The Forgotten Chapter
Inside the History of Health Care
1933 – 1945
by Binjamin Heyl
reviewed by Mira de Vries
This book is in Dutch, thus inaccessible to the
English language reader. The review is included here because of the
importance of the subject matter.
Most Dutch people have a vague idea about the elimination of disabled
people by physicians during the Third Reich. A typical Dutch response
is, “They couldn't help it, Hitler made them do it.”
This response exposes five major misconceptions:
- Physicians are always wise, compassionate, and morally
irreproachable;
- The elimination was Hitler's idea;
- It only happened in his regime;
- He possessed the power to force physicians to act in
violation of
their consciences;
- No lesson can or should be learned from this history for
the
practice of medicine in the Netherlands or elsewhere today.
These misconceptions are born of lack of familiarity with this shameful
history, which is perhaps to be forgiven, considering the paucity of
attention it has received during the intervening decades. Not until the
eighties and nineties did historians begin to dedicate themselves to
this subject. Their publications are mostly in German, some with
translations into English. Binjamin Heyl addresses this omission for
the
Dutch.
The idea to eliminate the disabled was conjured up by an Englishman,
Francis Galton, a cousin to Charles Darwin. Galton and his followers
proposed that various forms of disability, including social disability,
are hereditary, and that the disabled bear more offspring than the
able, thus breeding the human race backwards: survival of the least
fit. To reverse this trend, the disabled should be removed from the
gene pool, firstly by being prohibited from producing offspring. This
idea was called eugenics (good genes).
Eugenics became hugely popular among scientists and physicians, in
particular psychiatrists, across the world. Their lobbying led to many
states in North America and Europe adopting laws for forced
sterilization, which continued long after the capitulation of the Third
Reich, in some places as late as a decade ago. Eugenics was also the
basis for laws limiting immigration.
Hitler had read a book on this subject (in jail), and became highly
enthusiastic. Therefore he was hailed by eugenicists in Germany and
elsewhere. Especially American psychiatrists praised him and lamented
their own deficiency regarding this subject. German physicians
massively joined his party.
With supposed compassion for the disabled living ostensibly unlivable
lives plus economic considerations thrown in, forced sterilization was
upgraded to mass murder. Hitler appointed his personal physician to
head the elimination program, codenamed T-4 after the address of the
headquarters, 4 Tiergarten Street in
Berlin. Yet Hitler understood that such a program would be politically
sensitive. Therefore he refused to ratify it into law, much to the
consternation of those who implemented it. In 1941 he even ordered its
discontinuation. However, it did not stop. After this moment the mass
murder of the disabled was called wild euthanasia.
There were a minority of physicians who refused to participate in mass
murder. As long as they did not engage in counter-propaganda, they were
left alone.
Of course the T-4 program is not wholly comparable to modern-day
medical practice in the Netherlands and elsewhere, but it is dangerous
to make ourselves blind to the similarities. Examples are:
- extensive documentation of patients;
- strong hierarchy in medicine;
- politically motivated atmosphere of economic crisis
necessitating
cutbacks;
- manipulation of language;
- reverence for the State, the interests of which are served
by
physicians, rather than their serving the causes of perpetuating life
and lessening pain;
- expansion of medicine's social domain;
- unchallengeable authority of science. “Social
scientists
are now
ashamed of it, but this is where the roots of their profession lie.”
“We also see how in the beginning of the 21st
century,
physicians, professors, ethicists, politicians, boards of directors,
managers, consumer societies, nurses and carers, families, friends, and
acquaintances, are incapable of turning the tide of increasing
dehumanization, in particular inside nursing homes. The anonymous,
hidden dehumanization virus has been able to perform its destructive
work for years.”
“Why would Dutch people be braver and more virtuous than Germans, or
other peoples? Those who believe they are, on what grounds?”
In the second half of the book, Heyl relates the history of health care
in the Netherlands during the same period. Contrary to other areas
occupied by the nazis, in the Netherlands (Aryan) disabled people were
left largely unmolested. The majority of Dutch physicians rejected
eugenics, tipping the balance of social pressure among physicians the
other way. This illustrates the power of leading opinions in medicine.
Only people considered Jewish were eliminated, regardless of their
state of health. Heyl points out that in his yearly report, the chief
medical inspector (comparable to the Surgeon General in the US) failed
to mention the deportation of entire nursing home populations,
including patients and staff. Barring individual initiatives, most
organizations in the Netherlands were willing to comply with the
elimination of the Jews, which is why it was so thorough.
Heyl ascribes a special role in health care to nurses. During the
Nurenberg and other trials they were systematically exonerated. Were
they not merely following orders? Wrong, asserts Heyl. Nurses are the
most powerful [professional] group in health care. Without them there
can be no care. They should take advantage of this power to demand
better health care instead of slavishly following doctors' orders. He
points out that during recent media attention to the inadequate care in
nursing homes, several nursing home physicians announced resigning
their posts, but nurses did not. He furthermore posits:
“Many nurses carry out actions without knowing
what
they're
doing and what the consequences of their actions could be from a legal
viewpoint. For instance, 12% occasionally administer euthanatics
(substances for euthanasia) without realizing that this is punishable
by law. … Dedicated nurses are willing to relieve the physician
of this task. … In many cases … the nurses do not know the object
of the treatment.”
“Nurses are still strongly inclined … to function uncritically as an
extension of the physician's arm . … The most powerful [professional]
group in health care ... still allows itself to be swayed by what other
powerful parties in and outside of health care determine and decide.”
Heyl is calling on nurses to read the writing on the wall.
The author can be contacted by
removing the asterisk from his e-mail
address.
We wish to thank Mr. Heyl for the complementary copy of his book for
our library.
Copyright © MeTZelf
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