euthanasia! There is too much suffering!" He set the blame for 'too much suffering' squarely at the feet of Catholics and, in particular, the Catholic Hospital system when he focussed the need for more euthanasia in the region of Wallonia (which has a higher Catholic population than the rest of Belgium).

As if not enough, when heckled for these comments from a person in the front row of the audience. He leaned forward in an aggressive manner, pointed an accusatory index finger and said: "You wait until you are paralysed!" My colleague, Kevin Fitzpatrick was sitting next to said heckler in his wheelchair, himself being paralysed forty years ago by a bullet.

The direct inference here is that you or I or anyone wouldn't want a life in a wheelchair and all that comes with it. We might agree. But the further inference that such a life would not be worth living is not only an eerie reminder of Binding and Hoche and all that followed in Nazi Germany, it also puts another person (in this case, Vermeersch) in the role of the Karl Brandt or Phillipp Brouher et al in determining whose life is worthy and whose is not. The echo of some sort of 'Final Solution' for people living with a disability is frightening.

There would seem to be a fear of suffering that finds expression in eliminating the sufferer. Joined to a general fear of one's own possible suffering at the end it seems to me to be a fear of humanity itself in all its uncertainty.

That, no doubt, is an example in extremis. But I don't think it's an isolated case at all. No-one wants to suffer; no-one wants to willingly see others suffer. But we know and learn from experience and the law that compassion is tempered both by the law and right action.

Compassion can be defined as: a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering. Compassion, from the latin com- "together" pati "to suffer". Intrinsic to a proper understanding of compassion is an action or actions. To 'suffer with'.

A feeling or emotion alone is not compassion and probably, more likely, simply pity or distress. If we take the etymological meaning, then the component of action intrinsic to compassion, we could observe that; if killing were to be the action, to fulfil the 'suffer with' idea would also require our death too! So to call euthanasia a 'compassionate response' is ultimately wrong at a very basic level but something, I suspect, that is beyond the general populous and the media to come to terms with.

So, we can accept, at face value, the claim, using a contemporary example, by Dr Rodney Syme when he says that he acted out of compassion in providing Nembutal to Mr Guest in Melbourne nine years ago; or we can objectively judge his 'compassionate action' as errant; rendering it not compassionate at all by definition. We can also legitimately question, though without any way of finding an answer, why it is that someone like Dr Syme cannot accept the wisdom of the law that puts proper limits on our actions. Because, ultimately, tearing down the laws of the land (as he wishes to do) does not bring freedom, it ushers in anarchy.

But, if it is all about ending suffering, then we're in a very dangerous place indeed because we could not contain euthanasia law to only some who are suffering. It would logically and inexorably spread to all as we have seen in Belgium.

That eugenics is still alive and well would be beyond doubt if one were to even casually read the works of Peter Singer and Julian Savalescu, our Australain philosopher exports, who advance, amongst other propositions, the idea that we should be able to dispose of children born with disabilities (read: unacceptable traits) shortly after birth before the point that, they say, children reach 'personhood'.

Anthony Horvath, Director of the Policy Intersections Research Centre, in his forward to the new edition of Binding and Hoche's book, takes a direct shot at Savalescu to make the point that the Nazi premise, based on Binding and Hoche was a scientific one, or more appropriately a pseudo-scientific one. Horvath argues that theirs was a cool and calculated approach to human destruction and that while the likes of Rudolf Hess and Savalescu disagree on some points, the core premise of eugenics as res ipsa loquitur, "The thing that speaks for itself" ( ie: that is self-evident) remains.

Horvath also argues that it was Binding & Hoche's couching of the discussion in pseudo-scientific terms that created its irresistible appeal for the Nazi's because it enabled this otherwise outrageous proposition to be reconciled with German domestic law at a time in history where the economics of disposing of those whose very existence came at significant cost to society created an additional 'rational' reason to proceed.

It is also telling, again as Horvath observes that:

"He (Binding) goes out of his way to dispense with religious rationale, which has no place in secular society. He specifically targets Christianity, labelling the Church's refusal to let people die 'good deaths' as unchristian.

"Binding believes he is standing on the firm ground of scientific reality: "I can find absolutely no reason, from a legal, social, moral, religious point of view, not to allow those who want it, to kill those beyond salvation, who desperately desire it."

"Indeed, he believes that his is the compassionate view, saying that it stems "from the deepest compassion".

"Or, to put it another way, given what he (Binding) knows about compassion, and what he knows about people, allowing people to kill themselves is self-evidently the proper position for a scientifically minded person exhibiting 'cool calculated logic'."

It is easy to see, I think, why this was and is so seductive.

Horvath summarizes that it was precisely because neither Binding nor Hoche were national Socialists but, rather, respected academics providing 'dispassionate, rational, judgement on the whether or not it was ethical to 'dispose' 'of the 'unworthy'' that their work had the weight that it did. But, as I emphasised before, it was the doctors that implemented and designed the T4 program, not SS thugs. It was the doctors who 'ran it all'.

In summarizing I want to draw together some of the characteristics of this terrible period in world history that remain 'in play' today. It may be that some, if not all, these observations are always 'in play' to some degree in all ages. But it may also be, as Horvath reflects on the economic and social drivers in Europe generally in the period post World War I, that there exists today a similar set of circumstances which not only enables the euthanasia argument to flourish as it has done, but also provides something of an imperative.

A few observations:

Binding and Hoche emphasised that their ideas should be implemented with a 'voluntary' and 'consenting' nature. How often do we hear the claim that 'we only want voluntary euthanasia'? Even Savalescu says that modern eugenics is 'voluntary'. But, also as we have seen, the ideal of 'voluntary and with full consent' has fallen away dramatically in Belgium and Holland.

The original Hereditary Health Courts had at least the pretence of a process. Modern euthanasia bills likewise rely on the promotion of a process, or safeguards so-called.

The T4 process, once it embarked upon increasing number of killings, falsified the death certificates. Some euthanasia bills insist that the cause of death should be the underlying illness - a falsehood, a lie.

Binding and Hoche provided a 'scientific and academic basis' for their program. In recent years there have been a procession of supposedly academic studies, each supporting its predecessors and developing a false claim that there is no risk to the vulnerable, building the false consensus that scientifically presented argument is ipso facto a sound ethical basis for action.

There was something of a vox populii support for the idea at the time. We know that current polling, disregarding the problems with such devices, tells us that support for euthanasia is at a similar level as it was (or seems to have been) between the World Wars.

Giving the impression that doctors are the properly competent persons to make moral and ethical judgements on the worth of a life. Again we see this in the recent case of Dr Rodney Syme amongst others. Doctors are no capable of sound moral judgement or moral error than anyone else.

There was a clear financial imperative to the T4 program. Although mostly still 'the elephant in the room' some commentators openly admit today that euthanasia would benefit the bottom line of state's health budgets.

You will also recall Binding and Hoche's insistence that religious opinion and ethic be expunged from the public square on this issue even going so far as accusing the Church of being cruel and indifferent to suffering by 'standing in the way'. This is a classic position. How often have we heard that it is the Church that is wielding power 'behind the scenes' over our politicians on this issue?

And I'll close by quoting again from Horvath in what he sees as the right lessons to be drawn from the horrors of the 20th century:

  • Deference to 'experts,' including deference by 'experts' to other 'experts,' is dangerous.
  • Allowing ethical considerations regarding life and death to be linked to the interests of the 'social organism' (society or the state) is dangerous.
  • Believing that there is one set of moral principles for the 'individual' and another set for the 'social organism' is dangerous.
  • Asserting that certain ethical considerations, behaviours and attitudes flow directly from scientific data is dangerous.
  • Behaving as though ideas - even grotesque, inhuman, ideas - can be carefully considered for their relative merits as though they have no consequences or implications is dangerous.

No doubt there will be those standing ready to accuse me of illegitimately associating the euthanasia movement with the horrors of Nazism and the holocaust. I hope the thoughtful reader will at the very least acknowledge that I have trodden carefully.

It is not so much people or programs we need to be concerned about but, rather, the consequences of adopting bad ideas - especially those that seem benign.

For the full text of this essay:
The wiki page on this subject is worth a read:
An interesting essay on Eugenics from the July 1904 edition of THE AMERICAN JOURNAL OF SOCIOLOGY by Francis Galton (who coined the word 'eugenics') gives an overview of the thinking in the Western World at that time: see:
This book has recently been re-translated with a foreword by Anthony Horvath (quoted in this article). See:
For an overview of eugenics laws in the USA see:
"It (the state) must proclaim as unfit for procreation all those who are inflicted with some visible hereditary disease or are the carriers of it; and practical measures must be adopted to have such people rendered sterile." "It must see to it that only those who are healthy shall beget children; that there is only one infamy, namely, for parents that are ill or show hereditary defects to bring children into the world and that in such cases
it is a high honour to refrain from doing so." & "Those who are physically and mentally unhealthy and unfit must not perpetuate their own suffering in the bodies of their children." Adolf Hitler Mein Kampf
Also: "Sparta must be regarded as the first völkisch state. The exposure of the sick, weak, deformed children, in short, their destruction, was more decent and in truth a thousand times more human than the wretched insanity of our day which preserves the most pathological subject." Source unknown.
Michael Burleigh, Death and Deliverance: Euthanasia in Germany, 1900-1945 (1994, Cambridge University Press, New York, NY), pp. 22-23.
See: The Nuremburg Laws:
See: BBC History: Dr Josef Mengele - the angel of death
In 2005 the Groningen Protocol developed by Dutch doctors allowed (though remaining outside the law) the killing of newborns with problems such as spina-bifida. It is said that between 25 and 100 newborns die this way each year.
Full text available at:
For reports on the Brussels debate see:
Allowing the Destruction of Life Unworthy of Life, its Measure and Form. Policy Intersections Research Center Dec 2012.
Euthanasia deaths where there was no evidence of request or consent are at 32% & 23% of reported cases respectively.
The 'social organism' was a Nazi phrase that enabled the attribution of rights normally reserved to persons to the state.