Modern Bioethics and the Nazi Regime
The consideration of past atrocities in the field of human experimentation has vastly influenced bioethical debate in the past few decades, more than any other time in history. And rightly so. With such "scientific experiments" as the Tuskegee syphilis study, New Zealand's "Unfortunate Experiment" and the Nazi sterilization, "euthanasia" and experimentation regimes happening in the near past, and the vast leaps in scientific and technological knowledge occurring today, it is no wonder that bioethics is today a rapidly growing field, and is rapidly growing to become a part of our society. As a society, it is our duty to remember these misguided attempts to "further scientific knowledge for the betterment of humankind", in order that similar experiments do not occur in the future.
The Nazi regime in particular has had a large effect upon the bioethics of today, with much debate including the accusation of "Nazi" whenever human rights and human lives are put at stake. Doctors and scientists around the world are anxious not to repeat the mistakes of the Nazi regime in areas such as sterilization, euthanasia and human experimentation.
When Hitler became the Chancellor of the Third Reich in 1933, his party, the National Socialists, set about bringing in a law that was, as they saw it, to the betterment of the Aryan race. This law which would allow physicians to sterilize people who, in the words of Hitler himself were "in any way visibly sick or who have inherited a disease and can therefore pass it on."1 Within six months, the sterilization law had been passed and put into practice, and over the many years of National Socialist power, an estimated 200,000 to 350,000 people were sterilized. Mental conditions such as mental deficiency, schizophrenia, manic depressive insanity, epilepsy, Huntington's chorea and hereditary alcoholism accounted for the majority of sterilization's, but physical diseases or deficiencies which labelled a person for sterilization also included hereditary blindness, hereditary deafness, grave bodily malformations and "crippled" states such as club foot, cleft palate and harelip.
There seemed to be little opposition to these sterilization procedures from any physician in the country, indeed, in his essay Sterilization and the Nazi Biomedical Vision, Robert Jay Lifton states that the great majority of doctors he himself interviewed saw no reason to oppose the law at the time. Indeed, these doctors "believed the laws to be consistent with prevailing medical and genetic knowledge concerning the prevention of hereditary defects..."2 This lack of opposition is perhaps less surprising than it should be when the political climate of the time is considered.
However, far from being only a part of the Nazi's less than proud past, sterilization is still an issue today in many countries. A few years ago there was the resolution to a 10 year long court case in Michigan in the United States. The mother, who was also legal guardian, of a mentally disabled young woman, appealed to the courts to allow her to have her daughter sterilized. The case was approved by the probate court, but the Supreme court remanded the case to the Court of Appeals, who reversed the probate court's decision. The mother then appealed to the Michigan Supreme Court, who then overruled the Appeals Court, stating that the "probate court has the statutory authority to permit the plenary guardian of a ward to consent to a tubal ligation of the ward for birth control purposes,"3 and that "the Court of Appeals majority had failed to distinguish between the unfortunate history of forced eugenic sterilization and the separate concept of voluntary sterilization."4 They stated that since the ward was unable to exercise an important right, refusing the possibility of sterilization had made the decision for her just as allowing the sterilization would make the decision for her, and that "legislature has instead provided a mechanism designed to encourage a guardian, upon concluding it is in the ward's interests to apply to the probate court for an order authorizing the consent for an extraordinary procedure such as sterilization."5
Perhaps surprisingly to many people, Germany was spurred into this policy of sterilization by the example of the United States, which had been sterilizing inmates of penitentiaries for many years already. It was, however, the only country in which the "genetic cleansing" procedure of sterilization was eventually extended to the practice of what the Nazi's called "euthanasia". This transition from sterilization to "euthanasia" was a byproduct of the Nazification of the medical profession. This process was achieved through "a combination of ideological enthusiasm and systematic terror."6 A member of the medical faculty of the University of Berlin named Rudolf Ramm wrote of the "erroneous" belief that "a doctor should under no circumstances take a patients life, since for the incurably sick and insane, "euthanasia" was the most "merciful treatment" and "an obligation to the Volk (people of the Aryan or Nordic race)."7 Ramm stated that a physician was to become "a cultivator of the genes"8 or "a biological soldier"9 that is, one whose duty it was to protect the purity of the Aryan race. This practice of "euthanasia" was a racist ideal, carried out upon those who were, in the words of Thomas A. Cavanaugh:
"unsightly embarrassments to be gotten rid of: children with hydrocephaly, microcephaly or Down's syndrome; adults with withered legs, senility or epilepsy. Thus, the Nazi made the judgement that a life was not worth living in terms of and on behalf of a racist idealization of a biologically purified Aryan Volk."10
And in the midst of this racist environment, it was seemingly only a matter of time until the Nazi's began to see not only mentally and physically deficient people as what the Nazi's called lebensunwertes Leben, "life unworthy of life", but also began to see those people who were of any race other than Aryan, such as the Jews, as being equally deserving of eugenically therapeutic "euthanasia". And so began the Nazi Holocaust which is so well known today, where those who were classified as lebensunwertes Leben were not only killed in the millions, but also became the guinea pigs for a whole series of ghastly human experiments which were the basis from which the Nuremberg code was established in 1947.
Because of this erroneous misuse of the term "euthanasia" by the Nazi's to describe their needless, ruthless killing, advocates of voluntary euthanasia today, all over the world, must constantly battle against the Nazi parallel. Opponents constantly raise fears that if voluntary euthanasia is legalised, we will begin to slide down the "slippery slope" into euthanising people who cannot make the decision for themselves, but who we deem suitable to die. However, as Cavanaugh states, this argument is "ad hominem, the very weakest of arguments; indeed, perhaps no argument at all."11 An important distinction is to be made between Nazi "euthanasia" and voluntary euthanasia as it is advocated today. The similarity they share is the belief that some lives are not worth living, and that ending that life is therefore somewhat justified. The distinction, however, is that "the Nazi's regarded the subject, an individual human being, as not being worthy of the property of being alive, [while] contemporary advocates of ... VAE [voluntary active euthanasia] speak of life, under certain conditions, as not worth living. They regard the individual as having a property that is not worth having."12
This is the crucial difference. Euthanasia today is carried out for the benefit of, and with an expressive wish from the individual who is to die. The "euthanasia" of the Nazi regime was carried out for the supposed benefit to the Volk, and without the expressed wish of the person who was to die. This puts the two forms of euthanasia in vastly different categories, which bear no relation to each other.
The accusation of "Nazi", however, is most prevalent today whenever the use of human subjects for experimentation is considered. The horrific experiments the Nazi doctors performed upon the inmates of concentration camps, such as hypothermia experiments where subjects were left in freezing conditions simply to observe the effect on the human body, and which resulted in many deaths, are never allowed to stray far from any debate concerning the use of human subjects.
However, in a way we have the Nazi's to thank for the strict guidelines that govern human experimentation today. The Nazi war crimes were the basis from which the Nuremberg Code was established, and this was the first such document establishing a universal code of conduct under which experimenters must practice. The Nuremberg Code was also, no doubt, the forerunner of the Declaration of Helsinki, which is today the "Bible" of biomedical research involving human subjects.
If it were not for the atrocities performed by the Nazi's, would we be so strict on human experimentation today? Or would research projects such as the Tuskegee syphilis study be commonplace? Would our society have advanced to the moral standards we hold today without the nasty wake-up call provided by the actions of the Nazi's? This is a question it is not possible to answer, but that has been the cause for much speculation.
Another point to consider is that we must not simply point our finger at the Nazi's and say, "the experimentation and sterilization were only isolated to Germany, and only the Nazi's could be so evil", for that is far from the truth. Our culture has a bigoted view of the Nazi's as "almost mythically evil beings."13 Yes, they may be the only ones who escalated from sterilization into genocide, but the forced sterilization procedures they performed were occurring all over Europe and America both before and after the Holocaust.
So is all this reflection and speculation about the past valuable? Undeniably. A famous quote tells us that if we do not learn from our history, we are doomed to repeat it. This is a fact that has been proven again and again throughout the ages, when people have failed to learn from what their history had taught them. The question to ask here is, are we doomed to do the same? Will we, in these times of incredible scientific and technological advance, forget the crimes committed in the past, or somehow justify them so we can repeat them? In some parts of the world these lessons have still not been learnt. The recent genocide in Serbia and Croatia is a harsh reminder that although we say that we have grown beyond those morally clouded times, in truth we may only think we have. Therefore we must continue to keep the past in mind when we debate these delicate bioethical issues, in order that we do not unknowingly repeat the sins of the past.
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References
1 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 533.
2 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 537.
3 http://courts.co.calhoun.mi.us/ca020398.htm
4 http://courts.co.calhoun.mi.us/ca020398.htm
5 http://courts.co.calhoun.mi.us/ca020398.htm
6 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 537.
7 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 538.
8 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 537.
9 Lifton, R. J. 1999, "Sterilization and the Nazi Biomedical Vision", Contemporary Issues in Bioethics, Beauchamp, T.L & Walters, L. (eds) 5th edn, Wadsworth Publishing Company, Belmont, CA. p. 537.
10 Cavanaugh, T. 1997, "The Nazi Accusation and Current US Proposals", Bioethics, Vol. 11, no.3 & 4. p. 294.
11 Cavanaugh, T. 1997, "The Nazi Accusation and Current US Proposals", Bioethics, Vol. 11, no.3 & 4. p. 292.
12 Cavanaugh, T. 1997, "The Nazi Accusation and Current US Proposals", Bioethics, Vol. 11, no.3 & 4. p. 293.
13 Hentoff, N. et al. 1988, "Contested Terrain: the Nazi analogy in Bioethics" Hastings Center Report, Aug. Sep., p. 31.