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:
  1. Physicians are always wise, compassionate, and morally irreproachable;
  2. The elimination was Hitler's idea;
  3. It only happened in his regime;
  4. He possessed the power to force physicians to act in violation of their consciences;
  5. 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.

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