Eugenics and involuntary euthanasia

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgWhile I am on vacation, I'm reprinting a number of "Classic Insolence" posts to keep the blog active while I'm gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I'm guessing that quite a few of my readers have probably never seen many of these old posts.) These will appear at least twice a day while I'm gone (and that will probably leave some leftover for Christmas vacation, even). Enjoy, and please feel free to comment. I will be checking in from time to time when I have Internet access to see if the reaction to these old posts here on ScienceBlogs is any different from what it was when they originally appeared, and, blogging addict that I am, I'll probably even put up fresh material once or twice.

i-30480cfb1997bc2a9b883717cf304758-EnthanasiePropaganda.jpgAs longtime readers know, I've had a longstanding interest in the Holocaust. A precursor to the mass killings that occurred during the Holocaust was known as the T4 euthanasia program. This was a program in which as many as 200,000 people deemed "useless eaters" or "life unworthy of life" were "euthanized" (a euphemism for "murdered," actually) by a variety of means, including starvation, overdoses of narcotics, poisoning, and early prototypes of gas chambers later used to to such lethal effect in the death camps used to exterminate Jews and others that the Nazis considered enemies of the Reich or otherwise "undesirable." The T4 program, which ran from 1939 to 1941, when Hitler ordered a temporary halt to the program due to protests from churches and the victims' families, provided the development and proving grounds for methods of mass murder that would later be expanded to the industrialized killings of millions from 1941 until the end of the war. Indeed, Josef Mengele himself learned his trade in this program. Of course, even this "temporary halt" was nothing of the sort. The program continued in secret.

A recent article got me thinking about the T4 program again. Why it did so will become apparent in a moment, but first I would like to list a few quotes from the article. They are quotes justifying the "euthanasia" of the "feebleminded" from around the appropriate time period:

    1. But I am in favor of euthanasia for those hopeless ones who should never have been born - Nature's mistakes.
    2. So the place for euthanasia, I believe, is for the completely hopeless defective: nature's mistake; something we hustle out of sight, which should never have been seen at all. These should be relieved the burden of living, because for them the burden of living at no time can produce any good thing at all. . . . For us to allow them to continue such a living is sheer sentimentality, and cruel too; we deny them as much solace as we give our stricken horse. Here we may most kindly kill, and have no fear of error.
    3. release the soul from its misshapen body which only defeats in this world the soul's powers and gifts is surely to exchange, on that soul's behalf, bondage for freedom.
    4. A third variety of reaction results from an accusing sense of obligation on the part of the parents towards the defective creature they have caused to be born. The extreme devotion and care bestowed upon the defective child, even with sacrifice of advantages for its normal brothers and sisters is a matter of common observation. This position is understandable, but to the impersonal observer may appear to partake of the morbid. Disposal by euthanasia of their idiot offspring would perhaps unbearably magnify the parents' sense of guilt.
    5. It is submitted that the state of mind of the parents of an idiot may as fairly become a subject of psychiatric concern as the interrelationships in the families of psychotic patients, and the unwholesome reactions stand as much in need of correction in one case as in the other.
    6. It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified. Parents who have seen the difficult life of a crippled or feeble-minded child must be convinced that, though they may have a moral obligation to care for the unfortunate creature, the broader public should not be assume the enormous costs that long-term institutionalization might entail.

    Here's an interesting question for you. What is the source for each of those quotes? They are all consistent with the rationales that Nazis used to argue for "euthanasia," namely not wasting society's resources and the supposed "mercy" that killing such children would be. They all date to the 1930's and early 1940's. They all sound as though they came from Third Reich eugenicists.

    All but one of them didn't come from the Third Reich, however. Here are the sources:

    1. Kennedy, F. (1942) The problem of social control of the congenital sterilization, euthanasia. Am. J. Psychiatry, 99, 13-16.
    2. Ibid.
    3. Ibid.
    4. Anonymous (1942) Euthanasia. Am. J. Psychiatry, 99, 141-3.
    5. Ibid.
    6. Pamphlet published by Dr. Heilig, representative of the Nazi Physicians' League. From: Robert N. Proctor, Racial Hygeine: Medicine Under the Nazis, Harvard University Press, Cambridge, 1989, p. 183

    Yes, the first five quotes come from Americans, the first three from neurologist Foster Kennedy, in an article based on a speech he gave to the American Psychiatric Association in May 1941. The fourth and fifth quote come from an editorial published in the same issue and seem to be considering parents who might object to the killing of their "feeble-minded" children as being worthy of "psychiatric concern." These are all discussed in a fascinating article that appeared a recent issue of History of Psychiatry. (Found via Autism Diva and Mind Hacks.)

    Also appearing in the same 1942 journal was an editorial against the killing of the "feebleminded" written by Leo Kanner. Yes, that Leo Kanner, the one who published the first major work describing the condition now known as autism in 1943. Indeed, as part of his argument against involuntary euthanasia of such children, he correctly invoked the Nazis, asking rhetorically, "Shall we psychiatrists take our cue from the Nazi Gestapo?" He did, however, comment that "sterilization is often a desirable procedure" for "persons intellectually or emotionally unfit to rear children," although he did object to sterilization performed "solely on the basis of the I.Q." Even though there was a "point-counterpoint" sort of debate in this journal, it should also be remembered that the journal itself came down on the side of Kennedy, not Kanner.i-56b64497335bc582e8ff4df97a4affc8-Wir_stehen_nicht_allein.jpg

    When looking back at the atrocities of the Nazi regime in the name of eliminating undesirables from the volk, it is important to realize that the ideas the fueled their quest to kill those deemed burdens on society were not unique to Germany. Far from it. As this 1942 journal shows, advocacy of various types of eugenic measures was widespread in the U.S., including among the most elite physicians in the nation. True, no one was advocating selective breeding or the killing of "lesser races" in the service of producing a "master race," as the Nazis were, but there was a disturbing similarity in the thinking of the medical elite in the U.S. with that of Nazi advocates of racial hygeine. As the History of Psychiatry article points out:

    It is surprising that a debate on murder could have appeared in the most prominent psychiatric journal in the USA at the time. But as historians have noted, eugenic sterilization was legally sanctioned in the USA long before the Nazi sterilization law of 1933. The logical progression from sterilization (killing presumed genes) to 'euthanasia' (killing presumed gene carriers) occurred much more slowly in the USA, but accelerated in the early 1940s under German influence. The progression from sterilization to killing is 'logical' because, once it has been established that the state should actively participate in preventing the reproduction of 'genetically undesirable' people through compulsory sterilization, it eventually seems more 'efficient' to wipe out the alleged gene carriers themselves. In a chilling and prophetic statement in 1923, Swedish Member of Parliament and sterilization opponent Carl Lindhagen asked, 'Why shall we only deprive these persons, of no use to society or even for themselves, the ability of reproduction? Is it not even kinder to take their lives? This kind of dubious reasoning will be the outcome of the methods proposed today'.

    How prophetic were Lindhagen's words!

    It was only the postwar revelation of all the atrocities the Nazis committed in the name of eugenics and racial hygeine that utterly discredited this sort of thinking in the U.S. Yet, at the eve of our entry into the war, in the most prestigious psychiatric journal in the U.S., prominent physicians were debating, in essence, whether the Nazi approach to dealing with severely disabled children was the correct one, with at least as many prominent neurologists and psychiatrists arguing that it was as arguing that it was not. (Indeed, early in his regime, Hitler himself spoke approvingly of the compulsory sterilization programs that had been implemented in several states in the U.S. by the 1930's.) We should not forget that, particularly in an era in which the genetic basis of psychiatric diseases are being discovered, lest history repeat itself.

    This post originally appeared on the old blog on October 10, 2005.

    More like this

    Reading about this kind of stuff always makes me more than a little queasy. The sad thing is, this kind of warped thinking about people with disabilities has not magically disappeared with the Holocaust. That's why there's still so much debate raging about things like preimplantation genetic diagnosis, amniocentesis, and "therapeutic" abortion (used to destroy fetuses that are discovered to have an anomaly or a genetic defect) well as the general "hide them away and maybe they won't get noticed" kind of treatment people with severe disabilities still experience these days.

    It was, in fact, this kind of "better off dead" thinking that almost cost me my life some thirty-odd years ago. There were physicians who, upon discovering that I had hydrocephalus, decided I'd be better off dead than risking the chance that I'd be mentally retarded. As I was only a few weeks old at the time, and my mother was not accepting of their bad attitude, she managed to find a "maverick" neurosurgeon who didn't think this way and decided to give me a chance and perform the necessary surgery. Thankfully not all physicians subscribe to the "better dead than disabled" philosophy that ran so terribly rampant through the Nazi regime in their quest for the "perfect Aryan race"...and still pollutes our thinking today. A casual read through the autism blogs or other kinds of disability blogs will show that this attitude is still encountered unacceptably often, even some sixty-odd years after the demise of the Nazi regime. What a sad commentary on a regrettably sizable swath of humanity. And as for the American contribution to this kind of thinking...what a shame that supposed "experts" thought (and still think) it's all right to play God and decide who's life is "worthy" of living. That's a misuse of scientific knowledge if there ever was one.

    By medrecgal (not verified) on 30 Aug 2006 #permalink

    It's interesting to note that the American eugenic program was Hitler's model for the T4 program. He is actually on record as having admired it, used it for his model, and said that he felt the Americans were ont he right track. This was specifically a response to the forced sterilization program in the US that had started in the 1920's and continued through the 50's.

    It's an awful condemnation on our own history.

    Actually, the chilling thing for me at least is that, on some level, these ideas make sense. The logical holes are much smaller in the case of sterilisation and euthanisation on mental health grounds versus racial grounds. As a normal, functioning human, it's easy to look at people with mental disabilities and see their "suffering". It isn't a far jump from there -- on coldly logical grounds -- to coming up with ways to "relieve" that suffering or at least prevent it by sterilisation.

    One of the tragedies of the mentally handicapped is that many people find their conditions horrifying. I mean, to be completely frank, the idea that I could have been born -- or could become through injury or disease -- mentally handicapped is simply terrifying to me. It would mean the destruction of everything I value about my own personal identity, not to mention my ability to function in normal society. I don't know. When I think about that, sometimes I think that I would rather be dead in that case.

    But it's easy to forget that the people who are born with these illnesses have no control over them any more than I do over being right-handed or brown-haired or whatever else. Nor do most of the people who develop these illnesses later in life have much control over that, either. Fate's a bitch.

    So it's helpful to remember that it's not a matter of "medical" logic alone and to reexamine the premises on moral grounds. Before you make any judgement, first you need to consider what you value. Do you value only efficiency? Sure, then maybe forced euthanisation seems like a good idea. It's hard to argue that it's not the best approach on the grounds of building an efficient, normative society. But compassion is another value, and it can be just as important or more important than efficiency. And, looking to myself as I did above, once I get past the initial horror I feel at considering the plight of the mentally handicapped, I remember what's so easy to forget whenever you consider a group in the abstract -- they're people, too. They have every right to live their lives, just as all humans do. And maybe I think their quality of life is less than what I'd accept, but so is the quality of life of an orphan born in a third world slum. But I wouldn't advocate the wholesale murder of third-world orphans, and I hope most other people would similarly abstain from pushing that point!

    So, it comes to a matter of value. Do we place an innate value on human life for its own sake, even if it's not a life we would choose for ourselves? Or do we draw a line and say this life is worth living and that life is not? That's a judgement for each person to make on their own, but I would caution those who would choose the second to think it through a little further and consider that lines can be moved and how they would feel if they chanced to fall on the wrong side...