Silence, Scapegoats, Self-Reflection: The Shadow of Nazi Medical Crimes on Medicine and Bioethics 9783737003650, 9783847103653, 9783847003656

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Formen der Erinnerung

Band 59

Herausgegeben von Jürgen Reulecke und Birgit Neumann

Volker Roelcke / Sascha Topp / Etienne Lepicard (eds.)

Silence, Scapegoats, Self-Reflection The Shadow of Nazi Medical Crimes on Medicine and Bioethics

With 8 figures

V& R unipress

Bibliografische Information der Deutschen Nationalbibliothek Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar. ISBN 978-3-8471-0365-3 ISBN 978-3-8470-0365-6 (E-Book) Ó 2014, V& R unipress in Göttingen / www.vr-unipress.de Alle Rechte vorbehalten. Das Werk und seine Teile sind urheberrechtlich geschützt. Jede Verwertung in anderen als den gesetzlich zugelassenen Fällen bedarf der vorherigen schriftlichen Einwilligung des Verlages. Printed in Germany. Titelbild: Ó Uli Mayer, Fulda Druck und Bindung: CPI buchbuecher.de GmbH, Birkach Gedruckt auf alterungsbeständigem Papier.

Contents

Jürgen Reulecke Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

Volker Roelcke, Sascha Topp, Etienne Lepicard Introduction: Conflicting Values in Medicine and Bioethics . . . . . . . .

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Post-War Trials: Setting Stages, Structuring Narratives Paul Weindling Consent, Care and Commemoration: The Nuremberg Medical Trial and Its Legacies for Victims of Human Experiments . . . . . . . . . . . . . .

29

Etienne Lepicard The Nuremberg Medical Trial and Its Reception in France and Israel, 1947 – 1952: A Comparative Perspective . . . . . . . . . . . . . . . . . . .

47

Annette Weinke Judging Medical Crimes in Divided Germany . . . . . . . . . . . . . . . .

87

Memories, Concerns, and Legal Issues of the Victims Helmut Bader The Voice of the Victims and their Families: The Case of Martin Bader

. 103

Rolf Surmann Rehabilitation and Indemnification for the Victims of Forced Sterilization and “Euthanasia”. The West German Policies of “Compensation” (“Wiedergutmachung”) . . . . . . . . . . . . . . . . . . 113

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Contents

Professional Organizations Gerrit Hohendorf The Sewering Affair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Sascha Topp Shifting Cultures of Memory : The German Society of Pediatrics in Confrontation with Its Nazi Past . . . . . . . . . . . . . . . . . . . . . . . 147 Donna Evleth The French Medical Association (L’Ordre des M¦decins) and the Nazi Past . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Rakefet Zalashik Nazi Medical Atrocities and the Israeli Medical Discourse from the 1940s to the 1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Past and Present: Debates on Implications for Professionalism and Ethics in Medicine James Kennedy The Legacy of National Socialism for the Dutch Euthanasia Debate

. . . 213

Isabelle von Bueltzingsloewen Starvation in French Mental Hospitals under Nazi Occupation: Misinterpretations and Instrumentalization since 1945 . . . . . . . . . . 231 Volker Roelcke Between Professional Honor and Self-Reflection: The German Medical Association’s Reluctance to Address Medical Malpractice during the National Socialist Era, ca. 1985 – 2012 . . . . . . . . . . . . . . . . . . . . 243

Dedicated Voices William E. Seidelman ‘Requiescat sine Pace’: Recollections and Reflections on the World Medical Association, the Case of Prof. Dr. Hans Joachim Sewering and the Murder of Babette Fröwis . . . . . . . . . . . . . . . . . . . . . . . . 281 Michael Wunder Learning with History : Nazi Medical Crimes and Today’s Debates on Euthanasia in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

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Contents

Appendix (Documentation) Jewish Medical Association of Palestine. Motion to the World Medical Association (1947). With an Introduction by Etienne Lepicard . . . . . . 315 Bund der “Euthanasie”-Geschädigten und Zwangssterilisierten / BEZ (Federation of Victims of “Euthanasia” and Forced Sterilization) (2008) . 327 Bundesärztekammer / BÄK (German Medical Association) (2008) . . . . 331 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN (German Association for Psychiatry, Psychotherapy, and Nervous Disorders) (2008) . . . . . . . . . . . . . . . 333 Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ (German Association of Child and Adolescent Medicine) (2008) . . . . . . . . . . 337 Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin / DGSPJ (German Association for Social Pedicatrics and Youth Medicine) (2008) . 341 Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ (German Association of Child and Adolescent Medicine) (2010) . . . . . . . . . . 345 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN (German Association for Psychiatry, Psychotherapy, and Nervous Disorders) (2010) . . . . . . . . . . . . . . . 349 Deutscher Ärztetag (German Medical Assembly): The Nuremberg Declaration (2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 Contributors

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 Index of Persons and Selected Institutions . . . . . . . . . . . . . . . . . 369

Jürgen Reulecke

Preface

As former spokesman of the Collaborative Research Center “Cultures of Memory” (Sonderforschungsbereich “Erinnerungskulturen”) at the University of Giessen, which was one of the sponsors of the conference “Memories and Representations of Nazi ‘Euthanasia’ in Post-World War II Medicine and Bioethics”, I am pleased that this omnibus volume with such an appealing topic and program is now available. By way of introduction, due to my great interest as a contemporary historian not only in the history of medicine, but also in related sciences like demography, psychoanalysis and psychogerontology, I would like to say something about a text written nearly seventy years ago that has fascinated me ever since I discovered it: a short essay from the year 1946, written by the psychoanalyst Alexander Mitscherlich who was 38 years of age at the time. Mitscherlich was born in Munich in 1908 († 1982). After earning a degree in history at the University of Freiburg, he began studying medicine. During this course of study (after serving a prison sentence during the Nazi regime) he was introduced by Viktor von Weizsäcker, a neurologist from Heidelberg, to the “biographical method” as the core concept of an “anthropological medicine”. Then Mitscherlich became the director of the German medical commission observing the Doctors’ Trial in Nuremberg, which began in November 1946 and ended with the sentencing to death of the seven main defendants in August 1947 and their ultimate execution in Landsberg in summer 1948. Here I would like to briefly outline one of Mitscherlich’s concepts, which I believe offers an outstanding prelude to the topics covered in the volume. His essay in the literary journal Die Fähre of late fall 1946, entitled Historiography and Psychoanalysis (Geschichtsschreibung und Psychoanalyse),1 written in response to his first impressions of the Doctors’ Trial in Nuremberg, amounted to an appeal to initiate a close cooperation between the two, still quite 1 Alexander Mitscherlich, “Geschichtsschreibung und Psychoanalyse: Bemerkungen zum Nürnberger Prozess”, in: Die Fähre 1(1), 1946, 29 – 39.

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distant disciplines. He entreated historians and psychoanalysts to contribute to a future in which “the nations [obtain] a truly refined ear for the tones of an impending disaster”, in order to “render the perpetrators harmless before the crime”, for all misdeeds always had a long history in the human psyche, which can never be entirely denied. However, with a view to us future generations of historians, Mitscherlich felt the need to establish that we, too, would presumably continue to direct our gaze only toward the “anonymity of an epoch, toward styles, files and battles”, overlooking the acting subjects, namely the interplay between their sensual and mental experience on the one hand, and their unconscious experience in the historical process on the other. Thus he demanded an “unsparing memory”, for one could only learn from history “if one has precise knowledge of the human gesticulation through which it is conveyed”. Therefore he advocated giving the defendants in Nuremberg the chance to submit themselves to intensive psychoanalysis, so that their personalities could be assessed without any “self-projection”. Analyzing historical events without linking them to insight into history and human nature presented a real danger that the individual defendants, who had appeared before the court in Nuremberg “like a band of street boys caught doing mischief”, would become the “national victims of (later) legends”. In my view Mitscherlich’s appeal is still justified today cum grano salis: Only gradually are historians opening up to suggestions from psychoanalysis, and just as gradually psycho-scientists are emerging who are willing to learn from historians that they must take seriously the long-term development from the here and now into what becomes history. This volume documents the forms and breadth of content in which the events in medicine during the National Socialist era became “legends” (Mitscherlich) – various narratives in the postwar period, which were then able to fulfill a wide variety of functions for the (de-)stabilization of the self-image of medicine as a profession, but were also applied to the (self-)critique of medical ideas and agendas as well as to legitimate positions on medical ethics. In this sense the volume presents a deep historical dimension, both to the self-conception of medicine and to the current debates about central issues of medical ethics and bioethics.

Volker Roelcke, Sascha Topp, Etienne Lepicard

Introduction: Conflicting Values in Medicine and Bioethics

In international debates on medical ethics, it is frequently assumed that in Germany there are specific, restrictive positions regarding euthanasia, human subject research, and human reproduction. For example, the author of an essay on “The Dilemmas of German Bioethics” in the US-American journal The New Atlantis talks of the “burden of history” responsible for the hesitancy to accept new biotechnologies in relation to medicine and human reproduction: Supposedly, “Germany has enacted some of the strictest bioethics policies in the world” on euthanasia, experimentation with human subjects, and “manipulation of nascent human life”.1 Others speak of the public discussion in Germany as being “haunted” by its past.2 Moreover, its Nazi past is used to explain Germany’s allegedly unique position among European countries on the topic of euthanasia, an issue generally discussed in all the other countries in the same terms as abortion, divorce and homosexuality, namely as something with individual autonomy at its core.3 Even in the German bioethics community itself, there is a widespread conviction and critique that core bioethical issues, especially surrounding end-of-life decisions, may not be freely discussed in the broader public, due to “the trauma inflicted by National Socialism”. Triggered by conflicts around the highly controversial Australian bioethicist Peter Singer, but not restricted to this context, one protagonist of such critical views even characterized certain ethical positions that refer to the Nazi past as “anti-

1 Eric B. Brown: “The Dilemmas of German Bioethics”, in: The New Atlantis – A Journal of Technology and Society, Spring 2004, 37 – 53, here 38, 39; available at http://www.thenewatlantis.com/publications/the-dilemmas-of-german-bioethics (accessed 30 August 2014). 2 Edward Stourton: “Germany’s eugenics controversy”, BBC News World Edition, 12 April 2001, available at http://news.bbc.co.uk/2/hi/programmes/correspondent/europe/1272125.stm (30 August 2014). 3 Joachim Cohen, Isabelle Marcoux, Johan Bilsen et al.: “Trends in acceptance of euthanasia among the general public in 12 European countries”, in: European Journal of Public Health 16, 2006, 663 – 669, here 667.

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bioethics” – a polemic published in the prestigious bioethics journal The Hastings Center Report.4 Thus, the impact of the Nazi past on present-day German debates in medical ethics is widely taken for granted. It appears to be clearly fixed and almost selfevident, and beyond any need for further questioning or even investigating whether this impact is the same for all the fields of medical ethics named above, or whether the references to and consequences drawn from the past can potentially change over time. At the same time, in many, if not most such evaluations, it is assumed that the repercussions of the Nazi past are specific to Germany, and – what is more – that they may perhaps be understandable, but are not really justified.5 However, some probing analyzes of the historical knowledge used in such critiques by bioethicists have shown that bioethicists’ rejections of references to the Nazi past of medicine have frequently operated with stereotypes, and do not make use of the latest available historiography.6 One might ask whether the perceived link between recollections of the Nazi past and supposedly restrictive ethical positions really does exist, and – if it does – whether it is as static as frequently assumed. A further question is whether such a link is really unique in the international context. Have there really not been any debates on the implications of Nazi medical atrocities in the medical communities of other European countries, in Israel, or the United States, and – if so – what were the specific contexts and actors, and why did such discussions and deliberations disappear (if at all) over time? As a matter of fact, since the end of World War II, Nazi medical atrocities have been a topic of ambivalent and constantly changing reactions and debates, both in Germany and internationally. After the initial legal proceedings, among which the Nuremberg Medical Trial (1946/47) received particularly broad international publicity,7 the public attention quickly receded by the end of the 1940s with the 4 Bettina Schöne-Seifert, Klaus-Peter Rippe, “Silencing the Singer : Antibioethics in Germany”, in: The Hastings Center Report 21, 1991, 20 – 27, quotation from the abstract. 5 See, e. g., Schöne-Seifert/Rippe, 1991; Barbara Guckes, Das Argument der schiefen Ebene: Schwangerschaftsabbruch, die Tötung Neugeborener und Sterbehilfe in der medizinethischen Diskussion, Stuttgart: Gustav Fischer 1997; Brown, 2004; Roland Kipke, “Schiefe-Bahn-Argumente in der Sterbehilfe-Debatte”, in: Zeitschrift für medizinische Ethik 54, 2008, 135 – 146. 6 See Hans-Walter Schmuhl, “Nationalsozialismus als Argument im aktuellen MedizinethikDiskurs: Eine Zwischenbilanz”, in: Andreas Frewer, Clemens Eickhoff (eds.), “Euthanasie” und die aktuelle Sterbehilfe-Debatte: Die historischen Hintergründe medizinischer Ethik, Frankfurt/Main 2000, 385 – 407; Eva Corinna Simon, Geschichte als Argument in der Medizinethik: Die Bezugnahme auf die Zeit des Nationalsozialismus im internationalen Diskurs (1980 – 1994), Diss. Med., Giessen University 2004. 7 On the Nuremberg Medical Trial and other legal proceedings, see, e. g., Dick de Mildt, In the Name of the People: Perpetrators of Genocide in the Reflection of their Post-War Prosecution in West Germany : The “Euthanasia” and “Aktion Reinhard” Trial Cases, The Hague: Martinus Nijhoff 1996; Hanno Loewy, Bettina Winter (eds.), NS-“Euthanasie” vor Gericht: Fritz Bauer

Introduction: Conflicting Values in Medicine and Bioethics

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beginning of the Cold War. Although many victims of the atrocities wrote about their experiences in the early postwar period, their accounts found little resonance. A prolonged early period of (near) silence was followed by renewed attempts by victims, and later individual physicians and representatives of medical organizations, to describe what had happened.8 Varying narratives developed, some of which served to stabilize the identity of the profession, whereas others had a critical and destabilizing effect. Three basic narrative paradigms may be differentiated, which emerged consecutively since the 1960s, and some of which still coexist in Germany today : First, an isolationist paradigm, characterized by presumed historical discontinuities and the isolation of individual perpetrators. It created an image according to which the Nazi period was an isolated phenomenon in medicine, and those responsible for medical atrocities were isolated in the profession. It also implied that the culprits could be brought to trial, and that the “problems” of medicine began in 1933 when the Nazis came to power, that is, that they were the und die Grenzen juristischer Bewältigung, Frankfurt/M./New York: Campus 1996, 35 – 58; Michael Marrus, “The Nuremberg Doctors’ Trial in historical context”, in: Bulletin of the History of Medicine 73, 1999, 106 – 123; Christian Bonah, Etienne Lepicard, Volker Roelcke (eds.), La m¦decine exp¦rimentale au tribunal: Implications ¦thiques de quelques procÀs m¦dicaux du XXe siÀcle europ¦en, Paris: Êditions des Archives Contemporaines 2003; Paul J. Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent, Houndmills/Basingstoke: Palgrave Macmillan 2004; Michael S. Bryant, Confronting the “Good Death”: Nazi Euthanasia on Trial 1945 – 1953, Boulder, Colorado: The University Press of Colorado 2005. Little research has been performed on the reception of the Nuremberg Medical Trial and of specific medical atrocities, but see: Etienne Lepicard, “Trauma, Memory, and Euthanasia at the Nuremberg Medical Trial, 1946 – 1947”, in: Austin Sarat, Nadav Davidovitch, Michal Alberstein (eds.): Trauma and Memory : Reading, Healing, and Making Law, Stanford: Stanford University Press 2007, 204 – 224. 8 For an early analysis of this silence, see “1946 – 1996, Le procÀs des m¦decins — Nuremberg: Êthique, responsabilit¦ civique et crimes contre l’humanit¦ – Actes du colloque tenu — l’UNESCO les 7 et 8 d¦cembre 1996”, in: Revue d’Histoire de la Shoah, no. 160, Mai-Ao˜t 1997. For a few random examples of victims’ voices, see, e. g., Miklos Nyiszly, Auschwitz: A doctor’s eyewitness account, New York: Fell 1960; Wanda Poltawska, And I am afraid of my dreams, London: Hodder & Stoughton 1987 (orig. in Polish, 1962); for voices of individual physicians, see e. g. Henri Baruk, “Les m¦decins allemands et l’exp¦rimentation m¦dicale criminelle”, in: Revue d’histoire de la m¦decine h¦braique 7, 1950, 7 – 21; Leo Alexander, “Medical Science under Dictatorship”, in: New England Journal of Medicine 241, 1949, 39 – 47; Leo Alexander, “Ethics of Human Experimentation”, in: Psychiatric Journal of the University of Ottawa 1 (1 – 2), 1976, 40 – 46; Helmut Ehrhardt, Euthanasie und “Vernichtung lebensunwerten Lebens”, Stuttgart: Enke 1965; Klaus Dörner, “Nationalsozialismus und Lebensvernichtung”, in: Vierteljahrshefte für Zeitgeschichte 15, 1967, 121 – 152; Hartmut M. Hanauske-Abel, “From Nazi Holocaust to Nuclear Holocaust: A Lesson to Learn?”, in: The Lancet 328, 1986, 271 – 273; William Seidelman, “Mengele medicus: Medicine’s Nazi heritage”, in: Milbank Quarterly 66, 1988, 221 – 239; Frank Schneider (ed.), Psychiatrie und Nationalsozialismus, Berlin: Springer 2011; more comprehensive bibliographic information is given in the specific chapters of this volume.

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result of outside political pressure. Thus, a few scapegoats within the field of medicine were blamed, while medicine as a profession remained “uncontaminated”. There was almost no interest in the perspective or the suffering of the victims of the atrocities, nor attempts to support them, for instance, with measures for rehabilitation or compensation. Second, the continuity paradigm: It assumed and focused continuities on the level of physicians’ careers, institutional structures, patterns of medical thought, and basic value orientations across the political breaks in 1933 and 1945. Accordingly, the medical atrocities were not simply the result of outside pressure from 1933 onwards, but rooted at least as much in latent, problematic potentials inherent in modern medicine itself. This kind of narrative justified a fundamental critique of postwar medicine. It was associated with first attempts to identify surviving victims and to support them, both on a personal level and in finding public and political recognition. Third, a complex-localizing paradigm which combined features of both preceding paradigms, but went beyond them. It conceded that there had been outside pressures on medicine, as well as such contributing factors as overarching mental dispositions (including value hierarchies). But it also pointed to the specificities and complexities of local constellations, and to the scope of choice generally available for individual and group action. This perspective increased the burden of responsibility on the part of physicians involved up to 1945, as well as the necessity for self-reflection by members of the profession in the postwar period.9 However, in contrast to the by now extensive historiography on medicine during the Nazi period,10 studies which systematically examine the historical dynamics of the references to the Nazi past in post-World War II medicine and bioethics are scarce, and the few existing publications address only very circumscribed issues or individual institutions. Apart from the accounts of the 9 Volker Roelcke, “Trauma or Responsibility? Memories and Historiographies of Nazi Psychiatry in Postwar Germany”, in: Austin Sarat, Nadav Davidovich, Michal Alberstein (eds.), Trauma and Memory: Reading, Healing and Making Law, Stanford: Stanford University Press 2007, 225 – 242. 10 For the most recent synthesis on human subject research during the Nazi period, see Paul J. Weindling, Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust, London: Bloomsbury 2014; on the programs of patient killings (“euthanasia”), see Maike Rotzoll et al. (eds.), Die nationalsozialistische “Euthanasie”-Aktion ‘T4’ und ihre Opfer, Paderborn: Schöningh 2010; Gerrit Hohendorf, Der Tod als Erlösung vom Leiden, Göttingen: Wallstein 2013; for a general overview, see Volker Roelcke, “Medicine During the Nazi Period: Historical Facts and Some Implications”, in: Sheldon Rubenfeld (ed.), Medicine After the Holocaust, New York: Palgrave Macmillan 2010, 17 – 28; an updated German version of this overview is published as “Medizin im Nationalsozialismus – radikale Manifestation latenter Potentiale moderner Gesellschaften? Historische Kenntnisse, aktuelle Implikationen”, in: Heiner Fangerau, Igor Polianski (eds.), Medizin im Spiegel ihrer Geschichte, Theorie und Ethik: Schlüsselthemen für ein junges Querschnittsfach, Stuttgart: Franz Steiner 2012, 35 – 50; see also Wolfgang U. Eckart, Medizin in der NS-Diktatur: Ideologie, Praxis, Folgen, Vienna: Böhlau 2012.

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immediate postwar trials,11 these studies focus almost completely on postwar German medical and bioethical contexts, thereby ignoring potential similar developments in other national contexts, or in the international community of physicians and bioethicists (such as the World Medical Association, WMA). What is more, most of these publications do not explore the broader implications of the individual cases. Thus, a first, very selective sketch of reactions in the German medical community up to the early 1990s is given in an article by Norbert Jachertz, commissioned by the German Medical Association (Bundesärztekammer, BÄK).12 A detailed and carefully analyzed study by Thomas Gerst is limited to the immediate postwar period.13 An outline for the following decades up to the 1980s is given in an article by Stefanie Westermann, using the BÄK’s journal Deutsches Ärzteblatt as an exemplary source.14 Further studies address, e. g., the strategies of university medical schools and their representatives in dealing with the Nazi past, specific medical disciplines such as psychiatry or pediatrics, or representatives of professional organizations.15 So 11 See fn. 7. 12 Norbert Jachertz, “Phasen der ‘Vergangenheitsbewältigung’ in der deutschen Ärzteschaft nach dem Zweiten Weltkrieg”, in: Robert Jütte (ed.), Geschichte der deutschen Ärzteschaft, Cologne: Deutscher Ärzteverlag 1997, 275 – 288 (for a critical analysis of this article, see the chapter by Volker Roelcke in this volume). 13 Thomas Gerst, Ärztliche Standesorganisation und Standespolitik in Deutschland 1945 – 1955. Stuttgart: Steiner 2004. 14 Stefanie Westermann: “‘Die deutsche Ärzteschaft und ihre Standesvertretung will auch heute mit solchen Personen nichts zu tun haben’: Die NS-Medizin im Spiegel des Deutschen Ärzteblatts”, in: Richard Kühl, Tim Ohnhäuser, Gereon Schäfer (eds.): Verfolger und Verfolgte: ‘Bilder’ ärztlichen Handelns im Nationalsozialismus, Berlin: LIT-Verlag 2010, 241 – 259. 15 For university medical schools, see Sigrid Oehler-Klein, Volker Roelcke (eds.), Vergangenheitspolitik in der universitären Medizin nach 1945: Institutionelle und individuelle Strategien im Umgang mit dem Nationalsozialismus, Stuttgart: Franz Steiner 2007; for particular medical disciplines, see Gerrit Hohendorf, “The Representation of Nazi Euthanasia in German Psychiatry 1945 to 1998: A Preliminary Survey”, in: Korot – The Israeli Journal of the History of Medicine 19 (for 2007/2008), 2009, 29 – 48; Sascha Topp, “Remembering Nazi ‘Euthanasia’ in Post-War Germany : The Case of German Pediatrics”, in: Korot – The Israel Journal of the History of Medicine and Science 19 (for 2007/2008), 2009, 49 – 64; idem, Geschichte als Argument in der Nachkriegsmedizin: Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie, Göttingen: V & R unipress 2013, 41 – 56; for further specific aspects, see also Franz-Werner Kersting, Karl Teppe, Bernd Walter (eds.), Nach Hadamar : Zum Verhältnis von Psychiatrie und Gesellschaft im 20. Jahrhundert, Paderborn: Schöningh 1993; Michael Kater, “The Sewering Scandal of 1993 and the German Medical Establishment”, in: Manfred Berg, Geoffrey Cocks (eds.), Medicine and Modernity : Public Health and Medical Care in Nineteenth- and TwentiethCentury Germany, Cambridge/New York: Cambridge University Press 1997, 213 – 234; Roelcke, 2007; Stefanie Westermann, Richard Kühl, Tim Ohnhäuser (eds.), NS-‘Euthanasie’ und Erinnerung: Vergangenheitsaufarbeitung, Gedenkformen, Betroffenenperspektiven, Berlin/Münster, LIT-Verlag 2011.

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far, conceptual issues related to the construction of collective memories of the medical field’s Nazi past have been addressed only in an article by Sascha Topp, one by Lutz Kaelber, and in the introduction to a special issue devoted to the topic in Korot – The Israel Journal of the History of Medicine and Science (2007/ 2008).16 It is the aim of this volume to address the outlined issues in a more comprehensive and systematic manner and on an international level. It analyzes the emergence and dynamics of postwar narratives on Nazi medical atrocities in various national contexts, such as France, Germany, Israel, and the Netherlands, as well as the references to the Nazi past in the international discourse on biomedical ethics. The focus is on the following aspects in particular : legal proceedings in the immediate postwar period, with special attention to the Nuremberg Medical Trial (1946/47) (in the following: NMT) and its reception in various national contexts; debates and scandals concerning representatives of the profession, and associated narratives; collective memories and identity politics of professional medical organizations; and, finally, conclusions for ethics and medical professionalism drawn by historical actors, including victims and professional organisations. The first part focuses on postwar trials which addressed medical atrocities, thereby setting the stage for the structure of emerging narratives. Paul Weindling focuses on the NMT and its legacies, in particular the emergence of what was later (since the 1960s) referred to as the “Nuremberg Code”, the concept of “enlightened consent”, as well as the implications of historiographical approaches taking into account the perspective of the victims of medical atrocities. Here, the hitherto neglected importance of commemoration and care of victims of medical experiments is illuminated. Etienne Lepicard explores how the narratives on Nazi medical atrocities developed in the immediate aftermath of World War II within the medical communities of France and Israel. His study, based on the comparative survey of two leading medical journals in each country (La Presse m¦dicale, le Concours m¦dical, Mikhtav le-haver and Dapim refuiyim) takes as its starting point 1947, 16 Sascha Topp, “Collective Memory : Representation of National Socialist Euthanasia”, in: Korot – The Israel Journal of the History of Medicine and Science 19 [for 2007/2008], 2009, 11 – 27; Volker Roelcke, Etienne Lepicard, “Medical Narratives on National Socialist Euthanasia: Professional Identity and Ethics between Politics of Memory and Historiography, ca. 1945 – 2000: Introduction”, in: Etienne Lepicard, Volker Roelcke (eds.), Medical Narratives on National Socialist Euthanasia: Professional Identity and Ethics between Politics of Memory and Historiography (= Korot – The Israel Journal of the History of Medicine and Science 19 for 2007/ 2008), 2009, Special Issue, 3 – 9; Lutz Kaelber, “Child Murder in Nazi Germany : The Memory of Nazi Medical Crimes and Commemoration of ‘Children’s Euthanasia’ Victims at Two Facilities (Eichberg, Kalmenhof)”, in: societies 2, 2012, 157 – 194. doi:10.3390/soc2030157; for further information see: http://www.uvm.edu/~lkaelber/ (24 September 2014).

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the year in which the WMA was established. While La Presse m¦dicale reflected the perspective of the Paris medical establishment, and indeed published accounts of the NMT as well as the ten principles of medical research ethics, the main place (lieu de m¦moire in Pierre Nora’s terms) where the Nazi medical atrocities were addressed was at the first meeting of the WMA in Paris in September 1947. There, another type of narrative developed, shaped by the personal experience of both Jewish survivor-physicians and former deportee-physicians, who requested a formal apology from the German medical community. It was not until the early 1950s, however, that the first attempts were made to address contemporary issues of medical ethics from a historical perspective. As a core example for this, Lepicard presents the case of the Jerusalem Declaration on Medical Ethics (1952). Annette Weinke reconstructs the prosecution of Nazi medical crimes during the Allied military governments and in the first decades of divided post-war Germany. She identifies specific contexts in the two German states which help to explain the phenomenon of remarkably mild or even missing sentences pronounced by the courts. Beyond the already ambivalent positions of Allied judges towards aspects like human experimentation, basic assumptions and attitudes on the side of German authorities were frequently based on former traditions of German adjudication. Weinke implies that this may not simply be considered as a side-effect, but rather as the core of a more general kind of politics of memory (Vergangenheitspolitik) advocated by the judicial and medical communities as well as e. g. the churches: a politics characterized by commonly shared exonerating formulae – such as “mercy killing” – and furthermore by efforts to integrate former Nazi representatives into postwar society. And even new social developments in the Federal Republic in the 1960s and 1970s, such as the student protest movement, the strong efforts of the Frankfurt chief prosecutor Fritz Bauer, the Eichmann trial or the foundation of critical research institutions, did only slowly develop a deeper impact on the lenient policy of judging medical crimes. The second part of the volume focuses on the perspective of the victims of Nazi medical atrocities, their memories, concerns, and legal issues as viewed from their point of view. Helmut Bader, son of a victim of the medical killings (“euthanasia”), gives a very personal account both of his father Martin’s biography and the family’s difficulties in dealing with the initially “lost” memory. Based on the results of personal research, the author embarks on a journey in which he himself – and with him, the reader – will meet his father (again). Complemented by the family memory of the mother’s bitter and ultimately unsuccessful struggle for compensation in postwar Germany – she died in 1986 – this testimony is exemplary for thousands of wives, husbands, brothers and

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sisters, sons and daughters whose suffering went unheard prior to and again after 1945. From the immediate postwar period onwards, the West German politics of compensation excluded victims of the Nazi sterilization and euthanasia programs from any kind of indemnification. The argument was that they had not been victim of “typical National Socialist injustice”, in particular anti-Semitism, or atrocities in the context of Nazi warfare. Rolf Surmann analyzes the development of these politics of compensation by analyzing legislative texts, ministerial statements, expert panel proceedings and parliamentary debates. He reconstructs how – compared to other victim groups – those suffering from the consequences of medical crimes were marginalized time and again over decades. Some of the medical experts involved in the compensation debates – including even former perpetrators – combined the refusal of compensation claims with demands for a new sterilization law in the early 1960s. In addition, the Ministry of Finance in the (Konrad) Adenauer era strongly shaped the political discussion. As Surmann reconstructs, it was only from the 1980s onward that as a consequence of changing political cultures, the foundation of a new victim organization as well as the activities of younger representatives from the medical profession, some modest improvements could be achieved on behalf of the “forgotten victims” of over-restrictive indemnification rules. The main steps of political recognition of this group of victims (1988, 1998, 2006) took almost too long as many of those concerned already had died. Professional organizations, their representatives, and their strategies of addressing medical atrocities that occurred during the Nazi period are at the center of the following part of the volume. Gerrit Hohendorf analyzes the case of Hans Joachim Sewering, former president of the BÄK and in the early 1990s presidentelect of the WMA. Sewering had to withdraw from the office of WMA-president in January 1993 after mounting public pressure on him as well as on the WMA following accusations that he had been responsible for the death of a 14-year old girl in the context of the program of child euthanasia. Next to the historical facts available in the early 1990s, Hohendorf reconstructs three distinct narratives of relevant actors in the conflict, namely the narrative of Michael Franzblau, an American physician who was among the group insisting on Sewerings withdrawal and thereby relied on a fixed image of the “Nazi doctor”; the narrative of Sewering himself of the past events as given in public statements and in an interview with the author ; and that of representatives of the catholic institution Schönbrunn in Bavaria which had been home of the killed girl, and for which Sewering had acted as interim medical director in the years from 1942 onwards. Hohendorf documents that it was only a change of strategy of the catholic institution in defending the nuns who had worked in Schönbrunn at the time which resulted in a sudden implausibility of Sewering’s account of the past. Until

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that shift of strategy, Sewering’s account had resonated well with broader postwar exonerating narratives of unknowledgeable physicians which had been instrumentalized or even mislead by the regime. Sascha Topp addresses the question in which constellations the crimes of Nazi child euthanasia were referred to in the professional organization of German pediatrics (Deutsche Gesellschaft für Kinderheilkunde/DGK). Four distinct phases of dealing with the past may be identified. Until the end of the 1950s, the DGK made every effort to go back to day-to-day business and to again become internationally integrated in the scientific community. Therefore at the level of the DGK’s board, there was a mere silence on the years between 1933 and 1945, and former NSDAP members as well as protagonists of Nazi euthanasia were unanimously accepted in the association’s ranks. However, at the beginning of the 1960s, pediatricians had to deal with the issue anew since Professor Werner Catel, member of the DGK and one of the main protagonists of the child killing program was at the core of a public scandal. His renewed and public claim for legitimate “limited euthanasia” of severely malformed children – so-called “monsters” – provoked a wide range of reactions. Two groups in particular stood against him: representatives of social pediatrics, aiming for the rehabilitation of children with combined disabilities, as well as particular members of the DGK who had suffered Nazi persecution. Catel also functioned as a scapegoat, since all critical attention resulting from confronting the killing program was focused on him, whereas the broader involvement of the community of pediatrics was not looked at. The Catel dispute had a deep impact: First, on subsequent debates on medical ethics, here in terms of a significant delay of discussing important questions of the medical treatment of handicapped children; and second (in association with the upcoming of a new generation in medical schools and professional networks), a profound shift within the cultures of memory in the 1990s, resulting in new forms of representation of what had happened before 1945. Concerning the most recent phase of critical self-reflection, the author uncovers a process of internalization of the precarious past into the self-image of the association’s members and representatives, consisting of two consecutive steps: the recognition of the fate of Jewish colleagues by the end of 1990s, as well as the activities to implement a living memory of the victims of Nazi child euthanasia and their relatives (since 2012). The chapter by Donna Evleth examines the French Medical Association (l’Ordre des M¦decins) created by the Vichy government in October 1940 to regulate the practice of medicine in France. It describes the anti-semitism that existed within the Ordre during the Vichy period from 1940 to 1944, and the way in which the governing body of the Ordre, the Conseil Sup¦rieur, implemented the anti-semitic legislation of the Vichy regime. The chapter goes on to discuss the new Ordre des M¦decins created in 1945. It focuses on this new Ordre’s

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characteristic method of dealing with its Vichy and anti-semitic past: amnesia and silence. The silence was not broken until 1997, when Bernard Glorion, then president of the Ordre, made a public statement of repentance for the Ordre’s exclusion of the Jews during the Vichy period. Yet this statement was not endorsed by the Ordre as a whole. Rakefet Zalashik investigates how the medical discourse in Jewish mandatory Palestine and Israel was affected by, first, the news about the Nazi medical atrocities that reached the Yishuv, i. e. the Jewish community in mandatory Palestine, and then the first-hand testimonies of survivor-physicians. She identifies two main periods – the pre-state (1942 – 1948) and the Israeli stages (1948 – 1980s), which she presents in detail by analyzing the publications of Israeli physicians from the early 1940s up to the 1990s. She documents the relative absence of broader debates on the related issues during the second period, and the transition that occurred in the 1990s with the development of a curriculum on the topic in Israeli medical schools. The next section of the volume looks into post-war debates on potential implications of Nazi medical atrocities for ethics and professionalism in medicine. James Kennedy describes the references to the patient killings during the Nazi period in post-war Dutch discussions on euthanasia which were initiated by the booklet Medische macht en medische ethiek (“Medical Power and Medical Ethics”), published in 1969 by the psychiatrist and psychologist Jan Hendrik van den Berg. The booklet articulated the public unease about medical capabilities (in particular regarding intensive care treatment) that seemed to go beyond the humane. Van den Berg used this unease to argue for the right to die and to legitimate mercy killing. The debate took place mainly in the 1970s and early 1980s and lead to a shift in publicly accepted value hierarchies, from a priority of the sanctity of life to a preference for continuing life only where it was judged as “meaningful”. The decision about the meaningfulness of life was seen to be completely up to the individual concerned, implying that it was voluntary, and that the individual was acting in full autonomy. Initial critical arguments that there might be larger social and economic ramifications at work which might exert pressure on the decision of those concerned, or create the plausibility of assumed consent in the absence of the ability to decide, had disappeared by the early 1980s. References to the Nazi past, present in the initial phase of the debate, did not strengthen the cautionary position towards euthanasia, but to the contrary : Since National Socialism supposedly had nothing to do with the Dutch past, according references – it was argued – were not applicable to the Dutch context. As a result of this development, it was seen as the task of the physician to help the patient in case of his or her voluntary decision to die. Isabelle von Bueltzingsloewen documents and analyzes the broad resonance of the allegation, since the early 1980s, that the excessive mortality in French

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psychiatric asylums during World War II was the result of a deliberate decision of the Vichy regime to let the mentally ill people starve to death. According to the rumor, this phenomenon amounted to a French “euthanasia” program comparable to the “T4” program perpetrated by German physicians together with the Nazi state. In her book published in 2007, L’H¦catombe des fous, Bueltzingsloewen has already demonstrated the inanity of what she called “the gentle extermination thesis”. In particular, she showed that, if there had indeed been an excessive mortality, it was due not to any deliberate decision, but to a lack of solidarity within French society. After summarizing the main findings of her extensive previous study, Bueltzingsloewen in the present contribution addresses the question as to how such a weak thesis could spread so easily and so quickly over these last two decades. According to her analysis, one central explanatory factor is the instrumentalization of the “gentle extermination thesis” within the psychiatric profession, and from outside, for a critique and reform of institutions of psychiatric care. Since the 1980s, both public debates on the Holocaust, and activities in medical historiography confronting the Nazi period have markedly intensified in the German national context. Volker Roelcke reconstructs the long path of the BÄK from defensive and self-exonerating reactions to outside critique towards an acknowledgement of the initiative and responsibility of medical organizations themselves, and their representatives, for many, if not most of the medical atrocities during the Nazi period. Starting with the strong reaction of the BÄK-president Karsten Vilmar after a critical essay in the prestigious British medical journal The Lancet, Roelcke analyzes the further steps to self-reflection, and an increasing readiness to see the duty of the organized medical profession not only in protecting its supposedly endangered image, but also in confronting the causes and corollaries of extreme forms of misconduct. Exemplary stages in his reconstruction are the project of a published edition of the NMT protocols and evidence, the debates and activities around the re-detected patient files of the “Aktion T4”-medical killing program, as well as topic statements by BÄK representatives and publications commissioned by the organization, converging in the Nuremberg Declaration of the German Medical Assembly (Deutscher Ärztetag) in 2012. The various references of the BÄK to the Nazi period at these particular occasions implied specific and changing images and narratives of this past. Next to the hesitant development of self-reflection on the side of BÄKrepresentatives, Roelcke’s analysis points to the fact that time and again, the dynamic of this process was driven not by the respective presidents, or the board of the BÄK, but rather by individuals or groups who were marginal to the organization, and occasionally even viewed as whistle blowers (as in the case of the Lancet-author Hartmut Hanauske-Abel). The two concluding chapters represent dedicated voices from two different

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perspectives on the repercussions from the Nazi period for present day medicine and bioethics. William Seidelman speaks as a physician with comprehensive clinical experience in treating Holocaust survivors, and at the same time conscious of problematic traditions and value hierarchies implicit in modern medicine, including the Nazi period. Having personally been involved in the debates around the former BÄK-president and WMA-president elect Hans Joachim Sewering in the early 1990s, he recounts official and background activities and statements of BÄK- and WMA-representatives, as well as those physicians critical towards Sewering taking office. He documents the BÄK’s polemic interpretation of Sewering’s withdrawal as a consequence of activities of the World Jewish Congress, and on the other hand it’s lack of interest, and explicit repentance regarding the fate of Babette Fröwis, the girl in whose killing Sewering was involved. Michael Wunder, a clinical psychologist, represents the working group on the history of Nazi euthanasia and forced sterilization (Arbeitskreis zur Erforschung der NS-Euthanasie und Zwangssterilisation), formed in the early 1980s in the context of larger social movements and the history workshop movements, and closely associated with the central organization of those concerned by forced sterilization and euthanasia. As an outspoken voice of these groups, Wunder is also member of the German Ethics Council (Deutscher Ethikrat). In his contribution, he compares the normative arguments and the available empirical evidence on the practice of euthanasia between the present German bioethical debate, the debates and practices in the Netherlands since the early 1990s, and the Nazi period. He argues that although it is not possible to directly learn from history, it is necessary to learn with history in the sense of clarifying the historical implications and dynamics when talking about the supposed autonomous decisions on the value of an individual’s life. The volume is completed by an appendix with a number of official statements on the relevance of Nazi medical atrocities for postwar medicine and bioethics by various medical organizations (from the Motion of the Jewish Medical Association of Palestine, 1947, to the Nuremberg Declaration of the German Medical Assembly, 2012) and by the organization of victims of euthanasia and forced sterilization (the former Bund der Euthanasie-Geschädigten und Zwangssterilisierten). Beyond their immediate documentary value, these documents are contextualized and analyzed in some detail in particular in the contributions by Etienne Lepicard, Volker Roelcke, and Sascha Topp. Given the variety of contributions to this volume and their multitude of perspectives and national contexts, some insights and conclusions may be summarized with regard to conflicting values in medicine and bioethics: The striking early silence, or else exculpatory strategies, like pointing to individual scapegoats, or minimizing the extent of atrocities initiated by physicians (and

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instead referring to outside actors like “the state”, or “the Nazi regime”) may all be understood as responses to a major concern of physicians’ organizations and their representatives: the concern that confronting the question of the potentially broad involvement and even the initiative of physicians and their representatives in the atrocities could imply imminent danger to the reputation of, and trust in, the profession and its organizations, both in the public sphere as well within the international scientific community. Interestingly, this concern implied the potential for contradicting modes of action. Over decades this fear stimulated harsh reactions like the refusal to accept supposed accusations of collective guilt, as well as a general avoidance of confronting the past other than through stereotypical formulas about the criminal nature of the political regime. However, since the 1990s and coinciding with the end of the Cold War, new approaches to accepting historical responsibility may be observed, culminating even in public apologies. Apparently, these activities are again important for the self-image, and concern on reputation of German medical associations or for the way they are perceived abroad, since now it is perceived to result in bad reputation if an institution would not be prepared to confront its Nazi past. Such activities were part of a broader stream of public apologies on the international level occurring around the turn of the millennium.17 These developments indicate the extent to which debates on medical atrocities were and are intermingled with and embedded in wider national and international representations of the Nazi past. On another level, the various cases presented here document that, as long as strategies of rejection of guilt dominated professional medical groups, most of the critical questions and considerations originated either from outside of the professional groups or from their margins, but not from the center, that is, from representatives of such organizations. As documented in several chapters (e. g., those by Hohendorf, Lepicard, Roelcke, Seidelman, Topp, Weindling, and Zalashik), the victims of Nazi medical crimes or individual physicians who had close ties to and knowledge of the suffering of victims of medical atrocities were frequently the first and often isolated voices who could be understood as agents of memory. Regarding bioethical debates, the exemplary cases presented here (e. g., in the chapters by Kennedy, Topp, Weindling, Wunder) show persistently recurring motives and argumentations, for instance with regard to end-of-life decisions since the beginning of the 20th century. Despite the deep social shifts in the second half of the last century, it becomes obvious that current justifications of 17 See Carola Sachse, “Was bedeutet ‘Entschuldigung’? Die Überlebenden medizinischer NSVerbrechen und die Max-Planck-Gesellschaft”, in: Berichte zur Wissenschaftsgeschichte 34, 2010, 224 – 241.

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the expansion of limits on legal euthanasia (most recently this year in Belgium, Switzerland, the Netherlands, and Luxembourg) have been (and still are) in part based on utilitarian arguments throughout this ethical debate. Whereas supporters of legal euthanasia frequently refer to the values of “autonomy”, “humanity”, “liberalization” and “democratization”, historical examples amply document that precisely these humanitarian and liberal arguments were used to shift the boundaries of self-determination and heteronomy into contexts in which newborns and mentally disabled children, comatose patients, or other individuals with restricted or no capacity for self-determination became the targets of “humanitarian” killings. The proclaimed notion of a clear demarcation between conditions of autonomy and those with a lack thereof may thus clearly be discounted as a myth. A last reflection on the contributions is that, although hardly anyone would deny the relevance of past events on a biographical level – be they as recent as yesterday, or part of a more distant past – particularly for making current and future life decisions, experiences made by other human beings are so easily dissociated from one’s own perception of what is relevant. Perhaps this is why the voices of the survivors of Nazi medical atrocities and the Holocaust should not be lost out of sight, since they are so important for a more comprehensive, historically grounded understanding. Finally, a few words on a very specific and important issue are in order: Namely, the question as to how we might appropriately speak about Nazi medical atrocities. Although we use the “scientific” language of historiography, all of us are very much emotionally affected by the content of our work, and that these emotions cannot be separated from the intellectual and moral reasons and motivations for doing this work. Nevertheless, we are convinced that in order to adequately describe and understand the past, we have to use the theoretical and methodological tools of historiography, which include the moral and the scientific terminologies used in the historical sources, for example, the term “euthanasia”. Among other reasons, the use of this term makes it possible to analyze the rationality and self-perception of the historical actors, the continuities of thought and action which they constructed themselves. It also helps to direct attention to the ways these rationalities and selfperceptions were seen and interpreted within the medical community in the postWorld War II era, in legal trials, and in public debates. The term “euthanasia” was already used in debates on the killing of “life unworthy of living” (such as severely disabled newborn babies) decades before the Nazi period, both in Germany and abroad, as in the U. S. or the United Kingdom. As documented in several contributions to this volume, it was also used in the postwar justifications by physicians involved in the Nazi “euthanasia” program. To substitute it specifically for the Nazi period by the terms “killing” or “murder” would be historically inadequate and

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would disrupt this broader context of the use of these terms. At the same time, we are well aware that we must constantly reflect on the appropriateness of these tools and terminologies in enabling us to adequately describe the perspectives of the victims, while not concealing the rationalities of the perpetrators. Our ultimate intention for this kind of historical research consists in creating knowledge and attitudes that contribute to systematic self-reflection by physicians, biomedical scientists, ethicists, and all others concerned with human suffering.

Post-War Trials: Setting Stages, Structuring Narratives

Paul Weindling

Consent, Care and Commemoration: The Nuremberg Medical Trial and Its Legacies for Victims of Human Experiments

The “Nuremberg Code” On 18 August 1947 the tribunal of three judges presiding at the Nuremberg Medical Trial (NMT) promulgated a set of guidelines on the conduct of human experiments, and how research subjects could be protected. This feature of concluding judicial guidelines at the Medical Trial was unique among all the Nuremberg Trials, and the Trial was also distinctive in that victims gave eloquent testimony about what they had endured at the hands of their medical torturers. It meant that the trial documentation gained iconic status as an overview of human experimentation and atrocities under National Socialism. After the Trial, involved lawyers and psychiatrists supported efforts to secure compensation, and even arranged care for some victims. The legacy of the NMT has substantial importance in medicine of the second half of the twentieth century when there was an upswing of clinical research, and an evident need for ethical regulation. The question was raised around the time of the Nuremberg Trials as to those victims who were killed, and how they could be best commemorated? An International Scientific Commission on Medical War Crimes worked parallel to the Medical Trial to assemble details of all unethical experiments and research by the Nazis.1 The task emerged as too great for the limited resources at the time, and the Commission was further marginalized in the post-war medical politics.2 The focus became that of legally based “informed consent”. However, the history is wider ranging and more complex. It is overlooked how several of the Trials considered evidence for medical 1 Paul J. Weindling, “Die Internationale Wissenschaftskommission zur Erforschung medizinischer Kriegsverbrechen”, in: Angelika Ebbinghaus, Klaus Dörner (eds.), Vernichten und Heilen: Der Nürnberger Ärzteprozess und seine Folgen, Berlin: Aufbau-Verlag, 2001, 439 – 451; Paul J. Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent, Basingstoke: Palgrave-Macmillan 2004. 2 Idem, John W. Thompson: Psychiatrist in the Shadow of the Holocaust, Rochester/New York: Rochester University Press 2010.

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atrocities. Human experiments were already raised at the four-power International Military Tribunal. They were given a high profile as part of a general pattern of Nazi atrocities. During the following period of United States administration, the trials of Air Marshall Erhard Milch (because of the low pressure experiments) and the SS economic administrator Oswald Pohl also considered the experiments, because of his resourcing of the experiments in the concentration camps. Other trials concerned atrocities perpetrated by specific groups (notably the judiciary, high command and industrialists).3 The fact that victims did not volunteer or consent was part of the prosecution case in the successor trials. The issue was raised in the trial against 23 officials of the IG Farben chemical corporation, when the extensive typhus (Fleckfieber) experiments at Buchenwald were part of the prosecution case. The defense countered that conscientious tests with animals were carried out to ensure the safety of the drugs.4 Moreover, the defense alleged that the criteria for criminality of experiments established at the Medical Trial were not met. The defense argued, using evidence from the Auschwitz and Mauthausen-Gusen camp doctor, Helmuth Vetter (a former scientist at Elberfeld), that rather than (criminal) experiments, there had been allegedly legitimate “clinical tests” or “practical tests”.5 “Medical Experiments” figured as part of Count Three (slave labor) in the charges against the defendants. Here the charge was of: “Experiments on human beings (including concentration camp inmates), without their consent, were conducted by IG Farben to determine the effects of deadly gases, vaccines, and related products.”6 Indeed, the defense took the position of a collective denial of responsibility and knowledge of the criminal experiments at Auschwitz.7 The accused pleaded that they were conscientious professionals. The judges accepted the distinction between an experiment (Versuch) and a clinical test or trial: “Without going into detail to justify a negative factual conclusion, we may say that the evidence falls short of establishing the guilt of said defendants on this issue beyond a reasonable doubt. […] The question as to whether the reports submitted to Farben by its testing physicians disclosed that illegal uses were being made of such drugs revolves 3 Idem, “Victims, Witnesses and the Ethical Legacy of the Nuremberg Medical Trial”, in: Kim C. Priemel, Alexa Stiller (eds.), Reassessing the Nuremberg Military Tribunals: Transitional Justice, Trial Narratives, and Historiography, New York: Berghahn Books 2012, 74 – 103. Paul J. Weindling, “Der Nürnberger Ärzteprozess: Ursprünge, Verlauf, und Nachwirkungen”, in: Kim C. Priemel, Alexa Stiller (eds.), NMT: Die Nürnberger Militärtribunale zwischen Geschichte, Gerechtigkeit und Rechtsschöpfung, Hamburg: Hamburger Edition 2013, 158 – 193. 4 Trials of War Criminals Before the Nuremberg Military Tribunals under Control Council Law No. 10, Washington: US Government Printing Office 1950 (in the following: TWC), IG Farben Case, VII, 250. 5 Ibid., 253, 328. 6 Indictment, TWC, vol. VII, 54, 55. 7 Case VI, Closing Statement for all defendants, TWC, VIII, 972.

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around a controversy as to the proper translation of the German word ‘Versuch’ found in such reports and in the documents pertaining thereto. The prosecution says that ‘Versuch’ means ‘experiment’ and that the use of this word in said reports was notice to the defendants that testing physicians were indulging in unlawful practices with such drugs. The defendants contend, however, that ‘Versuch’, as used in the context, mean ‘test’ and that the testing of new drugs on sick persons under the reasonable precautions that Farben exercised was not only permissible but proper. Applying the rule that where from credible evidence two reasonable inferences may be drawn, one of guilt and the other of innocence, the latter must prevail, we must conclude that the prosecution has failed to establish that part of the charge here under consideration.”8

This verdict of the judges at the IG Farben trial that “tests” were permissible effectively reversed the verdict and guidelines pronounced by the judges at the close of the Medical Trial. The distinction between a therapeutic “test” and an experiment relied on some skilful conjuring with terminology by the defendants and defense lawyers. Here, it can be seen that the Nuremberg Trials left an ambivalent and contradictory legacy, on the one hand with guidelines to protect research subjects, and on the other hand permissive allowing constant clinical testing. Victims of experiments are a hardly researched group. Most research is perpetrator oriented. The result is that very basic knowledge of victims’ identities is still being established.9 Until recently we had only details of clusters of victims. There is a strange irony regarding the ethical and legal protection of victims of medical atrocities. This is that the principles of informed consent and protection of personal data lead to the withholding of victim-related data. This is a sort of “Catch 22” (to echo the title of the novel by Joseph Heller) situation, when the bureaucratic rules are absurd: that the information about victims cannot be released without their consent, but you will never know who the victim may have been unless this is released. Such a situation prevents the reconstructing of victims’ life histories – something that provides a long overdue historical basis for compensation and recognizes victims and survivors as individual persons. The effect of non-disclosure of names is not to protect the victims but to protect the identities of the perpetrators of medical atrocities. Moreover, the idea of a “Nuremberg Code” with “informed consent” as a key feature can be seen as retrospective constructs dating from the 1960s. From about this time, the first efforts to identify victims arose, but this was (and remains) a highly marginalized activity, outside the historical mainstream. The Medical Trial was in Chief Prosecutor’s Telford Taylor’s words “no mere murder trial”, by which he meant that human experiments were more complex 8 Case VI, Decision and Judgment, TWC, VIII, 1172. 9 Paul J. Weindling, Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust, London: Bloomsbury 2014.

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in terms of their intention and organization than straightforward acts of violence.10 In fact, the prosecutors delegated to the medical case construed medical atrocities as acts of violence and murder, but ethical issues were periodically discussed in court. The resulting judicial guidelines on human experiments provided research subjects with safeguards, both at an individual and collective level. How public was the judicial declaration on human experiments? The NMT was conducted under military security. Yet throughout journalists, the German delegation of medical observers, other medical observers and national delegates were present. In 1949 the neurologist Alexander Mitscherlich who led the delegation from the not as yet institutionally fully unified Medical Chambers of the West German states (Arbeitsgemeinschaft der Westdeutschen Ärztekammern) included the judicial guidelines as a contribution for a future international agreement in his published documentation of the trial.11 Although 10.000 copies of Wissenschaft ohne Menschlichkeit were distributed to the chambers of physicians, it is likely that the circulation was in fact limited through the lack of interest by the physician-members, a situation which the chambers themselves apparently did not try to change.12 The reissued edition in April 1960 did include the judicial guidelines, and Mitscherlich’s book has shaped all subsequent analyzes of the NMT, at least in Germany.13 It was even used by German officials 10 Idem, “‘No mere murder trial’: The discourse on human experiments at the Nuremberg Medical Trial”, in: Volker Roelcke, Giovanni Maio (eds.), Twentieth-Century Ethics of Human Subjects Research: Historical Perspectives on Values, Practices, and Regulations, Stuttgart: Franz Steiner 2004, 167 – 180. 11 Alexander Mitscherlich, Fred Mielke, Wissenschaft ohne Menschlichkeit, Heidelberg: Lambert Schneider 1949, 267 – 268. There exists an earlier, preliminary and more selective documentation published before the conclusion of the NMT: Alexander Mitscherlich, Fred Mielke (eds.), Das Diktat der Menschenverachtung: Der Nürnberger Ärzteprozeß und seine Quellen, Heidelberg: Lambert Schneider 1947. The 1949 edition was reprinted, with a new introduction, as Alexander Mitscherlich, Fred Mielke, Medizin ohne Menschlichkeit, Dokumente des Nürnberger Ärzteprozesses, Frankfurt/M.: S. Fischer 1960; see also the modified English version of the preliminary documentation: Alexander Mitscherlich, Fred Mielke (with contributions by Ivy, Taylor, Alexander and Deutsch), Doctors of Infamy: the Story of the Nazi Medical Crimes, New York: Henry Schuman 1949 – this, of course, did not include the guidelines proclaimed by the judges in their final statement during the trial. 12 On the origins and distribution of the two versions of the documentation, see Thomas Gerst, “‘Nürnberger Ärzteprozess’ und ärztliche Standespolitik: Der Auftrag der Ärztekammern an Alexander Mitscherlich zur Beobachtung und Dokumentation des Prozeßverlaufs”, in: Deutsches Ärzteblatt 91(22 – 23), 1994, A-1606 – 1622. 13 The various documentations of the NMT in Germany, the US, and France, each selective in its own way and their specific references to euthanasia and human subjects research are analyzed in Etienne Lepicard, “Trauma, Memory, and Euthanasia at the Nuremberg Medical Trial, 1946 – 1947”, in: Austin Sarat, Nadav Davidovitch, Michal Alberstein (eds.): Trauma and Memory : Reading, Healing, and Making Law, Stanford: Stanford University Press, 2007, 204 – 224.

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of the Ministry of Finance (Bundesfinanzministerium) to adjudicate compensation applications. The ethical discourse was by no means restricted to the courtroom.14 Victims had established an ethical agenda prior to the NMT. There was an explosion of human rights discussions around 1946 – 48, as with the UN Genocide Declaration and the UN Declaration on Human Rights. Here, the judicial declaration should be considered in the context of a wider human rights discourse. Figures like the genocide campaigner, Raphael Lemkin, and the medical intelligence officer, John Thompson, provide a link between the Medical Trial and international organizations like UNESCO.15

Towards a code The term “Nuremberg Code” was probably not used until the 1960s. The idea of consent was qualified in a variety of ways, for example as “enlightened” or “voluntary”. Once one scrutinizes its origins, status and meaning, the Nuremberg Code and the associated idea of “informed consent” are retrospective constructs of a more recent bioethical discourse – when there was a “codification of the Code” from the 1980s. During the war, victims protested that experiments violated their rights as prisoners. On 4 March 1945 liberated Auschwitz prisoner doctors made an international declaration on how prisoners had been treated as experimental animals; they hoped that the Allies and neutral states would bring to trial those responsible.16 Their intention was that bringing the perpetrators to justice would mean that such atrocities should not recur in the future. Survivors and witnesses of human experiments called for documentation of Nazi medical atrocities, justice and compensation. The released prisoners organized committees and issued newsletters about the experiments.17 By asking when the issue of unethical experiments was first raised, and by whom and in what circumstances, we find that the research subject, and medical understanding of the victim is at the core of the story. This contact with victims was lost, when what later became known as the Nuremberg Code has achieved recognition. The Allied Medical Intelligence Officer, John Thompson, who drove forward an ethical agenda, illustrates this loss of perspective. Crucial was the encounter with victims, in his case survivors at Belsen. Thompson defined what scientific 14 On the parallel debates in Palestine and France, see the contributions by Etienne Lepicard and Rakefet Zalashik in this volume. 15 Weindling, 2010. 16 The National Archives of the UK (TNA) WO 3O9/470. Weindling, 2004. 17 Weindling, 2004.

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practices were criminal, and began documenting where and when the criminality occurred. He alleged that 90 % of the work of leading German clinicians and researchers was criminal. In November 1945 he was the first to identify the human experiments as “Medical War Crimes” – this new term provided a basis for joint medical and legal investigations.18 Thompson alleged that “the sacrifice of humans as experimental subjects” was widespread in Germany. He demanded comprehensive documentation and ethical analysis. He was convinced that inaction would condone the experiments, and that “there is equally a danger that these practices may continue in Germany or spread to other countries”.19 Thompson secured an inter-Allied meeting of war crimes investigators. He established the International Scientific Commission at Nuremberg to document and ethically analyze all unethical medical experiments, not just the handful that came to trial. Thompson provided a corrective to a standard bioethical narrative of seeing a progressive development of codes from the generalized Hippocratic Oath to the Helsinki Declaration. This approach moved from the Hippocratic Oath, to the Prussian regulations on medical experiments of 1900, the Guidelines of the Reich’s Ministry of the Interior on human subject research (Reichsrichtlinien) of 1931, to the Nuremberg Code, and then on to the Helsinki Declaration.20 Thompson wished to put the suffering person first: He combined Martin Buber’s idea of a communing relationship with the Roman Catholic philosopher Jacques Maritain’s person-based philosophy.21 By way of contrast, other medical experts at Nuremberg, the American physiologist Andrew Ivy and the neurologist Leo Alexander looked back to Hippocrates. We know from the work of Thomas Rütten that Hippocrates was an ambivalent basis for medical ethics, not least because the SS viewed Hippocratic medicine as heroic.22 Ivy’s “Outline of Principles and Rules of Experimentation on Human Subjects”, presented at a meeting at the Pasteur Institute on 1 August 1946, importantly began with the demand: “I. Consent of the subject is required”, i. e. only volunteers should be used; “(a) The volunteers before giving their consent, should be told of the hazards, if any.”23 18 Idem, 2010, 115 – 116, 147. 19 Ibid., 115 – 116. 20 On the Prussian regulations and the Reichsrichtlinien, see Jochen Vollmann, Rolf Winau, “Informed consent in human experimentation before the Nuremberg code”, in: British Medical Journal 313, 1996, 1445 – 1449 21 Weindling, 2010, 83, 99, 240, 291. 22 Thomas Rütten, “Hitler with or without Hippocrates?”, in: Korot: The Israeli Journal of the History of Medicine 12, 1997, 91 – 106. 23 Weindling, 2010, 138 – 39. Minutes of Meeting to Discuss War Crimes of a Medical Nature, Appendix B, TNA, WO 309/471. For a variant text, see the Outline in Medical Experiments no.125990, National Archives and Records Administration (NARA), RG 338 290 – 59 – 17.

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Ivy’s agenda of a set of guiding principles was intended as a modern form of Hippocratic Oath, and his public speaking frequently mentioned the Oath. At the same time, his outlook was permissive in terms of research, even though he recognized ethical limitations. Ivy was at root a mechanistic physiologist, relying on animal experiments. Again, there is a contrast to Thompson, who advocated that students should learn from their own bodies rather than animal experiments. The ethos of Ivy’s viewpoint was geared to the take off of clinical research and trials. Two implications were: 1. Voluntary or Informed Consent provided a safeguard within a model of science that was reductionist. 2. The relationship was contractual between researcher and subject, or by extension physician and patient. Ivy briefed the legal staff of General Taylor on the ethics of experimenting on prisoners. His concern was that the public should not lose confidence in “ethical experimentation”. Ivy’s route was essentially a bargain struck between researcher and subject, and by extension between physician and patient. Taking a philosophical view, the corresponding epistemology in the analysis of experimentation was empirical and associationist, and mechanistic in its presuppositions. Mitscherlich, the German medical observer at the Medical Trial, reflected on what was the human component in doctor-patient relations. Mitscherlich declared that it would be a mistake for physicians to distance themselves from the Trial, by seeing the accused in terms of an individual lapse of moral standards. In fact, every doctor needs to recognize what happens when the individual suffering human being becomes an object or a case – “ein Fall”.24 This position represented a quite fundamental critique of mechanistic reductionism as the epistemological basis of medicine. Survivors of experiments were key prosecution witnesses at the Nuremberg Medical Trial. They included four of the Ravensbrück “Rabbits”, and a Roman Catholic priest. The Nuremberg prosecutors had appealed in the press and on the radio for victims’ testimony. The survivors’ voice was heard strongly. The resulting evidence brought out links to “euthanasia” and genocide. In one dramatic incident, the Roma victim of a Dachau sea water drinking experiment, Karl Höllenrainer, when called to give evidence punched the experimenter the Austrian internist, Wilhelm Beiglböck. This was an exceptional confrontation in its directness, but is indicative of the stress of the courtroom encounter. Those survivors who gave evidence were representative not only of the groups ex24 Alexander Mitscherlich, “Der Arzt und die Humanität: Erste Bemerkungen zum Nürnberger Ärzteprozeß”, in: Die Neue Zeitung, 20 December 1946.

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perimented on – as sulfonamide treatment of wounds, or seawater drinking, but even more broadly of victims as a whole.25 Their role raises a crucial issue of how many victims there were and how widespread the experiments.

“Enlightened Consent” The neurologist Leo Alexander realized that the legal basis of the NMT – the prosecution of war crimes as crimes against humanity – was too narrow. He tried to broaden the basis of the trial by applying the genocide concept. Alexander argued that the German research represented “killing methods for a criminal state”, and as “an aggressive weapon of war”.26 As in Ivy’s draft Code of 31 July 1946, Alexander required consent, and voluntary participation of the experimental subject. While Ivy required the experiment to be useful, Alexander preferred a more generalized viewpoint, that the experiment should not be unnecessary ; both concurred that results should be for the good of society. Alexander amplified the concept of consent, as based on proven understanding of the exact nature and consequences of the experiment. He considered that a doctor or medical student was most likely to have the capacity for full understanding. The degree of risk was justified by the importance of the experiment, and the readiness of the experimenter to risk his own life.27 Alexander as a neurologist had a greater psychological understanding than Ivy, when he defined what constituted “enlightened consent”. His criteria were “legally valid voluntary consent of the experimental subject” requiring: “A. The absence of duress. B. Sufficient disclosure on the part of the experimenter and sufficient understanding of the exact nature and consequences of the experiment for which he volunteers, to permit an enlightened consent on the part of the experimental subject.” The idea of an enlightened consent gave the subject greater agency than being merely a recipient of passive information. His outline of principles went on to state: “2. Experiments should be humanitarian “with the ultimate aim to cure, treat or prevent illness, and not concerned with killing or sterilization. 3. No experiment is permissible when there is the probability that death or disabling injury of the experimental subject will occur. 25 Weindling, 2013a, 74 – 103. 26 Alexander Papers, Durham NC 4/34 Memorandum to Taylor, McHaney and Hardy, “The Fundamental Purpose and Meaning of the Experiments in Human Beings of which the Accused in Military Tribunal No. 1, Case No. 1) have been Indicted: Thanatology as a Scientific Technique of Genocide”. 27 Leo Alexander, “Ethics of Human Experimentation”, in: Psychiatric Journal of the University of Ottawa 1(1 – 2), 1976, 40 – 46.

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4. A high degree of skill and care of the experimenting physician is required. 5. The degree of risk taken should never exceed that determined by the humanitarian importance of the problem. Ethically permissible to perform experiments involving significant risks only if not accessible by other means and if he is willing to risk his own life. 6. […] the experiment must be such as to yield results for the good of society and not be random and unnecessary in nature.”28

Finally, to protect the research subject, Alexander included special provisions to protect mentally ill patients, requiring where possible the consent of the patient in addition to the next of kin or guardian. This provision was not included in the eventual Code. The judges adopted Ivy’s notion of voluntary consent, which was less comprehensive than Alexander’s enlightened consent. They shifted the focus away from the physician to the research subject. What was novel was the right to withdraw from the experiment. Ivy had required far less when he called for informing the subject of potential hazards. The view that the Code “grew out of the Trial itself” omits the formative preliminary period, and the crucial interAllied discussions.29 While the Code was not applied in sentencing, the judges followed Ivy in intending that it should prevent future abuses.30 Alexander and Ivy cited the Hippocratic notion of the doctor’s duty of care for a patient. Hippocratic ideas were opaque given the problems of translation and interpreting the semi-mythical Hippocrates. They became subsumed in the political ideology of totalitarianism. Medical opposition to interference in the doctor-patient relationship meant that – in Ivy’s words “We must oppose any political theory which would regiment the profession under a totalitarian authority or insidiously strangle its independence.”31 Ivy found support in the medical press. An editorial in the British Medical Journal diagnosed the problem as political: “the surrender, in fact, of the individual conscience to the mass mind of the totalitarian State.”32 Morris Fishbein, the editor of the Journal of the American Medical Association (JAMA) linked the evidence on compulsory sickness insurance to the deterioration of the 28 Ibid. 29 Evelyne Schuster, “Fifty Years Later: the Significance of the Nuremberg Code”, in: The New England Journal of Medicine 337, 1997, 1436 – 1440; idem, “The Nuremberg Code: Hippocratic Ethics and Human Rights”, in: The Lancet 351, 1998, 974 – 977. 30 Paul J. Weindling, “Le Code de Nuremberg, Andrew Conway Ivy et les crimes de guerre m¦dicaux nazis”, in: Christian Bonah, Etienne Lepicard, Volker Roelcke (eds.), La m¦decine exp¦rimentale au tribunal: Implications ¦thiques de quelques procÀs m¦dicaux du XXe siÀcle europ¦en, Paris: Êditions des Archives Contemporaines 2003, 185 – 214. 31 Andrew C. Ivy, “Nazi War Crimes of a Medical Nature”, in: Phi Lambda Kappa Quarterly 22(4), 1948, 5 – 12. 32 “Doctors on Trial”, in: British Medical Journal 1, 25 January 1947, 143.

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ethics of the German medical profession.33 Physicians turned the abuses of Nazi medicine into a rallying cry against the socialization of medical services.34 The autonomy of science reflected a situation of doctors opposing central state planning and the welfare state. The scales of justice were heavily tilted by the weight of Cold War requirements for strategically relevant clinical research, and by professional defense of the status of the individual practitioner. In June 1947 the British Medical Association issued a statement on War Crimes and Medicine, diagnosing that the corruption of medicine arose from its becoming “an instrument in the hands of the state to be applied in any way desired by its rulers.” The view conveniently absolved physicians from primary guilt.35 The World Medical Association has remained the main international body setting international standards on human experimentation. It was first at this Association that voluntary and enlightened consent became “informed consent”. The Nuremberg Code thus arose from the concerns of Allied medical war crimes investigators as they encountered the survivors of the human experiments and gathered the records of medical atrocities in concentration camps and clinics. Thompson took a crucial initiative in convening an international committee of forensic pathologists and other medical and legal investigators. His International Scientific Commission offered an alternative tribunal to a public trial – that of expert evaluation conducted in closed session. The debates on research provided the initial stimulus for the formulation of a code of experimental ethics. The judges reverted to Ivy’s notion of “voluntary consent”, while they recognized the autonomy rights of the experimental subject in having the freedom to leave the experiment at any time. The judicial promulgation of the guidelines left the status of these guidelines unresolved. Although promulgated to a military tribunal, the proceedings were conducted under a glare of publicity with press, and medical, legal and governmental observers. It meant that the guidelines were effectively published. Subsequent accounts of the Trial, the US abbreviated edition and the digest by the medical observer Alexander Mitscherlich, included these. Ivy warned how the evils of bureaucratized and unethical Nazi science could recur. The lesson Ivy drew from Nuremberg was that it was necessary to sustain clinical freedom for the medical researcher. The cancer drug Krebiozen offered

33 Washington University (Seattle), Beals Papers, Box 1 folder 16 Morris Fishbein to Walter Beals, 20 May 1947. 34 This argumentation may also be identified in the contemporary French medical context, as pointed out in the chapter by Etienne Lepicard in this volume. 35 “War Crimes and Medicine”, Statement by the Council of the Association for Submission to the World Medical Association, London: British Medical Association, June 1947.

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the hope for a non-toxic therapy. Unfortunately, the drug was condemned as bogus, and Ivy was discredited.36 Ivy has been further discredited in that historian Jon Hearkness argues that Ivy committed perjury at Nuremberg. Ivy maintained that Statesville, Illinois penitentiary experiments had the approval of an ethical committee. Although this committee had been appointed, it had not met, a mitigating factor is that Ivy did correspond with committee members on an individual basis. One might also see Ivy as taking in effect “Chairman’s Action”. So while technically giving a misleading impression regarding the Committee, there were some exonerating circumstances.37 Ivy has also been – unfairly – lambasted as incompetent in his evidence at Nuremberg. While infectious diseases were not a special area of his expertise, Ivy did well regarding digestive physiology regarding the seawater drinking experiments. He had even conducted a self-experiment. He also noticed that Beiglböck altered evidence. Ivy is a tragic figure, and although not beyond criticism does merit a degree of rehabilitation, as not unethical in his experiments, and as essentially well motivated. Ivy’s engagement with Krebiozen shows something more positive than just scientific naivety :, as motivated by support for a non-toxic cancer cure. So while he allowed scientific standards to lapse, the motive was patient welfare. Here we see a common pattern with medical scientists involved at Nuremberg. Alexander moved from neurology to psychiatry, more concerned with care for the whole person. Thompson similarly moved from neuro-physiology to education (initiating the UNESCO programme for Germany), and then also to psychiatry. For, the contact with victims remained a determining experience. Those driving forward the ethical agenda cared for victims. Alexander supported the efforts to look after the Polish “rabbits” indicate this, with the efforts of others in the USA to organize care and therapy.

Legacies The victims’ perspective opens the way to more fully historicized concepts and methods in the understanding of the patient both historically and in modern clinical contexts. Informed Consent as the cardinal principle of physician-pa36 Andrew C. Ivy, John F. Pick, William F.P. Phillips, Observations on Krebiozen in the Management of Cancer, Chicago: H. Regnery Co. 1956; Herbert Bailey, A Matter of Life or Death: The Incredible Story of Krebiozen, New York: G.P. Putnam’s Sons 1958; Patricia Spain Ward: “‘Who will bell the cat?’ Andrew C. Ivy and Krebiozen”, in: Bulletin of the History of Medicine 58, 1984. 37 Jon M. Harkness, “Nuremberg and the Issue of Wartime Experiments on US Prisoners: The Green Committee”, in: Journal of the American Medical Association 276(20), 1996, 1672 – 1675.

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tient relations is a very recent innovation, and linked to the “birth of bioethics” since the early 1970s when dedicated institutes – the Kennedy and Hastings Institutes – were founded in the United States.38 Bioethics chimed with more critical and sceptical views of science as part of the counter-culture of protest since the 1960s, leading to the history of eugenics. Bioethicists – as an emerging lay professional group – wanted a code as part of a sense of the need to regulate innovations. A code also served to legitimate bioethicists’ nascent endeavors. Thus the Nuremberg principles became referred to as the “Nuremberg Code” during the early 1960s. Many of the Nuremberg Trials – that is the initial four power prosecution of the Nazi leadership, and the twelve successor trials conducted by the Americans – dealt with aspects of unethical medical research. But only the trial of twenty physicians and three medical administrators ended with the judges formulating a set of principles. The American judges had two aims: first to make clear the principles supporting their judgment. Second, – at the prompting of the Chicago physiologist Andrew Ivy who was expert witness to the court, and had entered into the area as nominated representative of the American Medical Association – to issue a series of guidelines that might prevent such abuses occurring in the future. Ivy had two objectives: first, that there should not be a massive public surge of outrage against all clinical research. In this sense the judicial principles that he recommended were permissive – it was the lay judges who empowered the research subject by inserting that the subject could terminate the experiment at any time. Second, that public opposition to vivisection should be defeated by showing that human research was by far the greater cruelty. There is a thin thread of evidence linking the Helsinki Declaration of 1964 to what has been called – retrospectively the Nuremberg Code, the judicial pronouncement of 19 August 1947. On the other, and here philosophical commentaries are enlightening – consent goes back to the contract tradition in philosophy. This has echoes of commercial contracts, as well as of the regulation of political power between subject and ruler.39 To their credit, the first major collection on the Nuremberg Code was edited by the Boston University bioethicists George Annas and Michael Grodin in 1992. Despite their important efforts, the history of informed consent remains problematic as de-historicized and restricted to a series of legal verdicts. It involves less the democratizing of clinical knowledge but the notion of being informed. Here the subject takes a passive role, with the expert being actively in authority, as instructing about risks etc. The term “Nuremberg Code” is retro38 Albert Jonsen, The Birth of Bioethics, New York: Oxford University Press 1998. 39 Neil C. Manson, Onora O’Neill, Rethinking Informed Consent in Bioethics, Cambridge: Cambridge University Press 2007.

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spective construct: it appears to have first been used from 1963 in the AngloAmerican context.40 On the one side, the American bioethicist, Jay Katz argued that although the Nuremberg Code was an important symbolic statement, it had no major role, as case law was decisive.41 His view contrasts to that of Annas and Grodin that “all contemporary debate on human experimentation is grounded in Nuremberg”. They commend – rightly in my view – the remarkable “focus on universal ethical codes in the context of a trial.” But their view is ironically as fixated on court room procedure as Katz. The Harvard anesthetist Henry Beecher, a noted critical voice against unbridled experimentalism, in 1966 cautioned against excessive experimentation, and characterized the Nuremberg code as “legalistic”, whereas Helsinki more wholly ethical in spirit.42 American bioethicists have been content to work through a legal framework, and since 1973 references have been made to Nazi doctors in US court rulings.43 The legacies have conventionally been considered at a medical level – at that of the WMA, and the transition to Helsinki. What this shows is that the judicial principles were ignored, then the effort was made to introduce a Hippocratic style “Code of Geneva”, and finally informed consent came to operate. While both paths are significant, it seems to me that two elements are missing: the commemoration, and care of victims of the experiments, as will be illustrated in the following. An example is the case of the twenty children selected in Auschwitz, experimented on with a tuberculosis preparation at Neuengamme concentration camp, and brutally killed in the cellar at Bullenhuser Damm. The twenty children were commemorated anonymously, not least on a memorial plaque dating from 1967. The journalist Günther Schwarberg first found photographs in 1977, and a list of names in 1978. (One was incorrect but finally identified by the mother in 1982). It meant that relatives could be at least informed as to their children’s fate. A memorial dates from 1980, and rose garden from 1982. In 1994 two Dutch victims were commemorated by a memorial stone in Eindhoven. This commemorates the

40 Irving Ladimer, Roger W. Newman (eds.), Clinical Investigation in Medicine: Legal, Medical and Moral Aspects, Boston: Law-Medicine Research Institute, Boston University 1963, 116: “The Nuremberg Code”. See Andrew C. Ivy to Irving Ladimer, 23 March 1964, Andrew C. Ivy Papers, American Heritage Center, Laramie. 41 Jay Katz, Experimentation with Human Beings: The Authority of the Investigator, Subject, Professions, and State in the Human Experimentation Process, New York: Russell Sage Foundation 1972. 42 Quoted according to George J. Annas, “The Nuremberg Code in US Courts: Ethics versus Expediency”, in: George J. Annas, Michael A. Grodin (eds.), The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation, New York: Oxford University Press 1992, 201 – 222, here 205. 43 Ibid., 206 – 208.

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children by name. In 1995 on the 50th anniversary streets were named in the Hamburg district of Burgwedel after the children.44 In 1985 the radical historian Götz Aly called for the destruction of body parts from anatomical collections. Until this time, institutions felt aggrieved when accusations were levelled against them, and Aly was primarily concerned to show the networks of perpetrators. The distinguished biochemist Adolf Butenandt declared this an insult to the dignity of the Max Planck Society, the prestigious research organization directed by him. Then things suddenly changed in 1989. This culminated in a conference of German university ministers and rectors in 1989. In December 1990 histological specimens and brains of 33 children and youths killed in 1940 at Brandenburg-Görden and held by the Max Planck Institute for Brain Research in Frankfurt were buried. But representatives of German academic institutions were present, rather than relatives or other Nazi victims.45 Removal of body parts was done rapidly in the Federal Republic from 1989, virtually as (to use a National Socialist phrase) a Nacht und Nebel Aktion (“activity at night and fog”) in that the contaminating specimens disappeared without documentation. The idea was not to document, to inventories and to establish provenance. There is consequently no listing of institutes which held body parts deriving from Nazi persecution and genocide. In Austria, the process took longer but has been more thoughtful, as individual urns at the Zentralfriedhof Vienna received the parts of victims in 2002 and again in 2014. Memorials for victims of research atrocities are few, and only exceptionally commemorate victims with the dignity of their full name. The Strasbourg gravestone for the victims of the anatomical collection is stark and dignified, yet necessarily anonymous. The identities of the victims are now known, and we can understand how Auschwitz was a selection center for victims across Europe. The most personally and engaged is for the one already mentioned for the children killed at Bullenhuser Damm. Here the lives of the children have been reconstructed with a caring dignity. In Heidelberg, Carl Schneider’s victims are commemorated, but the memorial depersonalizes. Known victims have been anonymized by giving only first names and the initial of the family name.46 44 Günther Schwarberg, The Murders at Bullenhuser Damm: The SS Doctor and the Children, Bloomington: Indiana University Press 1984; transl. of the German edn. Der SS-Arzt und die Kinder. Bericht über den Mord vom Bullenhuser Damm, Hamburg: Gruner & Jahr 1979. 45 “Trauerfeier für Präparate von NS-Opfern”, in: Frankfurter Allgemeine Zeitung, 19 December 1990. Paul J. Weindling, “‘Cleansing’ Anatomical Collections: The Politics of Removing Specimens from German Anatomical and Medical Collections 1988 – 92”, in: Annals of Anatomy 194(3), 2012, 237 – 242. 46 Idem, “From Scientific Object to Commemorated Victim: the Children of the Spiegelgrund”, in: History and Philosophy of Life Sciences 35, 2013, 415 – 430. Christoph Mundt, Gerrit Hohendorf, Maike Rotzoll (eds.), Psychiatrische Forschung und NS Euthanasie: Beiträge zu

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German officials, researchers and the public have steadfastly upheld anonymization. For the Berlin-Buch memorial, the sculpture endorsed the agenda of withholding victims’ names. The molecular biologist and human rights activist Jens Reich reflected: “When we stand before it and contemplate the sculpture, it is not the fate of one individual that is brought to mind. There is no reference to a name or a historically verifiable person. Only this anonymity permits us to contemplate why this figure now stands in this park. Only from such an ideal-type depiction of the child’s body can our thoughts return to ourselves and become concrete. For example through the question: Could also one of our own children have suffered such a fate?”47 Here the response by Jens Reich to the sculpture explains that there are no names which evoke an identifiable historical person, and that only with anonymization is reflection possible. The memorial represents a negation of individual suffering, and appears to me as fundamentally misconceived. The Spiegelgrund memorial has gone decisively in the direction of individual commemoration. This is appropriate for three reasons: 1. The victim is commemorated as an individual – and identity is restored. 2. Only by knowing an individual name can the circumstances of the individual’s life history be reconstructed. 3. Anonymization perpetuates an oppressive stigma. The concealment also colludes in an official interest in concealing links between victim and perpetrator. The German Research Council (Deutsche Forschungsgemeinschaft/DFG) has a memorial for the General Plan Ost but victims were never contacted and invited. This is made harder as there is no online listing of the researcher files. History offers an important form of public accountability for medical malpractice. The historian can assess whether practitioners and researchers have shown due care for persons in their care. Unless one names, we cannot identify, understand the extent of the atrocity and the suffering. For without a name, we cannot under-

einer Gedenkveranstaltung an der Psychiatrischen Universitätsklinik Heidelberg, Heidelberg: Wunderhorn 2001. 47 Jens Reich, “A. Franziska Schwarzbach: Gedanken vor dem Denkmal in Buch”, https:// www.mdc-berlin.de/720978/de/about_the_mdc/campus/wissenschaft_und_kunst/Skulptur enpark/a_franziska_schwarzbach (1 Sept 2014): “Wenn wir vor ihr stehen und über sie nachsinnen, dann werden wir nicht auf ein Einzelschicksal geführt. Es gibt keinen Namen, es wird keine historisch nachweisbare Person zitiert. Nur in dieser Anonymität kann uns das Nachdenken über die Figur auf den Grund für ihre Aufstellung hier im Park führen. Nur vor einem so idealtypischen Kinderkörper wiederum können wir jedoch auch das Nachdenken zu uns zurückführen, konkret werden lassen. Etwa durch die Frage: Hätte eines deiner eigenen Kinder auch so ein Schicksal erleiden können.”

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stand the networks of institutions, how a person was transferred from camp to camp, and clinic to clinic. We have no analysis of who the victims were? How many? Compiling such an analysis is an arduous task because of data protection.48 Similarly, there has been a lack of compensation for victims. The UN Human Rights Division passed on 4 July 1950 a resolution on the plight of victims of the so-called scientific experiments. The Bundesfinanzministerium turned down numerous applications from the mid-1950s onwards. Under regulations of 1953 and 1956 the Bonn government denied compensation on the grounds that the experiments were not harmful, or that the victim was not in need. At first sterilization victims and all former Resistance combatants were automatically excluded, but then given the lowest rate of compensation. While 87 sterilization victims received 2000 DM, only one had received compensation for sulphonamide experiments, albeit at a far higher rate. Its position was regarded with contempt both by survivors’ representative bodies, and psychotherapists, sympathetic to survivors’ trauma. There was hardly any effort to cover the full costs of care, and to provide medical assistance for victims. The demands of sterilization victims for operative reversal of sterilization were ignored. Sickness insurance funds have never responded to the need to redress medical injuries. Some attention was given to the maimed and injured “rabbits” of Ravensbrück (the victims of medical experimentation who themselves used this term), but generally the situation has been and remains one of neglect and marginalization. The final chapter in the history of compensation is that of the injuries falling into the category of “sonstige Personenschäden” attached as subsidiary to the forced labor compensation. Here, the single lump sum compensation has been often re-traumatizing and perceived as a further injury. This view was vividly stated by the sterilization survivor, Simon Rozenkier to the New York Times in 2003.49 By the early 1960s the German government wished to declare the post-war era over, and terminate compensation procedures, which still did not adequately recognize medical crimes.50 Doctors who were former Nazis adjudicated on compensation applications. Their diagnostic categories were relics of the Nazi era.51 Psychiatrists pointed out that by labeling a claimant as a hereditary schizophrenic, the Germans were denying responsibility for the traumatic after effects of the experiments. At this point John Thompson teamed up with the New York psychiatrists Martin Wangh, Kurt Eissler and William Niederland, who had 48 For a comprehensive reconstruction see Weindling, 2014. 49 Steven Greenhouse, “Capping the Cost of Atrocity ; Survivor of Nazi Experiments Says $8,000 Isn’t Enough”, in: The New York Times, 19 November 2003. 50 Christian Pross, Wiedergutmachung: Der Kleinkrieg gegen die Opfer, Frankfurt/M.: Athenäum 1988, 110. 51 Ibid., 142.

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pioneered analysis of “survivors’ syndrome”, to organize the Provisional Committee for Victims of Human Disasters in 1964. The Committee protested to the German Chancellor Erhard that 43 % of compensation claims were rejected by the Federal German government, which disregarded clear evidence of damage to health because of “outmoded” medical knowledge.52 Their studies acted as symbolic bridge between first hand observers of the atrocities and concerned social scientists and historians. In September 1964 Jay Katz asked Taylor about preparatory drafts of the Final Code.53 The Committee invited the Yale psychologist, Robert Lifton to address the meeting on psychological effects on the Hiroshima and Nagasaki victims – indicating a wish to critically engage with the psychology of the victor.54 Lifton contacted Leo Alexander, McHaney and Telford Taylor, as his interest was aroused by the problem of the Nazi medical psychology.55 The meeting rekindled recognition for the victims of human experiments, and marked an entry point of historians and bioethicists into the field. The Nuremberg Code at last began to achieve legal recognition, although this has been a lamentably slow process. We are left with an irony. Data protection laws and ethics are meant to protect victims. But instead, the effect is to protect perpetrators, by concealing the places where a particular victim was selected. On balance, data protection laws protect the perpetrators, and the legal, administrative and financial agencies supporting research. Despite Germany’s efforts in Holocaust recognition, commemoration and memorials are few for victims of medical atrocities. The medical victims can be seen as marginalized, misunderstood, and essentially forgotten – indeed, never recognized in any meaningful way. There is no memorial naming all victims of the “euthanasia” killings. While a number of institutions have memorials for victims of “euthanasia” at respective institutions, full names are rarely given in the Federal Republic (in contrast to Austria). At most, as at the Heidelberg Psychiatric clinic, the first name and initial is given. Public prosecutions could allow names to be cited. Here, we may cite the history of the adolescent, Ernst Lossa, who was a medically murdered victim at Kaufbeuren, as an exception.56 The irony of the current situation is that an ethic nominally to protect the 52 New York Public Library (NYPL), Manuscripts and Archives Division, Robert Jay Lifton Papers, Box 20, Wangh folder, Provisional Committee to Chancellor Ludwig Erhard 3 March 1965. 53 Columbia Law Library, Telford Taylor Papers, TTP-CLS-14/5/6/115 Jay Katz to Taylor, 2 Sept. 1964; Taylor to Katz, 11 September 1964. 54 NYLP, Lifton Papers, Box 20, Martin Wangh to Lifton 7 Feb 1965. 55 TTP-CLS-14/6/16/343, Lifton to Taylor, 3 July 1979. NYPL Lifton Papers Box 5, Alexander to Lifton 10 October 1978. 56 Paul J. Weindling, “‘Jeder Mensch hat einen Namen’: Psychiatric Victims of Human Experiments under National Socialism”, Die Psychiatrie 7, 2010, 255 – 260.

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person has the effect of depersonalizing and limiting the ethical obligation of physician to patient in terms of a formulaic contract. We find a situation of anonymization and depersonalization reflected in our limited understanding too of Nazi medical atrocities limited to perpetrators, and disinterested in victims and their life histories. In the Federal Republic, there is a situation of nominal and inadequate compensation.57 Every conceivable barrier is placed to block understanding of victims of medical atrocities. The system is one of screening out the identity of the individual person. The anonymized blacked out or partially suppressed names are synonymous with a society uncomfortable with the legacy of a traumatic past. The strict confidentiality required serves to protect institutions and bureaucrats from scrutiny. The question remains, whether the mission to legitimate clinical research rendered the Code too permissive in what it condoned, and too weak in the provision of safeguards for the patient?58

57 Idem, “‘Sonstige Personenschäden’ – die Entschädigungspraxis der Stiftung ‘Erinnerung, Verantwortung und Zukunft’”, in: Constantin Goschler (ed.), Die Entschädigung von NSZwangsarbeit am Anfang des 21. Jahrhunderts, vol. 2, Göttingen: Wallstein 2012, 197 – 225. 58 I gratefully wish to acknowledge: Wellcome Trust Grant No 096580/Z/11/A on research subject narratives; AHRC grant AH/E509398/1 Human Experiments under National Socialism.

Etienne Lepicard

The Nuremberg Medical Trial and Its Reception in France and Israel, 1947 – 1952: A Comparative Perspective

Introduction In a previous work, upon which this paper is based, three accounts of the Nuremberg Medical Trial published between 1947 and 1950 were compared: the official American report on the trial; the work of the French army psychiatrist FranÅois Bayle, Croix gamm¦e contre caduc¦e; and Alexander Mitscherlisch and Fred Mielke’s Medicine without humanity, also called Doctors of Infamy in English.1 This previous study provided some heuristic categories for the continuation of my work. These accounts offer three kinds of narratives reflecting three ways of coping with the past and its atrocities, which lead to three different legacies within medical ethics. The three kinds of narratives are: the official American report, which is comprised of about 1500 pages of mainly raw data completely devoid of comments, and for which no time seems to exist. Our reading is thus shaped by the order in which the material is presented and by the amount of data the anonymous editor gave us. FranÅois Bayle’s volume, although also a work of about 1500 pages, is more or less chronologically organized. It consists of evidence brought to the trial and comments on them by the author. This is the narrative of a psychiatrist and researcher attempting to understand the psychology of the main protagonists. Finally, Mitscherlisch and Mielke’s work constitutes a relatively short and vivid narrative, built of evidence and comments like Bayle’s, but in which the authors do not hesitate also to appeal to 1 Etienne Lepicard, “Trauma, Memory, and Euthanasia at the Nuremberg Medical Trial, 1946 – 1947”, in: Austin Sarat, Nadav Davidovitch, Michal Alberstein (eds.), Trauma and Memory : Reading, Healing, and Making Law, Stanford: Stanford University Press 2007, 204 – 224; Trials of War Criminals (TWC) before the Nuernberg Military Tribunals under Control Council Law No. 10, vol. I – II, Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office 1950; FranÅois Bayle, Croix gamm¦e contre caduc¦e: Les exp¦riences humaines en Allemagne pendant la DeuxiÀme Guerre Mondiale, Neustadt (Palatinat): Commission scientifique franÅaise des crimes de guerre, Imprimerie Nationale 1950; Alexander Mitscherlich, Fred Mielke, Doctors of Infamy : The Story of the Nazi Medical Crimes, New York: Henry Schuman 1949.

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the broader historical framework of eugenics in order to explain things. This is a personal narrative, which brings us, the readers, to share the moral reflections of its authors. In this preliminary study, it was also suggested that these three kinds of narratives reflect three ways of coping with the past and its atrocities: an institutional, policy oriented one, with the official report that looks to protect the future of medical research; a first intellectual attempt to understand the past with FranÅois Bayle’s book; and one where the accent of dissent dominates and brings the reader to share the shock felt by its authors when they heard and read the evidence brought to the court.2 Finally, in this former study these three accounts served to represent three kinds of medical ethics or three voices within medical ethics: the voice of research, which came to its climax with the “Nuremberg Code”; the voice of the profession, which refers before, and after, and even still to the “Hippocratic tradition”; and last but not least, the voice of the patient and of civil society, which calls for a patient-centered ethics yet to be written. These conclusions were reached in examining the three books according to their literary characteristics, and according to the mode each of them developed to deal with the two main issues of medical ethics that were debated at the Nuremberg Medical Trial, euthanasia vs. human experimentation. In this chapter, I want to focus on two specific contexts, France and Israel, and try to see if the reception of the Nuremberg Medical Trial (NMT) in general, and of the two ethical issues debated there in particular, has had any influence on the formation of the ethical discourse in post-World War II medicine. France and Israel were chosen as it is in France that the two first international congresses of medical ethics were organized (in 1955 and 1966) and in Israel that the memory of the victims of the Nazi medical crimes are expected to be most vivid.3 Here, I will present some elements of the first reception of the NMT within the French and Israeli medical communities and check the validity of the categories previously elaborated.

2 For an even earlier account by Mitscherlich, see the opening of Annette Weinke’s article in this volume. 3 Actually, besides Germany, the United States may be worth as a comparative context too, as it is in this country that bioethics first developed as an independent academic field.

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Some background and chronology World War II represents a special moment in the history of the French medical community.4 Some of the measures taken by the Vichy Government were continued after the end of the war, others were stopped. In 1940, the Vichy Government created the long expected French Medical Association (l’Ordre National des M¦decins, in the following FMA).5 While they were renewed after the war had ended, in 1940 the Vichy Government had also dismantled the medical unions, which were then reestablished after Liberation.6 In 1945, the new government enacted the Social Security Act that established the post-World War II French medical insurance system.7 On the French stage, 1947 is the year of the publication of the Code of Deontology. The text, prepared by the National Council of the FMA and the State Council (Conseil d’Êtat), received final approval by the government on 27 June of that year. It was unique in that it was actually part of French administrative regulations.8 On a global level, 1947 – 48 are the crucial years of the creation of both the World Medical Association (WMA) and the World Health Organization, the latter as part of the new United Nations, especially in charge of issues of public health.9 Regarding the development of medical ethics in France, in 1955 the FMA organized the 1st International Congress of “Morale m¦dicale” and then, in 1966, the second.10 The difference between them is amazing. The second one focused on a single theme – medical responsibility. It appears to me to have been as 4 See the chapter by Donna Evleth in this volume. 5 See Bernard Glorion, “Ordre des m¦decins”, in: Dominique Lecourt (ed.), Dictionnaire de la pens¦e m¦dicale, Paris: P.U.F. 2004, 814 – 820. Donna Evleth, “La Bataille pour l’Ordre des m¦decins, 1944 – 1950”, in: Le Mouvement Social 229, October-December 2009, 61 – 77, also presents a good summary of the origins of the Vichy Ordre. 6 Paul Cibrie, “Mort et r¦surrection des syndicats m¦dicaux”, in: Le M¦decin de France 51(1), 1945, 3 – 12; H¦lÀne Berlan, Etienne Th¦venin, M¦decins et soci¦t¦ en France, Toulouse: Privat 2005. 7 Bruno Valat, Histoire de la S¦curit¦ sociale, Paris: Economica 2001. 8 “Decret 47 – 1169 of 27 June 1947”, in: Journal Officiel, 28 June 1947, 5993; “Code de D¦ontologie m¦dicale”, in: La Presse m¦dicale 55(40), 5 July 1947, 461 – 462 and 464. See also Louis Portes, “Pr¦face au Code de D¦ontologie”, in: idem, A la recherche d’une ¦thique m¦dicale, Paris: Masson/P.U.F. 1954, 87 – 101. 9 Sung Lee, “WHO and the developing world: the contest for ideology”, in: Andrew Cunningham, Bridie Andrews (eds.), Western Medicine as Contested Knowledge, Manchester : Manchester University Press 1997, 24 – 45. As far as I know a history of the WMA remains to be written. For a first sketch, see the WMA history self-presentation http://www.wma.net/en/ 60about/70history/index.html (21 August 2014). 10 Premier congrÀs international de Morale m¦dicale, vol. I (Rapports); II (Compte rendu communications), Paris: Ordre national des m¦decins 1955, and Second congrÀs international de Morale m¦dicale, I – II vols., Paris: Masson 1966.

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boring as the first one, still under the shock of World War II, was sparkling – dealing with many themes and topics and suggesting more questions than answers.11 One of the reasons for this change in ethical questioning probably has to be sought in the huge reform the French medical system passed in 1958 when de Gaulle returned to power.12 This medical reform is known as the Debr¦ reform for Robert Debr¦ (1882 – 1978), a pediatrician who was nominated in 1956 by the government to chair an interdepartmental committee in charge of working it out (Comit¦ interminist¦riel d’¦tude des problÀmes de l’enseignement m¦dical, de la structure hospitaliÀre et de l’action sanitaire et sociale).13 A member of the Resistance during World War II, Debr¦ had written a report advocating the launch of such a reform after the Liberation.14 It was not until the peculiar context of 1958 when de Gaulle was back in power (and one of Robert Debr¦’s sons was Prime Minister) that Debr¦ succeeded in convincing the government to back the reform with two ordonnances (imposed regulations) on 11 and 30 December of that year, despite the opposition of the French medical elite. This reform became especially known for the link it created between medical research and medical teaching.15 From the point of view of medical ethics, it put the biomedical paradigm at the forefront of institutional excellence in medicine, focusing mainly on pure biological factors to the exclusion of psychological, environmental and social factors, or other elements such as communication skills. In a sense, “medical responsibility” was the only ethical issue that remained debatable thereafter. A few scholarly works have analyzed the impact of this reform: Haroun Jamous published a sociological analysis of the reform and some historians of French biomedicine refer to it.16 However, besides a short article by 11 George Weisz, “The origins of medical ethics in France: the international congress of Morale M¦dicale of 1955”, in: idem (ed.), Social Science Perspectives on Medical Ethics, Philadelphia: University of Pennsylvania Press 1991, 145 – 161. 12 See Berlan, Thevenin, 2005, 159 – 165. 13 See ibid. and the electronic file “Les r¦formes de l’enseignement de la m¦decine — travers les archives du MinistÀre de l’¦ducation nationale (1905 – 1970)”, in: Jean-FranÅois Picard et Karine Gay (eds.), HISTRECMED (Histoire de la recherche m¦dicale en sant¦ publique dans la France du XXe siÀcle), Thiais: CNRS 2013, 18 October 1956 there (website : http://www.histrecmed.fr/index.php?option=com_content& view=article& id=139:enseignement-de-lamedecine& catid=10:documentation& Itemid=130 (9 September 2014). 14 See Robert Debr¦, “Organisation de la profession m¦dicale et de l’enseignement de la m¦decine”, in: idem, M¦decine, Sant¦ Publique, Population (Rapports pr¦sent¦s au Comit¦ M¦dical de la R¦sistance et au Comit¦ National des M¦decins franÅais. Transmis au Comit¦ FranÅais de la Lib¦ration Nationale, — Alger, en Janvier 1944), Paris, Êditions du M¦decin franÅais 1945, 69 – 99. 15 See Berlan, Thevenin, 2005, 159 – 165. 16 For a sociological analysis, see Haroun Jamous, Sociologie de la d¦cision: La r¦forme des ¦tudes m¦dicales et des structures hospitaliÀres, Paris: CNRS 1969. For historical perspectives, see Jean-FranÅois Picard, “Pouss¦e scientifique ou demande de m¦decins? La recherche m¦dicale en France de l’Institut National d’HygiÀne — l’INSERM”, in: Sciences

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Anne-Marie Moulin, as far as I know there is not yet any scholarly work analyzing the impact of this reform on the development of medical ethics in France.17 As a reminder, it was in 1983 that the French President FranÅois Mitterand (1916 – 1995) created the French Consultative Committee of Ethics on Health and Life Sciences (Comit¦ Consultatif National d’Êthique pour les Sciences de la Vie et de la Sant¦). In a sense, this initiative constitutes the terminus ad quem of my research, although for the present paper I focus mainly on 1947 and its immediate legacies. For the Israeli medical community, World War II and its immediate aftermath represent a period of tremendous challenges and transformation. Through a short period of time, it passed from a health care system based mainly on the “sick funds” of trade unions to a national health care system.18 This represents a major transformation in itself, even though previous attempts had been made before the establishment of the State of Israel to build some cooperation between the health department of the (Jewish) National Council (Va’ad leumi, the main national institution of the Yishuv, i. e. the Jewish community of Palestine, before the establishment of the State of Israel) and the Department of Health of the British Palestine Government.19 Actually, physicians educated in the West had arrived in Palestine during the second half of the 19th and early 20th centuries as part of the Zionist movement.20 The period of World War I also saw the relatively large-scale involvement of the

17 18

19 20

Sociales et Sant¦ 10(4), 1992, 47 – 106; Alain Larcan, Jean-FranÅois Lemaire, De Gaulle et la m¦decine, Paris: Synth¦labo 1995; Jean-Paul GaudilliÀre, Inventer la biom¦decine: La France, l’Am¦rique et la production des savoirs du vivant (1945 – 1965), Paris: La D¦couverte 2002, especially 310 – 315. Anne Marie Moulin, “Medical ethics in France: The latest great political debate”, in: Metamedicine 9(3), 1988, 271 – 285. Shifra Shvarts, The Workers’ Health Fund in Eretz Israel: Kupat Holim, 1911 – 1937 (Rochester Studies in Medical History), Rochester : University of Rochester Press 2002, and idem, Health and Zionism: The Israeli Health Care System, 1948 – 1960 (Rochester Studies in Medical History), Rochester : University of Rochester Press 2008; see also the first chapter of Dani Filc, Circles of Exclusion: The Politics of Health Care in Israel, Ithaca/London: ILR (Cornell University Press) 2009. Nissim Levy, The History of Medicine in the Holy Land: 1799 – 1948, Haifa: Hakibbutz Hameuchad and the Bruce Rappaport Faculty of Medicine/Technion 1998, 204 – 206 and 238 – 242 (in Hebrew). Quite often one can find the assertion that no scientific medicine existed in Palestine before the British Mandate. Such an assertion forgets to take into account the history of medicine within the Ottoman Empire and assumes that Europe, or the West, rather than local factors and agents, should receive credit for the application of modern science in this region. For an opposite view see, for instance, Miri Shefer, “Communicable diseases in Ottoman Palestine: Local thoughts and agents”, in: Korot – The Israel Journal of the History of Medicine and Science 21, 2011 – 2012, 19 – 49 (in Hebrew).

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American Zionist Medical Unit, which worked in various places in the country. Later, the Hadassah Medical Organization, a local organization with American support, took the reins and gradually concentrated its forces to establish a University Hospital and Medical School in Jerusalem.21 The 1930s were years marked by a massive emigration of physicians from Germany and central Europe, bringing a certain degree of unemployment in the medical field. After Hitler came to power in Germany, efforts were made to organize a congress in Palestine gathering Jewish physicians from all over the world. The preparation and the suggested topics of the congress clearly reflect the degrading conditions of Jews in Europe. That congress, entitled The First World Congress of Jewish Physicians, was finally held in April 1936 in Tel Aviv.22 In a sense, it represents an attempt made by the Jewish physicians of the Yishuv to take a lead among the global Jewish community of physicians. A “World Covenant of Jewish Physicians” was initiated in order to help the Jewish physicians who were victims of anti-Semitic measures.23 By the early 1940s, the two main forces structuring the medical field among Jews in Mandatory Palestine were the Hebrew Medical Union (Hahistadrut harefuit haivrit) and the General Sick Fund (Kupat holim clalit) of the main trade union of the workers. Even as the Ministry of Health slowly took its place within the Israeli health system, this equilibrium of forces remained quite unchanged until the liberal turn of the late 1970s when the right took over the government.24 As to medical ethics, there was an attempt within the Hebrew Medical Union of Palestine to formulate an ethical code during 1945.25 In the early years of the State of Israel, some scholars were to publish quite a lot on the Jewish roots of medical ethics. Assembled in the Israeli Society for the History of Medicine and Science, they hoped to (re-)constitute the Jewish medical tradition and to base medical ethics on a kind of Jewish Hippocrates, with such figures as Assaf the physician, Itzhak Israeli, Maimonides and Amatus Lusitanus.26 It was not until 2001 that a 21 See Levy, 1998, 175 – 196. 22 Ibid., 277 – 279, and Naomi Menuhin, Dr. Izrael Milejkowski in the First Jewish Physicians World Congress in Palestine 1936, Beer Sheva: Ben Gurion University of the Neguev (MA thesis, in Hebrew) 2012. 23 Levy, 1998, 278. 24 See Filc, 2009, 26 – 28. 25 See, for instance, “The ethical code”, in: Mikhtav le-haver 101, 15 January 1945, 823; “Toward the national commission”, in: Mikhtav le-haver 111, 1 April 1945, 905 – 906; “The second meeting of the plenary national commission – a) the ethical code”, in: Mikhtav le-haver 118, 15 July 1945, 998 – 999. Without further notification, all of the articles quoted that appeared in Mikhtav le-hever, Dapim refuiyim, Harefuah or Eitanim are in Hebrew. 26 See, for instance, Süsmann Muntner, “On the antiquity of Assaf the physician and his editorship of the first medical book in Hebrew”, in: Harefuah (Medicine) 33, 1947, 165 – 167, 180 – 183, 196 – 202; Joshua O. Leibowitz, “Itzhak Israeli’s Doctors Ethics”, in: Eitanim (bimonthly magazine on issues of public health and medicine) 2(4), 1949, 165 – 168.

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Bioethics National Council was created in Israel, finally beginning its work in October 2004.27

Sources and method, or the protagonists of the story As in the preliminary study, here I am using a method that combines literary “reception theory”, also called “reader-response theory”, which puts the accent on the reader’s active role in reading texts and events, and Peter Burke’s version of La Nouvelle histoire, which brings the social and cultural factors to the fore in historiography.28 Regarding the French context, besides the National Council of the French Medical Association (Conseil national de l’ordre des m¦decin), there are two other institutional protagonists in this story : the Acad¦mie des Sciences Morales et Politiques (ASMP) and the Acad¦mie Nationale de M¦decine (AM). While the ASMP is part of the so called Institut de France founded under the Ancien Regime, the French Academy of Medicine is a professional academy that at that time played the role of consultant to the French government, especially in terms of evaluating new drugs and therapies. Between these three institutions a somewhat dramatic relationship began to develop when in 1948, Professor Louis Portes (1891 – 1950), President of the FMA turned unexpectedly (but not irrationally) to the ASMP, seeking people with whom he could talk about ethical issues in medicine.29 One might have expected him to turn first to his fellows at the Academy of Medicine, but he did not. There is no explicit evidence of any tension, but an unspoken story is 27 As far as I know, there is no historiography of this relatively new Israeli institution. For an overview of the status and work of the first council see http://stwww.weizmann.ac.il/bioethicscouncil/ ; on the current one, see http://health.gov.il/Services/Committee/bioethics/ Pages/default.aspx (21 August 2014, both in Hebrew). For an early English-language account of the situation around the constitution of the National Council, see Michael L. Gross and Vardit Ravitsky, “Israel: Bioethics in a Jewish-Democratic State”, in: Cambridge Quarterly of Healthcare Ethics 12, 2003, 247 – 255. 28 See, among others, Hans Robert Jauss, Toward an Aesthetic of Reception, Minneapolis: University of Minnesota Press 1982; Peter Burke, History and Social Theory, Cambridge: Polity Press 2011 (2nd ed.); see also Etienne Lepicard, “La biom¦decine — la crois¦e de la litt¦rature et de l’histoire: Êthique? bio¦thique? d’o¾ viennent donc nos discours?”, in: Annuaire de l’Êcole pratique des hautes ¦tudes (EPHE), Section des sciences historiques et philologiques 139, 2008, 302 – 306, and idem, “La premiÀre r¦ception de ‘L’Homme, cet inconnu’, d’Alexis Carrel”, in: Histoire des sciences m¦dicales, 46(1), 2012, 9 – 18. 29 See Louis Portes, “A propos des problÀmes moraux que soulÀve l’exercice de la m¦decine (Communication — l’Acad¦mie des Sciences Morales et Politiques, 18 October 1948)”, in: idem, A la recherche d’une ¦thique m¦dicale, Paris: Masson et P.U.F. 105 – 112, and JeanRobert Debray, “L’Acad¦mie des Sciences Morales et Politiques et l’¦thique m¦dicale”, in: La Presse m¦dicale 58(1), 1950, 14.

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suggested. A similar event, perhaps even more dramatic in a sense, took place in 1959, when the new ex-president of the French Academy of Medicine, Robert Debr¦, had the decrees implementing the reform to completely reorganize medicine and medical education in France published without previously discussing them with his colleagues at the French Medical Academy. At least on this occasion the issue did not pass in silence.30 The other protagonists of the story are two leading medical journals: one the organ of the (Parisian) elite of the university hospitals – La Presse M¦dicale; the other reflecting a more professionally oriented press – Le Concours M¦dical. A survey of the latter is captivating because this journal openly favored contradictory debates between readers and authors (for instance on medical paternalism and medical responsibility),31 but is also provocative for the expressions of xenophobia, bordering on racism, still contained there in the aftermath of World War II.32 On the Jewish side, the main institutional protagonists are the Hebrew Medical Union of Mandatory Palestine (which became, after the establishment of the State of Israel, the Israel Medical Union)33 and various sick funds, the biggest and most influential of which was Kupat holim clalit, the “General Sick Fund”. After the establishment of the Israeli State, the Ministry of Health would

30 See, chronologically, Ren¦ Pi¦deliÀvre, Jean Delay, “Adoption d’un voeu relatif — la r¦forme des ¦tudes m¦dicales et des structures hospitaliÀres”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 248 – 249; Robert Debr¦, “A propos du procÀs-verbal: Mise au point”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 278 – 281; Xavier Leclainche, “La r¦forme de l’enseignement de la M¦decine et des húpitaux”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 281 – 287; Ren¦ Pi¦deliÀvre, “La r¦forme de la M¦decine”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 302 – 309; Charles Oberling, “La r¦organisation de la profession m¦dicale”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 332 – 337; Louis Pasteur Vallery-Radot, “Sur la r¦forme des ¦tudes m¦dicales”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 143, 1959, 352 – 355. 31 See Ren¦ Savatier, “Les responsabilit¦s m¦dicales (extraits)”, in: Le Concours m¦dical 73(14), 1951, 1307 – 1308, and Henri Planche, “Du paternalisme m¦dical”, in: Le Concours m¦dical 73(19): 1951, 1769 – 1771. Savatier was a well-known professor of law at Poitiers University. In the article he attacked the medical paternalism he saw taking shape in the presentations people from the National Council of the FMA had recently made before the Acad¦mie des Sciences Morales et Politiques. From the article, Planche cannot be identified, but he protested against the position of Savatier, who defended Louis Portes, President of the FMA. 32 Georges Lavall¦e, “La France aux prises avec des n¦cessit¦s d’immigration et des d¦sirs d’¦migration”, in: Le Concours M¦dical 68(32), 1946, 1088 – 1089. Lavall¦e had been president of the Conf¦d¦ration des Syndicats M¦dicaux FranÅais and was editor-in-chief of Concours M¦dical. 33 In English, people usually referred to this organization as the Israel Medical Association. In this article, I prefer to refer to it as the Israel Medical Union, to do justice to the importance of the social context of its origins, as it was born as one of the professional trade unions of the Yishuv, the Jewish community in Palestine.

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have to find its place in a public space that had not waited for it to exist and take up its work. Strangely enough, neither the Hebrew Medical Union nor the General Sick Fund seem to have kept archives from the pre-state period, so the historian has to base his interpretations on what has been published within the two institutions’ respective bulletins: The Mikhtav le-haver (“Letter to a member”) and the Dapim refuiyim (“Medical pages”). The first one is typically the bulletin of a national medical association, just that in this case, the association existed before the state and defined itself as a trade union in accord with the general socialist trend that prevailed within the Zionist movement. The complete title of Dapim refuiyim reads “Medical Pages for the Physicians of the Sick Fund of the General Trade Union of the Hebrew Workers in the Land of Israel”. This full title tells us a couple of things about this peculiar medical journal. Its targeted audience was the physicians of the sick fund, so it may be defined as a professional journal. The fact that it belonged to the General Union of the Hebrew Workers denotes its Zionist and socialist orientation as well.34 Besides these two journals, it must be noted that the founding of the state corresponds with a first wave of new professional and scientific publications: Haahot beerez Israel (“The Israeli Nurse”, 1948), Eitanim (a public health bimonthly publication of the General Sick Fund, 1948), Harokeah haivri (“The Hebrew pharmacist”, 1950), for instance. Finally, one personality has to be mentioned here, as his role appears to have been instrumental in many ways: Dr. Mark (Meir) Dvorjetski (1908 – 1975). Born in Vilnius (today’s Lithuania) and raised in Poland, Dvorjetski studied medicine in Nancy (France) and in Vilnius. During World War II, he served at first as physician in the Polish army and then became a prisoner-doctor in various camps after having practiced as a physician in the Vilnius ghetto. After the war he was in Paris for a couple of years before making his “alya” and emigrating to Israel in 1949. But even before his emigration he was in contact with Jewish medical leaders in Mandatory Palestine; in September 1947 he even represented the Jewish Medical Association of Palestine at the founding meeting of the WMA in Paris. A survivor himself, he began to testify about and investigate the Nazi medical deeds during World War II. He was a member of the first board of Yad Vashem, the official state institution for the commemoration of the Shoah, and when Israel Prizes were attributed for the first time in 1953, he won for the field of the social sciences. He later founded the first chair in Holocaust studies at Bar Ilan University. In 1961, he testified at the Eichmann trial.35 His personal papers are preserved in Yad Vashem in Jerusalem.36 34 See Shvarts, 2002. 35 For a first sketch of Dvorjetski’s biography, see his book Bein ha-betarim (lit. “Among the

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The French reception of the NMT (1946 – 1947), or euthanasia as a human experiment In La presse m¦dicale, the first article to catch my attention was entitled “Inhumane Medicine”, published in February 16, 1946.37 The article was signed by Jean-Robert Debray (1906 – 1980), one of the leading figures of the Ordre des m¦decins, who later presented ethical cases at the Acad¦mie des Sciences Morales et Politiques. Under such a title – “Inhumane medicine” – I expected to find a statement about what had just happened in Nazi Germany, but this was not the case. The issue was the Social Security Act of 19 October 1945 establishing the social insurance system and the fear physicians felt about it. The fear was that the state would take control over medicine, while physicians felt bound by what they called “la charte m¦dicale”, the medical agreement which guaranteed them: 1) freedom of prescription, 2) freedom of choice [of his family physician by the patient], 3) complete privacy of the physician/patient relationship (colloque singulier), and 4) the status of a liberal profession with payment according to services rendered.38 Debray’s claim was that the Order would protect the integrity of the profession in case the reform was misused. In fact, as we will see further, this fear was also expressed later in reference to the loss of control medicine experienced under the Nazi regime, but in this particular paper that was not yet an issue. In other articles, still without any reference to the NMT, people testified about what they saw as military physicians or what they experienced as deported physicians. For instance, on 6 April 1946, a review was published of the book by Charles Richet and his sons about their experience in the camps, Les trois bagnes.39 In this review one can sense the personal involvement of the author, namely Philippe Pagniez (1873 – 1947), a member of the French Academy of Medicine who wrote extensively for La Presse m¦dicale in his later years.40 Quite remarkable is the long opening sentence describing the horrors of the camps using biblical terms and speaking of the Nazi Moloch, in contrast to the “care for

36 37 38 39 40

pieces”, an allusion to the covenant described in Gn. 15, 9 – 21), Jerusalem: Kiryat-sefer 1956, and the many references to his work in Boaz Cohen, Israeli Holocaust Research: Birth and Evolution, translated by Agnes Vazsonyi, Abingdon/New York: Routledge (Routledge Jewish Studies Series) 2013. Dr. Mark Dvorjetski Archive (MDA), RG P 10, Yad Vashem Library, Jerusalem. Jean-Robert Debray, “La m¦decine inhumaine”, in: La Presse M¦dicale 54(7), 16 February 1947, 113 – 114. See Evleth 2009, 65, 73. Berlan and Th¦venin note “freedom of installation” instead of “prescription” as the first article of the charter ; see Berlan, Th¦venin, 2005, 153 – 154. Philippe Pagniez, “Trois bagnes”, in: La Presse M¦dicale 54(15), 6 April 1946, 218. Jean Lhermitte, “Notice n¦crologique sur M. Philippe Pagniez”, in: Bulletin de l’Acad¦mie nationale de m¦decine 131, 1947, 646 – 650.

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absolute truth” which is said to have animated the authors of the book, and the “striking realism of the official American documentary photographs” that illustrated the book. Another example appeared a week later on 13 April 1946, this time in the form of a long article by Jean Braine and Andr¦ Ravina on “the concentration camp and the ‘charnier’ (mass grave) of Schörzingen (Würtemberg)”.41 It consists of a personal account and reflections by two medical officers (one of them Andr¦ Ravina [1892 – 1973], who was part of the Scientific Board of La Presse M¦dicale) in the face of what they encountered when entering Germany with the French army. On 18 May 1946 an article on the typhus experiments at the Buchenwald camp appeared, authored by R. Waitz and M. Ciepielowski of Strasbourg.42 It consists of a long, precise description, with graphics and a short evaluative notice at the end, of experiments performed in the camps and recollected by two prisoner-doctors. Robert Waitz (1900 – 1978) was a physician and professor at the Strasbourg medical school who had been deported to Auschwitz III and then to Buchenwald for his activities in the Resistance. He testified at Nuremberg.43 Marian Ciepielowski (1907 – 1973) was a Polish doctor who later immigrated to the United States.44 I have quoted these articles among many to say something that is perhaps evident, but which I believe is important to recall: the NMT if it played a role in triggering the formation of a collective memory, did not come completely out of the blue, as a vibrant exchange of data, personal experiences and evaluations regarding medicine in Nazi Germany was already under way. Having said that, in the particular protagonist of my story that is La Presse m¦dicale, the peculiar attention dedicated to the NMT itself is sufficiently remarkable to examine how the trial was (re)presented there. On 5 April 1947, the journal published long extracts of the indictment presented by U.S. Prosecutor Telford Taylor at the opening of the NMT six months earlier.45 The publication of the act itself is preceded by a short notice that reads as follows: 41 Jean Braine, Andr¦ Ravina, “Le camp de concentration et le charnier de Schörzingen (Würtemberg)”, in: La Presse M¦dicale 54(17), 13 April 1946, 243 – 244. The French word “charnier” originally designated any place where bones of the dead (humans or animals) were deposited. It took on the meaning of “mass grave” or even of “killing fields” after the carnage that occurred during World War I. 42 Robert Waitz, Marian Ciepielowski, “Le typhus exp¦rimental au camp de Buchenwald”, in: La Presse M¦dicale 54(23), 28 May 1946, 322 – 324. 43 Robert Waitz, M¦decin, r¦sistant, dans les camps d’Auschwitz III, Buna-Monowitz, et de Buchenwald, Paris, Union des d¦port¦s d’Auschwitz, Cercle d’¦tude de la d¦portation et de la Shoah – Amicale d’Auschwitz, Association des professeurs d’histoire et de g¦ographie, 2011. 44 Stanislaw Klodzin´ski, “Sabotage at the SS Institute of Hygiene at the Buchenwald camp: Dr. Marian Ciepielowski” (in Polish), in: Przegla¸ d lekarski 34, 1977, 141 – 145. 45 Telford Taylor, “Acte d’accusation des m¦decins allemands criminels de guerre jug¦s —

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“We believe interesting enough to make known to our readers the text of the Indictment of the German War criminal physicians, who sit in judgment these days at Nuremberg in front of an American Military Tribunal. The text has been published by the “French documentation” [the official press of the French government]. Needless to recall that the facts brought against the defendants [lit. indicted] stand above any contestation and that their reality has been established by written documents and irrefutable photographs. We will publish in a following issue the impressions of Dr. Inbona, formerly deported, who attended the trial as a witness.”46

Two remarks: First, as we will see further, it was not every medical journal that decided to publish such an official document as the indictment in its columns. So this publication in itself has a particular significance for history and memorybuilding.47 Second, here, too, we find the claim for truth that appeared in the review of Richet’s book about “written documents and irrefutable photographs”, denoting the difficulty of contemporaries to believe what people coming back from the camps were telling. Of course, the indictment (12 pages of transcript) was not published in extenso and cuts were made. However, the main structure remained, with the four charges of the accusation: conspiracy, war crimes, crimes against humanity and membership in a criminal organization. Under the count of war crimes appear the twelve categories of medical experiments, as well as the killing of 112 Jews in order to complete the Jewish skeleton collection for the anthropological display that was supposed to be held at the Anatomy Institute of the Reich University of Strasbourg to exhibit the inferiority of the “Jewish race”, the fate of the tubercular Polish natives and the implementation of the “Euthanasia program”. One week later, on 12 April, an article by Jean-Marie Inbona (Paris) appeared,48 a descriptive account of the trial coupled with some personal reflections about it. After the description of the organization and the atmosphere of the trial, the author recalled who the defendants were, concluding his introduction by saying that “it’s about the trial of the German medical leaders, and so of a great part of the German medical profession”.49 Then he came to refine his main point. Others may analyze and classify the documentation – and he names

46

47 48 49

Nuremberg par le Tribunal militaire No 1 (9 D¦cembre 1946)”, in: La Presse M¦dicale 55(20), 5 April 1947, 238 – 239. Ibid., 238. As far as I know, Jean-Marie Inbona (1908 – 1972) did not testify before the tribunal but had been sent there by the F¦deration des m¦decins d¦port¦s; see Andr¦ Ravina, “La fin du procÀs des M¦decins allemands criminels de guerre”, in: La Presse M¦dicale 55 (61), 18 October 1947, 705 – 706, here 705. For instance, it was translated into Hebrew and published in the newsletter of the Hebrew Medical Union (see note 108 below). Jean-Marie Inbona, “Le procÀs des m¦decins allemands, leur responsabilit¦ dans la technique du g¦nocide”, in: La Presse M¦dicale 55(21), 12 April 1947, 250 – 251. Ibid., 250, col. 1 (italics from the original).

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among others FranÅois Bayle –, but he wants to go beyond the “objectivity” of the trial to address a point the trial does not study or refer to. He wants to develop: “The research and study of the motives that push these physicians to participate in this broad enterprise of extermination, which has resulted with the death of millions of human beings in the most awful suffering. And so, one gradually sees a completely new medical specialization formed for the exclusive services of extermination.”50

“Under the pressure of the questions”, continues Inbona, “most of these physicians ultimately take refuge behind the scientific experiments, to which the German army owed knowledge and from which it had even benefited, according to their statements.”51 “I believed that at first”, he acknowledged, referring to his own experience at Buchenwald as well, and what he saw of the typhus experiments.52 Confronted, however, with the evidence exposed and what he had read from the “talks, letters and circulars by Himmler and his medical collaborators”, he was struck “by many contradictions, by disproportions between the aim and the effect sought”, and “especially by a strange naivety and incoherence in the reports”, underlining that this had also been noticed by Waitz and Ciepielowski in their article.53 If the case of the typhus experiments alerted him, his starting point to understand the “true motives” of the Nazi physicians was precisely “this famous act of euthanasia established by Hitler”, a French translation of which Inbona quoted in full.54 This is an important point to notice as FranÅois Bayle interpreted euthanasia the same way – another type of experimentation. Not something different, not to say, for instance, anything connected to eugenics. Inbona interpreted this letter from Hitler as well as other documents produced at the NMT, notably letters from Heinrich Himmler, as examples of a double language: “We are struck by the discrepancies and contradictions between the facts exposed in letters, documents more or less confidential, and the statements made for the layman.”55 Moreover, Inbona came to ask: “How can we explain this necessity that appears evident to Himmler and the physicians around him, to conceal (lit. camoufler) under the terms of scientific experiments, procedures of pure ex50 51 52 53 54 55

Ibid., col. 2 (italics from the original, the latter emphasis is mine). Ibid. Ibid. Ibid. Ibid. Beside Hitler’s letter to Philipp Bouhler and Karl Brandt authorizing the “mercy death” (Inbona used the term “euthanasia” here) of certain incurable people, Inbona quotes two letters from Heinrich Himmler to physicians working with him: Documents 250 and 365 presented at the NMT. The former connected to the intention to introduce tubercular Poles to “these camps of inanition, about which the extermination role has to be carefully hidden”, and the latter referring to “the suppression of Jews unable to work thanks to Brack’s medicine (lit. remÀde”); see ibid., col. 3.

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termination, the effects of which they judge worth seeking?”56 His answer was twofold. On the one hand, he argued that this camouflage helped Himmler attract highly qualified scientists who would not have agreed to work if the main purpose had been explicitly termed as research on mass killing procedures. On the other hand, it helped him justify the number of people working in “military scientific research”, while the army was requesting more and more medical and paramedical staff members every day.57 In other words, although it may be difficult from our point of view to understand how euthanasia, or the other actions referred to in Himmler’s letters quoted here, could have been interpreted by Inbona as “scientific experiments”, this was precisely his point. In his view, all of these camouflaged actions have to be taken as experiments of a new science – the science of (mass) killing. At this point, Inbona summarized in one huge table eight of the experiments at stake, giving for each of them: 1) the experimental protocol as written down by the German physicians; 2) its critics; 3) the motive and aim actually pursued.58 For instance, to keep going with the typhus experiments already mentioned, Inbona notes in column 1) that “Prof. Mrugowsky” studied “the effect of various vaccines in Block 46, at Buchenwald”, in column 2) that there is “no mention seriously made of any vaccine tried on a deportee after [he developed] an experimental typhoid”, and in column 3) that this denotes “a – an attempt of mass extermination by injection of blood coming from a typhus patient and enabling the study of the precise date (lit. date) of incubation and of the evolution of the disease; b – excellent statistics establish precisely the date of incubation and the different stages of the typhoid”.59 The author took care to specify that only some examples of “scientific experiments” (inverted commas are his) are given in the table based on the various documents found that were produced during the sessions in Nuremberg. He then turned to the topic he had personally studied, the state of undernourishment, which was “the first and most constant means of extermination sought”.60 He underlined that “some of these procedures of extermination required the assistance of many physicians and we see [in the documents] directors of the health services, general inspectors, biologists, epidemiologists, president of the Red Cross, Himmler himself, coming in person to see the effects of these procedures and exchanging many letters about them”, so that he quite naturally concluded: “It is

56 57 58 59 60

Ibid. Ibid. Ibid., 251. Ibid. Ibid., 250, col. 3, and idem, “Les avitaminoses dans le camp de Buchenwald”, in: La Semaine des Húpitaux de Paris 21, 21 July 1945, and idem, “Êvolution des avitaminoses chez les d¦port¦s aprÀs leur lib¦ration”, in: Le M¦decin franÅais 22, 25 February 1946.

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not possible that an important contingent of the German medical profession was able to ignore some of these scientific modes of extermination.”61 After having reached such a conclusion, Inbona went on to ask: “Was Himmler the promoter of this new technique of extermination and his medical surroundings only implementers?”62 Here too, his answer reflected the position of Bayle, according to which each of the main physicians indicted was in fact psychologically dependent on one of the main Nazi figures.63 However, if Inbona justly recognized that this may have been the case for such people as Karl Gebhardt and Karl Brandt, personal physicians of Himmler and Hitler, respectively, he also raised another issue, which was whether the relative lack of culture of Himmler could explain “the naivety of the imagined [scientific] procedures, the absurd way some of these experiments were performed, their incomplete character”.64 His answer here was clearly negative, given the scientific reputation of such people as Kurt Blome, Gerhard Rose, and Adolph Pokorny. But if one could not blame the lack of culture of the leaders or their surroundings, how caould the haphazard approach of the experiments be explained? We are facing an aporia. Inbona, at this point, introduced the key notion of “genocide” as an illuminating concept. This notion was first formulated by RaphaÚl Lemkin in 1944 in order to specify the kind of crime that the notion of “crimes against humanity” left too vague in his eyes, speaking only about “civil populations” without taking into account the persecution of one specific group or another.65 This very notion helped Inbona to go a step further back than Bayle and to indicate Hitler himself as the origin of all that happened, and so to show the logical necessity of creating this new medical specialization. “When one studies Hitler’s mystique and its surrounding concepts […], one understands how these physicians were able to be part of such a mystique. They realized that it was necessary to perfect the war campaign by the creation of a new medical specialty.”66 Others had given a name to this new science – thanatology, as Brigadier General Telford Taylor christened it in his opening 61 62 63 64 65

Idem, 1947, 250, col. 3. Ibid. See Lepicard, 2007, 211 – 212. Inbona, 1947, 250, col. 3. Raphael Lemkin, Axis rule in occupied Europe: Laws of occupation, analysis of government, proposals for redress, Washington [D.C.]: Carnegie Endowment for International Peace, Division of International Law 1944; see also Bernard Bruneteau, “G¦nocide: Origines, enjeux et usages d’un concept”, in: Barbara Lefebvre, Sophie Ferhadjian (eds.), Comprendre les g¦nocides du XXe siÀcle: Comparer-Enseigner, Rosny-sous-Bois: Br¦al 2007, 20 – 50, here especially 21 – 22; for an analysis of the intended use of the concept of “crimes against humanity” at Nuremberg, see Michael R. Marrus, “The Nuremberg Doctors’ Trial in Historical Context”, in: Bulletin of the History of Medicine 73, 1999, 106 – 123. 66 Inbona, 1947, 251, col. 1.

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statement in the trial on 9 December 1946, labeling it a “macabre science” and giving it the narrow sense of “the science of producing death”.67 But perhaps more important than the label itself was the fact that this labeling, in the opening statement, was a response to the need to find some unity among the horrors. Taylor, before describing the Nazi experiments one by one, and two sentences before speaking about “thanatology”, was actually asking: “Are they [the experiments] a heterogeneous list of horrors, or is there a common denominator for the whole group?”68 A need to understand the perpetrators and their crimes was expressed here. For the prosecution, it was clear that “euthanasia” and the “slaughter of the tubercular Poles” had no relation to “research or experimentation”;69 Inbona introduced them as experiments of the new science. In both narratives, as in Bayle’s account, I cannot but see the same kind of intellectual attempt to understand the perpetrators. An understanding which, in my view, also permits the authors to distance themselves from the atrocities. In unifying the various crimes and in identifying Nazi leaders (Bayle’s version) or even only Hitler’s mystique (Ibona’s version) as the key factor at the origins of a newly identified medical specialty (newly identified but, of course not acceptable), did people not transform an unbearable past that did not cease to raise questions into something more manageable, something that had nothing to do with the medicine that we are practicing during peacetime?70 Transforming “euthanasia” into a medical experiment of a new – but unacceptable – science seems to be a way to differentiate it from every other kind of euthanasia: who would dare to renew the experience of the ‘Third Reich’? 67 See “Opening Statement of the Prosecution”, in: TWC, 1950, 38 (which corresponds to page 23 of the English transcript, now accessible online, see http://nuremberg.law.harvard.edu/ NurTranscript/TranscriptPages/62_23.html (4 September 2014). Six names are indicated as personal authors for this statement (Opening Statement for the United States of America, Harvard Law School Library Item no. 565): Dr. Leo Alexander, medical consultant to the prosecution; Alexander G. Hardy, Arnost Horlik-Hochwald, James M. McHaney and Jack W. Robbins, all four of counsel; and Brigadier General Telford Taylor, Chief of Counsel for War Crimes. In consequence, it may well have been introduced by Leo Alexander, as also seen in the reference given by Paul Weindling in his contribution to this volume note 22. Alexander did not coin the term “thanatology”, however, as is sometimes claimed. In an essay first published in the Journal of the American Medical Association on 27 April 1912, a certain Dr. Roswell Park claims that he “long ago coined” the expression. This may be not the end of the story, as this author quite ingenuously admits in the next sentence that “years later I found [the expression] had been incorporated in the scientific dictionaries, though never before heard by me or encountered in my reading”. See Roswell Park, The Evil Eye, Thanatology, and Other Essays, Boston: Richard G. Badger – The Gorham Press 1912, 32 – 48, here 33. As an academic discipline approaching death in a multidisciplinary manner, thanatology did not really take off until the 1970s. 68 TWC, 1950, 37 (page 23 of the English transcript). 69 Ibid. (page 22 of the English transcript). 70 On Bayle, see Lepicard, 2007, 211 – 212.

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On 18 October 1947, another article on the NMT appeared in La Presse m¦dicale, describing the atmosphere and what happened during the last days of the trial (19 – 20 August 1947).71 The author, Andr¦ Ravina, who had written a previous article presented above about what he observed upon entering Germany as a military doctor in 1945, was, according to what he says in this article, called to Nuremberg by the American services for the last days of the trial.72 Like the article by Inbona six months earlier, Ravina’s is written in the first person singular – the testimony/memoir of a witness. Like his predecessor, Ravina looks to relate to his readers the atmosphere at the court and to elaborate on his own reflections. The feeling of a personal account is perceptible in the very first lines of the first paragraph: “Upon American services’ request, I left on the evening of 17 August for Nuremberg, where I met Drs. Ibona and Berlioz, sent to the trial by the F¦d¦ration de M¦decins d¦port¦s (‘association of deported physicians’).”73 Quite quickly too, he introduced to his narrative the figure of M¦decin Lieutenant-Colonel Bayle, who, together with Mss. Chalufour from the French mission to the Justice Court, helped them to obtain the permits necessary to enter the courtroom. Unlike Inbona, who shortly after the beginning of his article began to develop his own ideas on the trial, Ravina describes the hall, the defendants, the arrival of the court, etc. He then turns to summarize the expos¦ given by the judges in these two days reserved for the verdict (the last day of the hearing of the trial had been held a month before, on 19 July), and only in the last third of the article does Ravina add some personal philosophical remarks. Three points are genuine and deserved to be noted in Ravina’s account of the general overview given by the judges at the first morning session (19 August): a presentation of what would later be called the “Nuremberg Code” of medical 71 Andr¦ Ravina, “La fin du procÀs des M¦decins allemands criminels de guerre”, in: La Presse M¦dicale 55(61), 18 October 1947, 705 – 706. 72 Ibid., 705, col. 1. What the exact purpose of the Americans was is not clear, however. For a hypothesis, see below. 73 Ibid. Besides the article analyzed previously and the couple of articles he wrote about the pathology of deportation linked to undernourishment quoted in note 60 above, so far I have not been able to find much information about Jean-Marie Inbona. Nor about Berlioz, who may turn out to be the same person as a Dr. Charles Berlioz, a specialist on medical statistics who worked and wrote in the field of medical insurance before and after the war. As far as I know, there is not much literature about the F¦d¦ration des m¦decins d¦port¦s either. Was it the same organization as the Association Nationale des M¦decins D¦port¦s et Intern¦s de la R¦sistance, which played an important role later with respect to the compensation issue? We may suppose so, as in a press release by the latter Inbona appears as Treasurer of the Association. See “Association Nationale des m¦decins d¦port¦s et intern¦s de la R¦sistance: Compte-rendu de l’Assembl¦e g¦n¦rale du 8/12/1945”, in: Le Concours m¦dical 68(2 – 3), 13 – 20 January 1946, 2. Also worth noting is the MD thesis of Xavier d’Arras, Des m¦decins d¦port¦s franÅais dans les camps de concentration Nazis, Bordeaux: Facult¦ de m¦decine de Bordeaux 1994. (I am pleased to thank Jean-Marc Dreyfus for bringing my attention to that work).

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ethics; the place given to the deported at the trial; and some personal psychological remarks of Ravina on the overall atmosphere. Here, I will look only at the first of these points, as it is the most relevant for the argument of this chapter. After a brief account of the description by the judges of the various experiments performed by the defendants, Ravina goes on to say : “The president then announced that he will expose what the Anglo-Saxons consider to be the rules of medical experimentation on human beings.”74 “The consent of the [human] subject is absolutely necessary and [the experimentation] should not be attempted unless useful results for humanity cannot be obtained by other procedures. Experimental research on human beings should be based on previous experiments made on animals. It should not be initiated if people think a priori that it can result in death or disabling injury, and should not inflict any physical injury or mental disorder that is not strictly necessary. The degree of risk to be to be taken should never exceed that is determined by the humanitarian importance of the problem. Everything should be made in order to protect the experimental subject against any possibility of injury, pain, or deadly accident. Finally, the experiment should be conducted, through all its stages, by persons perfectly qualified.”75

Having compared this summary with the full original record (see Table 1), some remarks are in order. Even if the author does not label these rules “ethical code” – the very word “ethics” does not even appear in Ravina’s introductory sentence, just the concept of “rules” – there is no doubt that he considered these rules sufficiently significant to isolate and summarize them. These two actions of isolating and summarizing appear to me essential toward the transformation of such “rules” into a “Nuremberg Code”. A couple of things that are lacking in Ravina’s account are perhaps more important than those he included. While the general issue of consent appears first, for instance, it is not specified whether or not this consent had to be voluntary. Moreover, the entire description of consent in the full record, which caused it to be almost unimplementable in practice, totally disappeared from Ravina’s account (see section no.1 in Table 1). In addition, it must be noted that one of the elements – if not the major element that characterizes the strength of the Nuremberg points of medical ethics in my eyes – is completely lacking in Ravina’s account. I mean the possibility for the human subject to stop his participation in the experiment at any time, merely on account of his subjective feelings, as well as the analogous demand that the scientist be prepared and willing to put an end to the experiment at any sign of risk to the experimental subject (see sections no. 9 – 10 in Table 1).76 Here is 74 Ibid., col. 2. 75 Ibid. 76 See Etienne Lepicard, “ProcÀs de m¦decins et codification ¦thique: Une lecture compar¦e des ‘Richtlinien’ de 1931 et du Code de Nuremberg”, in: International Journal of Bioethics 12(2), 2001, 41 – 47.

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not the place for a detailed analysis of the reasons for such differences. Let us note, however, that the ten points of medical ethics had been formulated by judges bearing in mind the defendants they were judging,77 while the summary in La Presse medicale had been written by a physician belonging to the French medical establishment and speaking to his fellow physicians, so that the importance of outlining the perspective of the patient may have been felt differently. Finally, without further analyzing Ravina’s article, it is worth mentioning that the author adopts Inbona’s use of Lemkin’s notion of genocide as a key concept to understand the participation of physicians in the extermination enterprise. Nazi leaders, especially Himmler, did not look “to obtain useful results for the army forces” through experiments, as they pretended. They used them to cover up “their true goal”, which was “to obtain methods of extermination altogether scientific and discreet in order to enable the quick elimination of individuals or ethnic groups considered unable to adapt to the Nazi system”.78 This, according to Ravina, was the thesis of the Americans and especially of Dr. Alexander, and this was also the thesis of Inbona in the article we analyzed above, but Ravina wants to go a step further. He does not think that the close of the NMT “resolves all the problems raised by the participation of an important contingent of German physicians in Nazi crimes”.79 “It is possible that some governments” in a near future “will ask from the members of the medical profession [lit. corps m¦dical] of their country to help them in their extermination work” based on “new destruction means unknown until these last years”.80 Consequently, toward the end of his article Ravina calls for the establishment of an international medical law (lit. droit medical international) to which all physicians from all countries would be bound, whatever the orders of their own national leaders. And he concludes, “Such a result would be a happy and direct consequence of the Nuremberg trial.”81 This raises, in my eyes, the issue of the plurality of the Nuremberg trial legacy, a legacy which can no longer be seen as limited to human experimentation and the “ethical code”. Further research is obviously needed here. For instance, Ravina’s suggestion for the establishment of an international

77 For a thorough analysis of the constitution of the Nuremberg Code, see Paul J. Weindling, “The Origins of Informed Consent: The International Commission for the Investigation of Medical War Crimes, and the Nuremberg Code”, in: Bulletin of the History of Medicine 75, 2001, 37 – 71, and idem, Nazi Medicine and the Nuremberg Medical Trial: From Medical War Crimes to Informed Consent, Houndmills/Basingstoke: Palgrave Macmillan 2004. 78 Ravina, 1947, 706, col. 3. 79 Ibid. 80 Ibid. 81 Ibid.

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medical law was debated repeatedly at the French National Academy of Medicine in the years to follow, but had its origins in the aftermath of World War I.82 In parallel to this exploration in La Presse m¦dicale of 1947, I would like now to summarize some findings about the second press protagonist of my story within the French medical landscape, i. e. Le Concours M¦dical. This journal had been founded at the end of the 19th century and had been at the origins of the medical trade unions. It mainly focused on medicine as a liberal profession and on the defense of its independence.83 In great contrast to La Presse m¦dicale, however, this organ published almost nothing on the NMT. In the “news from the profession” part of the journal one can find some accounts (or press release) of one meeting or another where deported physicians talked about their experiences, but I did not find a single full article on the topic.84 That is not to say that there is no important information there. For instance on 27 July 1946 a summary of the Second Conference on “Scientific German Atrocities” was published, which was organized by one of the French medical trade unions, the Union des m¦decins franÅais. According to that press release, Professor Desoille from Paris Medical School spoke about the attitude of German physicians, and Dr. GilbertDreyfus of the Medical Society of Paris Hospitals spoke about the attitude of French prisoner-doctors. The presentation of the first talk is especially relevant to this article, as its author had shown: “in the light of official documents from the Nuremberg trial, how the systematic destruction of the human person and dignity was organized. He stresses, supported by Professor Champy (who chaired the conference), the fact that the German medical profession as a whole participated in this dirty work. The most famous German scientists were involved, with an undisguised pleasure, in pseudo-scientific experiments on prisoners: vivisection, cooling and resuscitation, sterilizations, typhus inoculation, etc. These crimes, unprecedented in history, arouse the indignation of any

82 See, for instance, Jules Voncken, “La formation morale du m¦decin au point de vue international”, in: Bulletin de l’Acad¦mie de M¦decine 133, 15 March 1949, 235 – 240. Following Voncken’s presentation, the Academy nominated a special committee in charge of formulating recommendations. See Pierre Oudard, “Vœux: Au nom de la commission de la Formation morale des M¦decins”, in: Bulletin de l’Acad¦mie de M¦decine, 133, 29 March 1949, 278 – 279. 83 See, for instance, Evleth, 2009, 61 – 77, where the author summarizes the early attempts to establish a FMA between various professional as well as political forces; for the role played by Le Concours m¦dical, see especially 63 – 64. 84 For instance, see the press release quoted above, “Association Nationale des m¦decins d¦port¦s et intern¦s …”, 13 – 20 January 1946, 2, and Marcel Chaton, “La lutte contre l’esprit de guerre et la collaboration du corps m¦dical mondial”, in: Le Concours m¦dical 69, 15 November 1947, 1923.

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civilized [human] being. As a challenge to Justice, however, for the most part their authors have not even been bothered, but treated with a revolting indulgence.”85

In order to understand what some people in France, in the immediate aftermath of World War II, knew about the involvement of the German medical profession in Nazi atrocities, such a publication is doubtlessly an important document. The fact that this was published in the “news from the profession” part of the journal, however, indicates more about the diffusion of the information than about anything else. In particular, this says nothing about the position of the journal itself regarding these issues. Moreover, it has to be noted that this information is provided by two people (Pr. Desoille and Dr. Gilbert-Dreyfus) who belong to the Paris medical establishment, the Presse m¦dicale milieu. The journal itself, Le Concours m¦dical, did not deem the topic sufficiently important to publish even a single full article on the topic. In the same period of time, 1946 – 1947, one can find in the journal articles such as “Racism, Eugenism and Genetics”,86 “May Physiology Inspire Politics?”,87 inspired by the essay “Wisdom of the Body” by the American physiologist Walter B. Cannon, and some echoes of the pessimism of Herman J. Muller, who had just won the Nobel Prize in Medicine or Physiology for 1946.88 The latter two were written by the journal’s editor-in-chief, suggesting that the absence of echoes about Nuremberg may have been a deliberate choice. The new Code de d¦ontologie89 and even the establishment of the WMA were entirely different matters.90 As previously stated, in June 1947, the French gov85 “Compte-Rendu de la deuxiÀme conf¦rence de l’Union des M¦decins FranÅais sur ‘Les atrocit¦s scientifiques allemandes’”, in: Le Concours m¦dical 68(30), 27 July 1946, 785. 86 Pierre Labignet, “Racisme, Eug¦nisme et G¦n¦tique”, in: Le Concours M¦dical 68(31), 3 August 1946, 825 – 826. 87 Georges Laval¦e, “La physiologie peut-elle inspirer la politique?”, in: Le Concours M¦dical 68 (49), 7 December 1946, 1497 – 1499. 88 Idem, “Les propos pessimistes d’un prix Nobel”, in: Le Concours M¦dical 68(50), 14 December 1946, 1545 – 1546. 89 See, for instance, “Echos & Commentaires: A propos du code de d¦ontologie”, in: Le Concours m¦dical 68(36), 7 September 1946, 999; “Que devient le code de d¦ontologie”, in: Le Concours m¦dical 68(45), 9 November 1946, 1335; “Le code de d¦ontologie fantome”, in: Le Concours m¦dical 69(14), 5 April 1947, 617; Jean Mignon, “Le code de d¦ontologie en premiÀre lecture, La m¦decine a-t-elle cess¦ d’Þtre une profession lib¦rale?”, in: Le Concours m¦dical 69(28), 12 July 1947, 1204 – 1206; idem, “L’esprit du code de d¦ontologie, d’aprÀs la pr¦face et les travaux pr¦paratoires”, in: Le Concours m¦dical 69(32), 9 August 1947, 1364 – 1366; idem, “Le contrúle du Conseil d’Êtat sur les juridictions de l’Ordre, ou le souverain d¦chu”, in: Le Concours m¦dical 69(36), 6 September 1947, 1501 – 1503; Dr. Auslander (Andr¦zieux), “R¦flexions sur le code de d¦ontologie”, in: Le Concours m¦dical 69(44), 1 November 1947, 1841 – 1842. 90 See, for instance, Fernand Decourt, “Une conference m¦dicale international — Londres”, in: Le Concours m¦dical 68(36), 7 September 1946, 995 – 996; idem, “La conf¦rence m¦dicale international de Londres des 25, 26 et 27 septembre 1946”, in: Le Concours m¦dical 68(43), 26 October 1946, 1249 – 1251; Raymond Jodin, “D¦fense professionnelle sur le plan mondial”,

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ernment passed a law regulating the medical profession entitled the Code of Deontology. This was the result of collaboration between the FMA and the French Council of State (Conseil d’Êtat). One might inquire about the necessity to pass a law regulating the medical profession at this peculiar time, and it seems legitimate to seek a connection with what happened to medicine under the ‘Third Reich’.91 The broader context of the newly established Fourth Republic, which had to deal with the heritage of the Vichy government – including the very creation of the FMA – needs to be taken into account there as well.92 Regarding the discussion resulting in the founding of the WMA, the French medical trade unions were first in line, as even before World War II they had been involved in the first attempts to build international medical cooperation.93 After a few meetings in London and Paris (1945 and 1946), the first official Congress was held in Paris in September 1947. As Le Concours m¦dical was a professionally oriented journal, it is quite evident why these two events, the publication of the Code of Deontology regulating the French medical profession and the foundation of the WMA, in charge of coordinating the activities of the medical profession on the international level, found relatively extensive coverage in its pages. In this latter, news-of-the profession context of the launching of the WMA is where allusions to Nuremberg, or more precisely to what happened in Nazi Germany, can be found in this journal. Four articles gave an account of the first and founding meeting of the WMA held in Paris, 16 – 21 September 1947. The first of these articles, anonymous, is dedicated to the technical functioning of the new association, the establishment of its bylaws and the fact that the Americans in: Le Concours m¦dical 69(18), 3 May 1947, 772 – 773; “Echos & Commentaires – Le CongrÀs mondial et Quelques pr¦cisions sur le Premier CongrÀs mondial de l’A.M.M.”, in: Le Concours m¦dical 69(39), 27 September 1947, 1626 – 1627; Fernand Decourt, “La PremiÀre Assembl¦e g¦n¦rale annuelle de l’A.M.M., r¦ception faite par le corps m¦dical franÅais en dehors des s¦ances de travail”, in: Le Concours m¦dical 69(40), 4 October 1947, 1662 – 1664; “Association M¦dicale Mondiale (press release)”, in: Le Concours m¦dical 69(41), 11 October 1947, 1685 – 1686; Fernand Decourt, “Anecdotes sur la PremiÀre Assembl¦e g¦n¦rale de l’A.M.M.”, in: Le Concours m¦dical 69(48), 29 November 1947, 2005 – 2006. 91 This was one of the questions the late David Bankier of blessed memory, head of the International Institute for Holocaust Research of Yad Vashem and professor at the Hebrew University of Jerusalem, repeatedly asked me, and to which I have yet to find a satisfactory answer. 92 For an overview using a longue dur¦e approach, see Robert A. Nye, “M¦decins, ¦thique m¦dicale et Êtat en France, 1789 – 1947”, in: Le Mouvement Social 214(1), 2006, 19 – 36. 93 The London conference of September 1946 was convened by the British Medical Association in the name of the Association Professionnelle Internationale des M¦decins (APIM), founded in 1925 by Fernand Decourt who was still its Executive Secretary at the time of the conference; see Decourt, September 1946, 995 – 996, and idem, October 1946, 1249 – 1251. Actually, the WMA explicitly succeeded the APIM, see “World Medical Association”, in: British Medical Journal, 27 September 1947, 498 – 500 (I would like to thank Professor William Seidelman for bringing this article to my attention).

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“bought” it in a sense, as in exchange for the promise of a considerable donation they requested that the secretariat be located in New York.94 The second is a long and descriptive article by Fernand Decourt, general secretary of the defunct APIM, who had resigned from his position at the second London meeting. From every point of view, the meeting was far from a quiet one, yet the session dedicated to the Nazi medical crimes was unanimously depicted as a notable exception.95 Interestingly enough, only the two French speakers are explicitly called by name, with the motion presented by the Hebrew Medical Union representative recognized only thanks to the terms used to speak about the German medical profession: “The German medical profession, all the way up to some of its great masters, was befittingly stigmatized and some avenging orders of the day (it was all that could be done) were voted, anathematizing the German medical profession as a whole and solemnly requesting that it express regrets and apologies for the crimes committed, and this [to be done] officially. If not, any German organization would be excluded for a very long period (some speak of 10 to 25 years) from the right and honor of joining any international medical organization.”96

As we will see later, the title of the motion presented by the Jewish Medical Association of Palestine read “Let Us Throw the Anathema Against the Murderer-Doctors”.97 The third article is the official summary as released to the press.98 The issue of the Nazi medical crimes appears twice in it. First, in the descriptive part of the summary, where it appears that only two issues besides the issue of the inner functioning and the bylaws of the new association were discussed: war crimes and the relationship between medicine and the state. As in the account by Decourt, only the names of the French speakers appear there. Finally, after the results of the election to the board of the new association, a whole section is devoted to the motion on the war crimes, which had finally been adopted by the representatives. Quite surprisingly, the section begins by stating that upon graduation from medical school every physician will have to swear the oath given afterwards. I say quite surprisingly because it is well-known that the WMA rewrote the Hippocratic Oath at the next meeting of the WMA in Geneva in 1948, but I was not aware that a first formulation had already been discussed 94 95 96 97

See “Echos & Commentaires …”, 1947, 1626 – 1627. See Decourt, October 1947, 1663, as well as “WMA”, September 1947, 499. See Decourt, October 1947, 1663 (my emphasis, E.L.). See note 143 below. As already stated above, the representation of the Jewish physicians of the Yishuv called itself in Hebrew, the Hebrew Medical Union, but at the WMA meetings in London as well as in Paris, it uses the expression of Jewish Medical Association of Palestine. Perhaps because of the presence of an Arab Medical Association of Palestine; see, for instance, Decourt, October 1946, 1249. 98 “Association M¦dicale Mondiale (press release)”, October 1947, 1685 – 1686.

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and adopted at the Paris meeting.99 The second part of the section is devoted to a motion adopted at the Paris meeting, requesting from the German medical trade unions (lit. syndicats m¦dicaux allemands) an open statement of remorse in order to be re-admitted to international medical organizations: “a) We, members of the Medical Union, have come to know the great number of individual or collective acts of cruelty performed since 1933 within mental asylums and concentration camps, and the violations of medical ethics. These acts have brought to death some millions of people. A great number of our members are guilty, either as instigators, or as technical or executive agents. b) We regret that the German medical profession as a whole neither protested nor wanted to know anything about these acts, of which, nevertheless, they could not have been ignorant. c) We want to reprove in a solemn manner these attacks, to detach ourselves from the criminals who have committed them, and to recall to all our members the respect, not only of life, but also of the human personality, dignity and liberty.”100

In terms of building memory within the profession, this “open request” is interesting on two levels. First, in the way it summarized what happened in Nazi Germany in connection to medicine, it offered a parallel account to Nuremberg. Today we have become used to thinking about the topic in the categories determined at the NMT, the various categories of medical experiments, the euthanasia issue and a few others like the Jewish skeleton collection and the fate of the tubercular Poles. In the summary of point a) above, there are no such details. It is about “acts of cruelty” and “violation of medical ethics” in certain places and by “a great number of our members”, and here is where details come – “instigators, technical or executive agents”, i. e. in the categories of people who may have committed these acts.101 There is no tribunal and there are no specific defendants awaiting a judicial decision, it is about the correct and incorrect conduct of a whole profession. One parallel with Nuremberg does exist, however, and this is the second point I want to make. Although the WMA motion did not refer to Nuremberg, and even though the two contexts are completely different, in neither case were there any expressions of remorse on the part of the defendants. No any such reaction from the German Medical Association (GMA) was forthcoming as a positive response to the WMA’s request. The new GMA

99 See the Geneva Declaration presented on the WMA website: http://www.wma.net/en/ 30publications/10policies/g1/index.html (4 September 2014). These changes were initiated by Charles Richet; see for instance Henri Baruk, “La defense de la vie et le caractÀre sacr¦ de la m¦decine — propos de l’exp¦rimentation m¦dicale criminelle”, in: La Presse m¦dicale 56 (45), 7 August 1948, 551 – 552; here 551, col. 3. 100 See “Association M¦dicale Mondiale (press release)”, October 1947, 1686. 101 Ibid.

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would integrate the WMA in 1951 without having expressed any “regrets” nor “solemn condemnation” for what happened.102 In summary, besides these very brief accounts in the context of a professional framework, reported as byproducts of professional news in this second journal, there is almost complete silence about what happened to medicine under the ‘Third Reich’ and about the NMT.103 This silence may be as eloquent as the items published in La Presse m¦dicale and presented above. How can one explain such a silence by one of the leading professional journals – one that can be otherwise characterized as quite democratic and encouraging debate among physicians, in comparison to La Presse m¦dicale, which represented the elite of the profession? One possible answer is that the latter may have felt that one of its main functions was “education”. Indeed, most of the main contributors to the journal were professors at the Paris Medical School, while Le Concours sought rather to address the many problems of a professional order that relates to the private and social life of the physician, i. e. to help the general practitioner in his everyday professional life. Was there also a class issue, or a professional one (did psychiatrists react differently, for instance)? I have no answers yet, but it seems to me that if there are any they would have to be sought in the kind of audiences addressed by the various journals. In any case, quite exclusively oriented toward the medical profession, Le Concours m¦dical did not realize the importance of the NMT for the future of the profession.

Israeli reception of the NMT (1946/47), collective voice or personal involvements? A.

A journal’s special issue (1946) on “The struggle for life and health within the ghettos under Nazi occupation”

A few months before the beginning of the NMT, Dapim refuiyim, the professional journal of the General Sick Fund of Hebrew Workers in the Land of Israel, published a special issue on the way Jews coped with the sanitary difficulties they faced in the ghettos in Eastern Europe and in various other war 102 Ibid. As already stated, as far as I know there is no scholarly historical account of these founding years of the WMA. See note 9 above. As the fourth article, also from Decourt’s pen, constitutes a continuation of the second one, and focuses exclusively on technical issues of professional politics that occurred behind the scenes at the Congress, I did not find it appropriate to deal with here. 103 The only exception in the years 1946 – 1947 is an account about a presentation on Clauberg’s experiments given at the Academy of Surgery ; see P. Lacroix, “Les op¦rations du Professeur Glauber (sic!)”, in: Le Concours m¦dical 68(42), 19 October 1946, 1195.

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contexts as well.104 In the issue, three articles describe the sanitary and health conditions in the ghettos of Vilnius, Kovno and Lodz, respectively ; one deals with a peculiar area, Transnistria; two speak about the situation in the Resistance movement in France and Belgium, including the involvement of Jews; and, finally, one deals with the refugee camps in the Arab country of Yemen. From the journal issue itself and without cross-references to other archival material of the sick fund, it is not clear who had been the initiator of this special issue. Mark Dvorjetzki would have been a good candidate, as his article about the Vilnius ghetto is the longest and best organized one (30 pages, half the volume), and because he later became the editor-in-chief of the journal. At that time, however, he was still living in Paris, and the fact that his article was an adaptation of a chapter of a book he had just published may well explain his length and structure.105 As to the purpose of the special issue, a short, anonymous introduction recalls the role Jewish physicians played during the entire Gola era (the “deportation” period during which Jews were dispersed among the nations) and presents the volume as an homage “from physicians whose fate allowed them to take part in the building of a new life in the moledet (fatherland), to those whose destiny brought them to fall on the gola’ strife during the struggle to save some lives (nefashot) from Israel”.106 The point connected with our topic is that the volume did not touch on the Nazi medical crimes, besides to stress the fact that the Nazis were at the origin of the difficult medical situations described. On the contrary, the special issue underlined the capacity for resistance of Jews in general, and of Jewish physicians in particular. This last fact conformed to the main narrative developing in Israel during the period – a heroic narrative of resistance and fighting symbolically represented by the Warsaw ghetto revolt of 1943.107

B.

The NMT in the mirror of the Israeli press

The news published on the Nuremberg Medical Trial itself appears to have been rather scarce, both in the general and the medical press, although information 104 “The struggle for life and health within the ghettos under the Nazi occupation” (special issue), in: Dapim refuiyim 6, September 1946, 61. As already noted, all of the quoted articles that appeared in Mikhtav le-hever, Dapim refuiyim, Harefuah or Eitanim are in Hebrew, as are the articles quoted from the general Israeli press titles Hazofe and Davar. 105 Mark Dvorjetski, “In the Vilna Ghetto”, in: Dapim refuiyim 6, September 1946, 3 – 33, and idem, Le ghetto de Vilna (Rapport sanitaire), GenÀve: Union O.S.E. 1946. Originally written in Yiddish, the book appeared in Hebrew in 1951. 106 “The struggle for life and health …”, 1946, 2. 107 See Hanna Yablonka, Survivors of the Holocaust: Israel after the War, New York: New York University Press 1999.

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about the human experiments perpetrated by the Nazis had reached the Yishuv during the war itself as noted by Zalashik in this volume. As already reported above, Mikhtav le-haver, the Hebrew Medical Union’s newsletter, had published part of the indictment issued by Brigadier General Telford Taylor at the NMT on 25 October 1946.108 However, and surprisingly enough, this publication was quite delayed: It did not appear until July 1947, more than six months after it had been presented to the court, and was a Hebrew summary of what had been published in the French journal La Presse m¦dicale on 5 April 1947.109 As far as I know, no other direct allusion to the NMT appeared in the medical journals I have reviewed.110 By the same token, and in complete contrast to the coverage of the trial of the Major War Criminals held in Nuremberg before the International Military Tribunal in 1945 – 1946, the coverage of American Trial no. 1 (NMT) in the Israeli general press amounted to barely a dozen articles.111 Among these, the majority constituted a couple of articles written by one author and published under various pseudonyms in different journals;112 the rest were mere translations of breaking news delivered by news agencies like Reuters. Nevertheless, the in108 “Accusation act against war criminal physicians”, translated from the French by K., in: Mikhtav le-haver 166, 15 July 1947, 1471 – 1473. A possible name for the translator would be Moshe Krieger, in keeping with his later role at the founding meeting of the WMA in Paris (September 1947) and in formulating the “Jerusalem Declaration on Medical Ethics” (August 1952); see below. 109 Taylor, 1947. Actually, contrary to what appeared in the title of the article, the indictment was signed on 25 October 1946; it was the Opening Statement of the Prosecution that was pronounced on 9 December 1946. The French article is in fact the full publication of most of the indictment. Only what had already been stated in count II (war crimes) and repeated on count III (crimes against humanity) was not published twice. The Hebrew translation, however, is a summary of the indictment. Further research would be welcome here to check what had effectively been transmitted to the Hebrew reader. 110 For 1947, I have Dapim refuiyim, Mikhtav le-haver, Harefuah. In an October issue, Mikhtav le-haver published an account of the WMA meeting in Paris and reproduced Mark Dvorjetski’s speech in Hebrew but, as already stated above, there were no direct references to the NMT in the account of the WMA meeting; see Moshe Krieger, “The H.M.U at the meeting of the World Medical Association (lit. Union) in Paris”, in: Mikhtav le-haver 172, 15 October 1947, 1535 – 1537, and Mark Dvorjetski, “On the crimes of the German physicians and their punishment”, in: Mikhtav le-haver 172, 15 October 1947, 1537 – 1539. The only exception found is a short notice that appeared shortly before the opening of the NMT, see “German physicians on trial”, in: Mikhtav le-haver 150, 15 November 1946, 1322. 111 For this research I used: Mendel Piekarz with the assistance of Baruch Z. Ophir and Varda Arad, The Jewish Holocaust and Heroism through the Eyes of the Hebrew Press, 4 vols., Jerusalem: Yad Vashem 1966. Note that this compilation reviews the general, literary and army press, but not the medical journals. 112 See, for instance, Shabtai Keshev-Klugman, “Hamada al safsal haneesham – Mishpat harof ’im (Science on the dock – Physicians’ trial)”, in: Hazofe 2755, 24 January 1947, 2 and 7, and Aharon Scheinfeld, “Haposh’im haktanim – mikhtav miniremberg (The petty criminals – Letter from Nuremberg)”, in: Davar 6553, 5 February 1947, 2.

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troduction of one of these articles gave a good account of the completely different atmosphere that prevailed at the second trial, a change which might explain the gap in coverage between the two trials: “Apparently nothing had changed in the town of Der Stürmer113 since the time I left it, that day following the sentence that we received in astonishment and in a heavy feeling that injustice had been done: these are the same stone piles in place of houses, the same clusters of German girls running after each “Ami” (this is what people call the Americans) and the same trams full of intimates of Strecher,114 who are closed in a gloomy silence, which does not bode well for me, the oslander115 and the Jew. Nothing. This is just smoke and mirrors. Come near this same huge building of Fürth Street, the place of judgment, and quite spontaneously the question will appear on your lips: “is this really Nuremberg?” Where are the guys from the military police who stood a whole year long at the corner of the two streets crossing Fürth Street on both sides, checking “the rights” of every foreigner approaching this “holy of holy” place, if we may say so. The policemen are not there anymore, not here and not in front of the courthouse. You have to actually enter the building to encounter anyone ready to check your ID, and he does so without any enthusiasm, nor conviction, but out of pity and just to obey his orders to check.”116

Afterwards, the author went on in a journalistic, sometime even poetic style, describing the absence of not only the policemen but also of the journalists, concluding the first part of his article saying with a certain sadness and despair : “the world is not ‘interested’ in Nuremberg.”117 The reason for this disinterest being in his eyes that, contrary to what happened at the International Nuremberg Trial, politics is no longer on the dock, but science, “the last sanctuary and hope of mankind” or “the new divinity [lit. elil]”.118 Shabtai Keshev-Klugman is not the first author I read who described the atmosphere reigning at the NMT. Both of the articles analyzed above, which 113 This is the wording of the article that appeared in Davar, see Scheinfeld, 1947; Hazofe repeats Streicher here. Der Stürmer was a weekly Nazi magazine published in Nuremberg by Julius Streicher (1885 – 1946) from 1923 up to the end of World War II. It had been considered by the IMT as the most highly representative organ of Nazi anti-Semitism and propaganda. Streicher was one of the defendants at the Major War Criminals Trial in Nuremberg; convicted of “crimes against humanity”, he was sentenced to death and executed. See “Der Stürmer”, in: Dinah Shelton (ed.), Encyclopedia of Genocide and Crimes Against Humanity, 3 vols., Detroit: Macmillan Reference USA 2005, vol. 1, 247 – 249; “Julius Streicher (1885 – 1946)”, in: Robert S. Wistrich, Who’s Who in Nazi Germany, Routledge, 2001 (3rd edition, paperback), 250 – 252. 114 See note 113 above. 115 I suppose that this is the Yiddish pronunciation for Ausländer in German (lit. stranger, foreigner). 116 Keshev-Klugman, 1947, 2. 117 Ibid. 118 The last sentence is slightly different in Hazofe and Davar. Compare ibid., and Scheinfeld, 1947.

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appeared in the Presse m¦dicale, described it. Still, I never got such an impression of emptiness. It is right to notice that neither Inbona nor Ravina, as far as I know, attended the Trial of the Major War Criminals of 1945 – 1946, so they were not able to make any comparison as Keshev-Klugman did. The fact that at least one of the French authors says that the Americans had invited him may perhaps echo the atmosphere described by Keshev-Klugman, signifying that the Americans, too, may have sensed the general disinterest and decided to do something toward the conclusion of the trial. The mere publication of a summary of the indictment pronounced against the 23 defendants of the Nuremberg Medical Trial in the bulletin of the Hebrew Medical Union, and the absence of any direct account of the Nuremberg judgment, contrast with the number of accounts of the founding meetings of the WMA. Especially contrasting, for instance, is the detailed account of the new association’s first congress, which took place in Paris just a month after the Nuremberg judgment. Later on, however, Israeli medical journals reported quite extensively about a declaration adopted by the Second World Congress of Jewish Physicians held in Jerusalem from 10 – 14 August 1952. Known as the “Jerusalem Declaration”, this is the only text of the period comparable, in terms of scope and intention if not in historical setting, with what became known as the “Nuremberg Code” of ethics. I will now turn to analyze this declaration, coming back later to the founding meeting of the WMA, as I believe this will help contextualize the origins of the declaration.

C.

The “Jerusalem Declaration (1952)” in context

In 1952, the Israeli Medical Union organized the Second World Congress of Jewish Physicians in Jerusalem. As previously stated, a first congress had taken place in Tel Aviv in 1936 in the context of the deteriorating situation in Nazi Germany. This one had been an attempt by the medical community of the Yishuv to coordinate the efforts of all Jewish physicians around the world to help their persecuted brothers flee Germany. In 1952, the context was different. Nazi Germany had been finally defeated, the State of Israel had been established in 1948, and the Hebrew Medical Union had become the Israeli Medical Union in October the same year.119 The atmosphere was of building the future and not particularly turned toward the past. Mark Dvorjetski was part of the organizing committee and had been writing to his friend Henri Baruk about it since April 1950. Dvorjetski probably hoped to push the organization of a session on the Nazi medical experiments and their ethical consequences, and, having en119 See “On the change of name of our Union”, in: Mikhtav le-haver 195, 1 October 1948, 1711.

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countered some difficulties in realizing this, called upon his friend who was an associate professor at the Paris Medical School. In any case, on 12 June 1952 Baruk wrote a letter to the president of the congress vigorously backing Dvorjetski’s request, among other arguments stating that: “These problems are on the top of the agenda everywhere. Nobody would understand that a Jewish Congress avoided these issues, which are most especially of our concern. I have to tell you, actually, that the entire world is expecting the position taken by the Jewish physicians on these issues to be of vital importance for the future of medicine.”120

One month later, on 9 June 1952, the president sent him an answer, asking him to give a lecture on medical ethics together with Dvorjetski.121 In the end the two friends gave separate lectures, but joined together to submit a motion to the congress regarding the Nazi medical crimes and their consequences.122 This motion was made public and became known as “The Jerusalem Declaration”.123 This is that motion that I will now analyze after having summarized it. How does the “Jerusalem Declaration” read, five years after Nuremberg and in comparison to the trial? The declaration is formulated in the name of the congress and its first part (1) is dedicated to the description of four topics (a to d): “[The Congress] exposes before the entire world the Nazi medical crimes, to wit: a – The utilization of medical science for the extermination of children, old people, mental patients, incurables and cripples, under the project that was known as Mass Euthanasia; b – Forced sterilization of men and women […] in concentration camps [… that were carried out as] a preliminary experiment, with the view of applying it on a much wider scope to whole nations in Europe, in order to turn them into exploitable slaves 120 Henri Baruk to Dr. Brand, 12 June 1952, MDA RG P 10 File 20/1 (1947 – 1960). I am quoting from a copy of the letter found in Dvorjetski’s papers in Yad Vashem. On the top of the copy, there is a handwritten address in Hebrew saying: “Paris, 15 of June 1952. To the attention of Dr. Dvorjetski peace and benediction (Shalom uvrakha, usual salutation in Hebrew)! I received your letter and here is the letter I sent to Dr. Brand. With feelings of friendship. H. Baruk.” 121 Henri Baruk to Mark Dvorjetski, 9 July 1952, MDA, RG P10/20, File 1 (1947 – 1960). 122 For an account of the two lectures, see Henri Baruk, “Les problÀmes nouveaux de l’¦thique m¦dicale: õ propos du DeuxiÀme CongrÀs Mondial des M¦decins Juifs (J¦rusalem, Ao˜t, 1952)”, in: La Presse m¦dicale 60(72), 12 November 1952, 1544 – 1545. A copy of Dvorjetski’s lecture is among his papers in Yad Vashem, see Dr. M. Dvorjetski (sic) (Tel Aviv), “The Jewish Medical Resistance and Nazi Criminal Medicine during Disasterous (sic) Period – A lecture at The World Jewish Medical Congress in Jerusalem 12th August 1952”, typescript annotated, 15 pages, MDA RG P 10 File 61. 123 The declaration was published in extenso in three languages (Hebrew, French and English) in the medical journal of the General Sick Fund edited by Dvorjetski. Here I am quoting the English version even though quite important differences exist between the versions. One of these differences being especially relevant to my interpretation, I present it below; see “The Jerusalem Declaration on Medical Ethics”, in: Dapim refuiyim 11(4), December 1952, 329 – 332. The French version appeared at the end of Baruk’s article, op. cit. note 122 above.

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incapable of perpetuating themselves through offspring; c – Physical and moral degradation of human beings […] designed to deprive the victims of their human image and dignity ; d – The criminal medical experiments in which human beings were employed as test animals […]”124

Then, in a second part (2) the Congress “rises up and protests against the indifference and desire to forget these crimes […]”. Such an “apathy [constituting] a silent moral partnership with those German physicians who surrendered medical science […]”.125 In a third part (3), the Congress “expresses its deep fear and anxiety, lest these transgressing Nazi biological doctrines, and their distorted trend of thought, be transferred and implanted, knowingly or unknowingly, into the medical and biological science of our times”.126 And so, as a consequence, in a fourth part (4), the Congress declares that “nobody is granted the right to sacrifice any human being for the needs of scientific effects”; it requests that “the medical world elaborates definite and exact standards for the differentiation between experimental physiology on animals and the application of medical and therapeutic efforts to humans”. Specifying that in physiology “the test animal is employed as an instrument, a victim […]”, while in therapeutics “the human must not be an instrument or a victim for the scientist, rather the opposite: the scientist must be the servant of the patient […]”, the Congress notes the “very weighty problems of medical ethics” raised by “certain therapeutic ways that are willing to obtain palliative results at the cost of anatomic destruction of the limbs, of causing new diseases, or of the weakening or dissolution of the human personality”. Finally, the Congress declares “we have to consolidate anew the foundations of medical conscience: no physician is permitted, under any circumstances, to utilize scientific data for the destruction and damaging of a human being”.127 As understandable from such a summary, while it shares much with the ten rules of medical ethics in the Nuremberg Code, this text functions quite differently. First, it gives mass euthanasia the first place and concludes with an absolute prohibition for physicians to use science in order to destroy or damage human beings. At Nuremberg, the tribunal was much embarrassed by the very issue of euthanasia. During the trial, the issue occupied considerable time, but ultimately the debate turned around the question as to whether or not Hitler’s written authorization regarding the possibility of euthanasia had legal status. On the day of the judgment, no reference to it appeared among the ten points of

124 125 126 127

“The Jerusalem Declaration …”, 1952, 331. Ibid. Ibid. Ibid.

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medical ethics.128 Second, the Jerusalem declaration refers to the eugenic context, especially in connection with the research on methods of mass sterilization. Third, regarding human experimentation, it aims to make a clear (more implementable?) distinction between physiological experiments for the sake of science and therapeutic trials.129 The declaration did not refer at all to informed consent, however.130 What kind of text is the Jerusalem declaration? If we go back to the three categories suggested at the beginning of this paper – research, profession and patients –, it seems obvious that the declaration came out of the consciousness of some physicians intending to speak to the conscience of fellow physicians. Whereas the ten points of the Nuremberg Code arose from pressure by research lobbies and from judicial tradition in terms of consent,131 here we have a medical consciousness protesting. The absence of any direct reference to informed consent reflects, in my view, the traditional paternalistic approach of physicians toward patients. What are the origins of this text? What is its context? And what legacy has it left? Formally speaking, the text comes from “the Second World Congress of Jewish Physicians, which gathered in Jerusalem”.132 As previously noted there had indeed been a first congress of the same type in 1936, apparently with the same purpose on the part of the physicians of the Yishuv, i. e. the Jewish community of Palestine, to become the vital center of all Jewish physicians around the world. In a sense, the expression of the Zionist ideal in medicine. In Israel, the physicians were not organized in an association like in the United States, nor in an “Order” as in France, but in a trade union, which was called the Hebrew Medical Union (Hahistadrut harefuit haivrit) in the 1930s and became the Israeli Medical Union (Hahistadrut harefuit haisraelit) after the establishment of the State of Israel in 1948.133 In the Union newsletters, in the immediate aftermath of 128 See Marrus, 1999. Marrus argues that the trial missed the chance to use the category of “crimes against humanity” properly, preferring to refer to the category of “war crimes”; a position which disqualified the German victims; see ibid., 117 – 118. 129 This seems to have been the hobbyhorse of Baruk at that time, as he was fighting the use of psycho-surgery and insulin shock in psychiatry ; see Baruk, 1952, but also idem, 1948, and idem, “La question de ‘l’exp¦rimentation chez l’homme’ en medicine: Essai th¦rapeutique licite et exp¦rimentation illicite”, in: La semaine des húpitaux de Paris 30(31), 14 May 1954, 1962 – 1966. 130 For a comparison with Nuremberg, see Weindling, 2001, and idem, 2004. 131 Ibid. 132 “The Jerusalem Declaration …”, 1952, 331. 133 More research is needed here to investigate what such a difference means in terms of organizational structure, if there was such a difference, and so on, in terms of international contacts. For instance, at the beginning it was not the Ordre that represented the French physicians at the WMA but the Conf¦d¦ration des Syndicats M¦dicaux FranÅais; see the selfpresentation of the WMA history on its website, op. cit. note 9.

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the war, a chronicle entitled “external relations” or “foreign affairs” was published regularly which, in my eyes, testifies to the existence of a will to unify Jewish medical forces around the world with Israel at the center.134 That means that the Congress was indeed an issue for professional politics. In the issue of Dapim refuiyim, however, the journal of the General Sick Fund, in which the Jerusalem declaration was published, we are informed that the declaration issued in the name of the congress was in fact the summary of two lectures, one given by Mark (Meir) Dvorjetski and the other by Henri Baruk.135 Consequently, if one wants to understand the origins of the declaration, one must take a look at these two unusual figures. Henri Baruk (1897 – 1999) was a French psychiatrist who had renovated the Charenton asylum before World War II and remained head of it throughout the war years.136 A disciple of Babinski, he developed his practice at the crossroads of Pinel’s moral therapy and research work on experimental psychopathology. He also developed a peculiar psychiatric theory based on the Jewish notion of Zedek (“justice”). He had just been appointed associate professor at the Paris Medical School in 1946 when he first met Dvorjetski at the founding meeting of the WMA in Paris.137 Marc Dvorjetski, a physician and survivor of various concentration camps, had arrived in Paris after the war, with the intention of immigrating to Israel.138 Zionist from his early years as a student, he was connected with the Zionist movement and, although he had not yet immigrated to Israel, he was part of the Hebrew Medical Union delegation at the WMA founding meeting. That congress held a session dedicated to “the ‘scientific crimes’ perpetrated by the Germans”.139 Two lectures were scheduled, to be followed by presentations of motions from various delegations (Danish, British, French, etc.). A vote on a 134 See the chronicles in Mikhtav le-haver of these years, for instance. The necessity of supporting the Israeli medical community as part of their Jewish commitment was also perceived by leading Jewish physicians in other countries. Henri Baruk, for instance, in his 1952 article about the congress in Jerusalem presented not only the ethical issues debated there, but also the organizational ones at length, turning to his fellow French Jewish physicians for help. Note that this article does not appear in a confessional journal, but in La Presse m¦dicale; see Baruk, 1952. 135 “The Jerusalem Declaration …”, 1952, 329. The Declaration was actually submitted to the Congress under both names and that of Moshe Krieger from Tel Aviv, who headed the delegation of the Jewish Medical Association of Palestine at the Paris WMA Congress of September 1947. See Baruk, 1952, 1545, col. 1. 136 Henri Baruk, M¦moires d’un neuropsychiatre, Paris: T¦qui 2000 (2nd revised edition), and Pierre Pichot, “Êloge de Henri Baruk (1897 – 1999)”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 184(7), 2000, 1353 – 1358 (meeting of 24 October 2000). 137 Actually, I am supposing that they first met at the Paris WMA meeting because the correspondence held in Dvorjetski’s papers at Yad Vashem began immediately after that meeting; see MDA RG P 10, File 20/1 (1947 – 1960). 138 For more biographical details, see the references quoted in note 35 above. 139 See “AMM/WMA 1er CongrÀs Mondial – Programme”, in: MDA RG P 10 File 73.

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resolution was also planned.140 The two opening lectures were given by Charles Richet, Jr. (1882 – 1966), physiologist, professor at the Paris Medical School, member of the French Academy of Medicine, who had been deported to Buchenwald in June 1943 for belonging to the Resistance movement, and by Henri Desoille (1900-?), inspector general for the Ministry of Labor and professor of occupational medicine at the Paris Medical School, who had been deported to Mauthausen for his activities in the Resistance.141 As stated by Rakefet Zalashik in another chapter of this volume, the Israelis at first intended to produce evidence documenting the participation of German physicians in the war crimes, but as this was not possible in spite of all efforts, they (especially Moshe Krieger) decided to compose their delegation in such a way that it could constitute at least in part a “living testimony” of what had been done in Nazi Germany. Finally, they asked Mark Dvorjetski, who was still living in Paris, to contribute, as “he has seen from his flesh the tricks of the Nazis [Hebr.: ta’alule hanazim] and their physicians – in Vilnius ghetto and in several concentration camps”.142 After the two lectures by the French speakers, representatives spoke in the names of their delegations and so did Dvorjetski. He presented a three-page motion in the name of the Jewish Medical Association of Palestine143 entitled “Let Us Throw Anathema Against the Murderer-Doctors” (19 – 20 September 1947).144 I suggest studying this motion in order to contextualize the Jerusalem 140 Ibid. 141 Ibid. On Charles Richet Jr., see Leon Binet, Antonin Mans, “Êloge de Charles Richet”, in: Bulletin de l’Acad¦mie Nationale de M¦decine 152(3 – 4), 1968, 44 – 51; on Henri Desoille, biographical details are rather scarce and can only be drawn from other articles, for instance Henri Desoille, “Le Reclassement professionnel des d¦port¦s en France”, in: Bulletin de l’Amicale de Mauthausen, July 1954, 11 – 13, where the author is presented as professor of occupational medicine (see also the introduction of the series; ibid., 9); Jean-Pierre Le Crom, “Les ann¦es ‘fastes’ de la ‘Revue FranÅaise du Travail’, (1946 – 1948)”, in: Revue FranÅaise des Affaires Sociales 4, 2006, 25 – 43, where Desoille is presented as inspector general for the Ministry of Labor in 1947. In the press release of July 1946 published in Le Concours M¦dical and examined above (see note 85), Desoille is also presented as professor of occupational medicine. In consequence, I suppose he held the two positions concurrently, working for the government and teaching at the medical school. 142 Krieger, 1947, 1535. 143 Contrary to the name that appears everywhere in the official publications (Hebrew Medical Union), the one that appears in the accounts of the WMA meetings is The Jewish Medical Association of Palestine. It has to be noted that Palestine was represented by two delegations a Jewish one and an Arab one –, even before the UN vote on the partition of Mandatory Palestine. For Dvorjetski’s personal analysis of the meeting, see “Quelques r¦flexions sur le 1er CongrÀs Mondial des M¦decins”, in: MDA RG P 10 File 73, 11 pages. According to its content, this document corresponds to a lecture given by Dvorjetski before the Soci¦t¦ d’Histoire de la m¦decine h¦braque (Paris) after the WMA meeting. 144 See “Let Us Throw the Anathema Against the Murderer-Doctors – Motion of the Jewish Medical Association of Palestine”, in: MDA RG P 10 File 73 (Lectures and lists from the

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declaration, especially as the 1952 declaration begins in French with the words: “The Second World Congress of Jewish Physicians […] declares: to renew its indignation …”145 “To renew its indignation” implies that the Congress had already expressed it once but, obviously, the First Congress in 1936 had not been in a position to express anything of the kind, so what could have been that first time if not this 1947 statement, by the same author, in the name of the same institution, i. e. the Jewish Medical Union of Palestine, which had since become the Israeli Medical Union? Regarding the 1947 motion, it would be interesting to understand how much of it is the text of Dvorjetzki himself, the fruit of his personal research and experience, and how much the main ideas were debated and adopted by the union. At the beginning it refers to “the Nuremberg proceedings in general and the proceedings of the 23 doctors”.146 Interesting enough, it does not note the ten points of medical ethics that emerged from the latter, but relates to both of the trials in a more general manner : They have “partially unveiled to the world the medical crimes committed by the German doctors under the Nazi regime”.147 Later it lists and tries to define whom we have to consider as criminals among the German medical doctors. In this manner it turns out to be a list of Nazi medical crimes that is much broader than the list and categories elaborated during the Nuremberg trials. For instance, it notes the presence of physicians on the ramp, selecting people for the gas chambers of the extermination camps, as well as those who participated in the elaboration of the racial theories. Further it requests that the WMA consider the German doctors “collectively” and not to accept them in the world association until they have expressed as a corporation their mea culpa (see appendix, statements of medical organizations).148 In 1952, when Baruk, Dvorjetski and Moshe Krieger (who headed the Israeli delegation at the 1947 WMA meeting in Paris) formulated the Jerusalem declaration in the name of the Second World Congress of Jewish Physicians, the World Medical Association had already accepted the German Medical Association as a member the previous year, without any open statement coming from its

145 146 147 148

World Medical Conference held in Paris, 16 – 21 September 1947), 3 pages. The presentation of the translation into Hebrew that appeared a month later in Mikhtav le-hever listed the date of 17 September 1947 for the talk. See Dvorjetski, 1947, 1537. The account of the meeting quoted note 143 above explicitly states that Dvorjetski gave his talk on 19 September 1947. As noted above, the English version begins stating: “[The Congress] exposes before the entire world the Nazi medical crimes, to wit.” Compare “The Jerusalem Declaration …”, 1952, 332, and Baruk, 1952, 1545. “Let Us Throw the Anathema …”, 1947, 1. Ibid. Ibid., 1 – 3.

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part in regard to the Nazi medical crimes.149 In Israel, the compensation agreement between the Federal Republic of Germany and the State of Israel was on the political agenda. Being a victim of medical experiments was one of the criteria for receiving compensation. Through this process of negotiating compensation, the State of Israel won its legitimacy to represent Jews worldwide, which was not an obvious task at first glance. Dvorjetski, who had been asked to be part of the commission in charge of compensating the victims of experiments, finally declined, as he opposed any form of compensation from Germany.150 Consequently, it seems fair to say that the Jerusalem declaration represents at least in part a protest against this state of affairs of contemporary politics in general, with the acceptance of compensation from Germany ; and of medical politics in particular, with the acceptance of the German Medical Association back into the world medical community. As it reads in the Jerusalem Declaration, such a protest was the voice of the collective – i. e. the “World Congress of the Jewish Physicians gathered in Jerusalem”, yet in practice it resulted largely from the personal involvement of a very few people who were convinced that they had to speak out as Jews and as human beings. Commenting on the WMA 1947 meeting in Paris before the Society for the History of Hebrew Medicine, Dvorjetski concluded: “Let me […] express my hope that the Society for the Study of Jewish History will not content itself with the study of the history of Jewish medicine and Jewish medical ethics, but will also dedicate its time [lit.: son activit¦] to this holy struggle against criminal science. This is one of our duties: to arouse the world consciousness and through it accomplish the will of our departed.”151

Conclusion In this paper, after recalling a few results of a previous study, I have presented preliminary findings of a comparative survey of some main medical journals in France and in Israel (or the Jewish Mandatory Palestine) regarding how the NMT was reported on and how it had marked the development of a discourse on medical ethics in both countries. While in France the leading medical journal of the Parisian elite did report about the NMTand functioned as a stage for former, 149 No doubt further research is needed here. In Dvorjetski’s papers, a copy of the minutes of a meeting of the WMA council dated 1949 shows that there were contacts with German doctors willing to sue the German criminal physicians. See “Minutes de l’Assembl¦e du Conseil du mercredi 20 avril 1949 au dimanche 24 avril 1949. Crimes m¦dicaux”, MDA RG P 10 File 73 (Lectures and lists …), 1 page. 150 See the last part of Rakefet Zalashik’s chapter in this volume. 151 “Quelques r¦flexions …”, 11.

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deported physicians, another journal, the organ of the main confederation of medical professional unions, did not allude to it directly. Two other professional issues took central stage: the new regulations for the French medical profession and the founding meeting of the WMA. While there were no direct allusions to the ten principles of medical ethics announced in Nuremberg a month earlier in the published account of the WMA meeting, the topic of the war medical crimes was on the top of its agenda. In Israel, the newsletter of the Jewish physicians’ association largely echoed the medical crimes perpetrated and the actions taken by the association on the international level to work toward the punishment of such crimes. Quite surprisingly, almost no echoes of the NMT were found. Another journal, the organ of the sick fund of the main workers’ trade union (which employed the majority of the Jewish physicians in Palestine at the time), reported relatively early on the heroic deeds of Jewish doctors in Europe during the war and later on the Nazi medical crimes as well, its editor-in-chief himself being a survivor who worked extensively on the topic. In the years 1946 – 1947, neither in France nor in Israel did the two main topics of medical ethics debated at the NMT – human experimentation and euthanasia – seem to have constituted debated topics among the medical communities of these countries. This is not because medical ethics was not on the top of the professional agenda, as in both countries there were attempts to codify regulations for the profession including professional ethics. It was only in subsequent years that both topics aroused debates within the profession. The 1952 Jerusalem Declaration, fruit of the cooperation between a French and an Israeli physician, represents a major attempt to link this kind of debate to what happened to medicine in Nazi Germany, but still without any direct connection to the NMT. These are very preliminary findings and much further research is needed, particularly to better understand the role played by survivors and deported physicians in regard to debates on euthanasia and human experiments.152

152 The research for the French section of this paper was conducted as part of the project “Memories and Histories in Medicine: Remembrances of Nazi ‘Euthanasia’ between Political Instrumentalisation and Historiography, ca. 1945 – 2000”, directed by Volker Roelcke and myself, and funded by the Deutsche Forschungsgemeinschaft through the multidisciplinary grant “Erinnerungskulturen” – “cultures of memory”, Justus Liebig University of Giessen/Germany (DFG SFB 434). See also Etienne Lepicard, “Reception of National Socialist ‘Euthanasia’ Vs. ‘Human Experimentation’ and the Transformation of Medical Ethics into Bioethics, 1947 – 1980s”, in: Korot – The Israeli Journal of the History of Medicine 19 (2007/2008, published 2009), 65 – 81. The research for the Israeli section was conducted as part of the project: “The Nuremberg Medical Trial and the Construction of the Ethical Discourse in Medicine, Israel 1947 – 1970” thanks to a four month in residency-scholarship at the Yad Vashem International Institute for Holocaust Research, Jerusalem/Israel (The Baron Friedrich Carl von Oppenheim Chair for the Study of Racism, Antisemitism, and the Holocaust, funded by the von Oppenheim Family of Cologne).

“Permissible medical experiment”, orally given at Nuremberg on 19 August 1947, and published in TWC in 1950 The great weight of the evidence before us is to the effect that certain types of medical experiments on human beings, when kept within reasonably well-defined bounds, conform to the ethics of the medical profession generally. The protagonist of the practice of human experimentation justify their views on the basis that such experiments yield results for the good of society that are unprocurable by other methods or means of study. All agree, however, that certain basic principles must be observed in order to satisfy moral, ethical and legal concepts: 1. The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may be possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity. 2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

Ravina’s account in La Presse m¦dicale, 18 October 1947

What the Anglo-Saxons consider to be the rules of medical experimentation on human beings.

The consent of the [human] subject is absolutely necessary

and [the experimentation] should not be attempted unless useful results for humanity cannot be obtained by other procedures.

Table 1: Comparison between the official account of the Nuremberg ten points of medical ethics with the one published in the French medical journal La Presse m¦dicale.

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7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death. 8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

Everything should be made to protect the experimental subject against any possibility of injury, pain, or deadly accident.

Finally, the experiment should be conducted, through all its stages, by persons perfectly qualified.

10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill, and careful judgment required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.

9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible.

6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by experiment.

The degree of risk to be taken should never exceed that is determined by the humanitarian importance of the problem.

It [Experimental research on human beings] should not be initiated if people think 4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. a priori that it can result in death or disabling injury, and should not inflict any physical injury or mental disorder that is not strictly necessary. 5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur ; except, perhaps, in those experiments where the experimental physicians also serve as subjects.

Experimental research on human beings should be based on previous experiments 3. The experiment should be so designed and based on the results of animal experformed on animals. perimentation and a knowledge of the natural history of the disease or other problem under study that the anticipated results will justify the performance of the experiment.

Table 1: (Continued)

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Judging Medical Crimes in Divided Germany

Introduction In December 1946, the United States Military Tribunal I opened a case against twenty-three defendants charged with “murders, tortures, and other atrocities committed in the name of medical science”.1 It was the first of twelve Nuremberg “follow-up” trials held under United States auspices in the years between 1946 and 1949. Alexander Mitscherlich, at the time a young lecturer at Heidelberg University, had been dispatched as one of three official observers by the West German Medical Chambers. A few days after the opening, he gave his preliminary impressions of the proceedings in Neue Zeitung, the leading daily in the American occupation zone. The doctors in the dock, Mitscherlich wrote, were actually “highly reputable leaders” in their respective fields of science. They had not simply “given voice to their own evil spirit” through their participation in Nazi crimes. Instead, he argued, they had come under the sway of a very particular interpretation of the Hippocratic Oath, one that did not extend protection to the well-being of the individual patient but to that of the body politic (Volkskörper) as a whole.2 Mitscherlich’s critique was a response to the typical arguments of the defendants and their attorneys, who tended to agree that crimes were committed against patients under the “Third Reich”, but insisted that these were attributable wholly to a small minority of fanatical SS doctors and incompetent careerists.3 These argumentative figures of the psychopath and of the pseudo1 Telford Taylor, Opening Statement, 9 January 1946. Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10 [TWC], 15 vols., Washington, DC, 1949 – 53, vol. I, 2. 2 Alexander Mitscherlich, “Der Arzt und die Humanität: Erste Bemerkungen zum Nürnberger Ärzteprozess”, in: Neue Zeitung, 20 December 1946; quoted from Tobias Freimüller, Alexander Mitscherlich: Gesellschaftsdiagnosen und Psychoanalyse nach Hitler, Göttingen: Wallstein 2007, 101. 3 In 1948, Mitscherlich’s colleague Fred Mielke attended a convention of German physicians in

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d

scientific Nazi doctor found a counterpart in another narrative that also formed during the Allied trials and the concurrent de-Nazification program. In this second reading, a high degree of professionalism and academic excellence was seen as a shield that immunized its bearers against the utilitarian doctrines of Nazi medicine. Medical professionals and officials whose cooperation had been essential in carrying out eugenic and racist policies were granted an a priori assumption that they had been highly qualified but completely apolitical re searchers whose professional self-image of conducting “objective science” automatically put them at odds with the regime.4 The thesis that the Nazi regime was a genuinely anti-science system, one in which no “real” science but only pseudo-science could flourish, has been largely discredited by a number of studies examining the science policies and funding practices of such leading institutions as the Kaiser Wilhelm Gesellschaft and the Deutsche Forschungsgemeinschaft (DFG).5 Rüdiger Hachtmann reiterated the point recently that the “unlimited medical science” of the Nazi period actually connects to longer traditions. In the late 19th century, social Darwinism had provided the concept of a disease-free society, and medical paternalism had already emerged in the context of the First World War, when the idea of a Stuttgart, where he tried to calm down the participants with the statement that only 300 to 400 physicians had been directly involved in medical crimes; Tobias Freimüller, “Mediziner : Operation Volkskörper”, in: Norbert Frei (ed.), Hitlers Eliten nach 1945, Frankfurt/M.: Campus 2005, 13 – 64, here 25. 4 See, for example, the testimonies of Hans Heinze: Annette Weinke, “Nachkriegsbiographien brandenburgischer ‘Euthanasie’-Ärzte und Sterilisationsexperten: Kontinuitäten und Brüche”, in: Wolfgang Rose, Anstaltspsychiatrie in der DDR: Die brandenburgischen Kliniken zwischen 1945 und 1990, Berlin: be.bra wissenschaft, 2005, 179 – 235. In the words of Steven Remy, “presumed adherence to unpoliticized scholarly inquiry” was retroactively “solidified into a form of resistance to National Socialism”, an idea that helped prevent a serious confrontation in postwar Germany with “activities of the regime that required and received the support of professors – forced sterilization, ‘euthanasia’, and other variants of ‘racial hygiene’, weapons and high technology research, Ost- und Westforschung, historical justifications for territorial expansion, the construction of the ‘Aryan Jesus’, Germanic folklore and ‘ancestral heritage’, ‘Grossraumwirtschaft’ and other endeavors”. (Steven P. Remy, The Heidelberg myth: The Nazification and Denazification of a German University, Cambridge/London: Harvard University Press 2002, 207.) 5 Doris Kaufmann (ed.), Geschichte der Kaiser-Wilhelm-Gesellschaft im Nationalsozialismus: Bestandsaufnahme und Perspektiven der Forschung, Göttingen: Wallstein 2000, 2 vols.;, Berlin: Max-Planck-Gesellschaft 2000; Hans-Walter Schmuhl, The Kaiser Wilhelm Institute for Anthropology, Human Heredity and Eugenics, 1927 – 1945, New York: Springer 2008 (original German version: Grenzüberschreitungen: Das Kaiser-Wilhelm-Institut für Anthropologie, menschliche Erblehre und Eugenik, 1927 – 1945, Göttingen: Wallstein 2005) Rüdiger Hachtmann, Wissenschaftsmanagment im “Dritten Reich”: Die Generalverwaltung der KaiserWilhelm-Gesellschaft, Göttingen: Wallstein 2007, 2 vols.; Susanne Heim/Carola Sachse/Mark Walker (eds.), The Kaiser Wilhelm Society under National Socialism, Cambridge: Cambridge University Press 2009; Mark Walker et al. (eds.), The German Research Foundation 1920 – 1970: Funding Poised between Science and Politics, Stuttgart: Franz Steiner 2013.

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threatened body politic had gained ground among the German intelligentsia.6 Against this backdrop, a majority of medical professionals were likelier to welcome than to reject the principles of Nazi biopolitics, and many proved active in applying them in their daily work. This was particularly true in the so-called “war sciences” research, which led to further radicalization and gave rise to a “consuming” research on human subjects.7 In the context of new paradigms like Vergangenheitspolitik (policy of the past) and research agendas like “Atrocities on Trial”, war crimes and NS trials have increasingly become the objects of historiographic interest.8 However, despite the growing strand of literature on the postwar biographies of Nazi perpetrators, representatives of the medical profession have gained relatively little attention. Nevertheless, a number of studies – for instance Dick de Mildt’s pioneering book on the “euthanasia” experts9 – do make it obvious that investigations went through various phases, in part defined by changes in court rulings and varying levels of public interest. Thanks to the now-established “new perpetrator research” (“neuere Täterforschung”),10 we know how this group was able to reintegrate in both the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR) in almost exemplary fashion. After a short transitional phase marked by material insecurity and loss of social position, most of them had managed to return to their prior career paths by the early 1950s. Isolated attempts by West German investigators to bring charges against a few doctors for murdering patients generally did not force even temporary interruptions of their jobs, let alone make them lose their hospital positions. Even among the accused individuals, a reassurance gained hold by the end of the 1960s that any attempts at prosecution would sooner or later be abandoned. While no basic differences in court rulings and public interest can be seen compared to the treatment of other types of Nazi crime, there are two aspects in which the “medical complex” differed greatly from the majority of other West 6 Rüdiger Hachtmann, “Forschen für Volk und ‘Führer’”, in: Dietmar Süss, Winfried Süss (eds.), Das “Dritte Reich”: Eine Einführung, Munich: Pantheon 2008 (revised edition 2012), 205 – 225, here 211. 7 See Winfried Süß, “Medizin im Krieg”, in: Robert Jütte (ed.), Medizin und Nationalsozialismus: Bilanz und Perspektiven der Forschung, Göttingen: Wallstein 2011, 190 – 200; for a critical discussion of this volume, see the chapter by Volker Roelcke in this volume. 8 See Patricia Heberer, Jürgen Matthäus (eds.), Atrocities on Trial: Historical Perspectives on the Prosecuting War Crimes, Lincoln: University of Nebraska Press 2008; Norbert Frei, Adenauer’s Germany and the Nazi Past: The Politics of Amnesty and Integration, New York: Columbia University Press 2002. 9 Dick de Mildt, In the Name of the People: Perpetrators of Genocide in the Reflection of their Post-War Prosecution in West Germany : The “Euthanasia” and “Aktion Reinhard” Trial Cases, The Hague: Martinus Nijhoff 1996. 10 On this concept see Frank Bajohr, “Neuere Täterforschung”, in: Docupedia-Zeitgeschichte, 18 June 2013; http://docupedia.de/zg/Neuere_Taeterforschung (31 August 2014).

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German NS trials. First, the latter usually dealt with cases in which most of the victims were foreigners [i. e., non-German citizens], which was not the case in “euthanasia” trials. Second, a distinctive feature about “euthanasia”, forced sterilization and other medical wrongdoings was that the same groups that, prior to 1945, had led the public discourse on the treatment of “unworthy” life became main actors once again after 1945 in the context of Vergangenheitspolitik. Very quickly, they assumed a position which enabled them to determine the standards according to which the participation of groups and individuals should be assessed. Next to the doctors themselves, who appeared at postwar trials not only as the accused but also as witnesses and experts, the debate about how to confront the past also involved former officials of medical professional associations, representatives of the state administration, legal faculties and jurisprudence, and of the Catholic and Protestant (Lutheran) churches. In the Soviet occupation zone and GDR, where the absence of a free public sphere allowed only a limited debate on these subjects, these positions were taken by the “antiFascist” bloc, victims’ associations, local journalists and legal professionals.

Medical trials under Allied occupation When in 1943 the Allies issued their first, rather general declaration on Nazi criminality, they omitted any explicit reference to medical crimes, although the Soviets and British at least already possessed very concrete evidence that their own citizens had fallen victim to German experiments on humans. Soon after the defeat of the German Reich, the Allies agreed to appoint an International Military Tribunal (IMT) to try the main war criminals, but found it difficult to reach a common understanding on how to proceed against Nazi-implicated medical professionals. There was neither a unified concept of “medical war crimes” nor a list of the possible criminal suspects to be tried for such, and the separation between acceptable and unacceptable research methods appeared highly problematic.11 This ambivalence was partly due to a worldwide softening of ethical standards with regard to experimentation on human subjects that had come about during the mobilization of war economies and associated weapons 11 According to Weindling, it was the American psychiatrist and scientific intelligence officer John West Thompson who first conceived the notion of “medical war crimes” in November 1945; Paul J. Weindling, “Victims, Witnesses, and the Ethical Legacy of the Nuremberg Medical Trial”, in: Kim C. Priemel, Alexa Stiller (eds.), Reassessing the Nuremberg Military Tribunals: Transitional Justice, Trial Narratives, and Historiography, New York: Berghahn Books 2012, 74 – 103, here 75; see also Paul J. Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent, Houndmills/Basingstoke: Palgrave Macmillan 2004, 108 – 112; see also Weindling’s article in this volume.

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research. It was also because of the general rush by the various Allies, even before the war ended and in anticipation of an emerging conflict between East and West, to secure high-caliber German scientists, whose expertise and research was believed to be necessary in the further development of chemical and biological weapons.12 However, the sequential liberation of concentration camps and the resulting encounter with victims of medical experiments caused the Allies to begin investigating a large number of German medical professionals. During preparations for the IMT, Victor Brack (former coordinator of the so-called “action T4” and one of the later defendants in the Nuremberg “Doctors’ Trial”) gave the investigators a list of twenty-four main suspects.13 The specific form in which medical crimes were represented at the IMT, and even more so during the subsequent “Doctors’ Trial” (Successor Trial no. 1), reflected the limits of historical understanding for Nazi criminality. As Michael Marrus pointed out recently, the trial presented “Nazi ‘euthanasia’ in simple utilitarian terms” of “removing ‘useless eaters’ from a country fully mobilized for war (presented as ‘the principal rationale’) and pursuing the struggle against Germany’s enemies”.14 Also by focusing mainly on foreign victims, the trial de-emphasized the fact that the majority of the victims were German nationals. One achievement of the Nuremberg Medical Trial that cannot be underestimated lies in its attempt to develop a set of ethical principles with regard to human experimentation. Another can be seen in the reconstruction and presentation of a first outline of the historical events. As to the issue of “euthanasia”, the US judges evaded a similar form of clarity.15 Despite the enormity of the crime with its hundreds of thousands of victims, their ethical reasoning almost completely disappeared behind a smokescreen of judicial formalities. Confronted with Karl Brandt’s self-justification that the mass killings had been conducted following a universally binding framework of law and humanitarian 12 See Linda Hunt, Secret Agenda: The United States Government, Nazi Scientists and Project Paperclip, 1945 to 1990, New York: St. Martin’s Press 1991; Mario Daniels, “Von ‘Paperclip’ zu CoCom: Die Herausbildung einer neuen US-Technologie- und Wissenspolitik in der Frühzeit des Kalten Krieges (1941 – 1951), in: Technikgeschichte 80, 2013, 209 – 223. 13 See Udo Benzenhöfer, “Nürnberger Ärzteprozess: Die Auswahl der Angeklagten”, in: Deutsches Ärzteblatt 93(45), 1996, A-2929 – 2931. 14 Michael Marrus, “The Nuremberg Doctors’ Trial and the Limitations of Context”, in: Heberer, Matthäus (eds.), 2008, 103 – 122, here 113. 15 In his analysis of the official report of the Doctors’ Trial, published by the US government in 1950, Lepicard comes to the conclusion that the way “euthanasia” was reflected in the statement of the prosecution and in the judgment constituted an obstacle for a broader ethical debate; Etienne Lepicard, “Trauma, Memory, and Euthanasia at the Nuremberg Medical Trial”, in: Austin Sarat, Nadav Davidovich, Michal Alberstein (eds.), Trauma and Memory : Reading, Healing, and Making Law, Stanford: Stanford University Press 2007, 204 – 224.

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considerations,16 the court replied: “Whether or not a state may validly enact legislation which imposes euthanasia upon certain classes of its citizens is a question which does not enter into the issues […] Assuming that it may do so, the Family of Nations is not obligated to give recognition to such legislation when it manifestly gives legality to plain murder and torture of defenseless human beings of other nations.”17 Did this not also apply to the many German victims of the “euthanasia” policy? In the opinion or perhaps the wishful imagination of the American judges, this was a matter on which the newly formed German courts, East and West, would deliver their verdicts. During the early postwar years, investigation of “euthanasia” crimes was one of the few areas of German jurisdiction in Nazi matters, after the Allies had enacted Control Council Law no. 10 (CCL 10) that created the legal basis for formally empowering German criminal courts in this area.18 It was symptomatic of the reservations that German courts (especially in the West) held against the form of international criminal law created in London and Nuremberg that the courts initially referred to both CCL 10 and the old Reich criminal law, but soon went over to judgments based solely on the relevant paragraphs of national law, i. e. for murder, accomplice to murder and manslaughter. One consequence of this self-limiting turn to traditional German legalities was that the connection between “euthanasia” and the genocide of Jews and Roma was from the beginning suppressed in the German rulings practice.19 Despite growing uneasiness about the Allied War crimes program among West German jurists, the early “euthanasia” cases generally ended with relatively clear attributions of guilt and very stiff sentences. For example, between 1946 and 1951, fifteen doctors were punished with death penalties or very harsh prison sentences.20 In general, the courts rejected the argument of the defense 16 See Ulf Schmidt, Karl Brandt, The Nazi Doctor: Medicine and Power in the Third Reich, London/New York: Hambledon Continuum 2007. 17 Case I, Decision and Judgment, TWC, vol. I, 197 – 198. 18 Under Allied supervision, newly constituted German courts in the Soviet and Western occupation zones delivered more than 5000 verdicts against NS perpetrators; see Edith Raim, Justiz zwischen Diktatur und Demokratie: Wiederaufbau und Ahndung von NS-Verbrechen in Westdeutschland 1945 – 1949, Munich: Oldenbourg 2014, 652. 19 Ibid., 1053 – 1094. 20 See de Mildt, 1996; Michael Greve, Die organisierte Vernichtung “lebensunwerten Lebens” im Rahmen der “Aktion T4”: Dargestellt am Beispiel des Wirkens und der strafrechtlichen Verfolgung ausgewählter NS-Tötungsärzte, Pfaffenweiler : Centaurus 1998; Michael S. Bryant, Justice and National Socialist Medicalized Killing: Postwar “Euthanasia” Trials and the Spirit of Nuremberg, 1945 – 53, in: Dick de Mildt (ed.), Staatsverbrechen vor Gericht: Festschrift für Christiaan Frederik Rüter zum 65. Geburtstag, Amsterdam: Amsterdam University Press 2003, 9 – 23; Patricia Heberer, “Early Postwar Justice in the American Zone: The ‘Hadamar Murder Factory’ Trial”, in: Heberer, Matthäus (eds.), 2008, 25 – 47; Willy Dressen, “NS‘Euthanasie’-Prozesse in der Bundesrepublik Deutschland im Wandel der Zeit”, in: Hanno

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that the defendants had been convinced of the legality of Hitler’s decree on so called “mercy killings” (Gnadentod). Nor did they accept their justification that they had practiced “euthanasia” out of idealism. Instead, most prosecutors and judges insisted that natural-rights law itself qualified the killings as illegal. But by the late 1940s, the phase of relatively tough line was largely over. For the most part, exonerations and mild sentences of no more than one to four years of imprisonment now became the rule. And that is more or less how things remained for the next four decades. In the Soviet zone, the de-Nazification process of the medical professions ran through three successive waves and was considered completed by 1948. However, because of various inconsistencies and inappropriate criteria, on the whole it had the character of a superficial intervention. The country’s health agencies, which were responsible for the practical implementation of the process, gave compromised doctors the possibility of proving themselves as good servants of the anti-Fascist reconstruction cause.21 The criminal prosecution also lacked a unifying concept or direction. This was mainly because the Soviet Military Administration (SMAD) initially kept jurisdiction for all Nazi cases under its own aegis. The Soviets changed policy on this matter in mid-1947, however, and in the area of the Soviet zone there were subsequently a total of five court trials against seven defendants. The case that received the most attention took place in the summer of 1947 at the Dresden Regional Court.22 This was planned as a show trial designed to run concurrently with the Americans’ “Doctors’ Trial” in Nuremberg. On orders from the SMAD legal department, the defendants – including T4 organizer Hermann Paul Nitsche – were accused of “crimes against humanity” under CCL 10. Although the Soviet Union had abolished the death penalty on 26 May 1947 and Moscow went before the UN General Assembly to call for a worldwide rejection of capital punishment a few months later, this made no difference in the justice system of the SBZ. Nitsche and three other defendants received death sentences that were to be carried out soon after ; two of the convicted prisoners managed to kill themselves first. With the exception of four further cases that were tried in Magdeburg in the early 1950s, this basically concluded the history of criminal justice treatment of “euthanasia” crimes in

Loewy, Bettina Winter (eds.), NS-“Euthanasie” vor Gericht: Fritz Bauer und die Grenzen juristischer Bewältigung, Frankfurt/M./New York: Campus 1996, 35 – 58; Angelika Ebbinghaus, “Mediziner vor Gericht”, in: Klaus-Dietmar Henke (ed.), Tödliche Medizin im Nationalsozialismus: Von der Rassenhygiene zum Massenmord, Cologne: Böhlau 2008, 203 – 224. 21 See Weinke, 2005. 22 See Boris Böhm (ed.), Fundamentale Gebote der Sittlichkeit: Der “Euthanasie”-Prozess vor dem Landgericht Dresden 1947, Dresden: Sandstein 2008.

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East Germany.23 The rest of the accused in the Dresden doctors’ trial were freed by the mid-1950s thanks to a variety of amnesty measures. The lack of further trials does not mean, however, that the security forces were no longer interested in the suspects. The state Vergangenheitspolitik in this area remained to the very end a mixture of intensive investigations with pragmatic restraints and a will to cover-up, as was the case generally for the East German treatment with regard to suspects of Nazi crimes in their own country.24

“Cold war medicine” and failed attempts for justice The founding of the Federal Republic was followed by a clear drop in energy for a criminal justice treatment of “euthanasia” and other medical crimes. The decline in prosecutorial intensity came in part because the cases against doctors and nurses at the killing facilities and facilities with killing function had already been dealt with right after the war. In addition, after the constitution (Basic Law) of the FRG took effect, courts showed far greater inhibitions about rejecting the apologetic and justifying strategies of the accused, which on the whole tended to drag out the trials. However, with the wrap-up of the Nuremberg trials and the successive release of prisoners by the Allies, the main cause was that the political and judicial establishment of the FRG no longer considered it appropriate to continue further German trials of Nazis. The rulings passed down by the German Supreme Court for the British zone (OGHBZ) and the German Supreme Court (Bundesgerichtshof – BGH, founded in 1950) sent decisive signals. Both courts developed a series of exculpatory legal constructs that – although explicitly presented as exceptions – subsequently found ubiquitous use in the lower courts, always on behalf of the defendants. According to Karl Teppe, one BGH ruling of November 1952 especially had the effect of a “caesura and track-switch” in a process in which courts at all levels “were meticulous and strict in defining the illegality of the actions of the accused, but were always ready to justify their forms of behavior and their motives, to exercise clemency and show (escape) paths to exoneration”.25 Starting with the Koblenz court trial of the former director of the psychiatric 23 See Frank Hirschinger, “Die Strafverfolgung von NS-Euthanasieverbrechen in der SBZ/ DDR”, in: Henke (ed.), 2008, 225 – 246. 24 See Henry Leide, NS-Verbrecher und Staatssicherheit: Die geheime Vergangenheitspolitik der DDR, Göttingen: Vandenhoeck & Ruprecht 2005. 25 Karl Teppe, “Bewältigung von Vergangenheit? Der westfälische ‘Euthanasie’-Prozess”, in: Franz-Werner Kersting, Karl Teppe, Bernd Walter (eds.), Nach Hadamar: Zum Verhältnis von Psychiatrie und Gesellschaft im 20. Jahrhundert, Paderborn: Schöningh 1993, 202 – 252, here 251.

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asylum at Scheuern (Nassau), Karl Todt, and of the former head physician Adolf Thiel (judgment in 1948), the “euthanasia” trials also became a fixed part of church-based Vergangenheitspolitik. The Protestant church’s engagement in this area partly grew out of its promise at war’s end to take on ethical and moral leadership functions; but it was also due to the circumstance that the “euthanasia” policy was inescapably part of its own history, because many of the deported victims had been residents of church facilities. The church emphasized that it always maintained an attitude of rejection of the state’s “euthanasia” program, and of the selections demanded by the state in carrying it out.26 In contrast to forced sterilizations under the Nazis, which the Protestant church still failed to recognize as an injustice after the war,27 church leaders looking back on “euthanasia” were led by the feeling that they had stood on the right side, the side opposed to National Socialism. The clergy’s participation in criminal justice trials of the “euthanasia” crimes was therefore constitutive to the self-images both of certain protagonists as well as of the Protestant church as an institution of resistance under the “Third Reich”. Looking past the many petitions and memoranda of the church’s lobby work starting in 1947 on behalf of the defendants in Allied trials, church dignitaries and functionaries appeared at the “euthanasia” trials primarily as character witnesses. The original initiative apparently did not come from the church itself, but from the Hessian Justice Ministry after the spring 1946 start of its investigations of the killings at Hadamar, Eichberg and Kalmenhof.28 In August 1946, a few months before the main proceedings began in the US “Doctors’ Trial”, Father Gerhard Braune, director of the psychiatric asylum at Hoffnungsthal, a Bethel branch, and writer of a protest statement against the murders of patients in July 1940, was asked to contribute a report on the history of “euthanasia”. In this he named Herbert Linden, Leonardo Conti and Philipp Bouhler as the driving forces of the crime – all three had taken their own lives in 1945, the latter two while in Allied prison – while he described Brandt, the prospective main 26 See Uwe Kaminsky, “Vom eugenischen Dunkel am Fuße des anti-euthanatischen Leuchtturms: Zur Nachgeschichte von Eugenik und ‘Euthanasie’ am Beispiel der Evangelischen Kirche nach 1945”, in: Justizministerium des Landes NRW (ed.), Justiz und Erbgesundheit, vol. 17 : Zwangssterilisation, Stigmatisierung, Entrechtung: ‘Das Gesetz zur Verhütung erbkranken Nachwuchses’ in der Rechtsprechung der Erbgesundheitsgerichte 1934 – 1945 und seine Folgen für die Betroffenen bis in die Gegenwart, Geldern: JVA Geldern 2007, 195 – 201. 27 Early statements on this issue by church dignitaries pointed to the ineffectiveness of forced sterilization to prevent the transmission of sexual diseases and genetic defects; see Henning Tümmers, Anerkennungskämpfe: Die Nachgeschichte der nationalsozialistischen Zwangssterilisationen in der Bundesrepublik, Göttingen: Wallstein 2011, 94 – 96. 28 See Dieter Gosewinkel, Adolf Arndt: Die Wiederbegründung des Rechtsstaats aus dem Geist der Sozialdemokratie (1945 – 1961), Bonn, J.H.W. Dietz Nachf. 1991; Matthias Meusch, “Die Frankfurter ‘Euthanasie’-Prozesse 1946 – 1948: Zum Versuch einer umfassenden Aufarbeitung der NS-“Euthanasie”, in: Hessisches Jahrbuch für Landesgeschichte 47, 1997, 253 – 286.

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defendant for Trial No. 1, as a trusted associate of the Bethel facility director Friedrich von Bodelschwingh (who had died in early 1946). After these statements, Brandt’s defense attorney, Cologne lawyer Robert Servatius, contacted Braune himself. Braune thereupon provided a sworn statement in which he attested that Hitler’s top “euthanasia” program officer Brandt was not an active promoter of these unscrupulous extermination measures. Both of the Bodelschwinghs, meaning “Pastor Fritz” and his eponymous nephew, also took up Brandt’s cause. The elder Fritz (soon before his own death) told a British journalist he believed Brandt was an “idealist”, one who had thought he “was helping these people through the killing”.29 His nephew also provided an affidavit30 and campaigned for a commutation of the death penalty imposed on Brandt.31 Bodelschwingh, who was active on behalf of other Allied prisoners, wrote a protest letter to General Huebner in which he equated the American treatment of German POWs with the Roman persecution of early Christians.32 Given this background it was no wonder that the later Bethel clinic director also had close contacts to Stille Hilfe (Quiet Help), the best-known aid organization for convicted war criminals, and that he offered room and board at Bethel to a number of “euthanasia” perpetrators who had gone underground.33 With their engagement on behalf of high-ranking Nazi perpetrators, Protestant church functionaries prepared the ground for the soon-to-come revisionist history of the Allied criminal justice program. Moreover, they also paved the way for a softening in the perception of the “euthanasia” perpetrators, which soon came to also affect the West German verdicts in Nazi trials. Probably due to their imperturbable sympathy for eugenics, in which they saw an “act of charity” and a “sword for help”,34 church functionaries tended to identify with all surviving parties who took part in the murder of patients, even as they distanced themselves from the goals of the “euthanasia”. The churches’ maneuverings (also in other Nazi cases) were decisive in solidifying the idea that all participants in the Nazi era had found themselves in a “tragic forced circumstance” that allowed them only the option of acting against the excessive killing of the sick within the limited possibilities of a “loyal opposition”. This shifting of the definition of perpetrator came with a changed view of the crimes themselves. 29 Quoted from Ernst Klee, Was sie taten – was sie wurden: Ärzte, Juristen und andere Beteiligte am Kranken- oder Judenmord, Frankfurt/M.: S. Fischer 2010, 240. 30 See Weindling, 2004, 254. 31 Letter Becker to Pastor Friedrich von Bodelschwingh, 7 July 1948; Political Archive of the Foreign Office (PAAA), Becker papers, vol. 3/1; see also Weindling, 2004, 304. 32 Letter von Bodelschwingh to General Huebner, 27 June 1949; PAAA, Becker papers, vol. 17. 33 See Klee, 2010, 242. 34 Theodor Wenzel, “Eugenik oder Barmherzigkeit als Grundlage der sozialen Hilfe”, in: Die Innere Mission 37(5/6), 1947, 1 – 11; quoted from Kaminsky, 2007, 197.

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The earlier West German NS investigations had proceeded from the usually unspoken assumption that the true purpose of the selections and “relocations” of patients (i. e., to killing sites) was known only to Hitler and his closest associates. But argumentative figures like that of the “collision of duties” and the “banned mistake” implied a far broader circle of people who probably had knowledge of the events. All this went together with the widespread acceptance of the exculpatory argument presented by defendants, attorneys and psychiatric evaluators, who claimed that the removal of the “incurably sick” actually served to rescue the majority of patients who still had a chance at recovery. In reality, long before 1933, a number of doctors demanded they be allowed to make prognoses about the curability of patients (or lack thereof); but this position was no longer critically discussed after the war. In the course of the postwar case verdicts, this attitude was actually reinforced. Similarly the concept of a “merciful death” underwent a renewal, in that the Nazi census and “removal” of supposedly incurably sick people was no longer understood as the expression of National Socialist population policy but as the supposed act of resistance and of saving (other) lives. Given all this, it becomes understandable why representatives of the West German medical profession did not reflect on their own part in the crime, and why their views in evaluating the right to life of the highly disabled did not undergo a transformation. At the end of the 1960s, 40 percent of West Germans still expressed the opinion that the killing of “barely aware” mentally ill patients was ethically justified.35 The “paradigm of a selective-preventive social medicine” (in Falk Pingel’s words) survived the first wave of trials, insofar as the repressive measures were not typically National Socialist but could be categorized within another, older tradition of exclusion.36 The judiciary view of the victims, which divided those persecuted into different categories and recognized one or another group at the cost of the rest, also had its effects on contemporary history. The German Institute for the History of the National Socialist Era, founded in Munich in 1949 and renamed the Institut für Zeitgeschichte (IfZ) in 1952, aimed for a praxis of Wiedergutmachung. In its early expertises it solidified the view of the courts that the killings of mentally handicapped and of Jews had been implemented by no more than a few people without the knowledge of the German population.37 35 Quoted from Falk Pingel, “NS-Psychiatrie im Spiegel des historischen Bewusstseins und sozialpolitischen Denkens in der Bundesrepublik”, in: Kersting, Teppe, Walter (eds.), 1993, 174 – 201, here 185. 36 Ibid., 188. 37 Hans Buchheim, “Das Euthanasieprogramm”, in: Gutachten des Instituts für Zeitgeschichte, vol. 1, Munich: Institut für Zeitgeschichte , 1958, 60 – 61, here 61.

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In 1959 the former T4 program functionary Werner Heyde was discovered to be still living in Germany under the false identity of “Fritz Sawade”, a name he had held since the late 1940s, with protection from the Schleswig-Holstein state government. This set off a new stage of criminal prosecutions. Supported by Hessian Justice Minister Georg August Zinn (SPD), the Frankfurt state attorney general Fritz Bauer took on the task of investigating the “euthanasia” complex comprehensively – i. e., also including the perpetrators in the judiciary – until his death at a relatively young age in 1968. The new investigations in Hessen in part took up where the early postwar prosecutions had left off; but they also broke with the old Vergangenheitspolitik that had favored mild sentencing and clemency. In 1958, Zinn himself had justified the practice of early parole for all convicted perpetrators, saying that the mere issuance of verdicts had already adequately served justice, in that they made it clear that “the acts of the convicted were not true euthanasia [sic] and did not implement a legal measure of the then state authorities, but were criminal wrongs”.38 Now, in the late 1960s, the second wave of trials followed in a climate that had changed greatly since the early 1950s. Several major events had contributed to a greater readiness of society to confront the repressed crimes of the past: these included the GDR propaganda campaigns against former Nazis and regime functionaries who still served among the West German elites; the founding of a national coordinating office for Nazi crimes at Ludwigsburg,39 and the Israeli kidnapping of Eichmann in Argentina and his subsequent trial in Jerusalem. However, the mere fact that German courts now again handled a larger number of NS cases did not automatically result in different verdicts. For example, the Frankfurt jury that delivered a verdict in the cases against the three T4 experts Aquilin Ullrich, Heinrich Bunke and Klaus Endruweit (prosecuted by Bauer) found that those killed had been “sick people without a natural will to live”.40 The court therefore let the accused go, claiming that they had lacked the experience to recognize the killing by gas of their victims as a crime, all the more so since they could fall back on Hitler’s authorization order and the authority of statements from leading German psychiatrists. The verdict was appealed. The BGH in a final ruling did not dispute the lower court’s view that while the killing of “spiritually dead” people was illegal, under certain circumstances it was nevertheless not a matter for which someone could be found guilty or liable for punishment. The BGH only complained that the lower court had presumed an absence of a “will to live” in victims for whom the evidence actually suggested 38 Quoted from Klee, 2010, 207; the author himself does not give an explanation for Zinn’s stance, which was probably more complex and therefore deserves closer inquiry. 39 See Annette Weinke, Eine Gesellschaft ermittelt gegen sich selbst: Die Geschichte der Zentralen Stelle Ludwigsburg 1958 – 2008, Darmstadt: Wissenschaftliche Buchgesellschaft 2008. 40 Quoted from Dressen, 1996, 50.

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the opposite.41 The highest German criminal court’s praxis of perpetratorfriendly verdicts did in 1974 give rise to harsh public protests, after an appeals ruling in the case of the killing doctor Kurt Borm; but these protests did not cause a lasting change of course. In the mid-sixties, Bauer had sought the prosecution of 22 participants at the Jurists’ Conference of 1941 on suspicion that they had been accomplices to murder ; during that conference, leading judges and prosecutors had sanctified the mass murder of patients by their decision to suppress private criminal complaints by relatives or other citizens.42 Those investigations were finally suspended by Bauer’s successor Horst Gauf after the responsible magistrate kept pushing the cases back by years. In the literature one sometimes finds the opinion that the justice system had been forced into a “fail-safe” role with regard to “euthanasia” crimes,43 but this is only accurate insofar as the prosecutors and the courts were in fact the institutions that had spent the longest and most intensive time considering the issue. But this opinion fails to recognize that in this process, representatives of criminal justice, the medical community and churches also got to appear as experts on their own behalf, and were determined to develop a coherent interpretation of the past.

41 Quoted from ibid. 42 See Helmut Kramer, “‘Gerichtstag halten über uns selbst’: Das Verfahren Fritz Bauers zur Beteiligung der Justiz am Anstaltsmord”, in: Loewy, Winter (eds.), 1996, 81 – 131; Irmtrud Wojak, Fritz Bauer 1903 – 1968: Eine Biographie, Munich: C.H. Beck 2009, 363 – 400. 43 Teppe, 1993, 252.

Memories, Concerns, and Legal Issues of the Victims

Helmut Bader

The Voice of the Victims and their Families: The Case of Martin Bader

Family background My father, Martin Bader, was born on 20 November 1901 in Giengen,1 a town of 4000 citizens. He was murdered in 1940 in a euthanasia program called “Aktion T4”. I do not have many memories of him as he was taken to a psychiatric hospital when I was four years old. I met him a few times when we visited him, and I clearly remember his characteristic way of walking. After his death, my mother often spoke about his life and carefully kept written records of his life and death. When reading them as a child, I became quite familiar with my father’s life. As an adult I started to research his life and the circumstances surrounding his death. I keep the documents as the most precious treasure of our family history, and I consider it my duty to honor the memory of my father and to protect his fate from oblivion. The documents2 I have based my research on, are: – his autobiography – letters from the psychiatric hospital – documents on Nazi euthanasia – post-war documents.

Autobiography Martin Bader : Thirty Years of My Life is the title of the thick black notebook in which my father wrote about his life. He began his autobiography on 1 February 1930: “Preface! As I feel that I will not live another thirty years I will make the 1 All places mentioned in this article are located in what is today the German federal state of Baden-Württemberg. 2 All documents are in the private archive of the author, except list of transportation.

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effort and write down all the memories which still come to my mind. In these 30 years I have led a life full of joy but also sorrow. Not everyone reading this book will have been through such a lot in the same lifespan. The younger generation will find a lot to emulate but also some warnings. Everyone should read this book thoughtfully. The end shall be written by someone else if I do not manage to do it myself.” The last entry was made in 1931. His prophecy became true sooner than he himself would have expected: he lost his life before he reached the age of thirty-nine.

Preface in the black notebook of Martin Bader written in German, 1 February 1930

In beautiful handwriting and perfect style and grammar, my father not only spoke of his own experiences but also reported about events of everyday life, painting a vivid picture of life and customs one hundred years ago.

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My father’s childhood was very hard: his father, a factory worker, died when Martin was eight years old. That meant that apart from going to school he also had to work in order to contribute to the family income for four brothers and three sisters. After finishing school he began an apprenticeship as a shoemaker. In October 1918, at the age of eighteen, he and his twenty-seven year old sister came down with the “Spanish influenza” (encephalitis lethargica sive epidemica). While his sister died in hospital, he recovered from the illness without apparent aftereffects. After his apprenticeship, he followed the very common custom of craftsmen those days: he took to the road in Bavaria and looked for work with different masters of his craft in order to perfect his skills. His autobiography is full of amusing events and exact descriptions of the habits and customs of Bavarian people. He loved their way of life, wore their traditional costume, and climbed their mountains. Standing on the peak of a high mountain on New Year’s Day 1921, he was overwhelmed by the greatness of nature: “When I saw the enormous number of mountain peaks for the first time in my life, I was speechless. I can hardly put my feelings into words. I felt something solemn and sublime. I can say I felt close to heaven.” After years of travelling he took his master craftsman’s diploma (Meister) at the age of twenty-three. He established his own workshop in his home town and soon had many customers who not only had their shoes repaired but also had shoes and riding boots made to measure. In 1925 he married his Bavarian girlfriend Maria, and soon my sister was born.

Bridal pair Maria and Martin Bader, mid-1920s

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But after a short time of family happiness, the apparently forgotten illness broke out again: “In 1926 I started suffering from a tremor of the nerves in the left part of my body, a consequence of the influenza in 1918.” He gradually developed Parkinson’s disease: tremor of the left hand and dragging of the left leg. He sought recovery in a psychiatric hospital in Tübingen. During the following 12 years there were periods of productivity interspersed with disability, and intervals where his condition deteriorated to the point of hospitalization. Ultimately in 1938 he was institutionalized at the Schussenried Psychiatric Asylum in the hope of finding an effective medical treatment.

Maria, Martin and Helmut Bader, 1934

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Letters from the Schussenried psychiatric asylum3 My mother kept over a dozen letters and postcards which my father wrote during his stay in the psychiatric institution. As well as providing a window into his suffering, these letters give details of life in the asylum: 28 December 1938 (in response to a letter from my mother): “My heart is full of sadness, as there is no word of coming home soon.” 12 March 1939: “If you only knew what it means to live amongst mental patients day and night.” And two weeks later: “Imagine there are only lunatics around you with whom you can’t exchange one single reasonable word. Not even at night do you get to rest. I am the only normal human being here. […] I am dying of homesickness!” 21 June 1939 (after a visit by my mother): “I regret that I went back with you into this prison.” This passage sounds almost tragicomic: “Mina [my father’s half sister Wilhelmine Rau, H.B.] wrote that I should wait patiently for God to lead me into his paradise, but I think it is a bit too much to ask, waiting for death at the age of only 38.” 3 September 1939 (after the outbreak of the war): “I am dying of sorrow. Most men are going to war, but I must sit here whilst there is so much work to do outside.” He quotes his fine school reports with praises and prizes, his excellent examination for the master craftsman’s diploma, and his knowledge of accounting: “There would certainly be a job involving written work for me.” He asks my mother to look for a job for him. The doctor’s comment added to this letter is interesting: “Mr. Bader seems to be succumbing to a strong self-deception in his enthusiasm and desire to join life outside. Apart from his disability and weakness he would have trouble, as most of these jobs are occupied and demand top performance. At this time of rapid change, daring attempts are not advisable.” 20 November 1939: “Please send me a woolen blanket because it is so cold at night and blankets are so rare. […] When will you come and see me at last? I feel so sorry for my poor children when they will have to say that their father died in a mental asylum.” 13 December 1939: “Now I am in the punishment ward, which means that I am outside in the cold all day long. I am sitting on a garden bench freezing to death. I have never thought of such a hard and cruel fate. The reason is a stupid joke: I ran after a nurse, and now they think that I am simulating my bad walking. […] If only one crumb of bread falls into the mud they eat it from there because they are starving. They steal like rats. Kicks and blows are normal in this ward.”

3 Württembergische Heilanstalt Schussenried; in 1953 renamed to Psychiatrisches Landeskrankenhaus Schussenried; since 1996: Zentrum für Psychiatrie Bad Schussenried (ZfP).

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12 February 1940: “Now I have got everything my heart might desire. After nine weeks in the punishment ward they have given me a nice single room and I have enough to eat.” In his comment the doctor notes that it had not been a “punishment ward”, but that my father had been excited and out of consideration for the female staff had been taken to a different ward. He added: “He has written to his vicar lamenting about being hungry and suggesting food items that he could send. But we did not post the letter. Now he is apparently satisfied with the food.” 21 March 1940 (longing to be at home he gives a prognosis about the war): “I really have an easy life: I lie on the sofa all day long, something I could not do at home! […] I don’t agree with your consoling suggestion that I should wait for the end of the war until I return home. The war may last three to five years, and I would like to celebrate my 40th birthday at home.”

His last message is a postcard dated 1 May 1940 in which he thanks my mother for a parcel. Whenever I read my father’s letters I feel how desperate he must have been, how lonely he was away from his family. And I am always struck by the clarity of his thoughts and his ability to put these into words without any signs of mental deficiency. As with his autobiography, the handwriting is beautiful, the penmanship perfect without spelling mistakes or grammatical errors. Admittedly, Parkinson’s disease must have handicapped him. Notwithstanding this, I am haunted by the question of why my father was locked away in a psychiatric asylum. And even more so, why was he ultimately sent into the gas chamber at Grafeneck?

Documents on euthanasia On 23 June 1940 my mother sent a postcard to my father which was returned with the note “Delivery not possible”. Shortly afterwards, a letter dated 24 June arrived from the director of the Schussenried Psychiatric Asylum: “Dear Madam, A few days ago your husband was transferred to another institution, the name of which I do not know. For that reason I cannot give you any information on the health of your husband. Heil Hitler! Dr. Götz”. Doctor Hugo Götz definitely knew where my father had been transferred to. On 16 February 1940 he had already been informed about euthanasia by the highest ranking medical officer of Württemberg, Dr. Eugen Stähle. He was bound by oath to secrecy.4 A few days later there followed a letter from the “Landes-Pflegeanstalt Grafeneck”, dated 27 June. The euphemistic name of this institution implied that it was a nursing home. My mother was informed that my father had been 4 Ernst Klee, “Euthanasie” im NS-Staat: Die “Vernichtung lebensunwerten Lebens”, Frankfurt/ M.: S. Fischer 1989, 134.

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transferred to Grafeneck on 14 June and had unexpectedly died from a cerebral apoplexy on 26 June. His body had already been cremated. If my mother wished so, they would send the urn with his ashes. My mother wrote to the “nursing home” inquiring about the sudden death of her husband and received this letter, dated 6 July 1940: “Dear Madam, Your husband died from a cerebral apoplexy on 26 June 1940, a so-called brain stroke. As the word stroke implies, death occurs all of a sudden, so he did not suffer for long as you might suppose. The urn with his ashes was sent to the cemetery in Giengen on 3 July 1940. Heil Hitler! Dr. Jäger.” Dr. Jäger was the alias of doctor Ernst Baumhardt,5 one of the organizers of the euthanasia program at Grafeneck. As ascertained by the court in Tübingen in 1949, at least 10,654 humans were murdered here in 1940.6 After my father’s death my mother did not get a widow’s pension. Only my sister and I received an orphan’s allowance of RM7 7.70 each per month. So my mother had to earn enough to support the entire family. She worked in different households and in a little shop. How and when my mother came to know that my father had not died a natural death I do not know. But it could well have been in the same year in which he was murdered: within three months, three men of our home town also lost their lives at Grafeneck. In our small town practically everyone learnt about the fate and unusual death of fellow-citizens. In addition rumors about the isolated Grafeneck castle were circulating in the whole area. Of course it was not advisable to talk about what was going on up there. My mother expressed her suspicions about the unnatural cause of my father’s death to the mayor of our town, who rejected her with the following ominous response: “Don’t dare to say that, it could become dangerous for you!”

Post-war documents In 1947 the district court at Münsingen investigated the Grafeneck murders. As far as the transports from the Schussenried Psychiatric Asylum are concerned, the only document that gives evidence is the asylum’s so called “Main Book” (Hauptbuch).8 Besides personal data and diagnosis it shows patients’ admission and discharge dates. The dates of the transports are registered with absolute “German accuracy”. The court ordered medical and nursing staff to reconstruct the transport lists, and 5 Idem (ed.), Dokumente zur “Euthanasie”, Frankfurt/M.: S. Fischer 1986, 17. 6 Thomas Stöckle, Grafeneck 1940: Die Euthanasie-Verbrechen in Südwestdeutschland, Tübingen: Silberburg-Verlag 2002, 17. 7 Reichsmark, currency in Germany between 1924 and 1948. 8 Archive of ZfP Bad Schussenried: Hauptbuch 1938, serial no. 4.505.

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from this it was determined that 620 patients had been taken to Grafeneck in nine transports. The court also required the asylum to classify the patients according to the following criteria: “a) able to work in % and b)g not fit to live?’ ” This last term seems to show that Nazi vocabulary was not yet out of use! Doctor Paul Morstatt, the doctor who was responsible for my father and who was also director of the psychiatric institution in 1947, pointed out to the court the difficulty of remembering and assessing patients after such a long time.9 My father’s name can be found on the list of the second transport of 75 men, dated 14 June 1940: “No. 6: Bader, Martin – Date of birth: 20 Nov. 1901 – Admission to institution: 12 Sept. 1938 – Diagnosis: Encephalitis epidemia [sic!] – a) able to work: 0 % – b) “unworthy of living?” – Here without entry.10

List of transportation to T4 killing center Grafeneck including Martin Bader’s name: “transferred on 14 June 1940 to unknown” [location]

9 Ibid., comments on assessing patients concerning “ability to work” and “fit to live”, dated 17 December 1947. 10 Ibid., transport list dated 14 June 1940.

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The “Main Book” of the institution and the transport list provide clear evidence of the correct date of my father’s death. All inquiries by the court and depositions of the guards at Grafeneck prove that all patients were taken to the gas chamber the day they arrived. Because 14 June 1940 was a Friday, the brutal work had to be done immediately before the personnel went on their weekend holiday. At the “Grafeneck Nursing Home” there were no beds for keeping patients. In 1957 my mother tried to apply for compensation for my father’s death. For that she needed the death certificate that should have been kept by the registry office of our home town, but the document had obviously been destroyed by the Nazi staff. The only official notice of my father’s death is the short entry in the family book of the registry office: “Died 26 June 1940 at Grafeneck, district of Münsingen”. This false entry has never been amended to reflect the true date of my father’s death: 14 June 1940. As Grafeneck is part of the Münsingen district administration (Landratsamt Münsingen) my mother sent an inquiry there and received a typically bureaucratic response dated 25 September 1957 that was nonetheless absurd: “The district court is not competent in this matter as your husband had not taken up residence at Grafeneck.” On 20 November 1957 my mother submitted a petition for compensation to the “Regional Office for Compensation” (Landesamt für Wiedergutmachung) in Stuttgart. It was rejected nine days later – very quickly indeed for a bureaucracy. The rejection was based on Section 1 of the German Restitution Law for victims of National Socialist persecution (Bundesentschädigungsgesetz/BEG): “Euthanasia does not necessarily create a basis for compensation regarding damage or loss of life. The condition for which compensation is provided is persecution. Persecution is only recognized in cases involving political opposition against National Socialism, race, faith or ideology.” The handicapped victims of euthanasia did not receive any compensation in post-war Germany. On 9 January 1958 my mother filed a petition with the Ministry of Justice of Baden-Württemberg seeking compensation based on undue social hardship. The Ministry rejected the petition on 29 June 1958 giving the following reasons: “Herr Dr. R […] [the doctor who treated my father before admitting him to the Schussenried Psychiatric Asylum, H.B.] has informed the bureau for compensation that, considering the kind of illness of the husband of the petitioner, cure or a change for the better could not be expected. With regard to the entries in the Main Book, the Schussenried Psychiatric Asylum made a comment to the effect that the possibility could have existed that the condition of health of the husband of the petitioner could have improved.”

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Decisive in the end was the harsh statement of the doctor, as is documented by the following comment: “According to the definite statements of the doctor who treated the deceased for many years it seems unlikely that the health conditions of the husband of the petitioner – had he survived – could have improved to the point where he could have returned to work and supported the petitioner. Even if the Schussenried Psychiatric Asylum admits the possibility of an improvement of the patient’s health condition, this possibility is not enough to justify the application of Section 171 […] BEG. Probability must be given, and in this case the probability which lies between possibility and certainty cannot be calculated. Therefore the petition must be rejected.”

Rejection of the mother’s petition for recompensation: extract of reasoning by Ministry of Justice of Baden-Württemberg, 29 June 1958

After these decisions, my mother gave up and never again attempted to seek compensation, nor did she receive any. She eventually received an old-age pension and was finally able to retire after many years of hard work supporting our family. She died in 1986 at the age of ninety-one.

Rolf Surmann

Rehabilitation and Indemnification for the Victims of Forced Sterilization and “Euthanasia”. The West German Policies of “Compensation” (“Wiedergutmachung”)

Preliminary remarks Before discussing the West German policies of rehabilitation and indemnification for Nazi victims, especially for forced sterilization and “euthanasia” victims, we should mention a few preliminary points. In principle it should first be noted that the cornerstones of this policy were not formulated by the German parliament (Bundestag) or by the federal government, but by the Western Allies. In the course of negotiations on the Bonn Treaties in the early 1950s, the Western victors laid down the conditions for expanding the sovereignty rights of the Federal Republic of Germany. The core of the Allied indemnification policy was defined in the Überleitungsvertrag (Transitional Agreement).1 In the fourth section of this Agreement, the Western Allies obliged the Federal Republic to pay financial indemnification to persons who had been persecuted for their “race”, worldview or faith and who consequently suffered damage to their life, body, health, freedom, property, assets or economic advancement. As a participant at the negotiations later remembered, West German politicians for their part unsuccessfully attempted to at least have the most venomous of the demands removed. The indemnification policy was therefore based on the Allied understanding of indemnification at the time and on the cornerstones set by the Western victors. This also means that their stance towards forced sterilization and Nazi “euthanasia” was at least rudimentarily reflected in this basic constellation. On the other hand, the task of creating a uniform legal framework that would transform the Federal Republic’s original liability for indemnification from an enforceable liability based on private law into a general, statutory obligation fell upon the shoulders of West German lawmakers. This meant that the Bundestag as a legislative institution was essentially given 1 See Auswärtiges Amt (ed.), Verträge der Bundesrepublik Deutschland: Serie A: Multilaterale Verträge, Bonn et al.: Heymanns 1957.

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the chance to interpret the legal claim from a socio-political viewpoint.2 However, this opportunity for interpretation – within the bounds of Allied specifications – was also restricted by the limited capacity of West German society to pay compensation for all damages caused. In this respect the indemnification laws are generally an indicator of the status of West Germany’s Entschädigungspflicht (indemnification obligations) compared with other social tasks. The political discussion at the time focused especially on the question of which groups of persons, on this basis, would be included in the indemnification legislation and which would not, and which would be included only with limited rights. The operative question was therefore: what constitutes “typical Nazi injustice”? In order to make this more precise, the requirement was added that the groups of persons concerned would have to have been “persecuted” by the National Socialists. In other words, it did not suffice that a victim had suffered damages/losses caused by state functionaries: there had to have been an explicit will to persecute resulting from National Socialist ideology. Thus, the indemnification legislation oriented itself on Nazi ideology, or at least on what might be regarded as such. It was therefore always an expression of the ability to recognize Nazi crimes as such. Although the actual indemnification legislation was finalized with the Bundesentschädigungsschlussgesetz (Federal Compensation Settlement Act) of 1965, up to the present day there are still political and legal debates on German indemnification obligations – ranging from the intensive efforts of victims excluded from indemnification to obtain recognition to more general debate triggered by various processes of societal change. A well-known example is the foundation Erinnerung, Verantwortung und Zukunft (Remembrance, Responsibility and Future), a foundation established in 2000 which, after decades of efforts, secured compensation payments for victims of forced labor in the Nazi period. A practical consequence of this was that in addition to the original indemnification legislation, a graded buffer system of benefit institutions had to be created which also reflects the degree of societal recognition and rehabilitation of various groups of victims. As far as the victims of forced sterilization and Nazi “euthanasia” are concerned, this means that their classification as regards indemnification cannot be seen as static – for example, on the basis of how they were considered under federal indemnification laws – but that we are dealing here with changes that have continued for decades and been shaped by the socio-political discourse of the day. I would like to distinguish between three different developmental stages: 2 See Otto Küster, Wiedergutmachung als prinzipielle Rechtsaufgabe, Frankfurt/M.: SchulteBulmke 1952, no pag.

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1. formation of a discriminating basic constellation in the 1950s and ’60s which is expressed in the parliamentary resolution to the Federal Compensation Act (BEG); 2. correctional approaches at the time of the coalition between Social Democrats and from the early 1970s to the early1980s and the beginning of a new social orientation within the context of the debate on the so-called “forgotten victims” in the 1980s; 3. rehabilitation without equivalent progress in indemnification from the 1990s through till the present.

The basic constellation The core of compensation legislation for injury to persons as laid down in the Transitional Agreement consists of the Bundesergänzungsgesetz (BErG; Additional Federal Act for Compensation of Victims of National Socialism) of 1953 which was hastily approved under Allied pressure, followed by the Bundesentschädigungsgesetz of 1956 (BEG; Federal Act for Compensation of Victims of National Socialism), which supplemented the BErG, and finally the Bundesentschädigungsschlussgesetz (BEG-SG; Federal Compensation Final Law) of 1965, which led to a certain expansion of benefits but also closed the indemnification process by setting a 1969 deadline for submission of claims. The legal position of victims of forced sterilization and “euthanasia”, as already mentioned, essentially depended on whether the damage they had suffered was judged to be specifically the result of National Socialist persecution and was based on the Gesetz zur Verhütung erbkranken Nachwuchses (GzVeN; Law for the Prevention of Genetically Diseased Offspring) – the so-called Erbgesundheitsgesetz (Genetic Health Law) – which was enacted on 1 January 1934. One of the peculiarities of this law was that it had already been drafted by the Prussian Health Council at the time of the Weimar Republic.3 However, the version approved in 1934 differed from the Weimar version particularly in the following points: it opened up the possibility of forced sterilization and added a catalogue of so-called hereditary diseases. Although the evolution of the law shows the influence of eugenicist and racist ideology on contemporary thought and in particular on scientific and medical thought, one would have expected a critical debate on this subject not least because of the post-1945 practice which was based on the law. What obstacles had to be overcome – both in Germany and elsewhere – 3 See Udo Benzenhöfer, Zur Genese des Gesetzes zur Verhütung erbkranken Nachwuchses, Münster : Klemm & Oelschläger 2006.

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becomes clear if we look at the efforts made by the United Nations (UN) since 1949 to have the concept of “race” declared obsolete. To what extent particularly the Federal Republic failed to heed these efforts is evident in the wording of the BEG itself. As already mentioned, one of the reasons justifying a right to compensation continues to be, even today, “persecution for reasons of race”. Such a formulation implicitly assumes the existence of races. In view of this persistence of old ideologies, it is not surprising that the range of what could be defined as racism was not part of the discussion. Hans Giessler, for instance, in a book series published by the Federal Ministry of Finance, interpreted the official view with the words: “Even someone who was sterilized for reasons of biological heredity was not defined as having been racially persecuted, although the sterilization may indeed have been carried out for the purpose of keeping the race clean of defective genetic characteristics. The sterilized person was not classified as belonging to an inferior human race.”4 Of central importance in this context is a hearing of the Parliamentary Committee for Compensation held in 1961. Participants included specialists who were expected to take a stand on indemnification for victims of forced sterilization and “euthanasia”. The hearing became a plea for a new sterilization law, and indeed one that included forced sterilization.5 Berlin professor Dr. h.c. Hans Nachtsheim, stressing his decades of experience as a geneticist and eugenicist, claimed that “Every civilized nation needs eugenics, in the nuclear age more so than ever”, and expressed support for forced sterilization. It is therefore not surprising that he had no sympathy for the compensation claims of persons 4 Hans Giessler, “Die Grundsatzbestimmungen des Entschädigungsrechts”, in: Walter Brunn et al., Das Bundesentschädigungsgesetz: Erster Teil, in: Bundesminister der Finanzen in Zusammenarbeit mit Walter Schwarz (eds.), Die Wiedergutmachung nationalsozialistischen Unrechts durch die Bundesrepublik Deutschland, vol. 4, Munich: C.H. Beck 1981, 20. 5 For the following see “Protokoll der 34. Sitzung des Ausschusses für Wiedergutmachung am 13. 4. 1961”, Parlamentsarchiv des deutschen Bundestags, Ausschußprotokolle 3120; see also www.euthanasiegeschaedigte-zwangssterilisierte.de/dokumente/bt-protokoll-13-04-1961.pdf (30 August 2014). In general see Katja Neppert, “Warum sind die NS-Zwangssterilisierten nicht entschädigt worden? Argumentationen der fünfziger und sechziger Jahre”, in: Matthias Hamann, Hans Asbek (eds.), Halbierte Vernunft und totale Medizin: Zu Grundlagen, Realgeschichte und Fortwirkungen der Psychiatrie im Nationalsozialismus, Berlin/Göttingen: Schwarze Risse 1997, 199 – 226; Rolf Surmann, “Was ist typisches NS-Unrecht?”, in: Margret Hamm (ed.), Lebensunwert – zerstörte Leben: Zwangssterilisation und “Euthanasie”, Frankfurt/M.: Verlag für akademische Schriften 2005, 198 – 211; Stefanie Westermann, Verschwiegenes Leid: Der Umgang mit den NS-Zwangssterilisationen in der Bundesrepublik Deutschland, Cologne/Weimar/Vienna: Böhlau 2010; Henning Tümmers, “Spätes Unrechtsbewußtsein: Über den Umgang mit den Opfern der NS-Erbgesundheitspolitik”, in: Norbert Frei, Jos¦ Brunner, Constantin Goschler (eds.), Die Praxis der Wiedergutmachung: Geschichte, Erfahrung und Wirkung in Deutschland und Israel, Göttingen: Wallstein 2009, 494 – 530; Henning Tümmers, Anerkennungskämpfe: Die Nachgeschichte der nationalsozialistischen Zwangssterilisationen in der Bundesrepublik, Göttingen: Wallstein 2011.

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who had been sterilized during the National Socialist period. Nachtsheim was not the only expert at the hearing who could claim this type of experience. Another resolute defender of the GzVeN was Marburg professor of psychiatry Werner Villinger, who introduced himself to the Committee as – among other qualifications – associate judge of the so-called Erbgesundheitsgerichte (hereditary health courts) in Hamm and Breslau since 1936 which had in fact been established in the context of Nazi “hereditary policies”. Not only did he declare that compensation claims were unjustified, but he saw them as a particular psychiatric risk to applicants, who he claimed might then suffer “compensation neuroses” as a result of concessions being made to the victims. Although there were also experts who were opposed to these opinions, the Parliamentary Committee for Compensation came to the conclusion that the GzVeN was not inconsistent with the rule of law. In a second step of the argument, however, the Committee declared that this was a secondary conclusion, and it justified the need for a developing a hierarchy of victims based on financial reasons. As compensation for “genuine victims of persecution” was limited by lack of funds, it would not be justified “to indemnify persons who had been sterilized because of a genetic disease for their sterilization. […] Within the scope of a general compensation scheme […] this would cause a financial burden of between 1 billion and 1 14 billion marks, with up to 60 % of this compensation amount paid to insane or feeble-minded persons or to severe alcoholics.”6 For the victims of the Nazi forced sterilization and “euthanasia” programs, this meant that they were not recognized by compensation legislation as having been persecuted “for racial reasons”, and that they were not considered entitled to compensation. Section 79 of the 1953 BErG allowed them only compensation for hardship, provided that they had been sterilized without having been made to appear before the so-called genetic health courts. Specifically, Section 79 (3) no. 7 stipulated that victims might be eligible to receive hardship payments if they “had not been persecuted within the meaning of the Act and had been sterilized […] without prior legal proceedings under the Law for the Prevention of Genetically Diseased Offspring of 14 July 1933”.7 The same applied to “dependent survivors of persons who had fallen victim to the Nazi ‘euthanasia’ program if it must be assumed that if the killing had not taken place these persons would currently be receiving maintenance”.8 6 See Norbert Schmacke, Hans-Georg Güse, Zwangssterilisiert – Verleugnet – Vergessen: Zur Geschichte der nationalsozialistischen Rassenhygiene am Beispiel Bremen, Bremen: Brockkamp 1984, 165. 7 BErG, printed in: Hendrik George van Dam, Das Bundesentschädigungsgesetz, Düsseldorf: Verlag Allgemeine Wochenzeitung der Juden in Deutschland 1953, 236. 8 “Härteausgleich nach § 171 Absatz 4 Nr. 1 BEG § 5 Absatz 1 Nr. 2 Gesetz zur allgemeinen

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In addition to assistance for the purchase of household items, hardship benefits under the BEG included subsistence allowances. Loss of earning capacity was not recognized. Pensions for damage to body or health under section 32 BEG were thus excluded in principle. This regulation was adopted under Section 171 (4) no. 1 BEG. In 1957, the Allgemeines Kriegsfolgengesetz (AKG; General Law Regulating Compensation for War-induced Losses) slightly expanded the scope of entitlement. Pursuant to Section 5 (1) no. 2 AKG, Nazi victims who did not qualify under section 1 BEG could receive benefits “if sterilization, although based on the Genetic Health Law, had been performed in violation of the provisions of this law or in a medically flawed manner”.9 These persons were thus considered to be victims of “other government injustice” and explicitly not victims in the sense of a “typical Nazi injustice”. The reasons justifying payment of “hardship benefits” to these victims are a reaffirmation of the Erbgesundheitsgesetz (GzVeN) and thus per se a justification of the violation of an individual’s right to physical integrity : a victim could claim hardship benefits only if errors had been made in the application of the law. These arguments formed the basis of decisions by the compensation offices, and in individual cases they even went beyond the legal restrictions. For instance, one regional financial office argued in its notice of rejection that since the GzVeN was not illegal as such, the applicant could not claim under the General Law Regulating Compensation for War-induced Losses. Court rulings went along the same lines. For example, the Bremen regional court notified one applicant that it only verified whether the medical officer responsible for the pertinent report had acted under the rules applicable at the time.10 Such reasoning was not only an insult to persons who had been persecuted on grounds of racial hygiene: it also marked the final point in the development of compensation legislation. Over the years, attempts to achieve a change were rejected with reference to the opinion of the Parliamentary Committee for Compensation referred to above. Furthermore, the limited possibilities for application that had been allowed had, as a result of their restrictive formulation and interpretation, no practical significance. Moreover, every victim of racial hygiene who submitted applications for compensation or subjected to so-called follow-up assessments was often confronted with this same attitude and sometimes even faced the same doctors that had previously been responsible for their sterilization. For these persons, therefore, the first decades of the Federal Republic were not a time of rehabilitation and indemnification, but indeed a period Regelung durch den Krieg und den Zusammenbruch des Deutschen Reiches entstandener Schäden (AKG)”, Bundesgesetzblatt I, 1747. 9 See Hermann-Josef Brodesser et al., Wiedergutmachung und Kriegsfolgenliqidation: Geschichte – Regelungen – Zahlungen, Munich: C.H. Beck 2000, 163. 10 Schmacke, Güse, 1984, 155.

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of discrimination and disparagement. These years are therefore quite correctly referred to as the time of the “second ordeal” or – from the other perspective – as the period of the “second guilt” (Ralph Giordano).11 Indeed, the debate about this type of persecution was marked by an astonishingly high degree of continuity in persons and ideologies from the time of National Socialism.

Correctional approaches and new orientations in society Although the Final Federal Compensation Act (BEG-SG) had intended to draw a political closing line under the politics of restitution, criticism was not silenced. During political debates about a possible inclusion of victims of forced sterilization and Nazi “euthanasia” into this legislation, some members of parliament were not prepared to accept their exclusion. Among them were politicians from the Christlich Demokratische Union (CDU; Christian Democratic Union) and the Christlich Soziale Union (CSU; Christian Social Union) as well as Social Democratic politicians (Sozialdemokratische Partei Deutschlands; SPD). Social Democratic critics gained influence following the establishment of a coalition of the Social Democrats and Liberals in 1969. But this was not only a consequence of the leading role of the SPD in the new government: it can also be explained by a change of paradigms within the political culture. Federal chancellor Willy Brandt (SPD) was particularly associated with the hope that after the last two decades of federal politics that many had found restorative, a progressive political counter-project would come into being that would also apply to restitution policies. But although influential Social Democrats like the then parliamentary party leader Herbert Wehner (SPD) had articulated the party’s criticism of the political concepts of compensation during the Adenauer period, the coalition government chose to ignore the problem. What remained was only a small scope for change, which in principle confirmed the BEG-SG. New initiatives also emerged from within society. Of particular importance was a petition from police officer Valentin Hennig in support of a relative who had become a victim of forced sterilization.12 Against the backdrop of the 1974 Bundestag statement that the so-called Erbgesundheitsgesetz (GzVeN) was suspended, members of the German parliament took up the petition. In connection with a reformulation of the mitigation of hardship regulation for Jewish victims 11 Ralph Giordano, Die zweite Schuld oder Von der Last Deutscher zu sein, Hamburg: Rasch und Röhring 1987. 12 See Valentin Hennig, Zur Wiedergutmachung von Zwangssterilisation im Nationalsozialismus: Eine Dokumentation, Berlin: Frieling 1999; see also Horst Biesold, Klagende Hände: Betroffenheit und Spätfolgen in bezug auf das Gesetz zur Verhütung erbkranken Nachwuchses, dargestellt am Beispiel der “Taubstummen”, Solms: Jarick Oberbiel 1988.

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of persecution, they succeeded in having victims of forced sterilization included in the compensation settlement. The Federal Ministry of Finance issued the decree to this effect on 26 August 1981.13 Although the German government still explicitly refused to acknowledge any obligation to grant compensation, it was prepared to grant a one-time assistance of 5,000 marks under the condition that the applicant would thereafter relinquish any further claims. The government also granted ongoing assistance in special cases where the aggrieved person was, at the time when his application was considered, recognized as still suffering considerably due to persecution in the sense of Article 1 of the BEG-SG. In this case monthly payments were possible. But once again, all this did not silence criticism, which indeed intensified due to a social shift of values initiated by the “1968 movement”. The point of departure of members of “the ’68 generation” was not determined by a political discourse about restitution, but instead by attempts made by a great variety of social groups to account for National Socialist crimes in general. What these groups had in common was the intention to do away with the historical and political burden which had characterized the “CDU-State” – as it was often called. The Gesundheitstag (“day of health”) in Berlin in 1980, for instance, stood under the motto “Medicine and National Socialism”.14 Homosexuals, who until 1969 had been prosecuted under the National Socialist version of Article 175 of the German Civil Code, refused to simply forget the injustice done to them and fought for their rehabilitation and indemnification. In 1987, victims of forced sterilization and Nazi “euthanasia”, after being defeated in their fight for inclusion in the BEG – which had led to the dissolution of their organization – once again united in the Bund der ‘Euthanasie’-Geschädigten und Zwangssterilisierten, or BEZ (Association of victims of “euthanasia” and forced sterilization).15 Historical research such as that of Gisela Bock16 on forced sterilization under National Socialism or more general research by Detlev Peukert17 emphasized, 13 See idem, “‘Härteregelung’ für Zwangssterilisierte”, in: Recht und Psychiatrie 1, 1983, 73 – 76; in more general terms see Brodesser et al., 2000, 162 – 168. 14 See Gerhard Baader, Ulrich Schulz (eds.), Medizin und Nationalsozialismus: Tabuisierte Vergangenheit, ungebrochene Tradition? (= Dokumentation des Gesundheitstages Berlin 1980, vol. 1), Berlin: Mabuse-Verlag 1980. 15 See Sascha Topp, Geschichte als Argument in der Nachkriegsmedizin: Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie, Göttingen: Vandenhoeck & Ruprecht unipress 2013, 224 – 228. 16 Gisela Bock, Zwangssterilisation im Nationalsozialismus: Studien zur Rassenpolitik und Frauenpolitik (= Schriften des Zentralinstituts für sozialwissenschaftliche Forschung der Freien Universität Berlin, 48), Opladen: Westdeutscher Verlag 1986. 17 Detlev Peukert, Volksgenossen und Gemeinschaftsfremde: Anpassung, Ausmerze und Aufbegehren unter dem Nationalsozialismus, Cologne: Bund-Verlag 1982; english translation:

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albeit in different ways, the racial character of the crimes committed in the name of Rassenhygiene. Besides, new research associations developed such as the Arbeitskreis zur Erforschung der nationalsozialistischen “Euthanasie” und Zwangssterilisation (Group for research on National Socialist “euthanasia” and forced sterilization)18 or the project group for the “forgotten victims” of National Socialism19. Psychiatrist Klaus Dörner was an early critic of his profession and its deeds under National Socialist rule. Together with Deutsche Gesellschaft für Soziale Psychiatrie (the German Society for Social Psychiatry) he confronted German politics and society with the crimes and tried to break the silence. In many ways he called for rehabilitation and indemnification of the victims.20 In Hamburg, an initiative for the recognition of all victims of National Socialism was more politically oriented. In their Curiohaus Appeal of 8 May 1985, this amalgamation of individuals from different social spheres demanded a fundamentally new Compensation Act that should include all of the formally excluded or only partly included victims. As an immediate measure, the initiative recommended a hardship reserve fund. This would enable as many as possible of the even then already aged victims to receive swift financial help in a non-bureaucratic way before the new law was established. In addition, it demanded that all discriminatory laws from the period of National Socialism be abolished. All this can be found in the brochure Wiedergutgemacht? NS-Opfer der Gesellschaft noch heute.21 To make these issues better known and accepted, the signatories of the Hamburg Initiative could rely on a combination of new media and innovative political structures, of which the most advanced was the recently founded leftwing daily Taz (die tageszeitung), and the likewise newly founded party of the Green movement. Not surprisingly, it was the parliamentary group of the Greens that called for a special meeting to discuss the internal contradictions of the Compensation Act, which was to be held in September 1985, the 50th anniversary

18 19 20

21

Inside Nazi Germany : Conformity, Opposition, and Racism in Everyday Life, trans. by Richard Deveson, New Haven: Yale University Press 1987. Topp, 2013, 213 – 224. Projektgruppe für die vergessenen Opfer des NS-Regimes in Hamburg (ed.), Verachtet – verfolgt – vernichtet: Zu den “vergessenen” Opfern des NS-Regimes, Hamburg: VSA-Verlag, 1986. See for example Klaus Dörner (ed.), Gestern minderwertig – Heute gleichwertig? Folgen der Gütersloher Resolution. Dokumentation und Zwischenbilanz des Menschenrechtskampfes um die öffentliche Anerkennung der im 3. Reich wegen seelischer, geistiger und sozialer Behinderung zwangssterilisierten oder ermordeten Bürger und ihrer Familien als Unrechtsopfer und NS-Verfolgte, 2 vols., Gütersloh: Jakob van Hoddis 1985 and 1988. Hamburger Initiative “Anerkennung aller NS-Opfer” (ed.), Wiedergutgemacht? NS-Opfer – Opfer der Gesellschaft noch heute, Hamburg: Initiative “Anerkennung aller NS-Opfer” 1986.

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of the Nuremberg racial laws.22 This led to parliamentary advances that aroused a great deal of public attention. For instance, a draft law was presented which was to regulate adequate provision of benefits for all victims of National Socialism. In addition, the Greens brought in a petition for the abrogation of the sterilization law (GzVeN) and the repeal of all decisions made under this law. At the same time, the parliamentary group of the Social Democrats (SPD) demanded that the options for improved benefits should be examined and in a second step proposed a special foundation fund for the reduction of injustices caused by the policies of indemnification.23 Despite strong public resonance, the result of these advances fell short of expectations. Apart from the hardship fund introduced in the states that had a coalition government formed by the Social Democrats and the Greens, the Bundestag passed a resolution on 5 May 1988 in which all forced sterilizations carried out under the Erbgesundheitsgesetz (GzVeN) were classified as a “national socialist injustice”, but without drawing the necessary political consequences in terms of indemnification. On 7 March 1988, only the regulations for the mitigation of hardship were revised, giving access to the hardship fund to all those who had been excluded from the BEG).24 This facilitated ongoing monthly payments in cases where applicants could prove their personal hardship. The result was that this category of persons was granted a one-time payment of 5,000 marks and ongoing financial assistance in special cases taking into account the nature and severity of the injustice. On this basis, victims of forced sterilization were paid 100 marks per month starting in 1990; from 1998 onwards they received 120 marks. Under special circumstances this amount could be increased under the terms of BEG Section 7 (3). However, other legal benefits related to personal hardship were offset against this amount. These regulations are all very complicated. As a rule therefore, no practical consequences evolved for the applicant. Payments for victims of Nazi “euthanasia”, for instance, were considerably lower than those for victims of forced sterilization. Up to 2002, for example, the former could receive a one-time payment. But since this assistance was dependent on the family income, it excluded nearly all victims. For this group there were in actual fact no ongoing 22 See Die Grünen im Bundestag, Fraktion der Alternativen Liste Berlin (eds.), Anerkennung und Versorgung aller Opfer nationalsozialistischer Verfolgung: Dokumentation parlamentarischer Initiativen der Grünen in Bonn und der Fraktion der Alternativen Liste Berlin, Berlin: Die Grünen im Bundestag 1986. 23 Deutscher Bundestag, Drucksache 10/4638; see also Die Grünen im Bundestag, Fraktion der Alternativen Liste Berlins (eds.), 1986; further Deutscher Bundestag, Drucksache 13/6824. 24 “Richtlinien der Bundesregierung über Härteleistungen an Opfer von nationalsozialistischen Unrechtsmaßnahmen im Rahmen des Allgemeinen Kriegsfolgengesetzes (AKG) – Härterichtlinien”, in: Bundesanzeiger 119, 19 March 1988.

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payments. A glance at the exceptional provisions illustrates what a steeplechase such an application meant and how disappointing the result often was. For instance, entitlement to financial assistance depended on the precise date of the assassination of the parent or parents concerned.25 Translated into figures: In 2003 the federal government reported that, until 1988, 8.805 victims of forced sterilization had received compensation under the 1980/81 regulation, and that after the 1988 revision, i. e., between 1988 and 2002, 4.971 victims had received a one-time payment of 5.000 marks. This amounts to 13.776 people, a small number compared to the overall number of approximately 400.000 victims. Of these, 1.733 persons had received an ongoing payment by 2002. In respect of victims of Nazi “euthanasia”, 161 persons received the onetime payment, and twenty of them received an additional ongoing payment.26 Considering the many political debates on and revisions of the grounds for a decision on indemnification, these figures illustrate a strong determination to exclude these groups of victims from compensation. In 1990, this regulation was also applied to the territory of the former German Democratic Republic (GDR).27 For victims of forced sterilization and Nazi “euthanasia” living here, this meant that they remain disadvantaged even under the new political regime.

Rehabilitation without equivalent progress in indemnification In the 1980s already, compensation for victims of National Socialism was, in some quarters, not considered a mere legal obligation of the state or a moral debt, but also a necessary part of the process of coming to terms with the crimes of National Socialism. This was seen as a way of preventing future crimes of the same or a similar nature. Groups connected to the feminist movement, for instance, established a connection between forced sterilization and Nazi “euthanasia” on the one hand and new medical techniques such as prenatal diagnosis or in-vitro fertilization. In addition, there were scandals because of the continued validity of National Socialist verdicts against respected personalities, such as the verdict against the well-known Lutheran pastor and theologian Dietrich Bonhoeffer, which received special attention. For other victims, the general reassessment of the context of persecution encouraged rehabilitation. This was the case for the victims of National Socialist military jurisdiction. In this case, the debate about the so-called Wehrmacht exhibition lead to the 25 See Surmann, 2005. 208. 26 See Bundesministerium der Finanzen (ed.), Entschädigung von NS-Unrecht: Regelungen zur Wiedergutmachung, Berlin 2003, 42 and 43. 27 See Brodesser et al., 2000, 164. See also Bundesanzeiger 235, 19 December 1990.

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conclusion arrived at by the Bundestag that World War II had been a war of extermination for which the Germans were responsible. This in turn had consequences for the evaluation of the behavior of those who had refused to participate in the war. The sentences against conscientious objectors and war deserters were consequently quashed.28 Not least, new topics like the living will or assisted dying necessitated both the elimination of continued National Socialist elements in jurisdiction and a stronger demarcation from the crimes of National Socialism.29 These efforts culminated in the Gesetz zur Aufhebung nationalsozialistischer Unrechtsurteile in der Strafrechtspflege (Law for the abrogation of National Socialist wrongful judgments in criminal justice), which was passed in 1998.30 This act was very important for the victims of forced sterilization, because it quashed all the judgments which had led to forced sterilization. Parliamentary groups emphasized and the German Bundestag and the Bundesrat (Federal Council) ascertained that the forced sterilizations had been an injustice of National Socialism and therefore an expression of the condemned National Socialist concept of ‘life unworthy of living’. This evaluation also needed to find a legal expression. The decisions for sterilization under the former sterilization law could not endure. It had taken 43 years after the abolishment of the so-called Erbgesundheitsgerichte (genetic health courts) before their verdicts were also quashed. But the new resolution did not lead to an improvement of the legal situation for cases of indemnification. Even moderate attempts by the BEZ were turned down with, in some cases, rather arrogant arguments. The Federal Ministry of Finance for instance argued that an application could not be approved because this group of victims was in a comparatively privileged position.31 Furthermore, the legal position of the Bundestag with regard to forced sterilization was not yet clearly defined. The 1974 Bundestag resolution had merely suspended the sterilization law insofar as it was still an active part of federal law.32 This meant that from a legal point of view the law still existed. The BEZ 28 For the latest research results, see Joachim Perels, Wolfram Wette (eds.), “Mit reinem Gewissen”: Wehrmachtrichter in der Bundesrepublik und ihre Opfer, Berlin: Aufbau 2011. 29 For example Andreas Frewer, Clemens Eickhoff (eds.), “Euthanasie” und die aktuelle Sterbehilfe-Debatte: Die historischen Hintergründe medizinischer Ethik, Frankfurt/M./New York: Campus 2000. 30 Bundesgesetzblatt I, 28 August 1998, 2501. 31 Letter of Federal Finance Minister Hans Eichel, dated 29 May 2001, Archive of BEZ, copy in the private archive of Rolf Surmann. 32 See Andreas Scheulen, “Zur Rechtslage und Rechtsentwicklung des Erbgesundheitsgesetzes 1934”, in: Hamm (ed.), 2005, 212 – 219; Lotte Incesu, Günther Saathoff, “Die verweigerte Nichtigkeitserklärung für das NS-Erbgesundheitsgesetz – eine ‘Große Koalition’ gegen die

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therefore demanded from the parliamentary parties that the Bundestag should declare the law void. But the Bundestag did not act until the Nationaler Ethikrat (National Ethics Council) supported the demand33 – with reference to contemporary ethical debates – and other organizations concerned about the politics of memory who had a special connection to the parliamentary parties – such as the Gegen Vergessen – für Demokratie society (“Against oblivion and for democracy”) – joined in the support. Parliament then – in 2006 – declared that the law had never been part of the legal system of the Federal Republic because it went against the German Constitution.34 This resolution was without doubt an important success for the BEZ, because it put an end to the legal basis for forced sterilization crimes. But once again, the consequences for the policy of indemnification were not taken into consideration. Therefor the critical debate about the policies of indemnification can still not be considered closed. It has, on the contrary, been intensified by this resolution. For as I have shown, the victims of forced sterilization and Nazi “euthanasia” have over many years been excluded from payment of compensation in the context of the BEG precisely because it was argued that the so-called Erbgesundheitsgesetz (GzVeN) was compatible with the constitutional state. Paradoxically, the first exceptions from the general refusal to grant compensation were based on the argument that juridical or medical mistakes had been made in the application of this law. Those who now declare that this law was never compatible with the legal system of the Federal Republic should consequently admit that an error of law was committed with disastrous consequences for the victims and draw the necessary political consequences with regards to compensation. This is more so the case since the second argument for the rejection of such compensation, namely that German society could not afford this financial burden, is no longer valid, as by now only very few of the victims are still alive. Nevertheless, both government and parliament still seem to cling to their political position of the 1990s with regard to victims of crimes of racial hygiene, when Germany initially refused to follow the suggestion of the United States that “unfinished business” should be settled and mistakes in indemnification policies made in the 1950s and 60s in the context of the global political and ideoZwangssterilisierten”, in: Demokratie und Recht 16(2), 1988, 125 – 132; Svea Luise Hermann, Kathrin Braun, “Das Gesetz, das nicht aufhebbar ist: Vom Umgang mit den Opfern der NSZwangssterilisation in der Bundesrepublik”, in: Kritische Justiz 43(3), 2010, 338 – 352. 33 “Erklärung des Nationalen Ethikrates zum Appell des Bundes der ‘Euthanasie’-Geschädigten und Zwangssterilisierten e.V. zum ‘Erbgesundheitsgesetz’”, 24 November 2005, Tätigkeitsbericht 2005, 13; www.ethikrat.org/dateien/pdf/taetigkeitsbericht-2005.pdf (21 August 2014). 34 Based on Deutscher Bundestag, Drucksache 16/3811, 13 December 2006, “Ächtung des Gesetzes zur Verhütung erbkranken Nachwuchses vom 14. 7. 1933”.

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logical situation prevailing at the time should now be corrected. Only in the face of global political, economic and juridical pressure was the German government prepared to make concessions. The BEZ, however, was not satisfied with this resolution and continued to demand a compensation scheme that would match the levels provided under the BEG and take into account the decades of discrimination suffered by this group of victims. On 27 January 2011 – Holocaust Memorial Day –, in a decision showing excellent PR timing, the Bundestag increased ongoing benefits for victims of forced sterilization from 120 to 291 euros.35 Recipients of these payments also included persons described in the Bundestag resolution as victims of Nazi “euthanasia” measures and referred to in the implementation directive of the Federal Ministry of Finance as injured parties of the Nazi “euthanasia” policy.36 This, however, avoided the necessity for a fundamental correction and represented no more than a further improvement of the hardship guidelines of the Allgemeines Kriegsfolgengesetz (AKG). For the BEZ, this meant that the Bundestag resolution basically failed to do justice to the task of designing a suitable compensation policy. They argued that the victims were still not being recognized as victims of “typical Nazi injustice”, nor did they receive appropriate benefits. There are two further problems arising from the Bundestag resolution. One of them results from the expansion of the group of persons eligible for ongoing payments to include persons described in the resolution as “victims of ‘euthanasia’ measures”. This term is not used in the classification of compensation legislation and therefore the Federal Ministry of Finance replaced it with the usual designation “persons affected by ‘euthanasia’”. There are two groups of people covered by this designation. Originally these were the families of victims of Nazi “euthanasia” crimes, and later on persons who were to be killed but managed to escape their fate were also included. The introduction of the problematic notion of “direct injury” – in the sense of the logic of the crime, persons injured by “euthanasia” were affected only indirectly – reversed what had previously been the equal treatment of these two groups in terms of compensation, with the consequence that now only the second group of victims was eligible for the new benefits. It must be noted that the overall group of persons affected by “euthanasia” meanwhile represents no more than a very small group of people. When the resolution was passed, there were approximately 250 relatives who would have been entitled. Because of the new restriction, only three 35 Deutscher Bundestag, Drucksache 17/4543, 26 January 2011. 36 “Neufassung der Richtlinien der Bundesregierung über Härteleistungen an Opfer von nationalsozialistischen Unrechtsmaßnahmen im Rahmen des Allgemeinen Kriegsfolgengesetzes (AKG-Härterichtlinien)”, 28 March 2011; www.verwaltungsvorschriften-iminternet.de/bsvwvbund_28032011_BMF.htm (30 August 2014).

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persons were ultimately granted benefits. After having had to fill out extensive questionnaires, the others were turned down. In the 1980s, this ministerial or administrative way of processing claims of victims by refusing to accept even the details of their claims was referred to as “guerilla warfare against the victims” (Christian Pross)37. It has become a central focus of criticism against the implementation of the parliamentary resolutions. This ongoing manner of processing claims continues to be irritating. But there is another, more fundamental problem with the resolution. In his speech to the Bundestag, CDU/CSU Member of Bundestag Manfred Kolbe felt it was necessary to highlight one of the sentences of the motion in his own words: “We wish to retain the second Act to amend the Federal Compensation Act as a final law”,38 referring to the BEG-SG of 1965 and its explicit refusal to recognize the victims of racial hygiene crimes as victims of the Nazi regime. Not only does this somehow relativize the subsequent federal resolutions, particularly with regard to the GzVeN, because in the mid-1960s the Bundestag decision was explicitly inspired by a different understanding of this law; nor is there any recognizable wish for distance from the manner in which the resolution was passed at the time – which can be seen as particularly scandalous in the reflection process of the following decades. The Bundestag’s presumably final debate on this controversy that has marked the entire history of the Federal Republic therefore neither reinstates the victims to their due legal position nor does it provide a clear closure to the process of coming to terms with these crimes, especially in view of their after-effect after 1945. There remains an ambivalence that leaves much unanswered in the current debate on the limits of the right to life.

37 Christian Pross, Wiedergutmachung: Der Kleinkrieg gegen die Opfer, Frankfurt/M.: Athenäum 1988. 38 Deutscher Bundestag, “Stenografischer Bericht, 87. Sitzung, 27 January 2011, 9819 (Plenarprotokoll 17/87)”. The BEZ Working Group (successor organization of the BEZ), following up on an enquiry of the parliamentary group of the Left Party, criticized the answer of the federal government to this enquiry in “Stellungnahme der AG BEZ zur Antwort der Bundesregierung vom 22. 2. 2012 auf die Kleine Anfrage der Linksfraktion (Deutscher Bundestag, Drucksachen 17/8589 und 17/8729)”; www.euthanasiegeschaedigte-zwangssterilisierte.de/bez_entschaedigung.html (30 August 2014).

Professional Organizations

Gerrit Hohendorf

The Sewering Affair1

On the difficulty to appreciate a former president of the German Medical Association and not to deny his Nazi past Hans Joachim Sewering was one of the most influential public figures in the German medical establishment from the 1950s to the 1990s. Despite his past in National Socialism, he was president of the Bavarian Medical Association (Landesärztekammer Bayern) from 1955 to 1991, president of the Bundesärztekammer (German Medical Association, subsequently abbreviated as “BÄK”) from 1973 to 1978, and chairman of the Kassenärztliche Vereinigung (Association of Statutory Health Insurance Physicians) in Bavaria for decades. He was awarded the Paracelsus Medal of the BÄK in 1992. When he died in June 2010 the former presidents of the BÄK Jörg-Dietrich Hoppe and Karsten Vilmar wrote an obituary in the German Medical Journal (Deutsches Ärzteblatt), which had a quasi-official character. The authors honored his life’s work to improve medical education for physicians and students, to implement quality management in medicine and to defend the freedom of physicians in the health care system. They concluded their obituary by stating that Sewering had rendered outstanding

1 This chapter originated in the context of the research project “Geschichte(n) als Argument in der Biomedizin: Vergegenwärtigungen der nationalsozialistischen ‘Euthanasie’ zwischen Politisierung und Historiographie, ca. 1945 – 2000” directed by Volker Roelcke and Etienne Lepicard. The project was part of the Sonderforschungsbereich Erinnerungskulturen (cultures of memory) at Justus Liebig University of Giessen/Germany and funded by the Deutsche Forschungsgemeinschaft (DFG SFB 434). See also Gerrit Hohendorf, “The Sewering Affair”, in: Korot: The Israeli Journal of the History of Medicine 19 (2007/2008, published 2009), 83 – 104. The author wants to thank Volker Roelcke, Sascha Topp and Etienne Lepicard for the inspiring atmosphere of discussion in the project. The author is also indebted to William E. Seidelman for valuable hints and suggestions. William E. Seidelman made available some important documents from his private archives to the author. The author is also grateful to Markus Krischer of Munich for his help and to Nikolaus Braun from the Archiv des Bezirks Oberbayern in Munich for his generous support.

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services to the preservation of ethical norms in the work of the physician.2 The authors excluded the time of National Socialism in their short account of Sewering’s biography, mentioning nothing of his membership in the SS and the National Socialist Party, nor about his involvement in National Socialist “euthanasia” measures. This obituary provoked a slew of critical letters to the editor of the Deutsches Ärzteblatt and a letter of protest signed by about 80 medical historians, physicians and psychotherapists. In this letter it was argued that the obituary did not live up to the BÄK’s obligation to accept historical responsibility for its National Socialist past.3 This letter of protest was published only after critical reporting in the press and radio.4 In contrast, an obituary acknowledging Sewering’s undisputed merits without concealing his National Socialist past was published in the journal of the Bavarian Landesärztekammer, the Bayerisches Ärzteblatt. The former president of the Bavarian Landesärztekammer Hans Hellmuth Koch mentioned the disputed facts of Sewering’s biography and concluded with the statement that it might be difficult to pass final judgement about Sewering’s involvement in National Socialism.5 Even back in 2006 the Deutsches Ärzteblatt had at least already mentioned the accusations raised against Sewering involving the death by so-called “euthanasia” of Babette Fröwis, who following his order had been transferred from the Catholic asylum, in Schönbrunn near Dachau to the state asylum Eglfing-Haar in 1943. But according to the Deutsches Ärzteblatt these accusations had never been proven.6 Nevertheless the dispute about Sewering’s obituary shows that the German medical profession had not fully come to terms with its National Socialist past even in 2010. In 2008 the Berufsverband Deutscher Internisten (Professional Association of German Specialists in Internal Medicine) had honored the then 92-year-old Hans Joachim Sewering with its highest decoration for his achievements in promoting the professional independence and freedom of the physician. In defense of Sewering’s Nazi past it was argued that public prosecution had been suspended and that Sewering’s statements were fully credible. There was some irritation in the German press and some protests, especially by Michael Kochen, president of the Deutsche Gesellschaft für Allgemeinmedizin und Familien2 Jörg-Dietrich-Hoppe, Karsten Vilmar, “Hans Joachim Sewering †: Gestalter im Dienst der Ärzteschaft”, in: Deutsches Ärzteblatt 107(28 – 29), 2010, A-1409. 3 Gerrit Hohendorf, Heiner Fangerau, Bettina Wahrig, “Kein Hinweis auf die Rolle im Nationalsozialismus” (letter to the editor), in: Deutsches Ärzteblatt 107(28 – 29), 2010, A-1520. 4 See for example Wolfgang Wagner, “Blinder Fleck im Leben des Ärztefunktionärs”, in: Frankfurter Rundschau 66, 30 July 2010, 5. 5 H. Hellmut Koch, “Professor Dr. Dr. H. c. Hans Joachim Sewering †”, in: Bayerisches Ärzteblatt 65, 2010, 392. 6 Birgit Hibbeler, “Sewering wird 90 Jahre: Verdient, aber umstritten”, in: Deutsches Ärzteblatt 103(4), 2006, A-209.

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medizin (German Society of General Practice and Family Medicine), and by the International Dachau Comittee, the association of former prisoners at the Dachau concentration camp. Nevertheless, the debate remained superficial, merely echoing the old arguments of 15 years before, when the Sewering affair had attracted great interest all over the world.7 Outside of Germany – especially in the US – Sewering is regarded as an example of the inability of the German medical establishment to critically examine the role of the German medical profession in National Socialism.8 The Sewering affair in 1992/93 created a much greater stir internationally than in Germany.9 In the novel Just Like That by Lily Brett, Sewering even achieved a dubious form of literary fame. He is cited as an example of German doctors who were members of the SS and became very successful after the war.10

The Sewering affair 1992/1993 What was the Sewering affair about? Hans Joachim Sewering was not only active in national professional politics, he was also a member of the executive board of the World Medical Association (WMA) as treasurer since 1971 and had been 7 See for example Whitney R. Craig, “Top German Doctor Admits SS Past”, in: The New York Times, 16 January 1993, as well as the references given in fn 9. 8 See Michael H. Kater, “The Sewering Scandal of 1993 and the German Medical Establishment”, in: Manfred Berg, Geoffrey Cocks (eds.), Medicine and Modernity : Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany, Cambridge: Cambridge University Press 1997, 213 – 234, and Lawrence W. White, “The Nazi Doctors and the Medical Community : Honor or Censure? The Case of Hans Sewering”, in: Journal of Medical Humanities 17, 1996, 119 – 135. 9 See for example Craig, 1993; Jennifer Leaning, “German Doctors and their Secrets”, in: The New York Times, 2 February 1993; Anonymous, “Top doctor admits he was a Nazi”, in: The Toronto Star, 17 January 1993, and Judy Siegel, “IMA pleased by withdrawal of ex-Nazi”, in: The Jerusalem Post, 19 January 1993. Nevertheless, the German Press reflected the international stir about Sewering’s Nazi past, see for example Anonymous, “Anschuldigungen gegen Sewering”, in: Frankfurter Allgemeine Zeitung, 18 January 1993; Julia Albrecht, “Von der Reiter-SS zum Weltärztechef”, in: tageszeitung, 20 January 1993; Hans-Helmut Kohl, “Sewering wird nicht Präsident”, in: Frankfurter Rundschau, 25 January 1993; Anonymous, “Ärzte: Höchste Ethik”, in: Der Spiegel, 25 January 1993, 195 – 196. Only the Süddeutsche Zeitung published a report based on its own investigations in its local and German issues: Thomas Soyer, “Sewering wehrt sich gegen Euthanasie-Vorwurf”, in: Süddeutsche Zeitung, 20 January 1993; idem, “Sewering soll auf die Watch List”, in: Süddeutsche Zeitung, 22 January 1993, and idem, “Sewering verzichtet auf Ehrenamt”, in: Süddeutsche Zeitung, 23 January 1993. The local Dachauer SZ (Süddeutsche Zeitung) printed an interview with Hans Joachim Sewering entitled “SZ-Gespräch mit Professor Hans Joachim Sewering zu Euthanasie-Vorwürfen aus der Ärzteschaft – ‘Ich habe keinen Grund, mich zu verstecken’”, in: Dachauer SZ, 22 January 1993. 10 Lily Brett, Einfach so, Vienna/Munich: Franz Deuticke 1994, 423.

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nominated “president-elect” at the WMA assembly of delegates in Marbella (Spain) in September 1992. Before he could take office as president of the WMA, accusations were made known at the turn of the year 1992/1993 that he had been a member of the SS since 1933 and of the NSDAP since 1934,11 and was responsible for the death by “euthanasia” of at least one child, the 14-year-old Babette Fröwis in 1943, when he was working as a consulting physician at the Catholic asylum in Schönbrunn. These accusations had already been public knowledge since 1978, when the German weekly news magazine Der Spiegel critically reported about this representative of the medical profession’s claim to power after the Second World War. Under the caption Sewering: Saubere Weste (“Sewering: A Clean Slate”), the magazine took up the “most delicate topic for doctors since the National Socialist era”, “euthanasia”, as well as reporting on bookkeeping irregularities in Sewering’s practice in Dachau. Der Spiegel published excerpts from Babette Fröwis’s patient file, including a nude photograph of Babette and the medical order for her admission to the Eglfing-Haar Asylum, signed by Dr. Sewering.12 Der Spiegel had already posed the crucial question here: Did Sewering really not know at that time what such a transfer to EglfingHaar meant? Sewering stepped down from his office as BÄK president at its congress in Mannheim in 1978 without referring to these accusations directly. In his resignation Sewering’s Nazi past did apparently not play an important role, nor was it discussed publicly. The protest against Sewering’s nomination as president of the WMA was initiated in Germany by Michael Kochen, professor for general medicine in Göttingen13 ; in North America William Seidelman14, Michael Kater15, Michael 11 Federal Archives/Bundesarchiv Berlin (Berlin Document Center, hereafter BDC) R 9345, Reichsärztekartei, film no. 60, Sewering, Hans; SSEM film 62xx R 59: Sewering joined the “SS-Sturm 2/I/31” on 1 November 1933 as an “SS-Mann”. PK film C 242 picture 1236 – 1238 Gaupersonalamt München-Oberbayern, Reference of the Kreispersonalleiter of 13 August 1942: Sewering joined the NSDAP on 1 August 1934: “In politischer sowie sozialer Hinsicht einwandfrei. Hat bisher für die Ortsgruppe und damit für die Bewegung kein Interesse gezeigt.” (“Impeccable in political and social relations. Hitherto he was not interested in the ‘Ortsgruppe’ and therefore in the ‘Bewegung’”); there is no reference to the so-called “ReiterSS”. 12 Anonymous, “Entmündigung zur Herde: Die ärztlichen Standesgremien nach dem Zweiten Weltkrieg”, in: Der Spiegel 21, 1978, 77 – 88, especially 86 – 88. Copies of the cited documents were the private property of Dr. Hans Halter, Berlin, who made them available to Michal H. Kater, see Michael H. Kater, Doctors under Hitler, Chapel Hill/London: The University of North Carolina Press 1989, 264. 13 See Michael M. Kochen, “Ehemaliger SS-Mann künftiger Präsident des Weltärztebundes?”, in: Zeitschrift für Allgemeinmedizin 69(1), 1993, 8. 14 See William Seidelman’s contribution to this volume. 15 In his book Doctors under Hitler, which appeared in 1989, Michael H. Kater had made reference to Sewering’s Nazi past and his involvement in the death of Babette Fröwis, see Kater, 1989, 3 – 4.

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Grodin, and Michael Franzblau were active, as was Michael Weingarten in Tel Aviv. In January 1993, the American Medical Association finally intervened and drew up a resolution of protest under Chairperson Raymond Scalettar. The World Jewish Congress also declared that a former Nazi was an unacceptable president for the WMA and threatened to call on national medical associations to withdraw from the organization.16 The BÄK, however, stood by Sewering and announced in the Deutsches Ärzteblatt: “Prof. Hans J. Sewering is the target of a smear campaign”.17 According to the journal, the accusations raised against him of being involved in Nazi “euthanasia” had never been proven. In Sewering’s defense, the BÄK pointed out that Sewering was supported by the Catholic church and had received the German Order of Merit. After the U.S. Justice Department stated on 21 January 1993 that it intended to put Sewering on a “watch list” that would bar him from entering the U.S., and the Munich diocesan chancery (the archbishop’s central administration of the diocese) abandoned its unreserved support of Sewering on 22 January, Sewering declared his resignation from the office of president-elect on 23 January, on the grounds that he wanted to avert great damage to the World Medical Association through the threatened boycott by the World Jewish Congress.18 The Sewering affair caused some tensions in the relationship between the BÄK, the American Medical Association (AMA) and the WMA: The AMA representatives claimed that they had not been properly informed by the BÄK about Sewering’s Nazi past when he was elected to become the next president of the WMA in Marbella in 1992.19 In response, the president of the BÄK, Karsten 16 Reuter’s News Service, New York, 22 January 1993: “The World Jewish Congress said on Thursday it was considering calling on national medical groups to withdraw from the World Medical Association if it confirmed a former Nazi as its president.” 17 BÄK, “Prof. Sewering Ziel einer Verleumdungsaktion”, in: Deutsches Ärzteblatt 90(4), 29 January 1993, A-165; this is also the source for the following quotations. 18 See Hans-Helmut Kohl, “Sewering wird nicht Präsident”, in: Frankfurter Rundschau, 25 January 1993. 19 See Raymond Scalettar, “Motives and actions are misrepresented” (letter to the editor), in: Deutsches Ärzteblatt 90(11), 19 March 1993, A-760 – 761, and Anonymous, “Prof. Sewering’s resignation from WMA President-Elect”, in: World Medical Journal 39, 1993, 23. In a personal letter to Raymond Scalettar, chairman of the Board of Trustees of the American Medical Association, Norbert Jachertz, the former editor-in-chief of the Deutsches Ärzteblatt, insisted that the reproaches against Sewering were also known to the American Medical Association, even if some of the American delegates were not informed, see Norbert Jachertz’s letter to Raymond Scalettar of 5 March 1993, copy of this letter is the private property of William Seidelman. The background of the Sewering’s election in autumn 1992 is still unclear. Michael Kater assumes that an old collusion between the German Medical Association and the American Medical Association to readmit the pro-Apartheid Medical Association of South Africa in 1981 played a role in electing Sewering without proper consideration of his Nazi past; see Kater, 1997, 223, and Winfried Beck, “The World Medical Association and South Africa”, in: The Lancet 333, 24 June 1989, 1441 – 1442.

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Vilmar, argued that the “claims had already been raised against Professor Sewering many years ago. He was previously exonerated by a ruling of the 1st District Court of Dachau on 7 September 1946, on the basis of factual investigations and testimony, in a due process of law as part of the denazification process instigated by the allied military government.”20 What Karsten Vilmar did not mention in his statement is the well-known fact that the rulings of the denazification courts (Spruchkammern) must be interpreted very cautiously as far as the question of “historical truth” is concerned. A general tendency to whitewash National Socialist collaboration must be accounted for.21 In his declaration at the spring meeting of the WMA in 1993, Vilmar claimed that Sewering had achieved great benefits for this organization and that he saw “his professional life fulfilled through the function of president as the last challenge in his professional and honorary activities”.22 His main argument was that, according to the German constitution, Sewering must be considered to be innocent as long there was no conviction by a court of law. Thus the BÄK neither was obliged nor had the possibility to refute the accusations against him, which were based mainly on conjecture. Nevertheless, the WMA was interested in coming to terms with the Sewering affair after his resignation, declaring that such a situation should never occur again.23 And despite his vigorous support for Sewering, Karsten Vilmar was elected treasurer of the WMA in 1993. The BÄK consequently endeavored to limit the damage. The 96th annual German Ärztetag (Medical Assembly) in Dresden passed a statement declaring that the events surrounding Sewering’s candidacy were unfortunate and welcoming his resignation: “With this, the Ärztetag sees the matter as settled.”24 A request that Vilmar, too, should withdraw from his office as president of the 20 Karsten Vilmar, “Statement by the President of the German Medical Association on the occasion of the 135th Council Session of the World Medical Association on Prof. Dr. Dr. h.c. Hans Joachim Sewering’s relinquishing the office of ‘president-elect’ of the World Medical Association”, in: World Medical Journal 39(2), 1993, 22 – 23. 21 See for example Lutz Niethammer, Die Mitläuferfabrik: Entnazifizierung am Beispiel Bayerns, Berlin: Dietz 1982, and Clemens Vollnhals (ed.), Entnazifizierung: Politische Säuberung und Rehabilitierung in den vier Besatzungszonen, Munich: Deutscher Taschenbuchverlag 1991. 22 For this and the following quote, see Anonymous, “Professor Sewering’s resignation from WMA President-Elect”, in: World Medical Journal 39(2), 1993, 22 – 23. 23 Letter from James S. Todd, Executive Vice President of the American Medical Association, to Michael A. Grodin on 16 April 1993: “The AMA will continue to take strong measures to try to assure that the WMA never has a problem like this again.” Copy of the letter in the property of William E. Seidelman. 24 See H.L., “Die Delegierten begrüßen Sewerings Rückzieher”, in: Deutsche Ärztezeitung, 10 May 1993, 8, and Norbert Jachertz, “Sewering: Schlußstrich”, in: Deutsches Ärzteblatt 90 (21), 1993, A-1572 – 1573.

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BÄK, was not approved. The matter was not settled for dermatologist Michael Franzblau in California, who founded a “Committee to Bring Dr. Hans Joachim Sewering to Justice”, and appealed to the German and the Bavarian state governments.25 In July 1996 a full page advertisement was published in the New York Times with the question: “Why is the German state of Bavaria harboring an accused war criminal?”26 The Munich public prosecutor’s office actually conducted several preliminary inquiries, inspected all surviving records from patients at Schönbrunn who were transferred to Eglfling-Haar, and questioned the four witnesses who were still alive, nuns of Schönbrunn. It did not, however, as of 2003, see any grounds for opening formal preliminary proceedings against Sewering. The main argument of the Munich public prosecutor is that the National Socialist “euthanasia” program, especially the children’s “euthanasia”, was a secret affair of the Reich about which an outsider like Sewering could not have known anything.27 The unresolved shades of the past, combined with Hans Joachim Sewering’s political influence in Bavaria, are reasons why to this very day there are three different, contradictory stories about one and the same historical event. These different stories are either constructs from memories of those involved as individuals or institutions, or reconstructions of a particular image of Nazi doctors from an American perspective, for instance in the Internet publication by Franzblau. These stories are able to lead parallel existences because there are still lacunae in the landscape of memory about National Socialist medicine and “euthanasia” that have resisted historical elucidation even up to the beginning of the 21st century. These three contradictory stories will be presented below; following their reconstruction, some new historical findings will be discussed.

25 See Michael J. Franzblau, “Nazi Medical Crimes Unpunished 50 Years Later”, in: Dermatopathology 2(2), April-June 1996, 83 – 86. Via the website www.badnazidoctor.com, the “Committee to Bring Dr. Hans Joachim Sewering to Justice” offers information about the Sewering case and claims that during Sewering’s term as physician at the Schönbrunn asylum 900 patients were transferred to euthanasia facilities. 26 The New York Times, 14 July 1996. 27 See Markus Krischer, Kinderhaus: Leben und Ermordung des Mädchens Edith Hecht, Munich: Deutsche Verlags-Anstalt 2006, 241 – 254. Order of the public prosecutor Munich, 10 August 1993: “Thus it is absolutely credible when Prof. Sewering testifies that he didn’t know anything about the existence of the euthanasia of children (Kindereuthanasie) in the EglfingHaar asylum.” In the decision of 13 March 2003 the Munich public prosecutor’s office argues that positive knowledge about the continuation of euthanasia in the Eglfing-Haar asylum after 1941 cannot be proven against Sewering (Staatsanwaltschaft München I 320 AR VII 23/ 93).

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Franzblau’s account of the Sewering case The Sewering case in the view of Michael Franzblau, as presented in the Internet and in printed articles,28 is shaped by the construct of the Nazi doctor, who is, through membership in the National Socialist party and the SS, an enthusiastic adherent of the National Socialist ideology of “racial hygiene” and thus inevitably developed an inclination towards medical crimes and especially towards Nazi “euthanasia”. The early SS and party membership of Hans Joachim Sewering, who joined the general SS as early as 1933 and the NSDAP in 1934, fits into this image.29 From this perspective it seems logical that Sewering also took part in the so-called “wild euthanasia” program between 1942 and 1945, bearing the responsibility for the transfer of 900 patients to euthanasia facilities while he worked as a doctor in the hospital for tuberculosis patients set up in Schönbrunn. The proof for this seemingly logical story is the crucial evidence documenting the transfer order of 14-year-old Babette Fröwis from Schönbrunn to the “killing center” in Eglfing-Haar, signed by Sewering. Sewering’s case appears to be the quintessential symbol of the failure of the German medical profession to come to terms with its National Socialist past. At the same time, his example is one of many that illustrates the moral arguments that still call for the profession to distance itself morally and legally to condemn Nazi doctors after 50 years.30

Sewering’s own account of the story Sewering’s autobiographical version of the story could hardly be more different from the preceding one.31 His memberships in the NSDAP and the SS were, as he tells it, a forgivable youthful folly, borne by a wave of enthusiasm for National Socialism. In addition, he alleged that his membership in a National Socialist organization was a prerequisite for completing his medical training. Thus he was able to “hole up with the SS cavalry”, he continued, which was the easiest way in Germany back then.32 He decided for an “inner emigration” from National Socialism (innere Emigration, implying withdrawal form public activities) after the “Night of Broken Glass” pogrom (Reichskristallnacht) on 9 November 1938. 28 See reference 25. 29 See Franzblau, 1996, 85. 30 See also White, 1996, 124: “There is little doubt that Sewering participated directly in the euthanasia program.” 31 Sewering told this story in an interview with the author [G.H.] on 19 June 2006 in his home in Dachau, see also Anonymous, “SZ-Gespräch mit Professor Hans Joachim Sewering” (cit. note 9). 32 As the BDC documents show, Sewering joined the General SS, see reference 11.

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In May 1942 he began working at Munich’s tuberculosis hospital, which had been established in the buildings of the Schönbrunn asylum. When the asylum’s resident doctor was drafted to the military, Sewering took over the medical care of all its patients. In his eyes the “case” of Babette Fröwis was purely a tale from the Spiegel magazine. The nuns had asked him for his signature on various occasions, as they did for the transfer of the 14-year-old girl, whose care they were no longer able to cope with. The nuns had acted in good faith and known as little as he had about the continuation of the patient murders in Eglfing-Haar after the end of centrally organized euthanasia in 1941. Moreover, as proof of his anti-Nazi attitude, he claims to have saved from deportation a Jewish wife and her husband who were living in Schönbrunn. Thus all accusations against him were disproven and he had no reason to hide, considering his contributions to health care in Germany. Words of regret regarding Babette Fröwis’s deathly fate never crossed his lips. On the contrary, he was not even able to comprehend the question posed about such an emotional reaction.33 And so it seems that Sewering had a clear conscience until old age, confirmed by the fact that no official investigative proceedings were opened against him.

The story in the view of Schönbrunn and church authorities34 At the Bavarian Ärztetag in 1978, the Munich Archbishop’s Ordinariate issued a statement that allegations cast on doctors working in church institutions during the time of National Socialism were without foundation, a character reference that could only have referred to Sewering, whose involvement in Babette Fröwis’s death had just been made public by Der Spiegel magazine.35 There seems to have been an unspoken agreement between the church institution of Schönbrunn, whose destiny during the National Socialist era was controlled by Prelate Steininger and Sewering, to cast the events from 1940 until 1945 in a certain light. This very point of view can be found in the report that Steininger wrote for the Ordinariate at the beginning of the 1950s. It represents the official historio33 Anonymous, “SZ-Gespräch mit Professor Hans Joachim Sewering” (cit. note 9). 34 The Schönbrunn version relies mainly on the account in the Markus Krischer’s book Kinderhaus (cit. note 27). Hopefully, further historical research including the Schönbrunn archive may elucidate the institution’s history during the Nazi period in more detail and under different perspectives, such as the positions taken by the nuns and Bavarian church institutions when confronted with the Nazi euthanasia program. The new sources will also allow the fate of the patients (Pfleglinge) at Schönbrunn from 1940 to 1945 to be reconstructed in detail. 35 See Norbert Jachertz, “Sewering – Ende einer Karriere: Weshalb der designierte Präsident des Weltärztebundes sein Amt nicht antritt und was 1943 in Schönbrunn passierte”, in: Deutsches Ärzteblatt 90(5), 5 February 1993, A-239 – 240.

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graphy of the fate of the institution during those terrible times, which, as if by a miracle, was able to survive intact through all dangers. Files were allegedly embellished through the tireless efforts of the nuns so that patients could be saved from certain death. After all, the Nazi takeover of the institution in the spring of 1941 was prevented, after the deportations of patients had begun.36 Thus the rescue of Schönbrunn became the esteemed prelate’s life achievement. In the proceedings of the Denazification Court Steininger exonerated Hans Joachim Sewering, claiming that he was absolutely not a National Socialist. Steininger testified that he had discussed political problems and all other difficult topics with Sewering.37 Sewering remained connected to Schönbrunn as a consulting physician until the 1970s, under the prerequisite that he cast no doubt on the institution’s account of the rescue of Schönbrunn. This very consensus between Sewering and the Church institution on “historical facts” was doomed once it was no longer possible to ignore the question of who was responsible for the transfer of 14-year-old Babette Fröwis to the Eglfing-Haar Asylum. What is more, the recollections of the surviving nuns provide strong evidence that the nuns feared the death of the patients transferred even after 1941. Sewering’s attempt to make the nuns from Schönbrunn responsible for Babette Fröwis’s move to Eglfing-Haar was bound to elicit an official backlash from the Munich Ordinariate: namely that the asylum’s nuns knew very well that deportation between 1940 and 1944 meant death for the patients in their care. It would not have occurred to any of the nuns “to cause patients to be transferred due to psychological anomalies to any institution where it was known that this would mean the death of the patient.”38 The deportation of the inhabitants of the Schönbrunn institution were an

36 See Archiv des Erzbistums München und Freising, Archiv der Franziskanerinnen von Schönbrunn no. 1.3.3.2.1.: Aufzeichnungen des Anstalts-Direktors Josef Steininger über Vorkommnisse in der Anstalt Schönbrunn während der Zeit der nationalsozialistischen Hitler-Regierung. 37 See Krischer, 2006, 97 – 109, 140 – 159, 216 – 223, 238, 251. 38 See ibid., 249. In response to Sewering’s shifting blame to the nuns, the directorate of the Schönbrunn institution distanced itself from Sewering in a statement of 22 January 1993, see Thomas Soyer, “Sewering verzichtet auf Ehrenamt: Katholischer Orden bezweifelt Darstellung des Mediziners”, in: Süddeutsche Zeitung, 23/24 January 1993, and in more detail Thomas Soyer, “‘Die Schwestern ahnten, was mit diesen Leuten passiert’: Interview mit Generaloberin Benigna und Domkapitular Anneser über die ‘Euthanasie’-Opfer aus Schönbrunn während der Jahre 1940 bis 1945”, in: Süddeutsche Zeitung, local issue Dachauer SZ, 25/26 January 1997, 14 – 15. The press release from the Erzbischöfliches Ordinariat München of 22 January 1993 reads as follows: “According to the statements by the nuns still alive, no nurse would have thought of arranging the transfer of patients with mental disorders to another institution where it was known that this might cause the death of the patients, let alone would they fully consent to such a transfer.”

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unspoken burden for the nuns of Schönbrunn.39 Even after the Sewering Affair in 1992/1993, it took another 14 years before the archives were opened for independent historical research. Since 2007 the archives of the Schönbrunn institution are opened for historical research.40 Several commemorative ceremonies in 2010, 2011 and 2012 marked a change in the institution’s dealing with its history during National Socialism, including the reopening of a new memorial for the victims. In consequence of a more critical attitude towards the role of Prelate Steininger, the Franziskanerinnen von Schönbrunn decided to rename Prelate Steininger street. Now the main street of Schönbrunn is named instead after the founder of the institution, Victorine von Butler.

Historical sources With this we leave the level of stories and legends and turn finally to the historical sources available today. In so doing it is necessary to recall the various forms of National Socialist “euthanasia” and the function of the Eglfing-Haar mental hospital and asylum:41 39 See Sr. M. Benigna Sirl, “Ansprache bei der Feier am ,Tag des Gedenkens an die Opfer des Nationalsozialismus’ in Schönbrunn am 27. Januar 2011”, in: Sr. M. Benigna Sirl, Peter Pfister (eds.), Die Assoziationsanstalt Schönbrunn und das nationalsozialistische Euthanasie-Programm (= Schriften des Archivs des Erzbistums München und Freising vol. 15), Regensburg: Schnell & Steiner 2011, 141 – 142. 40 Since 2007 Tanja Kipfelsperger has been reconstructing the fate of the former inhabitants of Schönbrunn in National Socialism in the framework of a medical thesis project supported by the Institute for History and Ethics of Medicine at the Technical University of Munich. First results of this and other historical work on the Schönbrunn institution and its confrontation with the National Socialist “euthanasia program” were presented and critically discussed in a colloquium held in Schönbrunn in October 2010, on the occasion of the 150th anniversary of the institution’s founding, see Sirl, Pfister (eds.), 2011. 41 For general information see Michael Burleigh, Death and deliverance: ‘Euthanasia’ in Germany c. 1900 – 1945, Cambridge: Cambridge University Press 1994; Henry Friedlander, The Origins of Nazi Genocide: From Euthanasia to the Final Solution, Chapel Hill/London: The University of North Carolina Press 1995; Ernst Klee, “Euthanasie” im NS-Staat: Die “Vernichtung lebensunwerten Lebens”, Frankfurt/M.: S. Fischer 1983; Hans-Walter Schmuhl, Rassenhygiene, Nationalsozialismus, Euthanasie: Von der Verhütung zur Vernichtung ‘lebensunwerten Lebens’, 1890 – 1945 (= Kritische Studien zur Geschichtswissenschaft vol. 75), Göttingen: Vandenhoeck & Ruprecht 1987; Götz Aly (ed.), Aktion T4 1939 – 1945: Die “Euthanasie”-Zentrale in der Tiergartenstraße 4 (= Stätten der Geschichte Berlins vol. 26), Berlin: Edition Hentrich 1989; Bernd Walter, Psychiatrie und Gesellschaft in der Moderne: Geisteskrankenfürsorge in der Provinz Westfalen zwischen Kaiserreich und NS-Regime (= Forschungen zur Regionalgeschichte vol. 16), Paderborn: Schöningh 1996, 629 – 684; Heinz Faulstich, Hungersterben in der Psychiatrie 1914 – 1949: Mit einer Topographie der NSPsychiatrie, Freiburg: Lambertus 1998; Maike Rotzoll et al. (eds.), Die nationalsozialistische “Euthanasie“-Aktion “T4” und ihre Opfer : Geschichte und ethische Konsequenzen für die Gegenwart, Paderborn et al.: Schöningh 2010. For a short survey see Gerrit Hohendorf,

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From October 1939 on, all mental hospitals and asylums in the German Reich were obligated to register their patients and inmates with the state authorities. Within the framework of the clandestine “euthanasia” “Aktion T4”, under the direct auspices of the Führer’s chancellory, psychiatric experts decided about whether patients would live or die, often based solely on a one-page registration form. The patients were transported to one of the killing institutions established by the “Aktion T4” program to suffocate the victims using carbon monoxide gas. In Bavaria the state asylums initially had to transfer the selected patients to the killing institutions; afterwards they served as transit institutions for patients from asylums run by charitable organizations and the Church. The actual transports of patients from the Schönbrunn asylum began on 20 March 1941. They were taken to the asylum in Eglfing-Haar, which acted as a transit institution for patients of non-state institutions in Upper Bavaria. A total of 582 patients were deported from Schönbrunn between March and June 1941.42 According to the historical investigations done by Tanja Kipfelsperger, 206 inhabitants of the Schönbrunn institution were killed at the Hartheim institution in Upper Austria.43 The negotiations for handing over the premises of the Schönbrunn institution to the city of Munich’s health department to establish an auxiliary hospital in 1941 did not take place after the patients had been deported, as institution director Steininger claimed after the war, but rather parallel to the deportations.44 In this respect Steininger seems to have resigned himself to abandoning the patients in his care, which he saw as inevitable. Even after the end of “Aktion T4” in August 1941, further transports con“Ideengeschichte und Realgeschichte der nationalsozialistischen ‘Euthanasie’ im Überblick”, in: Petra Fuchs et al. (eds.), “Das Vergessen der Vernichtung ist Teil der Vernichtung selbst”: Lebensgeschichten von Opfern der nationalsozialistischen Euthanasie, Göttingen: Wallstein 2007, 36 – 52. Especially for Bavaria, see Michael von Cranach, Hans-Ludwig Siemen (eds.), Psychiatrie im Nationalsozialismus: Die Bayerischen Heil- und Pflegeanstalten zwischen 1933 und 1945, Munich: Oldenbourg 1999, and Gerrit Hohendorf, “Euthanasie im Nationalsozialismus – Historischer Kontext und Handlungsspielräume der Akteure”, in: Sirl, Pfister (eds.), 2011, 53 – 82. For a reflection of the impact of euthanasia crimes during National Socialism on medical ethics today, see Rael Strous, “Hitler’s Psychiatrists: Healers and Reseachers Turned Executioners and Its Relevance Today”, in: Harvard Review of Psychiatry 14, 2006, 30 – 37, and Gerrit Hohendorf, Der Tod als Erlösung vom Leiden: Geschichte und Ethik der Sterbehilfe in Deutschland seit dem Ende des 19. Jahrhunderts, Göttingen: Wallstein 2013. 42 See Krischer, 2006, 135 – 166, and Bernhard Richarz, Heilen, Pflegen, Töten: Zur Alltagsgeschichte einer Heil- und Pflegeanstalt bis zum Ende des Nationalsozialismus, Göttingen: Verlag für Medizinische Psychologie im Verlag Vandenhoeck & Ruprecht 1987, 171. 43 See Tanja Kipfelsperger “Medizinhistorische Erkenntnisse aus den Krankenakten von Schönbrunn”, in: Sirl, Pfister (eds.), 2011, 119 – 138, here 133. 44 See Krischer, 2006, 140 – 143, and Annemone Christians: “Das Münchner Gesundheitsamt und seine Zusammenarbeit mit der Kongregation Schönbrunn”, in: Sirl, Pfister (eds.), 2011, 119 – 138.

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nected to killings followed; to be precise, another 172 patients in December 1943. In June 1944 the negotiations with the spiritual head of the Third Order Hospital in Munich, Steininger made it clear that if anything about the upcoming transfers was revealed to the nuns, they could become very agitated. “It is generally feared that when patients are transferred away, they will hardly be alive in three months’ time.”45 The transcript of the negotiations clearly proves that it was generally known in Schönbrunn that the killing of patients still continued after the end of Aktion T4, especially in Eglfing-Haar. Sewering’s involvement in the collective transports in 1943 and 1944 cannot be proven by the existing sources, but it seems implausible that he knew nothing about the context of these transports since he was a confidant of Steininger. Formal responsibility lay with the superior administration, the Upper Bavarian state social services, the city of Munich department of health, and the health department of the Bavarian Ministry of the Interior. Indeed, after Aktion T4 was halted in August 1941, the killing of patients in German asylums continued in various forms, especially through overdosed medication and starvation. In Bavaria the Ministry of the Interior ordered that a special starving ration be introduced for non-working patients. The killings in the “Houses of Hunger” in Eglfing-Haar and in the asylums’s Kinderfachabteilung (special children’s wards) was the responsibility of the director, Dr. Hermann Pfannmüller.46 Between 1939 and 1945 about 3,000 patients died in the asylum at Eglfing-Haar. A study of all deaths of patients from Munich in this period showed that only a third of the patients in Eglfing-Haar died by natural causes. About two thirds of the deaths in Eglfing-Haar were caused by systematic neglect of nursing and medical care, starvation und probably – in the case of adult patients as well – overdosed medication.47 Babette Fröwis’s transfer did not take place in the context of one of the collective transports mentioned above. It was an individual transfer due to disturbing behavior. Babette Fröwis was probably registered by the Eglfing-Haar asylum with the Reichsausschuss zur wissenschaftlichen Erfassung von erb- und anlagebedingten schweren Leiden (“Reich Committee for the Research of Hereditary and Constitutional Severe Diseases”), the called camouflage organisation for “children’s euthanasia”, and admitted to the so-called special children’s ward (Kinderfachabteilung) there. She was killed with repeated doses of 45 See Krischer, 2006, 218. 46 See Gerhard Schmidt, Selektion in der Heilanstalt 1939 – 1945, Stuttgart: Evangelisches Verlagswerk 1965, 95 – 147, and Richarz, 1987, 177 – 188. 47 This study was done by the working group “Psychiatry and welfare care in National Socialism in Munich” (Michael von Cranach, Annette Eberle, Gerrit Hohendorf and Sibylle von Tiedemann) with support from the Documentation Center on National Socialism in Munich. The results will hopefully be published in form of a book commemorating the Munich “euthanasia” victims.

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Luminal, simulating a natural death by bronchial pneumonia.48 According to what is known today, Sewering referred a total of nine patients from Schönbrunn to Eglfing-Haar between June 1943 and February 1945, five of whom died.49 Besides the above-mentioned killing of Babette Fröwis in the Kinderfachabteilung, most of them starved to death, some of them in the notorious “House of Hunger” number 22. The grounds for transfer written in the short transfer papers signed by Dr. Sewering range from restlessness, bothering other patients and attempts to flee, to assault and battery of the staff. In all cases Sewering confirmed in writing that the patients could not be kept in Schönbrunn and that admittance to a locked ward was necessary. For 46-year-old Auguste H., Sewering specifically noted that the patient’s hours-long yelling was an unbearable disturbance for the patients of the tuberculosis hospital.50 Most of the patients were transferred by Sewering in the months November and December 1943. The example of Kreszenz H. shows that there definitely were alternatives to transferring patients if it was thought that they could no longer be kept in Schönbrunn. Kresenz H. had lived in Schönbrunn since 1920 and became restless in 1943, refusing food. She was transferred by Sewering to the University of Munich Psychiatric and Neurological Hospital, where no patient killings took place. This might have given her a small chance to survive. Nevertheless, after various transports she finally died in the notorious “House of Hunger” number 22 in 1944.51 Between 1939 and 1945 a total of 905 inhabitants of the Schönbrunn institution were transferred directly or by detours to a state institution, most of them to the asylum of Eglfing-Haar. Of these, 546 did not survive the war and most probably became victims of the National Socialist “euthanasia” program.52

Conclusion When we critically compare the three accounts again on the basis of the source materials, their constructed character becomes clear : the real Sewering can be identified neither in the narrative of the protagonist of “wild euthanasia” or as the prototype of the Nazi doctor and war criminal; nor can his version of himself as unknowing and innocent be supported by the sources. The legend of the heroic rescue of Schönbrunn by Prelate Steininger is also nothing more than a 48 Archiv des Bezirks Oberbayern, Munich, stock Eglfing-Haar, patient file 7179. 49 Archiv des Bezirks Oberbayern, Munich, stock Eglfing-Haar, patient files 7179, 7709, 7893, 8662, 8702, 10607, 11906, 11107, 12101. 50 Archiv des Bezirks Oberbayern, Munich, stock Eglfing-Haar, patient file 7709. 51 Archiv des Bezirks Oberbayern, München, stock Eglfing-Haar, patient file 7610; see Krischer, 2006, 192 – 196. 52 See Kipfelsperger, 2011, 132 – 133.

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skilful reinterpretation of the events documented in the sources, as the institution was saved at the end of the war, but almost all of the patients in its care had disappeared.53 It is hardly possible to reconstruct what Sewering and Steininger discussed with each other in those difficult times, despite what Steiniger claimed after the war. However, it is not plausible that Sewering was as unknowledgeable as he declared 50 years later. This was either a conscious deception of the public, or else the creative efforts toward self-exoneration by his autobiographic memory. In fact, the sources tell the story of two men who ultimately functioned within the machinery of transfers controlled by the Bavarian Ministry of the Interior’s department of health, and who did what was expected of them, namely make room to be used for the medical demands of war by transferring mentally disabled and ill patients in their care. In addition, Sewering and his predecessors exposed disruptive patients to the danger of being killed in the asylum of Eglfing-Haar. Even if one were to presume the unlikely circumstance that Sewering knew nothing about the impending danger, the real scandal would still be that the discovery of the death of Babette Fröwis, whom he had transferred, did not arouse any emotional expression of regret at all; not to mention the fact that, instead of admitting that he had played into the hands of murderers, he shifted the blame to the nuns in Schönbrunn. In this respect Sewering’s case is a late example of the German “inability to mourn”, as Alexander and Margarete Mitscherlich diagnosed back in the 1960s.54 Confronted with the findings of historical research about the role of medicine in National Socialism since 1987, the BÄK was obliged gradually to abandon the isolating interpretation that German medicine, aside from a small group of misled perpetrators, had remained innocent in those “dark days”. This development towards accepting historical responsibility for the profession’s widespread involvement in National Socialist health and annihilation policy was counteracted at the very moment when a leading representative of West German post-war medicine was confronted with his own Nazi past. Thus, solidarity with a highly decorated colleague and former president of the BÄK seemed more important than solidarity with the victims of Nazi medicine. This position even dominated the official obituary published in the Deutsches Ärzteblatt on the occasion of Hans Joachim Sewering’s death in summer 2010. The future will show whether there will be a fundamental change in the attitude and the responsibility of the German medical establishment towards medicine in National Socialism, towards the perpetrators of medical crimes and, especially, towards the victims of Nazi medicine. 53 See Krischer, 2006, 98 – 99. 54 Alexander Mitscherlich, Margarete Mitscherlich, Die Unfähigkeit zu trauern: Grundlagen kollektiven Verhaltens, Munich: Piper 1967.

Sascha Topp

Shifting Cultures of Memory: The German Society of Pediatrics in Confrontation with Its Nazi Past1

During World War II German pediatricians were involved in the medical program for killing mentally and physically handicapped children on three levels. First, the expert panel that decided about the life and death of thousands of children with hereditary or congenital diseases (Reich Committee for the Scientific Registration of Serious Hereditary and Congenital Illnesses; Reichsausschuß zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden) included one child psychiatrist, Hans Heinze, and two pediatricians, Werner Catel and Ernst Wentzler. Second, approximately 30 pediatricians were involved in carrying out the program at the committee’s killing centers, the Special Children’s Wards (Kinderfachabteilungen).2 Third, pediatricians were involved in identifying, reporting and referring children to the Reichsausschuß.3 1 The results presented here emerged in the context of the research project “Geschichte(n) als Argument in der Biomedizin: Vergegenwärtigungen der nationalsozialistischen ‘Euthanasie’ zwischen Politisierung und Historiographie, ca. 1945 – 2000” directed by Volker Roelcke and Etienne Lepicard, also conducted by Gerrit Hohendorf, whom I would like to thank for constructive exchange and all of his precious advice. The project was part of the DFGSonderforschungsbereich 434 Erinnerungskulturen (cultures of memory) at Justus Liebig University of Giessen/Germany. I would like to thank the members of the Historical Committee and the Archive of the Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ) for their support. This gratitude is also due to all those who confided in me and trusted me with their memories. For their critical revisions of this chapter I wish to express my thanks to Etienne Lepicard and Volker Roelcke. 2 See e. g. Udo Benzenhöfer, Kinderfachabteilungen und “NS-Kindereuthanasie”, Wetzlar : GWAB 2000; Sascha Topp, “Der ‘Reichsausschuß zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden’: Zur Organisation der Ermordung minderjähriger Kranker im Nationalsozialismus 1939 – 1945”, in: Thomas Beddies, Kristina Hübener (eds.), Kinder in der NS-Psychiatrie (= Schriftenreihe zur Medizin-Geschichte des Landes Brandenburg; 10), Berlin: be.bra wissenschaft 2004, 17 – 54. 3 See Lothar Pelz, “Kinderärzte im Netz der ‘NS-Kindereuthanasie’ am Beispiel der ‘Kinderfachabteilung’ Görden”, in: Monatsschrift für Kinderheilkunde 151, 2003, 1027 – 1032; idem, “… Aber ich sorge mich so um mein Kind …”: Kinderärzte und NS-“Kinder-Euthanasie”, Göttingen: Vandenhoeck & Ruprecht 2006; idem, “Mecklenburgische Kinderärzte und NS‘Kindereuthanasie’”, in: Ekkehardt Kumbier, Stefan J. Teipel, Sabine C. Herpertz (eds.), Ethik

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We know very little about the extent to which pediatricians performed additional activities in the context of medical crimes, such as forced sterilization according to the so-called Erbgesundheitsgesetz (Law for the Prevention of Genetically Diseased Offspring, Gesetz zur Verhütung erbkranken Nachwuchses, GzVeN), or experiments on human subjects in the occupied territories of Europe and in the Nazi concentration and extermination camps in order to prevent and control diseases in the military. Likewise, so far there has been no systematic research on the interplay of pediatric expertise and measures for the implementation of National Socialist population policy. Examples of this include the areas of “genetic counseling” (eugenics/racial hygiene) and also the National Socialist Gesundheitsführung (health guidance/health control). In particular, the youth organizations of the National Socialist German Worker’s Party (Nationalsozialistische Deutsche Arbeiterpartei, NSDAP), the Hitler Youth (Hitler Jugend, HJ) for boys and the Federation of German Girls (Bund Deutscher Mädel, BDM), which – at least since 25 March 1939 – were based on compulsory membership and included almost all German children and youths between the ages of ten and eighteen, provided a wide field of activity for pediatricians.4 Historical-critical reflection about the so-called Gleichschaltung (“enforced” political conformity) of pediatric professional associations and of the Nazi party membership of non-Jewish pediatricians is also still in its early stages. And there are even more desiderata in view of the processes of remembrance and “forgetting” within the German pediatric profession from 1945 up to today.5 In light of the wider context of National Socialism, the Holocaust and the culture(s) of memory, the historical responsibility of the pediatric profession is diverse. It directly affects the historical and ethical identity of this section of the German medical profession. Part of the responsibility has been accepted. A commemoration ceremony held in Dresden in 1998 and the historical research project by the medical historian and former pediatrician Eduard Seidler of Freiburg and the Historical Committee of the Society of Pediatrics and Adolescent Medicine (DGKJ; since 2005, former appellation: German Society of Pediatrics, Deutsche Gesellschaft für Kinderheilkunde, since 1883, in the following DGK) have helped to acknowledge those Jewish pediatricians who were forced into emigration, deportation or annihilation between 1933 and 1945. When the Society’s former president Lothar Pelz spoke out in Dresden about the und Erinnerung: Zur Verantwortung der Psychiatrie in Vergangenheit und Gegenwart, Lengerich: Pabst Science Publ. 2010, 59 – 69. 4 See Thomas Beddies, “Du hast die Pflicht gesund zu sein”: Der Gesundheitsdienst der HitlerJugend 1933 bis 1945, Berlin: be.bra wissenschaft 2010. 5 See Sascha Topp, Geschichte als Argument in der Nachkriegsmedizin: Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie, Göttingen: V & R unipress 2013.

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guilt of pediatricians in the era of National Socialism,6 it was the first statement of this kind by a German medical association.7 However, the Dresden statement did not yet include the crimes of “child euthanasia”. This step did not take place until twelve years later with a second commemoration event in Potsdam. This ceremony was opened with an official statement by the professional association. It was presented to the public during the annual congress in 2010 by the president at that time, Fred Zepp (University of Mainz). The statement, in turn, formally asked for forgiveness addressed to the victims and the families concerned, and announced a voluntary commitment by the Society to deal critically with its own past and also to commemorate the victims of the Nazi child euthanasia program.8 Second, a symposium was held at the same time in Potsdam, which brought the discussion up to date with several scientific contributions on current research.9 Third, the DGKJ presented an exhibition. This was shown later at seven locations in Germany and is intended to be used further by interested institutions to initiate a living memory.10 A bilingual exhibition catalog was published in the 2012,11 and in 2013 a virtual 6 “The German Society of Pediatrics took on a burden of guilt during the National Socialist era in Germany.” See “Public Commemoration Ceremony in Conjunction with the 94th Annual Meeting of the German Society of Pediatrics and Adolescent Medicine, Dresden Schauspielhaus”, in: Monatsschrift für Kinderheilkunde 147, Suppl. 1, 1999, 2. The lives of the Jewish pediatricians were reconstructed in an extensive study. See Eduard Seidler, Jüdische Kinderärzte 1933 – 1945: entrechtet – geflohen – ermordet; Jewish Pediatricians, Victims of Persecution, 1933 – 1945, completed new edition, Basel: Karger 2007. 7 In 1988 the Berlin Medical Association published a preliminary declaration on the guilt of physicians in National Socialism: “Erklärung der Ärztekammer Berlin zur Schuld von Ärzten im Nationalsozialismus, Drucksache der Delegiertenversammlung 7/93”, in: Deutsches Ärzteblatt 85(48), 1988, C-2069. 1992 in Cologne, under the presidency of Uwe Henrik Peters, adopted the German Association of Psychiatry and Neurology (Deutsche Gesellschaft für Psychiatrie und Nervenheilkunde DGPN, renamed DGPPN at the same occasion of annual congress) a first resolution, with which the general meeting of the Society distanced itself from horrors of the Holocaust. See ‘Resolution der Mitgliederversammlung’ DGPN, Cologne 1992. Private archive Volker Roelcke. In 1994 the medical crimes were addressed at the annual congress of both, the DGPPN and the German Society for Gynecology and Obstetrics made their own past the subject of discussion. However, only the president of the gynecological association, Professor Hermann Hepp, actually apologized to the women who had been victims of forced abortion or sterilization in the era of National Socialism. See Annette Tuffs, “Apologies for Nazi crimes”, in: The Lancet 344, 1994, 808. 8 http://www.dgkj.de/ueber_uns/geschichte/gedenkveranstaltung_2010/ (25 February 2014). 9 See the list of contributions of the historical symposium on 17 September 2010 in: 106. Jahrestagung der DGKJ. Hauptprogramm, 16 – 19 September 2010. Potsdam-Babelsberg 2010, 87. 10 http://www.dgkj.de/ueber_uns/geschichte/kinderaerzte_und_die_medizinverbrechen_an_ kindern_in_der_ns_zeit/ (25 February 2014). 11 See Thomas Beddies (ed.), Im Gedenken der Kinder : Die Kinderärzte und die Verbrechen an Kindern in der NS-Zeit – In memory of the children: Paediatricians and crimes against children in the Nazi period, im Auftrag der Deutschen Gesellschaft für Kinder- und Ju-

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exhibition was released under the same title: “In Memory of the Children”.12 Given these efforts since 2010, this last step could be regarded as a comprehensive, sustained program. But how did the entire process take place from the end of World War II up to the critical self-reflection of the present? As the two latest efforts at self-representation in Dresden and Potsdam already show indirectly, only since the mid1990s has it been possible to internalize the precarious events in the profession’s self-image. The process of addressing the issues of guilt and responsibility, which might have brought about an earlier shift in the culture(s) of memory, was delayed time and again. However, long periods of sustained silence were interrupted on several occasions by intensive debates – on the policy of remembering individual members, as well as on medical ethics. One of these confrontations with the past occurred between 1960 and 1967 with the dispute concerning Professor Werner Catel (Kiel, Schleswig-Holstein),13 his involvement in the Nazi medical killing program and his public propagation of “limited euthanasia” in the postwar era. As will be shown here on the basis of particular events in the aftermath of the “Catel dispute”, which is – 1981: The Tegernsee Symposium “Ethical Problems in Pediatrics and Related Areas”, – 1983: 100th anniversary of the DGK in Munich, – 1994: Symposium “Pediatrics in Germany 1918 – 1945” in Hanover, – 1998: Commemoration ceremony in Dresden, – 2010: Commemoration ceremony in Potsdam, it had a deep impact on the further development of the elements used to represent the precarious past among pediatricians – resulting in shifting the cultures of memory several times – even up to day.

gendmedizin e.V. (DGKJ), Berlin: Druckhaus Berlin-Mitte GmbH 2012; https://www.kon textwochenzeitung.de/fileadmin/user_upload/2013/4/03042013/Buch_Im_Gedenken_der_ Kinder.pdf (25 February 2014). 12 http://www.im-gedenken-der-kinder.de/ (25 February 2014). 13 After Catel had fled from Leipzig in the Russian occupation zone to western Germany (Hesse) in 1946 he was appointed professor and director of the Department of Pediatrics at University Medical School in Kiel, Schleswig-Holstein again since 1954. See Hans-Christian Petersen, Sönke Zankel, “‘Ein exzellenter Kinderarzt, wenn man von den Euthanasie-Dingen einmal absieht’: Werner Catel und die Vergangenheitspolitik der Universität Kiel”, in: Hans-Werner Prahl, Hans-Christian Petersen, Sönke Zankel (ed.), Die Uni-Formierung des Geistes: University Kiel und der Nationalsozialismus, vol. 2, Kiel: Schmidt & Klaunig 2007, 133 – 179.

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The debate about Catel and “child euthanasia” at the DGK: 1960 to 1967 Some initial discoveries about celebrated traditions are evident in the forms and functions of remembering within the DGK. For example, every annual convention has always opened with the commemoration of pediatricians who passed away in the previous year. Apart from naming the respective individuals, the biographies of particularly deserving individual colleagues have been brought to mind on such occasions. Besides this spirited remembrance practice of honoring the dead, eulogies, memorial addresses and hagiographical articles have been released about the history of discipline and its prominent protagonists. In 1966 and 1983/84 historical exhibitions about the history of pediatrics were held. Finally, prizes named after the founding fathers of pediatrics were awarded to commemorate the Society’s foundation in 1883 and its development since that time. The ritualized remembrance of the past has served as an identity-generating element within this group of physicians. However, over decades the era of National Socialism was not explicitly recognized as part of the organization’s own history. Uninterrupted correspondence with virtually all incriminated colleagues has been preserved in the historical archives of the DGK/DGKJ. Besides Werner Catel, collegial correspondence was found between the offices of chairman and the secretary to the Board and Ernst Wilhelm Bayer, Hans-Christoph Hempel, Hanna Uflacker, Ernst Wentzler and Hans-Joachim Hartenstein who all had been involved in the program of children killing.14 Supporters of National Socialism, including Thilo Brehme (1897-?),15 Kurt Hofmeier (1896 – 1989),16 Franz Hamburger (1874 – 14 At the Leipzig Kinderfachabteilung, Ernst Klemm, Hans-Christoph Hempel, Hans-Joachim Hartenstein and Hanna Uflacker, in addition to Catel himself, were part of the killing program. In the post-war period Hartenstein went on to carve out a career at the Society of Social Pediatrics, which was engaged in the rehabilitation of disabled children. He became a member of the task force of the Deutsche Vereinigung für die Gesundheitsfürsorge des Kindesalters (“German Association for the Health Care of Children”) (formerly : Reichsarbeitsgemeinschaft Mutter und Kind [“Mother and Child welfare organization], later: Deutsche Gesellschaft für Sozialpädiatrie [“German Society of Social Pediatrics”]) upon the recommendation of Gerhard Joppich in 1957. Hartenstein was a member of the scientific advisory council as well as of the extended Board of the Society for Social Pediatrics in the first half of the 1970s. Historical documents of the Gesellschaft für Sozialpädiatrie und Jugendmedizin (“Society for Social Pediatrics and Adolescent Medicine”), library of Kinderzentrum Munich. 15 Head of the Children’s Hospital in Brunswick since 1938, member of the NSDAP 1 May 1933, membership no. 2204630, vice-chairman of the National Socialist Cultural Community, Head of the Dept. of Culture German Labor Front (Deusche Arbeitsfront, DFA) 1933 – 1938, medical officer of the National Socialist Air Corps, member of the NSD Physicians’ League (Nationalsozialistischer Deutscher Ärztebund, NSDÄB) and National Socialist People’s

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1954),17 Walter Keller (1894 – 1967),18 Gerhard Joppich (1903 – 1992, see below), Hermann Mai (1902 – 2001, see below), Carl G. Bennholdt-Thomsen, (1903 – 1971, see below), Werner Catel and Felix von Bormann (1901 – 1978, see below), were welcomed to the Society during the redevelopment period of pediatrics after 1948.19 Hans Kleinschmidt (1885 – 1977), the first chairman of the DGK in the postwar era and also the last chairman during the war, declared in a letter to Secretary to the Board Fritz Goebel that he had no qualms about colleagues who were known to be National Socialists acting as representatives.20 These maxims remained absolutely valid in the 1950s and constituted the point of departure for the Catel dispute. The initial long period of silence in the 1950s ended suddenly. In 1960 an article entitled “Eingeschläfert (‘Put to Sleep’)” was published on 17 August in the weekly magazine Der Spiegel, after it had been revealed that Werner Heyde

16

17

18

19

20

Welfare organization (Nationalsozialistische Volkswohlfahrt, NSV). Federal Archive of Berlin (Berlin Document Center = BDC); see also Seidler, 2007, 53. Medical director of the municipal children’s and mothers’ home in Berlin-Charlottenburg, 1934 – 1938, habilitation under Georg Bessau in 1938, director of the Kaiserin-AugusteViktoria Hospital, 1938 – 1941, director of the children’s hospital of the Reich University of Strasbourg with chair, 1941 – 1944; http://www.charite.de/p_endo/kindarzt/geschBerlKHK/ berlkhk/Posterserie%205a.pdf (1 September 2014) member of the NSDAP since 1 November 1931, member of the Storm Troups (Sturmabteilung, SA) since July 1932 (also National Socialist Motor Corps, NSKK). Assessment of Johann Duken on the occupation of the Chair in Vienna (Franz Hamburger), 1944: “H. is third on the list in Vienna. As a National Socialist, H. is certainly a perfect choice. He has not yet proven himself to the full extent with his scientific achievements.” Federal Archive of Berlin (BDC); see also Seidler, 2007, 24 and 55 – 56. Head of the Children’s Hospital of the University of Vienna since 1930, co-editor of Münchener Medizinische Wochenschrift published by J. F. Lehmanns. See Ernst Klee, Personenlexikon zum Dritten Reich: Wer war was vor und nach 1945, Frankfurt/M.: Fischer 2007, 222; Seidler, 2007, 56 – 57. Member of the NSDAP, membership no. 6334240, member of the NSDÄP since 10 March 1941. Federal Archive of Berlin (BDC). See Thomas Lennert, “Die Deutsche Gesellschaft für Kinderheilkunde und der Karger-Verlag 1938/39”, in: Monatsschrift für Kinderheilkunde 143, 1995, 1197 – 1203. Chair of pediatrics and director of the Children’s Hospital of the University of Giessen 1938 – 1945, member of the NSDAP since 1937, membership no. 5859693, member of the Schutzstaffel (SS) from 1 November 1933, membership no. 252416, Oberscharführer (senior squad leader) of the SS battalion 1/83 since 1943, physician in the SS Medical Corps II/33, accreditation for the public health department. Keller was recommended by Johann Duken in 1944 for the Chair in Vienna (as successor to Franz Hamburger) as his second choice after Catel. Federal Archive of Berlin (BDC); Eduard Seidler, entry about Walter Keller, in: Neue deutsche Biographie, Bd. 11, Berlin: Duncker & Humblot 1977, 468; Klee, 2007, 303 – 304. Apart from Franz Hamburger, all of the persons mentioned are listed in the registers of members of the years 1948 – 1950, as are Hanna Uflacker, Hans-Joachim Hartenstein and Hans-Christoph Hempel. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 82, DGK 1949 – 1966, annual reports 1949 – 1955. Hans Kleinschmidt to Fritz Goebel, 4 March 1948. See Ute Jahnke-Nückles, Die Deutsche Gesellschaft für Kinderheilkunde in der Zeit der Weimarer Republik und des Nationalsozialismus, Med. Diss., Freiburg/Br. 1992, 129.

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had practiced medicine in Schleswig-Holstein under the false name of Fritz Sawade. In addition to the cover story about Heyde’s role as medical director of the Aktion T4 euthanasia program, the former Hamburg pediatrician Rudolf Degkwitz made accusations against Werner Catel. After a period of enthusiasm for the National Socialists, Degkwitz, a pediatrician internationally recognized for his work on the measles vaccine, turned his back on National Socialism and, as professor for pediatrics, adopted an increasingly critical position towards the regime during the war.21 Part of his family belonged to the resistance. He himself was sentenced to seven years imprisonment by the Volksgerichtshof (presided over by Roland Freisler) for what was called “undermining military morale”. He became President of the Public Health Authority of Hamburg for a short while after the war before emigrating to the United States (U.S.) in 1948. Degkwitz pressed criminal charges against Werner Catel a second time, whereupon preliminary proceedings were initiated at the District Court of Hanover in 1960. Various developments were triggered by the Spiegel article: The first consequence was a broad public debate: In the 1960s about 60 articles in succession were published in Der Spiegel, and four articles in the weekly newspaper Die Zeit, in which Catel’s involvement was mentioned time and again. A multitude of letters from readers was published with comments on Catel. Second, the press coverage increased pressure on Catel and the state government of SchleswigHolstein, which had come to Catel’s defense. Catel finally succumbed to public pressure and took early retirement in the same year. The third consequence was the beginning of a debate about and with Catel within the DGK, which was confronted with the fact that Catel still propagated the “annihilation of unworthy life” for heavily handicapped newborns and minors.

1960: Gerhard Joppich’s chairmanship – The beginning of the Catel dispute Ten days after the first Spiegel article was published, the Board of the DGK received a request from Professor Felix von Bormann of Bad Nauheim. Bormann demanded that President Gerhard Joppich22 and the Board of the Society launch 21 See Hendrik van den Bussche, “Rudolf Degkwitz: Die politische Kontroverse um einen außergewöhnlichen Arzt”, in: Kinder- und Jugendarzt 30(4), 1999, 425 – 431, 30(5), 549 – 559. 22 Student of the pediatrician Hans Kleinschmidt, member of the NSDAP since 1 February 1932, membership no. 949046, member of the HJ (regimental commander), regional physician of the HJ, member of the NSDÄP, accreditation by the public health department in 1938, at the same time head of the department of the Research Center for Medical Youth Studies (Forschungsstelle für ärztliche Jugendkunde); the book Gesundheitsführung der Jugend (“Health Guidance of the Youth”), written by Gerhard Joppich and Robert Hördemann in collaboration with other HJ physicians, was published by Lehmanns Verlag München in 1939. On 1 February 1940 exempted from combat as indispensable upon recommendation of the Reich

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an investigation, not against Catel, but against Degkwitz on grounds of denunciation. Bormann even demanded Degkwitz’s expulsion from the DGK.23 But who was the colleague who jumped to Catel’s side? Bormann was a pediatrician and bacteriologist who joined the NSDAP in 1932 and was known as a fanatic National Socialist. He had been head of the State Institute for Hygiene in Bremen during the war and was appointed as extraordinary professor in Hamburg in 1942, where he probably had met Degkwitz. As a hygiene consultant to the 9th Army, he had been involved in medical experiments on Russian prisoners of war with typhus. He reported on measures for fighting typhus in the army, which were carried out in the occupied territories at the expense of the civilian population.24 As described independently by Joachim S. Hohmann and Jürgen Peter, Bormann still defended his medical experiments, in particular those on persons from marginalized social groups, in an article published in the mid-1950s.25 The “isolation of contagious patients, sterilization of persons with hereditary diseases, execution of criminals warranting the death penalty or experiments with them” were, according to Bormann in the year 1956, “absoYouth Leader of the NSDAP, from 1 October 1941: university lecturer and medical director at the Kaiserin-Auguste-Viktoria Hospital in Berlin, appointment to the main office of the Public Health Department by the Reich Health Minister in 1942, head of the Reichsarbeitsgemeinschaft Mutter und Kind in 1943, recommended by Georg Bessau to the Medical Faculty in Berlin as suitable for a chair in 1943. Assessment by Johann Duken in 1944: “… he has a loyal and good political attitude without reserve.” Federal Archive of Berlin (BDC). See also Seidler, 2007. 23 Felix von Bormann to Gerhard Joppich, 26 August 1960, Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 63, DGK, 1. Correspondence on the congress in Kassel 1960, part 3: Board meeting guests of honor b) Board meeting (A-Z). 24 Member of the NSDAP since 1 October 1932, membership no. 1346452; Member of SA. Federal Archive of Berlin (BDC). G. W. Kross (Friedberg Hessen), “Prof. Dr. med. Felix v. Bormann 60 Jahre”, in: Ärztliche Praxis XIII(25), dated 24 June 1961, 1495. See Martin Hofer, Hans Rietschel (1978 – 1970) – Direktor der Universitäts-Kinderklinik Würzburg von 1917 – 1946, Med. Diss., Würzburg 2006, 39 – 41; Karl-Heinz Leven, “Fleckfieber beim deutschen Heer während des Krieges gegen die Sowjetunion (1941 – 1945)”, in: Ekkehart Guth (ed.), Sanitätswesen im Zweiten Weltkrieg, (Vorträge zur Militärgeschichte 11), Herford: E.S. Mittler & Sohn 1990, 127 – 166, here 147; Winfried Süss, Der “Volkskörper” im Krieg: Gesundheitspolitik, Gesundheitsverhältnisse und Krankenmord im nationalsozialistischen Deutschland 1939 – 1945, Munich: Oldenbourg Wissenschaftsverlag 2003, 229. See also Paul J. Weindling, Epidemics and Genocide in Eastern Europe 1890 – 1945, Oxford: Oxford University Press 2000, 255 – 256, 341, 362, 411. 25 See Felix von Bormann, “Medizinische Versuche am Menschen”, in: Nation Europa 6(7), 1956, 62 – 72. Jürgen Peter interpreted von Bormann’s text in the magazine, which he (J. Peter) regarded as right-wing extremist, as a book review of Das Diktat der Menschenverachtung by Alexander Mitscherlich and Fred Mielke in 1947/1948. According to the review, Bormann denounced in particular Viktor von Weizsäcker and the authors of the document collection as “henchmen of the victor’s justice”, see Jürgen Peter, Der Nürnberger Ärzteprozess im Spiegel seiner Aufarbeitung anhand der drei Dokumentensammlungen von Alexander Mitscherlich und Fred Mielke, Münster : LIT 2013, 145 – 148.

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lutely essential”, especially in times of war.26 The relationship between Catel and Bormann before and after 1945 is still unknown. However, the attitudes of both physicians towards the so-called “extermination of unworthy life” were very similar, as will be shown in more detail with regard to Catel’s position, when Bormann classified the mentally ill, in keeping with the notorious book by Karl Binding and Alfred Hoche (“Permission for the Destruction of Life Unworthy of Living”, 1920), as “mentally completely dead”, to whom no “personality value” can be attributed.27 The extent to which the Board was aware of the details of Bormann’s past is unknown. The chairman of the DGK, Gerhard Joppich, suggested to the close circle of the Board that Bormann be asked to conduct his own investigations. Board member Philipp Bamberger agreed and explained to Joppich, “I myself have the feeling that Mr von Bormann wants to vent his rage on Mr. Degkwitz due to a personal grudge from years ago”.28 Although the Board was united in this case, it resorted to referring to codes of practice. Bormann believed he could present evidence against Degkwitz and filed an application for his expulsion in accordance with the charter. This application was dismissed unanimously by the extended Board under the chairmanship of Philipp Bamberger in 1961.29

1961/1962: Bamberger’s chairmanship – A first statement on Nazi euthanasia At the same time the Board made a decision on the first public statement with regard to the “annihilation of unworthy life”. This statement by the DGK was published in 1961 in the journal Ärztliche Mitteilungen,30 the periodical of the German Medical Association and the National Association of Statutory Health Insurance Physicians, and was therefore directed at the entire German medical profession. According to DGK archives, Chairman-in-Office Philipp Bamberger 26 Description and quote: Joachim S. Hohmann, “Die nationalsozialistische ‘Euthanasie’ in sächsischen Anstalten und ihre strafrechtliche Ahndung in der SBZ”, in: Historical Social Research 20(4), 1995, 31 – 60, here 46; http://www.ssoar.info/ssoar/bitstream/handle/docu ment/3239/ssoar-hsr-1995-no_4__no_76-hohmann-die_nationalsozialistische_euthanasie_ in_sachsischen.pdf ?sequence=1 (1 September 2014). 27 See Karl Binding, Alfred Hoche, Die Freigabe der Vernichtung lebensunwerten Lebens. Ihr Maß und ihre Form, Leipzig: Meiner 1920. Quote here from Peter, 2013, 146. 28 Bamberger to Joppich, 7 September 1960, Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 63, DGK, 1. Correspondence on the congress in Kassel 1960, part 3: Board meeting guests of honor b) Board meeting (A-Z). 29 Bamberger to Secretary to the Board Joachim Wolff, 15 June 1961, Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 70, DGK 1961 – 1962, correspondence 1 January 1961 – 14 October 1961. 30 See Board of the German Society of Pediatrics, “Mit ärztlichem Berufsethos unvereinbar”, in: Ärztliche Mitteilungen 46, 1961, 1519.

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of Heidelberg played a major role in formulating this statement. However, he was not the one who took the initiative, as documented by files from the Ministry for State Security of the German Democratic Republic (GDR, Deutsche Demokratische Republik). According to the copy of a letter to Bamberger from Ulrich Köttgen (1906 – 1980), Director of the Children’s Hospital of the University of Mainz, Köttgen submitted to the Board an application that proposed issuing a public statement. He was a social pediatrician, who had been forced to leave his position as senior physician at the Children’s Hospital of the University of Jena during the war because of the critical distance to National Socialism he maintained.31 In his letter to the chairman of the Board, Köttgen referred explicitly to a statement by the Hamburg Medical Association in 1961, according to which approval had been allegedly granted by the parents in all cases of Nazi child euthanasia in Hamburg-Rothenburgsort.32 Köttgen wrote to Bamberger : “It is not only my opinion that it [the statement] says that the pediatrician is exonerated significantly from killing a child if the parents’ consent is given. Such an approach appears to be particularly questionable since, unfortunately, it is not very rare that such requests are made in concealed form by the parents. I have absolutely no intention to actively intervene in the lawsuit against Mr. Catel and the other physicians involved in any way. However, I feel it is absolutely necessary to clearly express that the parents’ approval of a punishable crime committed against a child does not relieve the physician from his responsibility in any way whatsoever. I am convinced that German physicians, in particular the closer colleagues of our discipline will be exposed to serious and justified criticism at home and abroad if they do not 31 President Hermann Olbing’s opening speech at the annual congress in Düsseldorf in 1981 featured a commemoration of Köttgen. “His resolute refusal to adapt to the zeitgeist of National Socialist Germany cost him first his position as assistant medical director at the children’s hospital of the University of Jena, and later on a position at a state psychiatric hospital.” Opening speech of the 77th congress in Düsseldorf, in: Monatsschrift für Kinderheilkunde 130, 1982, 325 – 329, here 329. See Köttgen’s autobiographic writings, according to which the head of the Children’s Hospital in Jena, Jussuf Ibrahim, told him in 1936 that, for political reasons, his prospects at the university were bleak and advised him to take over the surgery of an exiled Jewish colleague in Meiningen. Ulrich Köttgen, “50 Jahre medizinisches Lernen und Lehren in der Kinderheilkunde” (Vortrag gehalten 1977 am Medizinhistorischen Institut Mainz), in: Gunter Mann, Franz Dumont (eds.), Medizin in Mainz: Sonderdruck: Praxis und Wissenschaft. Entwicklungen und Erinnerungen. 40 Jahre Medizinische Fakultät und Klinikum 1946 – 1986, Mainz: Kirchheim 1986, 280. Köttgen was not a member of any of the Nazi organizations. During the war he was a medical officer with the rank of reserve senior medical officer. In 1944 Johann Duken named Köttgen as his second choice for a vacant chair, since he was “definitely talented and conscientious”. But, Duken also characterized Köttgen as being a “bit soft” (“er hat etwas weichliches”). Federal Archive of Berlin (BDC). 32 See N.N., “Approbation wird nicht entzogen: Gemeinsame Erklärung der Hamburger Gesundheitsbehörde und der Ärztekammer Hamburg”, in: Ärztliche Mitteilungen 46(5), 1961, 234 – 235.

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express that the old ethical laws of the medical profession still also apply to them. I felt it was necessary that especially the German Society for Pediatrics issue an appropriate statement to the public [,] and would, hereby, like to apply for this.”33

This application had prompted Philipp Bamberger to consult a trusted colleague, pediatrician Hans Asperger of Vienna, and to submit a question to the other members of the Board on the issue of euthanasia, which may well have evoked a wide range of opinions. Also Asperger demanded that the DGK take a stand against Catel and any euthanasia forms: “This must be opposed by the consciousness of mankind, which has prevailed since Hellenism and in particular throughout the entire history of Christianity, that innocent people may not be killed and that there is no unworthy life. According to my conviction, this is not only a demonstration of shocking value blindness, but also of a non-understanding of human relationships and psychological circumstances by someone who believes one is allowed […] to annihilate human life and dispose of misfortune by killing the reason for it.”34

Already on 24 January 1961, one week after Köttgen’s application Bamberger had sent a draft of a statement to all members of the Board, asking them for their opinion. In June he informed Secretary to the Board Joachim Wolff about the results. The draft was accepted by eleven members and rejected by five.35 This meant the required two-thirds majority had been achieved. The following statement was published in 1961: “Several articles that deal with the killing of incurable imbecile or severely physically deformed children carried out during the war have recently been published in the German press. The Board of Directors of the German Society of Pediatrics asserts in response that the destruction [of life], even of so-called “life unworthy of living”, can on no account be reconciled with the ethos of the medical profession.”36

We do not know who rejected the draft. The statement was intended not only as a means of distancing the organization from Werner Catel. The “annihilation of unworthy life”, radically propagated since the early twenties and still the subject of debate among physicians in the 1950s, was dismissed by the Board with reference to professional ethics. Remarkably enough, whereas quotation marks are used in order to display a critical distance the wording was still based on common dehumanizing terminology. Beyond that, the defensive nature of the 33 Köttgen to Bamberger, 13 January 1961, Abschrift. BStU, Archiv der Zentralstelle, MfS. HA XX, no. 4120, Bl. 13. 34 Asperger to Bamberger, 2 February 1961, Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 80, DGK 1961/62, 1. Bamberger’s correspondence, part 2 b) A-C. 35 Bamberger to Wolff, 15 June 1961, Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 70, DGK 1961 – 1962, correspondence 1 January 1961 – 14 October 1961. 36 See footnote 30.

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statement cannot be denied. No admission of guilt by the DGK was connected to this statement. At this point in time, when German pediatricians had at last caught up with the international pediatrics profession, the Board chose not to incriminate itself by using phrases that indicated the involvement of pediatricians in medical murders or crimes against humanity. Especially as no legally binding sentences had yet been passed against the protagonists of Nazi child euthanasia. A year later Werner Catel published his first apologia, Grenzsituationen des Lebens: Beitrag zum Problem der begrenzten Euthanasie (“Borderline Situations in Life. Article on the Problem of Limited Euthanasia”). He was the only one of about 50 former “euthanasia” experts to propagate in public a legal regulation for “limited euthanasia”. He differentiated between “euthanasia in a strict sense” and “euthanasia in a broader sense”.37 He understood “euthanasia in a strict sense” as alleviating the suffering and shortening the life of terminally ill human beings by physicians. He defined “euthanasia in the broader sense” as the “annihilation” of infantile idiots, so-called “monsters”, as well as adults with terminal mental illnesses. Catel demanded that a three-man expert panel be set up – a striking analogy to the Reich Committee (Reichsausschuß) – but now consisting of a public health officer (“Amtsarzt”), a medical specialist (“Spezialarzt”, not otherwise specified, presumably a pediatrician but not – as demanded by Catel on the very spot – the responsible general practitioner) and a judge, in order to decide about the “annihilation” of the “monsters”.38 Catel polarized opinions in the field of medical ethics. On the one hand, the correspondence he received documents the broad consent and approval of fellow physicians.39 On the other hand, the reviews, especially those by pediatricians, were of a more critical nature. The Swiss pediatrician Adolf Hottinger of the Children’s Hospital in Basel summarized his criticism: “The book is a dangerous book. It can surely be interpreted as apologia of a man who now defends a viewpoint he already took up in the past and also for deeds he carried out in the past.”40 In his review, the Swiss pediatrician Guido Fanconi assumed that Catel had a degenerated heart. Fanconi, who advocated that German pediatrics be readmitted to the international scientific community, closed with the words: “But if today, […], a failed man like Catel supports euthanasia, the mind of a 37 See Werner Catel, Grenzsituationen des Lebens: Beitrag zum Problem der begrenzten Euthanasie, Nürnberg: Glock & Lutz 1962, 101 – 110. 38 See ibid., 124. 39 Catel’s papers, Archive for Pediatrics and Adolescent Medicine in Berlin. It includes letters and book reviews by Friedrich Hartmut Dost, pediatrician and Catel’s former assistant in Leipzig, who shared his arguments in favor of “limited euthanasia”. 40 Adolf Hottinger, book review of Grenzsituationen des Lebens, in: Hippokrates, 1962, 815 – 817, here 817.

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Swiss man who tends towards leniency comes to a standstill and he casts this dangerous book aside with disgust.”41 German colleagues also expressed criticism. Gerhard Weber, professor in Munich and later chairman of the DGK, pointed out that Catel had not mentioned the Nazi medical killings at all and repeated the polemizing words of his colleague in Frankfurt, Bernhard de Rudder : “The physician is not a butcher!” (“Der Arzt ist kein Abdecker!”).42 The most comprehensive reaction came from the young social pediatrician Theodor Hellbrügge (1919 – 2014), who had trained under Weber in Munich. Hellbrügge had initially given a lecture at the request of the Catholic Academy in Bavaria. He compiled a nine-page paper entitled Ärztliche Gesichtspunkte zu einer ‘begrenzten Euthanasie’ (“Medical Aspects of ‘Limited Euthanasia’”) which was published in the Ärztliche Mitteilungen.43 Hellbrügge used the literature on Nazi medical crimes, which was accessible at the time, to expose Catel’s work as an apologetic piece. At the same time he was very aware that the euthanasia problem was a burning issue given the “Contergan/thalidomide catastrophe”, the births of handicapped children after the mother had taken the drug thalidomide during the early pregnancy.44 And around this time it became public that a mother who had had her deformed child killed with the assistance of a physician had been acquitted in the Belgian town of LiÀge. The child’s disability was traced back to the mother taking medication – thalidomide – during her pregnancy. The population of LiÀge staged a celebration in the streets after successfully campaigning for the parents’ acquittal. Hellbrügge concluded that, “as a medical problem, the elimination of ‘unworthy’ life was by no means exclusively an issue of the National Socialist era”.45 41 Guido Fanconi, book review of Grenzsituationen des Lebens, without details [Münchener Medizinische Wochenschrift 105, 1963, 1434.]. I would like to express my gratitude to his son, Andreas Fanconi in Zurich, Switzerland for the copy of this review. 42 See Gerhard Weber, book review of Grenzsituationen des Lebens, in: Monatsschrift für Kinderheilkunde 110, 1962, 543. Bernhard de Rudder had already referred to the Nazi “euthanasia” during the annual congress of the Society in Munich in 1959. In his lecture entitled “Medical Aspects of the World of Children” he denied in principle any ethical or judicial reasoning for abortion and based his argumentation to a certain extent on the past. Any easing of medical standards ultimately results in misuse and conditions which would have culminated “in medical murder not too long ago”. See brief information on the 58th congress of the DGK, Munich, September 1959. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 60, DGK 1960, correspondence 6 August 1960 – 31 December 1960. 43 See Theodor Hellbrügge, “Ärztliche Gesichtspunkte zu einer ‘begrenzten’ Euthanasie”, in: Ärztliche Mitteilungen 60(25), 1963, 1428 – 1440. 44 See N.N., “Mißgeburten durch Tabletten? Alarmierender Verdacht eines Arztes gegen ein weitverbreitetes Medikament”, Welt am Sonntag, 16 November 1961. See Beate Kirk, Der Contergan-Fall: eine unvermeidbare Arzneimittelkatastrophe? Zur Geschichte des Arzneistoffs Thalidomid, Stuttgart: Wissenschaftliche Verlagsgesellschaft 1999. 45 Hellbrügge, 1963, 1428.

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As one of the very first representatives of a younger generation of postwar physicians, in his article Hellbrügge presented a well-founded continuity argument, based constitutively on the broad status of research on Nazi euthanasia crimes in terms of medical ethics. Although he was inspired by the works of Alexander Mitscherlich and Fred Mielke, Hellbrügge’s text was developed independently and addressed almost all of the central features that can be observed about 20 years later in the broad historiography of National Socialist medical science in the 1980s:46 First, the elimination of the practice of temporally isolating the years from 1933 to 1945 by embedding the Nazi medical crimes in long-term developments of the 20th century, resulting in, second, the critical rejection of the myth of the abuse of medical science in National Socialism, which was widespread at this time. Third came the renunciation of the myth of an allegedly small group of ideological, fanatic perpetrators, based on the acknowledgement of a particular responsibility for the ”crimes against humanity” borne by the German medical profession and the resulting historical responsibility ; and fourth, the formulation of a moral declaration committing the profession to learn the lessons from historical experiences and incorporate them in its medical (and medical-ethical) identity of the present and future. The internal debate at the DGK intensified in 1962, when two Swiss colleagues declared they would leave the Society if Werner Catel and Wilhelm Bayer remained members. The pediatrician Bayer had killed children selected by the Reichsausschuß at his private hospital in Hamburg Rothenburgsort during the war ; however, like Catel, he had not been charged following preliminary investigations by the Hamburg Court in 1948/1949, because incriminated evidence no longer existed47 and the accused pediatrician “could not be proved [to have had] an awareness of injustice”.48 The court assumed it would be impossible to prove that the physicians had felt any sense of wrongdoing. The Swiss doctors Ernst Freudenberg (1884 – 1967) and Adolf Hottinger (1897 – 1975) insisted that 46 For the continuity paradigm created in the 1970s and 1980s in contrast to the isolation paradigm of the direct post-war period, see: Volker Roelcke, “Trauma or Responsibility? Memories and Historiographies of Nazi Psychiatry in Postwar Germany”, in: Austin Sarat, Nadav Davidovich, Michal Alberstein (eds.), Trauma and Memory : Reading, Healing, and Making Law, Stanford: Stanford University Press 2007, 225 – 242. 47 The University Department and Hospital of Pediatrics in Leipzig was partially destroyed by bombs of the Allied Forces in December 1943. According to statements made by witnesses heard by the State Security Service of the GDR, Catel’s former assistant medical director Hans-Christoph Hempel, who was directly involved in killing children at the Leipzig Kinderfachabteilung, destroyed medical records and X-ray films after the war. See Henry Leide, NS-Verbrecher und Staatssicherheit: Die geheime Vergangenheitspolitik der DDR, Göttingen: Vandenhoeck & Ruprecht 2005, 333. 48 District Court of Hamburg (14 Js 265/48), ruling in the criminal case against Wilhelm Gerhard Adolf Bayer, and also Werner Catel, dated 19 April 1949, 4 and 6: Papers of Werner Catel, Archive for Pediatrics and Adolescent Medicine in Berlin.

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their request be granted in spite of these circumstances, and applied for Catel and Bayer to be expelled. Freudenberg had worked in Marburg (1922 – 1937) and Hottinger in Düsseldorf (1929 – 1933: emigration to Basel/Switzerland) before the war.49 Freudenberg had been forced to step down in Marburg in 1937 based on the “Law for the Restoration of the Professional Civil Service” (Gesetz zur Wiederherstellung des Berufsbeamtentums) after refusing to divorce his wife of Jewish origin. He emigrated with his family to Basel/Switzerland in 1938 and resigned from the DGK in 1939.50 Hottinger had been excluded from the same.51 So how did the Board react in 1962? Chairman Bamberger advised Bayer and Catel to resign of their own accord. Bayer reacted to Bamberger’s letter by announcing his resignation effective at the end of 1962.52 After consulting his lawyer Fabian von Schlabrendorff, Catel refused to resign.53 Catel was obviously hoping for all allegations to be invalidated by the outcome of the preliminary proceedings in Hanover, which he expected to be positive. According to the charter, the procedure for Catel’s expulsion could not be initiated until the next 49 See Gerhard Stalder, “In Memoriam Adolf Hottinger”, in: Monatsschrift für Kinderheilkunde 123(10), 1975, 721. Samuel Buchs, Heribert Berger, “Prof. Adolf Hottinger – on his 60th birthday on 21 November 1957”, in: Schweizerische Medizinische Wochenschrift, 87(47), 23 November 1957, 1407 – 1408. 50 His resignation was the result of the dispute between Freudenberg and the chairman of the Society in 1939, Franz Hamburger, about his appeal to boycott the journal Annales Paediatrici (formerly Jahrbuch für Kinderheilkunde [“Annual for Pediatrics”]), which was published under this new title by the Jewish publisher Karger under the editorship of Freudenberg. In 1937 the Karger family business had to emigrate to Switzerland as well. See Lennert, 1995. Michael Bernhard, Der Pädiater Ernst Freudenberg, 1884 – 1967, Marburg: Tectum 2001, 61 – 72. Kornelia Grundmann, “Ernst Freudenberg und die Entwicklung der Pädiatrie in Marburg”, in: Verein für hessische Geschichte und Landeskunde (ed.), Günter Hollenberg, Aloys Schwersmann (Red.), Die Philipps-Universität Marburg zwischen Kaiserreich und Nationalsozialismus, Kassel: Verein für Hessische Geschichte und Landeskunde 2006, 193 – 206. Also Seidler, 2007. 51 Correspondence between Gerhard Joppich and Adalbert Loeschke, 26 – 27 November 1966 on the honorary membership awarded to Hottinger, which was intended as an “act of reconciliation”. Joppich assumed the expulsion from the Society was based at the time on political reasons, especially as Hottinger had a Jewish wife; collection of the correspondence of Adalbert Loeschke, Archive for Pediatrics and Adolescent Medicine in Berlin. Hottinger had gratefully accepted this type of rehabilitation. See Stalder, 1975, 721. 52 Bamberger to Wolff, 9 January 1963 with the demand to remove Bayer from the register of members. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 71, DGK 1961 – 63, correspondence 1 January 1963 – 10 September 1963, A-G. 53 Note by Secretary to the Board Wolff regarding a telephone call with the new chairman, Bennholdt-Thomsen, 19 January 1963. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 71, DGK 1961 – 63, correspondence 1 January 1963 – 10 September 1963, A-G. Fabian von Schlabrendorff was one of the group of officers during the war who organized the assassination attempt on Hitler on 20 July 1944 and only narrowly escaped being sentenced by the Volksgerichtshof. His book Offiziere gegen Hitler : Nach einem Erlebnisbericht was published in 1946 (Zürich: Europa Verlag) and there have been many editions since.

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general meeting. This congress was to take place in September 1963 in Cologne under the direction of Carl-Gottlieb Bennholdt-Thomsen. The Board rejected a second application from Felix von Bormann before the congress in Cologne. Bormann had requested information on whether the Society had issued a statement on the “annihilation of unworthy life” during the war. Obviously, his intention was to signal to the Board that they had no right to oppose Catel, as the DGK had been silent at the time. Secretary to the Board Wolff explained to Bormann that he had no time to search through old files for hours.54 A brief internal note was made with regard to Bormann: “With this our blades have probably crossed.” (“Damit haben sich die Schwerter wohl gekreuzt.”).55

1963: Bennholdt-Thomsen’s chairmanship and the annual congress in Cologne Unlike any other chairman before him, Carl-Gottlieb Bennholdt-Thomsen (1903 – 1971)56 attempted to solve the Catel dispute by arbitration right from the beginning of his term in office. He hoped to find support from other pediatricians who were particularly close to Catel. He thought of Friedrich Hartmut Dost, who had been Catel’s assistant in Leipzig during the war and had maintained a friendly relationship with Catel since the 1950s. When Dost raised the issue, this almost caused a crisis in his relationship with Catel.57 With the failure 54 Wolff to Bormann, 3 April 1963. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 85, correspondence on the congress in Cologne in 1963, part 4a) A-J. 55 Replying to Bormann’s letter to Carl-Gottlieb Bennholdt-Thomsen, 3 April 1963 by registered mail. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 85, correspondence on the congress in Cologne in 1963, part 4a) A-J. 56 Assistant at the Children’s Hospital of the University of Greifswald (de Rudder) 1932 – 1935, habilitation in 1935, assistant medical director at the Children’s Hospital of the University of Frankfurt/Main (de Rudder) 1935 – 1940, provisional head of the German children’s hospital of the University of Prague from 1 October 1940, extraordinary professor from 15 August 1941, ordinary professorship from 27 September 1943, head of the Children’s Hospital of the University of Prague; member of the NSDAP since 1 May 1937, membership no. 5427160, member of the NSDÄP, National Socialist Lecturers’ Association, the NSV, provisional regional physician 13 of the HJ (HJ division commander) until 1 October 1940, consulting physician of the command post of the HJ for Bohemia and Moravia by order of the Reich Youth Leadership, 1944 primo loco for chair in Hamburg (after the arrest and withdrawal of Rudolf Degkwitz). According to Johann Duken’s assessment in January 1944, B.-T. was suitable for the chair from a scientific point of view. “As an individual, B.-T. is not very welcome. He is very ambitious and has the corresponding submissive attitude wherever he sees a chance to be promoted.” Appointed to the Chair in Hamburg, January 1945. Federal Archive of Berlin (BDC). 57 “To confirm my previous point of view, I would like to let you know that I have no intention to resign from the German Society for Pediatrics. […] If, however, the Board of the Society nevertheless makes an attempt to expel one of its oldest members without any reason, I am authorized to let you know that this would have legal consequences […]. I am very sad that

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of this strategy, Bennholdt-Thomsen traveled to Kiel to visit Catel. The meeting was a matter of delicacy, as during the war Bennholdt-Thomsen himself had been approached by Hitler’s Chancellery and offered the directorship of a killing ward at one of the two children’s hospitals in Prague, of which BennholdtThomsen was the provisional director under Professor Herrmann Mai (1902 – 2001).58After his journey to Kiel Bennholdt-Thomsen had to admit to the Secretary to the Board: “The issue concerning Catel has not been solved yet. He still thinks that his behavior at the time was absolutely justifiable, even though he has the feeling that initially he had not been told the truth.”59

Although no minutes of the congress in Cologne have survived, it is certain that there was a heated debate. After the congress Hannah Uflacker returned her membership card to the Secretary to the Board with the explanation: “The events at the Congress of Pediatricians in Cologne in 1963 […] have clearly shown that arrogance and intolerance regrettably prevail, in particular among the old and elder members, to such a degree that satisfactory cooperation and an objective debate about scientific questions is no longer ensured at all, even resulting in personal defamation. It has therefore become intolerable for me to belong to the German Society of Pediatrics.”60

Not only the demand for Catel’s expulsion was addressed in Cologne, but also the euthanasia problem. The social pediatrician Ulrich Köttgen of the Children’s you have been approached with regard to this issue and I would like to request you to no longer commit yourself in any way, due to the friendly bond between the two of us.” Letter from Catel to Dost, dated 6 February 1963. Catel’s papers, Archive for Pediatrics and Adolescent Medicine in Berlin. 58 Whether the planned Kinderfachabteilung was actually implemented is still unclear. The State Secretary of the Reichsprotektor of Bohemia and Moravia, Karl Hermann Frank, expressed his general consent in 1942; however, he asked for “the issue to be tabled until further notice”, since the issue of the inclusion of Czech children as “Germanizable families” had to be clarified first. See Michal Sˇimu˚nek, “Planung der nationalsozialistischen ‘Euthanasie’ im Protektorat Böhmen und Mähren im Kontext der Gesundheits- und Bevölkerungspolitik der deutschen Besatzungsbehörden (1939 – 1942)”, in: Michal Sˇimu˚nek, Dietmar Schulze (eds.), Die Nationalsozialistische “Euthanasie” im Reichsgau Sudetenland und Protektorat Böhmen und Mähren 1939 – 1945, (Studies in the History of Sciences and Humanities, Vol. 22), Prague: Mervart 2008, 117 – 198, here 182 – 183. Bennholdt-Thomsen merged the two existing children’s hospitals during his term of office and, furthermore, seized the Czech children’s hospital without consulting its Czech staff. See ibid., 188. 59 Bennholdt-Thomsen to Wolff, 12 March 1963. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 71, DGK 1961 – 1963, correspondence 1 January 1963 – 10 September 1963, A-G. Original emphasis. 60 Hannah Uflacker to Wolff, 4 April 1965. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 75, DGK 1964 – 65, correspondence, 11 November 1964 – 12 April 1965 d) S-Z.

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Hospital of the University of Mainz gave a lecture about the situation of mentally and physically handicapped children, criticizing Germany’s deficit with regard to their rehabilitation and integration. He reported about the beginning of the parents’ association called Lebenshilfe für das geistig behinderte Kind (“Life Aid for the Mentally Retarded Child”), which had existed in Marburg since 1958.61 The final comments of Köttgen’s lecture were formulated under the influence of the debate about Catel in Cologne: “When one sees this broken creature, which is not seldom degraded almost to an animal by its environment, one would like to quote the apostle Paul: ‘For the creation waits with eager longing for the revealing of the sons of God.’ Ahead of us is an unmistakable demand. In Germany, we have fallen back to ancient times and bestial behavior in a horrendous manner with so-called euthanasia, the murder of such children. Let us not be satisfied with incriminating others, but show by active commitment that we are mature people of our time.”62

The discussion following Köttgen’s lecture includes a comment from the daughter of the psychiatrist Robert Gaupp,63 Vera Gaupp,64 a pediatrician from Stuttgart who had been a member of the extended Board in 1959: “I am grateful to Professor Köttgen for his critical statement regarding the concept of euthanasia. It is our job to foster, not kill. Pediatricians are seldom approached by parents with the wish for euthanasia. In fact, we admire the agape of the parents of aggrieved children, whom we neither can nor want to do without. I suggested years ago to distance oneself from Catel’s thoughts regarding euthanasia.”65 61 This organization was founded by Thomas Mutters and supported by the (child) psychiatrist Werner Villinger, a former “euthanasia” expert of the Aktion-T4 killing program. See Rolf Castell et al., Geschichte der Kinder- und Jugendpsychiatrie in Deutschland in den Jahren 1937 – 1961, Göttingen: Vandenhoeck & Ruprecht 2003, 387 – 394. For details on Villinger and the Lebenshilfe (“Life Aid”) organization, refer also to: Ruth Baumann, Charlotte Köttgen, Inge Grolle, Arbeitsfähig oder unbrauchbar? Die Geschichte der Kinder- und Jugendpsychiatrie seit 1933 am Beispiel Hamburgs, Frankfurt/M.: Mabuse 1994, 199 – 213. 62 See Ulrich Köttgen, “Lebenshilfe für das geistig behinderte Kind, Aufgabe und Entwicklung”, in: Monatsschrift für Kinderheilkunde 112(4), 1964, 204 – 206, here 206. 63 Since the 1920s Robert Gaupp had propagated eugenics, forced sterilization and also the “approval of the annihilation of unworthy life” called for by Binding and Hoche. See HansWalther Schmuhl, “Zwischen vorauseilendem Gehorsam und halbherziger Verweigerung. Werner Villinger und die nationalsozialistischen Medizinverbrechen”, in: Nervenarzt 73, 2002, 1058 – 1063, here 1058 – 1059. 64 Born in Heidelberg on 6 March 1904, Vera Gaupp passed the medical state examination in Munich in 1927 and subsequently worked at the second medical clinic in Munich under the direction of Professor Kämmerer. See her vita in the dissertation Über Dispersionsverhältnisse der Plasmaeiweißkörper bei Lues III (“About the dispersion ratios of plasma protein with Lues III”) (Prof. Dr. von Romberg), printing office of the Tübingen Students’ Union, Tübingen 1928. No documents on membership in National Socialist organizations could be found at the BDC, Federal Archive of Berlin. 65 Vera Gaupp, “Aussprache”, in: Monatsschrift für Kinderheilkunde 112, 1964, 208.

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If further hearings with Freudenberg and Hottinger took place regarding the expulsion of Catel, particularly following the events in Cologne, unfortunately no record remains. In mid-December 1963 Bennholdt-Thomsen pointed out that as Freudenberg had still not replied to an enquiry, “this buck had to be passed” on to the new chairman.66 When Bennholdt-Thomsen stood down as chairman in order to be succeeded by Gerhard Weber, he wrote: “Today, […], I would like to pass the baton of Chairman of the German Society for Pediatrics on to you. You will find out that, apart from the Catel issue and the congress, the chairmanship will by no means put you under the same strain as your rectorship.”67

1964 – 66: The chairmanships of Gerhard Weber, Hermann Mai and Adalbert Loeschke – “No intervening in a pending lawsuit” But why had no decision been made yet on the exclusion of Catel by 1963? Bennholdt-Thomsen’s attempts to mediate between the irreconcilable parties were not resumed by his successors. Weber, especially, was known as a critic of Catel.68 The delay was due to pending preliminary proceedings against Heinze, Catel, Wentzler and Uflacker at the District Court of Hanover. The wording used by Weber in a letter to his colleague Hermann Mai was: “You are probably aware of my attitude towards Mr C. The matter is temporarily suspended under the motto ‘no intervening in a pending lawsuit.’ However, I entirely share your opinion that the issue has by no means been settled.”69 In fact, no significant steps were taken by the Board until 1965. At the end of his term Weber enquired of the legal authorities whether the case had been closed.70 In February 1965 Catel informed the Board that the preliminary proceedings had been concluded, allegedly to his advantage.71 The District Court of Hanover had closed the 66 Bennholdt-Thomsen to Wolff, 16 December 1963. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 83, DGK 1963, part 1 c) gen., congress in Cologne in 1963. 67 Bennholdt-Thomsen to Gerhard Weber, 31 December 1963, ibid. 68 See footnote 42. 69 Weber to Hermann Mai, 3 April 1964. The secretary to the Board had already used a similar formulation for Hannah Uflacker in January 1964, when trying to dissuade her from resigning from the Society. Wolff to Uflacker (forwarded to Weber), 14 January 1964. Archive for Pediatrics and Adolescent Medicine in Berlin. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 91, DGK 1964, 1st correspondence on the congress in Munich 1964, part 5, Hefter charter. 70 Weber to the Zentrale Stelle der Landesjustizverwaltungen Ludwigsburg, 30 December 1964. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 74, DGK 1964, correspondence 11 November 1964 – 12 April 1965 a) gen. 71 Catel to Mai, 5 February 1965. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 74, DGK 1964, correspondence 11 November 1964 – 12 April 1965 a) gen. With this letter, Catel announced his intention to defend himself against the accusations in the

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criminal proceedings against Catel, Wentzler and Uflacker. The child killings had been classified as only manslaughter, not murder. As this statutory offence was subject to the statute of limitations, it could no longer be prosecuted in 1960.72 Now the Board had to deal with the Catel dispute once more, which was very awkward for the new chairman Hermann Mai. His own past might have forced him to hold back. In the the period of National Socialism he was a member of the NSDAP and the SA. In August 1939 he was recruited by the SS, even by the security service (Sicherheitsdienst) of the SS.73 Between 1936 and 1939 he was involved as a medical assessor in at least 24 lawsuits in which decisions were made on the forced sterilization of citizens of Munich according to the GzVeN at the Hereditary Health Court (Erbgesundheitsgericht) in Munich.74 The life of Hermann Mai offers several sources of future research, since after the end of the war he collaborated with his colleague and friend Albert Schweitzer (1875 – 1965) in Lambar¦n¦ and made sure the hospital there continued to exist after Schweitzer’s death.75 In 1983 the DGK campaigned for children in the ‘Third World’ and started the Hermann Mai Foundation, which still exists.76

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form of a monograph. This second apologia appeared a year later. See Werner Catel, Leidminderung richtig verstanden: Mit einer Einleitung von Fabian von Schlabrendorff, Nürnberg: Glock & Lutz 1966. Niedersächsisches Landesarchiv – Hauptstaatsarchiv Hannover, Nds 721 Hannover Acc. 90/ 99 no. 33/11, preliminary proceedings against the head of the Adolescent Psychiatric Asylum of the State Psychiatric Hospital in Wunstorf, Professor Dr. med. Hans Heinze, born in 1895, on the charge of murder et al., volume 11, 1964 – 169, grounds for the judgement in the process against Hans Heinze, Ernst Wentzler, Werner Catel and Hanna Uflacker, 176 – 177. Member of the SS since May 1937, membership no. 353219, from 20 April 1940 SS-Untersturmführer, member of the NSDAP from 1 May 1937, membership no. 4458713 and of the SA from 30 October 1933, HJ in 1935, member of NSD-Dozentenbund, DAF, NSV and NSDÄrztebund. Federal Archive of Berlin (BDC). It is still not clear whether he ever worked for the security service. In October 1945 Mai told the Chancellor of Westphalian Wilhelm University in Münster, Georg Schreiber, that he was not allowed to serve with the SS because he had joined the Wehrmacht at the beginning of the war. He was only slated to join the SS in the event of leaving the Wehrmacht. However, he was listed by the SS during this period without any influence of his own. Mai to Chancellor Schreiber, 7 October 1945. University Archives in Münster, inventory 242, file 283, vol. 1, no pag. Inventory of the Hereditary Health Court in Munich (individual lawsuits) at the State Archives in Munich. I would like to thank Dr. Annemone Christians from the Institute for Contemporary History in Munich/Berlin for our constructive exchange and her valuable references to case files involving Mai. For the practice of forced sterilization in Munich see also her current study : Annemone Christians, Amtsgewalt und Volksgesundheit. Das öffentliche Gesundheitswesen im nationalsozialistischen München, Göttingen: Wallstein 2013. http://www.schweitzer.org/german/personen/hermann_mai.htm (8 November 2008). See also Hermann Mai, “Gelebte Ethik in Lambarene”, in: Helmuth Müller, Hermann Olbing (eds.), Ethische Probleme in der Pädiatrie und ihren Grenzgebieten, München, Wien, Baltimore: Urban & Schwarzenberg 1982, 291 – 297. The purpose of the foundation is: “1. to prepare physicians, in particular from the Federal Republic of Germany, for activities promoting the health of children in the Third World; 2. to

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On the occasion of the newly pending decision on the case of Catel, in 1965 Mai tried several times to include Bennholdt-Thomsen in the consultations. Bennholdt-Thomsen refused, reasoning that “it is not possible for every chairman to fall back on his predecessor, this predecessor on his deputy etc. in the event of unpleasant issues.”77 Yet Mai insisted, fearing the escalation of the conflict regarding Catel’s expulsion at the forthcoming general meeting on the North Sea island of Norderney. He wrote to Bennholdt-Thomsen: “I am by no means trying to avoid these things, but I think it is my duty to make enquiries about the exact proceedings. Especially since they were held verbally to a great extent, […]. Does a corresponding application by Degkwitz actually exist? […] I can envisage the two members of our society, Degkwitz and Catel, both turning up in Norderney at the same time and then pressing ahead with the issue in their own way. All magazines would then be able to publish special issues.”78

The Board took pains to obtain the reasoning of the court in writing.79 Catel and his lawyer Fabian von Schlabrendorff refused to disclose the documents, using the protection of personal rights as an excuse.80 The judicial grounds would have indeed revealed to the Board the entire extent of the murder program. Catel knew how to prevent this. As a result, the Board lacked a reason to press ahead with the expulsion of Catel. Furthermore, Adalbert Loeschke,81 Head of the Children’s

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support projects for the direct prophylaxis and therapy of prevalent health disorders in deprived countries and the education of native physicians and health workers.” Charter of the H-M foundation (http://www.tropical-paediatrics.de/hermann-mai-foundation.html, 22 August 2014). See also charter 1983, Archive for Pediatrics and Adolescent Medicine in Berlin, folder 1, DGK Hermann-Mai Stiftung 1988 – 1993. From Mai’s letter to Bennholdt-Thomsen, 12 March 1965. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 74 DGK 1964, correspondence 11 November 1964 – 12 April 1965 a) gen. Ibid. Rudolf Degkwitz had already declared in 1964 that he first wanted to await the ruling of the court before publishing about Catel and the courts. He declined the invitation of Chairman Weber to take part in an event of the Society in Germany with the words: “…, but I do not want to be responsible for a repeat of the instance with Heyde, Schleswig-Holstein.” Rudolf Degkwitz to Weber, 29 August 1963(64). Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 75, DGK 1964 – 65, correspondence 13 April 1965 – 31 July 1965 a) gen. Heyde committed suicide (13 February 1964) on the eve of the euthanasia trial, which had been prepared with strong efforts by the Frankfurt General Public Prosecutor Fritz Bauer. Decision of the close circle of the Board during the extraordinary meeting of the Board in Regensburg on 12 June 1965, attended by Mai, Weber, Adalbert Loeschke, Asperger, Paul Frick, Wolff and, at the express request of the Board, Bennholdt-Thomsen. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 75, DGK 1964 – 65, correspondence 13 April 1965 – 31 July 1965 a) gen. Orientation on the current state of affairs regarding Professor Catel, Mai to Wolff, 15 August 1965. Archive for Pediatrics and Adolescent Medicine in Berlin, archive box 76, DGK 1965, correspondence 1 August 1965 – 31 December 1965 a) gen. Member of the SA since 1933, member of the NSDAP since 1 May 1937, 1932 – 1941 at the

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Hospital of the Free University of Berlin and Chairman of the Society in 1966, had been on good terms with Catel for years.82 It was Loeschke who supported the professional career of Catel’s former medical assistant Hans-Joachim Hartenstein in the 1960s upon Catel’s request. He also corresponded with Ernst Wentzler and acted as his adjutant in Berlin.83 Finally, Loeschke sponsored the child psychiatrist Gerhard Kujath until 1969, who must have known – back during the war – about child killings at the Kinderfachabteilung Berlin-Wittenau.84 A decision about Catel was delayed until 1967. The turning point came in the seventh consecutive year of this controversy, after seven Boards had hoped to find a solution. Catel declared his resignation on 4 July 1967. He referred the designated president, the Viennese pediatrician Hans Asperger (see above), to article 6 of the Convention on Human Rights (principle of the presumption of innocence) and complained about years of “persecution” and “defamation” by colleagues, in particular by Rudolf Degkwitz and Theodor Hellbrügge. He cited the lack of his own rehabilitation by the DGK as the main reason.85 This brought the “Catel dispute” to an end. Ten years later, when Friedrich Hartmut Dost received an invitation to a congress of the DGK planned in Kiel, he replied to the organizer Hans-Rudolf Wiedemann that he refused to take part as a matter of principle, since the congress was to take place in this very town:

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Children’s Hospital of the University of Cologne (Kleinschmidt), habilitation in 1936, 1942 extraordinary professor, 1939 medical officer, indispensable position as medical director of the Children’s Hospital of Cologne, 1941 head of the Municipal Children’s Hospital of Litzmannstadt (organization of the hospital). Federal Archive of Berlin (BDC). For details on Loeschke’s postwar career, see Gerhard Joppich, “In memoriam Adalbert Loeschke 1903 – 1970”, in: Monatsschrift für Kinderheilkunde 118, 1970, 469. Loeschke to Catel, 25 June 1959, correspondence of Adalbert Loeschke, folder C-E, Archive for Pediatrics and Adolescent Medicine in Berlin: “I have always admired your intelligence, your working power and your ability to summarize complex problems, just like others certainly do. Some people feel uncomfortable about your critical attitude towards medical issues raised. I think that’s not right. Nowadays, too many things are approved, applauded or accepted in silence. One is afraid to make enemies – which to me is the most cheerless sign of intellectual levelling at present. […] That you were different in this respect was something that I, who am ten years younger than you, have always liked about you.” See the correspondence of Adalbert Loeschke, Archive for Pediatrics and Adolescent Medicine in Berlin. Ibid. For details on Kujath, see Martina Krüger, “Kinderfachabteilung Wiesengrund: Die Tötung behinderter Kinder in Wittenau”, in: Arbeitsgruppe zur Erforschung der Geschichte der Karl-Bonhoeffer-Nervenklinik (ed.), Totgeschwiegen 1933 – 1945: Die Geschichte der Karl-Bonhoeffer-Nervenklinik, Berlin: Hentrich 1988, 151 – 176, here 157 – 158. Catel to Asperger 4 July 1967. Catel’s papers. Archive for Pediatrics and Adolescent Medicine in Berlin.

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“This town is also the residence of my former teacher, Professor Dr. Dr. W. Catel, whom I admire very much and who is a close friend of mine. […] You probably remember that my teacher was thrown out of the Society under the chairmanship of a former Board.”86

Werner Catel died in Kiel on 30 April 1981.

1981: The Tegernsee symposium “Ethical problems in pediatrics and related areas” In February 1981 a “symposium about ethical problems in pediatrics and related areas,” sponsored by the Volkswagenwerk Foundation, was held under the direction and organization of the president of the DGK, Hermann Olbing.87 It was followed up by an unusual remark. In his opening speech at the symposium, Hermann Olbing established implicit connections between the Nazi past and the delayed German debate on ethics: “Medical ethics was a non-issue for public debate in our country for a long time after World War II. There is surely no need for me to specify the reasons.” Although there was a boom in foreign and German scientific literature on medical ethics, Olbing observed with astonishment: “[…] strangely, the pediatric profession has been tight-lipped, and to a great extent even silent, with regard to ethical problems in the German-speaking world.”88 The Catel debate and even the Nazi past with regard to “child euthanasia” were referred to at this symposium only marginally, although central issues regarding abortion, the limitations of therapies for severely disabled children and children with unfavorable prognoses were subjects of heated debate (illustrated by the use of terms “worthy life – unworthy life”). As will be described in the following several speakers used terminology and arguments in the debate which were associated with, first, the German euthanasia debates in the period between the two world wars; second, the Nazi euthanasia programs; and third, the “limited euthanasia” propagated by Catel in the 1960s – although the speakers did not explicitly acknowledge these sources. Only the subsequent discussion revealed the connections to the past. In addition to the problematic areas of medical ethics mentioned above, contemporary questions on the surgical treatment of severely disabled newborns were also dealt with at Tegernsee. A study from England on this issue, which captivated German child surgeons and pediatricians alike, had been published 86 Dost to Wiedemann, 21 June 1977, ibid. 87 Archive for Pediatrics and Adolescent Medicine in Berlin, folder 9, DGK 1. Ethics, A-Z, 1.80 – 2.80 88 See Müller, Olbing (eds.), 1982, 1.

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shortly before the symposium. Professor John Lorber of the Department of Pediatrics and Children’s Hospital at Sheffield University took the position that failing to provide medical care to certain severely disabled children, e. g. those with spina bifida (a collective term for all congenital fissuring in the rear and front part of the vertebral column), after their birth was justifiable for humanitarian reasons. In the sub-section “The Fundamentals and Implementation of Selection” (Die Grundlagen und die Durchführung der Selektion) of his article, which was published in German in 1978, he submitted his reasons for calling for a regulated decision-making procedure in favor of or against operative treatment: “Humanity requires that severely disabled children should not be subjected to this endless and painful punishment under any circumstances even if it happens with the best of intentions.”89

However, Lorber was opposed to active euthanasia, since he felt its legalization was too risky : “It would be impossible to formulate legislation, however human are the intentions, that could not be abused by the unscrupulous. There have been plenty of examples in the past, especially in Hitler’s Germany. Few just or compassionate persons would wish to give such a dangerous legal power to any individual or group of people.”90

In the Tegernsee conference program, Hermann Mildenberger of the Children’s Hospital of the Medical University of Hanover now picked up on Lorber’s arguments, some of which were identical to those presented by Catel. In his contribution about the “limits of surgical treatment of multiply disabled children”, Mildenberger emphasized the tremendous stress to which families with a severely disabled child are exposed. He repeated Lorber’s claim that a “large percentage” of mothers are only able to meet the demands by taking tranquilizers. Families split up and in some cases fathers or mothers even commit suicide 89 John Lorber, “Der Rückschlag des Pendels bei der Behandlung der Myelomeningocele”, in: Monatsschrift für Kinderheilkunde 126, 1978, 9 – 13, here 11. With several articles since the early 1970s, Lorber had been involved in an intensive scientific debate, mainly in Great Britain, on the pediatric neurological and surgical treatment, prognosis and the possible selection criteria for children with spina bifida or anencephalus. See short bibliography in: John Lorber, Stephan A. W. Salfield, “Results of selective treatment of spina bifida cystica”, in: Archives of Disease in Childhood 56, 1981, 822 – 830. How it came that Lorber published this programmatic article just in the Monatsschrift remains still unresolved. However, his work probably could not pass unnoticed the German colleagues. 90 See John Lorber, “Ethical Problems in the Management of Myelomeningocele and Hydrocephalus”, in: Journal of the Royal College of Physicians 10(1), 1975, 47 – 60, here 57 – 58. Quote from: Eva-Corinna Simon, Geschichte als Argument in der Medizinethik: Die Bezugnahme auf die Zeit des Nationalsozialismus im internationalen Diskurs (1980 – 1994), Med. Diss. JLU Gießen, 23.

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out of despair. Healthy siblings are often neglected and, finally, Lorber’s main argument, a number of “potentially normal lives […] are lost by saving a severely disabled child, because the parents are reluctant to have more children”.91 Mildenberger had virtually no comments at all on Lorber’s argumentation. Since he ignored the question about the social background of family crises or even the general social ramifications in this specific context, the existence of disabled children appeared to be the only substantial reason for the problem.92 Instead, Mildenberger discussed three medical options:93 1. Killing (Töten), 2. assisted dying (Hilfe zum Sterben), or 3. assisted living (Hilfe zum Leben). The decision among these options was supposed to be based on general criteria. However, on closer inspection, all of the identified “authorities” – religion, state and conscience – proved to him to be either outdated, transitory and therefore relative, or too unsafe, since they are always also dependent on a social and cultural background. Therefore, there remains only the criterion of life itself, which is to be preserved due to the Hippocratic oath. Remarkably, according to Mildenberger, this still did not mean doctors could hide behind their medical obligations and burden the families concerned with the consequences of the physicians’ own inability to make decisions.94 Did Mildenberger feel it was ultimately legitimate to allow severely disabled children to die, or even to kill them? In his paper Mildenberger did not respond to the regulated decision-making (selection) procedure advocated by Lorber. But finally, after all abstract reflections, he returned – like Lorber – to the criterion of humanity. It has to be noticed here that Mildenberger omitted to mention two important aspects with regard to this criterion. First: Paradoxically it could indeed justify a decision in favor of or against life depending on the individual case. And second: Humanitarian perceptions may also be subject to environmental, cultural and historical influences, and therefore constitute no more secure a criterion for medical action than do the “authorities” of religion, state or conscience. Such a criticism would have been conceivable and justified based on the internal argumentation presented, especially in light of the issues 91 Lorber, 1978, 11. Quoted correctly by : Hermann Mildenberger, “Grenzen chirurgischer Therapie beim multipel geschädigten Kind”, in: Müller, Olbing (eds.), 1982, 205 – 210, here 206. 92 Apart from this, Mildenberger was extremely clear-sighted in noting that medical activities might be limited by an increasingly observable shortage of economic and financial resources, which would result in delicate problems in the future in terms of setting priorities, e. g. in equipment-based health care. This remark sparked a separate debate after the panel session. Some colleagues denied such a development. Eduard Seidler agreed with Mildenberger, stating that the “spirit of selection” (“Geist der Selektion”) will grow in the future. See Müller, Olbing (eds.), 1982, 223. 93 See Mildenberger, 1982, 209. 94 See ibid.

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discussed by Catel. What then could be understood under the “humanitarian medical science” desired by Mildenberger if the medical mandate to preserve life could be revoked simply by shifting the boundaries of such ambivalent criteria? This issue was not brought up, as it seems even not in the following discussion, or at least was not documented in the conference proceedings. Johannes Brodehl, also of the Children’s Hospital of the Medical University of Hanover, was considerably more specific in his subsequent contribution, which addressed the sensitive area of the everyday politics of medical decision-making: the attribution of the value of human life to oneself and to others. In the article “Grenzen der konservativen Therapie bei Kindern mit infauster Prognose” (“Boundaries of Conservative Therapy for Children with Infaust Prognosis)”95 he questions whether the medical commandment to preserve life is always advisable in the case of a conscientiously pronounced infaust prognosis. In other words, under what circumstances should intensive medical measures or treatment with medication be continued which go beyond medicated pain treatment and nursing procedures? Brodehl clearly answers this question in the negative in principle, but ruled out active measures to shorten life, since they contradict the principle of preservation of life. The main criterion for making a decision is the assessment of the “value of life”. Brodehl was aware of the risks related to this criterion, persisting that this “value of life” excluded to a great extent any interpretation by physicians, in particular for legal minors and mentally impaired patients. It is therefore essential that parents be involved. Although one can expect adults to express themselves and make their own decisions, Brodehl emphasizes that there is always a fine line between self-determination and determination by others in the special case of child patients, depending on the child’s age and condition. “However, I can by no means support any active measures to shorten such a life even in this condition. […] The boundaries of therapy are reached whenever the prognosis is infaust and the value of life is destroyed by despair, which means the physician’s humanitarian responsibility demands that he does not extend this life by means of intensive treatment.”96

According to Brodehl, the “value of life” can be observed or measured mainly through the existence of communicable or observable “hope”. If despair and hopelessness are the overriding feelings shared by all parties involved, the value of life may be undermined, and the life subsequently becomes “unworthy of 95 Definition given by Brodehl himself: hopeless prognosis of a disease resulting in death according to the findings of medical science, a condition which has no chance of improvement. See Johannes Brodehl, “Grenzen der konservativen Therapie bei Kindern mit infauster Prognose”, in: Müller, Olbing (eds.), 1982, 210 – 219, here 210. 96 Brodehl, 1982, 218.

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living”.97 In this way, he advanced a similar argument to Catel in Grenzsituationen des Lebens, however, in this case he applied it only to terminally ill children. Brodehl received critical remarks, although he presented this very isolated problem of infaust prognoses in a reflected manner and even tried to prevent potential misunderstandings by offering clear definitions of terminology. In a contribution to the discussion about the “limitations of therapies for children”, the pediatrician and medical historian Eduard Seidler called for the terms “unworthy life” and “worthy life” to be avoided in light of the German past. “I recommend removing the terms ‘worthy life’ and ‘unworthy life.’ They are linked to events of the history of our nation from which we would like to distance ourselves.”98 And the Protestant theologian Professor Jürgen Hübner of the University of Heidelberg reminded the audience that not only the burden of German history was a problem with regard to the terms “worthy of life” and “unworthy of life”. According to him, the term worthy itself, “which comes from the economical theory of the previous century”, posed an ethical problem. “One needs only to think about Social Darwinism. When making decisions in individual cases, physicians should not focus on the terms ‘worthy of life’ or ‘unworthy of life’, but rather on the question of whether there is still hope for human life in which a loving relationship is possible, or whether it may be an act of love to let a patient die.”99

Both suggestions are insightful in several respects, especially since the reference to euthanasia in the first half of the 20th century was initially intended as a mere terminological demarcation. Both Seidler and Hübner argued by invoking a past burdened by crime, whereas they agreed with Brodehl’s position on passive euthanasia in terms of the content. However, his considerations lacked any elements of an ethical position which prioritizes the collective or even an utilitarian tendency, which would have implicitly required an admonitory historical reference on Social Darwinism and Nazi children euthanasia. So why did they criticize the for the most part ahistorical, but ethically welldefined, use of the term “value of life” as brought up during the conference? The term “unworthy of life” had a strong signal effect on medical historians and theologians, notably in two respects: First of all, it probably evoked the radicalized debate on the “Permission for the Destruction of Life Unworthy of Living” (Binding/Hoche 1920) since World War I. Second, the term “unworthy of life” 97 Ibid. 98 Ibid., 223. For more details on the discussions of medical ethics in the pediatric profession, see Topp, 2013. 99 See discussion following the speech of Johannes Brodehl, “Grenzen der konservativen Therapie bei Kindern mit infauster Prognose”, in: Müller, Olbing (eds.), 1982, 210 – 219, here 223.

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was also a taboo within the pediatric profession, which still remained in place after the end of the Catel dispute. The self-critical preoccupation with the systematic selection and murder of thousands of children allegedly “unworthy of living” by German pediatricians and psychiatrists in the years 1939 to 1945 might not have been confronted yet, but according to the findings here, the profession was prepared to carefully approach it.100 As the entire discussion spectrum of the conference shows, none of the participants criticized the use of the term “euthanasia” itself, which, since the euthanasia lawsuits in the 1960s, for the German public primarily denoted the killing of patients in National Socialism. This term could also have been removed for historical reasons; was the connection simply overlooked? It is more plausible that the term was used for a mutually shared concept of “real” euthanasia, which was regarded as correct and justifiable at the beginning of the 1980s. This becomes more understandable if one assumes that the physicians involved in this discussion assumed that the term “euthanasia” was misused in the Nazi period and, for this very reason, laid a sovereign claim to this historical term. There are hardly any traces of the term (active, passive, indirect) assisted dying (Sterbehilfe) in the conference proceedings, which is a customary term nowadays in Germany.101 Since there was an interdisciplinary consensus on such a historically untarnished understanding of the term “real” euthanasia, the wish emerged for a clear, content-based differentiation from the Nazi form. Seidler expressed this desire normatively with his (“collective”) formulation: “[…] linked to events of the history of our nation from which we would like to distance ourselves.” In order to articulate a joint position in the area of pressing ethical issues, one had to dismiss individual taboos. The normative boundary was drawn specifically between passive and active euthanasia. In the discussions there is widespread consensus on the acceptance of passive euthanasia, in particular for humanitarian reasons. Its approval indirectly required coming to terms with the precarious past. As a result, the risky medical-ethical balancing act unintentionally paved the way for a cautious confrontation with the past of the medical and hence also the pediatric profession. However, the distant verbal reference to the “history of our nation” – rather than (more obviously) to the history of German pediatrics – confirms the impression that the internal confrontation 100 The Tegernsee meeting between Seidler and his pediatrician colleagues was about to develop into a lasting, close cooperation in terms of conscientious representation of the Nazi past, as subsequent events showed ten years later. See Johannes Brodehl, “Professor Dr. Eduard Seidler 70 Jahre”, Freiburg 21 April 1999. Archive for Pediatrics and Adolescent Medicine in Berlin, file 104 DGKJ e.V. 1999: Preise, Ehren- und korrespond. Mitglieder. 101 See above for Mildenberger’s formulation “assisted dying” and: Ottheinz Braun, “Probleme bei sterbenden Kindern”, in: Müller, Olbing (eds.), 1982, 270 – 279, here 276.

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with the profession’s own past had at least begun. On the other hand, the defensive stance taken by morally distancing oneself from the “wrong” euthanasia resulted in a persisting delay to undertake deeper historical reflection, especially about central argumentative continuities in the euthanasia discourse of the 20th century.102

1983: The centenary in Munich and the first steps towards dealing with the past In 1983, on the occasion of the 100th anniversary of the association, the first cautious debate began among pediatricians about their own role in National Socialism. One year before, Catel’s successor in Kiel (since 1961), Hans-Rudolf Wiedemann, had suggested the foundation of a Historical Committee. Wiedemann justified his application to the need, ”– especially in our present time, which is more traditionally hostile – […] to secure the traces‘, which means: to preserve important evidence from the life of the Society and particularly their outstanding members“.103

Under the chairmanship of Eduard Seidler, the newly founded Historical Committee of the DGK then held an exhibition about the history of the Society. A historical document proved the role played by Wentzler, Catel and Heinze in the Reichsauschuß.104 The volume Lebendige Pädiatrie (“Living Pediatrics”), published by Paul Schweier and Eduard Seidler, which referred briefly to the role of 102 See Gerrit Hohendorf, Der Tod als Erlösung vom Leiden. Geschichte und Ethik der Sterbehilfe seit dem Ende des 19. Jahrhunderts in Deutschland, Göttingen: Wallstein 2013; idem., “Die nationalsozialistischen Krankenmorde zwischen Tabu und Argument: Was lässt sich aus der Geschichte der NS-Euthanasie für die gegenwärtige Debatte um die Sterbehilfe lernen?”, in: Stefanie Westermann, Richard Kühl, Tim Ohnhäuser (eds.), NS-“Euthanasie” und Erinnerung: Vergangenheitsaufarbeitung – Gedenkformen – Betroffenenperspektiven, Berlin: LIT 2011, 211 – 230. The historical analysis of the euthanasia discourses in the 20th century, in particular the interpretation approach of an internationally comparative perspective, must still be regarded as a desideratum of research. See in parts: Andreas Frewer, Clemens Eickhoff (eds.), “Euthanasie” und die aktuelle Sterbehilfe-Debatte: Die historischen Hintergründe medizinischer Ethik, Frankfurt/M., New York: Campus 2000; Simon, 2004, and: Thorsten Noack, “Ein unglaubliches Kriegsgerücht: Anmerkungen zur zeitgenössischen Wahrnehmung der “Aktion T4” in der Tagespresse der Vereinigten Staaten”, in: Westermann, Kühl, Ohnhäuser (eds.), 2011, 45 – 66. 103 Minutes of the general meeting of the DGK 14 September 1982, Heidelberg, folder 1 DGK Board, minutes, opening speech, annual report 1980 – 1983 1a. Wiedemann had already filed his application during the meeting of the Board and Advisory Council on 12 September 1982. See minutes in ibid. Seidler chaired the committee. The Board advised Seidler to appoint Hans-Rudolf Wiedemann, Gerhard Joppich and Erich Püschel as members. 104 Personal message from Eduard Seidler, October 2008.

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Wentzler and Catel in the Reich Committee, was released after the historical exhibition in Munich.105 However, in the opening speech by President Hermann Olbing, the era of National Socialism was mentioned only in connection with how German pediatrics had relinquished its leading position in the world.106 With regard to the social context of addressing the issue in 1983, it can be assumed that several influences made it increasingly impossible to ignore the era of National Socialism. An unforeseen public debate was triggered by the U.S. miniseries Holocaust – The Story of the Family Weiss, which was broadcast in Germany in 1979.107 Left-wing political groups also formed within the German medical profession, initiated by the student revolts, the extra-parliamentary opposition and the social upheavals in the 1970s. They became increasingly politically active and formed a medical opposition in the course of the mid-1970s and 1980s which, in turn, wielded increasing power.108 This opposition demanded a debate about the role of the medical profession in National Socialism. These groups of the medical profession organized counter-events to the German Medical Assembly, criticized the unjust capitalist health sector and put the issue of “Medicine and National Socialism” at the top of the agenda.109 When the Historical Committee of Pediatricians took office in 1982, it did so at a time of upheaval with regard to German cultures of memory.110 Two years after the outbreak of the Historikerstreit (historians’ dispute) in 1986 about the assessment and comparability of the National Socialist extermination of the Jews in the collective German perception of history, Eduard 105 See Paul Schweier, Eduard Seidler (eds.), Lebendige Pädiatrie, München: Marseille 1983. 106 Olbing’s hints of great deeds, but also aberrations, by German pediatricians gave latitude for diverse interpretations. Speech by President Hermann Olbing on 12 September 1983 at the ceremony for the centenary of the foundation of the DGK, folder 1, DGK Board, minutes, opening speech, annual report 1980 – 1983 1a. 107 See Christoph Classen, “Zum Themenschwerpunkt”, in: Zeitgeschichte-online, Thema: Die Fernsehserie “Holocaust” – Rückblicke auf eine “betroffene Nation”, Christoph Classen (ed.), March 2004/October 2005; http://www.zeitgeschichte-online.de/sites/default/files/ documents/classen_einf.pdf (1 September 2014). 108 Examples for oppositional groups in German medicine (so-called Ärzte-Opposition) are the Liste 6: Demokratische Ärztinnen und Ärzte (LDÄÄ) (ticket 6: Democratic Physicians) as part of the Medical Association of Hesse, the Fraktion Gesundheit (Parliamentary Party Health) as part of the Medical Association of Berlin, the Deutsche Gesellschaft für Soziale Psychiatry (DGSP; German Association for Social Psychiatry) as well as the German Federal Section of the International Physicians for the Prevention of Nuclear War (IPPNW). For further details see Topp, 2013, 75 – 86; see also Roelcke, 2007, 232 – 234. 109 See Winfried Beck, Ärzte-Opposition, Neueckarsulm: Jungjohann 1987; Gerhard Baader, Ulrich Schultz (eds.), Medizin und Nationalsozialismus: Tabuisierte Vergangenheit, ungebrochene Tradition? Dokumentation des Gesundheitstages Berlin, 1980, Berlin: Verl.-Ges. Gesundheit 1980. 110 The influence gained by the so-called “68 generation” within pediatrics requires detailed investigation.

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Seidler inspired a medical student interested in history to write her dissertation about the history of the DGK in the Weimar Republic and in National Socialism on the basis of the collected archived material. The research project was completed in 1992.111 Under the presidency of Eberhard Schmidt and Johannes Brodehl’s chairmanship of the annual congress, the symposium “Pediatrics in Germany 1918 – 1945” was held in Hanover in 1994.112 It was the first historical symposium ever in the history of the annual congresses of the DGK. Several lectures about the history of pediatrics in the 20th century dealt with the fate of a persecuted Jewish pediatrician. Two lectures (of 10 minutes each) dealt with the issue of child euthanasia during the war.113 The symposium aroused great interest among the members, culminating in the first open and critical debate about the role of pediatrics in National Socialism within the Society. Consequently a motion was made at the General Meeting “to issue an official statement of the DGK on what happened before 1945 and what did not happen after 1945”.114 This led to the financing of a research project about the fate of Jewish pediatricians,115 which was completed with the aforementioned commemoration ceremony in Dresden in 1998. In his lecture entitled “Pediatrics and the State”, which was held during the congress in Hanover, Seidler also dealt with the era of National Socialism, referring at the end to the desideratum for research with regard to the crimes of Nazi child euthanasia.116 In 2003 these crimes were specifically addressed at the annual congress in Bonn, for the first time with 111 See Jahnke-Nückles, 1992. 112 See statement on the motives for this symposium: Johannes Brodehl, “Wie es dazu kam: Persönliche Erinnerungen an den Aufbruch der DGKJ zur Rückbesinnung auf ihre Vergangenheit”, in: “Public Commemoration Ceremony in Conjunction with the 94th Annual Meeting of the German Society of Pediatrics and Adolescent Medicine, Dresden Schauspielhaus”, in: Monatsschrift für Kinderheilkunde 147, Suppl. 1, 1999, 35 – 37. 113 Gerhard Ruhrmann, Wilhelm Holthusen (Reinbek), “Das Kinderkrankenhaus Rothenburgsort im ‘Dritten Reich’” and Udo Benzenhöfer, R. Heimig (Hanover), “Zur Rolle von Pädiatern bei der Planung der sogenannten ‘Kindereuthanasie’ im Dritten Reich”. See also Wilhelm Thal (Magdeburg), “Prof. Dr. Albert Uffenheimer (1876 – 1941) – später Nachruf für einen jüdischen Kinderarzt”. Agenda for the 90th annual meeting of the German Society of Pediatrics, Hanover, 18 – 21 September 1994, 65 f. Folder 36 DGKJ, agendas 1990 – 1996, 1997 – 2000, Archive for Pediatrics and Adolescent Medicine, Berlin. 114 Suggestion by member Professor Jürgen Natzschka (Hanover), minutes of the Board meeting on 15 February 1995, folder 1, general meeting of the DGK, 11 – 13 September 1995. Minutes of the general meeting of the DGK, Hanover, 20 September 1994; folder 1, DGK, meetings and conferences 1991 – 1996, printed in the Monatsschrift für Kinderheilkunde 143. Archive for Pediatrics and Adolescent Medicine, Berlin. 115 The final decision of the board and general meeting to finance the project for dealing with the past was made at the annual congress in Krefeld in 1995. Letter from Seidler to Eberhard Schmidt, 24 September 1996; Archive for Pediatrics and Adolescent Medicine in Berlin, folder 1, DGK, meetings and conferences 1991 – 1996. 116 Eduard Seidler, “Die Kinderheilkunde und der Staat”, in: Monatsschrift für Kinderheilkunde 143, 1995, 1184 – 1191.

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several articles.117 From 2008 on preparations began for a commemoration ceremony for the victims of “child euthanasia” to take place in 2010 (see above).118

Conclusion A few factors influencing the process of the debate about medical killings in pediatrics since 1945 can be pointed out here. The dispute at the DGK began with a public scandal regarding Catel and his involvement as an assessor in the child euthanasia program carried out during the war. The scandal was triggered by a pediatrician colleague, who brought about the criminal prosecution of Catel as well as a public debate. As such, Rudolf Degkwitz put the DGK in a situation that forced them to deal with Catel in the 1960s. In 1961 this resulted in the first and, for a long time, only statement by a medical group, notably a medical association, on Nazi euthanasia. The initiative for this step was taken not from the center of the Board, but rather from a representative of social pediatrics, a discipline which was just emerging and dealt primarily with the rehabilitation of disabled children: Ulrich Köttgen. The DGK Board then made an effort to distance themselves from the euthanasia of children during WWII as well as from new demands to kill “unworthy life” for reasons of professional ethics. The statement of 1961 can be regarded as the expression and first step of an internal group negotiation process about the pediatric profession acknowledging “collective” historical responsibility. Yet, this took place as a reaction to the public debates about Catel and did not show any sign of a comprehensive self-critical confrontation with the pasts of individual members. The case of the DGK is therefore a special case of the German postwar confrontation with Nazi medical crimes, since Catel was the only former euthanasia physician who advocated the legalization and implementation of the “extermination of unworthy life” in public again after 1945. With his book of 1962 in particular, he provoked a new discussion about euthanasia. That he himself tried 117 See Monatsschrift für Kinderheilkunde 151(10), 2003. There had been regular meetings of a working committee on the subject of the National Socialist “child euthanasia” under the direction of Eduard Seidler in the previous years. 118 See Letter to the editor “Euthanasia: Historical Committee”, in: Deutsches Ärzteblatt 106 (10), 2009, A-461 from Eduard Seidler, in response to an article about the scientific congress “Memories and Representations of Nazi ‘euthanasia’ in Post-WW II Medicine and Bioethics,” 12 – 15 November 2008, Justus-Liebig University in Giessen. See Norbert Jachertz, “Medizinverbrechen: Erinnern und Beherzigen”, in: Deutsches Ärzteblatt 105(50), 2008, A2698 – 2700.

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to set the discussion framework for “limited euthanasia” shows that he was well aware of the consequences of Nazi euthanasia. Any aspects that could weaken his argumentation in favor of euthanasia were simply excluded. The critique of his euthanasia postulate was particularly aggressive from colleagues in Switzerland. The fact that two of them, Freudenberg and Hottinger, were the ones to initiate the process of his expulsion from the DGK is due to two central and connected elements in the dynamics of representing the Nazi past: 1. the initiation of remembrance work from the periphery, and 2. the biographical connection between opposition to the Nazi regime and public criticism of Nazi perpetrators’ integration in the German medical profession after 1945.119 Re 1.: Freudenberg and Hottinger remained attached to the medical association, but, like Degkwitz, because they lived abroad, they were able to formulate their criticism both of the unchallenged integration of members tarnished with Nazi pasts and of euthanasia from the periphery. There may have been similar demands from colleagues living in the Federal Republic of Germany, but to date they remain undiscovered. Moreover, the request to expel Degkwitz came from within Germany, although it was crushed by the Board. Re 2.: Freudenberg’s and Hottinger’s lives outside the German borders were connected to the events before 1945 in a similar causal manner. Like Degkwitz, they had worked in Germany and were directly affected and threatened by the Nazi policies of marginalization and persecution. The influence of the biographical background of the protagonists involved in the Catel dispute can also be verified in an inverse sense as regarded the previous politics of the various chairmen presiding over the DGK each year. Those chairmen who had sympathized with National Socialism in the past took a considerably more restrained position on Catel’s membership, or tried to mediate between the conflict partners. In contrast, Bamberger, whose opposition to National Socialism is well documented,120 demanded the voluntary resignation of the colleagues Catel and Bayer. The public statement of 1961 was also published under the aegis of Bamberger. In the mid-1960s there was apparently a consensus on the Board to meet Catel’s demand for treatment according to the fundamental legal principle in 119 As a third element, the continuity of the position on euthanasia before and after 1945 is of particular significance. There are indications that Freudenberg, Degkwitz and Bamberger had all taken a negative position on Nazi euthanasia activities and had even done so in public back during war. See Topp, 2013. 120 See Wolfgang Uwe Eckart, “Lange Schatten aus Königsberg – Philipp Bamberger (1898 – 1983) und die Heidelberger Kinderklinik in schwerer Nachkriegszeit”, in: Georg F. Hoffmann, Wolfgang Uwe Eckardt, Philipp Osten (eds.), Entwicklungen und Perspektiven der Kinder- und Jugendmedizin: 150 Jahre Pädiatrie in Heidelberg, Mainz: Kirchheim 2011, 99 – 135.

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dubio pro reo, and to base the decision for or against expulsion on the results of the preliminary or potential court proceedings in Hanover. This decision was beneficial to the mentality of those members of the Board with an indifferent position towards Catel, as it meant they did not have to deal with the Catel’s case for the time being. This was a balancing act between the threat of a damaged reputation and the desire to clearly distance the organization from Catel. It remains to be said that although the expulsion process was accompanied by fierce arguments, it was never concluded by the DGK. It is no surprise that the group problem of calling into question the profession’s self-perception, triggered by the Catel dispute, stands out particularly. The pediatric profession based its claim for institutionalization, i. e. its right to exist and its social recognition, on the successful fight against the extremely high infant mortality at the end of the 19th and beginning of the 20th centuries. To a certain extent, in the 1960s the hostile reactions towards Catel, particularly from older colleagues, are an indication of how the once unanimously shared, positive self-perception of pediatricians was jolted, suddenly replaced by their concern about public confidence in pediatrics. Furthermore, the connection between a disciplinary – and in this case explicitly social pediatric – orientation and a critical position on Catel and the liberalization of euthanasia becomes evident, provided the respective representatives were not inhibited by their own former proximity to National Socialism. The accumulation of several incisive critical statements by pediatricians committed to the rehabilitation of disabled and severely disabled children (Hellbrügge, Weber, Gaupp, Köttgen, also Asperger) is proof itself, and at the same time indicates that specific value patterns were shared by some of the younger, historically unburdened representatives of this branch of pediatrics. The discussion about killing severely disabled children undermined the objectives of social pediatrics, which was in the process of becoming institutionalized in the 1960s. A two-step approach can be observed with regard to the objects of representation and steps undertaken since the 1990s. With the historical symposium in Hanover in 1994 and then the project on dealing with the fate of Jewish pediatricians, the medical association had arrived at the dawn of reflection on its precarious past (Aufbruch zur Rückbesinnung, J. Brodehl), addressing the Nazi child euthanasia in the process. At the very least, the foundation of the Historical Commission and the archives, which were initially intended only to cultivate traditions on the occasion of the centenary in 1983, can be identified as decisive prerequisites for the subsequent gradual approach to deal with the profession’s own past. However, since only the moral distancing from demonized individual perpetrators (scapegoats) and the dichotomization of a “true” and “false” euthanasia were dealt with, the self-made claim to deal with and remember the past

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in 1994 was already partially called into question. The chronology of events documents that the medical association postponed dealing with other aspects by setting its priorities – deliberately or unintentionally – in favor of one subject. The damage to circles from the profession’s own patient clientÀle and their families were addressed only after a substantial delay. This two-stage internalization process with a specific order of the processed topics, observed as an example in pediatrics, could be significant to the wider context of the German medical profession in terms of shifting culture(s) of memory :121 The internalization of the precarious past in the self-perception of this medical group, and the perception of its own history, was achieved first of all by identifying with the persecuted, mainly Jewish members. The work of remembering those affected from the ranks of the profession was still potentially ambivalent, as the members perceived themselves in part as persecuted during the Nazi period in order to further exonerate themselves, while accepting a share of the responsibility for the displacement and murder of Jewish physicians by identifying with them. It seems, however, that it was only this commitment to dealing with the past that enabled and facilitated the subsequent step towards remembrance work on the suffering which pediatricians inflicted on their own patients. In the new processes of negotiating medical ethics at the beginning of the 1980s, a border was drawn between the rejected active euthanasia and passive euthanasia. For humanitarian reasons the latter was regarded as justifiable or even necessary under certain conditions. The current debates appear to be only partially related to the euthanasia discourses of the German Empire, the Weimar years and in particular the period of National Socialism. They have been dissociated from the past on not only a terminological but also a conceptional level. By emphasizing the differences (isolation of Nazi euthanasia), the historical analysis evaded the content-based/argumentative continuities of the euthanasia discourse in the 20th century. This effect also resulted from the profession’s desire to distance itself morally from the perpetrators of Nazi euthanasia in their own ranks. As illustrated impressively in the past six decades by the verifiable invasion of the past through the back door via the field of medical ethics, in particular as regards the Nazi child euthanasia program, the medical profession’s enduring problems of applied medical ethics, implicitly including the – often quite varied – views on humanity, pity, dignity and hope (or desperation), are connected by a “value of life” that is self-determined or determined by others. Such value targets were and are constantly re-negotiated situationally in daily practice. 121 A similar example of this two-stage internalization process can be observed in the Medical Association in Hesse. See: Topp, 2013.

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Isolated forms of argumentation with reference to history, for instance in the dispute regarding the legalization of “limited euthanasia” demanded by Catel, show that this medical-ethical problem area has been intimately entangled with past politics in postwar pediatrics. A majority of the ethical positions cannot be distinguished on the basis of constitutively identifiable historical grounds. Apart from the above mentioned exception of the well-founded elaboration by Theodor Hellbrügge, criticism of active euthanasia has been more or less limited to sweeping references to the problematic National Socialist past. While only a few completely denied the current relevance of the euthanasia issue, the fact that references to the past were only marginal or completely absent during the ethics conference in 1981 corresponds to the startlingly absent reception of available historical knowledge as well as the pediatric profession’s delay in dealing with its own past up to the 1990s.

Donna Evleth

The French Medical Association (L’Ordre des Médecins) and the Nazi Past

The Vichy Ordre In July 1940, after Germany defeated France and occupied over half the country, the French Republic gave way to the Vichy government. It quickly produced a spate of anti-foreigner and anti-Semitic laws, some of which directly concerned the medical profession. On 16 August a law forbade the practice of medicine by anyone not born of a French father. On 3 October a comprehensive law, the Jewish Statute, racially defined the Jew and paved the way for quotas for Jews in medicine.1 On 7 October 1940 the Vichy government also created a new medical association, the Ordre des M¦decins. The Ordre would act through a 12-member governing body, the Conseil Sup¦rieur, and its role was to regulate medical practice and safeguard the honor, morality and interests of the medical profession.2 It is not known why the Vichy government decided to create an Ordre des M¦decins at this time. The law published in the Journal Officiel, signed by Vichy Minister of Health Serge Huard, gave no reason for its creation. Ren¦ Leriche, the 1 General works: Robert Paxton, Vichy France: Old Guard and New Order 1940 – 1944, New York: Alfred Knopf 1972; Michael Marrus, Robert Paxton,Vichy et les Juifs, Paris: CalmannL¦vy 1981; Joseph Billig, Le Commissariat G¦n¦ral aux Questions Juives, Paris: Editions du Centre de Documentation Juive Contemporaine (CDJC)1955 – 1960; Serge Klarsfeld, VichyAuschwitz, Paris: Fayard 1983 – 1985; Susan Zuccotti, The Holocaust, the French, and the Jews, Lincoln/Nebraska: University of Nebraska Press 1993; Ren¦e Posnanski, Les Juifs en France pendant la Seconde Guerre Mondiale, Paris: Hachette 1994; Denis Peschanski, Vichy 1940 – 1944: Contrúle et Exclusion, Brussels: Editions Complexe 1997; Jean-Pierre Az¦ma, Olivier Wieviorka, Vichy, 1940 – 1944, Paris: Perrin 1997; Vicki Caron, Uneasy Asylum: France and the Jewish Refugee Crisis, 1933 – 1942, Stanford: Stanford University Press 1999; Julian Jackson, France: The Dark Years 1940 – 1944, Oxford: Oxford University Press 2001. For studies specifically relating to medicine and the Jews, see Bruno Halioua, Blouses blanches, ¦toiles jaunes, Paris: Liana Levi 2000; Henri Nahum, La M¦decine FranÅaise et les Juifs 1930 – 1945, Paris: L’Harmattan 2006. 2 “Loi instituant l’ordre des m¦decins”, in: Journal Officiel, 26 October 1940, 5430 – 5431.

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first president of the Vichy Ordre, wrote in his memoirs that the Germans pressured the French to create this body. This reason was repeated in the eulogy for Leriche given at the Academy of Medicine in 1956, and by Dr. Jean Pouillard in his Historique of the Ordre in 2004.3 The archives of the Vichy Ordre make no mention of any German pressure. Historians have made their own speculations about the reason. For FranÅois Gazier, the notion of a professional order was part of the political philosophy of the Vichy government in general, since the resurrection of corporatism and the concomitant elimination of trade unions were part of the program of Marshal P¦tain’s National Revolution. Pierre Guillaume says that with the creation of the Ordre, the government was favoring the doctors, whom it doubtless considered as its natural supporters.4 In fact, there was no need for pressure from the Germans to create an Ordre. This had been a desire of members of the medical profession since the 19th century, with most historians situating the first real attempt to create an Ordre in 1845. The original reason was to provide a necessary policing of the profession against charlatanism. This initiative failed because the profession itself was divided, unwilling to commit itself to a firm solution. The effort nonetheless continued into the 20th century, right up to 1939. In the 20th century the Ordre was repeatedly blocked by quarrels within the Parliament, between the right and the left, the corporatist right, notably, being for it for ideological reasons, the left being against it, feeling that an Ordre must be preceded by the drafting of a formal code of medical ethics. The medical unions, which became an important force in the 20th century, also originally worried about being stripped of their disciplinary powers if an Ordre were to be voted. As we shall see, they later changed their minds. Still, a certain consensus had developed around a need to 1) regulate medical ethics, which, in the eyes of the profession, would be defined as honest behavior excluding charlatanism and kickbacks, professional confidentiality, proper relations with colleagues, and condemnation of fee splitting; 2) to regulate medical specialization. As it was, the doctors could and did self-list any number of unrelated, uncertificated specialties in the Guide Rosenwald, the most widely 3 Ren¦ Leriche, Souvenirs de ma vie morte, Paris: Seuil 1956, 89; Jean Pouillard, “Historique de l’Ordre National des M¦decins 1845 – 1945”, in: Histoire des sciences m¦dicales 39(2), 2005, 213 – 223, viewed through the online version http://www.conseil-national.medecin.fr/sites/ default/files/historique2012_0.pdf (23 August 2014). 4 FranÅois Gazier, “L’Ordre des M¦decins”, in: L’Exercice M¦dical dans la Soci¦t¦: Hier, Aujourd’hui, Demain, Colloque organis¦ par l’Ordre National des M¦decins le 29 et 30 septembre 1995 — Paris, Paris: Masson 1995, 286 – 287; Pierre Guillaume, Le rúle social du m¦decin depuis deux siÀcles (1800 – 1945), Paris: Association pour l’Etude de l’Histoire de la S¦curit¦ sociale 1996, 267.

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used medical directory, founded in 1887. Thus the profession may have accepted the Vichy-decreed Ordre as a providential opportunity to do something about these continuing issues.5 The decree that created the Ordre also dissolved the medical unions. Its article III stated that doctors would no longer have the right to form trade unions, that the existing unions were dissolved, and that their property and prerogatives would pass to the new Ordre. No reason was given for this decision. The unions protested, but their protests were not made public until after the war. Since the Vichy National Revolution proclaimed itself corporatist, the reasons may have been ideological, since the corporations were not supposed to have competition.6 Whatever the reason for its creation, there is no doubt that the Vichy Ordre des M¦decins went along with the government’s anti-Semitic policies and eventually implemented them. This was because anti-Semitism existed within the Ordre itself. In France of the 1920s and 1930s, two distinct types of anti-Semitism coexisted. There was a traditional, mainstream anti-Semitism which was protectionist and directed primarily against foreigners, with French Jews, although disliked, being recognized as having certain rights. There also existed a more virulent form of anti-Semitism, associated with the far right wing movement Action FranÅaise, which saw all Jews as a mortal danger to France. Medical antiSemitism fell into the first category, protectionist and xenophobic, a position represented notably by the medical trade unions. This position was behind the laws of the 1930s regulating the practice of medicine by foreigners. Many of these foreigners were also Jews, but it was their foreignness that mattered

5 There are a number of books and articles which discuss the early attempts to found an Ordre des M¦decins. See, for example, Jaques Aversenq, in: Bulletin M¦dical, 10 March 1923, 277 – 278; Paul Cibrie, L’Ordre des M¦decins, Paris: Midy 1935; Moez Nouh Gu¦tari, Contribution — l’¦tude de l’histoire de la cr¦ation de l’Ordre des M¦decins 1845 – 1945, ThÀse(M¦decine) Universit¦ de Toulouse III, 1986; Pierre Guillaume, “La Pr¦histoire de l’Ordre des M¦decins”, in: L’Exercice m¦dical dans la Soci¦t¦: Hier, Aujourd’hui, Demain, Colloque organis¦ par l’Ordre National des M¦decins le 29 et 30 septembre 1995 — Paris, Paris: Masson 1995, 273 – 284. For some examples of codes of ethics drawn up between 1904 and the 1930s see: Code de d¦ontologie m¦dicale, in: Revue de D¦ontologie et d’Int¦rÞts Professionnels M¦dicaux, May 1904, 395 – 412; Journal de M¦decine de Bordeaux 28, 12 July 1914, 481 – 482; Joseph Okinczyc, L’Ordre des m¦decins et le code de d¦ontologie m¦dicale, Paris: A. Maloine et fils 1924, 37 – 43; and especially M¦decin de France, 1 October 1936, 947 – 955. 6 “Loi instituant l’ordre des m¦decins”, in: Journal Officiel, 26 October 1940, 5430 – 5431; “Le coup de massue”, in: M¦decin de France, July-August 1945, 3 – 4.

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most. The medical anti-Semites never suggested the kinds of measures that the more virulent anti-Semites who came to power in the Vichy government favored, such as reversing naturalizations or setting up quotas for Jews in practice. The medical trade unions had contented themselves with campaigning to stop new naturalizations, which would also have the effect of limiting the number of Jews in practice.7 Historians such as Robert Paxton feel that Vichy’s anti-Semitism, although more virulent than the traditional variety, was not the same as Nazi Germany’s. Few at Vichy considered a ‘Final Solution’ for the Jews. Yet as Michael Marrus points out, Vichy’s policies victimized the Jews mightily, and made the Germans’ task of extermination easier. French historians Jean-Pierre Az¦ma and Olivier Wieviorka go even farther, stating that while the authors of the Vichy anti-Semitic legislation doubtless never meant exclusion and segregation to be the antechamber of extermination, the regime’s policy of collaboration with the Germans and its significant ethnocentrism made it a confirmed accomplice in the deportation of Jews from France.8 The Ordre des M¦decins, imbued with the profession’s traditional anti-Semitism, made little protest of the Vichy government’s anti-Semitic measures. In March 1941 Vichy founded the Commissariat for Jewish Questions. Its head was former Action FranÅaise member and fierce anti-Semite Xavier Vallat. Vallat immediately instigated a two percent quota for all Jews in the professions of law, medicine, pharmacy, dentistry and architecture. While the Ordre des M¦decins favored a quota for Jews, it wanted it only for students, not for practicing professionals as with Vallat’s quota. Beginning in May 1941 and continuing into 1942, the Conseil Sup¦rieur of the Ordre debated the question. Their position favored protecting French Jews at the expense of foreigners. Even the Conseil Sup¦rieur’s most open anti-Semite Paul Giraud took this position: “I am very much opposed to the Jews and I believe they have done my country a lot of harm, but finally they have acquired rights and we can’t just throw them out into the street.”9 The Conseil made a counter proposal to Vallat, limiting the quota to students and letting the law requiring doctors to have French fathers take care of elimi7 “Naturalisations”, in: M¦decin de France, April 1939, 629; “Demandes de subventions”, in: M¦decin de France, July 1939, 628 – 630. For a more complete discussion of the types of antiSemitism in general and medical anti-Semitism in particular, see Donna Evleth, “The Ordre des M¦decins and the Jews in Vichy France, 1940 – 1944”, in: French History 20(2) 2006, 204 – 224; Caron, 1999, 234 – 236, 323 – 330. 8 Paxton, 1972, 174 – 175; Michael Marrus, “Vichy et les Juifs: After Fifteen Years”, in: Sarah Fishman et al. (eds.), France at War : Vichy and the Historians, Oxford: Berg 2000, 45; Jean Pierre Az¦ma, Olivier Wieviorka, Vichy, 1940 – 1944, Paris: Perrin 1997, 159. 9 Archives de l’Ordre des M¦dicins (in the following: AOM) Minutes, Conseil Sup¦rieur, 7th session, 21 – 25 May 1941, 145. CAC20000243 1.

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nating the foreign Jews in practice. This proposal was ignored, and Vallat’s quota system became law on 11 August 1941. Priority in the quota was given on the basis of military service. The ‘eminent character’ of the doctors’ ‘professional merit’ might be considered, but it would be the Commissariat, not the Ordre, which would be the final judge of that. In all of the discussions by the Conseil, no mention was made, from 1941 until the end of January 1942, when the minutes of the meetings stop, of what had been going on in Germany with regard to the exclusion of Jews from medical practice. The council members treated it as strictly a French issue, rooted in xenophobia and an identification of patriotism with military service. This identification within the medical profession did not start with Vichy : in doctors’ listings in the Guide Rosenwald, military decorations come right after the year of the medical degree, and before any other professional information. It did, however, reach its high point in the Vichy period. There was a list of Jewish doctors permitted to practice on military grounds, which gives the individual’s exact military services (combatant’s card, Legion of Honor for military valor, Croix de Guerre, Military Medal). A few women were on this list because they were orphans or mothers of a soldier killed at the front.10 The law of 11 August stipulated that the departmental councils of the Ordre would designate which Jews would go and which could stay. Those who were refused the right to practice could appeal the decisions to the Conseil Sup¦rieur of the Ordre. Thus the councils of the Ordre would make decisions on every single Jewish doctor practicing medicine in France.11 Faced with the prospect of hundreds of appeals, there was a mini-revolt within the Conseil Sup¦rieur during its January 1942 session. One of the members, Charles Gernez-Rieux, stated that he did not want to make these kinds of decisions about the Jews. “I find it very painful, very unfair, and it’s not our role.” Another member, Armand Vincent, agreed with him. However, when the discussion turned to the possibility of refusing and resigning, the members of the Conseil backed down. The president, Ren¦ Leriche, proposed a solution: “Let each Conseil member, in his region, be given dossiers. Once we have examined the dossiers, if there are some that look interesting, we can write a letter to the Minister of Health saying that we have studied the question of the Jewish doctors, that it seems to us that there is reason to make proposals for some of them, which we are transmitting. The

10 Archives Nationales (AN) AJ38 150, Liste des m¦decins juifs r¦tenus par le Conseil d¦partemental de la Seine de l’Ordre des M¦decins (titres militaires), Liste — jour au 1er janvier 1943. 11 “D¦cret du 11 ao˜t 1941 r¦glementant, en ce qui concerne les Juifs, la profession de m¦decin”, in: Journal Officiel, 6 September 1941, 3787 – 3788; Bulletin de l’Ordre des M¦decins, October 1941, 203 – 207.

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Minister will transfer them to the Commissariat for Jewish Questions, which will probably say no. But we will have done what we could.”12

The Ordre thus admitted that it was the virulent anti-Semite Xavier Vallat who was the real decision maker, not they. The members of the Conseil Sup¦rieur did propose certain Jewish doctors on the basis of professional merit. For the department of the Seine alone, they proposed 24 such doctors. The Conseil even announced its promotion of these exemptions for professional merit publicly, in the Bulletin of the Ordre of August 1942.13 It was to no avail. Of the 24 Jewish doctors proposed, only one was allowed to continue practicing. But it was on the basis of his military record, not for professional merit.14 Departmental councils in the provinces also made such proposals. The council of the Alpes-Maritimes gave a unanimous recommendation to one Jewish doctor of foreign origin, without military credentials: “Of a great generosity and devotion toward his patients. Often pushes these qualities to the point of giving his indigent patients money so that they can buy medicine or food for their children.” This doctor was authorized to practice in February 1943, but it did him little good. He was deported in October of the same year and did not return.15 Ren¦ Leriche made one personal intercession for a Jew forbidden to practice. Acting on the request of the Hungarian Consul General, he wrote on 4 June 1942 to Louis Darquier de Pellepoix, the even more rabid anti-Semite who had replaced Xavier Vallat as head of the Commissariat, in favor of a Jew of Hungarian origin, Dr. Eric Legmann. Legmann was naturalized French, was married to a non-Jewish Frenchwoman and was the father of a son born in France. He was head of the Franco-Hungarian dispensary organized and financed by the Hungarian government. The Consul was pleading for Legmann’s retention because he had not found a Christian doctor who spoke Hungarian, and most of the dispensary’s 4000 patients were Hungarian workers who spoke little French.“It is hard not to agree with the Consul General”, Leriche told Darquier de Pelle-

12 This dialogue is found in AOM Minutes, Conseil Sup¦rieur, 13th session, 24 – 28 January 1942, 25 – 26. CAC20000243 1. 13 “Questions relatives aux m¦decins juifs”, in: Bulletin de l’Ordre des M¦decins, August 1942, 130 – 131. 14 AOM D¦cisions du Conseil Sup¦rieur 1942 – 1943. CAC20000243 1. 15 AN AJ38 3975. Conseil d¦partemental de l’Ordre des M¦decins des Alpes-Maritimes, 10 September 1942; Martyrologie de la M¦decine franÅais, in: Gazette M¦dicale de France, October 1946, 511 – 520, here 512; AN F9 5731 (3).

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poix.“There is an international relations factor that I don’t think I need to underline for you.”16 Darquier’s reply was a flat refusal. On 31 August 1942, Legmann was forced to stop practicing medicine.17 As the archives of the Ordre make clear, the Conseil Sup¦rieur did not itself make the policy for Jews in medicine. It did, however, implement it. In the final accounting, the Vichy Ordre, guardian of the ethics of the profession, irremediably compromised its own ethics with the exclusion of the Jews.

The postwar Ordre The Vichy Ordre died with the Liberation in 1944. An interim period followed, in which the Comit¦ M¦dical de la R¦sistance appointed temporary councils of the Ordre to govern until a new Ordre des M¦decins could be formed. An ordinance of 24 September 1945 reinstituted the Ordre, in a form very similar to that of the Vichy Ordre, with departmental councils and a National Council at the head, the members to be chosen by elections which occurred in March 1946. The temporary Conseil Sup¦rieur was primarily concerned with liquidating the Vichy councils, and carrying out a purge, which was generally limited to doctors who had collaborated directly with the Germans or joined French collaborationist organizations. The R¦sistance was also engaged in a battle with the returning medical unions for control of the Ordre in the future, a battle the unions would win. Although dissolved, they had not been out of medical politics. They had simply become members of the councils of the Ordre. They had realized as early as 1929 that instead of fighting the Ordre, it was better to join it, then control it from within.18 With a number of prewar xenophobic and anti-Semitic union members joining the councils of the Ordre, it is not surprising that the subject of discrimination against and persecution of the Jewish doctors was never mentioned by the members of the councils. Although the Vichy Ordre had been dissolved, the members of its councils were not purged. A large number of them went right on into the councils of the 16 CDJC CXVII-116. 17 Ibid. 18 “R¦ponse du Secr¦taire g¦n¦ral”, in: M¦decin de France, 15 June 1929, 386. The union confirmed this position in the fall of 1945. See also “Rapports de la Conf¦d¦ration avec l’Ordre futur des M¦decins”, in: M¦decin de France, September-October 1945, 81 – 82. For the details of the battle between the medical Resistance and the unions for control of the Ordre see Donna Evleth, “La Bataille pour l’Ordre des M¦decins 1944 – 1950”, in: Le Mouvement Social 229, October-December 2009, 61 – 77.

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new Ordre voted into office in March 1946. For the National Council the holdovers represented 76 %; for the departmental councils, 49 %, with over 50 % in 31 rural departments. This Vichy influence would continue for another fifteen years.19 The twelve members of the Conseil Sup¦rieur who heard the appeals of Jews forbidden to practice did not rejoin the councils of the Ordre after the war. This does not mean, however, that their careers suffered because of their action. Three of the twelve, Ren¦ Leriche, the president of the Conseil Sup¦rieur, Charles Gernez-Rieux and Marcel FÀvre became members of the Academy of Medicine, the profession’s most prestigious body, in 1946, 1955, and 1962 respectively. Andr¦ Lemierre, who was already a member of the Academy when he joined the Conseil Sup¦rieur in 1942, was elected as its president in 1952. It is interesting to read the eulogies for these four men which appeared in the Bulletin of the Academy after their deaths. Generally their role in the Vichy Ordre was given little or no mention. The Leriche eulogy (1956, by Maurice Chevassu, Bulletin de l’Acad¦mie, 6 March 1956) speaks only of his becoming its president, repeating the reason for its founding given in his memoirs. The eulogies for Lemierre (1956, by Louis Pasteur Vallery-Radot, Bulletin de l’Acad¦mie, 20 November 1956) and Gernez-Rieux (1971, by Jacques Tr¦fouel, Bulletin de l’Acad¦mie, 7 December 1971) do not mention the Ordre at all.20 The FÀvre eulogy (1978, by Lucien L¦ger, Bulletin de l’Acad¦mie, 30 May 1978) is the exception, devoting a full paragraph to FÀvre’s participation in the Vichy Ordre, even briefly mentioning the Jews. It is, however, an attempt to distance FÀvre from this Ordre, and what is written hardly fits the facts. “FÀvre shared with us his sorrow at having to deal with […] the Jewish doctors”, one reads. The archives of the Ordre show that FÀvre was one of the Conseil Sup¦rieur’s declared anti-Semites. The eulogy continues: “One day, no longer finding himself in harmony with the government, and the bulk of the work having been accomplished, FÀvre decided to resign. Almost all his colleagues wanted to imitate him. Leriche alerted the Minister who promised that the Conseil would soon be elected by the doctors. A few weeks later, the question was settled by the Normandy landing.” 19 “Ordonnance N8 45 – 2184 du 24 septembre 1945 relative — l’exercice et — l’organisation des professions de m¦decin, de chirurgien-dentiste et de sage-femme”, in: Journal Officiel, 28 September 1945, 6083 – 6088. The number of Vichy holdover members of the councils of the Ordre were found by comparing the lists of council members for the years 1941, 1942, 1943, 1946, 1948, 1950, 1958. 20 Maurice Chevassu, “Ren¦ Leriche (1879 – 1955)”, in: Bulletin de l’Acad¦mie de M¦decine 140, 6 March 1956, 120 – 130; Louis Pasteur Vallery-Radot, “Andr¦ Lemierre (1875 – 1956)”, in: Bulletin de l’Acad¦mie de M¦decine, 20 November 1956, 552 – 559; Jaques Tr¦fouel, “Eloge de Charles Gernez-Rieux (1898 – 1971)”, in: Bulletin de l’Acad¦mie de M¦decine 155, 7 December 1971, 812 – 816.

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In fact, the next Vichy Conseil, of which neither Leriche nor FÀvre were members, was elected on 22 May 1943, over a year before the landing in Normandy.21 Interesting also is the eulogy for Dr. Louis PortÀs, president of the Ordre in 1943 – 44 and re-elected in 1946. His eulogy states that “his name will remain inseparable from the function he fulfilled as President of the National Council of the Ordre”. There is no mention of any of his specific acts, only of his organizational methods. Absolutely no mention is made of the exclusion of Jews from medical practice, curious in view of the fact that the author of the eulogy is Edmond L¦vy-Solal, himself a Jew, although one allowed to continue practicing on the basis of his military decorations, Croix de Guerre and Legion of Honor.22 Nor does the posthumous collection of PortÀs’ views on the subject of medical ethics, A la recherche d’une Ethique m¦dicale, published in 1964, mention the Vichy Ordre’s treatment of the Jews. He mentions the Germans only twice, in the preface to the 1947 code of ethics of the Ordre where he recalls that the French medical profession unanimously refused to hand over to the Germans patients they were treating for gunshot wounds, and in a communication to the Academy of Moral and Political Sciences on euthanasia, where he discusses the Nazi euthanasia program in Germany for incurably ill children.23 This rule of silence was not even broken by two international congresses on medical ethics held in 1955 and 1966. The word ‘Jew’ was not ever spoken, despite the fact that several of the participants in these congresses were themselves Jews, and one of them, Jean Hamburger, who participated in both congresses, had been forbidden by Vichy to practice medicine.24 It is very hard to understand this total and continuing silence. One can only observe that, surely for different reasons, both the oppressors and the oppressed of the Vichy period wanted to turn the page and forget about this traumatic past. In September 1995, the Ordre des M¦decins celebrated its fiftieth anniversary, taking as its starting point not the founding of the Vichy Ordre in 1940 but the ordinance of 24 September 1945. For the occasion it organized a colloquium, “Medical Practice in Society : Yesterday, Today, Tomorrow”. In a special session of the French Medical History Society FranÅois Gazier presented an article, L’Ordre des M¦decins, 1940 – 1945. Less than half of this article is devoted to the Vichy Ordre, the rest dealing with the Ordre created by the French provisional 21 Lucien L¦ger, “Eloge de Marcel FÀvre (1897 – 1978)”, in: Bulletin de l’Acad¦mie de M¦decine 162, 1978, 359 – 365 22 Edmond L¦vy-Solal, “Eloge de Louis Portes”, in: Bulletin de l’Acad¦mie de M¦decine, 3 October 1950, 536 – 539. 23 Louis PortÀs, A la recherche d’une Ethique m¦dicale, Paris: Masson 1964, 97, 129. 24 Ordre National des M¦decins (ed.), Premier CongrÀs international de Morale m¦dicale, Paris: 1955, 110, 125, 245; Ordre National des M¦decins (ed.), DeuxiÀme CongrÀs international de Morale m¦dicale, Paris: 1966, 88, 261, 289, 308.

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government in Algiers and the ordinance of 24 September 1945. In the pages dealing with the Vichy Ordre, there is no specific mention of the Jews, only of foreigners. The article says only : “Alas, the Ordre and its Conseil Sup¦rieur aided in the application of the Vichy regime’s exceptional laws concerning the doctors who were sons of foreigners and who, with few exceptions, were forbidden to practice.”25 But in the same year 1995 an era of historical apology opened in France. On 16 July French President Jacques Chirac gave a major speech at the ceremonies commemorating the big roundup of Jews for deportation which took place in Paris on 16 and 17 July 1942. In a radical break with his predecessor, FranÅois Mitterrand, who claimed that the French Republic was not responsible for the crimes of the Vichy French State and refused to apologize in the name of France, Chirac admitted the responsibility of the French nation in this atrocious act, recognizing the existence of a collective guilt.26 Chirac’s speech was generally well received. Georges Suffert wrote in an editorial in Le Figaro: “Jacques Chirac has said what the Jewish community hoped for. He perhaps did more: he delivered our compatriots from their vague bad conscience. We must not cheat with memory.”27 Chirac’s gesture seems to have encouraged others. Two years later, on 30 September 1997, at Drancy, the transit camp where Jews from France were held before being deported, Mgr. Olivier de Berranger, in the name of the Catholic bishops of France and in the presence of representatives of the Jewish community and deportees’ associations, publicly asked forgiveness for the silence of the French bishops in the face of the anti-Semitic measures taken by the French State. Pierre Pierrard, President of a Judeo-Christian friendship organization, rejoiced that the scales had finally fallen from the eyes of his Christian brothers.28 But Dr. Hubert Dayan, President of the Association of Jewish Doctors of France (AMIF), asked: “After the repentance of the Church, when will come that of the Ordre des m¦decins?”29 It came soon. On 11 October 1997, before the presidents and secretariesgeneral of the departmental councils of the Ordre, Bernard Glorion, its president, delivered a declaration of “repentance” concerning the Ordre’s attitude toward the Jews during the Occupation. “Some of our colleagues, designated by the 25 Gazier, 1995, 287. 26 Allocution de M. Jacques Chirac, Pr¦sident de la R¦publique, prononc¦e lors des c¦r¦monies comm¦morant la grande rafle des 16 et 17 juillet 1942 (16 July 1995): http://www.jacque schirac-asso.fr/archives-elysee.fr/elysee/elysee.fr/francais/interventions/discours_et_decla rations/1995/juillet/fi003812.html (25 August 2014); Le Monde, 18 July 1995, 6, 11. 27 Georges Suffert, “Editorial”, in: Le Figaro, 19 July 1995, 1. 28 Tribune Juive, 20 October 1997, 20. 29 Hubert Dayan, “Editorial”, in: Journal de l’AMIF 462, September-October 1997, 3.

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government which sat at Vichy, participated in this sad and shameful operation of discrimination against and exclusion of Jewish doctors; some accomplished this task under constraint, others because of ideology […]. The historic truth obliges us to admit that values which are the very foundation of our ethics and our professional code were trampled.”30 But when a reporter asked Glorion if his declaration of repentance committed the whole of the Ordre des M¦decins, he stated that it was a personal initiative which had not yet been the object of internal discussions.31 The Jewish doctors were pleased. One of them wrote to Glorion: “I saw in your gesture an exemplary lesson of courage and dignity […]. I truly hope that your message will be heard and understood by all the doctors of our country.”32 It was not. Glorion soon found himself in a firestorm of criticism from members of the Ordre and the profession in general. Notably the president of the Council of the Ordre in the department of Calvados accused him in an editorial of rekindling rancors and grudges, of reopening wounds which had healed, of weakening the Ordre, adding that in any case the misdeeds of the Vichy Ordre were not the doing of the present Ordre.33 Dr. Hubert Dayan rebutted these criticisms, commenting that Glorion’s statement was one of a group of declarations on the same theme, made notably by the French president and the bishops of France. “Certain doctors fear that the Ordre will be weakened by Professor Glorion’s declaration. But neither France nor the Church of France have been weakened by the declarations of their most eminent representatives.”34 It seems, however, that the voice of Jewish doctors carried little weight against the tide of disapproval. Glorion was deeply hurt by this volley of protests, and in an interview with historian Bruno Halioua he expressed the fear that no one would even talk about his gesture of repentance in the coming decade.35 Glorion died in August 2007. In her condolence message, Minister of Health Roselyne Bachelot-Narquin made no mention of the repentance declaration. The 30 Jean-Yves Nau, “Le pr¦sident de l’ordre des m¦decins fait acte de ‘repentance’”, in: Le Monde, 12 October 1997; see “Les ‘regrets’ de l’Ordre des m¦decins”, in: Journal de l’AMIF 463, October 1997; Anne-Marie Casteret, “M¦decins: L’ordre et le repentir”, in: L’Express, 9 October 1997. 31 Ibid. 32 H. P. Klotz, 1997, “Lettre”, in: Journal de l’AMIF, 464, 3: “Dr. Klotz is asking us to publish the following letter that he addressed to Pr Bernard Glorion, President of the Ordre des M¦decins / Le Dr. Klotz nous prie de publier cette lettre qu’il a adress¦e au Pr Bernard Glorion, pr¦sident de l’Ordre des M¦decins” ; Hubert Dayan, “Editorial”, in: Journal de l’AMIF 464, 1997. 33 Halioua, 2000, 13. 34 Hubert Dayan, “Editorial”, Journal de l’AMIF 466, 1998, 3. 35 Bruno Halioua, “L’homme qui brisa l’omerta du Conseil de l’Ordre des m¦decins”, in: Journal de l’AMIF 562, October 2007, 4.

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obituary by corresponding member of the Academy of Medicine Aline Marcelli which appeared in the Bulletin of the Academy, of which Glorion was a member, mentioned only his reforms, notably in the areas of medical education and patients’ rights. It is telling that the Academy’s eulogy for this important figure in the French medical profession was not given by a full member.36 There was one notable exception to this silence. A eulogy, written by the newly-elected President of the Ordre des M¦decins appeared in its Bulletin in September 2007: “Symbolically, Professor Glorion was the one who, in 1997, expressed the repentance of the Ordre for the Conseil sup¦rieur of doctors, created by the Vichy government, which blindly applied the Vichy regime’s discriminatory laws against Jewish doctors.”37 This eulogy could not be a coincidence. The new President of the Ordre, elected in June 2007, was Michel Legmann, son of Eric Legmann, the Jewish doctor forbidden to practice under Vichy whom Ren¦ Leriche, then President of the Ordre, tried to help. Legmann was the first Jew to head the Ordre. He saw his election as part of a new era which began in 1997 with Glorion’s public declaration of repentance. “The professor had at the time asked for my help to write this declaration with him. He died last summer. I am anxious to pay homage to this great humanist.”38 This does not mean, however, that the Ordre as a whole has come to terms with its Vichy and anti-Semitic past. Repentance comes hard, amnesia is far more comfortable. The reactions to Glorion’s declaration are proof of this fact. One can legitimately wonder if, had the President of the Ordre at the time of Glorion’s death not been Michel Legmann, himself the son of an outcast Jew, Glorion’s act of repentance would not have continued to be forgotten, as he himself predicted.

36 Aline Marcelli, “Eloge de Bernard Glorion (1928 – 2007)”, in: Bulletin de l’Acad¦mie de M¦decine, 194(3), 2010, 473 – 480. 37 Michel Legmann, “Pr Bernard Glorion (1928 – 2007): ‘une certaine id¦e de la m¦decine’”, in: Bulletin l’Ordre des M¦decins, 7 September 2007. 38 Sylvie Bensaid, “Michel Legmann nouveau pr¦sident du conseil de l’Ordre”, in: Tribune Juive 31, 2007, 5 April 2008 (29 Adar II 5768).

Rakefet Zalashik

Nazi Medical Atrocities and the Israeli Medical Discourse from the 1940s to the 1990s

Introduction The Second World War and the horrors of the Holocaust have shaped many aspects of Israeli society. Various studies have examined the politics of memory and commemoration in Israel, others analyzed the absorption of Holocaust survivors into Israeli society, and others have dealt with the legal and moral aspects of restitution and the Reparations Agreement between Israel and West Germany signed in 1952, according to which West Germany would transfer thee billion marks to Israel as compensation for the material damage and suffering it caused the Jews during the Holocaust.1 However, very little has been written on the influence of the Holocaust on the Israeli medical profession. The aim of this article is to explore the influence of Nazi euthanasia and medical atrocities on the Israeli medical discourse and its evolution from the 1940s up to the 1990s as reflected in publications by Israeli physicians. The analysis of the publications on this topic written by Israeli physicians in Israeli medical journals from the 1940s up to the present shows that Nazi euthanasia and medical atrocities had very little impact on the medical discourse in Israel. 1 See, for example: Idith Zertal, Israel’s Holocaust and the Politics of Nationhood, Cambridge: Cambridge University Press 2005; Roni Stauber, The Holocaust in Israeli Public Debate in the 1950s: Ideology and Memory, London/Portland: Vallentine Mitchell 2007; Hanna Yablonka, Survivors of the Holocaust: Israel after the War. New York: New York University Press, 1999 (This book first appeared in Hebrew with a slightly different title: Foreign Brethren: Holocaust Survivors in the State of Israel 1948 – 1952, Jerusalem: Yad Izhak Ben-Zvi 1994); Dina Porat, The Blue and the Yellow Stars of David: The Zionist Leadership in Palestine and the Holocaust, Cambridge: Harvard University Press 1990; Anita Shapira, “The Holocaust: Private Memories, Public Memories”, in: Jewish Social Studies 4(2), 1998, 40 – 58; Dalia Ofer, “Linguistic Conceptualization of the Holocaust in Palestine and Israel 1942 – 53”, in: Journal of Contemporary History 31(3), 1996, 567 – 595; Tom Segev, The Seventh Million: The Israelis and the Holocaust, New York: Owl Book 2000; Rakefet Zalashik “Kölner Juden zwischen Orient und Okzident – Die Entschädigungspraxis bei körperlichen und gesundheitlichen Schäden”, in: Norbert Frei, Jos¦ Brunner (eds.), Die Praxis der Wiedergutmachung: Geschichte, Erfahrung und Wirkung in Deutschland und Israel, Göttingen: Wallstein 2009, 419 – 442.

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Accordingly, Nazi medical atrocities were hardly discussed among Israeli physicians before the 1990s and were not part of any national bio-medical debate. Only a small group of Israeli physicians, mostly Holocaust survivors, was active in raising medical ethical and moral questions related to Nazi medical crimes. Nevertheless, they dealt with the topic from a very specific perspective, focusing more on the documentation of Nazi medical atrocities and the attempt to punish the perpetrators, and less on the discussion of their possible implications on Israeli medical practice and research.

The pre-state period The first time that Jewish physicians in Mandatory Palestine publicly commented on the medical crimes of German physicians was in autumn 1942, when rumors of the mass murder of Polish Jewry reached the Yishuv, the Jewish settlement in Palestine.2 The Hebrew Medical Union in the Land of Israel (HMU) published a declaration titled “Our Mourning and Cry – on the Destruction of our Brothers in Europe” in the journal Mikhtav le-haver (“Letter to a member” – the organ of the HMU in Palestine) stating: “The horrors perpetrated against the Polish Jews have fundamentally shaken us as human beings, as Jews and as physicians. In the history of the physical and mental degeneration of humanity, never has a page been written that is comparable to what the Nazi depravity is writing now with the blood and sweat of their victims. This deep, horrible cruelty is so deviant that it is hard for human beings to grasp it. Even the physician, who so often witnesses degeneration and strange deviancies, stands astonished in the face of these horrors. […] What is the worth of our achievements in the medical field if the grandchildren of Virchow and Koch and their students are part of these horrors? Where is the hope if in the 20th century the beast takes over and controls human deeds?”3

Thus, Jewish physicians described the Nazi crimes against Polish Jewry as a unique psychopathology difficult for even physicians to understand,4 and expressed their shock and disappointment about the active role played by their 2 Dina Porat, “Palestinian Jewry and the Jewish Agency : Public Response to the Holocaust” (2008a), in: idem, Israeli Society, the Holocaust and its Survivors, London/Portland: Vallentine Mitchell 2008b, 251 – 281, here 253. 3 J. Sus, “Our Mourning and Cry – on the Destruction of our Brothers in Europe”, in: Mikhtav lehaver, 1 December 1942, 349. All translations from Hebrew are mine (R.Z.). All the articles quoted from Mikhtav le-haver, Harefuah, Dapim refuiyim, Niv harofe and Higiyenah ruhanit are in Hebrew in the original, and so those quoted from the popular press: Hazofe and Hadoar. 4 A similar understanding of the historical events is expressed by Fishel Shneorson, who entitled an article he published in 1943 “On the Criminal Psycho-Pathology of the Destruction Epidemic in Europe”, in: Harefuah 25, 1943, 186.

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German colleagues in these murderous actions. For them this was a break with the German medical tradition on both the professional and the personal levels: many of the Jewish physicians in Palestine had studied in German-speaking medical schools and admired German medicine and the German health system. The language used in this declaration and the ones to follow indicates the inability of the Jewish physicians in Palestine to grasp the scope of the horrors: “The great insanity” and “epidemic”,5 which are medical terms for biological events that cannot be predicted, explained or controlled, were chosen to describe the grave reality. “What happens cannot be explained even by medical professionals who are familiar with many deviances”, it stated.6 This declaration of 1 December 1942 should be understood as part of the general reaction of the Jewish settlement in Palestine, which felt totally helpless in the face of the annihilation of European Jewry.7 Nevertheless, Jewish physicians in Palestine felt more obliged and authoritative than the rest of the population to raise their voice, because of their self-image as a profession, which combined the understanding of the human body with moral postulates, making them the formal spokesman of the collective consciousness to pathological phenomena. Moreover, seeing themselves as part of the international scientific community, they thought that their voice could be heard beyond local and Jewish circles. Expressions of shock by the local medical community towards the atrocities in Europe continued well into the 1940s. The participation of German physicians in the euthanasia of the mentally ill and disabled, propagating racial medical theories, conducting medical experiments on prisoners and being on the frontlines of the annihilation of Jews and other peoples led to a deep crisis of German science and Western civilization. “Whenever I met Nazi physicians”, said the gynecologist Aaron Pertsikovitch, a Holocaust survivor himself, in a lecture given in 1946 to the members of the Association of Hebrew Physicians in Palestine, “I could not believe they were students of German medicine, in which we were educated and which was the dominant school in Europe”.8 Retrospectively, it seems that right after the war Jewish physicians in Palestine had three aims, which were interwoven with each other. The immediate aim of 5 See for example: “In the Light of the Destruction Epidemic in Europe”, in: Harefuah 24, 1943, 150 – 151; “After the Victory in Europe”, in: Mikhtav le-haver 114, 1945, 945 – 946, here 945. Mikhtav le-haver was published by the Central Committee of the Hebrew Medical Union. Consequently, I assume that the anonymous articles were published under the responsibility of the Central Committee of the Union. 6 Shneorson, 1943, 186. 7 Porat, 2008a, 254 – 257. 8 Aaron Pertsikovitch, “The Medicine in the Nazi Concentration Camp”, Harefuah 31, 1946, 8 – 10, here 10. During the war, Aaron Pertsikovitch had worked as a physician at the prisoners’ clinic in a concentration camp near Landsberg.

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the Hebrew Medical Union was to ensure that criminal physicians would be brought to justice. In the first decision approved at the national conference of the Hebrew Medical Union in 1945 it was called upon “to punish the Nazi physicians, who violated the profession of medicine, who were active in the various death camps and concentration camps. […] According to the rumors it turns out that these physicians not only did not alleviate the suffering of the victims, but, to their disgrace, they assisted the perpetrators, the rulers of the camps, and in many cases exploited the disaster their cruel rulers put on the heads of our people to ‘expand their medical experience’ as well.”9

The Union decided to demand from the victorious nations that the criminals of science would be brought on trial on the same level as the greatest war criminals and would be punished in the same way.10 To realize this decision, the organization appointed an investigative committee to collect survivors’ testimonies about the activities of German physicians and prepare the material for future criminal charges.11 In addition, the Union planned to request that other medical associations in England and America gather materials as well – all to be sent to the international investigative committee (which was not further specified). In this way the organization would “assist in the purification of the medical profession from such criminals and also fulfill [their] duty as a medical association towards our people and towards humanity”.12 They called on survivors to send testimony and to inform the Union about medical criminal activities during the Second World War, and asked physicians who were in contact with refugees to encourage them to provide names of German physicians who were involved in the atrocities.13 And indeed, letters did reach the organization, some of which were published in professional journals, supplying references for information about crimes committed by Nazi physicians during the war. For instance, in a letter of December 1945, the physician L. Olitzky drew the editor’s attention to a study published by SS Sturmtruppführer Erwin Ding, Über die Schutzwirkung verschiedener Fleckfieberimpfstoffe bei Menschen und den Fleckfieberverlauf nach Schutzimpfung (“On the protective effect of different typhus vaccines in humans and the course of typhus after vaccination”) in 1943,14 writing: “From this article, it is clear that Ding used human beings as

9 “Bring Punishment to the German Physicians – the Criminals of the Profession of Medicine”, in: Mikhtav le-haver 120, 1945, 1025 – 126, here 1025. 10 Ibid. 11 Ibid. 12 Ibid. 13 “On the Punishment of the Criminal Nazi Physicians”, in: Mikhtav le-haver 120, 1945, 1030. 14 Erwin Ding, “Ueber die Schutzwirkung verschiedener Fleckfieberimpfstoffe beim Menschen

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‘guinea pigs’ for vaccination against typhus and succeeded by this method in destroying a great number of non-immunized persons who were used as control cases for his experiments.”15 In May 1945 the journal Mikhtav le-haver reported about medical experiments conducted on forty young Jewish women in Auschwitz. One of the victims testified that many young German physicians came to the camp to attend lectures given on the experiments. It also quoted the exile Czech newspaper “The Liberation”, which claimed that the Czech government had collected testimonies from survivors about the medical experiments in Dachau, Natzweiler, Sachsenhausen and others. One testimony was by a 19-year-old man from Prague who reported about experiments with malaria, snakes’ venom and tetanus performed on himself and other prisoners.16 Another report was sent from Thessaloniki to the Hebrew Medical Union, relating the medical experiments carried out on Greek Jews in “Block 10” (Clauberg’s block) in Auschwitz by Horst Schumann, Johannes Golbel and other Nazi physicians. The report also mentioned the name of a Polish Jewish physician called Samuel who was forced to operate on other Jewish prisoners and was executed when a SS physician caught him simulating an operation. The survivors of the Greek Jewish community appealed to Palestine for help. Young sterilized Greek Jewish women who survived Auschwitz needed hormones, which were expensive and not supplied by the international aid agencies. The Greek community asked the Hebrew Medical Union to assist with the supply of such hormones.17 The second aim of Jewish physicians in Palestine was to make the atrocities public on both the national and the international levels, to laymen and professionals. Articles about euthanasia, types of medical experiments and the role Nazi physicians played in the murder of concentration camp prisoners, but also about the health situation of Jews in the ghettos and the work of Jewish physicians under these circumstances, were published in the professional and the und den Fleckfieberverlauf nach Schutzimpfung”, in: Zeitschrift für Hygiene- und Infektionskrankheiten 124(6), 18 June 1943, 670 – 682. 15 L. (Aryeh Leo) Olitzki, “The Horrors of Nazi Doctors”, in: Mikhtav le-haver 128, 1945, 1113. 16 “A German Medical Science…”, in: Mikhtav le-haver 114, 1945, 947. Ahead of the article appear three lines of introduction explaining that they are publishing extracts of an article published in Hatzofe by L. Beiz on 1 May 1945. The identification of the Czech journal entitled “Liberation” has so far not been possible. 17 “From the Horrors of Nazi Physicians (According to a letter sent from Saloniki to the HMU)”, in: Mikhtav le-haver 134, 1946, 1187. Dr. Maximilian Samuel was also mentioned in testimony given by Jewish Greek women survivors from Auschwitz after the war to the Yad Vashem collection. On Samuel, the opinion of the scholars diverges: i. e. while Lifton sees him as a “Jewish medical collaborator”, Nadav holds a more balanced opinion. Compare Robert J. Lifton, The Nazi Doctors, Medical Killing and the Psychology of Genocide, Basic Books 1986, 250 – 253 and Daniel S. Nadav, Medicine and Nazism, Jerusalem, Magnes Press 2009, 126 – 130.

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popular press during the 1940s and the 1950s. In 1946, a whole volume of Medical Pages (Dapim refuiyim), the organ of the Kupat holim clalit (“General SickFund”, the sick-fund of the main workers trade-union), was dedicated to the work of Jewish medical professionals in the ghettos during Nazi occupation, including the Vilna, Kovno and Lodz ghettos, as well as health care in Transnistria, in the French underground and in Brussels. These articles were firsthand testimonies by Jewish doctors who survived the Holocaust, reporting in a scientific manner on their observations on the state of the victims’ health as well as on the Nazi rationale for medicine and extermination. The third aim of the local medical community was to prevent the participation of German physicians in post-war medical scientific forums. Although Nazi medical crimes were conducted by individuals, and it was estimated that only a few thousand German medical professionals had actively participated in these crimes, Jewish physicians argued that since the deeds were not a secret, those who knew and remained silent were also to blame. It was clear to them that German physicians who participated in these crimes out of their own free will and exploited the war for their career interests had never expressed any regret nor apologized for their crimes after the war was over. The physician Jacob Michelsohn of Glasgow, who was the representative of the Hebrew Medical Union at the first international conference in London in September 1946, reported back from the event to his worried Jewish colleagues in Palestine that one of the tasks the newly emerging World Medical Association (WMA) had taken upon itself was to strengthen the principles of medical ethics in a way that would prevent physicians from following political movements that violated the sanctity of human life. The tragedy was that many members of the old German medical professional organization were active supporters of the Nazis. He argued that, in order to resist political pressure, physicians need to have a strong ethical basis and moral support from an international association.18 Michelson also reported that the Danish delegates had read document N.C. 223 of the International Scientific Commission on Medical War Crimes (ISC) to the conference. The crimes of medical professionals were discussed in the international “Field Information Agency ; Technical (FIAT)” conference in a meeting that took place at the Pasteur Institute in Paris on 1 August 1946. Colonel H. Wade was appointed to be head of the investigator’s office of the commission for war crimes.19 Another issue discussed in London was the question of refugee physicians, including Jews. Michelsohn promised to the 18 Jacob Michelsohn, “A Report from the International Conference of Physicians in London, 25 – 27 September 1946”, in: Mikhtav le-haver 150, 15 November 1946, 1319 – 1320, here 1319. 19 Ibid., 1320; on the ISC, see Paul Weindling, “The origins of informed consent: The International Scientific Commission on Medical War Crimes and the Nuremberg Code”, in: Bulletin of the History of Medicine 75, 2001, 37 – 71.

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conference participants that the Hebrew association would collect and send materials about Jewish refugee physicians who had not been properly absorbed into their new countries of refuge. Jewish physicians in Palestine followed very closely what was published on the Physicians’ Trial in Nuremberg. In July 1947 the editors of Mikhtav le-haver presented its Hebrew readers a summary of the accusations against Nazi physicians in the trial as published in La Presse Medicale in April of that year. The journal elaborated in detail the medical experiments conducted by those convicted: in Dachau, experiments for the German Luftwaffe in simulated high altitudes and low temperatures, and on malaria; experiments with mustard gas in Sachsenhausen; sterilizations in Auschwitz and Ravensbrück; on typhoid, phosphorus and toxic substances in Buchenwald; and euthanasia.20 The first occasion to try to bring Nazi physicians to trial, and to prevent German medical participation in international professional forums, was the first international conference of the WMA in September 1947, in Paris. The Jewish delegation included Moshe Krieger ; Mark Dvorjetski, a physician and a Holocaust survivor who was still living in Paris; Katzenelbogen from Jerusalem; and as an observer, Dr. Drezel from Tel-Aviv. In his speech Dvorjetski appealed to the WMA to “show courage and investigate the crimes which were conducted in the name of the medical science and use all means it has to prevent its reoccurrence. (…) On the walls of the faculty of medicine there is the slogan Sedare dolorum opus divinum est (alleviating pain is the work of the divine). The German physicians turned the work of the divine into the work of the Satan. […] Physicians from all countries! You cannot remain indifferent to the severe outcomes these tragic events have wrought and burden the consciousness of humanity. The shadows of the endless victims from all nations are standing before us, and among them thousands of physicians who were murdered by their criminal colleagues. They demand that we declare a boycott on the criminal Hitlerian science and on the physicians who functioned as hangmen. […] Let us declare on this stage a boycott against the murderous physicians and validate anew the fundamental slogan of the medical ethic: ‘Adam, you are my brother’.”21

According to Krieger’s report, Dvorjetski’s words made quite an impression on the participants, especially the moment when he took out a piece of soap made out of the bodies of Jews (!) and placed it on the president’s table. The delegation had a very clear demand to the WMA: to prevent the membership of German physicians in the new organization for a period of a whole 20 “Accusation Act against German Physician War Criminals”, in: Mikhtav le-haver 166, 15 July 1947, 1471 – 1473. 21 Mark Dvorjetski, “On the crimes of the German physicians and their punishment”, in: Mikhtav le-haver 172, 15 October 1947, 1537 – 1539, here 1538 (this translation by RZ; see also the statements of organizations, no. 1, in the appendix of this volume).

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generation – until a new generation emerged which, one could assume, did not participate in the horrible crimes conducted by German physicians from Hitler’s rise to power up to the end of the war. Its expectation that a similar demand would be raised by other delegations was in vain. Krieger tried to explain their position: two years after the war was over, it seems that the Germans did not regret their deeds, and did not ask for forgiveness, although they had certainly had enough time to do so. At the conference, the English delegation did not talk about German physicians at all, only defining war criminals in general.22 The two French lecturers, who were themselves victims of Nazi persecution, supported the idea of refusing membership only if the Germans did not express their regret and ask for forgiveness. Only one of the French delegates expressed a certain understanding for the position of the Jewish delegation to prevent their membership for a generation.23 The first attempt by the delegation from Palestine to increase the awareness of the international community to medical crimes failed. Nazi medical crimes were not a main topic at the Paris conference, and the delegation from Palestine was the only one to raise the issue. As Krieger reported: “Despite our efforts, we failed to pass a decision in the spirit of our position; however, we managed to achieve something else: a decision was accepted which demands from the German physicians and their various organizations to express regret and an apology, and the proposal to limit the punishment of excluding them from medical associations was not approved. This discussion will continue in the next conferences and then we will be able to fight our war again. Our position faced obstacles due to the international situation and all the complexity derived from the political problem between East and West Germany”.24

According to Krieger, besides the general disinterest, another reason for the failure was the fact that the Jewish delegation was not well prepared for such a campaign: it did not collect evidence of Nazi medical crimes nor did it bring, as originally planned, two delegates from the American zone who were victims and could have served as living testimony about the German physicians.25 Instead, Dvorjetski, who at that time was still in Paris, was the only one who participated in the WMA conference to have experienced the wickedness of the Nazis and their physicians on his own flesh.26 22 Moshe Krieger, “The H.M.U at the meeting of the World Medical Association in Paris”, in: Mikhtav le-haver 172, 15 October 1947, 1535 – 1537, here 1535. 23 Ibid., 1536. 24 Ibid., 1536. 25 For this the association received help from the French secretariat of the WMA and the French Ministry of Foreign Affairs as well as from the Jewish Agency and the Joint Distribution Committee (JDC), which were active in the displaced persons camps; ibid., 1535. 26 Ibid.

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At this stage, the Hebrew Medical Union had very limited financial and logistic sources to carry on a campaign against Nazi medical crimes and the physicians who committed them. However, it is also clear that for them, as Jewish physicians, it was their duty to do so. At this point, shortly after the Holocaust and before the foundation of the state of Israel, the identity of the initiators was Jewish, such that every Jewish physician could have participated in the efforts of the Hebrew Medical Union to act against the Nazi medical atrocities, even without living in Palestine.

The Israeli period An examination of publications in Hebrew, and of those that were translated into Hebrew for the local readership of Israeli physicians from the end of the 1940s until the 1960s, reveals a few dominant aspects in the discourse on Nazi euthanasia and other medical crimes. First, a clear universal point of view was articulated: the crimes were committed against many peoples and not only against Jews. Thus, it was not only the interest of Jewish victims to bring these criminals to justice, but the interest of the international scientific community. These crimes, which left a stain on medical science, ought to be studied and serve as a warning for future generations. It was important for Israeli physicians to emphasize that although euthanasia and medical experiments were not new concepts invented by the Nazis, they were misused and twisted by the regime, draining them of moral scientific content. Second, because in the 1950s and the 1960s, the fact that medical experiments had been conducted on concentration camp prisoners was not enough to reject them as illegitimate,27 Israeli physicians tried to prove that Nazi medical studies were devoid of scientific value and that the Nazi physicians themselves had recognized this at the time. Using Nazi correspondence on the medical experiments conducted during the war, Israeli physicians showed that the Nazis were aware of the fact that the condition of concentration camp survivors “already made [them] useless for the planned experiments”.28 “And if a Nazi physician were to come?” was the title of Dvorjetski’s lecture at a conference of radiologists in Paris, May 1949, where he asked the audience how it would treat any German 27 For a discussion on this issue from various perspectives see: Arthur Caplan (ed.), When Medicine Went Mad: Bio Ethics and the Holocaust, Totowa: Humana Press 1992. 28 “… die schon für die geplanten Versuche unbrauchbar machen”. See Mark Dvorjetski, “The Skeleton Collection from Strasburg”, in: Dapim refuiyim 9, 1950, 93 – 103, here 102. Dvorjetski is quoting here a “letter of the criminal Prof. Haagen to the criminal Prof. Hirt ”… “from the documents on the experiments in exanthematic typhus by Prof. Haagen in the concentration camp Natzweiler”.

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physician who tried to present his findings from medical experiments conducted on victims as scientific. Third, the Israeli medical discourse on Nazi medical atrocities – especially in the 1950s – was connected to wider political issues regarding questions of reparations, diplomatic relations with West Germany and the general question of the “other Germany”. As part of his attempt to win Israeli public support for signing a reparations agreement with West Germany, the Israeli prime minister David Ben-Gurion tried to promote the image of West Germany as the “other Germany”, claiming that the young generation of politicians in West Germany did not belong to the generation of the Nazis.29 Dvorjetski, one of the main figures who dealt with Nazi medical atrocities in Israel, opposed the Luxemburg agreement signed between Israel and Germany in 1952 as well as any diplomatic relationship between the two countries. As one of the 1953 winners of the Israel Prize, the State’s highest honor, for his studies on the Holocaust, and from 1955 as head of the chair of Holocaust studies at Bar-Ilan University,30 Dvorjetski led bitter battles in the general Israeli press against the agreement, arguing that there was no “other Germany”.31 The personal claims for restitution of the health damage of survivors who lived in Israel, submitted to the indemnification authorities in the West from 1953 onwards, and especially testimonies on medical experiments, also played a role in keeping the discussion alive.32 Israeli physicians complained that a young German physician had been sent to Israel to examine the victims of medical experiments, although there were experienced Israeli physicians who had been educated in Germany prior to the war. Moreover, some objected to the idea of personal indemnification for health damage because the German scientists never expressed regret or asked for forgiveness from their victims. For Dvorjetski, here was the proof that there was no “other Germany”.33 Others argued that there could be no compensation for the damages caused by the Nazi physicians to survivors, and some called upon Israeli physicians who wrote

29 Yehudit Auerbach, “Ben-Gurion and Reparations from Germany”, in: Ronald W. Zweig (ed.), David Ben-Gurion: Politics and Leadership in Israel, London/Jerusalem: Frank Cass/Yad Izhak Ben-Zvi 1991, 274 – 292. 30 Nadav, 2009, 101 – 108. 31 “The other Germany” was a term used by the Israeli Prime Minister, David Ben-Gurion to characterize post-war West Germany in order to gain public support for the reparations agreement, and a decade later for the opening of diplomatic relations between Israel and West Germany. 32 See for example: S. Gil, “Criminal Castration by X-Ray Radiation and Orchidectomy”, in: Harefuah 38(9), 1950, 141 – 142. 33 Mark Dvorjetski, “The Horrors of the Nazi Medicine”, in: Hadoar 18, March 1954, 333 – 334 and 341.

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medical opinions for survivors to identify themselves with the victims rather than with the German medical professionals who were among the perpetrators.34 “Telling what happened” was extremely important for Israeli physicians. Therefore they not only wanted to document the crimes conducted by Nazi physicians, but also informed the Israeli public about the severe health conditions and starvation in the ghettos and the concentration camps. Another type of account common up to the 1960s was told by Jewish physicians who practiced medicine during the Holocaust. These accounts revealed the doctors’ helplessness, but also exposed their frustration with treating prisoners who would sooner or later be murdered by the Nazis. From these accounts it is clear that some of the Jewish physicians felt they were forced by SS physicians to become murderers. Not only did Nazi physicians violate medicine, they also coerced Jewish physicians to be part of it. According to these accounts, the worst ethical dilemma these physicians faced were abortions and the killing of newborns to save the lives of their mothers. It seems that this, more than any other problem faced by doctors in ghettos and concentration camps, challenged their identity as physicians: they saw themselves as part of the Hippocratic tradition to save lives and do no harm, but also as Jews. This conflict continued to torture them even long after the war was over.35 Fourth, in the 1950s a new type of discussion emerged, on the prolonged effects of harsh conditions during the war on survivors who arrived in Israel. Issues such as the impact of the pathology of deportation and the health of survivors after they accomplished absorption were discussed, as well as the unique demographic and sociological problems of survivors in Israel. Most of the physicians who led this discussion had also been involved in the discussion on Nazi medical atrocities. One of the main arguments, which combined Zionist ideology with local medical practice, was that Jewish survivors in Israel suffered less from trauma than those who ended up living in other countries, because they had returned to the homeland and were living among their brethren.36

34 See the case of I. Shiloh in: Zalashik, 2009. 35 On this see: Tessa Chelouche, “Doctors, Pregnancy, Childbirth and Abortion during the Third Reich”, in: Israel Medical Association Journal/IMAJ 9, 2007, 202 – 206; Nadav, 2009, 110 – 119. 36 See for example: Gerda Berg, “Late reactions among liberated concentration camp prisoners”, in: Harefuah 50, 1956, 228 – 229, here 228; Mark Dvorjetski, “La pathologie de la deportation et les s¦quelles pathologiques des rescap¦s”, in: Revue d’Histoire de la M¦decine H¦braque 30, Mars 1956, 31 – 41, a publication of the talk Dvorjetski gave at the Third World Congress of Jewish Physicians on 11 August 1955; it was also published in Hebrew in Dapim refuiyim the same year. On this topic see: Nadav Davidovitch, Rakefet Zalashik, “Recalling the Survivors: Between Memory and Forgetfulness of Hospitalized Holocaust Survivors in Israel”, in: Israel Studies 12(2), 2007, 145 – 163.

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The relative absence of broader ethical deliberations Despite the centrality of the Holocaust and the great number of survivors and refugee physicians, the influence of ethical questions derived from Nazi euthanasia on Israeli medical discourse was marginal. First, very few articles on euthanasia or on medicine during the Holocaust were published. Within the first decades after the end of the Second World War, fewer than 30 articles were published on medicine and the Holocaust in Israeli medical journals: seven between 1946 – 1955, five between 1956 – 1965, four between 1966 – 1974 and only one between 1976 and 1986.37 Second, the discussion was carried out by a small group of Israeli physicians who were themselves survivors, and who, on Dvorjetski’s initiative, had established the Agudat harofim sride ha-shoah (“The Association of Physician Survivors of the Holocaust”). At the Second World Conference of Jewish Physicians in 1952, the topic was discussed as well, but found little echo in the Israeli professional press. Mark Dvorjetski, the most active figure, was a survivor of the Vilna ghetto and a few concentration camps. He had a close relationship with the French Jewish psychiatrist Henri Baruk, who was one of the central figures dealing with ethics and medicine and the morals of psychiatry in post-war France. Dvorjetski wrote a handful of articles and a few books on his experience as a physician and a survivor, which were promptly acknowledged by the state of Israel with the award he received in 1953. Another figure was Fishel Shneorsohn, a child psychologist from Russia, who had come to Palestine back in 1937. Although not a survivor, he had been very much involved in the fate of European Jewry from the outbreak of the Second World War. In 1942 he was one of the founders of the group ‘Al Domi’, which included thinkers like Martin Buber and Jewish religious leaders dedicated to helping European Jewry.38 From 1943 he published articles in Harefuah journal on the “criminal psychopathology of the annihilation epidemic in Europe” and similar topics. After the war, he was sent by the Jewish Agency to a series of displaced persons (DP) camps in Southern Germany. These DP camps had been established in the aftermath of WW II in order to receive people awaiting to find a country to go to. Among these people were many former inmates of Nazi German concentration and extermination camps. Shneorsohn developed a theory arguing that, just as the body becomes more immune after overcoming physical diseases, so in the case of mental stress as well. Thus, he claimed that the survivors were mentally more immune than the 37 The data were taken from Tomi Spenser “Foreword”, in: idem (ed.), Medicine and the Holocaust: Articles from “Harefuah” and [“Mikhtav le-haver”] (1946 – 2005), Ramat Gan: Israel Medical Association 2007 (in Hebrew), here p. iv of the English part. 38 On ‘Al Domi’ see: Porat, 2008b.

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general population.39 Another figure was Aaron Pertsikovitch (later Peretz), a gynecologist and survivor of four concentration camps, who was very involved in the discussion of absorbing survivors into Israeli society, in 1947 already criticizing their silencing by the society resident in Palestine before the war.40 Peretz, who was the head of the gynecology department at the Rambam hospital in Haifa for many years, participated in the Israeli medical discussions on Nazi medical experiments and the suffering of survivors. Hence, most of the Israeli physicians were indifferent to the topic. The discussion was perpetuated by a few figures, who eventually failed to initiate a more general discussion among Israeli medical professionals on the implications and consequences of Nazi medical crimes on post-war medical practice. Moreover, the Israeli discussion that did take place on Nazi euthanasia and other medical atrocities served more to de-legitimize German physicians and medicine than to examine their consequences on Israeli medical practice. The primary motivation was to expose crimes and to force the international community to punish the perpetrators. Although the lessons which should have been learned from these crimes were central, it was not up to Israeli medicine in particular, but to medicine in general to learn them. Thus, up to the late 1990s, in only a very few cases were ethical conclusions drawn from Nazi medical atrocities when discussing Israeli medical practice. For example, in 1952 in an article titled: “What is a Medical Consciousness?”, Dvorjetski submitted human and moral reasons for rejecting lobotomy operations conducted in Israel. With reference to the French Jewish psychiatrist Henri Baruk and the experiences of Nazi medical human experiments, he defined psychosurgery as a danger to the human personality and warned against its misuse by Israeli psychiatrists as a means of punishment or as a human experiment. Furthermore, he perceived the operation as a means to reduce the free will of the patient and degenerate his personality through a procedure which lacked a solid scientific basis, such that it was more of a medical experiment than a therapy.41 How can the relative marginality of Nazi euthanasia and other Nazi medical crimes in the Israeli medical discourse be explained? The obvious answer might be: because Israeli physicians belonged to the group of victims and not the 39 Fishel Shneorson, “The Magic Figure of the Survivor”, in: idem, Hebrew Pedagogic Psychology : Studies in Intimate Psychology, Tel-Aviv : Massada 1956, 222 – 262. (in Hebrew). 40 Aaron Pertsikovitch, “On the Mental State of the Newcomer”, in: Higiyenah ruh. anit (Mental Hygiene) 4(10), 1947, 34 – 37 (special issue dedicated to the Be‘ayot ha-higyenah ha-nafshit ba-Yishuv [“Problems of mental hygiene in the Jewish community in Palestine”], First Congress of the Society for Mental Hygiene in Eretz Israel, Jerusalem 1947, Arnold [Aaron Ham] Marzbach [ed.]). 41 Mark Dvorjetski, “What is a medical consciousness? What is Hebrew medicine?” in: Niv Harofe, 7 – 8, 1952, 60 – 72, here 67.

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perpetrators. As such, they did not feel they had to examine or revise their medical practice. But this answer is simplistic, and an explanation must be sought in the wider context of Israeli society and Israeli medicine. A possible explanation for this neglect is priorities. In the 1950s, the Israeli health system faced more urgent issues than discussing Israeli medical practice in the light of Nazi medicine. As a result of mass immigration, which doubled the size of the population within less than five years, the Israeli health system had to solve very basic health issues among the newcomers and teetered on the edge of bankruptcy.42 Under such circumstances, dealing with the potential ethical consequences of Nazi medical crimes might have been seen as a luxury. A second explanation for the relative avoidance can be found in the way Israeli society dealt with the Holocaust, its victims and survivors in other spheres as well. In general, there was a tendency “not to face the catastrophe as such”43 (namely, not to deal directly with the victims and the horrors), but rather to concentrate on the problems of the society facing the ‘otherness’ of the survivors. In this context, up to the 1960s survivors were not perceived by Israeli medical professionals as a distinct group.44 Their health problems, including mental problems were explained by absorption difficulties and seen as temporary. Part of this tendency “not to face the catastrophe as such” meant also not discussing Nazi euthanasia and medical experiments and their ethical implications. A third explanation is the perception that there was no need to confront the topic. First, most Israeli physicians – although of European origin – did not experience the atrocities directly, and survivors usually did not discuss medical and health atrocities, especially those caused by Nazi medical professionals. Second, and more important: after the end of the Second World War, and especially in the 1950s, medicine in Israel became more American-oriented, focusing on the scientific aspects. The shift of the main arena of ‘scientific’ medicine toward the United States, and the close relationship with American medicine expressed in financial and organizational co-operation, allowed Israeli physicians to avoid dealing with Nazi euthanasia and other medical crimes. American medicine was perceived to be untainted.

42 On the state of Israeli health system in the 1950s see: Nadav Davidovich, Shifra Shvarts, “Health and Hegemony : Preventive Medicine, Immigrants and the Israeli Melting Pot”, in: Israel Studies 9(2), 2004, 150 – 179. 43 Hanna Yablonka, “Holocaust Survivors in the Israeli Army during the 1948 War : Documents and Memory”, in: Israel Affairs 12(3), 2006, 462 – 483, here 481. 44 Phyllis Palgi, “Mental Health in Israel: Socio-Cultural Trends”, unpublished, Ministry of Health, Jerusalem, June 1962; Davidovitch, Zalashik, 2007.

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A transition in the 1990s As mentioned earlier, from the 1970s, the issue of medicine and the Holocaust as well as Nazi medical atrocities was practically absent in Israel, with only one article published on the topic between 1976 and 1986. From the mid-1980s the issue of Nazi euthanasia and medical crimes re-emerged within the Israeli medical discourse as a result of local and international tendencies. It was not only the time when the fiftieth anniversary of the end of the Second World War was celebrated, but also the acknowledgement by Israeli physicians that what happened in the Holocaust also has significance for the medicine of the present.45 From 1986 until 2005 around 30 articles on the Holocaust and medicine were published in Israeli medical journals – as many as had been published during the previous four decades. Awareness was raised during this period thanks to the activity of a few dedicated physicians who initiated conferences, edited volumes and led discussions in medical schools. This tendency continued and grew remarkably in the following years as well.46 The topic entered the curriculum of various medical schools in Israel, such as the program for the Study of the Holocaust and Medicine at the Department of Medical Education, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa founded by the late Tomi Spenser ; the Department for Healthcare, Ethics and the Holocaust, International Center for Health, Law and Ethics, Haifa University ; and is included in a course given at the school of medicine on humanism and medicine at Tel-Aviv University.47 In addition, annual scientific conferences on the Holocaust and medicine have been organized and held by the physician Shaul Shasha at Nahariya hospital, and there is a growing corpus of studies on the role of Nazi physicians as well as on the activity of Jewish physicians and Jewish hospitals during the Holocaust, most of them written by physicians, but also some by historians.48 These activities derive from the acknowledgement that the topic did not 45 Farfel Zvi, “Medicine during the Holocaust in the light of medical literature of the 1990s”, in: Harefuah 138(10), 2000, 890 – 894. 46 Shmuel Reis has identified at least six conferences dedicated to the subject during this period, and three book-length publications in 2006 – 2007; Shmuel Reis, “Holocaust and Medicine – a Medical Education Agenda”, in: IMAJ 9(3), 2007, 189 – 191. 47 Jeffrey M. Borkan et al., “A model for educating humanistic physicians in the 21st century : the new Medicine, Patient, and Society Course at Tel Aviv University” in: Education for Health 13, 2000, 346 – 355. 48 See for example: Shaul Shasha, “Morbidity in the ghettos during the Holocaust”, in: Harefuah 141, 2002, 364 – 368; idem, “Morbidity in the concentration camps of the Third Reich”, in: Harefuah 143, 2004, 272 – 276; idem, “Medicine in the concentration camps during the Third Reich”, in: Harefuah 144(4), 2005, 291 – 295; Orit Herschlag-Elkayam, Lea Even, Shaul Shasha, “Clinical manifestations of ‘Hunger Disease’ among children in the Ghettos”, in: Harefuah 142(5), 2003, 345 – 349; Chelouche, 2007; Nadav, 2009, chapters 5 – 10.

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receive enough attention in the past; that Israeli medical students and young physicians are not familiar with the history of medicine although it is important for their practice; and because of the understanding that not only Nazis during the Second World War, but we today are also prone to medical cruelty.49 In addition there is also a general growing awareness in Israeli medical discourse about ethical issues in the face of new questions regarding genetics, euthanasia and eugenics, which are not directly related to the past, but more to technological developments and changes in the field of medicine and science. In such debates Nazi euthanasia is in the background and serving as a point of reference.

Conclusion The influence of Nazi medical atrocities on the Israeli medical discourse and practice until the 1990s was very limited and minimal. It was a small group of physicians, mainly Holocaust survivors, who tried to promote a discussion on the topic among Israeli physicians. The content of this discussion focused primarily on the documentation of Nazi medical crimes and the severe state of Jewish victims’ health. It raised hardly any questions about how this past related to current medical ethical issues. A certain shift took place in the 1990s when medicine and the Holocaust, as well as ethical questions deriving from Nazi medical atrocities, were discussed and integrated into the curriculum of medical schools in Israel. Thus, one can argue that there was a delay of almost 50 years in the development of a local medical discourse concerning Nazi medical atrocities and euthanasia in Israel. Because Jews were among the main victims of Nazi medical crimes, and because many Jewish physicians who survived the Holocaust and many other survivors arrived in Israel, this marginality of the topic is relatively surprising.

49 Uri Weinberg, Shmuel Reis, “The Holocaust and Medicine – a learning moment”, in: British Medical Journal 331, 2005, 668; idem, “Pandora’s Box of Anatomy”, in: Harefuah, 147(5), 2008, 455 – 458 and 476 (in Hebrew); Reis, 2007; Spenser (ed.), 2007; Shmuel Reis, Tomi Spenser, “Holocaust and Medicine – lessons for today’s and future physicians”, in: British Journal of General Practice 53, 2003, 78 – 79.

Past and Present: Debates on Implications for Professionalism and Ethics in Medicine

James Kennedy

The Legacy of National Socialism for the Dutch Euthanasia Debate

The first real Dutch discussion of euthanasia and other forms of life-shortening treatment took place in the course of 1969. In that year the psychiatrist and phenomenological philosopher Jan Hendrik van den Berg published a slim book – it was only 55 pages long – entitled Medische macht en medische ethiek (Medical Power and Medical Ethics). In the United States, for example, it took a number of years before publishers dared to publish Medische macht because of its unabashed defense of mercy killing. But in the Netherlands it was an instant success; in the course of the next decade it was reprinted twenty-five times. Van den Berg’s thesis was simple. The sanctity of life made sense when the doctor did not possess much power to save life. Now, however, medicine was capable of cruelly and purposelessly keeping people alive who in fact should have died long ago. Armed with photographs, Van den Berg illustrated whom he had in mind: the “wholly failed” and “stunted young man” with hydrocephalus who was entirely unable to communicate with others; a young child with severely deformed limbs as the result of his mother having taken the infamous sleeping remedy Softenon (thalidomide); a man whose entire lower body had been removed by surgery ; and “voiceless” older patients who were more than ready for the end of life. Van den Berg believed that it was the duty of the doctor – in this dawning age of “medical power” – to help such patients die, either by letting patients refuse treatment, or by killing them by injection in their best interest. A “new” ethics, therefore, would have to replace the “old” ethics of the sanctity of human life, an ethics which moreover demanded full disclosure to patients about their true condition. In this news situation the physician was to preserve and lengthen life only when and where it was “meaningful” (zinvol). A “small commission” of experts would oversee where and whether such acts of mercy would be justified. But in his concluding sentences, Van den Berg appealed directly to the patient, for whom the pages had been written. It was up to him

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how he wished to die, with dignity or without, and he should expect the doctor to be there for him.1 Nowhere in Medische macht did Van den Berg use the word “euthanasia”, but in the press his support for both the “passive” and “active” termination of life – and indeed his approval of both voluntary and non-voluntary forms of mercykilling – was soon defined as such. Perhaps Van den Berg wanted to avoid a controversial term that might point to a troubling past. But on one thing he attempted to be tersely clear – what he advocated had nothing to do with the crimes of National Socialism. In taking as his motto that doctors only intervene to save life when it was “meaningful,” he insisted that “the specter of the years ’33-’45 need not arise [emphasis original]”.2 In this single sentence, the psychiatrist dismissed any comparison between his vision and that of the Nazis. Van den Berg’s appeal lay in his powerful articulation of public unease concerning medical capabilities that seemed to go beyond the humane and the compassionate, an unease that in many countries would feed both the drive toward patient rights and, in the Netherlands, to large and influential right-todie organizations. The advent of “medical power” was a concept that played a central role in the Dutch euthanasia debate. The Dutch used it frequently in the 1970s to discuss euthanasia and other issues in medicine, in both professional and popular works.3 But Van den Berg’s views hardly met with universal acclaim in the Netherlands. Medische macht had its critics, including not only the Catholic ethicist Paul Sporken but also the jurist Henk Leenen who, as pioneer in the field of health law, would play a central role in the legalization of euthanasia in the Netherlands. Leenen thought that Van den Berg did not distinguish enough between the role of the doctor and the will of the patient in his diagnosis of the problem; sometimes the voice of the patient seemed to count most; in other cases, it did not seem to matter.4 Critics of Van den Berg’s Medische macht did raise the specter of Nazism, as one reviewer did in the progressive weekly De Groene Amsterdammer in 1969, who warned readers that Van den Berg’s proposal that doctors save only life that was “meaningful” might be abused in the hands of ethically weak people, as had been the case in Nazi Germany.5 And Van den Berg’s sharpness at points suggested that he was being rather too directive, 1 Jan Hendrik van den Berg, Medische macht en medische ethiek, Nijkerk: Callenbach 1969. 2 Ibid., 52. 3 See, as just one example, Willem Metz, Onnozel leven, Nijkerk: Callenbach 1972, which says that “medische macht” forces physicians to make choices about whether to keep “retards” alive or not – though Metz does think they ought to be kept alive. 4 Paul Sporken, “Medische ethiek moet fundamenteel veranderen”, De Nieuwe Linie, 1 November 1969; Henricus Jacobus Josephus Leenen, “Moderne visies op de medische ethiek”, in: Katholiek Artsenblad 48, 1969, 352 – 354. 5 C. (Tineke) Wennen-van der Mey, “Medische ethiek ter discussie”, in: Groene Amsterdammer, 4 October 1969.

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as he was in his unequivocal condemnation of parents who would sacrifice their own happiness and those of their other children for keeping alive the child that had been “mismade” by Softenon.6 Van den Berg’s book fits in well with the tensions signaled by Ian Dowbiggin in his history of the euthanasia movement in the United States, in which the plea for greater human autonomy in choosing to live or to die was not unambiguously separated from the desire to “release” all those suffering from a “meaningless” life.7 But if that tension and the fears that came from it served to “stall” the euthanasia movement in America, it did not do so in the Netherlands. Dutch policy-makers and the Dutch public in the course of the 1970s and early 1980s decisively moved in a direction that, at least at the discursive level, eliminated the tension by insisting that “euthanasia” was – by definition – voluntary. Arguments that suggested that there might be larger social or economic reasons to advance euthanasia, present in early discussions in the Netherlands of the early 1970s, were purged from the discussion by about a decade later. Tellingly, too, Dutch debates, especially in the 1980s, had as their most emblematic cases those who could articulate their will to die, as opposed to those in coma or otherwise unable to make their wishes known, a striking difference with a country like the United States.8 The negative legacy of National Socialism arguably was one reason for this purge in the discourse and this direction; it was important for proponents to keep as much as distance as possible from that unsavory past. As has been argued elsewhere, the Dutch were able, relatively easily, to create space between themselves and either prewar eugenics or National Socialism, as it was not their history.9 Still, Dutch proponents of euthanasia took the misdeeds of National Socialism seriously enough to define their new project in a way that in its explicit focus on the “emancipated” individual, eliminated the tensions that had clouded Van den Berg’s book. This chapter examines the history of this development. It begins with – in international perspective – the noticeable paucity of discussion over euthanasia until the 1960s. It then looks at the early Dutch debates of the late 1960s and early 1970s, striking in their range and candor, which included discussions over what some thought were justifiable social indications for euthanasia. It concludes with a discussion of developments which led to the excision of such considerations from the public debate, thus 6 Van den Berg, 1969, 28. 7 Ian Dowbiggin, A Merciful End: The Euthanasia Movement in Modern America, Oxford: Oxford University Press 2003. 8 Peter G. Filene, In the Arms of Others: A Cultural History of the Right-to-Die in America, Chicago: Ivan R. Dee 1998. 9 Chris Rutenfrans, “Alles onder controle, eerst het water, nu de dood”, in: De Gids 160(7/8), 1997, 586.

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shielding the nascent pro-euthanasia movement from charges that it rather too much resembled the Nazis. “Euthanasia” in Dutch parlance came to be understood as in its central essence voluntary, far removed from National Socialist practice.

The dearth of public discussion over euthanasia Before the late 1960s euthanasia was barely a topic in the Dutch public sphere. Despite foreign discussions of euthanasia in the early 20th century, from the United States to Czechoslovakia, the Dutch remained remarkably uninterested, or at least remarkably silent, on the subject. Dick Meerman has shown how euthanasia (variously defined) generated much English and German literature on the subject after 1870, but very little within the Netherlands itself.10 Dutch eugenicists, in contrast to their German, American and English counterparts, never made much headway in prewar Holland because of the strength of the religious subcultures, the concomitant weakness of a state agenda in pursuing medical science, and a broad cultural hostility toward genetic determinism. The few Dutch eugenicists that there were seemed more concerned about class than about race. But whatever their predilections, both positive and negative eugenics remained a marginal phenomenon in the country, and to the extent that it existed its proponents were more inspired by “well-considered” Scandinavian repertoires than the “unscientific” ones of Nazi Germany, defined as they were by a political party and a dubious racial theory.11 All this may explain why euthanasia – often associated both during and after the war with other “eugenic” concerns – also seldom was discussed. Most of the literature explicitly opposing euthanasia came from Christian writers. The most uncompromising in tone and content was the work by the Catholic Ludovicus Bender, Thou Shalt Not Kill (Gij zult niet dooden; 1937). Among orthodox Calvinists, representing a significant and politically potent minority in the country, the most important address on the subject was given by the young physician Arie Lindeboom in 1932, who as professor emeritus of medicine in the 1970s would sharply and vocally oppose the rise of euthanasia. Lindeboom rejected the growing international lay sympathy for mercy-killing as a right to be demanded of the doctor, but accepted “euthanasia” as the softening 10 Dick Meerman, Goed doen door dood te maken: Een analyse van de morele argumentatie in vijf maatschappelijke debatten over euthanasie tussen 1870 en 1940 in Engeland en Duitsland, Kampen: J.H. Kok 1991, 81 – 107. 11 Jan Noordman, Om de kwaliteit van het nageslacht: Eugenetica in Nederland, 1900 – 1960, Nijmegen: SUN 1989, 243 – 261.

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of patient suffering – if carefully performed by the physician.12 Paralleling a pattern in the Anglo-American world, it was liberal Protestant and humanist voices – outside the medical profession – who first raised mercy-killing as a morally justifiable possibility. The theologian Michiel van Mourik Broekman, who was one of the relatively few Dutch proponents of sterilization even during the war, articulated, on the basis of humanitarian and Christian grounds, cautiously sympathetic views on euthanasia shortly before his death in 1945.13 In 1952 and again in 1955, the Humanist League (Humanistisch Verbond) tried to give away 250 guilders for the best essay on euthanasia, but neither contest yielded entrants. Only in the early 1970s would the League initiate another discussion of euthanasia, this time with more success.14 But these sympathetic voices found little if any traction. There was little social or political basis for it. During the Occupation, Dutch doctors largely had refused to cooperate with the nazification of medicine, although a minority sought rapprochement. Dutch doctors formally protested against anti-Jewish measures and German euthanasia policy, and most of them gave up their doctor’s titles rather than to be included in the Nazi-sponsored Physicians’ Chamber (Artsenkamer).15 The medical profession after the war coalesced around the resistance journal Medisch Contact – which in the postwar years became the journal of the (Royal) Dutch Medical Association, basked in its Resistance credentials. And as elsewhere, sympathy for “euthanasia” was inhibited by Nazi atrocities for a long time. The jurist Jan Remmelink, who would later oversee the first statistical study of euthanasia practice in 1991, echoed a common view in the mid-1980s, when he commented that the Nazis had “unquestionably made a normal discussion about [euthanasia] impossible for many years”.16 In noting the silence over euthanasia in the late 1960s, the prominent Catholic ethicist Sporken wrote:

12 Ludovicus Bender, Gij zult niet dooden, Hilversum: Paul Brand 1937; Gerrit Arie Lindeboom, “Euthanasie”, in: Predikant en dokter 2(6), 1932, 205 – 229. See also idem, Euthanasie in historisch perspectief, Amsterdam: Rodopi 1978, and idem, Euthanasie en euthanasiasme, Amsterdam: Buijten & Schipperheijn 1980. 13 Michiel Cornelius van Mourik Broekman, Beschikkingsrecht over leven en dood: Zedekundige opstellen over actueele vraagstukken, The Hague: H.P. Leopold, 1946, 85. The book was published after the author’s death. 14 Reported in Tjeerd Flokstra, Sjoerd Wieling, De geschiedenis van het Humanistisch Verbond, 1946 – 1986, Utrecht/Zutphen: Humanistisch Verbond 1986, 193. 15 For an overview of this history, see Joost Visser et al., Witte jassen en bruinhemden: Nederlandse artsen in de Tweede Wereldoorlog, Breda: Reality Bites Publishing 2010. 16 Jan Remmelink, “Hoge Raad, 27 november 1984”, in: Nederlandse Jurisprudentie 106, 1985, 461.

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“The word euthanasia […] has received a nasty connotation, through both the reality of euthanasia in the Nazi past and through science fiction about euthanasia in futuristic novels. Some people [therefore] do not want to think at all or hear about euthanasia.”17

None of this meant, however, that Dutch physicians – or their counterparts elsewhere – wholly abstained from shortening the lives of their dying patients during this period. The case of the general practitioners is instructive here. The vast majority of euthanasia cases (circa 85 %) recently performed in the Netherlands have been through G.P.s (huisartsen),18 and it seems plausible that before a regulated euthanasia regime came into place that they, too, were the most likely agents of what might be called mercy-killing in the period up to the 1970s. General practitioners, who often knew their patients and their families for decades, were often held in great esteem by their environment, and their almost priestly role at the deathbed was passively respected. That gave them some latitude to set in scene the last days and hours of a patient’s life, and to interpret their obligation to preserve life in the spirit rather than in the letter of the law, as they would have experienced it, particularly to the many patients to whom they themselves had become deeply attached. Though it is impossible to reconstruct the incidences of life-shortening actions by Dutch physicians, oral history research has suggested that G.P.’s not infrequently intervened to ensure that a terminal patient died at the right time – to spare the patient or the family from further suffering. Such actions might also be done out of more social considerations. One doctor recounted decades later that he ensured that a village funeral for the soon-to-expire patient conveniently would be able to take place on Saturday and not at midweek. Morphine, valium and other medications were employed to give “a little push” to the dying person.19 These practices, which might or might not be conducted with the consent or knowledge of the patient, were not directed by sinister state interest, coercive communal standards or by an authoritarian medical agenda, but by the social status and ethos of local physicians whose own medical training and expertise, we might add, was in comparison to hospital physicians relatively limited. There was only so much that they could do for their patients. Only in the 1970s would these interventions come to be defined as “euthanasia” and made into a public issue, and it was regulating these interventions that would serve as one of the major aims of pro-euthanasia reform. For the time being, though, such pro17 C.P. (Paul) Sporken, “Euthanasie: ingrijpen in het stervensproces?”, in: Katholiek Artsenblad 48, 1969, 12. 18 Esther Pans, “Euthanasie en recht”, presentation Utrecht Law School, 26 May 2014: http:// kvdl.nl/wp-content/uploads/2014/05/Euthanasie-anno-2014.pdf (10 August 2014). 19 Anne-Mei The, Verlossers naast God: Dokters en euthanasie in Nederland, Amsterdam: Theoris 2009, 29 – 38 .

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fessional practices were kept discreetly hidden, often to the patient and certainly to the wider public.

The first extensive public discussions: the 1960s The 1960s witnessed a change in the discussion. Due to the rapid changes in the ability of medicine to keep people alive but also to prevent suffering, medical ethics now seemed less self-evident than had previously been the case. Cautiously, several members of the medical community, including Lindeboom, then a leading figure at the Protestant Vrije Universiteit medical center, and the psychiatrist J.J.C. Marlet, began cautiously to explore the boundaries of acceptable and unacceptable forms of “euthanasia”. Marlet, writing in 1968, opined that euthanasia probably happened more often than people thought, and that the silence of physicians on this matter was the reason for this misconception. He further distinguished between different kinds of “euthanasia” including “the destruction of life that is considered unworthy of life”, which he rejected as dehumanizing and unworthy of the medical profession.20 But other, more “passive” forms of “euthanasia,” such as the stopping of treatment where it seemed of little value, could now count on more understanding. In particular, the ability to reanimate patients with a poor prognosis generated much discussion in the Dutch medical world in the course of the 1960s, and had also became part of a wider, public debate about end of life issues. The social-democratic broadcasting association (VARA) introduced the difficult issue of euthanasia in its 1965 program on public television, The Wilma Helgers Case, in which a fictional wife was accused and tried for euthanizing her ill husband, which ended with commentary by real medical specialists.21 Seen this way, Van den Berg’s 1969 book, if radical in its time for calling for the active killing of patients, was clearly a response to recent discussions, helping to explain its immediate resonance. This discussion about the proper boundaries of medical intervention was hardly a uniquely Dutch phenomenon. Nor were the cultural changes of the 1960s, which challenged authority, including medical authority. But the Neth20 Gerrit Arie Lindeboom, Opstellen over medische ethiek, Kampen: J.H. Kok 1960; J.J.C. Marlet, “Euthanasie”, in: L.H.Th.S. Kortbeek et al., Recent medisch ethisch denken, Leiden: Stafleu 1968, 167, 175; see for analysis Aart Hoogerwerf, Denken over sterven en dood in de geneeskunde: Overwegingen van artsen bij medische beslissingen rond het levenseinde, Utrecht: Van der Wees 1999, 54 – 55. 21 For written version of the program with notes, see Erica van Dijk, Milo Anstadt (eds.) De zaak Wilma Helgers: een weergave in woord en beeld van de door Erica van Dijk & Milo Anstadt samengestelde uitzending, Amsterdam: Querido 1965.

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erlands was marked by a particularly rapid set of social changes, in which the country transformed itself within a few years from a society dominated by both Catholic and orthodox Protestant politics and social organizations to one that demonstrably celebrated the freedoms of the “emancipated” individual.22 That meant consciously assaulting “taboos” surrounding sex in particular but also death, and making everything “bespreekbaar”, that is, up for discussion. For these reasons, there was increasing insistence that death and dying be more openly discussed at the bedside than had previously been the case. This trend is perhaps best evidenced in the success of J.J. Buskes’ Truth and Lie at the Sickbed (Waarheid en leugen aan het ziekbed; 1964), which went through eight printings in the next decade. Buskes – a prominent Protestant minister active on the political left – argued that the inability to talk about illness and death had made the sick and dying “onmondig”, literally mouthless. But doctors, nurses, pastors and family had the moral obligation to speak frankly and honestly to the patient about his condition, and about his desires. It also meant being open with him about difficult treatment options. It did not always mean telling the unvarnished truth, but it did mean rejecting the systemic lies and evasions too typical of hospital culture.23 Toward the end of the 1960s it had been something of a commonplace to say that the taboo that the healthy had placed around death had made it difficult for patients to make their own feelings and desires “bespreekbaar”, Our dying are being silenced to death, the popular journal Nieuwe Revu pronounced in 1969.24 This made it all the more urgent to speak the truth at the bedside.25 In 1971 the Protestant broadcasting association (NCRV) broadcasted, for example, the “taboo-breaking” Tenzij een wonder gebeurt (Unless a Miracle Happens), which taped Vrije Universiteit of Amsterdam physicianprofessor Kees van der Meer modeling frank talk to a dying patient about his hopeless condition.26 It was a portent of what was to come in the next decade. By around 1970 there was a widely perceived sense, at least in the mainstream media, that death was a taboo that was preventing people from living well – and from dying well. “After the sex wave, which at the moment is ruling the Western world, a new wave is beginning to ripple, namely, the problem of death”, Het Begrafeniswezen, journal of the Dutch death care industry, noted in 1970.27 22 James C. Kennedy, Nieuw Babylon in aanbouw: Nederland in de jaren zestig, Amsterdam: Boom 1995. 23 Johannes Jacobus Buskes, Waarheid en leugen aan het ziekbed, Baarn: Ten Have 1964, 132 – 151. 24 Anonymous, “Onze stervenden worden doodgezwegen”, in: Nieuwe Revu, 19 July 1969. 25 See for example, L.J. (Louwrens) Menges, “De waarheid aan het ziekbed”, in: Heije Faber (ed.), Over dood en sterven, Leiden: Universitaire Pers Leiden 1971, 61 – 70. 26 Cornelis van der Meer, Henk Mochel, Tenzij een wonder gebeurd: Begeleiding van stervenden, Kampen: J.H. Kok 1971. 27 Anonymous, “Denken over de dood”, in: Het Begrafeniswezen 25(6), 1 April 1970, 102.

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People on both sides of this issue shared the conviction that the silence surrounding death was wholly or largely lamentable, prompting in the media a strong reaction against this silence in the course of the 1970s. This, too, helps explain Van den Berg’s great appeal: Medische macht was expressly a taboobreaker, offering an utterly unflinching view of reality, demanding of physicians both a new forthrightness toward the patient as well as demanding that they act boldly out of a new ethic instead of timorously hiding behind the old. Thus the introduction of euthanasia came to be understood as part of an emancipatory process, in which the patient was not only to be freed from physical suffering but from the stifling silence which had hitherto confounded her.

Euthanasia and its perceived relations to social problems Still, there was the issue of what “euthanasia” actually meant and what it should mean, and whether Van den Berg’s call could so neatly be separated from a coercion that in the public mind was most emblematically associated with National Socialism. And whether “euthanasia” was to be defined as a wholly voluntary choice by the patient was simply not clear in the late 1960s and early 1970s. No one publicly advocated eugenics or a state-sponsored termination of useless mouths – that would have been considered repugnant by nearly everyone. But Van den Berg’s ambiguous stance on the question of who actually should decide raised questions on whether patients were really respected in their choice. Moreover, neo-Malthusian notions entered into the early debate over Dutch euthanasia, with voices insisting that “the euthanasia question” also be tied to the question of how society was going to manage the sharply rising number of old people. There was perhaps no Western country more consumed with the overpopulation “problem” than the Netherlands in the 1960s and early 1970s. As the Dutch broke with traditional religion and high birth rates, they at the same time found moral purpose in “world causes” – including population growth reduction, then seen as essential for Third World development. Warnings about high birth rates were both frequent and dire.28 It is not surprising, therefore, that a neo-Malthusian concern about overpopulation would play some role in not only the abortion debate,29 but in the emerging

28 See, for instance, for a rather militant example of this, Arie Corstiaan Drogendijk jr., “Op de grens van soort en individu”, in: Medisch Contact 29, 1974, 505 – 509. 29 Scholars investigating the history of the modern abortion debate are divided on how great role these neo-Malthusian concerns played, Joyce Outshoorn relativizing the significance Jan de Bruijn attaches to it; Jan de Bruijn, Geschiedenis van de abortus in Nederland, Amster-

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euthanasia debate as well. And the issues of euthanasia and overpopulation met each other most clearly in what was sometimes called the “the question of the elderly” (bejaardenvraagstuk). By the 1960s, the growing number of older people had become seen as a “social problem”30 – how to care for senior citizens, and how to pay for them. By the early 1970s, the growing problem of too many old people in the future was a topic of considerable debate, a debate which also included “euthanasia” (again, variously defined). The weekly Haagse Post had somewhat enigmatically proclaimed: “In the year 1970 more and more people see in the overpopulated Netherlands that the ending of meaningless life can also be done out of compassion.”31 In 1974, the gerontologist R.J. Zonneveld asked how society should position itself in respect to the large numbers of elderly and “passive, or even active euthanasia”.32 The first important body to publicly inveigh on “euthanasia” was the Dutch Reformed Church, the country’s largest Protestant body. In 1972 it expressed openness to the possibilities of euthanasia, in part out of respect to modern human maturity (“mondigheid”) but also considered the financial “sacrifices” that society bore for the elderly, and the natural call of the elderly to “make room for others”.33 Two early and prominent proponents of euthanasia in the Netherlands had themselves been vocal and active in combating overpopulation. Van den Berg’s objections to Medische macht stemmed in part from his observation that this power generated too many people who lived too long and too badly. In defending sterilization and abortion in 1966, Van den Berg had argued that the new power of the doctor had created a new challenge: overpopulation. “It can be a witness to love of humanity when, in a time of disastrous population growth, undesired human life is no longer protected. The physician who, blindfolded, stimulated population growth, should now take the blindfold off.”34 In 1969, Van den Berg

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dam: Van Gennep 1979; Joyce Outshoorn, De politieke strijd rondom de abortuswetgeving in Nederland, 1964 – 1984, The Hague: VUGA 1984. Adrianus Jacobus Jörg, Wat gaat ons de toekomst aan? Zes orientaties ten aanzien van de naaste toekomst, The Hague: Boekencentrum 1968, 98. Jörg was a cousin of the synodical chair when the Dutch Reformed Church’s position on euthanasia came out; see note 33. See sidebar by Marius Aalders, “Het recht om te sterven – een goed recht”, in: Haagse Post, 27 January 1971. Robert Jacques van Zonneveld, “Oud worden in onze maatschappij”, in: D.W. (Dirk) van Bekkum et al. (eds.), Oud worden, oud zijn, Deventer : Van Loghum Slaterus/Stichting BioWetenschappen en Maatschappij, 1974, 18. Nederlands Hervormde Kerk, Euthanasie, zin en begrenzing van het medisch handelen: Pastorale handreiking, The Hague: Boekencentrum 1972, 31 – 40; see also Frits de Lange, “Verschuivingen in het kerkelijk spreken, verschuivingen in het euthanasiedebat”, in: Frits de Lange, Jan Jans (eds.), De dood in het geding: Euthanasiewetgeving en de kerken, Kampen: J.H. Kok 2000, 46 – 57. Jan Hendrik van den Berg, “Een conflictspsycholoog over bevolkingsgroei”, in: idem, De zuilen van het Pantheon en andere studies, Nijkerk: Callenbach 1969, 55. In what might be a

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said in an interview that medical power had doomed “countless people” to further existence who otherwise would have died much earlier, with “calamitous” results, including a rising suicide rate among older people, and “the quickly growing overpopulation of our country”. Under these conditions, a change in medical ethics was inevitable.35 The other key figure was Piet Muntendam, who became the chairman of the Dutch Association for Voluntary Euthanasia (NVVE), founded in the early 1970s and which quickly became the preeminent pro-euthanasia organization in the country, drawing in tens of thousands of members in the first decade of its existence. Muntendam became chair in early 1976 at the age of 74, and who would play an essential role in giving the new organization a respectable and moderate face. A medical doctor and longtime public servant, Muntendam had been a driving force in the 1960s to reduce world population, and in the early 1970s would chair a national Commission on the Population Question (Commissie Bevolkingsvraagstuk), which published its findings in 1976.36 And it was perhaps natural for Muntendam, as a retired professor of social medicine, to be interested in the “social” aspects of euthanasia, including its economic aspects. For Muntendam in particular and the NVVE in general, it was clear “that voluntary euthanasia and everything surrounding it should naturally be part of the elderly question”.37 For Muntendam, this meant that the euthanasia issue must necessarily take on the economic side of an increasingly older population. For him, the priority of an individual’s right to choose when to die did not preclude discussion of wider economic and social issues. Especially in geriatrics, Muntendam exhorted his more timorous colleagues, “One not only may but must think, speak and write about euthanasia.”38

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small piece of evident supporting Bruijn’s contention (see footnote 29), the prominent Catholic intellectual Frederik Jacobus Johannes Buytendijk congratulated his friend Van den Berg with the appearance of Medische macht adding, “I understand that that you have kept the question of abortus provocatus on social indication out of consideration”. This suggests that Van den Berg regarded (or that Buytendijk had reason to suppose he had) euthanasia as part of a larger concern that included abortion rights – and these chiefly on the grounds of a wider social concern, including overpopulation. More research is necessary here; see letter in Peter Heij (ed.), Wat hen bewoog: Briefwisseling tussen F.J.J. Buytendijk en J.H. van den Berg, Nijkerk: Callenbach 1989, 131. Interview with Van den Berg, “Verworven medische macht vraagt vernieuwing van ethiek”, in: Jozeph Philip Calff, Medische ethiek vandaag, Amsterdam/Brussels: Elsevier 1969, 3 – 12. Piet Muntendam et al., Bevolking en welzijn in Nederland: Rapport van de Staatscommissie Bevolkingsvraagstuk vastgesteld te Leidschendam December 1976, The Hague: Staatsuitgeverij 1977. The report says nothing about euthanasia, and the most direct connection he made was that quality of life should now get more emphasis than the quantity of life. Editorial, “Oud worden – oud zijn”, in: NVVE Kwartaalblad 2(2), April 1976. Muntendam cited in:, “Prof. Muntendam en de euthanasiewetgeving”, in: NVVE Kwartaalblad 2(2), April 1976; Piet Muntendam, “Euthanasie, weer terug in de taboesfeer?”, in: NVVE Kwartaalblad 8(3), September 1982.

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Overpopulation was not the only concern. Compounding the great future surge of the elderly was the astronomical rise of medical expenses in general, which seemed to put into question whether the Dutch could afford to keep alive everyone who could be kept alive. The Protestant ethicist and Groningen professor Pieter Johan Roscam Abbing said in the early 1970s that keeping people alive at any cost would mean “reorienting the national budget […] so that 100 % of it must be expended for public health”.39 In particular, the advances in expensive technology – and the fact that such technology would not be available for everyone – meant, at the very least, that “passive euthanasia” was unavoidable. Medical decisions would have to be made – were already being made – that consigned some people to this kind of “euthanasia”. In a word, health care rationing and allocation already necessarily included “euthanasia”, and this trend would only get pronounced in the future.40 Together, the Netherlands’ aging demographic trends and the rise of hightech medicine seemed to spell deep trouble for the future – a future in which not only “passive,” but “active” euthanasia would likely be included. The rising number of patients suffering from dementia in particular seemed to a few commentators to necessitate euthanasia in the future. In 1970, the psychiatrists Flip Treffers and Hans van Berkestijn addressed the issue of euthanasia in part by pointing to television’s Brandpunt program which revealed that there were only 6,500 beds available for the 14,000 “mentally disturbed elderly,” though they were careful to avoid drawing conclusions.41 In 1972, the medical professor Van der Meer, speaking while still leaning against “active euthanasia”, came to the conclusion that this kind of euthanasia “must come [original emphasis]” given the advent of “very many senile elderly who must be cared for and who on the other hand as such barely seem to have significance (betekenis) for society”. Not only finances but the staffing – up to a quarter of the working population would be required to care for these elderly – suggested that a crisis lay ahead.42 But the concern was not restricted to the mentally incompetent elderly. A 1975 report by the Voluntary Euthanasia Foundation (SVE), a small pro-euthanasia advocacy group, noted – with some concern – that the Dutch public was showing a greater public interest in “euthanizing” people who lived “a very limited and, for the most of us, a meaningless existence”, because they in their great numbers

39 Quoted in Ben Herbergs, Laat me sterven voor ik wakker word…tien jaar strijd om het recht op een menswaardig levenseinde, Amsterdam/Brussels: Elsevier 1984, 48. 40 Hans van Berkestijn, Flip Treffers, “Het recht op de dood”, in: Groene Amsterdammer, 9 January 1971. 41 Ibid. 42 Henk Mochels interview with Cornelis van der Meer, “Geen euthanasie zonder duidelijke grens”, in: VU Magazine, February 1972.

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constituted “a too heavy burden for society”.43 Indeed, some of the SVE’s own people apparently subscribed to the view that the growing burden on society would prompt people to look to euthanasia as a solution, not only at the end of life, but at its beginning. The lawyer A. Seret, co-founder of the Foundation, hoped that once society had accepted voluntary euthanasia, it would dare to ask: “Shouldn’t we allow all these incurable and mutilated children to die shortly after their birth?” Jan Ekelmans, the future chairman of the NVVE, uttered similar concerns in the early 1970s.44

Nazi “euthanasia” versus Dutch-style euthanasia Such expressions helped to feed a coalescing anti-euthanasia movement, who did see an all-to-close link between an unsavoury past of coercion – which included National Socialism – and what was now being proposed. A large group of physicians, opposed to both abortion and euthanasia, publicly reminded physicians of their rejection of Nazi euthanasia during the war and urged them to take the same rigorous line now.45 Outspoken critics of euthanasia like the Amsterdam dermatologist Isaac van der Sluis, after offering a history of the international euthanasia movement, collected examples of utterances of Dutch euthanasia proponents that favored “involuntary euthanasia” in his book The Right to Kill Grandmother (Het recht om grootmoeder te doden; 1977).46 The Polish cardiologist Richard Fenigsen also claimed to hear his Dutch colleagues, in a Dutch hospital, make decisions to terminate a patient’s life on the basis of economic motives.47 The inveterate Lindeboom warned in his Euthanasie en Euthanasiasme (1980) that only a hair’s breadth separated voluntary and involuntary forms of euthanasia.48 Perhaps most poignant was Chris Rutenfrans’ and Catharina Irma Dessaur’s May the Doctor Kill? (Mag de dokter doden?; 1986) published after the pro-euthanasia consensus in the Netherlands was already reached. The book closed by expressing its fear that the spirit of Hitler might have won the war after all.49 The fact that Dessaur, a professor of law, was 43 Stichting Vrijwillige Euthanasie, De dood komt soms te laat, Lochem: De Tijdstroom 1975, 28. 44 Abraham Seret interviewed by P.J. Kat, “Recht van doodzieke om sneller te sterven”, in: NRC Handelsblad, 6 February 1973; Jan Ekelmans, “De mondige sterveling”, in: Medisch Contact 26, 1971, 791 – 796, here 794. 45 Brief artsen-actie ‘Eerbiediging menselijk leven’, published in: De Tijd, 21 February 1973. 46 Isaac van der Sluis, Het recht om grootmoeder te doden, Amsterdam: Saint Jacques 1977. 47 Ibid., 62 – 66; Richard Fenigsen, Euthanasie: Een weldaad?, Deventer : Van Loghum 1987, 18 – 19. 48 Lindeboom, 1980, esp. 77. 49 Catharina Irma Dessaur, Chris Rutenfrans, Mag de dokter doden? Argumenten en documenten tegen het euthanasiasme, Amsterdam: Querido 1986, 14, 140.

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Jewish accorded her a degree of consideration that pro-euthanasia proponents did not typically give their opponents whom they regarded as narrow moralists. But in the end, neither Dessaur’s moral stature, or the warning messages of any of these publications, had much impact on the direction of the debate. Other voices strongly disputed that what the Dutch were doing had anything to do with what occurred under National Socialism. Jan Menges, a Dutch physician whose dissertation “Euthanasie” in het Derde Rijk (1972) would be the only major Dutch-language study of German “euthanasia” for over two decades, issued a foreword in which he laid out the differences between illegitimate Nazi “euthanasia” and the legitimate forms of euthanasia possible today : “The interests of the patient did not count but only that of the state. There was no thought of openness: fictitious organizations, the use of false names, the writing of repugnantly hypocritical letters of condolence and even misinforming from the supervising doctors put from the outset of the actions a veil of deception over the affair. Through all of these facts the “euthanasia” of the Nazis has condemned itself and proved that one may speak more of murder than of a “saving act” (heilshandeling).”50

Others concurred. The television maker Henk Mochel aired a program in the early 1970s to take on the challenging task of showing that euthanasia these days was just a lot different from the type practiced by the Nazis.51 The time seemed ripe to point this out. The span of a quarter-century since Nazi atrocities had occurred enabled people, said the theologian-ethicist Roscam Abbing in 1972, to distinguish between euthanasia which was an “abomination” and that which was “justified”.52 For some, it became essential, in fact, that the Dutch be able to distinguish between the two types of euthanasia. The General Practitioner Truus Postma-Van Boven, who played such a key role in the Dutch debate (see below), thought the utilitarianism of Nazi Germany would best be countered if in fact thinking about euthanasia could be “broken open so that people can decide for themselves”.53 For Postma and others in the euthanasia movement, open discussion was the best way to counter any possible parallel with the Nazis. Occasionally, proponents of euthanasia thought that references to Nazi Germany were just what was needed as a reminder and a warning. The jurist Adrienne van Till-d’Aulnis de Bourouill, an early proponent of liberalizing euthanasia (without changing the law) and the secretary of the SVE, said in 1984 that it was good to occasionally hold up the mirror of the Nazi regime, so as to 50 Jan Menges, ‘Euthanasie’ in het Derde Rijk, Haarlem: De Erven Bohn 1972, vii. 51 Henk Mochel, Een milde dood: Gedachten en een verslag van een televisieserie over euthanasie, Kampen: J.H. Kok 1972, 12 – 13. 52 Pieter Johan Roscam Abbing, Toegenomen verantwoordelijkheid: Euthanasie – Eugenetiek – Moderne Biologie, Nijkerk: Callenbach 1972, 13. 53 Cited in Ineke Jungschleger, Wout Woltz, Dubbelinterview, in: NRC Handelsblad, 16 February 1974.

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remind contemporary society not to put pressure on people to end their lives, or end the lives of those unable to speak for themselves.54 And a year later she decried the proposal of the State Commission Euthanasia (not adopted) to euthanize coma patients without their permission – precisely on the grounds that this was the kind of thing that had been done in the Third Reich.55 The negative example of Nazism remained in the background of the euthanasia discussion, always prompting proponents to stress the voluntary nature of their proposals, and helping set boundaries for what was, and was not, permissible. Perhaps for this reason, and the pungent critique of opponents, Dutch arguments for euthanasia moved away in the course of the 1970s from economic or social arguments, and also away from non-voluntary forms of life-ending treatment. Writing in 1996, John Blad of the pro-euthanasia NVVE stated that none of “social” arguments for euthanasia had “survived the critical test of the democratic discussion”.56 The emphasis in the public debate over euthanasia came to focus heavily on the wishes of mentally competent patients who beseeched others to end their own lives. To be sure, there was also some attention given to other types of patients, such as newborns, but the debate mostly crystalized around patients who in sound mind wished to die. In contrast to countries like the United States, where coma patients were placed center stage, in the Netherlands it was precisely the patient who knew only too well what she wanted who figured most prominently. And in the most important cases which involved, it was a she; in the three most high-profile cases brought to court, all involved elderly women. Most emblematic and for its legal precedence enormously important was the Postma-Van Boven trial of 1973. The 78-year-old Margina Van Boven-Grevelink had suffered a cerebral hemorrhage in the spring of 1971, and had nearly died from it. But, because of various medical interventions during a two-month stay in an Assen hospital, she had survived, and in September was placed in the nursing home MariÚnhof in Oosterwolde, not far from her physician-daughter. There she faired very poorly, unable to walk, or to use her left arm, and was nearly blind and deaf. She was, however, able to make clear that she wanted to die. The 44-year-old Dr. Postma-Van-Boven, resolved, after some deliberation, to accede to her mother’s request, and, accompanied by her husband, injected some 200 milligrams of morphine in mid-October of 1971. The mother died within minutes. The director of the nursing home reported this to the Provincial 54 Bram Pols, “Secretaris van de Stichting Vrijwillige Euthanasie: Nieuwe wetgeving is onnodig”, in: Trouw, 29 February 1984. 55 H.A.H. (Adrienne) van Till-d’Aulnis de Bourouill, “PatiÚntenrecht en het artikel 292 bis van de Staatscommissie Euthanasie”, in: Medisch Contact 43(40), 25 October 1985, 1347. 56 John R. Blad, Abolitionisme als strafrechtstheorie: Theoretische beschouwingen over het abolitionisme van L.H.C. Hulsman, Rotterdam: Gouda Quint 1996, 325.

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Inspector of Health, who in turn alerted the police. That the case went to court at all, and only in February of 1973, probably stems from that the case leaked out to the press in the course of 1972, compelling uncertain authorities, reluctant to pursue doctors in such cases, to make a decision in favor of prosecuting PostmaVan Boven. Whatever the background, the trial made history : It was the first widely followed euthanasia trial in teh country, and though Postma-Van Boven was technically found guilty (and sentenced to a suspended period of one week in jail, plus a year’s probation), the court clearly sympathized with the purity of her motives and her desire to end the suffering of her mother.57 The verdict was particularly important in understanding suffering in non-somatic terms, leading to wider applications over time, in which “unbearable and hopeless suffering” became the basis for active interventions on the part of the doctor. And implicitly it also made communication between the patient and her physician the centerpiece in the decision-making. The Dutch euthanasia law of 2001 made the “conversation” (gesprek) between patient and doctor its foundation.58 That Dutch public discourse and eventually policy came to focus on the case of the suffering patient is partly because “euthanasia” was soon framed as an emancipatory project. Euthanasia as free act found resonance in a society where the emancipated citizen was deemed capable of making key decisions in life – even if these diverged from higher moral norms that had been imposed by others. In asserting the preeminence of the individual the Dutch perhaps went further than other societies in throwing off authority. And increasingly, the physician was expected to lend cooperation to those who wanted to die, as the “self-determination” of the patient became a more assertive principle. The notion, too, that society had a responsibility to prevent suffering was also deeply embedded in Dutch policies of “well-being” that reached their height in the 1970s. One might say that in the end the Dutch were more concerned about arranging a right to die for themselves and their loved ones than about tackling issues such as aging through end-of-life interventions. In any event, polls showed that by a huge majority (usually over 80 %) they supported the legalization of euthanasia. But framing euthanasia as the free choice of a free individual was also the conscious strategy of the country’s budding pro-euthanasia movement. The NVVE, which had 100,000 members by the 1980s and thus was in numbers larger than any other similar organization in the world, positioned itself in the 1970s 57 See Theodora W.L.E. Indewey Geerlings-Huurman, Het Leeuwarder Euthanasie-Proces: Feiten en commentaren, Nijkerk: Callenbach 1977. 58 Minister of Health Els Borst-Eilers, cited in James Kennedy, Een weloverwogen dood: Euthanasie in Nederland, Amsterdam: Bert Bakker 2002, 201 – 202.

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and 1980s as moderate, chiefly concerned with the right-to-die of its members than pressing for non-voluntary forms of “euthanasia”. Members could be gently chided by the leadership if they seemed to want more controversial measures as well. The genteel Muntendam, compelled to deemphasize his interest in euthanasia as a larger social problem, was successful in conveying a quiet confidence and moderation that avoided unnecessary controversy.59 Henk Leenen, who prepared the legal contours for the Dutch euthanasia policy, strove from the beginning of his attachment to the movement in the late 1970s to stress the voluntary character of euthanasia. He thus carefully undertook efforts to excise the pro-euthanasia camp of socio-economic motivations.60 Partly through these efforts, “euthanasia” in the Netherlands came by the early 1980s to be formally defined by government agencies as necessarily voluntary. And in 1984, the Dutch Royal Medical Association, after much internal discussion, would approve a set of guidelines under which this form of euthanasia could be performed. In turn, other more difficult issues such as infanticide, ending the life of those in coma, and physician-assisted suicide for patients with dementia were deferred to a later date. Tellingly, too, discussions about palliative care were brushed off until euthanasia was well established as a extensively regulated and protocolled practice in the 1990s; such discussion was seen as a distraction, used by critics, that prevented an “open” discussion over euthanasia.61 The British hospice movement found little interest, sympathy or emulation in the Netherlands until after 1990, and it was nearly a decade later before palliative care became a significant part of Dutch medicine. Although the NVVE’s first issue of its quarterly would hail Jan Hendrik van den Berg in 1975 as pioneer in the euthanasia cause, his star was already setting as prophet of the euthanasia movement. The proponents of euthanasia wanted there to be no doubt about their commitment to the right-to-die as anything other than commitment to an entirely volitional act. Increasingly, then, the Dutch euthanasia movement required spokespersons who stressed the wishes of the patient in a less ambiguous fashion than Van den Berg, so as to remove all doubt that euthanasia somehow yet lay in the shadow of the Third Reich.

59 Ibid., 90; Anonymous, “Professor Muntendam: Groeiend aantal medici aanvaarden euthanasie”, in: Volkskrant, 12 March 1977; Charles Groenhuijsen, Han van Gessel, “Rustig naar euthanasie-wet”, in: Volkskrant, 25 March 1978. 60 Author’s Interview with Henk Leenen, Amsterdam, 6 June 2000. 61 The, 2009, 204 – 217.

Isabelle von Bueltzingsloewen

Starvation in French Mental Hospitals under Nazi Occupation: Misinterpretations and Instrumentalization since 1945

In its issue of 10 June 1987, the French national daily Le Monde published an article entitled “Death asylums”,1 revealing that 40,000 mentally ill patients had died of hunger, cold and infections caused by undernourishment (especially tuberculosis) in French psychiatric hospitals between 1940 and 1945. Actually, this scoop was already dated, as it had been uncovered a few months earlier by psychiatrist Max Lafont in a book with the eye-catching title L’Extermination douce: La mort de 40. 000 malades mentaux dans les húpitaux psychiatriques en France sous le r¦gime de Vichy (“Gentle extermination. The death of 40,000 mentally ill patients in French psychiatric hospitals under the Vichy regime”).2 In this book, which received little attention at the time of its publication, Max Lafont had indeed suggested that the Vichy regime took advantage of the food crisis caused by the war and German occupation to get rid of a category of patients considered socially useless, a threat to the purity of the race and an excessive financial burden on society. Far more virulent than Max Lafont’s book, the article published in Le Monde vehemently implicated French psychiatrists, accusing them, like their German colleagues, of having contributed to the extermination of 40,000 mentally ill patients or at least of having abandoned them to death without attempting to save them. Several deeply shocked psychiatrists responded strongly to these allegations.3 In the two decades that followed these publications, several historians – in-

1 Claudine Escoffier-Lambiotte, “Les asiles de la mort: Quarante mille victimes dans les húpitaux psychiatriques pendant l’Occupation”, in: Le Monde, 10 June 1987. The author of this article was Doctor Claudine Escoffier-Lambiotte, a regular contributor to the newspaper. 2 Max Lafont, L’Extermination douce: La mort de 40 000 malades mentaux dans les húpitaux psychiatriques en France sous le r¦gime de Vichy, Le Cellier-Lign¦: Editions de l’AREFPPI 1987. 3 See Jean Ayme, “A propos de l’extermination douce”, in: Bulletin du syndicat des psychiatres des húpitaux, September 1987, 59 – 60, and Charles Brisset, “A propos de l’extermination douce de M. Lafont: un scandaleux amalgame du journal ‘Le Monde’”, in: L’Evolution psychiatrique 52, 4 October 1987, 959 – 965. At that time, Jean Ayme was president of the Union of Hospital Psychiatrists.

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cluding Henry Rousso4 and Claude Qu¦tel,5 both specialists on the Vichy regime – vigorously contested the “gentle extermination thesis”, which is also often referred to as the “hidden extermination thesis”.6 In 1989 were published the memoirs of the French psychiatrist, Pierre Scherrer, who had been the medical director of the hospital of Auxerre during the Occupation. This testimony, as well documented as it was finely shaded, contradicted many points of Max Lafont’s argument, but did not find any echo in the media.7 By contrast, the “gentle extermination thesis” was spread by the media and by several intellectuals such as the highly mediatized psychiatrist Boris Cyrulnik8 and critical publisher FranÅois Maspero.9 It imposed itself in collective memory, increasingly finding traction as an undisputable truth. It has also crossed borders. More specifically, it has been endorsed without caution in several German publications – for instance in an article by Sieglind Ellger-Rüttgardt, “Outside the norm: Disabled people in Germany and France under Fascism. A comparative historical study” (1991),10 in an article by psychiatrist Heinz Faulstich, “The number of ‘euthanasia’ victims” (2000),11 as well as in the French version of a book by geneticist Benno Müller-Hill, which appeared in 198912 under the title Murderous Science: Elimination by Scientific Selection of Jews, Gypsies and Others. Germany 1933 – 1945.13 In addition, the gentle extermination thesis has progressively become more radical. In 1998, psychiatrist Patrick Lemoine produced a work of fiction entitled 4 See Henry Rousso, “Compte rendu des livres de Max Lafont et de Pierre Durand”, in: VingtiÀme SiÀcle: Revue d’histoire 21, January-March 1989, 156 – 157, and Eric Conan, Henry Rousso, Vichy, un pass¦ qui ne passe pas, Paris: Fayard 1994 (2nd edition: Paris, Gallimard/ Folio 1996). 5 Olivier Bonnet, Claude Qu¦tel, “La surmortalit¦ asilaire en France pendant l’Occupation”, in: Nervure: Journal biologique et clinique IV, 2 March 1991, 22 – 32. 6 Muriel Habay, GeneviÀve Herberich-Marx, Freddy RaphaÚl, “L’identit¦-stigmate: L’extermination de malades mentaux et d’asociaux alsaciens durant la Seconde Guerre mondiale”, in: Revue des sciences sociales de la France de l’Est 18, 1990 – 1991, 38 – 62. 7 See Pierre Scherrer, Un húpital sous l’Occupation: Souvenirs d’un psychiatre, Paris: Editions de l’atelier de l’alpha bleue 1989. 8 Boris Cyrulnik, Un merveilleux malheur, Paris: Odile Jacob 1999. 9 FranÅois Maspero, Les abeilles et la guÞpe, Paris: Le Seuil 2002. 10 Sieglind Ellger-Rüttgardt, “Ausserhalb der Norm: Behinderte Menschen in Deutschland und Frankreich während des Faschismus. Eine vergleichend-historische Studie”, in: Christa Berg, Sieglind Ellger-Rüttgardt (eds.), “Du bist nichts, Dein Volk ist alles”: Forschungen zum Verhältnis von Pädagogik und Nationalsozialismus, Weinheim: Deutscher Studien Verlag 1991, 88 – 104. 11 Heinz Faulstich, “Die Zahl der ‘Euthanasie’-Opfer”, in: Andreas Frewer, Clemens Eickhoff (eds.), “Euthanasie” und die aktuelle Sterbe-Hilfe-Debatte: Die historischen Hintergründe medizinischer Ethik, Frankfurt/M./New York: Campus Verlag, 2000, 218 – 234. 12 That is, after the publication of the book of Max Lafont. 13 Benno Müller-Hill, Science nazie, science de mort: L’extermination des Juifs, des Tziganes et des malades mentaux de 1933 — 1945, Paris: Odile Jacob 1989.

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Rights of asylum,14 which was published by Êditions Odile Jacob, a large and reputed French publishing house. In the preface Lemoine contends, without providing any proof, that the Vichy regime really intended to eliminate mentally ill patients institutionalized in psychiatric hospitals. In other words, he asserted that the Vichy regime not only took advantage of the food crisis to get rid of the mentally ill but also actively organized the starvation, perhaps obeying German orders. This radical interpretation has remained isolated. Two years later, however, Max Lafont published a second edition of his book which was far more accusatory than the first.15 Lastly, on the occasion of the publication in 2001 of the second edition of a work of fiction by Pierre Durand, which also evokes the fate of mentally ill patients in asylums under the Vichy regime,16 the critical publishing house Syllepse decided to launch a petition campaign entitled “For the end of suffering”17 and enjoin the French government to admit its responsibility for the slaughter of mentally ill patients under the Vichy regime. This pressing request referred to the speech delivered by the French President in 1995, in which he had admitted the responsibility of the French state for the deportation of Jews under German occupation.18 This was, broadly, the memorial context within which I began my investigation in the spring of 2001. My study invalidated both the extermination thesis defended by Patrick Lemoine and the gentle (or hidden) extermination thesis defended by Max Lafont and other psychiatrists and non-psychiatrists after him.19 But actually I should not use the word “invalidate”, as these hypotheses 14 Patrick Lemoine, Droits d’asiles, Paris: Odile Jacob 1998. 15 Isabelle von Bueltzingsloewen (ed.), “Morts d’inanition”: Famine et exclusions en France sous l’Occupation”, Rennes: Presses universitaires de Rennes 2005. 16 Pierre Durand, Le train des fous: Le g¦nocide des malades mentaux en France 1939 – 1945, Paris: Editions Messidor 1988, and idem, Le train des fous, Paris: Editions Syllepse 2001. Pierre Durand was a Communist member of the R¦sistance who had been interned in Buchenwald concentration camp. 17 “Pour que douleur s’achÀve”. 18 On 16 July 1995, on the occasion of the commemoration of the 16 – 17 July 1942 raid of the Vel’d’Hiv’ during which almost 13,000 Jews (including more than 4,000 children) were arrested and sent to French transit camps before being transported to extermination camps, President Jacques Chirac officially acknowledged the responsibility of the French police in this tragic event. In 1992, on the 50th anniversary of the raid, his socialist predecessor FranÅois Mitterrand had refused to do so. On this point see Olivier Wieviorka, La m¦moire d¦sunie: Le souvenir politique des ann¦es sombres, de la Lib¦ration — nos jours, Paris: Le Seuil 2010. 19 This study was published in 2007 (2nd edition 2009) under the title L’H¦catombe des fous: La famine dans les húpitaux psychiatriques franÅais sous l’Occupation (“The Hecatomb of Lunatics: Starvation in French psychiatric hospitals under German occupation”). The word “hecatomb” is far more common in French than in English. It does not mean “sacrifice” or “massacre” but rather “massive mortality”.

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have never been validated by rigorous historical study. Here one must also point out the responsibility of historians, who contented themselves with disqualifying Max Lafont by pointing out the weaknesses of his work, but never held a genuine historical inquiry on this tragic event in spite of the fierce debate that I described above. Thanks to very abundant sources, most of which were never mobilized in the debate, I was indeed able to show that, although the starvation in French asylums between 1940 and 1945 did indisputably provoke the death of a great number of mentally ill patients – 45,000 according to my calculations,20 it was not an operation organized at the initiative of the regime of Marshall P¦tain in Vichy. There was therefore no deliberate intention by the government to eliminate the mentally ill. This means that the starvation did not amount to genocide or extermination. Nor does it mean, of course, that the Vichy government had no responsibility in this tragedy. By choosing to collaborate, Vichy also yielded to the increasing demands of German occupational forces, which organized the systematic pillage of France in order to finance the German total war effort21 and thus endangered the most fragile categories of the French population.22 Not only institutionalized mentally ill patients, but also the elderly in hospices23 and detainees in prisons or internal camps suffered profoundly from food shortages, much like the elderly who were left alone in large cities or infants deprived of milk, two other groups affected by massive mortality. The poor and the chronically ill were two further categories of persons who lacked the physical and/or mental capacities to develop a strategy for survival in a context marked by a severe food crisis. In addition, I showed that the Vichy government did not abandon mentally ill patients to their tragic fate but took measures to stop starvation in lunatic asylums. On 4 December 1942, a directive by the Secretary of State for Family and Health, initiated by the Secretary of State for Agriculture and Provisions, allocated a substantial quantity of supplementary rations to patients confined in French asylums.24 Unmentioned, relativized or even denied by supporters of the gentle extermination thesis, this directive demonstrates the will of the central 20 These calculations were confirmed by FranÅois Chapireau. See FranÅois Chapireau, “La mortalit¦ des malades mentaux hospitalis¦s en France pendant la Seconde Guerre mondiale: ¦tude d¦mographique”, in: L’Enc¦phale 35(2), 2009, 121 – 128. 21 See Fabrice Grenard, “Les implications politiques du ravitaillement en France”, in: VingtiÀme SiÀcle: Revue d’histoire 94, April-June 2007, 199 – 215. 22 See Von Bueltzingsloewen (ed.), 2005. 23 According to FranÅois Chapireau, 50,000 old or disabled residents died of hunger in French hospices between 1940 and 1945. But hospices were proportionately less affected than mental hospitals. 24 In September 1942, Max Bonnafous was appointed by Pierre Laval as head of the Secretary of Agriculture and Provision. His wife, H¦lÀne S¦rieux-Bonnafous, was a psychiatrist.

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powers to control starvation in psychiatric hospitals. As a result, there was also a significant decrease in mortality.25 Hence, contrary to what supporters of the gentle extermination thesis have often insinuated, it is not possible to place the extermination of the mentally ill in Germany by the Nazi regime on the same level as the death of French mentally ill patients due to starvation – or even to claim that it amounts to the same thing.26 The Nazis never expressed any interest in French mentally ill patients. Just because they decided to systematically eliminate Polish, Russian, Estonian or Lithuanian mentally ill patients,27 they did not necessarily intend to do the same in the occupied countries of Western Europe. The attitude of psychiatrists towards the institutionalized mentally ill constitutes another major element of differentiation between the French and German scenarios. We know for a fact that the extermination of German mental patients was possible because of the collaboration, or at least the tacit consent, of the great majority of psychiatrists. On the French side, on the contrary, it has been established that the directive of 4 December 1942, which gave institutionalized mental patients priority in the rationing system (along with other vulnerable categories of the population), was drafted under pressure from doctors in psychiatric hospitals. Beginning in the autumn of 1941, a number of physicians united to take action within the framework of the Soci¦t¦ M¦dicoPsychologique (Medico-Psychological Society),28 and later during the Congress of French Alienists and Neurologists held in Montpellier in October 1942.29 At 25 See the mortality curves. On the national scale, the mortality rate decreased from near 9 % in 1943. By contrast, Lafont, for instance, completely denied that such action ever existed: “To be clear : never, on a large scale, had attributed any food supplement been administered [in mental asylums] as [it had been administered] in other hospitals. In order to avoid the death of psychiatric patients, it would have been sufficient to generalise the administration of such supplementary portions. It had never been decided, it had never been done.” See Max Lafont, L’Extermination douce: La cause des fous. 40 000 malades mentaux morts de faim dans les húpitaux sous Vichy, Bordeaux: Editions Le Bord de l’Eau 2000, 85. [“Soyons clair : — aucun moment, de faÅon g¦n¦ralis¦e il ne fut attribu¦ un suppl¦ment comme ce fut le cas dans les autres húpitaux. Pour ¦viter les d¦cÀs des malades psychiatriques il aurait suffi de g¦n¦raliser l’attribution de ces suppl¦ments. Cela n’a pas ¦t¦ d¦cid¦, cela n’a pas ¦t¦ fait.”] 26 See Isabelle von Bueltzingsloewen, “Les malades mentaux morts de faim dans les húpitaux psychiatriques sous l’Occupation ont-ils ¦t¦ extermin¦s par le r¦gime de Vichy? Enjeux et m¦susages de la comparaison avec le cas allemand”, in: Christian Bonah et al. (eds.), Nazisme, science et m¦decine, Paris: Editions Glyphe, 2006, 259 – 279. 27 See Björn Mielbrandt, “‘Euthanasia’, Human Experiments, and Psychiatry in Nazi-Occupied Lithuania, 1941 – 1944”, in: Holocaust Genocide Studies 27, 2013, 242 – 275. 28 This scientific society, created in 1852, was allowed to continue its activities – unlike the Amicale des ali¦nistes, a corporative association of psychiatrists created in 1907. The Medico-Psychological Society was not representative of the profession, but its members used its regular sessions as a forum of debate. They interceded with the French government to try to obtain additional food for the mentally ill who were confined in psychiatric hospitals. 29 Because of war and occupation, this yearly gathering had not taken place since 1938.

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the local level, many asylum directors and head physicians also took on their patients’ cause, stepping up their appeals to prefects, sanitary authorities and provision services (with varying degrees of success) in order to obtain more food and fuel to heat their facilities. There were, of course, those who remained passive. But, contrary to the Lithuanian case, no one took advantage of the context to call for the “euthanasia” of incurable patients or to commend the Nazi regime for its initiative in this area. It is therefore surprising to read the words of Benno Müller-Hill in the French edition of Murderous Science: “Approximately 40,000 institutionalized mentally ill patients died of starvation in France […] French psychiatrists followed the German example without having received the order to do so”.30 Finally, the comparison with the German situation allows for a new examination of the delicate subject of eugenics.31 The extermination of mental patients by the National Socialist regime was in fact made possible by the strong attachment of the medical profession (and the overall population) to highly extremist eugenic theories, which was also shared by some psychiatrists in other countries, including the United States.32 This extremist (or negative) form of eugenics had few advocates in France and was not promoted in the framework of the national revolution advocated by the supporters of the Vichy regime.33 This being said, we cannot assert that these eugenic theories, largely circulated throughout French society in the period between the two world wars,34 had no influence on the tragedy that took place behind asylum walls between 1940 and 1945, and which seems to have been a minor event for a majority of the French 30 “A peu prÀs 40 000 malades mentaux hospitalis¦s sont morts par d¦nutrition en France […] Les psychiatres franÅais suivirent l’exemple allemand sans avoir reÅu d’ordres.” (Benno Müller-Hill, Science de vie: Science de mort, Paris: Odile Jacob 1989, 70.) 31 See Isabelle von Bueltzingsloewen, “Eug¦nisme et restrictions: Les ali¦nistes et la famine dans les húpitaux psychiatriques franÅais sous l’Occupation”, in: Revue d’histoire de la Shoah 183, October 2005, 389 – 402. 32 See Ian Robert Dowbiggin, Keeping America sane: Psychiatry and eugenics in the United States and Canada 1880 – 1940, Ithaca, New York: Cornell University Press, 1997. 33 The Vichy program of eugenics can be summed up by the introduction of a mandatory premarital certificate, a measure called for by numerous hygienists in the period between the two world wars. See Pierre-Andr¦ Taguieff, “Eug¦nisme ou d¦cadence, l’exception franÅaise”, in: Ethnologie franÅaise 24(1), 1994, 81 – 103; Anne Carol, Histoire de l’eug¦nisme en France: Les m¦decins et la procr¦ation XIX – XXe siÀcles, Paris: Le Seuil 1995, and Alain Drouard, L’eug¦nisme en question. L’exemple de l’eug¦nisme franÅais, Paris: Ellipses 1999. 34 Witness the huge success of Man, the Unknown by Alexis Carrel, published in 1935. Actually, this book had not been considered as a work of eugenics by such eugenicists as Herbert Spencer Jennings, probably due to the fact that Carrel was a follower of Lamarck’s rather than Darwin’s theory of evolution. However, it became a widely acclaimed best-seller in France as well as in the United States, in spite of the fact that it commended that the “insane, guilty of criminal acts” would be “disposed of in small euthanasic institutions supplied with proper gases” (chap. VIII, 12). It remained popular until the late 1950s.

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population. In order to obtain additional food for their patients, doctors in psychiatric hospitals had to fight against firmly rooted negative opinions about mental patients. Mentally ill patients were perceived as incurable and therefore a loss for society. Their survival was therefore not a priority in the context of a severe food shortage. Nonetheless, in an otherwise very unfavorable context, the humanist argument that a society has the intangible obligation to protect its weakest members, whatever the circumstances (as many psychiatrists like the Catholic Henri Ey affirmed during the period from 1940 – 194535), remained sufficiently audible to forestall eugenic and economic arguments. This victory was perhaps narrow. But it was in the name of humanism that the decision was taken to provide additional calories for institutionalized mental patients, despite some reticence, particularly as expressed by some members of the prestigious Academy of Medicine.36 One should now shed light on the strategies at work in the narratives of the past produced by the supporters of the gentle extermination thesis and ask why this weak thesis has spread so widely and easily over the two last decades. Historians are increasingly concerned with analyzing contemporary uses of the past. This means clarifying how the past, even the very ancient past, structures the discourse, practices and identity of specific groups or even of society as a whole.37 From this perspective, I have tried to identify the issues of memory at work in the instrumentalization of a highly traumatic event experienced by psychiatrists and other professionals involved in the field of mental health care, and I have noticed that these issues of memory have gradually shifted. This shift reflects not only the radical transformation in psychiatric care, but also the transformation of the relationship between French society and remembrance of the painful episode of the Vichy regime.38 First I established that, contrary to what the supporters of the gentle extermination thesis firmly claimed, the psychiatric profession did not try to 35 See the unpublished reports of 16 February 1941 and 2 February 1942 written by the Catholic psychiatrist Henri Ey, one of the head physicians at the Bonneval psychiatric hospital. 36 At the session of 3 February 1943, Dr. Pierre Martel, one of the members of the commission for food rationing created by the Academy of Medicine in September 1940, expressed his opinion that the additional food allocated to the mentally ill was not justified. Pierre Henri Martel, “Au sujet d’une circulaire qui attribue un suppl¦ment de ration alimentaire aux malades intern¦s des húpitaux psychiatriques”, in: Bulletin de l’Acad¦mie de m¦decine 107 (6), 9 February 1943. See also the article published by another member of the Academy of Medicine Paul Carnot, “La sous-alimentation actuelle et ses cons¦quences”, in: Paris M¦dical, 30 March 1943, 85 – 89. 37 See Philippe Joutard, Histoire et m¦moires: Conflits et alliance, Paris: La D¦couverte 2013. 38 See Henry Rousso, Le syndrome de Vichy, Paris: Seuil 1987 (2nd edition 1990); idem, La hantise du pass¦, Paris: Textuel 1998; Conan, Rousso, 1994/1996; Wieviorka, 2010, and Pierre Laborie, Le chagrin et le venin? La France sous l’Occupation, m¦moire et id¦es reÅues, Paris: Bayard 2011.

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conceal the facts. In other words, the death of 45,000 mentally ill patients due to starvation in French mental hospitals under Nazi occupation and the Vichy regime has never been a taboo. On the contrary, reference to this tragic event was always part of the strategy developed by militant (Communist or left-wing Christian) psychiatrists soon after Liberation.39 At that time the purpose was to make the most of the guilt provoked by recalling the tragic fate of mentally ill patients during the war, in order to pressure the government into taking concrete measures to make life in mental hospitals more humane, and also to promote a reform of psychiatric care in accordance with the demands expressed by some progressive psychiatrists in the 1930s.40 In other words, the aim was to call for improvements in the life and status of mental patients (and at the same time in their professional status) in the name of the suffering they had endured during the war.41 To achieve this goal, some radical psychiatrists – most of them Communists like Lucien Bonnaf¦, Louis Le Guillant or Henri Wallon – intimated that mentally ill patients who died of hunger in French lunatic asylums had suffered the same fate as German mental patients exterminated by the Nazi regime.42 In a paper presented in December 1946 at a session of the Swiss Society for Psychiatry, the general secretary of the Union of Mental Hospital Physicians, Georges Daum¦zon (who never joined the Communist party), declared for his part that the new union should urgently collect and publish documents about the mass murder of mental patients by the National Socialist regime. In his opinion, this urgency was justified by the fact that the prejudices that had led to this mass murder were still relevant, as shown by the reluctance of the French government to take measures to improve the condition of mental patients.43 Not surprisingly, during the 1970s the remembrance of the starvation that caused the death of 45,000 mentally ill patients was revisited by anti-psychiatrists, in particular by Communists and extreme leftists. The most hard-hitting intervention on this topic is probably the scathing book written by psychiatrist 39 In particular within the framework of the Union of Mental Hospital Physicians, created in May 1945. 40 See Isabelle von Bueltzingsloewen, “R¦alit¦ et perspective de la m¦dicalisation de la folie dans la France de l’entre-deux-guerres”, in: GenÀses 1(82), 2011, 52 – 74. 41 See for example the special issue of the prestigious journal Esprit published in December 1952 under the title “The misery of psychiatry” (“MisÀre de la psychiatrie”), in particular the striking article written by Lucien Bonnaf¦ and Louis le Guillant: Lucien Bonnaf¦, Louis Le Guillant, “La condition du malade — l’húpital psychiatrique”, in: Esprit 197 (“MisÀre de la psychiatrie”), 1952, 843 – 869. 42 Louis Le Guillant, Henri Wallon, “L’extermination des malades mentaux sous le r¦gime national-socialiste”, in: La Raison: Cahiers de psychopathologie scientifique, May 1951, 15 – 45. 43 Georges Daum¦zon, J. Jacobson, “Essai de recherche de la signification des assassinats de malades mentaux en Allemagne”, in: L’Information psychiatrique, August 1947, 267 – 271.

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Roger Gentis, one of the head physicians at the psychiatric hospital of Fleury-lesAubrais. The book was published in 1970 by the committed publisher FranÅois Maspero under the title The walls of the asylum.44 Roger Gentis was involved in the “therapeutic community” movement and in the promotion of the politique de secteur (sectoral policy) implemented in France in the early 1970s, which was dedicated to developing alternatives to hospitalization, i. e. outpatient care, to avoid the exclusion of mental patients from society. In this highly provocative text, Roger Gentis declared that the attitude of society towards mental illness had not changed since 1945. So, in his opinion, the scenario which had led to the extermination of mentally ill and disabled people by the Nazis in the Second World War could happen again even in France, where such radical policies are not at all inconceivable. The book by psychiatrist Max Lafont, which came out in 1987, is in line with this militant process, which developed as early as the Liberation. Born in 1950, Max Lafont belongs to a generation that did not experience the war. Although his corpus of sources is very poor and his methodology highly questionable (mostly using analogy reasoning, making a lot of amalgames, anachronisms, and risky generalizations), his study, based on a medical thesis defended in 1981,45 aims to clarify the conditions under which mentally ill patients committed to psychiatric institutions massively died of hunger under German occupation. But it must above all be read as a militant book: When it was written, the urgency was no longer to achieve a reform of psychiatric care but to denounce, in a context of economic crisis, financial restrictions that imperilled policies in the psychiatric sector and the therapeutic innovations which had been initiated in this framework since the end of the 1960s. In the second edition of his book, Max Lafont also castigates the closing of beds in mental hospitals which had led to the neglect of numerous mental patients who had no other choice but to live on the streets or go to prison, concluding: “Don’t you think that the ‘gentle extermination’ has now come down to the streets?”46 And yet the media impact of Max Lafont’s book cannot be explained by a new sensitivity to the condition of mental patients, but rather by a change in the configuration of memory. During the seventies, French public opinion rediscovered the scale of Vichy crimes, in particular the involvement of the Vichy regime in the deportation and extermination of Jews.47 Max Lafont’s book was published in a context marked by the highly mediatized trial of Klaus Barbie, head of the Lyon Gestapo, who was responsible for the deportation of thousands 44 Roger Gentis, Les murs de l’asile, Paris: Editions F. Maspero 1970. 45 At the Faculty of Medicine of Lyon University. 46 “Ne croyez-vous pas que l’‘extermination douce’ est, maintenant, descendue dans la rue?” (Lafont, 2000, 253.) 47 Rousso, 1987/1990, Wieviorka, 2010, and Laborie, 2011.

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of Jews and for the deaths of many members of the R¦sistance.48 Above all, many associations at the time were campaigning to emphasize collective memory’s duty to acknowledge all of the crimes perpetrated by a regime that had called for the elimination of entire groups of the population. In addition, during the mid1990s, the tragic fate of mentally ill patients under the Vichy regime met with a massive response in the fierce debate about Alexis Carrel.49 By stating that there was an indisputable connection between Alexis Carrel’s eugenic ideas and the massive mortality, described as genocide, of mental patients confined in asylums under the Vichy regime, and by calling on the French government to acknowledge its responsibility in this tragedy, the campaigners for renaming French streets named after Alexis Carrel50 implied that they were in a position to provide indisputable proof of the eugenic character of the Vichy regime that had been contested by historians.51 Thus they engendered an unhealthy competition between the Vichy regime and the Nazi regime. If the Vichy regime could be held responsible for thousands of deaths among mental patients, then it was, supposedly, in many ways similar to Hitler’s regime. This is shown in speeches delivered at ceremonies held to commemorate victims of starvation in French asylums during the war,52 and by the recent petition addressed to the President of the French Republic FranÅois Hollande asking for “a memorial to commemorate the handicapped who were victims of the Nazi and Vichy regimes”.53 In my opinion, these allegations have a very pernicious effect because they are confusing and lead to a dissociation of memory from history. I have shown that the starvation that decimated the population of mental 48 This trial, which was filmed, started on May 11, 1987 in Lyon. On July 4, 1987, Klaus Barbie was sentenced to life imprisonment for crimes against humanity. 49 Alexis Carrel, Nobel Prize winner for medicine in 1912, spent his entire career at the Rockefeller Institute for Medical Research in New York. In 1941 he decided to return to France, and Marshall P¦tain appointed him head of the French Foundation for the Study of Human Problems (also known as the Carrel Foundation) which had been set up to regenerate the country after the defeat of 1940. See Alain Drouard, Une inconnue des sciences sociales: La fondation Alexis Carrel (1941 – 1945), Paris: INED & La Maison des sciences de l’homme 1992. 50 The action group for changing the name of French streets named after Alexis Carrel was formed in 1993. 51 See Taguieff, 1994, Carol, 1995, and Drouard, 1999. 52 For instance, the ceremony held at the psychiatric hospital of Stephansfeld-Brumath on 5 January 1995 to commemorate the 49 mental patients of Alsace who were exterminated in the German asylum at Hadamar, or the ceremony held on 7 April 1999 to unveil a monument dedicated to mentally ill patients who died of hunger in Clermont-de-l’Oise psychiatric hospital and were buried in the local cemetery between 1940 and 1945. 53 Jean-Marc Maillet-Contoz, Charles Gardou, “Pour un m¦morial en hommage aux personnes handicap¦es victimes du r¦gime nazi et de Vichy”. Petition hosted on the webside Change.org: http://www.change.org/p/pour-un-m¦morial-en-hommage-aux-personnes-handicap¦es-victimes-du-r¦gime-nazi-et-de-vichy (19 August 2014).

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hospitals between 1940 and 1945 can be explained largely by the fact that, at that time, the majority of institutionalized mentally ill patients were deprived of social contacts and were not aided by solidarity movements like those that worked for other vulnerable groups of the French population, for instance for political prisoners54 or camp internees.55 They could not count on the help of their families because they often had no contact with them. Nor could they count on the help of charitable organizations56 because they were not considered war victims. It was therefore their social transparency or invisibility which was the major factor in the fate they suffered, and this raises the delicate question of the relationship between society and madness – a question which is already of topical interest. The instrumentalization of history by groups that sometimes defend contradictory causes is hardly surprising for historians. Yet historians feel very uncomfortable when historical reality is simply dismissed or even distorted in the name of a cause – even if this cause is respectable – especially when such deceit leads to the banalization or relativization of the “euthanasia” of mental patients by the Nazi regime that did really take place. By disputing the reality of the extermination of mental patients by the Vichy regime, the aim is of course not to minimize the criminal nature of this regime, which has been highlighted by numerous other historical studies, but merely to take the complexity of this regime and of this period into account.57 The Vichy regime contributed to the deportation of Jews to extermination camps. Yet it did not eliminate mental patients by food deprivation. I also want to add that, contrary to what many seem to think, the fact that mentally ill patients who died of starvation in French asylums during the Second World War were not exterminated by no means relegates them to the status of second-zone victims. Why should these victims, and more generally, civilian victims of wars or victims of famines or bombings, not be honored and given a place in our collective memory all the same?58 54 On the other hand the situation of common prisoners, especially those serving long sentences and having few contacts with their family, was very difficult. 55 Isabelle von Bueltzingsloewen, L’H¦catombe des fous: La famine dans les húpitaux psychiatriques franÅais sous l’Occupation, Paris: Flammarion 2009 (see fn. 19), chapter : “La rupture du lien social”: 289 – 323. 56 For instance, the French Red Cross or the Secours National, with which all French charitable associations had to be affiliated. All of them, however, were overwhelmed by the high numbers of people in need. See Jean-Pierre Le Crom, Au secours Mar¦chal! L’instrumentalisation de l’humanitaire (1940 – 1945), Paris: Presses universitaires de France 2013. 57 See Laborie, 2011. 58 A museum dedicated to the civilian victims of World War II is due to be inaugurated in the little town of Falaise in Normandy in 2015. However, the project could be postponed due to a lack of subsidies.

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20 17,6

18

17,8

16 14

12,7

%

12 9,9

10 8

11,8

6,3

6,2

6,1

6,3

6,6

7,6

6,5

6 4 2 0 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946

Graph 1: Annual mortality rates in French psychiatric hospitals between 1935 and 1946

Volker Roelcke

Between Professional Honor and Self-Reflection: The German Medical Association’s Reluctance to Address Medical Malpractice during the National Socialist Era, ca. 1985 – 20121

In May 2012 the German Medical Assembly passed the “Nuremberg Declaration”.2 For the first time since the end of the Second World War, in this document the organized medical profession in Germany took a comprehensive position on the latest state of historical research on human rights violations in the field of medicine during the National Socialist era, and also on the substantial share of the responsibility borne by the doctors and medical organizations of the period, as well as on the implications for the field of medicine today. This position paper enjoyed a thoroughly positive reception by international medical journals, including The Journal of the American Medical Association, the The Lancet of Great Britain, and the Israel Medical Association Journal, as well as the broader public.3 Yet, at the same time these reactions raised the question as to why it took over 65 years from the end of the war before such a position paper could be formulated by German medicine’s chief professional organization. It was also noted that the declaration apparently was not initiated by the core of the organization, for instance from the Executive Board of the Bundesärztekammer (German Medical Association, subsequently abbreviated as “BÄK”), but rather by an 1 For the provision of information, sources, and constructive critique, I am grateful to Johanna Bleker, Klaus Dörner, Angelika Ebbinghaus, Gerrit Hohendorf, Norbert Jachertz, Harald Jenner, Etienne Lepicard, Karl-Heinz Leven, Berit Mohr, Manfred Richter-Reichhelm, Udo Schagen, Heinz Schott, Rebecca Schwoch, and Sascha Topp. 2 For the official information of the Bundesärztekammer (the German Medical Association) see http://www.bundesaerztekammer.de/page.asp?his=0.2.8678.10302.10342 (3 April 2014), for the text of the declaration, see http://www.bundesaerztekammer.de/downloads/115daet2012_ nuernbergererklaerung.pdf (3 April 2014); see also appendix. 3 Edward H. Livingston, “German Medical Group: Apology for Nazi physicians’ actions, warning for future”, in: Journal of the American Medical Association (JAMA) 308, 2012, 657 – 658; Stephan Kolb et al., “Apologising for Nazi medicine: a constructive starting point”, in: The Lancet 380, 2012, 722 – 723; Shmuel Reis, “Reflections on the Nuremberg Declaration of the German Medical Assembly”, in: Israel Medical Association Journal (IMAJ) 14, 2012, 532 – 534; as example for the broader public, see Guido Bohsem, “Mediziner in der NS-Zeit: Ärzteschaft bittet um Verzeihung”, in: Süddeutsche Zeitung, 24 May 2012: http://www.sueddeutsche.de/wissen/ aerztetag-in-nuernberg-aerzteschaft-bittet-um-verzeihung-1.1365156 (2 April 2014).

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appeal from historians of medicine and members of the German branch of the IPPNW (International Physicians for the Prevention of Nuclear War).4 In contrast to these evaluations of the “Nuremberg Declaration” in 2012, following the overview of research on medicine in the National Socialist era initiated and financed by the BÄK in 2011, it would appear that since around 1990 this central institution of the organized medical profession5 had developed a number of activities to address and elucidate the past between 1933 and 1945: The editor of this overview, at the same time the official medical historian in the Board of the BÄK, stated that for one, “an independent team of historians” had compiled a commemorative publication on the occasion of the 100th German Medical Assembly in 1997, which contained “a special chapter about the difficult process of the German medical profession coming to terms with its past”. Further, he pronounced, “since 2006 the BÄK has collaborated with the Federal Ministry of Health and the National Association of Statutory Health Insurance Physicians to award a research prize” for scholarly works on the subject.6 Finally, because comprehensive works on the subject in recent years were lacking, the BÄK had now initiated and financed the overview of the “latest state of research”, an “orientation guide” and a “directory for future research in this area”.7 With all of these activities, the BÄK had “assumed its responsibility”, a claim that could not be made for all of the medical associations in the individual federal states.8 There is an obvious discrepancy here between the BÄK’s (or its representative’s) own perception of itself in the year 2011 on the one hand, and the international medical public’s assessment, including the initiators of the appeal to the Medical Assembly in 2012, on the other. In what follows, these contradictory assessments and the questions formulated in the international reaction to the “Nuremberg Declaration” will be explored. More specifically, it will be described at which occasions, in which forms, and with what kind of historical narratives the representatives of the German medical profession – that is, members of the 4 The initiative for the appeal to the German Medical Assembly is sketched in Reis, 2012; an English version of the appeal with the list of those who signed it, as well as the declaration itself may be found in the Israel Medical Association Journal 14, 2012, 529 – 530. 5 The BÄK (official full name: Bundesärztekammer – Arbeitsgemeinschaft der Deutschen Ärztekammern/Working Group of the German Chambers of Physicians) is de facto a roof organization of the federally organized state chambers of physicians; membership in one of the state chambers of physicians is obligatory for each practicing physician in Germany. 6 Robert Jütte, “Rezeption und kontroverse Diskursgeschichte der NS-Medizin nach 1945” (2011a), in: idem, in collaboration with Wolfgang U. Eckart, Hans-Walter Schmuhl and Winfried Süss, Medizin und Nationalsozialismus: Bilanz und Perspektiven der Forschung, Göttingen: Wallstein 2011b, 311 – 323, here 316. 7 Idem, Vorwort (2011c), in: idem, 2011b, 7 – 10, here 9 – 10. 8 Idem, 2011a, 316.

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Board of the BÄK – referred to the grave forms of medical malpractice in the period of National Socialism. The first section of the paper presents the basic historical knowledge on the most important facts established about the field of medicine up to 1945, thereby taking into consideration that this knowledge evolved itself over time. The second section depicts the crucial points at which the issue was addressed by representatives of the BÄK from the mid-1980s up to 2012 along with the most important actors and lines of conflict. These temporal parameters emerge, on the one hand, from an article about the German medical profession’s Nazi past published in the British journal The Lancet in 1986, which was roundly condemned by the top representative of the BÄK, but triggered a heated conflict in the German medical community, and on the other hand by the pronouncement of the “Nuremberg Declaration”.9 The conclusion sketches potential causes for the delayed confrontation with and acknowledgment of medical malpractice, whereby particular attention is paid to the hierarchies of values pursued by the BÄK. Two caveats which may affect the following description and analysis have to be made explicit: First, the reconstruction relies on official statements and publications of the BÄK and its representatives, including its journal Deutsches Ärzteblatt, as well as further published and unpublished sources of other historical actors who were involved in the relevant events and conflicts. Unpublished sources on the part of the BÄK, such as minutes of internal meetings, or correspondence of board members, were not available. As a result, one might argue that the perspective of outside critics of the BÄK could have been given too much weight in the interpretation, in contrast to the perspective of the actors representing the professional organization. Similarly, the author of this chapter was himself one of the historical actors, with specific opinions on the relevant issues which might enter into the historical reconstruction. However, in view of this role conflict, the author has taken great care to give very detailed documentation of the debates and conflicts in which he was involved himself, and utmost consideration to avoid premature interpretations. It is up to the reader to judge if the evidence presented allows to arrive at the formulated conclusions.

9 The reactions of the central medical organization in the immediate post-war period is addressed in Thomas Gerst, Ärztliche Standesorganisation und Standespolitik in Deutschland 1945 – 1955, Stuttgart: Franz Steiner 2004; a first outline for the following decades until the 1980s is given in Stefanie Westermann, “‘Die deutsche Ärzteschaft und ihre Standesvertretung will auch heute mit solchen Personen nichts zu tun haben‘: Die NS-Medizin im Spiegel des ‘Deutschen Ärzteblatts’”, in: Richard Kühl, Tim Ohnhäuser, Gereon Schäfer (eds.): Verfolger und Verfolgte: “Bilder” ärztlichen Handelns im Nationalsozialismus, Berlin: LIT 2010, 241 – 259.

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Historical findings on medicine in National Socialism and a few implications By now historical research has yielded a quite comprehensive, yet by no means conclusive knowledge base on medicine during the National Socialist period.10 Four main issues can be distinguished: 1. The effects of the change in government in 1933 on the medical profession, with two sub-topics: first the (self-) enforced conformation (Gleichschaltung) of professional medical organizations and societies, and second, the dismissal, forced emigration and ultimately the systematic annihilation of physicians who were classified as “Jewish” and “politically unreliable”; 2. The health and social policy motivated by eugenics, or racial hygiene, and oriented on the economic efficiency and performance of the “body of the nation”: This led, among other things, to the compulsory sterilization of over 360,000 people with supposed “hereditary diseases”, and to the systematic killing of around 250,000 to 300,000 psychiatric patients, disabled and other sick individuals from socially marginalized groups; 3. The use in medical research and teaching of subjects categorized as biologically or legally “inferior”. The corresponding medical research took place primarily in concentration camps, in psychiatric institutions, as well as in regular hospitals in Nazi-occupied territories; in academic teaching, documentation indicates that the bodies and body parts of political prisoners were used in particular in institutes of anatomy ;11 4. The exploitation and medical treatment of civilian forced laborers in medical institutions.

10 An overview and bibliography, together with considerations on some implications may be found in Volker Roelcke, “Medicine During the Nazi Period: Historical Facts and Some Implications”, in: Sheldon Rubenfeld (ed.), Medicine After the Holocaust, New York: Palgrave Macmillan 2010, 17 – 28, an updated German version of this overview is published as “Medizin im Nationalsozialismus – radikale Manifestation latenter Potentiale moderner Gesellschaften? Historische Kenntnisse, aktuelle Implikationen“ (2012a), in: Heiner Fangerau, Igor Polianski (eds.), Medizin im Spiegel ihrer Geschichte, Theorie und Ethik: Schlüsselthemen für ein junges Querschnittsfach, Stuttgart: Franz Steiner 2012, 35 – 50. The recently published volume by Jütte, 2011b, also aims at an overview; however, it suffers from some important omissions, inconsistencies and mistakes; further, as commissioned work of the BÄK, it is itself part of the story to be reconstructed here, and will therefore be analyzed in some detail below. 11 As a new synthesis on human subject research with particular consideration of the victims, see Paul J. Weindling, Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust, London: Bloomsbury 2014; on the use of bodies and body parts in anatomy, see Sabine Hildebrandt, “Anatomy in the Third Reich: An outline, Part II: Bodies for anatomy and related medical disciplines”, in: Clinical Anatomy 22, 2009, 894 – 905.

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Recent historical research has questioned three key assumptions that have long determined the image of medicine during National Socialism, and which now, years later, turn out to be obsolete myths, which apparently emerged from apologetic intentions.12 These three myths may be summarized as follows: 1. the assumption that the medical crimes were perpetrated by a few fanatic Nazi doctors, and that they were essentially the result of an irrational policy imposed upon the medical profession from the outside; 2. the assumption that the programs for compulsory sterilization and killing patients were the expression of an “ideology”, which had little or nothing at all to do with the current state of “correct” medical knowledge and values at the time; 3. the assumption that the research activities by doctors in concentration camps had nothing to do with the contemporary standards of the biomedical sciences, but were rather an expression of racist ideology, or even of mere individual perversion in the guise of science, and that this research thus should better be regarded as “pseudoscience”.13 In addition, it has been widely documented that the massive atrocities in the field of medicine were not the deeds of individual, isolated, fanaticized doctors, but took place with substantial participation by leading representatives of the medical community and medical societies. Also involved in this research were outstanding representatives of university medicine and biomedical research institutions like the Kaiser Wilhelm Society and the Robert Koch Institute.14 In

12 For more details, see Roelcke, 2012a; however, this does not imply that these myths, or parts of them have completely disappeared from recent historiography : examples may be found e. g. in Klaus-Dietmar Henke, “Einleitung”, in: idem (ed.), Tödliche Medizin im Nationalsozialismus: Von der Rassenhygiene zum Massenmord, Köln/Weimar/Vienna: Böhlau 2008, 9 – 29, here 9; the notion of “pseudo-scientific experiments” has a structural function in Winfried Süß, “Versuche der ‘Wiedergutmachung’” (2011a), in: Jütte, 2011b, 283 – 294. 13 For evidence of the contrary, see most recently e. g. Volker Roelcke, “Sulfonamide experiments on prisoners in Nazi concentration camps: coherent scientific rationality combined with complete disregard of humanity”, in: Sheldon Rubenfeld, Ruth Benedict (eds.), Human Subject Research after the Holocaust, Basel et al.: Springer International Publishing 2014, 51 – 66; more generally, see Weindling, 2014. 14 See e. g. Susanne Heim, Carola Sachse, Mark Walker (eds.), The Kaiser Wilhelm Society under National Socialism, Cambridge: Cambridge University Press 2009; Benoit Massin, “Mengele, die Zwillingsforschung und die ‘Auschwitz-Dahlem Connection’”, in: Carola Sachse (ed.), Die Verbindung nach Auschwitz: Biowissenschaften und Menschenversuche an Kaiser-Wilhelm-Instituten, Göttingen: Wallstein 2003, 201 – 254; Hans-Walter Schmuhl, The Kaiser Wilhelm Institute for Anthropology, Human Heredity and Eugenics, 1927 – 1945, New York: Springer 2008 (original German version: Grenzüberschreitungen: Das Kaiser-Wilhelm-Institut für Anthropologie, menschliche Erblehre und Eugenik, 1927 – 1945, Göttingen: Wallstein 2005); Annette Hinz-Wessels, Das Robert-Koch-Institut im Nationalsozialismus, Berlin:

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contrast to the still quite prevalent assumptions, the initiative, especially for the gravest violations of human rights (compulsory sterilization, so-called “euthanasia”, as well as most of the cases of humans subjected to medical research against their will) did not come from political authorities, but from doctors themselves. Many of the doctors involved also held prominent positions in postwar medicine. Similarly, stigmatizing and debasing terms and conduct toward sick and disabled people continued to be applied to a considerable extent even after 1945. A reconstruction of the medical profession’s past during the Nazi period that would take this information into account would point to significant similarities in fundamental concepts, attitudes, and behavior patterns between medicine in the Nazi context and medicine before and after it. Structural similarities with the medicine practiced in neighboring European countries and North America are also apparent.15 In other words: the atrocities in medicine between 1933 and 1945 were not specific to the period of National Socialism; rather, they were the extreme manifestations of problematic potentials and tendencies implicit in modern medicine in general.16 The knowledge on the historical facts obviously changed itself after the end of the war.17 Clearly, the medical profession of the post-WW II period could only confront medicine in National Socialism on the basis of the latest state of knowledge available at any given time. Yet, de facto, the three major documentations on the Nuremberg Trials (by Mitscherlich/Mielke 1949/1960, the official documentation of the American Military Tribunal of 1950, and the French documentation of 1950 by Francois Bayle),18 as well as the study of the SS state by the former concentration camp prisoner Eugen Kogon which discussed

15

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Kadmos 2008; Volker Roelcke, “Ernst Rüdin: Renommierter Wissenschaftler – radikaler Rassenhygieniker” (2012b), in: Nervenarzt 83, 2012, 303 – 310. This is illustrated by the exemplary case of eugenically motivated psychiatric genetics in Volker Roelcke, “Eugenic Concerns, Scientific Practices: International Relations and National Adaptations in the Establishment of Psychiatric Genetics in Germany, Britain, the US and Scandinavia, 1910 – 1960”, in: Björn Felder, Paul J. Weindling (eds.), Baltic Eugenics: BioPolitics, Race and Nation in Interwar Estonia, Latvia and Lithuania 1918 – 1940, Amsterdam/ New York: Rodopi 2013, 301 – 333. This argument is developed more comprehensively, and with detailed references in Roelcke, 2012a. For an overview on the history of historiography on medicine during the Nazi period, see idem, “Trauma or Responsibility? Memories and Historiographies of Nazi Psychiatry in Postwar Germany“, in: Austin Sarat, Nadav Davidovich, Michal Alberstein (eds.), Trauma and Memory: Reading, Healing and Making Law, Stanford: Stanford University Press 2007, 225 – 242; Sascha Topp, Geschichte als Argument in der Nachkriegsmedizin: Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie, Göttingen: Vandenhoeck & Ruprecht unipress 2013, 41 – 56. Etienne Lepicard, “Trauma, Memory, and Euthanasia at the Nuremberg Medical Trial, 1946 – 1947”, in: Sarat, Davidovich, Alberstein (eds.), 2007, 204 – 224.

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the integral role of doctors in the concentration camps (1947/1948), the monograph by Alice Platen-von Hallermund (1948), the detailed report by Gerhardt Schmidt from the Eglfing-Haar Asylum (1965)19 and the crucial publications of the early and mid-1980s, had already drawn the most important contours of the knowledge we have today, and from the early 1980s on, a profound intensification of research on the history of medicine continued to contribute further information.20 To this extent it is astonishing that the central organization of the medical profession – i. e., the Board of the BÄK – was for decades very hesitant, if willing at all, to address the available findings. Only if the professional organization of the post-WW II period had evaluated the known activities of physicians and their representatives in the Nazi context as harmless or even justified, one might argue that there would have been no reason to confront the past in any detail, to ask for the origins of such behavior, and for 19 Eugen Kogon, Der SS-Staat: Das System der deutschen Konzentrationslager, München: Karl Alber 1946, 3rd, extended edition, Frankfurt/M.: Verlag der Frankfurter Hefte 1948; Alice Platen-von Hallermund, Die Tötung Geisteskranker in Deutschland: Aus der Deutschen Ärztekommission beim Amerikanischen Militärgericht, Frankfurt/M.: Verlag der Frankfurter Hefte 1948; Gerhardt Schmidt, Selektion in der Heilanstalt 1939 – 1965, Stuttgart: Evangelisches Verlagswerk 1965. 20 Central publications from the 1980s, as well as exemplary studies from the following years are next to those already mentioned e. g. Gerhard Baader, Ulrich Schulz (eds.), Medizin und Nationalsozialismus: Tabuisierte Vergangenheit – ungebrochene Tradition? (= Dokumentation des Gesundheitstages Berlin 1980, vol. 1), Frankfurt/M.: Mabuse-Verlag 1980; Ernst Klee, Euthanasie im NS-Staat: Die Vernichtung “lebensunwerten Lebens”, Frankfurt/ M.: S. Fischer 1983; Benno Müller-Hill, Tödliche Wissenschaft: Die Aussonderung von Juden, Zigeunern und Geisteskranken 1933 – 1945, Reinbek: Rowohlt 1984; Beiträge zur nationalsozialistischen Gesundheits- und Sozialpolitik, vol. 1 – 15, Berlin: Rotbuch, 1985 – 1999; Fridolf Kudlien (ed.), Ärzte im Nationalsozialismus, Köln: Kiepenheuer und Witsch 1985; Gisela Bock, Zwangssterilisation im Nationalsozialismus: Studien zur Rassenpolitik und Frauenpolitik, Opladen: Westdeutscher Verlag 1986; Michael H. Kater : Doctors under Hitler, Chapel Hill/London: University of North Carolina Press 1989; Hans-Walter Schmuhl, Rassenhygiene, Nationalsozialismus, Euthanasie: Von der Verhütung zur Vernichtung “lebensunwerten Lebens” 1890 – 1945, Göttingen: Vandenhoeck & Ruprecht 1987; Paul J. Weindling, Health, Race, and German Politics between National Unification and Nazism, 1870 – 1945, Cambridge: Cambridge University Press 1989; Heinz Faulstich, Hungersterben in der Psychiatrie 1914 – 1949: Mit einer Topographie der NS-Psychiatrie, Freiburg/Br.: Lambertus 1998; Paul J. Weindling, Epidemics and Genocide, Oxford: Oxford University Press 2000; Klaus Dörner, Angelika Ebbinghaus (eds.), Vernichten und Heilen: Der Nürnberger Ärzteprozess und seine Folgen, Berlin: Aufbau 2001; Andreas Frewer, Günther Siedbürger (eds.), Medizin und Zwangsarbeit im Nationalsozialismus: Einsatz und Behandlung von “Ausländern” im Gesundheitswesen, Frankfurt/M./New York: Campus 2004; Astrid Ley, Zwangssterilisation und Ärzteschaft: Hintergründe und Ziele ärztlichen Handelns 1934 – 1945, Frankfurt/M./New York: Campus 2004; Paul J. Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent, Houndmills/Basingstoke: Palgrave MacMillan 2004; Wolfgang U. Eckart (ed.), Man, Medicine, and the State: The Human Body as an Object of Government Sponsored Medical Research in the 20th Century, Stuttgart: Franz Steiner 2006.

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potential consequences. Moreover, in case one were prepared to consider the interpretation (if only for reasons of probing reflection) that the inhumanity in the field of medicine during the National Socialist period may be seen as a particularly extreme form of medical malpractice, it should have been a central task of the medical profession to occupy itself systematically with questions about the scope and causes of such malpractice, and about possibilities for the prevention. Also, it would have been necessary to apologize to the victims and their survivors and support their efforts to receive reparations. The apparently very long and hesitant path toward recognizing the medical profession’s central complicity and responsibility for human rights violations, and toward the proclamation that it was willing to face the tasks associated with this responsibility in the future, is the subject of the following section.

Forms of (non-)attention 1.

Attacks and reactions: the “Hanauske-Abel case” and its consequences

As stated above, since the period around 1980 an intensified debate about medicine in National Socialism can be observed among German physicians.21 Concomitant with this shift, there were broader public discussions about the Holocaust and the conditions of its emergence, among others as a consequence of the German broadcast of the US miniseries Holocaust (1978 – 79) and Claude Lanzman’s film Shoah. Important stations along the way included the Gesundheitstag (“Health Day”) 1980 event organized as an alternative to the Deutscher Ärztetag (the German Medical Assembly), further the founding of the Working Group for the Study of National Socialist “Euthanasia” and Compulsory Sterilization (Arbeitskreis zur Erforschung der nationalsozialistischen “Euthanasie” und Zwangssterilisation, subsequently abbreviated as “AKEZ”) in 1983, the publications of Ernst Klee’s books on the program of killing patients, the study by Benno Müller-Hill on forced human subjects research, and the volume about doctors in National Socialism, Ärzte im Nationalsozialismus, edited by a group of historians of medicine headed up by Fridolf Kudlien (1985).22 The BÄK as central organ of organized German medicine took the stage in April 1987, in a striking interview with its president, Karsten Vilmar.23 Under the 21 See e. g. Norbert Jachertz, “Phasen der ‘Vergangenheitsbewältigung’ in der deutschen Ärzteschaft nach dem Zweiten Weltkrieg”, in: Robert Jütte (ed.), Geschichte der deutschen Ärzteschaft, Köln: Deutscher Ärzteverlag 1997, 275 – 288; Roelcke, 2007. 22 Baader, Schulz (eds.), 1980; Klee, 1983; Kudlien, 1985; on the Arbeitskreis, see Topp, 2013, 213 – 224. 23 The chronology of the following events is sketched in Johanna Bleker, Norbert Jachertz,

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title “Coming to Terms with the Past Must Not Diffame Doctors Collectively” (“Die ‘Vergangenheitsbewältigung’ darf nicht kollektiv die Ärzte diffamieren”), he responded in the Deutsches Ärzteblatt to an essay published by the renowned British medical journal The Lancet in November 1986 by Hartmut HanauskeAbel, a young physician working at the Children’s Clinic at the University of Mainz and member of the IPPNW. This essay not only outlined what was already known about medicine in National Socialism, but also decried the medical profession’s lack of willingness to criticize itself in the post-war era, and then finally postulated a parallel between the apolitical self-image of German doctors before and after 1945 and the inactivity of doctors in the face of what seemed in the 1980s to be the imminent danger of nuclear war.24 In the unusually long, eight-page interview, Vilmar not only criticized Hanauske-Abel’s position, but assailed him personally.25 He accused the author of the Lancet article of historical ignorance, and asserted to the readership of the Ärzteblatt (with a circulation of 197,000), that in the Lancet article German doctors had been attacked across the board and discredited with a kind of collective guilt. In fact, he claimed, only a few hundred doctors had been “verifiably” involved in medical crimes, and, those responsible essentially amounted to a “clique”, “radical cadre of doctors”, or even a sort of “macabre Order”, namely SS doctors, who had acted in complete secrecy so that the overwhelming majority of doctors could not have known about their criminal behavior. Further, in the immediate post-war period the medical profession had already made comprehensive efforts to elucidate and condemn the crimes perpetrated by doctors.26 With this portrayal, however, Vilmar had related the historical knowledge available at this time very selectively, at best. The Vilmar interview was published a few weeks before the (re-)election to the office of BÄK president scheduled for the German Medical Assembly (12 – 16 May 1987).27 After the growing criticism about the medical profession’s silence and minimization of human rights violations perpetrated in the National So-

24 25

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“Vorwort der Herausgeber”, in: idem (eds.), Medizin im Dritten Reich, Köln: Deutscher Ärzteverlag 1989, 2nd edition 1993, 7 – 10; before this interview, in 1983, the Deutsches Ärzteblatt had published a series of articles on the Gleichschaltung, the organisational homogenisation of the journal according to the intentions of the regime, by Norbert Jachertz. Hartmut M. Hanauske-Abel, “From Nazi Holocaust to Nuclear Holocaust: A Lesson to Learn?”, in: The Lancet 328, 1986, 271 – 273. The content of the interview and of the following publications is reconstructed in detail, but without analysis in Jürgen Peter, Der Nürnberger Ärzteprozess im Spiegel seiner Aufarbeitung anhand der drei Dokumentensammlungen von Alexander Mitscherlich und Fred Mielke, 2nd edition, Münster/Hamburg: LIT 1998, 249 – 280. Karsten Vilmar, “Die ‘Vergangenheitsbewältigung’ darf nicht kollektiv die Ärzte diffamieren”, in: Deutsches Ärzteblatt 84(31/32), 1987, A-1185 – 1188, A-1194 – 1197. This important context is pointed out in Jachertz, 1997.

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cialist era, the interview can be understood as Vilmar’s attempt to attract votes in the coming election, especially from the more conservative circles of doctors. Striking in the text of the interview were the interviewer’s comprehensive, often very specific questions, as was the surprising amount of specialized knowledge on the topic, for instance about the French historiography on doctors in National Socialism in the1960s and 70s.28 In fact, the substance of the interview was well prepared by the interviewer Kurt Gelsner. In response to the publication by Hanauske-Abel, Gelsner had offered the Deutsches Ärzteblatt a manuscript which remained unpublished.29 Gelsner had been press speaker and editor-inchief of the official publication of the Marburger Bund, the central organization of staff doctors in Germany, for over 14 years. His previous positions had included leadership posts with the conservative newspaper the Münchner Merkur and the Catholic magazine Feuerreiter.30 Following these events, the Medical Assembly in May 1987 was host to an intensive discussion that was not on the official agenda, but hardly unexpected by that time, about the interview and the broader topic of medicine in National Socialism.31 Vilmar was criticized vehemently for his statements about both the supposedly small number of those responsible for medical crimes, about the innocence of the majority of the medical profession, and also about the supposedly early critical discussion in the post-war period, but he also had his defenders. The discussion ended with a resolution in which the delegates demanded that the executive board of the BÄK “discuss and work out [the issue] in an appropriate form”.32 Vilmar himself praised the debate and spoke of the “shame […] about what happened”, without distancing himself from the content of his statements in the interview.33 Indirectly, he repeated his criticism of Hanauske-Abel and his alleged proposition of the collective guilt of German physicians. The Vilmar interview in April and the subsequent discussions at the German Medical Assembly were followed in early August by a “debate” on the interview in the form of letters to the editor of the Ärzteblatt. Although Hanauske-Abel himself had sent a detailed counterdeclaration (Gegendarstellung) to the state28 Vilmar refers to Jacques Delarue, Histoire de la Gestapo, Paris: Fayard 1962; Yves Ternon, Socrate Helman, Les M¦decins allemandes et le National-Socialisme, Paris: Tournai 1973; see Vilmar, 1987, A-1188. 29 For this information I am grateful to Norbert Jachertz. 30 See the obituary by Karsten Vilmar, “Gestorben: Kurt Gelsner”, in: Deutsches Ärzteblatt 96 (23), 1999, A-1592; here, the loyalty of Gelsner towards those responsible in the organization is stressed. 31 Norbert Jachertz, “Ärzte und NS-Zeit: Gnade des Verzeihens”, in: Deutsches Ärzteblatt 84 (22), 1987, A-1541 – 1542. 32 Ibid., A-1542. 33 Ibid.

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ments by Vilmar to the journal’s editorship, rather than printing this, a considerably shorter “opposite” view (Gegenmeinung) was published as part of the “debate”. In this text Hanauske-Abel pointed out various passages of the interview that attributed to him statements (for instance, on the collective guilt of German doctors), which he had not in fact made in this form. Vilmar ended the “debate” himself with “closing words” that did not address the critique.34 Parallel to this “debate”, 16 historians of medicine working at various German universities signed a critical statement on the Vilmar interview formulated primarily by Johanna Bleker and Heinz-Peter Schmiedebach in Berlin, which was submitted to the Ärzteblatt in mid-August 1987.35 Yet the editorship declined to publish the statement, arguing that the “debate” on the interview had already concluded with Vilmar’s “closing words”. It would be possible, however, for historians of medicine “to publish articles in the Deutsches Ärzteblatt after prior consultation with the editor”.36 In response Johanna Bleker argued that, considering the importance of the topic, the debate should not be concluded with a “short documentation of a few readers’ opinions”. Further, the text written by the historians of medicine was not a mere reader’s opinion, but rather a “professional rectification” of the statements in the interview, based on results of scholarly research by professional medical historians, which should not be excluded from the debate on the interview for formal reasons.37 In response, the editors repeated the formal argument, as well as the offer to publish “scholarly grounded papers of general interest on the topic of doctors and the Nazi era” – that is, specifically not on Vilmar’s statements and views.38 This definitively excluded the publication in the Ärzteblatt of a differentiated commentary on the interview involving any rectification of the false testimony and prejudices formulated there. After this unsatisfactory result, Bleker and Schmiedebach turned to the weekly Die Zeit, where their statement was published in November 1987, along with a sharp editorial commentary by Ulrich Stock as well as a German translation of the essay by Hanauske-Abel, which had not been published in any German medical journal up to this time.39 The statement listed a number of 34 The complete “debate” together with the “closing words” was published in issue 31/32 of the Deutsches Ärzteblatt of 1 August 1987. 35 Besides the authors Johanna Bleker and Heinz-Peter Schmiedebach, the statement was signed by Gerhard Baader, Wolfgang Eckart, Michael Hubenstorf, Peter Kröner, Fridolf Kudlien, Werner F. Kümmel, Georg Lilienthal, Gunter Mann, Kazem Sadegh-Zadeh, Sabine Sander, Heinz Schott, Eduard Seidler, Richard Toellner, Rolf Winau. 36 Letter Norbert Jachertz to Johanna Bleker, 26 August 1987, private archive of Johanna Bleker (in the following PA JB), Berlin. 37 Letter Bleker to Jachertz, 3 September 1987, PA JB. 38 Letter Jachertz to Bleker, 11 September 1987, PA JB. 39 Johanna Bleker, Heinz-Peter Schmiedebach, “Sich der Wahrheit stellen”, in: Die Zeit 46, 6

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errors and misinterpretations in the Vilmar interview and denounced the decades of silence by the organized medical profession. The historians of medicine remarked incisively that the primary purpose of the interview was to serve the professional society’s political goal of “saving the medical profession of the German Reich and the Federal Republic from ‘collective defamation’”.40 After the criticism of the previous behavior of the medical profession in general and of Vilmar in particular became public, before the end of the year, the historian of medicine Richard Toellner of Münster had mediated an agreement that a series of articles on medicine in National Socialism, co-ordinated by Johanna Bleker, would be published in the Ärzteblatt in the near future.41 Shortly after the decision was made to publish the series of articles, in January 1988 the Spiegel published a further critical article about Vilmar and the BÄK.42 It reported, among other things, that the regional medical association responsible for the critic Hanauske-Abel (the Landesärztekammer Rheinland-Pfalz) had taken the unusual step of withdrawing his membership after he had informed them that he would be accepting a fixed-term position with a children’s clinic in Boston. The article also contested Vilmar’s construction of a clear separation between criminal SS doctors on the one hand and the remaining members of the medical profession who continued to behave “normally”. It pointed out that Vilmar’s predecessor as president of the BÄK, Hans Joachim Sewering (in office from 1973 to 1978), as well as his predecessor Ernst Fromm (1959 – 1973) had been members of the SS. As the Spiegel had reported back in the 1970s, Sewering had also signed an order to relocate patients in 1943, on the basis of which a mentally disturbed girl from the tuberculosis clinic in Schönbrunn, at which Sewering was provisional director, was transferred to the notorious asylum in Eglfing-Haar near Munich. In the years up to 1945 the EglfingHaar clinic was one of the centers of patient killings – the transferred girl was slain there shortly after arrival. Yet well into the 1990s Sewering claimed that neither he nor the Catholic nurses in Schönbrunn had known about the killings in Eglfing-Haar.43 The Sewering case continued to haunt the BÄK. Because of the renewed public debates, in January 1993 the Catholic authorities responsible for the Schönbrunn

40 41 42 43

November 1987, 47; this was also the place of publication of the German translation of Hanauske-Abel’s article, and of the comments by Ulrich Stock. Bleker, Schmiedebach, 1987. Letter Richard Toellner to Jachertz, 23 November 1987, PA JB. Anonymous: “Ärzte unter Hitler : Mission verraten”, in: Der Spiegel 3, 18 January 1988, 76 – 80. On the various narratives on this case, see Gerrit Hohendorf, “The Sewering Affair”, in: Korot: The Israeli Journal of the History of Medicine 19 (for 2007/2008), published 2009, 83 – 104, and Hohendorf ’s ccontribution in this volume.

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asylum under Sewering’s provisional direction (the Diocesan Chancery of the Archbishop of Munich) clarified that the Catholic nurses had indeed known about the patient killings. It now appeared extremely improbable that the provisional director of the clinic was the only member of the medical staff who had known nothing about the killings. The admission by the Seat of the Archbishop thus resulted in the loss of plausibility for the version of the story that Sewering had been telling for decades, which implied his ignorance. This took place around the time Sewering was about to be inaugurated as president of the World Medical Association (the election had been held in 1992). As a result of the scandal Sewering immediately stepped down from his office as “president-elect” in January 1993. Even after his resignation, however, the BÄK, still headed by Vilmar, was unable to detect any wrongdoing by Sewering. On the contrary, it referred to “old, never proven accusations” and a “smear campaign” against Sewering, in which the World Jewish Congress was a significant participant. Rather than pursuing its own investigation into the matter (for instance, about the supposed “activities of the World Jewish Congress” reported in an American newspaper), the BÄK closed ranks with the prominent former BÄK official and attacked his critics in a completely incommensurate form.44 Back to the events of spring 1988: The BÄK had come under such pressure through the coverage in the Zeit and the Spiegel that it now welcomed the publication of the series of essays in the Ärzteblatt. The first of the 16 articles appeared in April 1988, and enjoyed such a positive reception that the Deutscher Ärzteverlag and the editors of the series decided to publish the entire series as a book, complete with commentaries and bibliography. A second edition with several additional chapters (including an analysis of the letters to the editor of the Ärzteblatt regarding the series) followed in 1993.45 Apparently the collaboration between Johanna Bleker and Norbert Jachertz had proceeded satisfactorily in the BÄK’s view. In any case, upon Jachertz’s suggestion, Vilmar contacted Johanna Bleker in April 1992 asking her to par-

44 BÄK, “Prof. Sewering Ziel einer Verleumdungsaktion”, in: Deutsches Ärzteblatt 90(4), 1993, A-165; in a press-statement of the BÄK and a report on the step-down by Sewering, the BÄK also speaks of a “campaign” and a “threat” of the Jewish World Congress: Pressestelle der Deutschen Ärzteschaft, Köln, 23 January 1993, as well as Norbert Jachertz, “Sewering – Ende einer Karriere: Weshalb der designierte Präsident des Weltärztebundes sein Amt nicht antritt und was 1943 in Schönbrunn passierte”, in: Deutsches Ärzteblatt 90(5), 5 February 1993, A239 – 240; on this supposed threat, see Michael H. Kater, “The Sewering Scandal of 1993 and the German Medical Establishment”, in: Manfred Berg, Geoffrey Cocks (eds.), Medicine and Modernity : Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany, Cambridge: Cambridge University Press 1997, 213 – 234; Hohendorf, 2009; as well as the chapter by William E. Seidelman in this volume. 45 Johanna Bleker, Norbert Jachertz (eds.), 1989/1993.

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ticipate in a planning meeting for the next project:46 The 100th German Medical Assembly was on the horizon for the year 1997, and for this anniversary the executive board of the BÄKwished to publish a book describing the professional organization’s historical development. As became apparent in the letter of invitation, preliminary discussions had already taken place with the representatives of various medical professional associations, from which a first proposal for the conception, content and structure of the volume had emerged. Jachertz had also succeeded in recruiting the historian Thomas Gerst for the BÄK’s anniversary project. Bleker, however, rejected the invitation to participate, explaining that she could not imagine how, considering the current perspective and standpoint of the professional associations of medicine, such a portrayal could be reconciled with the standards of medical historiography.47 Instead, another historian of medicine agreed to provide expert support for the BÄK book project: Robert Jütte, director of the Institute for the History of Medicine of the Robert Bosch Foundation in Stuttgart, who shortly thereafter (in 1994) was also appointed to the Academic Council (Wissenschaftlicher Beirat) of the BÄK as representative of the field of history of medicine. As planned, the volume on the history of the organized German medical profession was published in 1997. It was edited by Jütte, who also wrote one of the chapters. In addition to the editor, two of the other authors who contributed to the volume, Thomas Gerst and the editor in chief of the Deutsches Ärzteblatt Norbert Jachertz, were financed directly by the BÄK. The other authors were historians and staff members of associations of medical professionals.48 In this constellation it seems inappropriate to speak of the volume as “the result of the work of an independent team of historians” (as Jütte claimed in the research report on medicine in the National Socialist era contracted by the BÄK in 2011, cited at the beginning of this chapter49). Within the volume, two of the seven chapters addressed issues related to the Nazi past: One contribution, written by Martin Rüther, a local historian of the city of Cologne, was concerned with the “Ärztliches Standeswesen im Nationalsozialismus” (“The Nature of the Medical Profession in National Socialism”), a further chapter by Jachertz discussed “Phasen der ‘Vergangenheitsbewältigung’ in der deutschen Ärzteschaft” (“Phases of ‘Coming to Terms with the Past’ in the German Medical Profession”). The chapter by Rüther essentially summarized the state of knowledge about questions of “Gleichschaltung” (enforced conformation) and the organizational structure of medical organizations, and 46 Letter Karsten Vilmar to Bleker, 15 April 1992, PA JB. 47 Personal communication, Johanna Bleker to Volker Roelcke, 8 April 2014; as well as phone interview of Roelcke with Norbert Jachertz, 16 April 2014. 48 “Autorenverzeichnis”, in: Jütte (ed.), 1997, 307. 49 Idem, 2011a, 316.

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about party memberships in various groups of doctors, supplemented by a wealth of new details. The inhuman medical research of the period was dealt with in a single sentence and – in apparent ignorance of the state of knowledge available at the time – dismissed as “for the most part scientifically meaningless”.50 Mentioning only Josef Mengele and Sigmund Rascher by name meant implicating two dead doctors who obviously had no connection to the German medical profession in the post-war era. Participation in the inhuman research projects by leading representatives of the medical profession, as well as by leading members of various medical associations, as well as internationally renowned institutions of science, and their involvement in the planning, implementation and scientific exploitation of patient killings was not addressed. Willing collaboration in the context of the National Socialist health and social policy was described for only one medical functionary who acceded to an important role in the post-war medical profession – Karl Haedenkamp. And even this did nothing more than report on the state of research known from the public debates of the 1980s (when a street named after Haedenkamp was renamed), without providing any information about other medical functionaries who became important in the post-war era. It is impossible to reconstruct with any certainty whether these omissions by the author were a conscious decision or due to insufficient knowledge of the state of historical research. The chapter by Norbert Jachertz constituted one of the first attempts to describe more systematically the way the medical profession in the post-war period had addressed medicine in National Socialism.51 Jachertz divided the timespan of around 50 years into a first phase of intensive confrontation in the late 1940s, with coverage about the Nuremberg Medical Trial and the discussion in its immediate aftermath; then a stage of “incidental study” from the 1950s to the 1970s (to which less than one page of the chapter was dedicated); and, finally a second phase of more intensified engagement starting with the Gesundheitstag in 1980. Jachertz elaborated especially on the Vilmar interview in 1987 described above, and on the debates during the German Medical Assembly held the following year. He reported about Vilmar’s closing words on these debates in extensive detail. There, he wrote, Vilmar had recognized that medical organizations had gone over to National Socialism “with flying colors”. Jachertz also saw occasion for the positive remark that Vilmar had shown that he was “ashamed” about what had been done “by a number of criminal doctors that was

50 Martin Rüther, “Ärztliches Standeswesen im Nationalsozialismus 1933 – 1945”, in: Jütte (ed.), 1997, 143 – 193, here 180. 51 Jachertz, 1997; for an earlier account, see Michael H. Kater, “Unresolved Questions of German Medicine and Medical History in the Past and Present”, in: Central European History 25, 1992, 407 – 423.

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small in relation to the total number organized in the medical profession, but still too large”. Vilmar had confessed that this could not be forgotten. Jachertz thus portrayed Vilmar as interested in reconciliation, never mentioning that Vilmar had once again attacked his critics, and thus, implicitly, Hanauske-Abel in particular, who in Vilmar’s closing words had been termed “intolerant”, and likened to the National Socialists. Neither did Jachertz, who had already dealt with the subject in his own work on “Gleichschaltung” in 1983 and then as co-editor of the series of articles in the Ärzteblatt, raise the obvious questions as to why the organized medical profession had waited so long to address the subject and even then – as he certainly knew himself – continued to play it down. For instance, the former SS member Erich Fromm, Sewering’s predecessor, who had already been identified in the Spiegel back in 1988, made no appearance in Jachertz’s account. Neither was there any mention of the fact that, of the around 40 reviewers for the Aktion T4 program for killing patients (whose names were known upon the publication of Ernst Klee’s book in 1983, at the very latest), in the post-war period, three had not only become professors at German faculties of medicine, but were also able to become presidents of the national Psychiatric Association and thus representatives of major medical organizations.52 Jachertz did, however, briefly discuss the BÄK officers Haedenkamp and Sewering in “two biographical notes”. While he dealt with Haedenkamp in just a few lines, as an example for a problematic continuity in personnel, he defended the ¦minence grise of the BÄK. In Jachertz’s evaluation, even in 1997, there was “still no substantive evidence” for the assumption that Sewering knew of the patient killings in the Eglfing-Haar asylum at the time the young female patient was transferred there.53 There was no critical discussion of Sewering’s claims, which had long since become implausible, nor was there any commentary on the BÄK’s polemic against Sewering’s critics and the World Jewish Congress. With the sympathetic assessment by Jachertz in defense of Sewering, and Rüther’s perhaps comprehensive, but nevertheless selective thematization of the National Socialist past of medical organizations and functionaries, the volume edited by Jütte on the BÄK’s behalf in 1997 perpetuated the tradition represented by Vilmar in the 1980s, of “retarded” historical clarification accompanied by simultaneous defense of the medical profession.

52 These presidents were Friedrich Mauz, Friedrich Panse, and Werner Villinger ; the honorary membership of Mauz and Panse in the psychiatric association was officially withdrawn only in 2011: http://www.dgppn.de/fileadmin/user_upload/_medien/dokumente/mitgliederver sammlungen/mv2011/2011 – 11 – 24-beschluss-ehrenmitgliedschaften.pdf (16 April 2014). 53 Jachertz, 1997, 286.

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Untapped potential: the protocols of the Nuremberg Medical Trial and the patient files from the “Aktion T4” euthanasia program

Parallel to the events described above, in which the BÄK or its representatives behaved defensively and often polemically towards critics, the first half of the 1990s saw two fundamental opportunities to participate in a substantial manner in processes of illuminating and reflecting medical malpractice in the National Socialist era: The project of editing the protocols of the Nuremberg Medical Trial, and the discovery of the patient files from the Aktion T4 euthanasia program. In 1993 the psychiatrist Klaus Dörner contacted the BÄK with a proposal to publish a microfiche edition of the protocols of the Nuremberg Doctors’ Trials of 1946/47 along with an index volume, accompanying materials and a history of medicine contextualization. The background for this proposal was that up to this point in time it was not possible to access the complete trial protocols in any single place – they were only available in the form of partial collections archived in different locations. The written account of the Medical Trial encompassed the complete stenographic record of all 143 trial days, the prosecution’s materials, including 570 documents and nearly 1,000 attestations of innocence submitted by the defense – totalling around 25,000 pages, according to an initial calculation. For decades, the only documentation printed in German had been the documents selected and published by Alexander Mitscherlich and Fred Mielke in 1949, which represented only a fraction of the entire inventory of documents.54 Making a German-language edition of the materials available, the thinking went, could significantly simplify further historical research as well as their use in the education and training of physicians and other health-care practitioners. Dörner presented to the BÄK a concept for an edition to be published by the Stiftung für Sozialgeschichte des 20. Jahrhunderts (Foundation for 20th-century Social History), which estimated a total cost of 440,000 D-Marks to realize the project. The concept was accompanied by favorable opinions from the Göttingen University Library and from the historians of medicine Richard Toellner (Münster) and Rolf Winau (Berlin). The BÄK’s initial positive reaction to the proposal in April 1993 was followed by a rejection in January 1995.55 The BÄK 54 The data are mentioned e. g. in Thomas Gerst, “Edition zum Nürnberger Ärzteprozess”, in: Deutsches Ärzteblatt 98(15), 2001, A-956 – 957. 55 Klaus Dörner et al. (eds.): Der Nürnberger Ärzteprozeß 1946/47: Wortprotokolle, Anklageund Verteidigungsmaterial, Quellen zum Umfeld, Erschließungsband zur Mikrofiche-Edition, München: K. G. Saur 2000, 7 – 9; minutes of the Fachverband Medizingeschichte e.V. general assembly, 17 June 1995 in Mainz, 10a: “Projekt Dörner, Mikrofiche Edition der Dokumente des Nürnberger Ärzteprozesses”, in: private archive Volker Roelcke, Institute for the History of Medizin, Giessen University (in the following PA VR); see also Michael Emmrich, “Der

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explained its negative decision, first, by stating that its statutes precluded it from awarding such a high sum. This was surprising, since the required sum had been known from the outset, back when the BÄK had signaled its interest in supporting the project. A few months after Dörner received the negative decision, however, another kind of financial explanation was given in the Ärzteblatt, which claimed that there was no room for manoeuvre because the BÄK was already financing two other “major historical projects”.56 The Financial Report of the BÄK for the years 1994/95 and 1995/96, published in the Ärzteblatt in 1996, further shows, that for the years from 1995 on there would have been a wide margin for additional expenditures of around 110,000 D-Marks per year, had this been a priority for the BÄK executive board.57 On the other hand, Dörner was informed in the rejection letter, the BÄK had doubts about the value and feasability of the project itself. Consequently, Dörner decided to address the German medical profession not through the head of its institutional representatives, but directly at the “roots”. For this he contacted various medical societies and the medical associations of the federal states (Landesärztekammern) requesting address lists of their members, so that he could then send them an appeal for donations. With the support of Wolfgang Klitzsch, managing director of the Medical Association of North-Rhine, delegates of the German Medical Assembly in Stuttgart in 1995 were also informed by a handout, which requested that they disseminate the appeal for donations.58 In June 1995 Winau, in his function as chairman, informed the members of the Professional Association for the History of Medicine (Fachverband für Medizingeschichte) at their general assembly about what had occurred and requested that Robert Jütte express his opinion about the BÄK’s refusal. As mentioned above, in 1994 Jütte had been co-opted by the BÄK through appointment to its Academic Council; the BÄK’s rejection letter to Dörner of January 1995 had also referred to special expertise in the history of medicine. Jütte explained that he had consulted experts on the issue who had expressed “reservations about material and personnel conditions” and did not believe a

Nürnberger Ärzteprozess auf Deutsch – dafür fehlt es an Geld”, in: Frankfurter Rundschau, 6 February 1996. 56 Gisela Klinkhammer, „Spendenaufruf zur Publikation: Dokumente zum Nürnberger Ärzteprozess“, in: Deutsches Ärzteblatt 92(48), 1995, A-3374; one of the two projects referred to in this notice was probably the preparation for the 100th German Medical Assembly (Deutscher Ärztetag) 1997 mentioned before. 57 Harald Clade, “Finanzen/Etat der Bundesärztekammer – Sparkurs eingehalten, Finanzen im Lot”, in: Deutsches Ärzteblatt 93(25), 1996, A-1690 – 1692; I am grateful to Udo Schagen for drawing my attention to this publication. 58 Letter Klaus Dörner to Volker Roelcke, 7 April 2014, PA VR.

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complete edition of the documents to be necessary.59 He did not name any more precise reasons for the rejection on his part. Dörner’s appeal for donations finally was successful. Nearly 8,000 doctors donated a total of 1.4 million D-Marks, so that it was possible to finance not only the project of the complete edition with accompanying materials, but also a lecture series at the University of Hamburg. This lecture series resulted in a much acclaimed scholarly volume on the current state of research about the Medical Trial and the Nuremberg Code that emerged from it. The funds even covered the costs of publishing an English-language edition of the documents. The remaining surplus of 75,000 D-Marks was donated to the self-help organization of the surviving victims of medical crimes, the Federation of Victims of “Euthanasia” and Forced Sterilisation (Bund der “Euthanasie”-Geschädigten und Zwangssterilisierten, BEZ).60 The edition, the index volume and the scholarly volume accompanying the edition are now widely used in history of medicine research and in teaching for medical students. In another case in the mid-1990s, the BÄK again proved hesitant about contributing to historical clarification: After the archives of the Ministry for State Security (Ministerium für Staatssicherheit, in the following: MfS) of the German Democratic Republic were opened, in 1990/91 several tens of thousands of files on patients were identified who had been victims of the Nazi “T4 Aktion” patient killings.61 When the MfS documents were taken over by the Federal Archives in Berlin (Bundesarchiv, in the following: BA), these patient files were also transferred there. An index of perpetrators found along with this store of documents suggests that the MfS had kept the patient records for the purpose of collecting the names of doctors mentioned in the files who had participated in the killing program. In the context of the Cold War and the confrontations between East and West, the MfS apparently pursued the goal of protecting the doctors involved in the killings who practiced medicine in post-war East Germany (where there was a chronic lack of physicians) from having their past exposed. By the same token, the East German security services might possibly have exposed doctors practicing in West Germany, or pressure them to collaborate with the East.62 The trove of discovered documents had not been preserved well. Besides their poor material condition, demands from various local or regional archives for 59 Minutes of the Fachverband-Assembly, 5, PA VR. 60 Dörner et al., “Vorwort”, in: idem et al. (eds.), 2000, 8; see also Dörner, Ebbinghaus (eds.). 2001. 61 Volker Roelcke, Gerrit Hohendorf, “Akten der ‘Euthanasie’-Aktion T4 gefunden”, in: Vierteljahreshefte für Zeitgeschichte 41, 1993, 479 – 481. 62 Peter Sandner, “Schlüsseldokumente zur Überlieferungsgeschichte der NS-‘Euthanasie’Akten gefunden”, in: Vierteljahreshefte für Zeitgeschichte 51, 2003, 285 – 290.

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certain sets of the newly identified documents threatened to tear the complete set apart. Finally, because the documents had not been indexed in any archive records, it was not possible, for instance, to search for individual patient names. Consequently, in March 1994 the president of the BA and his superior, the Federal Minister of the Interior, received an open letter from historians of medicine requesting that the documents be archived in the constellation in which they were found. This was the only context in which it was possible to determine that each individual patient file belonged to the documents recording the program of patient killings. The open letter also included an appeal for the provision of staff resources to index the contents of the archive.63 An analogous open letter followed in April 1994, from the national Working Group for the Study of National Socialist “Euthanasia” and Compulsory Sterilization (Arbeitskreis zur Erforschung der nationalsozialistischen “Euthanasie” und Zwangssterilisation/AKEZ), of which Gerrit Hohendorf and Volker Roelcke, the authors of the publication about the discovery of the files, were members.64 Despite this appeal, however, the archiving and indexing of the files was quite slow to get under way, and took place only thanks to the assistance of the existing BA staff. Considering the enormous scope of the documents involved, this was an extremely dissatisfying situation, both for the relatives of the victims of the patient killing program and for the historians waiting to analyze their contents. And there was still no definitive decision about whether all of the documents would be archived together. In June 1995 a total of only around 7,500 patient names had been recorded, and for only a small portion of these were additional data noted, like the last institution in which a patient had been staying before being transported to the “euthanasia” center or the presumptive date of death.65 In order to secure that the documents remain together, to conserve the material condition of the files and restore them where possible, to make possible inquiries from relatives and research by historians (of medicine) on scientific issues, and, finally, to enable an adequate commemoration of the victims by 63 Letter by Volker Roelcke, Heinz Schott, Johanna Bleker et al. to the president of the Federal Archives (Bundesarchiv)/Federal Minister of the Interior, 15 March 1994, PA VR; on the imminent splitting of the archival holdings due tot he principle of provenience, see letter by Generallandesarchiv Karlsruhe to Psychiatrisches Landeskrankenhaus Wiesloch, 21 January 1994, PA VR; see also Thomas Gerst: “NS-Euthanasie – Zentrales Aktenverzeichnis”, in: Deutsches Ärzteblatt 100(41), 2003, A-2627. 64 Letter by the AKEZ to the president of the Bundesarchiv, 25 April 1994, as well as the parallel letter by Volker Roelcke to the deputy president of the Bundesarchiv Dr. Siegfried Büttner, 25 April 1994, both in PA VR; on the history of the AKEZ, see Topp, 2013, 213 – 224. 65 See the open letter, signed by Klaus Dörner, Gerrit Hohendorf, Klara Nowak, Volker Roelcke, Michael Wunder in the name of the AKEZ, 31 July 1995, addressed to the Federal Minister of the Interior, and in parallel to the president of the BÄK, private archive of Gerrit Hohendorf, Technical University Munich (in the following PA GH).

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name, in another open letter of July 1995 Hohendorf and Roelcke, along with representatives of the AKEZ, contacted the Federal Minister of the Interior and the president of the BÄK directly. This culminated in an appeal to provide suitable financial and personnel resources for the stated objectives. Specifically, they demanded the creation of two positions for archivists or historians, or, alternatively, three to four positions for mid-level archive staff, for a period of two years, which would have required funding of around 200,000 D-marks per year.66 In the historical view, the patient killings had come about through the collaboration between doctors and state authorities, and on the basis of repeated medical initiatives. Thus it seemed logical to call to account not only the responsible Federal authorities (as the legal successors to the Reich government responsible for the crimes) to provide project financing, but also the professional organization of physicians. A substantial contribution from the professional medical organization would have amounted to an acknowledgment of its historical joint responsibility and would also have been an important step toward ahistorical sound self-reflection on the impact of this past. The open letter to the Minister of the Interior led to coverage in newspapers with nationwide circulation and a story in the most important news program on state television, as well as statements of support from individuals like Rita Süssmuth, the vice president of the German Federal Parliament (Bundestag). As a consequence, the Federal Ministry of the Interior saw to it that in October of that year, four intermediate-level positions were created to archive and index the documents, although they were only advertized within the ministry.67 The executive committee of the BÄK discussed the appeal formulated in the open letter on 29 September. In a letter of response on 19 October, President Karsten Vilmar informed the AKEZ that the BÄK was “willing in principle to make a financial as well as a non-material contribution” and that it had contacted the Federal Minister of the Interior for this purpose. The letter continued: “However, I must inform you that support on the scale you mention in the abovementioned letter is completely beyond the financial capabilities of the German Medical Association, particularly as this does not occur [sic] to the legally stipulated tasks of the medical associations as statutory bodies under public law”.68 A short time later, in November 1995, the Deutsches Ärzteblatt officially reported the BÄK’s decision to participate “in principle also financially” in the basic indexing of the files. Also mentioned in this report was that Vilmar had 66 Ibid.; see also the statement by Jütte at the general assembly of the Fachverband Medizingeschichte, 22 June 1996, minutes of the Fachverband-Meeting dated 25 July 1996, PA VR. 67 See letter Roelcke to Robert Jütte, 13 December 1995, PA VR. 68 Letter Vilmar to Gerrit Hohendorf, 19 October 1995, PA GH.

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written to the minister of the interior, informing him that the task of archiving the files was a public duty.69 In early December Robert Jütte, in his role as representative of medical history on the Academic Council of the BÄK, informed Volker Roelcke by phone that per the agreement between the BÄK and the Ministry of the Interior, the basic archiving and indexing of the patient files was to be performed by the BA, but that the BÄK intended to provide funds above and beyond this to enable methodologically sound analysis of the documents. He asked for suggestions as to what principles and criteria could be used to guide this further work. Furthermore, a planning meeting was to take place at the BA in the forseeable future. In addition to the president of the BA and a representative of the Ministry of the Interior and of the BÄK, invited to participate in this meeting were Jütte himself, the archivist and historian Christina Vanja (of the State Welfare Association of Hesse) and Martin Dinges, archivist and historian as well as a colleague of Jütte’s at the Institute for the History of Medicine in Stuttgart, and, finally, also Roelcke in his function as one of the signatories to the open letter.70 Of the participants the BÄK planned to invite to the meeting, only Vanja and Roelcke were familiar with the latest state of research and the existing sources on the subject, since Jütte’s and Dinges’ research focuses were on the early modern era and the history of homeopathy, respectively. In a letter of 21 December, Jütte rejected the suggestion that other persons acquainted with the topic and relevant issues as well as a representative from the AKEZ be invited. At the same time he repeated the request to formulate ideas for the archiving work, and asked Roelcke to work with Christina Vanja to compose a working paper.71 At the official invitation of the BÄK and the BA, the meeting took place on 13 February 1996 in the BA in Berlin-Lichterfelde.72 Without an invitation, but after previous consultation with BA staff, it was also attended by Gerrit Hohendorf.73 As a result of the meeting Jütte’s colleague Martin Dinges outlined further steps toward the realization of the archiving and indexing project. At the meeting Vilmar had made it plain that no funds for the basic indexing or the conservation of the files would be supplied by the BÄK. Neither were pledges made to provide 69 Gisela Klinkhammer, “Untersuchung der ‘Euthanasie-Aktion T4’”, in: Deutsches Ärzteblatt 92(45), 10 November 1995, A-3038. 70 Letter Roelcke to Hohendorf, 12 December 1995, PA VR; the official function of Jütte as speaking for the BÄK is documented in the statement by Jütte at the general assembly of the Fachverband Medizingeschichte, 22 June 1996, minutes of the assembly dated 25 July 1996, PA VR. 71 Letter Roelcke to Jütte, 13 December 1995, as well as Jütte to Roelcke, 21 December 1995, PA VR; letter Jütte to Hohendorf, 26 January 1996, PA GH. 72 Letter Jütte (on behalf of the BÄK) to Roelcke, 30 January 1996, PA VR. 73 See the letters by Hohendorf to Jütte, 25 March 1996, Jütte to Hohendorf, 2 April 1996, both in PA GH, as well as Roelcke to Jütte, 29 February 1996.

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resources for a scholarly analysis; instead, the decisions about how the project would proceed, and about potential sponsors for the project were deferred until the next meeting, scheduled for mid-year.74 Even before this second meeting, two additional staff were employed by the BA in order to process the files.75 With this step it was expected that the basic indexing of the sources could be completed in a reasonable amount of time. For the “deeper” archiving of the documents proposed in the open letter, which constituted a prerequisite for subsequent systematic analysis, Hohendorf and Roelcke had collaborated with Christina Vanja to write a working paper that was sent to Jütte in April. In addition, all participants discussed the alternative of a project that would create a more comprehensive overview of all of the patient files available on the National Socialist “Euthanasia” program (later referred to as “inventory”, see below). The importance and practicability of such a project had already been discussed at the February meeting in the BA at the suggestion of Christina Vanja. This project was introduced by Hohendorf and Roelcke at the AKEZ’s regular spring meeting, at the Bedburg-Hau psychiatric hospital, where it was approved after a long discussion.76 The BÄK did not make a decision about its concrete participation in the indexing or analysis projects in the following months, either. Thanks to the internal resources of the BA, the basic indexing work was concluded in the mid1990s, so that at least queries about victims by their families could be answered. Yet, the realization of the two projects for a deeper analysis of the files and for a comprehensive recording of all source documents on National Socialist “euthanasia” were delayed. In the end Gerrit Hohendorf teamed up with Maike Rotzoll, psychiatrist and historian of medicine in Heidelberg (and also a member of the AKEZ) to apply for funding by the German Research Council (Deutsche Forschungsgemeinschaft/DFG) for a project in which deep indexing was combined with quantitative and qualitative analysis of the patient files. Its central goals were, first, the reconstruction of the actual (in contrast to the intended) selection criteria for the patient killings; and second, the reconstruction of exemplary biographies of victims. The project was ultimately realized with funding from the DFG from 2002 to 2005, culminating in a series of

74 Letter Jütte to Roelcke, 22 February 1996, as well as the attached proposal by Martin Dinges on “further steps” (dated 14 February 1996), PA GH; minutes of the meeting of 13 February 1996 in the BA signed by BA-deputy president Büttner, dated 3 April 1996, PA GH. 75 Letter BA to Roelcke, 30 April 1996, PA GH; letter Roelcke to Jütte, 20 May 1996, PAVR; the employment of the staff for the basic processing of the files was announced by the BA already during the meeting on 13 February 1996, as documented in the minutes of the meeting. 76 Letter BA to Roelcke, 30 April 1996, PA GH; letter Roelcke to Jütte, 20 May 1996, PA VR.

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publications that constitute today’s reference works on the first phase of the patient killings (Aktion T4).77 Also with several years’ delay, the project of an “inventory of the sources on the history of the ‘euthanasia’ crimes, 1939 – 1945” was tackled and finally concluded in 2003. The work of bringing together the inventories in Germany and Austria was performed by Harald Jenner, another member of the AKEZ; the work on Poland by Jerzy Grzelak. As can be read in the report about the finalization of the project in the Deutsches Ärzteblatt, the financing for the sources in Germany and Austria was supplied by the DFG; for the sources in Poland, by the Robert Bosch Foundation. In the Scientific Council of the project Christina Vanja served as chairperson, the BÄKwas represented by Robert Jütte, Karsten Vilmar and Otmar Kloiber, and the AKEZ by Gerrit Hohendorf.78 At the public presentation of the inventory Vilmar, now the honorary president of the BÄK since his replacement by Jörg-Dietrich Hoppe as president, said that he found it difficult to bear the knowledge “that doctors not only looked away and said nothing, but actively participated in the systematic murder of patients and so-called marginalized groups”. The “euthansia” crimes, he continued, are a constant and urgent warning to defend the basic values of medicine against the spirit of the times and intervention by the state.79 The fact that doctors were substantially involved in killing patients was not new; indeed, this had been known since the documentations produced at the time of the Nuremberg Doctors’ Trials,80 and thus hardly remarkable. What is relevant here, however, is that Vilmar, despite the historical state of knowledge at the time when he made his declaration (2003), repeated the decades-old clich¦ according to which the violations of human rights in the field of medicine during the National Socialist period had been forced upon the medical profession by the state, and thus from outside. The implication was that without state intervention 77 See e. g. Annette Hinz-Wessels et al., “Zur bürokratischen Abwicklung eines Massenmords: Die Euthanasie-‘Aktion’ im Spiegel neuer Dokumente”, in: Vierteljahreshefte für Zeitgeschichte 53, 2005, 79 – 107; Petra Fuchs et al. (eds.): “Das Vergessen der Vernichtung ist Teil der Vernichtung selbst”: Lebensgeschichten von Opfern der nationalsozialistischen “Euthanasie”, Göttingen: Wallstein 2007; Sascha Topp et al., “Die Provinz Ostpreußen und die nationalsozialistische ‘Euthanasie’: SS-‘Aktion Lange’ und ‘Aktion T4’”, in: Medizinhistorisches Journal 43, 2008, 20 – 55; Maike Rotzoll et al. (eds.), Die nationalsozialistische “Euthanasie”Aktion “T4” und ihre Opfer, Paderborn: Schöningh 2010. 78 See BÄK/Deutscher Ärztetag (ed.): Tätigkeitsbericht 2003/2004, dem 107. Deutschen Ärztetag 2004 in Bremen vorgelegt von Vorstand und Geschäftsführung, Köln: Bundesärztekammer 2004, 470 – 471; as well as Gerst, 2003. 79 Quoted according to Gerst, ibid. 80 Apart from the three quasi official documentations already mentioned above, the patient killings had been described in particular in Werner Leibbrand, Um die Menschenrechte der Geisteskranken, Nuremberg: Die Egge 1946; and in Alice Platen-Hallermund, Die Tötung Geisteskranker in Deutschland, Frankfurt/M.: Verlag der Frankfurter Hefte 1948.

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such inhumanity would not have come to be. In so doing Vilmar completely ignored the long-known truth that the idea for “destroying life unworthy of living” was not an invention of the National Socialist state, but had existed long before 1933, had been advanced repeatedly by prominent doctors in the Weimar Republic, and that even in the implementation of the patient killing program from 1939 onwards, leading medical functionaries and professors of psychiatry and pediatrics participated in central roles, and without any compulsion. In this perspective it was only consistent that Vilmar and the BÄK did not want to recognize any historical responsibility for the medical profession as such, beyond the culpability of individual doctors, and thus, accordingly, provided no financial support for the archiving and analysis of the patient files discovered from the Aktion T4 program of “euthanasia”. Over all, what is revealed by the case of the re-discovered files of victims of the patient killings is that the BÄK did not seize the initiative, be it in order to clarify the history of physicians’ involvement on the basis of historical reconstruction, or to contribute to an adequate remembrance of the victims. Instead, it reacted with considerable delay after publication of the discovery of the documents, and even then did not respond until after public debates and the publication of an open letter by the AKEZ. Apparently, after the documents were found, the historian of medicine in the Academic Council of the BÄK was initially unable to convey to the BÄK the importance of these documents such that the head of the organization could decide on a substantial commitment to archiving and analyzing them. After Vilmar’s announcement in autumn 1995 that there was a “willingness in principle” on the part of the BÄK to participate in the work to be done, the following months and years did see a certain activism that took the form of organizing working meetings and establishing committees. In taking the balance of the organization’s contribution ten years after this statement, however, it must be stated that the BÄK participated neither in funding the conservation and basic indexing of the inventory of documents (this took place with the BA’s own funding), nor in their historiographical analysis (funded by the DFG). Only in the project to take an inventory of the generally available files on Nazi patient killings was the BÄK involved through participation in its Scientific Council, but here, too, the funding came from other sources. Even when the third opportunity arrived to take on a leading role in the historical clarification of the extensive malpractice by physicians, the BÄK remained in a reactive, subordinate role: In the case of the prize mentioned briefly in the introduction, used by the BÄK today as a sign for a sense of historic responsibility, the “Award for Research on the Role of the Medical Profession in National Socialism” (Forschungspreis zur Rolle der Ärzteschaft im Nationalsozialismus). This distinction is awarded jointly by the Federal Ministry for Health

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(Bundesministerium für Gesundheit, BMG), the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) and the BÄK. It was initiated in 2005 by the Federal Minister for Health at the time, Ulla Schmidt, her undersecretary Klaus Theodor Schröder, and Manfred Richter-Reichhelm (who had been chairman of the KBV until 2004), in the context of discussions about a historical research project on the fate of Jewish doctors in Berlin. Richter-Reichhelm, in turn, addressed the question of a joint award and financial support for the prize to the KBVand the BÄK, who accepted this proposal. Half of the 10,000 Euros price money comes from the BMG, with the KBV and the BÄK contributing 2,500 euros each, but not – as the BÄK suggests regularly – an equal third part.81 Since 2007 the prize has been awarded every other year. In 2013 the jury made the irritating decision to honor a descriptive study about urologists in National Socialism, which was hardly ambitious conceptually, but indeed quite extensive: In this work the information for around one third of the 241 urologists described was taken from another publication without adequate identification – in other words, a plagiarism.82 Of the five members of the jury, two were historians of medicine, including Jütte for the BÄK, and three representatives from various other organizations without special expertise on the topic of the award.83 Both historians of medicine had their research focuses not in the field of medicine during the National Socialist period, but rather in earlier centuries. Since it is hardly likely that the prize was knowingly awarded to a plagiarism, it seems probable that the jury did not recognize the plagiarism due to its lack of familiarity with the material. The fact that not a single expert on the subject of the research award was represented in the jury raises the question as to how seriously the BÄK and the other participating institutions actually took the distinction. The history of its creation, the financing and composition of the jury choosing its winners thus document yet once more, after the organization’s behavior in the publishing the edition of documents, and after the discovery of the patient files, the BÄK’s lack of initiative and enthusiasm in endeavors to perform historical research to elucidate its past.

81 Thomas Gerst, “Ärzte im Nationalsozialismus: Preis für wissenschaftliche Forschung ausgeschrieben”, in: Deutsches Ärzteblatt 103(44), 2006, A-2915; on the initiative for the award, as well as the funding, see the e-mails by Manfred Richter-Reichhelm to Roelcke, 3 April 2014 and 4 April 2014; Lothar Janßen (Referat 311 Grundsatzfragen, Bundesministerium für Gesundheit) to Roelcke, 7 April 2014, all in PA VR. 82 Hermann Horstkotte, “Forschungspreis für ein Plagiat”, Zeit-online, 13 December 2013. 83 http://www.bundesaerztekammer.de/downloads/2012_Ausschreibung_FPAerzteNS_4_ RUNDE.pdf (16 April 2014).

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The 2008 Giessen conference and the project of a “literature study” on the state of historical knowledge

Under the presidency of Vilmar’s successor Jörg-Dietrich Hoppe, during the years from 2008 to 2011 the BÄK took a further half-hearted step toward acknowledging its historical responsibility. In December 2008, in an interview with Norbert Jachertz for the Deutsches Ärzteblatt, Hoppe declared: “It is truly high time to reach out to the victims [of the medical crimes in National Socialism] or their families” and express a public apology. The prerequisite for this, he continued, was an overview of the “state of scholarly findings about ‘euthanasia’ and human experiments”. For this a “small commission” was to be employed by the BÄK to work out a pertinent “literature study”. A “step to reach out to the victims” was to be made by the completion of his term of office in 2011.84 This announcement by Hoppe did not originate from internal discussions at the BÄK, however – it was preceded by an external cause. This was even apparent in the very context in which the interview was published: It was printed set in special graphics and inserted within an extensive article by Norbert Jachertz about a conference in Giessen that extended over several pages.85 The subtitle to the report in the Ärzteblatt stated: “A conference full of surprises […] investigated what consequences from the Nazi ‘euthanasia’ were taken after 1945, above all in the organized medical profession. A request for forgiveness has yet to be made”.86 In fact, the conference “Memories and Representations of Nazi Euthanasia in Post-World War II Medicine and Bioethics” had two stated goals: First, to bring together the current historical research on the way “euthanasia” during the period of National Socialism had been addressed by international post-war medicine and bioethics; second, for the closing day of the conference, representatives of various organizations and institutions were invited to deliver their opinions on the importance of the historical events for medicine and bioethics today. Speakers were invited from the BÄK and the World Medical Association (WMA), and further from those medical disciplines particularly affected by the “euthanasia” program (psychiatrists and pediatricians), from the central organization of victims, and from the German Ethics Council (Deutscher Ethikrat). 84 Interview by Norbert Jachertz with Jörg-Dietrich Hoppe, in: Deutsches Ärzteblatt 105(50), 12 Dezember 2008, A-2699. 85 The conference was titled “Memories and Representations of Nazi Euthanasia in Post-World War II Medicine and Bioethics”, 12 to 15 November 2008, Giessen University (organization: Volker Roelcke and Etienne Lepicard, in co-operation with Gerrit Hohendorf and Sascha Topp). 86 Norbert Jachertz, “Medizinverbrechen: Erinnern und beherzigen”, in: Deutsches Ärzteblatt 105(50), 2008, A-2698 – 2700.

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The invitation also asked the representatives of each organization whether they believed that asking forgiveness from the representatives of the victims would be suitable, or had already happened. In addition to Margret Hamm, managing director of the already mentioned Federation of Victims of “Euthanasia” and Forced Sterilisation (BEZ), the chairmen of the Deutsche Gesellschaft für Kinder- und Jugendmedizin (German Association of Pediatrics and Adolescent Medicine) Fred Zepp, and the Deutsche Gesellschaft für Sozialpädiatrie (German Association for Social Pediatrics) Hans-Michael Strassburg, as well as a representative from the executive committee of the Deutsche Gesellschaft für Psychiatrie, Psychotherapie and Nervenheilkunde (German Association for Psychiatry, Psychotherapy, and Nervous Disorders) Michael Seidel accepted the invitation and presented statements speaking for their respective organizations (see appendix to this volume). In different ways they all mentioned the failures of the previous decades and the substantial joint responsibility borne by doctors for the violations of human rights. The pediatricians pointed out the apology proffered in 1998, which asked for the forgiveness of Jewish colleagues and their descendants, who had been stigmatized from 1933 on, driven into emigration or deported and killed. Like the psychiatrists, however, they were forced to acknowledge that a comprehensive statement about joint complicity and responsibility for all of the events that took place, like a request for forgiveness from all groups of victims including the victims of “euthanasia”, had yet to be made. Margret Hamm listed concrete examples of the continuities in the medical profession and public media regarding stigmatizing and devaluating patterns of thinking about and behavior toward the disabled and other marginalized groups in society.87 In his response to the invitation, the chairman of the German Ethics Council, the jurist and former Federal Minister of Justice Edzard Schmidt-Jortzig, wrote that the “abuse of medicine by National Socialism” and, especially, euthanasia, “has consequences today regarding our legal regulation for the protection of abusive interventions by the attending physician or the state”. Due to time constraints, however, he would not be able to participate in the conference. Yet, he continued, a further member of the Ethics Council, Michael Wunder, would be speaking at the event and would be willing to participate in a podium discussion in his stead.88 Michael Wunder was indeed invited, but as a longstanding member and sometimes co-ordinator of the AKEZ, not as a representative of the Ethics Council. The response by the conference organizers to Schmidt-Jortzig that the latest historical research had documented clearly that medicine and biomedical sciences had by no means been the victims of one-sided abuse by 87 For all these statements, see the appendix to this volume. 88 Letter Edzard Schmidt-Jortzig to Roelcke, 29 September 2008, PA VR.

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“National Socialism”, further, that many of the atrocities occurred essentially on the basis of doctors’ initiative, thus necessitating a re-evaluation of the responsibility borne by doctors and medical institutions, as well as implied medical attitudes and value hierarchies,89 received no further response from the German Ethics Council. The WMA did not respond to the invitation, despite repeated queries to its general secretary Otmar Kloiber, who had been a member of the BÄK executive board for many years up to 2005. The BÄK initially reacted to the invitation, sent out around two months before the event, with a statement from its secretariat, explaining that because of scheduling conflicts neither the president nor any other representative of the association would be able to participate in the conference.90 Repeated queries finally resulted in a telephone conversation with Hoppe.91 When it was pointed out that the absence of a statement from the professional medical association might induce negative comments from the invited representatives of the media, the president decided at short notice to provide a written statement, which was submitted to the organizers a few days beforehand and read aloud at the conference. In this, Hoppe confessed that there had not been “a real confrontation with the failures and crimes perpetrated by doctors […] in the post-war years until well into the 70s”.92 From Vilmar’s administration as president onwards, the “taboo” on the subject had been “broken more strongly than ever before”, especially at the German Medical Assemblies of 1989 in Berlin and 1996 in Cologne and in statements made by the BÄK since then. These acknowledged “that the organized medical profession was not only involved in the National Socialist crimes, but supported them actively. The truth is: During the National Socialist era, doctors brought about, ordered, or mercilessly managed the death and suffering of humans. […] The crimes of ‘euthanasia’ are thus an urgent warning to defend the basic values of medicine against the spirit of the times and intervention by the state. The victims admonish us doctors to never again allow such crimes by doctors. Therefore we must preserve their memory. The past cannot be overcome. What has happened cannot be undone. But it remains our duty to keep the past ‘present’, so that lessons can be drawn from history”.

This declaration by Hoppe was, on the one hand, quite clear in acknowledging doctors’ share of responsibility for the suffering and death of humans entrusted 89 Letter Roelcke to Schmidt-Jortzig, 8 October 2008, PA VR. 90 E-mail Elke Boethin (BÄK) to Roelcke, 26 September 2008, PA VR. 91 E-mail Boethin to Roelcke, 31 October 2008, as well as Roelcke to Boethin, 31 October 2008, PA VR. 92 This and the following quotations from “Statement von Prof. Dr. Jörg-Dietrich Hoppe zur Tagung der Universität Giessen”, Pressestelle der BÄK, November 2008, PA VR (also in the appendix to this volume).

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to them, and it drew from this the conclusion that dealing with this history is important for the medicine of the present. It also admitted “that it was not only cowardice and opportunism that guided some of the doctors, but also conviction: Among medical professionals, National Socialist ideology fell on fertile ground.” However, according to this statement, the central causes for what happened are identified as “National Socialist ideology”, the “spirit of the times” and “state intervention”, that is, essentially factors that can be located outside the medical field. Further, the apparently timeless “basic values of medicine” are resorted to as a counter-balance against such outside factors. With this kind of argument, the declaration by Hoppe in 2008 (similar to that by Vilmar on the occasion of introducing the “inventory” in 2003) is not only quite distant from the historical knowledge available at this time.93 It also makes improper use of history in order to denounce political authorities or “the state” as the most important threat to the moral integrity of doctors, and turns this into an argument for the autonomy of the medical profession. The question as to why, despite the alleged “basic values of medicine”, decades had passed without the victims of medical atrocities being identified, addressed and supported, and why these “basic values” also did not lead to a systematic search for the responsible perpetrators and the mental structures guiding their behavior, not only remained unanswered in Hoppe’s statement – it was not even posed. However, the conference itself, which was attended by, among others, the former editor-in-chief of the Deutsches Ärzteblatt Norbert Jachertz, and the extensive coverage in such media as the Frankfurter Allgemeine Zeitung, Deutschlandfunk national radio and the Bavarian state radio and television Bayerischer Rundfunk, apparently made the necessity for further steps apparent 93 On the evidence for the initiative of physicians for almost all medical atrocities during the Nazi period, see Roelcke, 2012a. The rhetoric of the eternal “basic values of physicians” is part of the standard repertoire of medical functionaries, however, it is in contradiction to historical reality ; on the plurality and historical changes of ethical values in medicine since the late 19th century, see e. g. Andreas-Holger Maehle, Doctors, Honour and the Law: Medical Ethics in Imperial Germany, Basingstoke: Palgrave Macmillan 2009; Florian Bruns, Medizinethik im Nationalsozialismus: Entwicklungen und Protagonisten in Berlin, Stuttgart: Franz Steiner 2009; for the changing ethics of medical research during the 20th century, see e. g. Volker Roelcke, Giovanni Maio (eds.), Twentieth Century Ethics of Human Subjects Research: Historical Perspectives on Values, Practices, and Regulations, Stuttgart: Franz Steiner 2004; Andreas Frewer, Ulf Schmidt (eds.), Standards der Forschung: Historische Entwicklung und ethische Grundlagen klinischer Studien, Frankfurt/M.: Peter Lang 2007; on the changing ethics of physicians regarding euthanasia since the late 19th century, see Gerrit Hohendorf, Der Tod als Erlösung vom Leiden: Geschichte und Ethik der Sterbehilfe seit dem Ende des 19. Jahrhunderts in Deutschland, Göttingen: Wallstein 2013. That even the understanding of core contents of the hippocratic oath changed over time is documented for the Renaissance in Thomas Rütten, “Receptions of the Hippocratic Oath in the Renaissance: The Prohibition of Abortion as a Case Study”, in: Journal of the History of Medicine and Allied Sciences 51, 1996, 456 – 483.

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to the leadership of the BÄK in the following weeks.94 The above-mentioned interview between Jachertz and Hoppe, published four weeks after the conference, indicates that the BÄK, on the one hand, apparently realized its need to catch up on the state of knowledge of historical research, and, on the other hand, acknowledged that it was overdue to approach the victims. However, the need for further historical research – both on the period up to 1945 and on the decades of silence after 1945 – was not addressed in this interview. So how were the ideas announced by Hoppe implemented? The envisaged overview on the state of research was compiled and published as a book by Jütte and three other historians (of medicine) – as announced, before Hoppe’s term ended in spring 2011.95 However, the step toward the vicitims promised by Hoppe, combined with a request for forgiveness, never came and has yet to take place today. In contrast to Hoppe’s announcement and the standards formulated in the introduction of the overview by the Jütte,96 entire topic areas of the total subject are discussed practically not at all: for example, the exploitation or treatment of forced laborers in medical institutions (on which there is only a single page97); medicine in the territories “annexed” by the German Reich, such as Sudetenland and the German-controlled universities in Breslau, Königsberg and Prague; or medical care in the concentration camps. By no means up to date (at the time of publication) was the information on the forced emigration of doctors and health-care personnel. The chapter on medical research reflects primarily the perpetrators’ perspective on the research; the victims’ side and its importance for both the post-war trials and for historiography is limited to two sentences.98 There is no explicit, coherent overall conception for the volume; on the contrary, it contains fundamental inconsistencies: For instance, in the chapter on medical experiments, generalizing this work as “unscientific” or “pseudoscientific” is, correctly, declared to be obsolete, yet precisely this terminology is used to

94 See Ludger Fittkau, “Forderungen an die Ärzteschaft. Was folgt aus der Euthanasiepolitik der Nationalsozialisten? Eine Gießener Tagung zur Erinnerungspolitik“, Frankfurter Allgemeine Zeitung, 24 November 2008; Matthias Hennies, “Euthanasie und die Erinnerungskultur deutscher Ärzte”, Deutschlandfunk, “Studiozeit”, 20 November 2008; “Die dunkle Vergangenheit der Medizin: Versuch einer Aufarbeitung”, Bayerischer Rundfunk, “Wissenschaft und Forschung”, 17 November 2008. 95 Jütte, 2011b; see also Thomas Gerst, “Medizin in der NS-Zeit: Forschung kaum noch zu überblicken”, in: Deutsches Ärzteblatt 108(13), 2011, A-692 – 693. 96 On this in more detail Paul J. Weindling, “[Review of] Medizin und Nationalsozialismus: Bilanz und Perspektiven der Forschung, by Robert Jütte et al.”, in: The English Historical Review 127, 2012, 1593 – 1596; as well as Roelcke, 2012a. 97 Winfried Süß, “Medizin im Krieg“ (2011b), in: Jütte, 2011b, 193 – 194. 98 Wolfgang Eckart, “Verbrecherische Humanexperimente”, in: Jütte, 2011b, 124 – 148, here 133.

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structure the chapter on “Compensation”.99 Overarching issues such as the scope of action historical actors enjoyed in various contexts like individual doctor’s practices, medical faculties, professional societies, and in the “genetic surveys” or concentration camps, remain unaddressed. Some parts – especially the chapters on Jewish hospitals and on the history of reception100 – do little more than list the topics dealt with in individual publications along with the corresponding authors, without discussion what each publication achieved, or drawing any conclusions for broader issues, although this is precisely what Jütte emphasized in the introduction as one of the qualities of this “research overview”.101 The author of the chapter on the history of reception, for instance, does mention the history of persecuted German pediatricians contracted by the German Association for Pediatrics and Adolescent Medicine (the associated study was published in the year 2000102), but the massive gap in this “coming to terms with the past” by pediatricians escaped his attention: Its complete omission of any mention of pediatricians’ involvement in the killing of patients had been documented by Sascha Topp in the context of the 2008 Giessen conference and published in 2009, which, in turn, led to a second, memorial event of the pediatricians in 2010 that received a great deal of attention, and in parallel, resulted in the re-conceptualization of a travelling exhibition with an extensive catalogue.103 Finally, a tendency can be detected to obscure the role of medical functionaries in the Federal Republic who were burdened with a Nazi past, and, at the same time, to paint an incorrectly positive picture of the BÄK’s importance in dealing with the past: In the chapter on the history of reception, for instance, there is no question as to the causes of the decades of ignoring malpractice by the medical profession, and the SS pasts of BÄK presidents Fromm and Sewering, which may have had something to do with this lack of interest, are not mentioned at all. The brief portrayal of the emergence of the documentation about the Nuremberg Medical Trial in the 1990s points out the BÄK’s “support” for Klaus

99 Süß, 2011a, here the paragraph titled “Pseudomedizinische Versuche”, 285 – 287. 100 Robert Jütte: “Jüdische Krankenhäuser, ‘Krankenbehandler’, Ärzte in Ghettos und im KZ” (2011d), in: idem, 2011b, 256 – 266; idem, 2011a. 101 Idem, 2011c, 9 – 10. 102 Idem, 2011a, 317; Eduard Seidler, Verfolgte Kinderärzte, 1933 – 1945, Bonn: Bouvier 2000. 103 See the presentation by Sascha Topp at the Giessen conference 2008, as well as Sascha Topp, “Remembering Nazi Euthanasia in post-war Germany : The case of German Pediatrics”, in: Korot: The Israeli Journal of the History of Medicine and Science 19, 2009, 49 – 64; on the memorial assembly of the pediatricians 2010, see http://www.dgkj.de/ueber_uns/ge schichte/gedenkveranstaltung_2010/ (25 February 2014); on the exhibition: http://www. dgkj.de/ueber_uns/geschichte/kinderaerzte_und_die_medizinverbrechen_an_kindern_ in_der_ns_zeit/ (25 February 2014).

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Dörner’s campaign for donations,104 without mentioning that this campaign only came about because the BÄK had refused to take on the financing of the proposed project on its own past (see above). Just as inadequate is the claim that the BÄK had contracted an “independent team of historians” to investigate the history of the German medical profession,105 as has been shown above. Paul Weindling, historian of medicine from Oxford and one of the leading experts on the material worldwide, arrived at the following, quite critical r¦sum¦ in the summary of his detailed review of the BÄK’s overview publication: “The book serves a useful purpose, but it falls short in terms of historiography, coverage, editorial precision and cohesion.”106 One might conclude that the BÄK had presented this volume primarily as a quick, economical response to the questions that emerged after the 2008 Giessen conference when this response is compared with the much more thoughtful and comprehensive reaction of the German Association for Psychiatry, Psychotherapy and Nervous Disorders (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde, DGPPN): In 2009 this association decided to change its statutes to acknowledge the particular responsibility that resulted from the participation of its predecessor organization in the medical crimes during the National Socialist period. In 2010 it appointed an independent commission of historians of medicine and science to reappraise its history between 1933 and 1945. The commission received financing for carrying out a research project to last several years (with the position of the researcher to be filled by public advertisement), for the organization of two conferences and for several book publications on the history of the psychiatric association in National Socialism.107 From 2010 until 2012, three special issues of the association’s journal Der Nervenarzt were devoted to the topic.108 The DGPPN annual congress in 2011 featured a memorial event attended by several thousand, which included not only speeches by representatives of various groups of victims, but also a speech by the association’s president, who listed the various forms of injustice and wrongdoing in the field of psychiatry during the Third Reich, Jütte, 2011a, 311. Ibid., 316. Weindling, 2012. On the nominations to the commission, see: http://www.dgppn.de/dgppn/geschichte/nationalsozialismus/kommission-zur-aufarbeitung-der-geschichte.html (17 April 2014); none of the members of the commission was at the same time member of the DGPPN, or was funded by this organization. The first book-length publication out of the project is HansWalter Schmuhl, Volker Roelcke (eds.), “Heroische Therapien”: Die deutsche Psychiatrie im internationalen Vergleich, 1918 – 1945, Göttingen: Wallstein 2013; a book-manuscript by Hans-Walter Schmuhl on the psychiatric associations in the Nazi period is completed and is due to be published in 2015. 108 See Der Nervenarzt 81(11), 2010; 83(3), 2012; 84(9), 2013.

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confessed to the substantial share of responsibility borne by psychiatrists, including leading representatives of the professional organization, and apologized to the representatives of the victims.109 The professional association also initiated a comprehensive travelling exhibition on the subject, which was opened in the German Bundestag on International Holocaust Remembrance Day in 2014, with the Federal President of Germany in attendance.110 A substantial degree of the funding for this exhibition was also supplied by the DGPPN; additional sponsors (including the BÄK) were recruited by the association itself. Contrasted with these activities of the psychiatric association, the BÄK’s dissatisfying “literature study” appears quite inadequate.

Conclusion For the quarter-century since the end of the 1980s, the BÄK and its representatives took a more comprehensive stand on the subject of medicine in the National Socialist era apparently only when they were previously nudged toward this step by criticism from the outside. This is true for the Vilmar interview and the statement by Vilmar at the 1987 German Medical Assembly as well as for the series of articles in the Deutsches Ärzteblatt in 1988/1989, the BÄK’s appeals for donations to complete the edition of the protocols of the Nuremberg Doctors’ Trials in the mid-1990s, Vilmar’s declaration on the occasion of the presentation of the discovered patient files of euthanasia victims in 2003, Hoppe’s declaration at the 2008 Giessen conference, and the “research overview” published in book form in 2011. The commemorative volume on the occasion of the 100th German Medical Assembly in 1997 was an exception, a genuine concern of the BÄK containing two chapters dealing with the period of National Socialism. All of the public statements mentioned admitted to an increasingly massive scale of medical wrongdoing, but in spite of this, all of them, including Hoppe’s statement of 2008, explain this malpractice through the formula of pressure or compulsion from outside, by political authorities. Against this is set a supposedly timeless “medical conscience” endowed with integrity – in contrast to the historical knowledge that was already available in the late 1980s and continuously expanded since that time. Similarly, the historical publications financed by the BÄK, up to and including the “literature study” of 2011, offer a selective portrayal, tending toward idealization, of not only the real history of 109 The memorial event is documented in Frank Schneider (ed.), Psychiatrie im Nationalsozialismus: Erinnerung und Verantwortung, Berlin: Julius Springer 2011. 110 http://www.bundestag.de/dokumente/textarchiv/2014/48684060_kw05_holocaust_ausstel lung/index.html (17 April 2014).

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medicine in National Socialism (up to 1945), but also of the stance of the BÄK in the post-war era and its willingness to engage in critical self-reflection. If one asks for the value hierarchy inherent in these statements on the Nazi past of medicine, an irritating finding emerges: The BÄK’s concern about an immaculate reputation in the public, and thus the preservation of professional honor, had priority over the mission codified in the Declaration of Geneva of the WMA (and thus the pre-amble of the regulations of the German medical profession): to make the welfare of the patient the cardinal rule of medical conduct. From this mission must follow the imperative to search for the causes of medical wrongdoing, to sanction those responsible, and to develop mechanisms to prevent future malpractice. Considering this history of delayed, nearly always externally motivated actions to address the period of National Socialism by the BÄK, it is no surprise that the initiative for the “Nuremberg Declaration” in 2012 came, once again, not from the core of the organized medical profession. In fact, a draft of the text for this declaration was composed by a small group of IPPNW members and historians of medicine, who presented it to Frank Montgomery, Hoppe’s successor as BÄK president, a few days before the Medical Assembly in Nuremberg, along with an appeal signed by further historians of medicine and a number of clinicians.111 Montgomery himself and several other delegates brought the motion forward to the Medical Assembly, where the draft declaration’s original wording was passed unanimously and adopted as the official position of the Physicians’ Parliament, and thus became binding for the BÄK as well. As welcome as this decision is – the question remains as to whether the BÄK has truly embraced the content of the declaration, and whether they will make a lasting impact. By the time this chapter was written, two years after the Medical Assembly in May 2012, the BÄK has undertaken no further steps toward illuminating its history or honoring its obligations from the Nuremberg Declaration. It has neither supported historians in gaining access to archives that continue to be locked;112 nor has it initiated further necessary research, for instance on the identity of the victims of medical atrocities; nor has it endeavored to fund such research projects. The final item in the “Nuremberg Declaration” thus remains to be redeemed: “We commit ourselves as the German Medical Assembly to work toward actively promoting further historical research and the reappraisal of the 111 See Reis, 2012. 112 The difficulties for historical research caused by restricted access to archival sources are highlighted in Paul J. Weindling, “Menschenversuche und ‘Euthanasie’: Das Zitieren von Namen, historische Aufarbeitung und Gedenken”, in: Arbeitskreis zur Erforschung der nationalsozialistischen “Euthanasie” und Zwangssterilisation (ed.), Den Opfern ihre Namen geben: NS-“Euthanasie”-Verbrechen, historisch-politische Verantwortung und Erinnerungskultur (= Berichte des Arbeitskreises 7), Bad Irsee: Bildungswerk Irsee 2011, 115 – 132.

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past through the committees of the German Medical Association and through direct financial aid, as well as through institutional support, such as for unlimited access to archives”.113 Similarly, an apology to the victims of medical wrongdoing in the National Socialist era has yet to be proffered.

113 http://www.bundesaerztekammer.de/downloads/115daet2012_nuernbergererklaerung.pdf (3 April 2014).

Dedicated Voices

William E. Seidelman

‘Requiescat sine Pace’:1 Recollections and Reflections on the World Medical Association, the Case of Prof. Dr. Hans Joachim Sewering and the Murder of Babette Fröwis

Professor Dr. med. Hans Joachim Sewering and the murder of Babette Fröwis In October 1992, the World Medical Association (WMA), an international organization responsible for ethical standards in medicine, nominated as President-Elect for 1993 – 1994 Professor Dr. med. Hans Joachim Sewering of Dachau, Germany. An active member of the WMA and official representative of the German Medical Association, or Bundesärztekammer (BÄK), for over three decades, Sewering was due to assume the presidential office at the 1993 WMA General Assembly in Istanbul. Unbeknownst to many but not all in the WMA Sewering was a one-time member of the Nazi Party and the notorious SS terror organization. He was also linked to the killing in October 1943, of a 14 year old handicapped institutionalized adolescent by the name of Babette Fröwis who died as a result of intentional starvation and a purposeful overdose of barbiturates at the notorious child “euthanasia” killing center of Eglfing-Haar.2 Sewering’s impending WMA appointment caused alarm in circles within and outside Germany resulting in a concerted campaign to have him step aside from the presidency of the world organization. The first to express their unease were Professor Michael M. Kochen of the University of Göttingen and Professor Michael Weingarten of the University of Tel Aviv.3 This is an account of events that took place following professors Kochen’s and Weingarten’s communication of November 1992 concerning Sewering and the WMA and the implications of this affair for medicine worldwide. Sewering’s notorious background was well known in Germany. As far back as 1 “Let him rest without peace”. 2 Michael H. Kater, Doctors under Hitler, Chapel Hill/London: The University of North Carolina Press 1989, 3. 3 Private Archive of William E. Seidelman (hereafter PA Seidelman), copy of letter from Michael Weingarten, University of Tel Aviv, to Michael M. Kochen, University of Göttingen, 10 November 1992; PA Seidelman, copy of letter from Kochen to Weingarten, 23 November 1992.

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Cover of Der Spiegel, 22 May 1978

May of 1978, the journal Der Spiegel published a major article, based on the investigations of the physician-journalist Dr. Hans Halter, documenting Sewering’s involvement with the killing of Babette Fröwis.4 The Spiegel issue containing the article was highlighted on the cover that reads Ärzteführer Sewering und die Euthanasie (“Doctors’ leader Sewering and Euthanasia”).5 Documentation on Sewering’s history had also been published in English-language journals. Sewering’s membership in the Nazi Party and the SS was reported in a 1989 paper in The Lancet.6 Two years earlier the historian Michael Kater had published a lengthy paper which included details of Sewering’s iniquitous past as well as the SS links of another president of the BÄK leader who had actually ascended to the presidency of the WMA, Professor Ernst Fromm of Hamburg.7 In his 1989 book, Doctors under Hitler, Kater not only described Sewering’s 4 “Sewering: Saubere Weste”, in: Der Spiegel 21, 1978, 84 – 88. 5 http://www.spiegel.de/spiegel/print/d-40616562.html (12 April 2014). 6 Winfried Beck, “The World Medical Association and South Africa”, in: The Lancet 333, 1989, 1441 – 1442. 7 Michael H. Kater, “The Burden of the Past: Problems of a Modern Historiography of Physicians and Medicine in Nazi Germany”, in: German Studies Review 10(1), 1987, 31 – 56; “The 26th World Medical Assembly”, in: World Medical Journal 19(6), November-December 1972, 108 – 109; Ernst Fromm, “Greetings from the President Elect”, in: World Medical Journal 20 (3), May-June 1973, 41; “The 27th World Medical Assembly : Munich, October 14 – 20, 1973”, in: World Medical Journal 21(1), January-February 1974, 4 – 6.

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nefarious past but also Sewering’s “grandiose career in postwar medical politics”.8 The most authoritative chronicles of the 1992 – 1993 Sewering/WMA affair are a 1997 paper by Kater9 and a more recent account in 2009 by the German scholar Gerrit Hohendorf.10

The World Medical Association The killing of Babette Fröwis and the affair of Professor Sewering and the WMA represents a seminal event in the chronicles of the modern history of medicine and the values that organized medicine purports to espouse. The involvement of the WMA and its putative role as an organization with a mission “to serve humanity by endeavoring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world”11 raises important questions about the moral engagement and ethical sensitivity of organized medicine. Formally established on September 18, 1947 in Paris, France, the principal focus of the WMA was the promotion of closer ties among the national medical organizations and doctors of the world and the study of problems confronting the medical profession in different countries.12 Four weeks earlier, on August 20, 1947 in Nuremberg, Germany, there occurred another event that would directly and indirectly influence the WMA until today namely the judgment of what came to be known as the Nuremberg Medical Trial (NMT). The medical atrocities revealed by the NMT and the judgment of that trial would have a profound and enduring influence on medicine and medical ethics and the WMA.13 The trial judgment contained a set of rules, known as the Nuremberg Code on Human Experimentation, and thereby established the principles for medical research on human subjects.14 One year after the foundational meeting in Paris, the WMA 8 Kater, 1989, 3. 9 Idem, “The Sewering Scandal of 1993 and the German Medical Establishment”, in: Manfred Berg, Geoffrey Cocks (eds.), Medicine and Modernity : Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany, Cambridge: Cambridge University Press 1997, 213 – 234. 10 Gerrit Hohendorf, “The Sewering Affair”, in: Korot: The Israeli Journal of the History of Medicine and Science 19, 2007 – 2008, published 2009, 83 – 104. 11 http://www.wma.net/en/60about/index.html (12 April 2014). 12 Anonymous, “World Medical Association”, in: British Medical Journal 2, 27 September 1947, 498 – 500. 13 George J. Annas, Michael A. Grodin (eds.), The Nazi Doctors and The Nuremburg Code: Human Rights in Human Experimentation, New York: Oxford University Press 1992. 14 Sharon Perley et al., “The Nuremburg Code: An International Overview”, in: Annas, Grodin (eds.), 1992, 149 – 173; Susan E. Lederer, “Research without Borders: The Origin of the Declaration of Helsinki”, in: Volker Roelcke, Giovanni Maio (eds.), Twentieth-Century Ethics

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General Assembly meeting in Geneva, Switzerland, in September, 1948 adopted a position entitled “The German Betrayal and a Restatement of the Ethics of Medicine”.15 The accompanying statement detailed some of the crimes documented by the NMT. The WMA received a “Resolution from the Medical Chambers of Western Germany Concerning the Nuremberg Trials” disclaiming responsibility by mainstream and organized medicine in Germany of involvement in the atrocities of the Nazi regime.16 The West German medical profession was initially denied membership in the WMA until it demonstrated accountability for and an appropriate response as promised in the Resolution from the West German medical chambers regarding the role of the physicians of Germany in the wake of the revelations of the NMT.17 The secretary general of the medical profession of West Germany in the immediate postwar period was Dr. Karl Haedenkamp whose membership in the Nazi Party was the result of the personal intervention of Deputy Führer, Rudolf Hess. One of Haedenkamp’s responsibilities under the Hitler regime was to facilitate the “expulsion of Jewish and Marxist physicians from panel practice”.18 In 1951 the West German medical profession was accepted as a member of the WMA.19 Haedenkamp remained secretary general of the physicians’ organization in West Germany until 1955.20

Professor Sewering and the WMA Hans Joachim Sewering played a vital role over 33 years of involvement in the crisis-ridden history of the WMA. His participation began in 1959 as the West German delegate to the WMA. Seven years later Sewering joined the WMA Executive Committee and in 1971 succeeded his fellow SS alumnus, the then BÄK President Professor Ernst Fromm of Hamburg, as WMA Treasurer.21 In the 1970s Sewering personally guaranteed a loan to the WMA during a financial crisis brought about by the withdrawal of the American Medical Association (AMA) because of concern over issues of voting powers and financial administration.22 The WMA also faced a moral crisis and loss of membership on

15 16 17 18 19 20 21 22

of Human Subjects Research: Historical Perspectives on Values, Practices, and Regulations, Stuttgart: Franz Steiner 2004, 199 – 217. World Medical Association Bulletin 1, 1949, 1 – 20. Ibid., 9. Ibid., 10. Kater, 1987, 36. http://www.bundesaerztekammer.de/page.asp?his=4.3572 (6 August 2014). http://de.wikipedia.org/wiki/Karl_Haedenkamp (6 August 2014). Kater, 1987. Howard Wolinsky, “WMA’s Ex-President-Elect”, in: Physician’s Weekly 10, 1993, 22.

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account of its relations with South Africa and representation from Transkei, a black “homeland” within South Africa that had been established as part of the apartheid policies of the then government of South Africa. The role of the Medical Association of South Africa (MASA) within the WMA was also problematic given MASA’s response to the death in police custody of the black activist Steve Biko.23 Again Sewering is believed to have played a critical role in the restoration of MASA’s membership in the WMA during the apartheid r¦gime.24 One year after passing the baton of WMA Treasurer to Sewering, Fromm assumed the office of President of the WMA (1972 – 1973). In 1973, Sewering succeeded Fromm as BÄK President. In 1978, Sewering was forced to step aside from the presidency of the German doctors’ chamber because of alleged billing improprieties.25 The financial scandal in Germany did not adversely affect Sewering’s continuance as WMA Treasurer.

Response to Sewering’s impending appointment as president of the WMA In 1992, Kater’s authoritative 1989 account Doctors under Hitler was only available in an English-language edition and not readily obtainable in Germany. With the emerging uproar over Sewering’s impending WMA presidential appointment, photocopies of Kater’s published papers and other relevant material were dispatched to professors Kochen in Germany and Weingarten in Israel. Weingarten was in contact with various members of the Israel Medical Association (IMA) which is a member organization of the WMA. Dr. Ram Yishai, a former president of the IMA, had previously served as WMA president. Kater personally sent copies of his book Doctors under Hitler to Germany and Israel. In addition to documentation, Professor Kochen was provided with the names of potential contacts in Germany who were authorities on the history of medicine during the National Socialist (NS) period. In December 1992, Professor Michael Grodin of Boston University was informed of the developing controversy. Grodin, who together with Prof. George Annas edited a major book on the Nuremberg Code and medicine in the ‘Third Reich’,26 was very much aware not only of the history of medicine in Nazi 23 Tessa Richards, “The World Medical Association: can hope triumph over experience?”, in: British Medical Journal 308, 1994, 262 – 266. 24 Beck, 1989; idem, “The World Medical Association Serves Apartheid”, in: International Journal of Health Services 20, 1990, 185 – 191. 25 Kater, 1989. 26 Annas, Grodin (eds.), 1992.

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Germany but also of the WMA and its role vis-—-vis medical ethics and national medical organizations. Grodin provided important direction and effort in making contact with the AMA, principally the Executive Vice-President Dr. James Todd. Todd was very concerned about the potential impact of adverse publicity on the WMA. In a letter to Grodin dated January 5, 1993, Todd wrote “I would hope public dissemination of this material could be postponed until the WMA has had an opportunity to respond as to their intentions. The future and credibility of the WMA could be seriously damaged if not given adequate notice of this problem.”27 Professor Grodin also contacted Dr. Michael Franzblau of San Francisco. Franzblau is a dermatologist with an interest in the subject of medicine and the Holocaust. Franzblau was also a member of the House of Delegates of the AMA and was active in the Anti-Defamation League (ADL) of the Jewish organization B’Nai Brith. Franzblau maintained active political connections with members of the United States Congress. On January 9, 1993, Dr. Hartmut Hanauske-Abel was informed of the Sewering/WMA matter. Hanauske-Abel is a German physician who had been an outspoken critic of the BÄK. His public criticism of German physicians’ role in the Holocaust in 1986 at a major conference of the International Physicians for the Prevention of Nuclear War (IPPNW) in Cologne, Germany, which was subsequently published in The Lancet, resulted in public reprobation by the BÄK. The dispute with the BÄK included an unsuccessful lawsuit by HanauskeAbel who had temporarily relocated to the United States for a fellowship. The denial of his membership in the Landesärztekammer (the regional Medical Association under the roof of the BÄK) precluded Hanauske-Abel’s return to medical practice in Germany and he remained in the United States.28 In a phone conversation on January 9, 1993, Hanauske-Abel cautioned against any effort that would be perceived by the BÄK as being led by foreigners, Jews or the political left. He recommended the engagement of the medical establishment within Germany who could challenge the leadership of the BÄK in order to bring about Sewering’s withdrawal. Hanauske-Abel stated that he would be in contact with Michael Roelen, the press officer of the German chapter of the IPPNW.29 Roelen’s wife, Dr. Barbara Hovener, was one of the founders of the German 27 PA Seidelman, copy of letter from James S. Todd to Michael A. Grodin, 5 January 1993 (original states 1992). Copy provided by Grodin. 28 Hartmut M. Hanauske-Abel, “From Nazi Holocaust to Nuclear Holocaust: A Lesson to Learn?”, in: The Lancet 328, 1986, 271 – 273; idem, “Not a Slippery Slope or Sudden Subversion: German Medicine and National Socialism in 1933”, in: British Medical Journal 313, 1996, 1453 – 1463; Kater, 1997. 29 PA Seidelman, notes of phone conversation with Hartmut M. Hanauske-Abel, 18 January 1993.

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chapter of the IPPNW. It was thought that Roelen would be able to mobilize respected leaders in the German medical community to make a public statement to be published in a leading German newspaper such as Die Zeit.30 On the afternoon of January 12, 1993, a phone conversation took place with Dr. James Todd of the AMA who was in Washington, DC, for the inauguration of President Bill Clinton. In that conversation Todd stated that he had spoken the previous Saturday with Dr. Christoph Fuchs of the BÄK at which time Todd had told Fuchs that “Sewering was damaged goods and should withdraw”. Todd also said that Fuchs or someone at the BÄK had spoken with Sewering and suggested that he step down. “Sewering is not inclined to step aside.” During the January 12 phone conversation Todd stated that before the WMA vote on Sewering’s appointment he, Todd, had asked Sewering directly if there was anything in his past which might be a problem. According to Todd, Sewering denied that there were any problems related to his past. Todd also indicated that the AMA had conducted its own “internal investigation”. However, in Todd’s words, “we [the AMA] may have been duped”.31 Todd provided copies of letters that he and Patricia Hutar, the Director of the AMA Office of International Medicine, had sent to Dr. Andr¦ Wynen, the then Secretary General of the WMA. In Todd’s January 7 letter to Wynen, he formally requested on behalf of the AMA that the WMA conduct a fact finding regarding the allegations made against Professor Sewering and that the process should start immediately.32 On January 8, Hutar wrote to Wynen: “Based on the information available and to the extent the AMA was able to corroborate it, the AMA Executive Committee voted to request that Professor Sewering resign as President-elect of the World Medical Association. Dr. James S. Todd, Executive Vice President of the AMA, called Dr. Christoph Fuchs, Secretary General, German Medical Association on Thursday, January 7 and formally requested that Dr. Fuchs and Dr. Karsten Vilmar, President, German Medical Association ask Professor Sewering to resign as President-elect, WMA. Further, Dr. Todd informed Dr. Fuchs that if Professor Sewering refused to resign, the AMA would write to the World Medical Association and initiate actions to remove Professor Sewering as President-elect, WMA. Dr. Fuchs said that Dr. Vilmar and he would talk to Professor Sewering today, Friday January 8. He will contact Dr. Todd to let him know the outcome of their discussions with Professor Sewering.”33

30 PA Seidelman, copy of letter (original of fax) from Seidelman to Kochen, 11 January 1993. 31 PA Seidelman, notes of phone conversation with Todd, 12 January 1993, at 16:45 hrs (EST). 32 PA Seidelman, copy of letter from Todd to Andre Wynen (WMA), 7 January 1993. Copy of letter provided by Grodin at the request of Todd. 33 PA Seidelman, copy of letter from Patricia Hutar (AMA) to Wynen, 8 January 1993. Copy of letter provided by Grodin at the request of Todd.

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Dr. Franzblau, the San Francisco dermatologist, became very actively involved at this time. In addition to pursuing efforts against Sewering through the AMA and the ADL, Franzblau was part of an ADL delegation that visited Germany. Franzblau took advantage of the occasion to meet with the European correspondent for the New York Times, Craig Whitney, who prepared a report that was published in the New York Times on Saturday, January 16, 1993. The New York Times article, which included quotes from Prof. Kochen, triggered further coverage by the international press.34 By January 18, 1993, approximately 100 German physicians from thirteen cities had agreed to a public letter of protest to be published in three newspapers in Germany. A one page statement of protest by these German physicians entitled “Deutsche Ärzte protestieren” was published on January 22 in Die Zeit, Frankfurter Rundschau and Die Tageszeitung.35 An English language version had also been prepared for circulation. Following press reports in Germany about Sewering in which Kochen’s name was mentioned Kochen began receiving anti-Semitic and anonymous threatening phone calls.36 Kochen also reported that a Dachau newspaper published an interview with Sewering in which Sewering stated, “Kochen is a Jewish doctor who doesn’t like me”. According to Kochen a large German newspaper published in Frankfurt/Main had reported that the United States had barred Sewering from entering that country by placing Sewering on a “watch list”.37 A January 22 press release from the Reuters news agency stated that the World Jewish Congress (WJC) had asked its members in 72 countries to contact their national medical association to ask them “to withdraw support for the Bavarian doctor”. The Reuters report stated that the WJC would be holding a meeting the following week “to decide if it should call on the national medical associations to quit the WMA if Sewering’s election is not rescinded”.38 The BÄK sought clarification from the WJC of the decisive Reuters press release, nine months after the fact. According to the correspondence between Dr. Kloiber of the BÄK and Elan Steinberg, the Executive Director of the WJC dated October 13 and 14, 1993, the interpretation by Sewering and the BÄK of the press release from Reuters was incorrect and the WJC did not call for a withdrawal from the WMA but only for the withdrawal of support for Sewering as President34 Craig R. Whitney, “Top German doctor admits SS past”, in: The New York Times, 16 January 1993. 35 PA Seidelman, letter (fax) from Michael Roelen, 19 January 1993; “Deutsche Ärzte protestieren”, in: Die Zeit 4, 22 Januar 1993, 22. 36 PA Seidelman, letter (fax) from Seidelman to Roelen, 19 January 1993. 37 PA Seidelman, notes of phone conversation with Kochen, 21 January 1993. 38 Reuters News Service, New York, 22 January 1993: “Jewish Group Says It Is Considering Boycott of World Medical [Association]”.

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Elect.39 In addition, in a letter from Neal Sher of the Office of Special Investigation (OSI) of the United States Department of Justice to Evelyn Sommer of the WJC, Mr. Sher stated that the OSI had not, in fact, barred Sewering from entering the country but indicated that it was “reviewing the allegations”.40 Thus, two reports that received international attention appear to have been incorrect and in the case of the report concerning the WJC clarification was not sought until nine months after the event. The Reuters press release was to have significant consequences following its publication on January 22nd. What were never in dispute were the repercussions of an interview with Sewering that was reported in the Dachau edition of the newspaper, Süddeutsche Zeitung on the 22nd of January 1993. In that interview, Sewering implied that the sisters of Schönbrunn did not know the fate awaiting patients transferred to Eglfing-Haar and that they – and by implication he – had acted in good faith. The day following Sewering’s published interview, officials of the Schönbrunn institution, with the authorization of the Archbishop of Munich, issued a statement disclaiming Sewering’s assertion. According to the Schönbrunn statement: – Between January 1943 and June 1945, 444 patients were starved to death in “hunger houses” at Eglfing-Haar ; – Between 1940 and 1944 there was a planned transfer of patients out of Schönbrunn and the sisters knew that the children were to be destroyed as “unworthy life” as part of the “euthanasia” killings; – Between 1940 and 1944, 909 children from Schönbrunn were “transferred out”; – In 1943, 203 children from Schönbrunn were sent to Eglfing-Haar, 179 of them three days before Christmas; – The sisters would not have authorized or approved the transfer of these children to a place where they would be killed; – The sisters did whatever was in their means to protect the victims from planned destruction but were powerless to prevent the forceful removal of people; – Five decades after the event the four surviving sisters continue to be tormented by their memories of what happened.41 39 PA Seidelman, copy of letter (fax) from Otmar Kloiber (BÄK) to Elan Steinberg, (Executive Director of the WJC), 13 October 1993, source: Michael J. Franzblau; PA Seidelman, copy of letter (fax) from Steinberg to Kloiber, 14 October 1993, source: Franzblau; PA Seidelman, copy of letter from Kloiber to Steinberg, 18 October 1993, source: Franzblau. 40 PA Seidelman, copy of letter from Neal Sher (U.S. Department of Justice) to Evelyn Sommer (WJC), 19 January 1993, source: Franzblau. 41 Pressestelle des Ordinariates München: Stellungnahme der Leitung der Behinderteneinrichtung Schönbrunn zu Äußerungen von Professor Sewering in einem Interview mit den Lokalnachrichten der Süddeutschen Zeitung für den Landkreis Dachau, Schönbrunn (Dachau), 22 January 1993.

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Professor Sewering’s resignation from the WMA and the sequelae Following the dramatic declarations of the nuns Sewering stepped down as President-elect on the WMA. On January 23, 1993, the BÄK issued a press release announcing that Dr. Sewering was stepping aside from the WMA office. According to this statement Sewering said: “After I spent 25 years building up this world organization of doctors, including 20 years as its treasurer, it is now my duty to protect the World Medical Association from severe damage that could result from the threats of the Jewish World Congress.” In the same press release the president of the BÄK, Dr. Karsten Vilmar, issued a statement of support for Dr. Sewering.42 Forty-eight years after the end of the war and the revelations of the Holocaust, the president and a former president of the Federal Chamber of Physicians of Germany issued an old racist shibboleth suggesting that the problem was the result of an international Jewish conspiracy. No mention was made of the allegations against Sewering or the murdered children of Schönbrunn and EglfingHaar. On January 25, Professor Kater issued a denunciation of the statement of the BÄK. According to Kater “this statement suggested, in a most odious manner, the existence of an international Jewish conspiracy of the kind the National Socialists have often mendaciously posited to obtain their criminal goals”. Further, Kater stated: “If the Göttingen medical scholar, as a Jew, reacted sensitively to the appointment of a former SS man this is, in my opinion, fully understandable. What is not comprehensible is that no non-Jewish physician in Germany stepped forward to make this first move.”43 One week later the official journal of the BÄK, Deutsches Ärzteblatt, published an article on the affair.44 According to an official English-language translation provided by the BÄK the article asserted that Sewering’s election to the WMA presidency would have marked “the culmination of Sewering’s career as a top representative of the German medical profession”. The article follows with a restatement of Sewering’s assertion of an international Jewish conspiracy against the WMA. The official English translation reads: 42 Pressestelle der Deutschen Ärzteschaft, Cologne, 23 January 1993. 43 Michael H. Kater, letter entitled Concerning Dr. Hans Joachim Sewering, 25 January 1993, addressed to: The WMA, The AMA, The BÄK, The Canadian Medical Association, The Canadian Jewish Congress, The Canadian Broadcasting Corporation (“As It Happens”), ARD Television of the German Federal Republic. 44 The following quotations are to be found in Norbert Jachertz, „Sewering – Ende einer Karriere: Weshalb der designierte Präsident des Weltärztebundes sein Amt nicht antritt und was 1943 in Schönbrunn passierte”, in: Deutsches Ärzteblatt 90(5), 5 February 1993, A-239 – 240 (official English translation provided by the BÄK, 4 February 1993).

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“It was not only the threat of the Jewish World Congress that led to the resignation. It was preceded by the apodictic demand of the American Medical Association that the German Medical Association persuade Sewering to withdraw.”

The article continues with an emphasis on the international action of individual physicians and physicians groups, specifically Kochen, Seidelmann [sic], three unnamed Israeli physicians and the bioethicist professor Arthur Caplan. No mention is made of any non-Jewish participants such as Professor Kater, the German chapter of the IPPNW or the German physicians who organized and signed their names to the doctors’ protest published in the three German newspapers. Further, the article questioned the statement from Schönbrunn and suggested there were “some factual inconsistencies and questions regarding occurrences in Schönbrunn that required further examination and clarification”. The article concluded: “However, the World Medical Association and the American Medical Association were not concerned with these difficult considerations. Sewering would have been a burden simply because of the stir caused by the NS-membership. His incontestable merits and contributions to this organization did not count here. The American Medical Association quickly realized this and was the first to drop Sewering like the proverbial hot potato.”

In April 1993, the Council of the WMA met in Turkey at the Istanbul Hilton. Dr. Vilmar issued a statement in which he asserted that the demands for Sewering’s resignation were based largely on conjecture. He emphasized the fact that a 1946 investigation by the 1st Court Division of Dachau had exonerated Sewering and that the German Medical Association “was faced with the dilemma to be expected – with disregard for these constitutional principles – to pass a judgment for which it was neither authorized nor prepared on the one hand, and of protecting the World Medical Association from harm”.45 At the Istanbul meeting, the WMA Council was addressed by a close friend of Sewering, the WMA executive treasurer, Adolf Hällmayr. Concerning the death of Babette Fröwis, Hällmayr stated: “With regard to the papers (Sewering) signed transferring a 14-year-old epileptic girl to a Nazi euthanasia clinic near Dachau, the policy was that when disabled people became aggressive, they became dangerous and were no longer allowed to live in the convent.”46 45 Karsten Vilmar, “Statement by the President of the German Medical Association on the occasion of the 135th Council Session of the WMA on the waiver by Prof. Dr. Dr. h.c. Hans Joachim Sewering of the office of ‘President-Elect’ of the WMA”, in: World Medical Journal 39(2), 29 March 1993, 22 – 23. 46 “Professor Sewering’s resignation from WMA president-Elect”, in: World Medical Journal 39 (2), 29 March 1993, 22 – 23.

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Sixty years after Hitler’s rise to power, fifty-five years after the start of the euthanasia programs, and fifty years after the murder of Babette Fröwis, the death of an innocent handicapped girl in the Nazi terror state was justified with the assertion that disabled people who are aggressive are dangerous! That shameful comment is part of the official record of the world body that avows to be responsible for professional standards in medical ethics! From 1992, Sewering was succeeded as WMA Treasurer by his protector and advocate, Dr. Karsten Vilmar. In 1999 Vilmar retired as President of the BÄK and as WMA treasurer. His successor as president of the BÄKwas Professor Dr. med. Jörg-Dietrich Hoppe who also assumed Vilmar’s position as Treasurer of the WMA. As of March, 2008, Dr. Vilmar is listed as “Honorary Treasurer” of the WMA along with 12 other designated “officers” including Dr. Jörg-Dietrich Hoppe as “Treasurer”.47 In addition to controlling the position of WMA Treasurer, the BÄK has been responsible for the publications of the WMA; the official publisher being Deutscher Ärzte-Verlag GmbH, while the BÄK bank, Deutsche Apotheker- und Ärztebank, has been the official depository for the WMA.48 Since 2005, the position of Secretary-General of the WMA has been held by Dr. Otmar Kloiber the former Deputy Secretary-General of the BÄK.49 For the member organizations of the WMA Sewering’s departure was apparently the end of the story. It was back to regular business as far as they appear to have been concerned. For the Federal Chamber there was no remorse, no guilt, and no shame. Some months later the BÄK journal published a special announcement in honor of Professor Sewering’s 80th birthday.50 Not surprisingly, the announcement made no mention of his Nazi past nor of his involvement in the killing of Babette Fröwis nor his having to step aside from the WMA. The well respected German newspaper Süddeutsche Zeitung (published in Munich) played an important role in Sewering’s downfall with the publication of the January, 1993 interview with Sewering.51 In 1994, this progressive newspaper organized a health forum on prevention which was held in Nuremberg. Sewering was invited to participate, something which upset some of the participants. Kochen expressed his dismay at the Sewering invitation in a letter to the

47 “World Medical Associations Officers”, in: World Medical Journal 54(1), March 2008: http:// www.wma.net/en/30publications/20journal/pdf/wmj17.pdf (6 August 2014). 48 Beck, 1990. 49 http://www.wma.net/en/60about/60secretariat/index.html (12 April 2014). 50 EB, “Geburtstage”, in: Deutsches Ärzteblatt 93(4), 26 January 1996, A-205. 51 See note 41.

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newspaper.52 The Chair of the Health Forum rebuffed Kochen’s concerns claiming that Sewering “could pretty much clear the blames [sic] cited by you to clear himself of the accusations against him”.53 Sewering was considered to be an expert on the subject of prevention. In 2008, Sewering was awarded the Günther Budelmann medal by the Berufsverband Deutscher Internisten (German Federation of Internal Medicine) for “unequalled services in the cause of freedom of the practice, and the independence of the medical profession and to the nation’s health system”.54

Implications Babette Fröwis is representative of tens of thousands of helpless patients, children and adults, who were murdered by the state in a program designed and implemented by leading academics and scientists and clinicians. Babette’s cruel demise is symbolic of that of countless innocent victims whose deaths were the result of the willing participation, indeed leadership, of members of the German medical profession. It was a program that saw unspeakable cruelties perpetrated in the name of science and healing, cruelties which have been clearly documented by scholars in Germany and Austria.55 While this narrative has focused on Germany and the medical crimes of the Hitler period it needs to be stressed that what happened in Germany did not occur in isolation of events outside that country. The science of eugenics that led to scientific racism originated in England. Eugenic sterilization was introduced in other countries like the United States and Canada. Indeed, the Canadian province of Alberta had a sterilization law on its books until 1972.56 The decades since the NMT have seen astonishing advances in medicine that have created new challenges to the basic ethos of medicine and health care. Those developments include stem cell research, transplantation, joint replacement, re52 PA Seidelman, copy of letter from Kochen to Dieter Schröder (Chief Editor Süddeutsche Zeitung), 9 December 1993, source: Kochen. 53 PA Seidelman, copy of letter from Klaus Wagner (Chair of the Health Forum of the Süddeutsche Zeitung) to Kochen, 22 December 1993, source: Kochen. 54 Allan Hall, “Germans give former SS Doctor accused of killing 900 children a medal”, Mail Online, 26 May 2008: http://www.dailymail.co.uk/news/article-1021807/Germans-SS-doctor-accused-killing-900-children-medal.html?ITO=1490 (12 April 2014). 55 Volker Roelcke, “Medicine during the Nazi period: Historical facts and some implications for teaching medical ethics and professionalism”, in: Sheldon Rubenfeld (ed.), Medicine after the Holocaust: From the Master Race to the Human Genome and Beyond, New York: Palgrave McMillan 2010, 17 – 28. 56 Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity, Berkeley/ Los Angeles: University of California Press 1985; Angus McLaren, Our Own Master Race: Eugenics in Canada, 1885 – 1945, Toronto: McLellan & Stuart 1990.

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productive technology and neonatal care. These advances have resulted in significant improvements in the survival of newborn children, a reduction in disability and the extension of overall life expectancy. They have also created challenges in terms of the allocation of increasingly costly medical resources and the care of people at the end of their lives. Regrettably the years since the end of the Second World War have not brought peace nor seen the end of racism and discrimination.57 We continue to witness coercion by the state. Today the world is experiencing continuing racial/tribal conflict in the Sudan, central Africa and the Middle East. The challenges continue. That is why it is important to know what happened to the most advanced health care system and most sophisticated medical scientific community in the world because it could happen anywhere. It is an important reminder of our fallibility as clinicians, scientists, academics, teachers, administrators and politicians. We are all as fallible and as vulnerable as the doctors and scientists and professors of the previous century.

The death of Hans Joachim Sewering In conjunction with the 2008 conference on the theme “Memories and Representations of Nazi Euthanasia” at the University of Giessen the President of the BÄK, Prof. Jörg-Dietrich Hoppe, issued a strong statement acknowledging the involvement of the German medical profession in the crimes of the ‘Third Reich’ and the necessity of “keeping the past alive in the present so that lessons can be drawn from it”.58 Nineteen months later, on June 18, 2010, Professor Hans Joachim Sewering died in his 94th year. The official obituary published in Deutsches Ärzteblatt authored by Professor Hoppe and Professor Vilmar referred to Sewering as a leader in medical ethics in Germany.59 Professor Hoppe’s statement of November, 2008 notwithstanding, Hoppe and Vilmar’s obituary made no mention of Sewering’s career before 1947 nor his lengthy involvement with the WMA. Apparently Prof. Hoppe’s and the BÄK’s declaration of the necessity of “keeping 57 William E. Seidelman, “Nuremberg Lamentation: For the Forgotten Victims of Medical Science”, in: British Medical Journal 313, 1996, 1463 – 1467. 58 Statement from Jörg-Dietrich Hoppe, BÄK, on the occasion of the Giessen University conference “Memories and Representations of Nazi ‘euthanasia’ in Post-World War II Medicine and Bioethics”, 11 November 2008. 59 Jörg-Dietrich Hoppe, Karsten Vilmar, “Hans Joachim Sewering †: Gestalter im Dienst der Ärzteschaft”, in: Deutsches Ärzteblatt 107(28 – 29), 2010, A-1409: http://www.aerzteblatt.de/ archiv/77604/Hans-Joachim-Sewering-Gestalter-im-Dienst-der-Aerzteschaft (12 April 2014).

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the past alive in the present so that lessons can be drawn from it” did not apply in the case of Sewering. In response to the official revisionist obituary of Sewering a letter of protest signed by 81, principally German, physicians and academics was submitted to the Deutsches Ärzteblatt. The letter delineated critical details of Sewering’s dark but relevant past that had been selectively omitted from the official tribute. After some resistance, the journal reluctantly accepted the letter which was published on August 9, 201060 followed by a comment from the journal editor in defense of Vilmar, Hoppe and the BÄK.61 Seventeen months after the death of Sewering, on November 7, 2011, Prof. Hoppe passed away in his 71st year. Hoppe was succeeded by Dr. Frank-Ulrich Montgomery of Hamburg. Montgomery continues the tradition of the BÄK President holding the position of Treasurer of the WMA. Dr. Vilmar’s listing in the World Medical Journal (WMJ) as “Honorary Treasurer” continued until February, 2011.62 As of April, 2011, Dr. Montgomery is listed as the WMA treasurer and Vilmar’s name is absent from the list of WMA officers, chairpersons and officials.63

The 2012 Nuremberg Declaration of the BÄK Two years after Montgomery’s appointment the General Medical Assembly (Deutscher Ärztetag, the annual meeting of the delegates to the BÄK, and its de facto-parliament), on the occasion of its 2012 meeting, issued an historic declaration of responsibility for the medical crimes of the ‘Third Reich’. The May, 2012 Declaration of Nuremberg states in part: “In contrast to still widely accepted views, the initiative for the most serious human rights violations did not originate from the political authorities at the time, but rather from physicians themselves: The crimes committed by Nazi medicine were not those of 60 Gerrit Hohendorf, Heiner Fangerau, Bettina Wahrig, “Kein Hinweis auf die Rolle im Nationalsozialismus” (letter to the editor), in: Deutsches Ärzteblatt 107(28 – 29), 2010, A-1520: http://www.aerzteblatt.de/archiv/77851/Nachruf-Kein-Hinweis-auf-die-Rolle-im-Nationalsozialismus (12 April 2014). 61 Heinz Stüwe, “Nachruf: In eigener Sache”, in: Deutsches Ärzteblatt 107(31 – 32), 2010, A1520 – 1521: http://www.aerzteblatt.de/archiv/77836/Nachruf-In-eigener-Sache (12 April 2014). 62 “World Medical Association Officers, Chairpersons and Officials”, in: World Medical Journal 57(1), February 2011, ii: http://www.wma.net/en/30publications/20journal/pdf/wmj31.pdf (6 August 2014). 63 “World Medical Association Officers, Chairpersons and Officials”, in: World Medical Journal 57(2), April 2011, ii: http://www.wma.net/en/30publications/20journal/pdf/wmj32.pdf (6 August 2014).

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a few isolated and fanatical doctors, but rather took place with the substantial involvement of leading representatives of the medical association and medical specialists as institutional bodies, as well as with the considerable participation of eminent representatives of university medicine and renowned biomedical research facilities. […] Many of the doctors involved also held distinguished medical positions in the post-war period. Similarly, even after 1945, stigmatizing and debasing concepts and procedures with respect to ill and disabled people continued to be applied to an alarming extent. For decades, there was no systematic reflection given to the preconditions for such practices and ways of thinking. The documentation from the Nuremberg Doctors’ Trial as well as the 1947 ‘Nuremberg Code’ was simply forgotten. In the post-war decades, the issue of medicine under National Socialism tended to be regarded as a threat to the reputation of the medical profession.”64

With the Declaration of Nuremberg, the BÄK’s decades long pattern of mendacity and hypocrisy came to an end. Almost seven decades after the revelations of the NMT, the truth was finally acknowledged.

Whither the WMA? In preparing an earlier version of this paper for publication I engaged in communication with Dr. Kloiber of the WMA in order to clarify whether the WMA had issued an official statement of apology with respect to the published assertion by Mr. Hällmayr implying that the murdered handicapped institutionalized Babette Fröwis had been “aggressive” and “dangerous”. Dr. Kloiber was provided with a copy of the original earlier draft of the manuscript.65 In response to my query Dr. Kloiber wrote: “I could not find any official statement of the WMA in response to that statement. However consequence [sic!] has been that the World Medical Association since then demands that with every proposal for presidency the proposer has to testify the good standing and integrity of the candidate.”66 In a response to Dr. Kloiber, I asserted that the “consequence” he referred to related to the issue of the qualification of candidates for the position of President of the WMA and was not specifically about Mr. Hällmayr’s defense of Sewering with respect to the killing of Babette Fröwis. Dr. Kloiber did not confirm my assumption “that the World Medical Association has 64 For the official information of the German Medical Association/BÄK, see http://www.bundesaerztekammer.de/page.asp?his=0.2.8678.10302.10342 (3 April 2014), for the text of the declaration, see http://www.bundesaerztekammer.de/downloads/115daet2012_nuernbergererklaerung.pdf (3 April 2014); Stephan Kolb et al., “Apologising for Nazi medicine: a constructive starting point”, in: The Lancet 380, 2012, 722 – 723. 65 Seidelman, e-mail to Kloiber, 9 August 2010. 66 Kloiber, e-mail to Seidelman, 17 August 2010.

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never responded officially to Mr. Hällmayr’s statement regarding the killing of Babette Fröwis”.67 Kloiber wrote: “I am sorry, I cannot confirm your assumptions. I have looked up the documents (minutes) of the 135th Council Session in Istanbul. I have not searched other documents, press releases and the correspondence of that year. Furthermore I am not aware of what has been said in interviews and statements that have been given by WMA officers and officials at that time – and those were many. If you read the statement of Dr. Todd [Dr. James Todd of the AMA, W.S.] in the article you quoted, you will also find that the introduction of the new procedure for nominations is clearly a reaction to the statements that have been given in Istanbul.”68

In preparation of this version of the manuscript I wrote again to Dr. Kloiber requesting information on the current position of the WMA. My e-mail message of March 9 to Dr. Kloiber reads, in part: “1. Given the fact that the WMA was created by national medical associations in response to the revelations of the medical crimes of the Third Reich as revealed by the Nuremberg Medical Trial and that the Nuremberg Declaration of 2012 affirms the position of the founders of the WMA, has has [sic!] the WMA (my error in the original correspondence) issued an official response to the 2012 Declaration? 2. Given Prof. Hans Sewering’s vital role in the WMA over many years in particular in his capacity as WMATreasurer, and given the role he is now known to have played in the criminal activities of the Third Reich, specifically facilitating the death of Babette Froewis, the institutionalized handicapped adolescent girl who was murdered at Eglfing-Haar, and given the 2012 Nuremberg Declaration, has the WMA published an official obituary on the passing of Prof. Sewering documenting his past as well as his role in the WMA? 3. Given our earlier correspondence concerning the 1993 statement by Mr. Hällmayr, and in view of the 2012 Nuremberg Declaration, has the WMA given further consideration to issuing an official apology for Mr. Hällmayr’s statement blaming the victim for her death in a campaign of organized medical murder that BÄK [sic!] acknowledges resulted in ‘the killing of well over 200,000 mentally ill and disabled people’ including Babette. In preparing the revised version of my paper for the conference proceedings it is my intention to be as accurate and as fair as possible in my own presentation of the historical record and the official position of the WMA in this matter.“69

As of this writing no response has been received from Dr. Kloiber to this message which was resent to the WMA general e-mail address on April 2, 2014. A review of the online electronic version of the WMJ failed to reveal any reference to the death of Prof. Sewering. It is also notable that there is no ref67 Seidelman, e-mail to Kloiber, 18 August 2010. 68 Kloiber, e-mail to Seidelman, 21 August 2010. 69 Seidelman, e-mail to Kloiber, 9 March 2014, resent 2 April 2014.

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erence to the momentous Nuremberg Declaration of 2012 of the BÄK which had significant historical implications for the WMA. The WMA did publish obituaries on the passing of the BÄK President and WMA Treasurer, Jörg-Dietrich Hoppe (1940 – 2011)70 ; Alan J. Rowe (1926 – 2012), the former editor of the WMJ; Ian Field (1933 – 2012), the past Secretary General of the WMA71 and Dr. Peter Foley (1954 – 2013), the former Chair of the New Zealand Medical Association.72 Dr. Kloiber’s tribute to Dr. Hoppe describes the searing impact of World War II on Hoppe’s family and his childhood experience as a refugee and displaced person who also suffered physical trauma. The history of the WMA as published on the organization’s website ignores or glosses over critical events that shaped the organization especially its genesis in response to the revelations of the Nuremberg Medical Tribunal and the medical crimes of the Hitler period.73 Thus the tragic experience of the Hitler era, as reflected in the official record of the WMA, had a significant impact on the foundation and direction of the association. The singular specific reference to the NMT is to be found under the discussion of the WMA Helsinki Declaration which states, in reference to the preparation of a position paper to guide physicians on biomedical research involving human subject: “Undoubtedly, the member associations requesting the study of this matter were inspired in part by the horrors – revealed during the Nuremberg trials – of physicians engaging in experimentation on human beings with little or no regard for the welfare of the subjects.”74

Given this history it is perplexing that the WMA response to the profoundly important Nuremberg Declaration of 2012 is one of silence. So too is the silence of the WMA in response to the passing of a physician in the person of Prof. Sewering who, for better or for worse, had a profound impact on the WMA as its savior during times of political and financial crisis and is now an apparently forgotten symbol of why the WMA came into being.75 One encouraging example in this tragic litany occurred in 2013 with the awarding of the title of “WMA Cooperating Center” to the Steve Biko Center for 70 Otmar Kloiber, Joelle Balfe, “In Memoriam Jörg-Dietrich Hoppe”, in: World Medical Journal 57(6), December 2011, iii. 71 Vivienne Nathanson, “Ian Trevor Field”, in: World Medical Journal 59(1), February 2013, 36 – 37. 72 Mukesh Haikerwal, “In Memoriam Dr. Peter Foley”, in: World Medical Journal 59(2), April 2013, 80. 73 http://www.wma.net/en/60about/70history/index.html (12 April 2014); WMA, World Medical Association Bulletin 1, 1949, 1 – 20. 74 http://www.wma.net/en/60about/70history/01declarationHelsinki/index.html (12 April 2014). 75 Beck, 1998; Wolinsky, 1993; Richards, 1994.

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Bioethics at the University of Witwatersrand, Johannesburg, South Africa. The report in the WMJ is an explicit acknowledgement of the moral failures of that time leading to “a split in the World Medical Association. The failure of the Medical Association of South Africa and the WMA to clearly stand up for human rights at that time was certainly one of the serious mistakes of these organizations.”76 The moral confusion of the WMA is emphasized by the resolution on violence against women and girls adopted by the General Assembly at its October, 2010 conclave in Vancouver, Canada.77 In the spirit of that resolution and in keeping with the WMA’s own acknowledgement of error in addressing the tragedy of apartheid in South Africa, it is appropriate that the WMA acknowledge the role played in the killing of a handicapped teenage girl by a physician who became a senior officer of the association. In this spirit it would be fitting for the WMA to issue an official public apology for the statement made by another WMA official suggesting that Babette Fröwis contributed to her own death under the child “euthanasia” program of the Nazi terror state. Despite its own chaotic and problematic history the WMA has been able to make important contributions. Perhaps the most significant contribution it could make at this point, both for itself and the world of medicine at large would be an honest reflection, an acknowledgement of its history, and an apology. The WMA should officially disavow and condemn Mr. Hällmayr’s statement concerning the murdered Babette Fröwis and in some way honor her memory. The WMA should also acknowledge the legacy of Hans Joachim Sewering, who exploited the repute of the WMA to deceive the world.78 76 “New WMA Cooperating Center”, in: World Medical Journal 59(6), December 2013, 232. 77 http://www.wma.net/en/30publications/10policies/v3/index.html (12 April 2014). 78 I wish to acknowledge Prof. David Schaps of Bar-Ilan University and Dr. Susan Weingarten of Safed, Israel, for their guidance in Latin interpretation. I need to express my appreciation of the administration and my colleagues at the North Hamilton Community Health Centre and the Department of Family Medicine of McMaster University who permitted my involvement in this activity and provided the administrative support. Professor Michael Kater, Professor Michael Weingarten and Professor Michael Grodin provided important guidance and help. In addition to his active role with respect to the World Medical Association, Dr. Michael Franzblau made a generous financial contribution to the North Hamilton Community Centre to help offset the administrative costs associated with this effort. Important assistance with translation was provided by the late Morris Rabinowitz @Q: and his son Archie Rabinowitz. Dr. Leo-Paul Landry, the former Secretary General of the Canadian Medical Association provided helpful information and documentation. The late Mr. Joel Levi, Advocate, of Ramat-Gan, Israel provided welcome advice and suggestions. My family, my wife Racheline in particular, continue their immensely supportive role in my work despite its many distractions. Our daughter, Dr. Rhona Seidelman, has been an important historian/guide in this work. Professor Michael M. Kochen’s courage deserves special acknowledgement as well as his assistance in reviewing the original manuscript of and the final version of this paper. I am grateful to Prof. Volker Roelcke of the University of Giessen and his colleagues for their

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Babette Fröwis (1929 – 1943) ‘Requiescat in Pace’

Prof. Dr. med. Hans Joachim Sewering (1916 – 2010) ‘Requiescat sine Pace’

efforts in both providing a forum for presentation and discussion of this paper at the conference “Memories and Representations of Nazi ‘euthanasia’ in Post-World War II Medicine and Bioethics” and their efforts toward the publication of the conference proceedings as well as Prof. Roelcke’s advice on the preparation of the final version.

Michael Wunder

Learning with History: Nazi Medical Crimes and Today’s Debates on Euthanasia in Germany

What can we learn from history? This is a very old question and a very difficult one, too. The debate in medical ethics in Germany on end-of-life medical care – we don’t say “euthanasia”, we say Sterbehilfe – cannot be conducted without referring to the history of the debates on euthanasia. At the same time, today’s debates about end-of-life-care in Germany are frequently connected with a view to neighboring countries, especially the Netherlands. Against this background I will propose a three-fold comparison: between the historical debates on euthanasia in Germany prior to 1933, the current debate on end-of-life medical care in Germany and the current euthanasia practice in the Netherlands. But an answer to the question what does Nazi “euthanasia” mean for medicine today – as we all know – cannot be given in any final or ultimate way ; the best we can do is approach. Allow me to make two preliminary remarks: 1. I am convinced that we can only learn with history, not from history, since we all are in a state of historical development. History is not a book we can leaf through to find a solution to today’s problems. However, we can put an end to some typical arguments, for example, the assumption that the questions raised today about embryo research, euthanasia and eugenics are completely new. This is a very widespread ahistorical misconception in ethics and a fairly fashionable attitude. All of these questions and their answers have a long history. Thus, for today’s debate, knowledge about history is absolutely necessary. 2. The term “Nazi euthanasia” implies a well-defined and unique phenomenon. This is something we have to address critically. Of course, there was a specific way of organizing euthanasia in the time of National Socialism, characterized by brutality and ruthlessness. But I reject the position that euthanasia was an isolated phenomenon that only took place National Socialism. I think we have to look at the pre- and post-history of this phenomenon to understand what happened and get a sense for the risk of continuity and the re-introduction of compulsion, oppression and eugenics.

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German discourses on euthanasia before National Socialism To approach the answer to the question my lecture poses, I now turn to the prehistory of Nazi ”euthanasia”, which began in the year 1920. In 1920 the professor of criminal law Karl Binding and the professor of psychiatry and neurology Alfred Hoche published their famous booklet Die Freigabe der Vernichtung lebensunwerten Lebens1 (“Permission for the Destruction of Life Unworthy of Living”), which launched many discussions among physicians in the 1920s in Germany, as well as public debates. The booklet emerged in the wake of medical failures in the treatment of thousands of seriously injured soldiers of the First World War and the large number of patients who died of hunger in the psychiatric asylums and institutions for the disabled persons during this period. Because all of the basic arguments about euthanasia appear in this booklet, it is still of great interest today. Binding’s question on one of the first pages of this booklet is whether killing a terminally ill patient at his or her own request could be a reason for being exempted from punishment for murder or manslaughter. Based on the example of a patient who was physically severely ill and explicitly wished to be killed, Binding developed the concept of beneficent euthanasia with impunity, which he demanded for three groups: – “those who, due to illness or after being severely wounded, are terminal cases, who fully understand their situation and urgently wish to be delivered from their agony and are able to somehow express this wish”,2 – “those who had been mentally healthy, but somehow lost consciousness and waking up, would suffer a nameless misery”3 – the “incurable idiots who are the terrible image of real people and cause horror in each person who faces them”.4 These three groups are very important because they remain quite topical today. The first group comprises severely sick patients who demand their own killing. This is self-determined euthanasia, quasi the “sunny side” of the debate. The second group is, in the modern vernacular, the group of patients in a persistent vegetative state; and the third group consists of the severely disabled, including newborns and very old people with severe disabilities. Binding asks in the booklet: “Are there human lives that have lost their right to legal protection in such a way that their further existence has forever lost all 1 Karl Binding, Alfred Hoche, Die Freigabe der Vernichtung lebensunwerten Lebens: Ihr Maß und ihre Form, Leipzig: Felix Meiner 1920. 2 Ibid., 29. 3 Ibid., 33. 4 Ibid., 31.

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value to themselves or society?”5 His answer is that the value of an ill or disabled individual may become negative if his or her social contribution to the national community is weighed against the expenses of caring for such a patient. Based on this thinking, Hoche created the well-known terms of “useless eaters”, “empty human shells” and “burdening existences” (Ballastexistenzen). The National Socialists could easily pick up these terms und use them directly for their propaganda. Even in official discussions and instructions about the selection of patients for euthanasia, the National Socialist health administration was instructed to follow the “Binding-Hoche criteria”.6

Euthanasia during National Socialism In his short euthanasia decree of 1939 Adolf Hitler referred to “mercy killing”, or beneficent euthanasia.7 The draft euthanasia law of 1940/41, written in the Kanzlei des Führers (Führer’s Office in Berlin), was based on the above three groups. Paragraph 1 stipulated that doctors were allowed to kill severely ill patients on their explicit demand; paragraph 2 stated that people with an “incurable mental illness”, who otherwise would be kept in lifelong custody, were allowed to be killed by medical treatment.8 The law was not enacted because the National Socialist authorities were afraid that the Allies would use it for propaganda purposes. Furthermore, they did not want to endanger what the National Socialists viewed as a successful process of disguised killing at that time.9

5 Ibid., 29. 6 Peter von Rönn, “Verlegungen im Rahmen der Aktion T4”, in: Klaus Böhme, Uwe Lohalm (eds.): Wege in den Tod: Hamburgs Anstalt Langenhorn und die Euthanasie in der Zeit des Nationalsozialismus, Hamburg: Ergebnisse 1993, 137 – 231, here 138. 7 See Ernst Klee, “Euthanasie” im NS-Staat: Die “Vernichtung lebensunwerten Lebens”, Frankfurt/M.: S. Fischer 1983, 100; an English translation is to be found e. g. in Michael Burleigh, Death and Deliverance: ‘Euthanasia’ in Germany, c. 1900 – 1945, Cambridge: Cambridge University Press 1994, 112, and Henry Friedlander, The Origins of Nazi Genocide: From Euthanasia to the Final Solution, Chapel Hill/London: The University of North Carolina Press 1995, 67. 8 Karl-Heinz Roth, Götz Aly, Das Gesetz über Sterbehilfe bei unheilbar Kranken, in: Karl-Heinz Roth (ed.), Erfassung zur Vernichtung, Berlin: Verlagsgemeinschaft Gesundheit 1984, 101 – 179; exact wording: § 1 “Wer an einer unheilbaren, sich oder andere stark belästigenden oder sicher zum Tode führenden Krankheit leidet, kann auf sein ausdrückliches Verlangen mit Genehmigung eines besonders ermächtigten Arztes Sterbehilfe durch den Arzt erhalten.” § 2: “Das Leben eines Kranken, der infolge unheilbarer Geisteskrankheit sonst lebenslänglicher Verwahrung bedürfen würde, kann durch ärztliche Maßnahmen unmerklich für ihn beendet werden.” 9 Hans-Walter Schmuhl, Rassenhygiene, Nationalsozialismus, Euthanasie: Von der Verhütung

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In 1943, the leading psychiatrists of the “Third Reich” issued a memorandum demanding the enactment of a euthanasia law for the post-war period, in which both euthanasia conditions were to be included: the killing of severely ill individuals upon their personal request, and the killing of the disabled and mentally ill upon the request of society, if neither recovery nor cure was in sight.10 The characterization of euthanasia in the “Third Reich” by Leo Alexander, the US medical expert at the Nuremberg Medical Trial of 1946/47, is quite famous: “The beginnings at first were merely a subtle shifting in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as 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. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude towards the non-rehabilitative sick.”11

This is the actualization of the older slippery slope argument in a well-founded way. Two points are very important here: First, the pattern of selection and killing can develop in spite of the existence of explicit medical ethics. The distinction between “worthy to live” and “unworthy to live” is inherent in the special, radically medical thinking oriented only toward healing rather than alleviation and palliation, which can become a priority in certain situations. The medical attitude to heal at any price is obviously close to the attitude to exterminate in cases of failure or incurability. Second, a very subtle shift within basic attitudes may gradually launch a development that is difficult to stop and can result in a mentality of brutality and mass murder. Now I would like to look at present-day developments. My question is whether today’s claim of validity for the self-determination of modern euthanasia makes it fundamentally different from the euthanasia of the past.

zur Vernichtung “lebensunwerten Lebens”, 1890 – 1945, Göttingen: Vandenhoeck & Ruprecht 1987, 292 – 297; see Friedlander, 1995, 116. 10 Quoted in Klaus Dörner (ed.): Fortschritte in der Psychiatrie im Umgang mit Menschen: Wert und Verwertung des Menschen im 20. Jahrhundert, Rehburg-Loccum: Psychiatrie-Verlag 1984, 214. 11 Leo Alexander, “Medical Science under Dictatorship”, in: The New England Journal of Medicine 241(2), 1949, 39 – 47, here 44.

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Euthanasia in the Netherlands The first euthanasia law in the Netherlands was enacted in 1994.12 It stated that the act of euthanasia was illegal but not subject to punishment under special conditions, the so-called “criteria of diligence”: – the patient’s request must be voluntary – this request must be expressed continuously for at least two weeks – the illness is incurable – the patient must be informed and elaborate his position together with a physician and – a second physician has to give his consent.13 The law of 2001 replaced the old regulation. However, in contrast to its predecessor, it now explicitly allows active euthanasia, changing the criteria of diligence as follows: – it is not necessary for the patient to continuously request to be killed for a specific period of time – incurability is not an absolutely necessary prerequisite and – the age limit is reduced from 18 to 16. Today it is openly discussed whether these changes in the legislation point towards liberalization or towards a slippery slope. However, if we look at the statistics on euthanasia cases in the Netherlands, the answer to this question is quite easy.

12 For the debates in the Netherlands up to the 1990s, see the chapter by James Kennedy in this volume. 13 Marcus Düwell, Liesbeth Feikema, Über die niederländische Euthanasiepolitik und -praxis, Berlin: Institut für Mensch, Ethik und Wissenschaft (Selbstverlag) 2006, 13.

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Practice of Euthanasia in the Netherlands Euthanasia with consent Suicide assisted by physicians Euthanasia without consent 199014 2,300 cases 1.8 % of all deaths 199515 3,600 cases 2.4 % of all deaths

242 cases 0.3 of all deaths 238 cases 0.3 % of all deaths

976 cases *) 0.8 of all deaths 913 deaths 0.7 % of all deaths

200116 3,650 cases 180 cases 941 cases 2.6 % of all deaths 0.2 % of all deaths 0.7 % of all deaths *) including 375 cases of people able to consent who were not even asked

The most interesting point here is the column on the right. It shows an almost stable number of cases of euthanasia without consent, amounting to nearly 1,000 cases per year. The sum of the numbers for consented euthanasia cases and assisted suicides is the number of officially registered cases; the numbers for non-consented cases are the result of inquiries by accompanying research performed up to 2001. The reasons doctors gave in interviews conducted in 1990 about their motivation for euthanasia without consent were as follows: – any further medical treatment useless – hopeless situation, no prospect of recovery – the relatives could no longer bear the situation – quality of life was too poor.17 These are all heteronomous value judgments about life, which have nothing to do with the individual self-determination of the patient. But are they also abuse? Is it not rather an unavoidable development, because, in the words of Binding and Hoche, in these cases a “further existence has lost forever all value to themselves or society?”18 What is really interesting in the further course of this development is that 2,325 cases of euthanasia with consent were registered in the year 2005.19 14 P.J. van der Maas, J.J.M. van Delden, L. Pijnenborg, Medische beslissingen rond het levenseinde: Het onderzoek voor de Commmissie Onderzoek Medische Praktijk inzake Euthanasie, Den Haag: SDU 1991. (“Remmelink-Report”) 15 P.J. van der Maas et al., “Euthanasia, physician assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990 – 1995”, in: The New England Journal of Medicine 335, 1996, 1699 – 1705. 16 B.D. Onwuteaka-Philipsen et al., “Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995 and 2001”, in: The Lancet 362, 2003, 395 – 399. 17 Van der Maas, van Delden, Pijnenborg, 1991, 43. 18 Binding, Hoche, 1920, 29. 19 B.D. Onwuteaka-Philipsen et al., Evaluatie Wet toetsing levensbeeindiging op verzoek en hulp bij zelfdoding: Programma evaluatie regelingen (“Evaluation of the law about evaluation of killing on demand and assisted suicide: Programme Evaluation Regulations”), Part 23, Den Haag: ZonMw 2007.

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However, the decrease is seen in relation to the concurrent increase of up to 1,200 cases of terminal sedation.20 According to recent data the number of registered cases of consented euthanasia has increased again. The Annual Report of the Regional Euthanasia Examination Boards cites 2,636 registered cases in 2009 and 3,136 in 2010.21 Unfortunately, the reports from 2009 and 2010 do not give any information about the number of terminal sedations, so that it is not clear whether the increase can be explained by a less frequent use of this practice (which is presumed, but not proven, in the Annual Report of the Regional Euthanasia Examination Boards), or whether the number of terminal sedations quoted for 2005 must still be added to the data. There are indications that terminal sedation is applied more often than euthanasia. In a study from 2006, 410 physicians were questioned, reporting 211 cases of terminal sedation and 123 cases of euthanasia.22 Since “terminal sedation”, with its palliative intention to alleviate pain and thereby accept premature death as a side-effect, is intermingled with the terminal intention to shorten life, meaning to kill, it becomes a purely medical decision that does not concern the Euthanasia Act and for which the explicit wish of the patient is not required, which makes decisions by others a common practice. This therefore raises the question as to whether it is possible that many of the registered cases in the large group of euthanasia without consent we saw in the statistics of the 1990s are no longer included in today’s statistics. Even more significant is the development towards the heteronomous assessment about whether children’s lives are considered worthy or unworthy of living. Between 1997 and 2004, the pediatrician Dr. Eduard Verhagen of Groningen, by his own account, illegally killed 22 disabled children up to the age of twelve with their parents’ consent. However, he was not prosecuted. On the contrary : He analyzed and published the killings. In all 22 cases, he stated, their quality of life had been extremely low and none of them would ever have been able to lead an independent life; moreover, most of the children had been unable to communicate and were dependent on hospital care to prolong their lives. The assumption was that a longer life span would imply a longer period of suffering.23 Verhagen’s activities and publications led to the so-called Groningen Protocol, which was developed at the Groningen University Hospital (Universitair Medisch 20 A. van der Heide et al., “End-of-life Practices in the Netherlands under the Euthanasia Act”, in: The New England Journal of Medicine 356, 2007, 1957 – 1965. 21 Ministerie van Volksgezondheid, Welzijn en Sport, Jaarverslag regionale toetsingcommissies euthanasie, Rijswik 2010, 58. 22 J.A.C. Rietjens et al., “Terminal Sedation and Euthanasia: A Comparison of Clinical Practices”, in: Archives of Internal Medicine 166, 10 April 2006, 749 – 753. 23 Eduard Verhagen, P.J.J. Sauer, “The Groningen Protocol – Euthanasia in Severely Ill Newborns”, in: New England Journal of Medicine 359, 2005, 995 – 962.

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Centrum Groningen) in 2004 to protect physicians from legal prosecution in cases of euthanasia of children and adolescents. The protocol lists requirements for the euthanasia of children with disabilities between birth and twelve years of age, and has been approved by the Dutch Prosecution Office, which promised that cases of euthanasia would not be prosecuted if they fulfilled the requirements of the protocol: – The suffering is considered “hopeless and unbearable”. – There is no medical treatment to help the child. – The parents must give their consent to the euthanasia. – A second opinion from another physician is necessary. – The termination of life must be conducted by a physician; follow-up care must be provided for everyone involved.24 The Dutch development of euthanasia is characterized by further expansion to other areas and groups as well. In the case of minors between twelve and 16 years of age demanding euthanasia, the parents or other caregivers and custodians must give their consent. If, however, the minors are between 16 and 18 years old, the parents or other responsible adults must be involved, but their objections are insufficient to prevent euthanasia. The participation of patients suffering from dementia has been discussed repeatedly and critically, but is permissible on a case-by-case basis. In the discussion about involving the mentally ill and patients who are “sick-of-life”, ever more contributions are appearing that express support for the practice, most of them with reference to concrete cases.25 The latest expansion concerns outpatient euthanasia clinics that travel through the country in busses. Thus even the condition that the patient is known personally by at least one of the two physicians, considered to be absolutely necessary by many supporters of the practice of euthanasia, is dispensed with.26

d

d

24 Ibid.; information on the further development: Ministerie van Volksgezondheid, Welzijn en Sport: Gecombineerd Jaarverslag over de jaren 2009 en 2010 van de Commissie Late Zwangerschapsafbreking en Levensbeeindiging bij Pasgeborenen (“Bi-annual Report for the years 2009 and 2010 of the Committee on Late Abortion and Termination of Life of Newborns”), Rijswik 2011. 25 For example, the psychiatrist Boudewijn Chabot assisted a 50-year-old mentally ill woman in committing suicide and admitted to it in public in 2002 without any consequences whatsoever; see Raphael Cohen-Almagor, Euthanasia in the Netherlands: The Policy and Practice of Mercy Killing, Dordrecht: Springer 2004, 45 – 46. However, the euthanasia of the suicidal Edward Bronsgersma led to the conviction of the physician by the Supreme Court of the Netherlands; see ibid., 164 – 165. 26 In Belgium an Euthanasia Act has been in force since 2002. It closely resembles the Dutch law, although some of the regulations like the elimination of the age limit go further. The rate of euthanasia cases without consent is even higher than in the Netherlands. According to a study from 2001, 1.1 % of all deaths in Belgium can be traced back to consented (or volun tary) euthanasia. The numbers of cases without consent are unknown; we can only

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At the beginning of the euthanasia debate in the Netherlands it was promised that the legalization of euthanasia would lead to more autonomy and at the same time provide more security against escalation by imposing strict regulations. But in my opinion the Dutch development shows that linking measures of euthanasia to personal consent is not a firm bulwark against heteronomy and expansion. On the contrary : Once it becomes legal for those who wish to end a life to declare whether it is worthy or unworthy, then this judgment can be reached regardless of the patient’s own will. The motivation of the new proponents of euthanasia in the Netherlands and other countries may well be different from that of the early propagators of active euthanasia, Binding and Hoche. The results, however, are the same. They promise to reduce suffering and they promise to grant freedom to those who wish to be killed. But they also kill people who do not give their consent, based on the judgment by others that these lives are not worth living. Obviously, the “sunny side” – euthanasia by the free consent of the terminally ill patient – is inevitably connected with the other side, namely euthanasia of the disabled and severely ill, who, because they are not able to give their consent, are subject to lethal judgments passed on their lives by others. The slope is slippery indeed. We constantly live in a state of historical development; and this is why, although I do not believe we can learn from history, I think we may be able to learn with the history we live in.

The situation in Germany In Germany, and this is one of the differences from all the other countries in the international debate, we do not use the term euthanasia. Instead, we use the term Sterbehilfe, which can best be translated as “assisted dying”. I think that this term was not chosen consciously and with informed decision, but instead symbolizes a dishonorable reluctance to use the historical term euthanasia. Nevertheless, legalization about killing on demand is being discussed. The legal situation in Germany is as follows: Killing on demand, or actively assisted dying (aktive Sterbehilfe), is prohibited, (§ 216, Criminal Code, Strafgesetzbuch), whereas the omission or discontinuation of life-sustaining measures for the dying (passively assisted dying, passive Sterbehilfe) is allowed, as is the administration of pain-relieving measures that reduce suffering, even if they

speculate; see Luc Deliens et al., “End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey”, in: The Lancet 356, 2000, 1806 – 1811.

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unintentionally cause an earlier death (indirect assisted dying, indirekte Sterbehilfe). This is laid down in the professional regulations for physicians.27 No law about assisted suicide by physicians exists in Germany ; however, a physician may come into a conflict with his unconditional obligation to save lives and the criminal liability of denying assistance. This is the reason for the great difference to our other neighboring country, Switzerland, where these regulations do not exist and assisted suicide is allowed. In 2011 the German Medical Assembly agreed on a revision of the code of medical ethics to prohibit physicians from assisting at suicides. However, this prohibition will take effect only in the German federal states whose Medical Associations (Landesärztekammern) adopt it. 10 from 17 medical associations of the German federal states have overtaken the exact wording from the German Medical Assembly ; the others have changed the wording but most of whom agree with the sense. The present development is strongly influenced by a Federal Court verdict of 1994, in the case of Kempten. The Court decided that discontinuing the artificial nutrition of a 72year-old patient in a persistent vegetative state was legally permitted. The reasoning was that this corresponded with the supposed will of the patient concerned. This was the first time in Germany that the deprivation of nourishment had been accepted as a measure to terminate the treatment of an individual who was not about to die, as long as this was the declared or at least presumed will of the patient concerned. Since then the danger of a continuously growing number of cases of passively assisted deaths is increasing, and also gradually crossing the line towards actively assisted deaths. It is indisputable that a patient can refuse a life-saving measure, consciously and in direct communication with his physician, even if this measure helps him to survive for a long time. However, for years it was disputable whether this was possible in cases where the omission or discontinuation of such a measure is stipulated in a living will, or if no such document exists and the patient’s will is presumed by the physician or the legal representative. In Germany a legal regulation about living wills has been in force since 2009.28 This act allows every German citizen of age who is legally competent to agree or disagree, in written form, to upcoming medical examinations of his or her medical condition, treatments or medical interventions that might take place in situations where he or she is unable to consent. This applies irrespective of whether the medical condition is still treatable or at least relievable by medicine. 27 “Grundsätze der Bundesärztekammer zur ärztlichen Sterbebegleitung”, in: Deutsches Ärzteblatt 108(7), 2011, A-346 – 348. 28 “Drittes Gesetz zur Änderung des Betreuungsrechts (auch Patientenverfügungsgesetz), 3. BtÄndG/PatVerfG”, Bundesgesetzblatt I, Berlin, 2009, 2286.

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The act also regulates the status of the so-called presumed will, which becomes decisive when the contents of the living will do not apply to the current living and treatment conditions of the patient who wrote it, or if the patient has not prepared a written living will. The act defines the presumed will in more detail. It must be determined through concrete references such as previous oral or written statements, ethical and religious beliefs or other known personal moral concepts of the patient concerned. If these requirements are fulfilled, the presumed will is as legally binding as the written living will. The presumed will thus can be the basis for limiting the treatment of a non-lethal disease, for example pneumonia, in cases of dementia with deteriorated communication skills. Critics of this intended expansion, and I am one of them, think that this blurs the boundaries between active and passive assisted dying. So far the boundary was clear : passively assisted dying meant that the patient dies from a disease which the patient has declared should no longer treated, so that no obstacles hinder the natural course of dying. Due to the new regulation, a number of patients will die not from a lethal disease, but from not being treated with a measure that would save their lives. A prime example here is the young man who has stipulated in his living will that he does not wish to continue living should a leg amputation become necessary ; in this case he does not wish to be saved. After a road accident this man could find himself in a situation he could survive only by having his leg amputated. If his living will is complied with, no amputation would be performed and the man would die. Nobody in the medical profession can regard this as reasonable. So there is the danger of a step-by-step expansion blurring the boundaries, ultimately paving the way for a new argumentation, albeit followed by an old consequence. The will of the patient now becomes definite. What the patient wishes is right, even if the wish is only presumed. The responsibility of medicine and physicians becomes a secondary importance. Furthermore, in Germany there is a continuous public debate about increasing the possibilities for assisted dying. Even though opinion polls indicate support for active euthanasia to be as high as 80 %, the issue must be handled with care. Surveys that mention palliative treatment, for example, show approval drop to about 35 %,29 which is still an alarming number of people in our society.

29 Emnid survey on 5 July 2000 on behalf of the Deutsche Hospizstiftung, cited in https:// www.stiftung-patientenschutz.de/news/371/118 (5 September 2014).

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Conclusions The argument of history is always present in German debates on euthanasia. I do not mean the dishonorable reluctance to use the term “euthanasia” and its replacement with “assisted dying”, nor the claim that today’s assisted dying is completely different from the euthanasia in the past, nor the knee-jerk invocation of “Hitler’s methods” whenever the police use violence against demonstrators. Such claims are detrimental to the history argument. I am convinced that there is no simple continuity of political situations or social conditions between the past and today ; instead, there is the risk of continuity and reactivation of figures of thought. I think the example of the Netherlands shows that the slippery slope argument is very justified indeed, since present-day euthanasia practices have apparently increased since the introduction of legal permission. The development over the last ten or twelve years in the Netherlands reveals an internal logic of legal permission for euthanasia unfolding its dynamics: The first step is permission to kill a person who requested it openly and directly to the physician, followed by permission to replace direct consent with non-direct consent in a living will, and the interpretation of the supposed will. The next step is to gradually move on to killing people whose lives other people define as unworthy to live. Without the knowledge of history – and that means history from the 1920s up to today – euthanasia or assisted dying cannot be discussed in an informed, critical and sensible way. Therefore I think that the German experience of history will not inhibit the development of bioethics and medical progress. On the contrary, it is a resource and has a special value, and I think that we have the duty to say this openly in international debates. I know this is a quite risky standpoint, as it is sometimes called the “typical German argumentation” to look only backward and block the future.30 I think the history argument and the people using it in the present debates are being discriminated against here. However, no modern bioethics or medical ethics discussion is possible without the knowledge of history and lines of development. Please let us not be more simple-minded than we are. Let us use our knowledge in the international debates. And I truly hope this meeting will contribute to this approach.

30 I remember this debate at the Biomedicine Convention of the Council of Europe in the mid1990s. The German position was very clear, with the German delegation criticizing that the convention paved the way for research on people who were not able to give their consent. The basis for this argumentation was the German experience with history and the Nuremberg Code.

Appendix (Documentation)

Jewish Medical Association of Palestine. Motion to the World Medical Association (1947). With an Introduction by Etienne Lepicard

Below is presented, as far as I know for the first time to the English reader, the motion submitted by the Jewish Medical Association of Palestine at the first meeting of the World Medical Association (Paris, 16 – 21 September 1947) during the discussion on “the ‘scientific’ crimes perpetrated by the Germans”.1 The issue of the Nazi medical atrocities had already been discussed in a preparatory meeting of the yet to be established association (London, 25 – 27 September 1946), and promoted especially by the Danish delegates, who quoted documents gathered by the International Commission on War Crimes.2 The decision to hold a full session on the topic seems to have been a relatively late decision, however, as in May 1947, the agenda of the meeting had not yet been published, and not even an early “confidential and private” program of the meeting mentioned the two French former deportees who ultimately opened the session: Professor Charles Richet, Jr. and Doctor Henri Desoille, both of the Paris Medical School.3 After their keynote speeches, various national delegations presented “motions”: the Danish, British and French ones were recorded in the official program, as was the vote on a resolution.4 From the account published

1 The Hebrew Medical Union called itself The Jewish Medical Association of Palestine in the preparatory meetings as well as in the 1947 funding meeting of the World Medical Association, in order to differentiate itself from the then existing Arab Medical Association of Palestine also invited by the British Medical Association. See Lepicard chapter for more details. 2 See Jacob Michelsohn, “A Report from the International Conference of Physicians in London, 25 – 27 September 1946”, in: Mikhtav le-haver 150, 15 November 1946, 1319 – 1320, quoted by Zalashik in this volume p. 200. 3 See “The first meeting of the World Medical Association”, in: Mikhtav le-haver 162, 15 May 1947, 1435 and “Association M¦dicale Mondiale (priv¦ et confidentiel)”, s.d., in: MDA RG P 10 File 73 (Lectures and lists from the World Medical Conference held in Paris, 16 – 21 September 1947), AG1. 4 See “AMM WMA 1er CongrÀs Mondial – Paris – du 16 au 21 septembre 1947”, in: MDA RG P 10 File 73. Besides technical sessions dedicated to the approval of the bylaws of the new association and similar measures, only one full other session had been scheduled: “The Medical Profession and the State”, dealing specifically with the state of affairs in the various countries

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after the meeting by Moshe Krieger, the president of the Hebrew Medical Union who also headed the Jewish delegation at the meeting, we learn that the first concern of the Union was to present evidence of the crimes of the German doctors. As they did not succeed in gathering sufficient material, Krieger had the idea to bring along someone who would constitute living testimony of what had happened, and for that purpose finally turned to Dr. Mark Dvorjetski, a physician-survivor of various concentration camps who was living in Paris at that time.5 Born in 1908 in Vilnius (the Russian empire at that time, today Lithuania), Dvorjetski had started studying medicine in Nancy, France, before receiving his diploma from the University of Vilnius. In 1939, he found himself serving in the Polish army as a physician. Taken prisoner, he escaped from German internment and returned to Vilnius where he practiced medicine in the Jewish ghetto and became one of the initiators of the underground (1941).6 When the Nazis decided to liquidate the ghetto of Vilnius, he was sent to the Vaivara concentration camp7 and from there to various other labor camps in Estonia – Kumeräe, Lagedi, Vivikonna and Goldfieds.8 When the Soviet army advanced toward Estonia, the

5 6

7

8

regarding social security legislation. The presentation of a work in progress on the state of affairs regarding medical education concluded the program. See Moshe Krieger, “The H.M.U. at the meeting of the World Medical Association (lit. Union) in Paris”, in: Mikhtav le-haver 172, 15 October 1947, 1535 – 1537. On the Vilnius ghetto, see for instance Elzbieta Rojowaka, Martin Dean, “Wilno”, in: Geoffrey P. Megargee, Martin Dean (eds.), Encyclopedia of Camps and Ghettos, 1933 – 1945, Bloomington and Indianapolis: Indiana University Press (in association with the US Holocaust Memorial Museum) 2012, Vol. 2 Part B, 1148 – 1152. Vaivara was one of the last concentration camps to be established (summer 1943). At that time the Nazi leadership had two aims: 1) to implement the final stage of the destruction of European Jewry by liquidating all remaining ghettos, and 2) to utilize Jewish labor. Vaivara camp was the main camp over some twenty other labor camps located throughout Estonia. The commander was SS-Hauptsturmführer Hans Aumeier. The chief physician for the camps was Franz von Bodman. See Ruth Bettina Birn, “Vaivara main camp” and “Vaivara subcamp”, in: Geoffrey P. Megargee (ed.) Encyclopedia of Camps and Ghettos, 1933 – 1945, Bloomington and Indianapolis: Indiana University Press (in association with the US Holocaust Memorial Museum) 2009, Vol. 1 Part B, 1492 – 1495 and 1507 – 1508, respectively. One of the major sources about this camp are the reports by the SS camp doctor (Lagerarzt), which cover the period September 1943 to June 1944, discovered recently (2002) in the Estonian Historical Museum in Tallinn (holding documents 152/2/40). Even today the most comprehensive study is Mark Dvorjetski’s Histoire des camps Nazis en Estonie (1941 – 1944): L’¦volution du systÀme concentrationnaire, la vie quotidienne dans les camps, le non-conformisme et le movement de la R¦sistance des d¦port¦s, Paris: Sorbonne (PhD thesis) 1967, later published as a book: Jewish Camps in Estonia 1942 – 1944, Jerusalem: Yad Vashem 1970 (in Hebrew with an English summary). All of these labor camps were satellites of the Vaivara main camp, see Ruth Bettina Birn, “Kuremäe”, “Lagedi”, “Vivikonna OT and Vivikonna Baltöl [aka Werk IV Sillamäe]” and “Goldfields (‘Goldfeld’)”, in: idem, 1502 – 1503, 1503, 1508 – 1509 and 1498 – 1499, respectively.

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Germans evacuated the internees in this country to Stutthof camp near Danzig (today’s Gdansk) and from there to another labor camp, Dautmergen, one of the satellite labor camps of Natzweiler, Germany.9 Near the end of the war, Dvorjetski escaped from a forced march to the mountains of Tyrol, surviving by taking refuge in a forest until the Allies arrived. He arrived in Paris in May 1945 where he was in charge of the She’erit ha-Pletah (the central Jewish organization for displaced persons).10 Dvorjetski had been involved in the Zionist movement since his youth. In 1933, he was Chairman of the Zionist Socialist Workers Party in Vilnius and in 1939 was elected as a Jewish representative of that municipality.11 In 1947, when Krieger approached him to be part of the delegation of the Jewish Medical Association of Palestine at the first meeting of the WMA, he had already published in French a sanitation report on the Vilnius ghetto, initially written in Yiddish.12 Part of the book had been translated into Hebrew and published in a special issue on life and health in the ghettos of Dapim refuiyim, the organ of the main Jewish sick fund in Mandatory Palestine.13 Dvorjestki had also published various articles on his experience in the Yiddish and Hebrew press.14 Krieger, who was himself born in Lithuania, explained that he choose Dvorjetski because “he [MD] has seen from his flesh the tricks of the Nazis (orig. ta’alule hanazim) and their physicians – in the Vilnius ghetto and in several concentration camps”.15 While the paper by Dvorjetski is not written in a pure Oxford style, for obvious reasons connected to his biography, it is nonetheless quite well structured and presents an effective rhetorical contribution toward a double goal set him by Krieger and the Hebrew Medical Union: the criminal German doctors should be punished and medical ethics needs to be enhanced. After an introduction of two paragraphs, the text is divided into three parts, each starting

9 See Birn, “Vaivara main camp”, 1495, as well as Michael MacQueen, “Stutthof main camp” in: idem, 1420 – 1423 and Christine Glauning, “Dautmergen”, in: idem, 1023 – 1025. 10 For this outline of Mark Dvorjetski’s biography I relied on the archival presentation of the Yad Vashem Mark Dworzecki Archive (MDA) as well as on unpublished documentations graciously made available to me by Boaz Cohen. See also Daniel S. Nadav, “Marc Dvorjetski – a Doctor in the Ghettos and Labor Camps”, in: idem, Medicine and Nazism, Jerusalem: The Hebrew University Magnes Press 2009, 101 – 108. On the spelling of Dvorjetski’s last name, see fn. 71. 11 Ibid. 12 Mark Dvorjetski, Le ghetto de Vilna: (rapport sanitaire), Geneva : Union OSE (Œuvre de Secours aux Enfants) 1946, 85 pages. 13 “The struggle for life and health within the ghettos under the Nazi occupation” (special issue), in: Dapim refuiyim 6, September 1946, 61 pages. 14 See MDA RG P 10 File 1 (Bibliography of articles and publications written by Dr. Dworzecki). 15 Krieger, 1947, 1535.

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with one summarizing sentence.16 The introduction alluded to both the international trial of the main perpetrators and the medical trial held at Nuremberg (NMT), stating in a general manner that these trials had revealed the medical crimes committed in some concentration camps. It immediately added that the world still did not know what happened in many other camps. The author went on by listing who among the German doctors should be defined as criminal. He introduced this first part with a sentence stating that the physicians bound by the millenary (Hippocratic) medical ethics [my emphasis, E.L.] “are awaiting the judgment of such crimes”. Afterwards, he engaged in a personal testimony about what he saw, certainly the most moving part of this talk. This time, the one introductory sentence read: “The World’s Association of Doctors must have the courage to penetrate right through the depth of medical crimes and find the way to fill such an abyss so as to avoid new victims”. This manner of engaging in personal testimony after having reviewed the various kinds of criminal wrongdoings of German physicians, from a rhetorical point of view, truly enhances what the author had stated more generally in the first part. The last part of the text is dedicated to a direct appeal to the “Doctors from all countries!” in order to recruit them not only to condemn such crimes, but to collectively banish the perpetrators for at least one generation. This was the concrete proposal by the Jewish delegation. Dvorjetski introduced this part by turning to the common ground of all physicians: “For generations in the rooms of the Medical Faculties you can read the following words: Sedare dolorem opus divinum est; the Nazis doctors transformed the opus divinum into opus satanicum”. This universal note is characteristic of this part, and Dvorjetski came back to it quite often, concluding with what he saw as the “eternal basis of the medical ethics”: “Man thou are my brother”. It must be noted, however, that as for many other physicians of his generation, for him the Nazi doctors were just executioners of a “prostituted science”. On the other hand, there is no doubt that his testimony or “indictment”, as he called it, more than many other documents (in particular, those presented in the Nuremberg trials) reveals the scale of the involvement of German doctors in Nazi medical atrocities. It also shows how much the Nuremberg trials were based on the documents from a few camps, even if they were the major ones. If the paper fulfilled the expectations of the Hebrew Medical Union on a general level, there is no doubt that it also represents Dvorjetski’s personal response to the Nuremberg indictment. Further research is welcome in order to explore this aspect in more detail. For the establishment of the text, two English typescripts were used which

16 See fn. 44 below.

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were found in Dvorjetski’s papers at Yad Vashem Library.17 One (A) is attached to a letter (in French) that Dvorjetski sent to the editor-in-chief of a journal requesting publication, dated 25 September 1947.18 This is a six-page, doublespaced typescript marked with many corrections. This typescript (A) begins with the sentence: “To the Chairman and honorable Assembly”. The second (B) is a three-page typescript on thicker paper and without any deletions. The same text on the same kind of paper also exists in a French-language version. The pagination of the text presented here is from this typescript. In the same file, one can also find a five-page typescript with many deletions in French, a five-page Hebrew typescript, and also a Yiddish one.19 In the text presented here, the corrections appearing in typescript A were kept using a crossed-out font (i. e. crossing-out) when it was possible to read what had been crossed out. Once, such a reading was not possible and we simply put the xxxxxxx used by the person who typed the original text. There were also some words or groups of words added above a line of text, with or without signs of insertion. These words are indicated using brackets (i. e. [brackets]) to differentiate them from the words in parentheses which appeared in the original text. The major orthographic or graphic errors have been noted in footnotes, while the sometimes heavy English style was kept for historiographical reasons. Here is the text:

17 See MDA, RG P 10 File 73 (Lectures and lists from the World Medical Conference held in Paris, 16 – 21 September 1947). 18 From the letter alone it is impossible to know to which journal Dvorjetski sent it. However, the same file (MDA RG P 10 File 73) contains an answer from Andr¦ Ravina in the name of the board of La Presse m¦dicale dated 20 October 1947 declining the publication, as well as another letter from Dvorjetski (including a copy of his talk in French this time) and another answer from an editor, but in this case the dates of the two letters correspond to each other, which suggests that the first copy of the text (in English) was indeed sent to La Presse m¦dicale. The fact that the English copy of his requisitoire (indictment) was sent to a French journal on 25 September 1947 (i. e. only six days after Dvorjetski had talked at the WMA meeting), suggests that he might have given the speech in English. 19 See fn. 17 above.

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LET US THROW THE ANATHEMA AGAINST THE MURDERER-DOCTORS

Motion of the Jewish Medical Association of Palestine

To the Chairman and honorable20 Assembly, The medical science which was for generations the very symbol of human love, has been violated by the awful crimes committed by several German21 criminal doctors. The latters have shaken the faith of humanity towards the corporation who had the sacred mission to help the sick in his sufferings. The Nuremberg proceedings in general and the proceedings of the 23 doctors have partially unveiled to the world the medical crimes committed by the German22 doctors under the Nazi23 system and this in the concentration camps such as Buchenwald, Mauthausen, Dachau, Stu Struthof, Auschwitz, Maidanek. The World is still ignorant of treatments that were inflicted in nearly one thousand concentration camps in Poland, in the innumerable ghettos and extermination camps in Lithuania, Lettonia,24 Esthonia,25 Ukrainia,26 White Russia, Hungaria27 and other occupied countries where hand in hand with the Gestapo hundreds of German28 doctors have not only in theory but in practice lend their help for the extermination of millions of Belgians, French, Dutch,29 Jews,30 Norwegians, Greeks,31 Hungarians, Poles,32 Russians, Tziganes33 and others. Generations of doctors who have during centuries kept the sacred oath made for the observance of the medical moral are awaiting the judgment of such crimes.

20 21 22 23 24 25 26 27 28 29 30 31 32 33

Spelled “honourable” in both original typescripts. Without a capital in the two original typescripts used. Idem. Idem. Latvia. Estonia. Ukraine. Hungary. Without a capital in the two original typescripts used. Idem. Idem. Idem. Idem. Idem.

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Must be considered as criminal all the German34 doctors who have taken a part in the selection for “death” in the camps and who have personally decided of the death of human beings owing to their [creed] xxxxxxxx, political views or their non-German35 nationality. Criminals are all the German36 doctors who have personally taken part to the exterminations in the ghettos.– Those who have collaborated in the creation of gas chambers where more than 10 million37 of human beings of all nationalities, of all creeds and races have met with death. Criminals are those who have decided the death of hundreds and thousands of old people, sick and invalids.38 Also those who have practiced experiment on human beings and this without their consent or against their wishes experimenting immersion in cold water and forcing them to drink sea water for weeks as well as keeping them in a pressure room or maintained in the space. Criminals are also those who have willfully39 contaminated the prisoners by mean of injecting the typhoid microbes as well as that of tetanus40 etc.41 Those who have elaborated the principals of racial theories and of which they have made the basis of the precept of the education.

34 35 36 37 38

Idem. Idem. Idem. Millions in both original typescripts. In contrast to the indictment of the NMT, these first four first paragraphs listing who was criminal immediately enlarged the number of physicians involved in the Nazi medical atrocities and crimes. Starting with the presence of physicians on the ramp at the arrival of the transports in the extermination camps, to the euthanasia operation, and through the actions in the ghettos, the author recalls acts that, besides the euthanasia operation, did not find their way, or almost did not find their way, to the courtrooms. 39 “Wilfully” in the two original typescripts used. 40 “Tetanos” in the two original typescripts used. 41 These two paragraphs seem more in tune with the indictment of the NMT, with high altitude experiments (A), sea water (G) and freezing experiments (B) and typhus experiments (J). Compare “Indictment”, in: Trials of War Criminals (TWC) before the Nuernberg Military Tribunals under Control Council Law No. 10, vol. I, Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office 1950, 8 – 17.

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Criminals are those who have helped to the manufacture of soap made with human fat emanating from the victims of the cremating furnaces.42 [2] Also those who have helped to the operation called “cosmetic” transferring on Germans, the skin taken [per force] from the faces of living children. Those who have practiced without the consent of human beings and against their wishes the chemical, radiological and surgical sterilization.43 - - - - -44 The World’s Association of Doctors must have the courage to penetrate right through the depth of medical crimes and find the way to fill such abysm so as to avoid new victims. ----You have before you someone for whom those crimes are not only written stories, but who has escaped and of which the body has suffered from these crimes, one of the victims who remained the witness of those awful crimes committed by the German45 doctors under his very eyes and this in the ghetto of Vilno46 and in the seven concentration camps (Vaivara, Kour¦m¦, Laguedi, Viviconi, Goldfils, in Esthonia; Stutthof near Dantzig, Dautmergen near Nazweiller in Germany) where he was prisoner during four years (from September 6th 1941 to April 23rd 1945).

42 These two paragraphs are, again, of another character than the NMT indictment. The involvement of the theoreticians of racial hygiene as well as the industrialists brought to the fore fields that were not really represented nor dealt with at Nuremberg. 43 Again, these two last paragraphs are apparently more in tune with the Nuremberg indictment, even though, besides the sterilization experiments (I), the skin transplantations, as far as I know, have no parallel in the Nuremberg trials. Compare “Indictment”, in: TWC, 13. 44 This inter-paragraph line of hyphens appeared in typescript A. They are reduced to one hyphen at the end of the previous word in typescript B (i. e. here “sterilization-”). I have kept them here as in typescript A, as they isolate two of the three key sentences situated at the beginning of the three parts of Dvorjetski’s talk. 45 Without a capital in the two original typescripts used. 46 On the following place names, sometimes spelled slightly differently than today, see the introduction to the text.

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I am a witness to the fact that the german doctors in October 1941, the German47 doctors took to their death all the mental patients from the Vilno Hospitals. Also that the German48 doctors ordered to 200 Jewish49 children from Kailis factory at Vilno to present themselves clean and well dressed for a medical inspection. The children were skinned alive and the skin from their faces was transferred on the German50 soldiers. After that the children dissappeared disappear. I have seen in the Vaivara’s camp near Narva in Esthonia German51 doctors ordering that the prisoners should be thrown in holes full of water and where their slowly died through the effect of cold. I have been a witness to the fact that the German52 doctor von Bottmann53 ordered in December 194354 to his assistant Sarfoter55 to kill with his digging tool all aged prisoners, sick or weak and to kill by [through] Rivanol injections all the chronic patients.56 I can also say that I have seen the same Doctor von Bottman ordered to be undressed have all the Jewish57 doctors undressed and he fustigated as they had refused to take part in such criminal action.

47 48 49 50 51 52 53

54 55

56 57

Without a capital in the two original typescripts used. Idem. Idem. Idem. Idem. Idem. Franz von Bodmann (also written Bodman or Bottman) was born in 1908 and committed suicide in 1945. He was an SS officer and served as a physician in several concentration camps, including Auschwitz. In Vaivara he supervised all the labor camps. See Birn, “Vaivara main camp” as well as Ernst Klee, Das Personenlexikon zum Dritten Reich: Wer war was vor und nach 1945, Frankfurt am Main: Fischer Taschenbuchverlag 2007, 57 – 58. “December 1945” appears on both English typescripts used. Corrected according to the French version of typescript B. Erich Scharfetter was a sergeant (Unterscharführer) in the SS, born in 1908, and who served as paramedic (Sanitäter) in various camps. In 1980 he was sentenced to life imprisonment by a West German court. See Friedo Sachser, “Central Europe: Federal Republic of Germany”, in: American Jewish Yearbook 82, 1982, 201 – 225, here 213. For further reading on the deeds of von Bodmann and Scharfetter, see Mark Dvorjetski, Jewish Camps in Estonia 1942 – 1944, Jerusalem: Yad Vashem 1970 (in Hebrew with an English summary), 168 – 183. Ibid. as well as Klee, 2007, 58. Without a capital in the two original typescripts used.

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I stop here as the list of horrors that I have seen and had to bear would be too long. ----In the For generations in the rooms of the Faculties Medical Faculties you can read the following words : Sedare dolorem opus divinum est ; the Nazi doctors58 have transformed the opus divinum into opus satanicum. ----The World’s Association of Doctors which is a Federation of the organizations59 and not individuals must take an attitude towards the c o l l e c t i v i t y of to-day’s doctors in Germany, this although there must be a small number of German60 doctors that have suffered from the humiliation of the human and medical moral in Nazi61 Germany. Two years already have passed More than two years have already elapsed since the fall of Hitler. Has the medical World heard the German62 medical Corporation express regrets and a great mea culpa for the crimes committed since 1935 ? As well as the sincere wish to atone for same. [3] Doctors from all countries ! You cannot remain indifferent before the [moral] results of such drama and which weighs63 on the conscience of the entire humanity ! The images of the millions of victims innocent victims from all nations should stand before us and amongst them thousands of doctors who have perished from the hands of the (their criminal) colleagues ; such images are awaiting the a n a t h e m a that should be pronounced against the criminal [Hitlerian64] science and against the doctors executioners65. 58 59 60 61 62 63 64

Spelled the “nazis doctors” in both original typescripts. Spelled “Organisations” in both original typescripts. Without a capital in the two original typescripts used. Idem. Idem. Spelled “weights” in both originals. Without capital in the two original typescripts used.

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We must keep in mind the remembrance of all the doctors who have resisted, either as mobilized in the allied armies or as volunteer partisans, when either when giving their life to the resistance sanitary and medical resistance in the ghettos and in the concentration camps. We must erect a monument to the remembrance of the “resistant” doctors “Resistant and Martyr” doctors. Can the victim and his murderer can (sic!) next to one another take place in an Association ? The victim – and the man who was ready to exterminate him ? And – the victims e v e n t u a l victims of science German66 criminal science were from all countries, all creeds and all races ! Will [Can] the generation of German67 criminal doctors, such generation who has given its sanction, its blessing to crime of Doctors, on the walls of which are written the words of Pasteur “I am not asking you which are your opinions nor your faith but what are your sufferings ?”68 S H E CA N N O T D O S O. Facing the great anxiety of the danger of penetration of an inhuman and destructive science – The World’s Medical Corporation must devote all its efforts towards the reinforcement of moral actions in the formation of all doctors and in the practice of their sacred profession. We must proclaim69 here the universal indignity against the immoral and prostituted science. From this World’s tribune we must let us throw the anathema against the murderer-doctors ! Let us proclame here cry here anew the eternal basis of the medical moral:70 65 66 67 68

Spelled “Executioneers” in both originals. Without a capital in the two original typescripts used. Idem. Various versions of this sentence exist. The original one was delivered by Louis Pasteur (1822 – 1895) on 8 June 1886, when he inaugurated the Maternal Refuge of the Philanthropic Society and it reads: “On ne demande pas — un malheureux : de quel pays ou de quelle religion es-tu ? On lui dit : Tu souffres ; cela suffit ; tu m’appartiens et je te soulagerai !”, see Louis Pasteur, “Discours prononc¦, le 8 juin 1886, — l’inauguration de l’Asile Maternel de la Soci¦t¦ philanthropique”, in: Louis Pasteur Vallery-Radot, Œuvres de Louis Pasteur, 7 vol., Paris: Masson 1922 – 1939, vol. 7 “M¦langes scientifiques et litt¦raires”, 410 – 412, here 411. 69 Spelled “proclame” in both originals. 70 Just a “.” in typescript A.

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Man thou are my brother.

Dr. Mark Dworzecki71 (Delegation of the Jewish Medical Association of Palestine)

71 People use various spellings for Mark Dvorjetski’s name. Dworzecki is the one he himself used in the immediate aftermath of the war, and the one under which his papers are deposited at Yad Vashem Library. However, he later used a Romanization of his name – Dvorjetski. It is under this last one that most of his publication may be found, and as his family kept this spelling, I decided to use it here. Sometimes one can also find Dvorzhetski.

Bund der “Euthanasie”-Geschädigten und Zwangssterilisierten / BEZ (Federation of Victims of “Euthanasia” and Forced Sterilization) (2008)

Margret Hamm (Managing Director)

Statement on the occasion of the conference Memories and Representations of the Nazi “Euthanasia”, Giessen University, 12 to 15 November, 2008

As an organization of Nazi victims of forced sterilization and “euthanasia”, we keep a watchful eye on bio-political developments in the society of the Federal Republic of Germany. In our view these developments harbor new selection mechanisms that threaten human life, both at its inception and at its end. In the following I would like to enumerate just a few examples of our reservations and concerns about human dignity. In 2006/2007 the Deutsche Hygiene Museum in Dresden presented the United States Holocaust Memorial Museum exhibition “DEADLY MEDICINE: Creating the Master Race”. The location was chosen because of the special role this institution played in education about “racial hygiene” during the Nazi period. But that is another matter. The media prize “Im Zentrum der Mensch” (“With a Focus on People”) was awarded parallel to the exhibition. A journalist won for his article “Der gute Tod” (“The Good Death”). The award-winning text dealt with the introduction of impunity for killing disabled newborns in the Netherlands. Without going into any details of his argumentation, what concerns me is that although this award was granted in the context of the above-mentioned exhibition in the Deutsche Hygiene Museum, it did not provoke any outcry in the media. The argumentation/award for “euthanasia” startled only critical observers, who attempted to prevent the presentation of the award – to no avail.

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Yet this principle of selection is nothing new. Back in the mid-19th century there were attempts to apply scientific means to improve the human gene pool, in order to separate the “superior” from the “inferior” and attain a more productive and healthier society. Binding and Hoche’s publication of 1920, Die Freigabe und Vernichtung lebensunwerten Lebens. Ihr Maß und ihre Form (“Permission for the Destruction of Life Unworthy of Living: Its Measure and Form”) propagated the thesis that the disabled and mentally ill would impede the advancement of society, such that caring for them was a kind of luxury. National Socialist ideology picked up on this and linked it with “euthanasia” as the solution to the problem. The connection between eugenics and an envisaged “euthanasia” is recognizable in a speech by Hitler in 1929. Quoted by the Völkischer Beobachter newspaper in August 1929: If Germany were to have one million children each year and eliminate 700,000 – 800,000 of the weakest, ultimately the result might even be an increase in strength” – (Völkischer Beobachter of 7 August 1929, quoted in Trus, p. 51.) “Genetic burden” and social deviation were criteria for selection at the time. People who were socially weak or disagreeable to the state were excluded from procreation with the goal of attaining a healthy, productive “body of the nation” (Volkskörper). German ancestry was thus not enough to belong to the National Socialist racial community (Volksgemeinschaft). “Productivity” and “usefulness” were just as important criteria. The victims’ chances of survival were subject to these criteria: failure to fulfil them resulted in murder. Depending on the demands of science, their bodies or body parts could then be used for research. How do we conduct the debate about “euthanasia” today? What are the areas and terms used to approach the goal geneticists still aspire to: attaining a healthy, productive society in which only the strong and healthy have the right to exist (with human dignity)? These selection mechanisms are flanked on the political level by legislative procedures (for instance on PID, on changes in guardianship law), as well as by so-called “health service reform”. Attempts are being made to selectively influence and intervene in the beginning and the end of human life. In my view, today’s debate about assisted suicide/”euthanasia” must also include the discussion about brain death, as the boundary between life and death, and also about transplantation law. For example: Since 2005, of the 1220 persons from whom body parts were removed after determination of brain death, only 5.8 % had consented during their lifetimes to having their organs removed. (BioSkop No. 38, p. 8). Ultimately the debate concerns health service resources, which are scarce, as well as finding ways for the health service sector to save money on those who

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cannot afford good medical care. And it appears that this goal can actually be reached through the legalization of and legal protection for living wills. Bearing in mind that the subject has been outlined only briefly, let me conclude by attempting to summarize the BEZ’s current position on the subject of “euthanasia” and the topicality of this debate: Today’s science would like to use pre-natal selection or the manipulation “of society”, like the eugenicists back in the Nazi era, to attain the healthy, productive human being. For instance, by doing whatever is possible to prevent the birth of children with disabilities. Thus a new study from 2005 by Thomas Lemke, a social scientist in Frankfurt, asked patients with Huntington’s disease about their experiences with discrimination in everyday life. (This disease was also listed in the National Socialist “Law for the Prevention of Genetically Diseased Offspring”.) The result? Doctors often convey to couples that their desire to have a child is unwelcome. A comment from one hospital doctor is quoted as follows: “The Nazis had all of them sterilized, and that was the best thing they did.” (Süddeutsche Zeitung, “Angst vor Ausgrenzung”, 5 April 2005) If the elderly, to whom the victims of forced sterilization and “euthanasia” belong as well, have not died from a failure to receive adequate medical care, bowing to social pressure and citing the utilitarian argument, it is quite possible that their final years might be cut short through assisted suicide/“euthanasia” (e. g., by applying a living will). The Federation of Victims of “Euthanasia” and Forced Sterilization opposes this vision. We stand for guaranteeing human rights for all groups of society, regardless of an individual’s productivity, genetic makeup and state of health. Why are we not seeking alternatives, in politics and society, to halt this development in which the elderly, the ill and the disabled are degraded to customers or goods, or treated as a cost factor or “module element” in care sector? The concept of “dignity” is frequently mentioned in the debate about assisted suicide/“euthanasia”. Yet as the French sociologist David Le Breton said, “Dignity is not a condition, but a social relation”.

Bundesärztekammer / BÄK (German Medical Association) (2008)

The President, Prof. Dr. Jörg-Dietrich Hoppe

Statement on the occasion of the conference Memories and Representations of the Nazi “Euthanasia”, Giessen University, 12 to 15 November, 2008

After the war, the medical community (Ärzteschaft) was late, too late, in admitting the guilt of doctors in the time of National Socialism. Although German Medical Assemblies (Ärztetage) already occupied themselves with the Nazi era soon after the war, and – under the influence of the Nuremberg trials – also addressed the role of medical science, in the post-war period there was no real examination of the misconduct and crimes committed by doctors until well into the 1970s. Not until Prof. Dr. Karsten Vilmar took office as president of the German Medical Association (Bundesärztekammer) were the taboos more intensively removed from the subject: “The shame will always remain; we can never overcome the past”, said Vilmar at the 90th German Medical Assembly in Karlsruhe in 1987. All that remains for these physicians is “perhaps the grace of forgiveness but never that of forgetting.” Two years later in 1989, at the 92nd German Medical Assembly in Berlin, the medical historian Prof. Dr. Richard Toellner, from Munster, delivered a presentation on “Physicians in the Third Reich” which met with much resonance. On the occasion of the German Medical Assembly in Berlin the local Medical Association organized an exhibition on this subject. The 99th German Medical Assembly in Cologne then dealt with the involvement of the medical community in National Socialist crimes as an independent subject at the German Medical Assembly – 50 years after the Nuremberg Trials. Since then, the German Medical Association has on several occasions publicly admitted that the organized

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medical community was not only involved in National Socialist crimes, but that it had actively supported them. The truth is: In the time of National Socialism doctors caused, arranged, or mercilessly administered death and suffering upon human beings. Critical doctors who publicly raised their objections were few and far between. The vast majority of doctors kept silent or were in agreement. To this day the atrocities have not been fully dealt with. In recent years, however, the German medical community has occupied itself very intensively with the crimes physicians committed, and actively supported initiatives to research the role of doctors in the Third Reich. The realization that both male and female doctors not only turned their heads and kept quiet, but also actively participated in the murder of the sick and marginal groups within society, is not bearable. Research, however, shows that it was not cowardliness and opportunism alone which influenced some physicians, but also their conviction: The National Socialist ideology fell on fertile ground among the medical community. The crimes of “euthanasia” are thus a striking reminder to defend basic medical values against the zeitgeist and against government interference. The victims remind us never to allow such crimes to happen again at the hands of doctors. Therefore we must keep the memory alive. The past cannot be overcome. What happened cannot be undone. All that remains, however, is the responsibility of keeping the past alive in the present so that lessons can be drawn from it. The conference of Giessen University’s Institute for History of Medicine can, in this regard, be an important contribution in clarifying the role of the organized medical community in dealing with the darkest chapter of German medical history.

Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN (German Association for Psychiatry, Psychotherapy, and Nervous Disorders) (2008)

Statement on the occasion of the conference Memories and Representations of the Nazi “Euthanasia”, Giessen University, 12 to 15 November, 2008

The German Association for Psychiatry, Psychotherapy and Nervous Disorders (DGPPN) is the professional association of the German psychiatrists and psychotherapists with more than 4.400 members. The Association sees itself in the social, health care political and professional responsibility, to resolutely and insistently advocate an appropriate needs and desires based psychiatric care of the people who are mentally ill, to respect and strengthen their rights. The DGPPN has every reason to bear in remembrance the terrible crimes perpetrated by the National Socialists to the lives of people with mental illness and people with disabilities The Association holds this position especially in regard to the National Socialist forced sterilization law, the multiple forms of murder of the mentally ill and disabled people, and the misuse of these people for inhumane experiments. The DGPPN recognizes that many representatives of psychiatry and neurology, among them influential academic teachers, participated in the ideological preparation, the implementation, and the perfection of these National Socialist crimes. The DGPPN is using their histories and the culpable legacy of its delayed coming to terms with the past as an opportunity to position itself in the broad remembrance movement of the victims. The Association supports the diverse efforts of the expert community and public to meticulously reconstruct the events of those times. The DGPPN therefore actively supports the establishment of permanent memorial sites. Within its own expert community, the Association will also maintain and advance a dignified culture of remembrance. This re-

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membrance also applies to those psychiatrists who were persecuted, displaced, or murdered due to racial or political motives. The DGPPN, in cooperation with experts in medical history, is dedicated to precisely elucidate its own history and that of the psychiatric field in general before, during, and after the National Socialist dictatorship. In doing so, emphasis will be placed on the reconstruction of the historical, scientific and political interactions, on the activities and ideological influences of particular representatives of the field, as well as on the involvement of individual institutions of patient care, teaching, and research. The DGPPN, particularly in regard to those physicians starting their careers in our times, will teach the necessity of truthfully reconstructing and understanding the past, and keeping an honorful memory of the victims. The DGPPN is guided by the understanding that on the one hand, the National Socialist crimes in psychiatry had their roots in the merciless, inhumane National Socialist ideology. On the other hand, diverse social, political, careerpolitical, and expert opinion based currents and motives provided fertile soil for the willingness of many in the psychiatric and other medical fields to actively assist in, condone, or tolerate these crimes. The DGPPN will draw consequences of its history during the National Socialist regime in the form of an intensified effort of coming to terms with the past and advocating the development of a culture of remembrance within psychiatry. Consequences will also be drawn for its present practice as a scientific society. The DGPPN is of the opinion that many of the currents and motives that contributed to the National Socialist crimes in psychiatry belong by no means exclusively to the past, but are rather virulent today. This makes it ever more important to connect the historical knowledge with present and future challenges. Especially the historically proven correlation between times of economic crisis and the questioning of state responsibility in social service provision, as well as the critical analysis of societal efforts for the weak, ill, and needy people in the framework of a contemporary debate on rationing health services demand special attention. In lieu of the rejection of medical doctors’ responsibility during the era of National Socialism, the DGPPN dedicates special attention to social, political, and ethical dimensions. This entails explicitly discussing these dimensions as an imminent part of every medical treatment. This implies paying special attention to particularly disadvantaged and vulnerable social groups and their specific needs in professional psychiatric help. The DGPPN will address this issue and inform the public and health care policy decision makers of the correlation between social situation and mental health and/or its impairment. The DGPPN will continue and expand its engagement in the struggle against the stigma-

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tization of mentally ill people within society as a whole and especially within the health care system. The DGPPN will continue its engagement for the further development of the psychiatric support system. It calls for medical doctors’ responsibility for the active assistance of those mentally ill people whose illness cannot be cured to the degree hoped for, and who, particularly with permanent mental disorders, need appreciation, encouragement, and assistance. The DGPPN rejects a patriarchal model of medical treatment. The Association holds that professional treatment can primarily gain its legitimacy through the dialogue with the patient; and by respecting the patient’s right of self-determination. With this in mind, the DGPPN will advocate the undiminished human and civil rights for mentally ill and disabled persons.The DGPPN is especially engaged in the recognition of cultural diversity as a fundamental condition of respect for all mankind, and for a non-discriminating structuring of living and working conditions for people with mental disorders and disabilities. Only thus can barriers be torn down and can discrimination be stopped, and the chances of social participation be improved. In the complete and undiminished recognition of the human and civil rights and their advancement for people with mental disorders and disabilities, we find the guarantee that events such as the National Socialist crimes in psychiatry will not reoccur. Prof. Dr. Wolfgang Gaebel President of the DGPPN

Prof. Dr. Michael Seidel Chair of the DGPPN-Working Group for Mental Disorders in People with Intellectual Disabilities

Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ (German Association of Child and Adolescent Medicine) (2008)

The President, Professor Dr. Fred Zepp

Statement on the occasion of the conference Memories and Representations of the Nazi “Euthanasia”, Giessen University, 12 to 15 November, 2008

Ladies and gentlemen, dear Professor Roelcke, Thank you very much for the invitation to this conference. The German Society of Pediatrics and Adolescent Medicine regards it as a honor, as well as a responsibility to take a position on the involvement of physicians, especially pediatricians, during the Third Reich’s dreadful “Euthanasia”-programs. Many pediatricians at that time involved in these crimes against humanity may have died over the past decades, nevertheless, active remembrance of these horrible events combined with our serious commitment to face guilt and responsibility are fundamental in preventing any future deterioration of humanity again. The German Society of Pediatrics and Adolescent Medicine represents one of the oldest medical associations caring for the health and well-being of children and adolescents. Just a few months ago, at our annual meeting in Munich we celebrated the Society’s 125th anniversary. The German Society of Pediatrics has deep roots and a long-standing academic tradition. It emerged from the ever growing recognition of the specific needs of infants, children and adolescents, the understanding that physiology, pathophysiology and nosology of the pediatric population differs significantly from medical sciences in the adult population and, last but not least, from an unlimited desire to improve the well-

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being of children and adolescents. Over the 125 years of its existence, the German Society of Pediatrics and Adolescent Medicine has facilitated progress in the field of pediatrics in many ways, but we also have to recognize that during a critical and dark period of our German history, members of our society were involved in the most detestable crimes against humanity. During the Nazi era, it was argued that children who were physically or mentally handicapped represented so-called worthless lives: “lebensunwertes Leben” as it was phrased then. This ideological view was complemented by an alleged logical, economic approach based on considerations like efficiency and questions of social costs. Thus, the extermination of individuals considered worthless for the prosperity of the Nation became an integrate part of the Nazi state’s ideology. 1933, Nazi-Secretary of Interior Frick argued for the implementation of a law to prevent hereditary diseases and reasoned that “sick, weak and inferior individuals” should be prohibited from reproduction by means of “selection and elimination” in order to improve the “quality of the German Nation”. This attitude culminated 1939 when Nazi politicians, supported by pediatricians started to register physically or mentally handicapped children. Soon many of these children were transferred to specific “pediatric departments” – “Kinderfachabteilungen” – either to be murdered or to participate in unethical clinical research projects. The historical reappraisal of these events, the documentation of whoever were involved – pediatricians, scientists, hospitals and institutes – is an important obligation to our Society. It is mandatory for us to keep the memory vivid and to sharpen our conscience. Many important documents were intentionally destroyed at the end of the war, thereby obstructing the historical exploration of these events. To facilitate this research, the German Society of Pediatric and Adolescent Medicine, more than 20 years ago, implemented the “Committee on the History of Pediatrics and Adolescent Medicine in Germany” dedicated to elucidate the history and involvement of our profession during the Nazi regime. This Committee has received continuous support from the Society’s executive board since its founding. I am confident that many in the audience are aware of the book authored by this committee describing the fate of Jewish Pediatricians in Germany between 1933 and 1945, which was published under the auspices of our society. In recent years the Historical Committee has focused its research on the child and adolescent “Euthanasia”-program in National Socialist Germany. To this end, the Historical Committee launched a special working group. This group has regularly presented its results at the annual meetings of the Pediatric Society. In 2003, we published a special edition of the “Monatsschrift für Kinderheilkunde”, the official monthly scientific journal of our Society focusing on the topic of

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“Euthanasia”. This publication represents a widely recognized scientific evaluation of the role of German pediatricians in the era of the Nazi regime. But it takes more than just pointing to the role of German pediatricians in the years between 1933 and 1945. Commemoration of any kind is a crucial aspect. The Society plans to establish a commemoration ceremony dedicated to the victims of child and adolescent “Euthanasia” during the annual meeting of the Society to be organized in 2010 in Potsdam. Some of you will also remember that in 1998 in Dresden the Society organized a public ceremony commemorating the Jewish colleagues who were persecuted, expelled and murdered during the Nazi era. The German Society of Pediatric and Adolescent Medicine feels obliged to call to mind all the children and young adolescents who were brought to death by pediatricians and other medical staff in the years after 1939. While today it is difficult for new generations to imagine that pediatricians, who were compelled to assist children and to save theirs lives participated actively in exterminating them – for our Society it is of upmost importance to keep the memory alive and actively contribute to prevent that such crimes against humanity ever happen again. The discussion about the value of life, however, is not just a historical subject; rather today it is as evident as ever before. Modern research has provided us with extensive insight into the molecular and genetic basis of human life and human diseases. The continuously growing knowledge in life sciences creates means to interfere with early human development, manipulate genetic information and modify imprinting of inherited traits or biological concepts. The ethical implications and the answers necessary to these challenges presumably will become even more difficult as diagnostic techniques improve and become widely available. For pediatricians this is particularly evident in the field of pre-implantation diagnostics and prenatal diagnostics. Given the tools of modern molecular medicine, pediatricians are increasingly confronted with emerging discussions concerning the value of the life of a human being or even an embryo. Only a couple of weeks ago in the United Kingdom the BBC reported that a large fertility clinic in London has announced to screen at least 15.000 disease-related genes for less than 2000 E at a very early embryonic stage. Such considerations have become part of the daily routine in the field of preventive medicine, e. g. with intra-pregnancy diagnostics, neonatology or counselling before abortion, especially if abortions are discussed for medical reasons in a late stage of pregnancy. In these discussions, the relevance of a potential handicap, its impact on the quality of life and its presumptive negative worth for the individual and the society do play a role. Today modern medicine

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is in the position to prevent handicapped life, and in many cases, with the consent of the mother or both parents, this is actually done. The decision between the interest of the mother-to-be and the right to life of the unborn child poses most difficult considerations. Should the doctor respectively the pediatrician always decide in favor of the child ? – Which considerations and ethical values regarding the mother and the family must be taken into account ? – Some years ago, the German Academy of Pediatrics and Adolescent Medicine (DAKJ), the umbrella association of the Pediatric Societies in Germany, published a position paper on pre-implantation diagnosis, focusing on the view of pediatricians. At that time the Academy has refrained from giving definite answers to such questions. At the end of the day, any individual doctor has to reflect on his or her own conscience. Nevertheless, it is the shared conviction of the members of the German Society of Pediatrics and Adolescent Medicine that active remembrance and knowledge of child and adolescent “Euthanasia” during the Nazi regime must guide us in developing this conscience. Despite the progress of modern societies, we have to keep in mind that never in the history of mankind or in the development of medical sciences we have been provided with the knowledge and insight to decide or counsel on the value of life. Modern medicine is walking a tight rope between the chance of creating enormous benefits for those entrusted to us or running the risk of causing disastrous harm to mankind. We have to recognize that the intention to prevent a handicapped life in some aspects represents a characteristic of mankind ever since the evolution of the ancient world. This by no means will ever put the crimes of the Nazi regime in relative terms, but it hints at the complexity and the deep-rooted status of this question within western societies and culture. The vivid commemoration of our history, our responsibility as well as the guilt weighing on the shoulders of our profession hopefully will guide us to cope with the duties and challenges of a modern, ever faster changing world.

Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin / DGSPJ (German Association for Social Pedicatrics and Youth Medicine) (2008)

Statement on the occasion of the conference Memories and Representations of the Nazi “Euthanasia”, Giessen University, 12 to 15 November, 2008

The Deutsche Vereinigung für Säuglingsschutz (German Society for the Protection of Infants) was founded in 1909 to improve the health of all children, especially in the first years of life. Later this became part of the field of social pediatrics. Before 1933 nearly 50 % of all pediatricians in Germany were Jewish and many of them were very active in this field, including Arthur Schlossmann and Heinrich Finkelstein. They were all forced out of their practices and the scientific societies, and many of them were cruelly persecuted or even killed. In 1934 the Deutsche Vereinigung für Säuglings- und Kinderschutz (German Society for the Protection of Infants and Children; renamed in 1920) was merged with the new National Socialist organization Reichsarbeitsgemeinschaft Mutter und Kind. After the Second World War it was re-established in 1948 – under the unencumbered name of 1920 – partly by former members of the NSDAP. Many of these pediatricians had been more or less involved in the registration and examination of disabled children, some even in the killings. In the 1950s, the discussion about “unworthy life” re-emerged in Germany, actuated especially by Werner Catel (1894 – 1981), former director of the Children’s University Hospital in Leipzig, initiator and main consultant to the program of killing disabled children (Kinder-Euthanasie) and since 1954 director of another Children’s University Hospital, now in Kiel. He argued for the possibility to kill “totally idiotic children”. It was the pediatrician Theodor Friedrich Hellbrügge (1919 – 2014), who protested first and intensively against this argumentation. Since the early 1960s he had been the most active motor for the concept of rehabilitating disabled children in Germany, founding the Sozialpädiatrische Zentren (Social Pediatric

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Centers), introducing special physiotherapeutic and pedagogic methods and implementing many preventive activities for children. Today the main activities of the successor organization, now called Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin – DGSPJ (German Society for Social Pediatrics and Youth Medicine; change of name in 1996), are: – primary public health prevention, especially by informing society and empowering the public health service – individual secondary prevention through early recognition of developmental delays, screening procedures, e. g. for early detection of metabolic diseases and the vaccination of every child – so called tertiary prevention or rehabilitation of infants and children with developmental disorders, disabilities and chronic diseases, e. g. in the Social Pediatric Centers and special institutions for (re)habilitation. The basic aspects of treating children with developmental disorders in Germany today are: – early diagnosis by distinct anamnesis and clinical examination – extensive consultation with and support for the parents – application of therapeutic procedures with clear indications and definition of aims and – social support through specialized social counselling. Today’s main considerations, especially in the field of genetic diseases in children with developmental disorders, are: – no genetic diagnosis in fetuses, infants and young children without the agreement of the parents or the caregiver, respectively – no predictive diagnostic procedures in children, e. g. for neurodegenerative diseases, genetic forms of cancer or the disposition for intellectual or somatic disabilities, without clinical symptoms – in older children and adolescents under 18 years of age, all information and agreements on genetic counseling, therapeutical and surgical procedures should be provided to the caregiver as well as to the individual concerned – the prevention of connatal disabilities and chronic diseases can be supported in many aspects, e. g. by discouraging the use of alcohol, drugs and tobacco during pregnancy, by providing iodide and folic acid supplements to food before pregnancy, and by regular screening examinations of mother and child during pregnancy – prenatal diagnosis, e. g. by ultrasound, is advisable before the 12th week of gestation in order to detect severe congenital malformations. Amniotic fluid examination should be done only if parents wish to terminate the pregnancy

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in the case of a positive result. Fetal killing after the 12th week and preimplantation diagnosis is indicated only in very special individual situations. In the case of connatal or acquired disabilities there are several principles for the treatment of the children and the support of the entire family : – diagnosis should be performed according to the International Classification of Functioning for Children and Youth (ICFCY) regarding multidimensional somato-psycho-social aspects – the most important part of therapy is the support of all activities by the patients with special needs, especially motor and social activities, e. g. through play, sports, various forms of communication and fun – stabilization of family structures, social integration and adequate information for the caregivers are very important, especially to avoid doubts and uncertainties. Prenatal diagnosis cannot reveal all abnormalities of a newborn child. Even in the long-term future there will always be children with special needs in our society. In a smaller group of these patients special therapies, be they conservative or invasive, can be very successful, but they generally can improve but not “normalize” the disability. It is important that the families of these children have no consciousness of being “guilty”, especially the mothers. In advanced societies, persons with special needs have the legal right to support and optimal treatment and this can be improved in many ways. On the other hand, many unnecessary and sometimes harmful procedures are offered to those affected – these should be reduced or even prohibited. The cruel way many pediatricians and their co-workers handled multidisabled children especially during the Nazi era, and the memory of all victims between 1933 and 1945, continually challenges us to prevent these ideas from finding new traction, and to seek an adequate way to address the highly difficult ethical problems associated with the treatment of all disabled persons. Prof. Dr. Hans Michael Strassburg President of the DGSPJ 2009 – 2012

Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ (German Association of Child and Adolescent Medicine) (2010)

The President, Prof. Dr. Fred Zepp

Statement at the Memorial Event of the DGKJ, 18 September 2010, Potsdam

In 2008, the German Association of Pediatrics and Adolescent Medicine celebrated its 125th anniversary. Our scientific society currently has more than 14,000 members, over half of whom are below the age of 45 and were thus born more than 20 years after the end of the Second World War. Following a prolonged period of collective suppression, it may have been this age structure that allowed several well attended and successful scientific symposia on the subject of “Pediatrics and National Socialism” to take place during our annual conferences in the past decade. The memorial service for racially and politically persecuted pediatricians during the NS period, which took place in Dresden in 1998, was a particularly important event in the ongoing process of coming to terms with “National Socialism in Pediatrics”: The task of documenting the histories of pediatric colleagues who were persecuted, expelled or murdered after 1933 was given to us by the board of directors and the general meeting of the German Association of Pediatrics and Adolescent Medicine. This documentation has meanwhile been published in a new extended edition and has attracted the highest praise and acclaim at the international level. In recognition of the fact that, for a very long time, nothing had been done to clarify the role played by pediatricians during the NS period and that our society addressed its responsibility in this matter at a rather late stage, we are in the process of taking a second important and difficult step in coming to terms with the history of German pediatrics in the years 1933 to 1945. Today, we commemorate the underage victims of the inhuman NS medical “selection and culling” program, which also involved the assistance of many pediatricians.

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We commemorate the children and adolescents that were segregated from the so-called Volksgemeinschaft, the national community, sent to asylums and sterilized, who were used for human experiments and thousands of whom became part of the organized murder of sick children during the Second World War. Instead of perceiving these sick and disabled boys and girls as patients or wards under their protection, their doctors and caretakers used them in dubious experiments, deported them and killed them. Doctors and nurses betrayed, in the worst possible manner, the universal dependence of children on adults, the trust children naturally place in those responsible for their care. Even the parents and families were intentionally deceived: In many cases, they handed their children over in the hope that they would receive modern and promising treatments. Until the end of the Second World War, over 10.000 children and adolescents fell victim to various programs promoting the extermination of “life unworthy of living”; pediatricians referred many of them to politically indoctrinated state health authorities, inspected them, used them for experiments and caused their deaths. […] The scientific findings of the past years bring us face to face with the fact that even pediatricians disregarded the physical integrity of their patients and abused them for politically motivated gains. It was the doctors themselves who pronounced the death sentences on the children entrusted to their care and who gave them lethal doses of Luminal. It was doctors who observed numerous children starving to death in the “Special Pediatric Sections” without having to fear any legal consequences for their actions. We acknowledge the intellectual co-authorship and active involvement of pediatricians in these crime; we furthermore deplore all forms of non-resistance and conformity of opinion without which the regime could not have functioned and which allowed the perpetrators to commit their crimes; crimes that took place not in far-away places and occupied territories but in the midst of everyday life in Germany, in doctors’ surgeries and hospitals, government offices and scientific institutions. The complete disclosure of historical details and the shedding of light upon the darkness of one’s own past is a process that is without doubt painful. At the same time, we hope that by accepting the truth, acknowledging guilt and facing this responsibility, we are offering an appropriate apology to the victims and their families, many of whom are still suffering from the consequences of these acts. We cannot efface their suffering, but we can become aware of it and must not cease to concern ourselves with the past and search for ways of working through it. With the first steps towards the systematic processing of the NS past having been taken, the German Association of Pediatrics and Adolescent Medicine is committed to its task.

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We must stand up for the prevention of segregation and the violation of human dignity and ensure that inhuman ideologies do not gain a foothold. Ladies and gentlemen, all branches of science, especially bio-science and medical disciplines, must have clear ethical and legal boundaries. With regard to research and patient care, the protection of individual human dignity and human rights must come before the importance of any set targets. Science is bound by the essential rights and inviolable dignity of every individual. Children and adolescents are entitled to the same rights. National Socialist ideology largely acquitted doctors and researchers from their responsibility to their patients by placing its focus on the alleged higher values and political interests of the “national community”. We must confront the fact that many pediatricians lacked the strength to withstand temptation. They contracted a terrible debt of guilt not only with regard to themselves but also to the name of German pediatrics as a whole. We humbly bow to the victims and their families. In the name of the German Association of Pediatrics and Adolescent Medicine, we ask them for forgiveness for the suffering inflicted upon them by pediatricians during the NS period.

Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN (German Association for Psychiatry, Psychotherapy, and Nervous Disorders) (2010)

Annual Assembly of the Association, November 2010 The President, Professor Frank Schneider, Aachen Psychiatry under National Socialism – Remembrance and Responsibility

Ladies and Gentlemen! Under National Socialism, psychiatrists showed contempt towards the patients in their care; they lied to them, and deceived them and their families. They forced them to be sterilized, arranged their deaths and even performed killings themselves. Patients were used as test subjects for unjustifiable research – research that left them traumatized or even dead. Why has it taken us so long to face up to these facts and deal openly with this dark chapter in our history? Although we are proud that the German Association for Psychiatry and Psychotherapy (DGPPN) is one of the oldest scientific medical associations in the world, for too long now we have been hiding, denying a crucial part of our past. For that, we are truly ashamed. It is also a disgrace that we, the DGPPN, did not even stand up for the victims in the period after 1945. Worse still, we were partially responsible for the renewed discrimination that they faced in the post-war period. We are at a loss to explain why we are only now in a position to hold an event such as this. I stand before you today as President of an association that has taken nearly 70 years to end this silence and recall the tradition of enlightenment through science in which it stands. An independent scientific commission is currently overseeing a research project that is addressing the history of the association, or rather its predecessors, in the period between 1933 and 1945. But this is not enough. Irrespective of any research results, which we expect to receive in the next few years, I must offer our sincerest apologies – albeit

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shamefully late – to all the victims and their families who suffered such injustice and pain at the hands of the German associations and their psychiatrists. The German Association for Psychiatry and Psychotherapy has decided to give a clear signal by holding this commemorative event as a way of acknowledging and of standing up for the victims, of coming to terms with our past and of learning from this bleak period in our history. Ladies and gentlemen, welcome to this commemorative event. It is wonderful to see so many of you here and I would like to take this opportunity to thank you all for coming. The letters and documents we have just heard at the beginning of this commemorative event provide moving testimonials of the pain and suffering that mentally ill people were subjected to. Psychiatry under National Socialism is one of the darkest chapters in the history of our discipline. Throughout this period, psychiatrists and representatives of psychiatric associations repeatedly disregarded and heinously reinterpreted their professional duty to treat and care for their patients. Psychiatry was corruptible and it corrupted, it cured and it killed. It no longer felt it had an obligation to individuals; rather, in the name of supposed progress – the liberation of an entire society from the burden of providing welfare, improvements in the genetic makeup of an entire nation and, ultimately, humanity’s “deliverance from misery” – psychiatrists abused and killed vast numbers of people. They also saw to it that any undesirable colleagues were forced out of their jobs. It is important to remember that between 1933 and 1945 many of the psychiatrists working in academia emigrated from the Reich. They did not leave voluntarily. Psychiatrists of Jewish descent or those who had the wrong political views were forced out of their jobs and had to stop practicing. They and their families lost their livelihoods, their belongings – and all too often their home country. Driven out of Germany, they had to create new lives for themselves as strangers in an unfamiliar, foreign land. Most of those who could not flee Germany or Austria were deported to concentration or extermination camps. Few survived, and nothing we do can ever make up for the fate they suffered. This was all happening at a time when psychiatric research in the Reich was becoming increasingly focused on eugenics and “racial hygiene”. National Socialist healthcare, social and economic policies favored those who would most benefit the nation’s health and productivity. The weak were to be eliminated so that the strong could become even stronger. This devastating approach was nothing new. The term “eugenics” had been in use since the late 19th century, and the practice of sterilizing mentally ill patients was being promoted in the Scandinavian

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and Anglo-Saxon countries as well as in the German Empire. In the summer of 1914 a proposed Bill on Sterilization and Abortion was put forward in the Reichstag. It was only the outbreak of war that stopped the bill passing into law. On 14 July 1933, not long after Hitler seized power, the NSDAP passed a Law for the Prevention of Hereditarily Diseased Offspring. The psychiatrist Ernst Rüdin, who was President of the psychiatric association from 1935 to 1945, was involved in writing the official commentary to the law when he was director of the German Research Institute for Psychiatry. The law described sterilization – forced sterilization – as “protecting future generations”. This is a truly perverse view that offsets one person’s pain and suffering against another’s wellbeing. The law classed manic-depressive illness and schizophrenia as genetic mental illnesses. The same applied to many other conditions, such as hereditary forms of epilepsy, blindness, deafness, dwarfism, etc. The idea was to stop sick people having children so that their supposedly bad genetic material did not continue to pollute the health of the Volk. All doctors were obliged to report “hereditarily diseased” individuals to the authorities. Under the law, doctors forcibly sterilized more than 360,000 people. Over 6,000 died as a consequence of the operations. Since the concepts of eugenics and racial hygiene were so popular at the time, many psychiatrists held the sterilization law in high regard. As President of our predecessor organization, the Society of German Neurologists and Psychiatrists (Gesellschaft Deutscher Neurologen und Psychiater, GDNP), Ernst Rüdin spoke in its favor several times at the openings of annual congresses. Other countries around the world also supported eugenics-based sterilization. However, what set Germany apart was the fact that its law allowed people to be sterilized against their will. For its victims, the legislation was an appalling attack on the very core of their identity – an attack they were powerless to stop and that permanently robbed them of their right to physical integrity and to parenthood. Even once the war had ended, shame and silence continued to shroud what the victims and their families had endured. To this day the Federal Republic of Germany has still not formally recognized these individuals as victims of Nazi persecution, despite the fact that the sterilization law was an unequivocal expression of National Socialist, German racial ideology. The commentary to the law makes this very clear : “What is the aim of measures for the genetic and racial hygiene adequate for the German Volk? The existence at all times of a sufficient number of genetically healthy large families that are racially valuable to the German people.” At this point I would like to express my admiration for Dorothea Buck. The sculptor and author, who was herself one of the victims, co-founded the ‘Federal Organization of (Ex-) Users of Psychiatry’ in Germany. She has tirelessly dedicated herself to raising awareness of the issues and to ensuring that they are not

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forgotten. Klara Nowak, who passed away years ago, was another such person. Ms Nowak’s 1987 initiative resulted in the creation of the ‘Federation of Those Affected by “Euthanasia” and Forced Sterilization’ which until recently fought for the social rehabilitation of victims. Yet the violence did not end at forced sterilization – people were also murdered. In the 1920s, as a result of the World War and the Great Depression, disabled people began to be seen as financial burdens. Psychiatrist Alfred Erich Hoche published Allowing the Destruction of Life Unworthy of Living in 1920 in collaboration with the lawyer Karl Binding. In it, he coined the term “human ballast” and drew up a list of allegedly incurable mental illnesses that rendered sufferers “mentally dead”. This provided the basis for the call for “death to life unworthy of life!” published in 1930 in the National Socialist monthly bulletin. Later, Hitler issued a decree to start a “euthanasia” program. It was backdated to 1 September 1939, the date that Germany invaded Poland and World War II began. Professor Werner Heyde, chair of psychiatry and neurology of Würzburg University, was appointed Medical Director of the program that would later become known as “Aktion T4”. It is thought that, by the end of the war – and even several weeks afterwards – Aktion T4 and the killings that took place once the program had officially ended claimed the lives of at least 250,000 to 300,000 mentally and physically disabled people. From October 1939, all psychiatric hospitals and associated areas in the Reich received registration forms from Columbushaus on Potsdamer Platz, and as of April 1940 from Tiergartenstrasse 4, where the Berlin Philharmonic stands today. The forms were used to systematically record all patients and select who should die. Decisions were mainly based on “usefulness” criteria, that is, on how much work a person was capable of. Today, at the site of the former central administration-office for the killings all that commemorates the “euthanasia” victims is an indistinct plaque in the ground and a sculpture that was only dedicated to them upon completion. There is still no central, national memorial to the victims. This is a clear expression of the continuing denial surrounding the events, and of the humiliation that the survivors and their families still endure. It also represents a blind spot in the collective memory of our country and of German psychiatry. We at the DGPPN will be supporting current efforts to establish an appropriate national T4 commemorative and information center. Approximately fifty selected assessors, some of them renowned psychiatrists, evaluated the registration forms they received from the hospitals and decided who would live and who would die. Among the assessors were Werner Villinger, Friedrich Mauz and Friedrich Panse, all of whom held the office of President in our association during the post-war period. Friedrich Mauz and Friedrich Panse also later became honorary members. Although membership ends with the

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death of the individual, we condemn both these cases and will formally revoke the honours. Patients selected for death would be collected from their hospitals in grey buses that have now come to symbolize the killings, and taken to one of six mental institutions equipped with gas chambers. Medical facilities thus became extermination centers. Healing became destruction. Psychiatrists watched as the patients entrusted to their care were taken away to be murdered. In the order they were established, the six institutions were: Grafeneck, Brandenburg, Hartheim, Pirna-Sonnenstein, Bernburg and Hadamar. “Aktion T4” lasted nearly two years, from January 1940 to August 1941. Within that time, over 70,000 patients were killed. The public protests that eventually spelled the demise of the program did not come from the ranks of the psychiatric profession, but predominantly from the Church. The crucial sermon against the killing-program was delivered on 24 August 1941 by Clemens August Graf von Galen, Bishop of Munster and Cardinal of the Roman Catholic Church. “Aktion T4” was officially stopped immediately afterwards. But the Nazis took the knowledge and experience gathered during “Aktion T4” and applied them to the concentration camps to murder even more people – this time in their millions. At the same time as they were implementing Aktion T4, the Nazis were also murdering physically and mentally disabled children in over 30 psychiatric and paediatric hospitals as part of what is usually called “child euthanasia”. Previously it was thought that approximately 5,000 children had died. This figure was given by the perpetrators during post-war trials and then generally accepted as true. We now know that the actual number was far greater. And yet the killing continued, even after the centrally organized “Aktion T4” was officially stopped. During this decentralized phase of “euthanasia”, doctors in psychiatric facilities seeking to free up beds and save money killed patients – possibly many 10,000 – by administering overdoses or providing them with so little food that they starved to death. In a report on new admissions in 1943, Gerhard Wischer, director of the Waldheim psychiatric hospital, put it very succinctly : “Of course I could never accommodate the new patients without undertaking certain measures to free up space. The process itself is very straightforward, but there is a distinct shortage of the necessary medication.” Today it is hard to imagine that psychiatrists allowed patients in their care to be killed, that they chose who should live or die and then medically, scientifically – well, pseudo-scientifically – oversaw the deaths of children, adults and elderly people. An entry in a medical file from 1939 on a female patient suffering from a schizophrenic disorder, which is archived at the Federal Archives here in Berlin,

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reads as follows: “As before. Mentally dead. No change can be expected, so medical record should be closed. The only entry worth making is the date of death.” Before they were murdered, many patients were used for “research”. This involved ethically unjustifiable experiments that are far removed from scientific and research values. One example is the “euthanasia”-related experiments on mentally ill children and teenagers by Carl Schneider, Chair and Professor of Psychiatry at Heidelberg University, in collaboration with Julius Deussen, an employee at the German Research Institute for Psychiatry in Munich. The research involved elaborate experiments on patients, followed by their killing and autopsies. Patients at psychiatric hospitals were also used as test subjects in TB vaccination trials in Kaufbeuren, in work on the viral aetiology of multiple sclerosis in Werneck, and in neuropathological examinations on “euthanasia” victims who had probably been selected especially for this purpose. This was the project Julius Hallervorden carried out at the Kaiser Wilhelm Institute for Brain Research in Berlin-Buch in collaboration with the Brandenburg-Görden asylum, which was run by psychiatrist Hans Heinze. The murdered patients’ bodies and individual histopathological specimens were in high demand among scientists, and the research findings gained were being published even after the war ended. The Kaiser Wilhelm Institute for Brain Research used the brains of at least 295 “euthanasia” victims in its work, and even until recently there have been almost no qualms about using specimens taken from patients murdered during the Third Reich. The research was not confined to mental institutions. Tübingen-based psychiatrist Robert Ritter, for example, did research on Sinti and Roma people. He mainly focused on genealogical and epidemiological studies, which contributed to developing identification and selection criteria for “Gypsies”, who would then be deported to the “Gypsy camp” at Auschwitz. Granted, resistance and attempts to sabotage the many wrongs committed in the field of psychiatry during the Nazi era did exist. Even if over 50 percent of physicians were members of a National Socialist organization, i. e. the party itself or the SA or SS, that means that almost half of all doctors were not. So doctors did have some room for manoeuvre that they could take advantage of without sanctions being imposed, and resistance did not necessarily have negative personal consequences. Indeed, some did resist, although they were too few in number, all too few. Among doctors with private practices, in particular, there were some who did not report a single case of possible hereditary disease to the public health authorities between 1934 and 1939. One reason for this might have been that doctors working outside large hospitals had much more direct contact with their patients. This fact should serve as a reminder to us not to lose sight of the patients we care for, despite the demands and pressures of our everyday work.

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We must never allow our professional practice to be guided by ideology, but only by the wellbeing of our patients. Human dignity is always the dignity of the individual human being. No law may ever be allowed to disregard this. In 1946 Gustav Radbruch described the conflict between law and justice. In principle, the law takes precedence over justice “unless the extent to which a positive law contradicts justice is so intolerable that it must yield to justice as ’wrongful law’. […] When justice is not even aspired to and when equality, the very essence of justice, is deliberately flouted when drafting a positive law, such law is not only ’wrongful’, it is completely devoid of legality.” After the war ended, much the same occurred in the field of psychiatry as in many other areas of German society – collective denial. Neither psychiatric societies nor individual psychiatrists – with very few exceptions, such as Gerhard Schmidt and Werner Leibbrand – owned up to what had happened. This is a fact that leaves us utterly incredulous and deeply ashamed today. The story of Professor Werner Heyde, who has already been mentioned, is particularly mindboggling. Heyde was the Medical Director of the “T4 program”, and an arrest warrant was issued for him after the war. And yet from 1950 to 1959 he enjoyed a second career as a court-appointed medical expert in Schleswig-Holstein. Although he went by the name of Dr. Fritz Sawade, there were those in the medical and legal professions who were aware of his real identity, yet did not expose him. And many others, both within our field and beyond, knew about it. At the same time, early attempts to shed light on the wrongs committed by physicians during the Nazi era were impeded and thwarted. When Alexander Mitscherlich and Fred Mielke released their book Das Diktat der Menschenverachtung [The Dictate of Contempt for Human Life], which documented the trials of medical doctors in Nuremberg in 1947, many doctors protested because they were worried that the reputation of their profession would be tarnished. When the duo’s second book Wissenschaft ohne Menschlichkeit [Science without Humanity], was published in 1949, it was ignored. Professor Gerhard Schmidt, the former director of the psychiatric clinic in Lübeck, gave a radio talk about the crimes committed against the mentally ill and the mentally disabled as early as 20 November 1945 – yet he was unable to find a publisher for his book manuscript on the topic for 20 years, despite numerous attempts. I read the book many years ago, and it had a profound impact on me. But many psychiatrists in post-war Germany were afraid that publicising the details of these crimes would endanger efforts to rebuild their profession and damage its reputation, which they saw still positive at the time. A grievously misguided view, for the scientific community thus failed to acknowledge its responsibility. The German Psychiatric Association honoured Professor

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Schmidt for his life’s work by presenting him with its Wilhelm Griesinger Medal in 1986, the first year it was awarded. One of our organization’s prouder moments, even if it came far too late and has sadly been almost forgotten. And what about official legislation? The German federal government enacted the Bundesgesetz zur Entschädigung für Opfer der nationalsozialistischen Verfolgung or BEG [Federal Indemnification Law] in 1956, which provided for the indemnification of victims of Nazi persecution and came into force with retroactive effect. After some revisions, the BEG-Schlussgesetz [BEG – Final Law] was passed in 1965. Thus all victims who had suffered persecution under the Nazi regime due to their race, religion, or political views could file a claim for indemnification by 1969. However, the law did not apply to those who had been forcibly sterilized or to the families of victims of the “euthanasia”, since – it was argued – they had not been persecuted due to their race – a further humiliation of the victims, and still we did not speak out. Some of the expert witnesses called on during the hearings of the West German Bundestag’s Restitution Committee in the 1960s were the same psychiatrists who had justified forced sterilizations and participated in systematic murder during the Third Reich. Records of 13 April 1961 report that Werner Villinger rejected the idea of compensation payments on the contemptuous grounds that the payments might cause victims of forced sterilization to develop “neurotic ailments and suffering that could damage not only their current well-being and […] their ability to enjoy life, but also their ability to perform.” The Law for the Prevention of Hereditarily Diseased Offspring was not suspended until 1974. Formally, though, it continued to exist. In 1988 the West German Bundestag concluded that the forced sterilizations carried out under the Law counted as Nazi injustices. Ten years later the Bundestag passed a law repealing the rulings of the genetic health courts. Yet it took the Bundestag until 2007 to finally ban the Law for the Prevention of Hereditarily Diseased Offspring. The reason given was that the Law contravened the Basic Law anyway, so was effectively suspended at the time that came into force. The DGPPN supported calls to ban the Law at the time. The Federal Indemnification Act of 1965, however, applies to this day, which means that mentally ill people who were forcibly sterilized or murdered have still not been explicitly acknowledged as victims of the Nazi regime or as victims of racial persecution. Lawmakers need to take action and change this before it is too late. Victims will not have received due recognition of their pain and suffering, which continues to this day, until the German government repeals this injustice as well. The late 1960s and 1970s saw the first attempts to publish accounts of what happened in the field of psychiatry. Hans-Jörg Weitbrecht, Walter Ritter von Baeyer and Helmut Ehrhardt all wrote on the topic, yet all three presented

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psychiatry itself as a victim. A book commemorating the 130th anniversary of the German Association for Psychiatry and Psychotherapy in 1972 says that: “representatives of the psychiatric profession, despite their apparently farreaching authority, never supported, endorsed or aided abuses such as ‘euthanasia’ ex officio. This is another reason to reject as objectively unfounded the repeated attempts to charge ‘German psychiatry’ with the misconduct or the crimes committed by individual psychiatrists at the time.” This was written by Helmut Ehrhardt, President of the DGPN from 1970 to 1972, who himself had been a member of the NSDAP and who had written reports endorsing forced sterilization. As late as the hearings for the Federal Indemnification Act in the West German Bundestag in 1961, he said that the “actual content” of the Law for the Prevention of Hereditarily Diseased Offspring “was certainly not an invention of the Nazi regime, but rather something that in its essence reflected and still reflects current scientific conviction.” This further mocks and degrades victims. It is true that the association never officially endorsed killing patients. However, it is also true that it never officially condemned the practice either. There was never a single word of apology or reprimand. And yet, with just a few exceptions, it appears that the overwhelming majority of German psychiatrists and members of our association, whether researchers, academics or practitioners, took part in planning, implementing and creating scientific legitimacy for sterilization and murder. Research into German psychiatry under National Socialism only began in earnest in the early 1980s. The main contributions from psychiatrists came from Klaus Dörner – who began in 1969 and produced a series of publications in the 1980s – Asmus Finzen and Joachim-Ernst Meyer. Among the historians were Gerhard Baader, Dirk Blasius and Hans-Walter Schmuhl. In 1983 Ernst Klee published his shocking book, ‘“Euthanasia” in the Nazi State’, which I read at the time in stunned disbelief. So this was another book that deeply affected me. During an anniversary congress held under the presidency of Uwe Henrik Peters in Cologne in 1992 – when the name of the association was changed to DGPPN – the General Meeting passed a resolution in which the association reinforced “its feelings of revulsion and sorrow about the Holocaust of the mentally ill, Jews and other victims of persecution.” Back then there was no mention of the institutional and personal guilt of psychiatrists and their representative organization. However, it was a clear message that needed to be articulated. During this year’s congress we are showing a revised and updated version of the In Memoriam exhibition, which drew large international audiences when it was first shown in 1999 at the World Congress of Psychiatry in Hamburg. A series of symposia accompanied the exhibition. The decision by the World

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Psychiatric Association to select Germany and the DGPPN as the hosts of the World Congress was a conciliatory gesture from the international psychiatric community – and it presented us with the solemn duty to begin commemorating the victims and to make serious efforts to come to terms with the history of our profession. Over the past two years the DGPPN has held a series of in-depth discussions about how to deal with its own history. These talks were not controversial; they were conducted by mutual agreement. As a result of the talks, we amended the DGPPN’s Articles of Association exactly one year ago. The first paragraph now reads: “The DGPPN recognizes that it bears a special responsibility to protect the dignity and rights of people suffering from mental illness. This responsibility is the result of its predecessors’ involvement in the crimes of National Socialism, in killing and forcibly sterilizing hundreds of thousands of patients.” Another outcome of the discussions was that, early this year, the DGPPN Executive Committee established an international commission to address the actions of the predecessor associations that existed during the “Third Reich”. The commission is made up of four renowned historians of medicine and science: the chairman, Professor Roelcke from Giessen, Professor Sachse from Vienna, Professor Schmiedebach from Hamburg, and Professor Weindling from Oxford. The commission makes its decisions independently of the DGPPN, as we realize how important complete transparency is in this type of work. We are extremely grateful to the members of the commission for helping us in our efforts to come to terms with our past. The commission is overseeing the DGPPN-initiated and financed research projects involving Professor Schmuhl and Professor Zalashik. They aim to shed light on the extent to which the DGPPN’s predecessor organizations and their representatives were involved in the “euthanasia” program, in forced sterilizations of mentally ill patients and in other crimes between 1933 and 1945. The final report is due to be presented in just under two years, after which a second phase will begin the equally long-overdue task of addressing the post-war period. It will explore the consequences of the terrible crimes perpetrated under the Nazis, uncover who was involved, and reveal what lessons were learned and when. This will replace the speculation surrounding this period with solid facts. “Mentally dead”, “human ballast”, “life unworthy of living” – these are not easy words to say. They are deeply upsetting and disturbing – and, in light of the fact that psychiatrists were actively involved in Gleichschaltung, forced sterilization and murder, they fill us with shame, anger and the greatest sorrow. Our shame and regret are also rooted in the fact that it has taken this association, of which I am President today, 70 years to make a systematic effort to come to terms with its past and the history of its predecessors under National

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Socialism, and – irrespective of the historical facts that may come to light – to ask for forgiveness from the victims of forced migration, forced sterilization, human experiments and murder. In the name of the German Association for Psychiatry and Psychotherapy, I ask you, the victims and relatives of the victims, for forgiveness for the pain and injustice you suffered in the name of German psychiatry and at the hands of German psychiatrists under National Socialism, and for the silence, trivialisation and denial that for far too long characterized psychiatry in post-war Germany. Many of the victims, even those who were not killed, and their families are no longer with us today. For them, this request comes too late. But perhaps it is not too late for the survivors and for the victims’ descendants – some of whom are with us here today – for mentally ill people everywhere and for today’s psychiatrists and the DGPPN itself. We cannot undo pain, injustice and death. But we can learn lessons, and we have learned a great many – in the psychiatry profession, in medicine as a whole, and in politics and society. And we can commemorate the victims by coming together to advocate humane, patient-oriented psychiatry and by working together to fight the stigmatization and marginalization of mentally ill people. As psychiatrists, we must not pass value judgements on people. We teach, research, treat, support and cure. When we speak of the inviolability of human dignity, we mean the dignity of each and every individual, and no law or research objective must ever cause us to disregard this again. We have learned important lessons from our failures. This offers hope for current debates on medical ethics, which, given their focus on topics such as preimplantation genetic diagnosis and assisted suicide, risk descending all too quickly into questions of the “value” of a human life. These discussions will always be murky, but I believe that my goal and the goal of the DGPPN as a whole is perfectly clear – we must ensure we provide humane medical care, contribute to a more benign future, and respect the dignity of every single individual. Ladies and gentlemen, thank you for your attention. Professor Frank Schneider President of the German Association for Psychiatry and Psychotherapy (DGPPN)1 1 The original German text of this speech was unanimously adopted by the Executive Board of the DGPPN as an Association Document on 23 November 2010. We are very grateful to Carsten Burfeind (Berlin) and Prof. Volker Roelcke (Giessen) for their comments and suggestions. [Editorial note: full references for quotations and historical details of this speech may be found at http:// www.dgppn.de/history/psychiatry-under-national-socialism/speech-professor-schneider.html].

Deutscher Ärztetag (German Medical Assembly): The Nuremberg Declaration (2012)

Nuremberg Declaration, adopted at the 115th German Medical Assembly, 23 May, 20121

In 2012, the 115th German Medical Assembly is taking place in Nuremberg, the same city in which, 65 years ago, 20 physicians were indicted for medical crimes against humanity as leading representatives of the “state medical services” of the National Socialist state. Research carried out over past decades has shown that the scale of the human rights violations was even more extensive than presumed during the trials. Today we know significantly more about the aims and methods of the involuntary human experimentation carried out on many thousands of victims, which in many cases resulted in their death, as well as the murder of over 200,000 mentally ill and disabled people, and the forced sterilization of over 360,000 people classified as “genetically diseased”. In contrast to assumptions still widely held today, the impetus for these most grievous violations of human rights did not originate from the political authorities, but from physicians themselves. These crimes were not the acts of individual physicians, but were carried out with the participation of leading representatives of the established medical profession and professional medical societies, as well as with significant involvement by distinguished medical academics and members of renowned biomedical research institutions. These human rights violations committed by National Socialist medicine have left a lasting impact, and raise questions concerning the self-perception of physicians, their professional actions and medical ethics. The 115th German Medical Assembly therefore states in its Nuremberg Declaration that:

1 Authorized English translation of the Nürnberger Erklärung, adopted by the 115th German Medical Assembly 2012 (DÄT 2012 Drucksache I-26).

362

Deutscher Ärztetag

– We acknowledge the significant shared responsibility of physicians for the injustices of National Socialist medicine and regard that which has happened as a warning for the present day and the future. – We express our deepest regret that physicians, in contravention of their duty to treat, were complicit in multiple human rights violations. We commemorate the surviving victims and those who have already passed away, as well as their descendants, and ask for their forgiveness. – As the German Medical Assembly, we pledge to work actively towards promoting future historical research and open evaluation by the professional bodies of the Federal Republic through direct financial and institutional support, such as ensuring unlimited access to archives.

Contributors

Helmut L. Bader is a retired deputy principal of a High School in South Germany. He has contributed chapters to “Das Vergessen der Vernichtung ist Teil der Vernichtung selbst”: Lebensgeschichten von Opfern der nationalsozialistischen “Euthanasie” (ed. by Petra Fuchs et al., Göttingen: Wallstein, 2007); and Die nationalsozialistische “Euthanasie”-Aktion “T4” und ihre Opfer (ed. by Maike Rotzoll et al., Paderborn: Schöningh, 2010). Isabelle von Bueltzingsloewen is a professor in history and sociology of health at Universit¦ de Lyon, France. She is author of a study on starvation in French mental asylums during World War II: L’H¦catombe des fous. La famine dans les húpitaux psychiatriques franÅais sous l’Occupation (Paris: Flammarion, 2009), and editor of “Morts d’inanition”. Famine et exclusions en France sous l’Occupation (Rennes: Presses Universitaires de Rennes, 2005). Donna Evleth is an independent historian living in Paris. She has written several articles on the history of the French medical profession during World War II: “Vichy France and the Continuity of Medical Nationalism” (Social History of Medicine, 1995); “The ‘Romanian Privilege’ in French Medicine and AntiSemitism” (Social History of Medicine, 1998); “The Ordre des M¦decins and the Jews in Vichy France, 1940 – 1944” (French History, 2006). Gerrit Hohendorf, M.D., is senior lecturer at the Institute for the History and Ethics of Medicine, Technical University Munich. He is author of Der Tod als Erlösung vom Leiden: Zur Geschichte und Ethik der Sterbehilfe in Deutschland (Göttingen: Wallstein, 2013), and editor (with Maike Rotzoll et al.) of Die nationalsozialistische “Euthanasie”-Aktion “T4” und ihre Opfer. Geschichte und ethische Konsequenzen für die Gegenwart (Paderborn: Schöningh, 2010). James Kennedy is Professor of Dutch History Since the Middle Ages at the Universiteit van Amsterdam, The Netherlands. His specialization is the postwar

364

Contributors

period, including the history of euthanasia. He published a book on this topic entitled Een weloverwogen dood. Euthanasie in Nederland (Amsterdam: Bert Bakker, 2002), and more recently supervised a project on Dutch doctors’ attitudes toward euthanasia. Etienne Lepicard, M.D., Ph.D., is teaching history, religion and ethics at the School of Health Professions, Ashkelon College, Israel; he is also a member of the Israel National Council for Bioethics. Previously, he was a research fellow at the Institute for the History of Medicine, Giessen University, Germany, and at the International Institute for Holocaust Research, Yad Vashem, Jerusalem. His book L’Homme, cet inconnu d’Alexis Carrel (1935), ¦chographies d’un bestseller is about to appear at Les Belles Lettres, Paris. Volker Roelcke is Professor of the History of Medicine at Giessen University, Germany. He is editor (with Paul Weindling and Louise Westwood) of International Relations in Psychiatry : Britain, Germany, and the United States to World War II (Rochester, NY: University of Rochester Press, 2010), and (with HansWalter Schmuhl) of “Heroische Therapien”. Die deutsche Psychiatrie im internationalen Vergleich, 1918 – 1945 (Göttingen: Wallstein, 2013). William Seidelman, M.D., is Emeritus Professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Canada, whose medical practice included the care of Holocaust survivors. He is the author of numerous articles on medicine during the Nazi period and the implications for academic medicine and medical professionalism. Rolf Surmann, Ph.D., is an independent historian and publicist, with a focus on post-World War II history. He is among others the author of Abgegoltene Schuld. Über den Widerspruch zwischen entschädigungspolitischem Schlussstrich und interventionistischer Menschenrechtspolitik (Hamburg, Münster : Unrast, 2005), and a regular contributor to Blätter für deutsche und internationale Politik. Sascha Topp, Ph.D., is lecturer at the Institute for the History of Medicine at Giessen University, Germany. He is author of Geschichte als Argument in der Nachkriegsmedizin. Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie (Göttingen: Vandenhoeck & Ruprecht unipress, 2013). His current research focuses on medical selection procedures in the second half of the 20th century in the context of workrelated recruitment programs and processes of nation building.

Contributors

365

Paul J. Weindling is Research Professor in the History of Medicine at Oxford Brookes University. He is author of Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent (Basingstoke: Palgrave-Macmillan, 2004); John W. Thompson, Psychiatrist in the Shadow of the Holocaust (Rochester, NY: Rochester University Press, 2010); and Victims and Survivors of Nazi Human Experiments: Science and Suffering in the Holocaust (London: Bloomsbury, 2014). Annette Weinke, Ph.D., is assistant professor at the history department of Friedrich Schiller University in Jena, Germany. She is the author of Die Nürnberger Prozesse (München: C. H. Beck, 2006), and editor (with Norbert Frei) of Toward a New Moral World Order? Menschenrechtspolitik und Völkerrecht seit 1945 (Göttingen: Wallstein, 2013). Currently she is working on a collective biography of human rights lawyers and activists in the 20th century. Michael Wunder, Ph.D., is a psychologist and psychotherapist, and head of the Counselling Center of the Protestant Foundation Alsterdorf in Hamburg. He has published on medicine during National Socialism, disability aid, and issues of bioethics. He was member of the Committee of Inquiry „Ethics and Law of Modern Medicine” of the German Federal Parliament and is currently member of the German Ethics Council (Deutscher Ethikrat). Rakefet Zalashik, Ph.D., is visiting assistant professor at the Center for Medicine, Health and Society as well as Jewish Studies at Vanderbilt University, Nashville. She is the author of Ad Nafesh: Refugees, Immigrants, Newcomers and the Israeli Psychiatric Establishment (Tel-Aviv, 2008; in Hebrew) and Das unselige Erbe. Die Geschichte der Psychiatrie in Palästina 1920 – 1960 (Frankfurt a. M.: Campus, 2012). Currently, she is working on the history of bioethics after the Holocaust in Israel, Germany and the U.S.

Illustrations

p. 104: preface, black notebook, Martin Bader, 1 February 1930 (private archive, Helmut Bader, Schwäbisch Gmünd; in the following PA Bader) p. 105: bridal pair Maria and Martin Bader, mid-1920s (PA Bader) p. 106: Maria, Martin, and Helmut Bader, 1934 (PA Bader) p. 110: list of transportation to “T4”-killing center Grafeneck including Martin Bader’s name (Archive of Zentrum für Psychiatrie Bad Schussenried, Hauptbuch 1938, serial no. 4.505) p. 112: Rejection of Maria Bader’s petition for recompensation: extract of reasoning by Ministry of Justice of Baden-Württemberg, 29 June 1958 (PA Bader) p. 282: Cover of DER SPIEGEL, Nr. 21/1978; Copyright DER SPIEGEL p. 300: portrait Babette Fröwis (1929 – 1943) (Archive of Bezirk Oberbayern, Munich, stock Heil- und Pflegeanstalt Eglfing-Haar, patient file no. 7179) p. 300: portrait Hans Joachim Sewering (1916 – 2010) (from Deutsches Ärzteblatt 107, 2010, A-1409; Copyright: Jürgen Gebhardt, Berlin)

The chapter by Annette Weinke is a slightly modified English version of “Juger les m¦decins criminels en RFA et RDA”, in: Lise Haddad, Jean-Marc Dreyfus (eds.), Une m¦decine de mort: Du code de Nuremberg — l’¦thique m¦dicale contemporaine, Paris: Êditions Vend¦miaire 2014, 145 – 166. The chapter by Volker Roelcke is a slightly modified English version of “Zwischen Standesehre und Selbstreflexion: Zur zögerlichen Thematisierung von medizinischem Fehlverhalten im Nationalsozialismus durch die Bundesärztekammer, ca. 1985 – 2012“, in Stephan Braese, Dominik Groß (eds.), NS-Medizin und Öffentlichkeit – Formen der Aufarbeitung nach 1945, Frankfurt am Main: Campus 2015 (in press).

Index of Persons and Selected Institutions

Acad¦mie des Sciences Morales et Politiques / ASMP (Academy of Moral and Political Sciences) 53 seq., 56, 191 Acad¦mie Nationale de M¦decine / AM (French National Academy of Medicine) 53 seq., 56, 66, 79, 80, 184, 190, 194, 237 Action FranÅaise 185 seq. Adenauer, Konrad 18, 89, 119 Agudat harofim sride hashoah / Association of Physician Survivors of the Holocaust 206 Al domi (lit. “don’t keep silence”, Ps. 83: group of Jewish intellectuals from Palestine) 206 Alexander, Leo 13, 32, 34, 36 seq., 39, 45, 47, 62, 65, 304 Aly, Götz 42, 141, 303 Amatus Lusitanus 52 American Medical Association / AMA 40, 135 seq., 284, 286 – 288, 290 seq., 297 Amicale des ali¦nistes (French corporate association of psychiatrists) 235 Annas, George J. 40 seq., 283, 285 Anti Defamation League / ADL 286, 288 Arab Medical Association of Palestine 69, 315 Arbeitsgemeinschaft der Westdeutschen Ärztekammern (Working Group of the Medical Chambers of the West German States) 32 Arbeitskreis zur Erforschung der nationalsozialistischen “Euthanasie” und Zwangssterilisation / AKEZ (Working

Group for the Study of National Socialist “Euthanasia” and Compulsory Sterilization) 121, 250, 262 – 267, 270, 277 Artsenkamer (Dutch Physicians’ Chamber) 217 Asaph Judaeus 52 Asperger, Hans 157, 167 seq., 180 Association des m¦decins isra¦lites de France / AMIF (Association of Jewish Doctors of France) 192 seq. Association Nationale des M¦decins D¦port¦s et Intern¦s de la R¦sistance (French National Association of Deported and Internees Physicians of the Resistance) 63, 66 Association of Hebrew Physicians in Palestine, see Israel Medical Union Association Professionnelle Internationale des M¦decins / APIM 68 seq. Assoziationsanstalt Schönbrunn 18, 132, 134, 137 – 145, 254 seq., 289 – 291 Aumeier, Hans 316 Ayme, Jean 231 Az¦ma, Jean-Pierre 183, 186 Baader, Gerhard 253, 357 Babinski, Joseph 79 Bachelot-Narquin, Roselyne 193 Bader, Helmut 17, 103, 106, 363, 367 Bader, Maria 105 seq., 367 Bader, Martin 103 – 107, 110, 367 Baeyer, Walter Ritter von 356 Bamberger, Philipp 155 – 157, 161, 179

370 Bankier, David 68 Barbie, Klaus 239 seq. Baruk, Henri 13, 70, 75 seq., 78 seq., 81, 206 seq. Bauer, Fritz 12, 17, 93, 98 seq., 167 Baumhardt, Ernst (alias Dr. Jäger) 109 Bayer, Wilhelm 151, 160 seq., 179 Bayerische Landesärztekammer 131 seq. Bavarian Ministry of the Interior (Bayerisches Innenministerium) 143, 145 Bayle, FranÅois 47 seq., 59, 61 – 63, 248 Beecher, Henry 41 Beiglböck, Wilhelm 35, 39 Beiz, L. 199 Ben-Gurion, David 204 Bender, Ludovicus 216 seq. Bennholdt-Thomsen, Carl-Gottlieb 152, 161 – 163, 165, 167 Berg, Jan Hendrik van den 20, 213 – 215, 219, 221 – 223, 229 Berkestijn, Hans van 224 Berlan, H¦lÀne 49 seq., 56 Berlioz, Charles 63 Berranger, Olivier de 192 Berufsverband Deutscher Internisten (Professional Association of Specialists in Internal Medicine) 132, 293 Bessau, Georg 152, 154 Biko, Steve 285, 298 Binding, Karl 155, 164, 173, 302 seq., 306, 309, 328, 352 Blad, John 227 Blasius, Dirk 357 Bleker, Johanna 243, 250, 253 – 256, 262 Blome, Kurt 61 Bock, Gisela 120 Bodelschwingh, Friedrich von 96 Bodmann, Franz von 316, 323 Bonhoeffer, Dietrich 123, 168 Bonnaf¦, Lucien 238 Bonnafous, Max 234 Borm, Kurt 99 Bormann, Felix von 152 – 155, 162 Bouhler, Philipp 59, 95 Boven-Grevelink, Margina Van 227 Brack, Victor 59, 91

Index of Persons and Selected Institutions

Braine, Jean 57 Brandt, Karl 59, 61, 91 seq., 95 seq. Brandt, Willy 119 Braune, Gerhard 95 seq. Brehme, Thilo 151 Breton, David Le 329 Brett, Lily 133 British Medical Association / BMA 38, 68, 315 British Medical Journal 34, 37, 68, 210, 283, 285 seq., 294 Brodehl, Johannes 172 – 174, 177, 180 Bronsgersma, Edward 308 Bruijn, Jan de 221, 223 Buber, Martin 34, 206 Buck, Dorothea 351 Bueltzingsloewen, Isabelle von 20 seq., 231, 363 Bulletin de l’Acad¦mie de Medecine (Bulletin of the French Academy of Medicine) 54, 56, 66, 79 seq., 190 seq., 194, 237 Bund der “Euthanasie”-Geschädigten und Zwangssterilisierten / BEZ (Federation of Victims of “Euthanasia” and Forced Sterilisation) 120, 124 – 127, 261, 270, 327, 329 Bundesarchiv (German National Archives) 134, 261 seq. Bundesärztekammer / BÄK (German Medical Association) 15, 18, 21 seq., 70, 81 seq., 131 seq., 134 – 137, 145, 155, 243 – 246, 249 – 252, 254 – 256, 258 – 269, 271, 273 – 278, 281 seq., 284 – 292, 294 – 298, 310, 331 Bundesfinanzministerium (German Federal Ministry of Finance) 33, 44 Bundesrat (Federal Council of the German States) 124 Bundesregierung (German Federal Government) 122, 126 seq. Bundestag (German Federal Parliament) 113, 116, 119, 122, 124 – 127, 263, 276, 356 seq., 365 Bunke, Heinrich 98 Burke, Peter 53

371

Index of Persons and Selected Institutions

Buskes, Johannes Jacobus 220 Butenandt, Adolf 42 Butler, Victorine von 141 Büttner, Siegfried 262, 265 Buytendijk, Frederik Jacobus Johannes 223 Cannon, Walter B. 67 Caplan, Arthur 203, 291 Carrel, Alexis 53, 236, 240, 364 Carrel Foundation, see French Foundation for the Study of Human Problems Catel, Werner 19, 147, 150 – 170, 172 – 176, 178 – 180, 182, 341 CDU/CSU (Christian Democratic/Social Union) (German party) 127 Chabot, Boudewijn 308 Chalufour (Aline?) 63 Champy (Christian?) 66 Chevassu, Maurice 190 Chirac, Jacques 192, 233 Ciepielowski, Marian 57, 59 Clauberg, Carl 71, 199 Clinton, William (Bill) 287 Collaborative Research Center “Cultures of Memory” (Sonderforschungsbereich “Erinnerungskulturen”) 9, 83, 131, 147 Comit¦ m¦dical de la R¦sistance (Medical Resistance Committee) 50, 189 Commissariat for Jewish Questions (Commissariat g¦n¦ral aux questions juives) 183, 186 – 188 Commissie Bevolkingsvraagstuk (Commission on the Population Question) 223 Concours M¦dical (French medical journal) 16, 54, 66 – 68, 71, 80 Conf¦d¦ration des Syndicats M¦dicaux FranÅais 54, 78 Congress of French Alienists and Neurologists 235 Conseil sup¦rieur (Higher Council of the Vichy French Medical Association) 19, 183, 186 – 190, 192, 194 Conti, Leonardo 95

Cranach, Michael von Cyrulnik, Boris 232

142 seq.

Dapim refuiyim (Israel medical journal) 16, 52, 55, 71 – 73, 76, 79, 196, 200, 203, 205, 317 Darquier de Pellepoix, Louis 188 seq. Darwin, Charles 236 Daum¦zon, Georges 238 Dayan, Hubert 192 seq. De Groene Amsterdammer (Dutch weekly magazine) 214 Debray, Jean-Robert 53, 56 Debr¦, Robert 50, 54 Decourt, Fernand 67 – 69, 71 Degkwitz, Rudolf 153 – 155, 162, 167 seq., 178 seq. Desoille, Henri 66 seq., 80, 315 Dessaur, Catharina Irma (Pseudonym of Andreas Burnier) 225 seq. Deussen, Julius 354 Deutsche Forschungsgemeinschaft / DFG (German Research Council) 43, 83, 88, 131, 147, 265 – 267 Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (German Society of General Practice and Family Medicine) 132 seq. Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (German Society for Gynecology and Obstetrics) 149 Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ (German Association of Child and Adolescent Medicine) 147 – 151, 174, 177, 270, 337, 345 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN (German Association of Psychiatry, Psychotherapy and Nervous Disorders) 149, 270, 275 seq., 333 – 335, 349, 352, 356 – 359 Deutsche Gesellschaft für Soziale Psychiatrie / DGSP (German Association for Social Psychiatry) 121, 176 Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (German Associa-

372 tion of Social Pediatrics and Youth Medicine) 341 seq. Deutscher Ärztetag (German Medical Assembly) 21 seq., 176, 243 seq., 250 – 252, 256 seq., 260, 266, 276 seq., 295, 310, 331, 361 seq. Deutscher Ethikrat (German Ethics Council) 22, 269 – 271, 365 Deutsches Ärzteblatt (German Medical Journal) 15, 32, 91, 131 seq., 135 seq., 139, 145, 149, 178, 245, 251 – 253, 255 seq., 259 seq., 262 – 264, 266, 268 seq., 272 seq., 276, 290, 292, 294 seq., 310, 367 Die Grünen (German party) 122 DIE ZEIT (German weekly newspaper) 153, 253, 255, 287 seq. Ding, Erwin 198 Dinges, Martin 264 seq. Doctor’s Trial in Nuremberg, see Nuremberg Medical Trial Dörner, Klaus 121, 243, 259 – 262, 275, 357 Dost, Friedrich Hartmut 158, 162 seq., 168 seq. Dowbiggin, Ian 215, 236 Dreyfus, Jean-Marc 63 Drezel, Dr. 201 Duken, Johann 152, 154, 156, 162 Durand, Pierre 232 seq. Dutch Association for Voluntary Euthanasia / NVVE 223, 225, 227 – 229 Dutch Medical Association 217 Dutch Reformed Church 222 Dvorjetski, Mark (Meir) 55 seq., 72 seq., 75 seq., 79 – 82, 201 – 207, 316 – 319, 322 seq., 326 Dvorzhetski Mark (see Dvorjetski) Dworzecki Marek (see Dvorjetski) Eberle, Annette 143 Eckart, Wolfgang 253 Eglfing-Haar asylum, see Heil- und Pflegeanstalt Eglfing-Haar Ehrhardt, Helmut 13, 356 seq. Eichmann, Adolf 17, 55, 98

Index of Persons and Selected Institutions

Eissler, Kurt 44 Ekelmans, Jan 225 Ellger-Rüttgardt, Sieglind 232 Endruweit, Klaus 98 Erhard, Ludwig 45 Europarat (Council of Europe) 312 Evleth, Donna 19, 49, 183, 363 Ey, Henri 237 Fachverband Medizingeschichte (Professional Asssociaton for the History of Medicine) 259, 263 seq. Fanconi, Guido 158 seq. Faulstich, Heinz 141, 232, 249 Fenigsen, Richard 225 FÀvre, Marcel 190 seq. Field, Ian 298 Field Information Agency, Technical (FIAT) 200 Finkelstein, Heinrich 341 Finzen, Asmus 357 Fishbein, Morris 37 seq. Foley, Peter 298 Frank, Karl Hermann 163 Franzblau, Michael J. 18, 135, 137 seq., 286, 288 seq., 299 Franziskannerinnen von Schönbrunn 140 Freisler, Roland 153 French Foundation for the Study of Human Problems 240 French Ministry of Foreign Affairs 202 Freudenberg, Ernst 160 seq., 165, 179 Frick, Paul 167, 338 Fromm, Ernst 254, 258, 274, 282, 284 seq. Fröwis, Babette 22, 132, 134, 138 – 140, 143 – 145, 281 – 283, 291 – 293, 296 seq., 299 seq., 367 Fuchs, Christoph 287 Gaebel, Wolfgang 335 Galen, Clemens August Graf von 353 Gauf, Horst 99 Gaulle, Charles de 50 seq. Gaupersonalamt München-Oberbayern 134 Gaupp, Robert 164, 180

373

Index of Persons and Selected Institutions

Gaupp, Vera 164 Gazier, FranÅois 184, 191 seq. Gebhardt, Karl 61, 367 „Gegen Vergessen – Für Demokratie“ 125 Gelsner, Kurt 252 Gentis, Roger 239 German Association of Child and Adolescent Medicine, see Deutsche Gesellschaft für Kinder- und Jugendmedizin / DGKJ German Association of Psychiatry, Psychotherapy and Nervous Disorders, see Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde / DGPPN German Federal Ministry of Finance, see Bundesfinanzministerium German Federal Ministry of the Interior, see Bundesministerium des Inneren German Medical Assembly, see Deutscher Ärztetag German Medical Association, see Bundesärztekammer German Medical Corporation, see German Medical Association German Supreme Court 94 German Supreme Court for the British zone 94 Gernez-Rieux, Charles 187, 190 Gerst, Thomas 15, 256 Giessler, Hans 116 Gilbert-Dreyfus (alias Gilbert Debrise) 66 seq. Giordano, Ralph 119 Giraud, Paul 186 Glorion, Bernard 20, 49, 192 – 194 Goebel, Fritz 152 Golbel, Johannes 199 Götz, Hugo 108 Grafeneck, see Landespflegeanstalt Grafeneck Grodin, Michael A. 40 seq., 135 seq., 283, 285 – 287, 299 Grzelak, Jerzy 266 Guide Rosenwald / Rosenwald Medical Directory 184, 187

Guillant, Louis Le 238 Guillaume, Pierre 184 seq. Haagen, Eugen 203 Haagse Post (Dutch weekly journal) 222 Hachtmann, Rüdiger 88 seq. Haedenkamp, Karl 257 seq., 284 Halioua, Bruno 183, 193 Hallervorden, Julius 354 Hällmayr, Adolf 291, 296 seq., 299 Halter, Hans 134, 282 Hamburger, Franz 151 seq., 161 Hamburger, Jean 191 Hamburger Initiative “Anerkennung aller NS-Opfer” 121 Hamm, Margret 116 seq., 124, 270, 327 Hanauske-Abel, Hartmut 13, 21, 250 – 254, 258, 286 Hardy, Alexander G. 36, 62 Harefuah (Israeli medical journal) 52, 72 seq., 196 seq., 204 – 206, 209 seq. Hartenstein, Hans-Joachim 151 seq., 168 Hearkness, Jon 39 Heil- und Pflegeanstalt Eglfing-Haar 132, 134, 137 – 145, 249, 254, 258, 281, 289 seq., 297, 367 Heinze, Hans 88, 147, 165 seq., 175, 354 Helgers, Wilma 219 Hellbrügge, Theodor Friedrich 159 seq., 168, 180, 182, 341 Heller, Joseph 31 Hempel, Hans-Christoph 151 seq., 160 Hennig, Valentin 119 Hepp, Hermann 149 Hermann Mai Foundation (Hermann-MaiStiftung) 166 seq. Hess, Rudolf 284 Heyde, Werner (alias Fritz Sawade) 98, 152 seq., 167, 352, 355 Himmler, Heinrich 59 – 61, 65 Hippocrates 34, 37, 52 Hirt, August 203 Hitler, Adolf 34, 52, 59, 61 seq., 77, 87 seq., 93, 96 – 98, 108 seq., 134, 140, 142, 148, 161, 163, 170, 202, 225, 240,

374 249, 254, 281 seq., 284 seq., 292 seq., 298, 303, 312, 324, 328, 351 seq. Hitler Youth (Hitler Jugend / HJ) 148, 153, 162, 166 Hoche, Alfred 155, 164, 173, 302 seq., 306, 309, 328, 352 Hofmeier, Kurt 151 Hohendorf, Gerrit 18, 23, 131, 143, 147, 243, 254, 262 – 266, 269, 283, 363 Hohmann, Joachim S. 154 seq. Hollande, FranÅois 240 Höllenrainer, Karl 35 Hoppe, Jörg-Dietrich 131 seq., 266, 269, 271 – 273, 276 seq., 292, 294 seq., 298, 331 Hördemann, Robert 153 Horlik-Hochwald, Arnost 62 Hottinger, Adolf 158, 160 seq., 165, 179 Hovener, Barbara 286 Huard, Serge 183 Hubenstorf, Michael 253 Hübner, Jürgen 173 Huebner, Clarence R. 96 Humanistisch Verbond (Humanist League) 217 Hutar, Patricia 287 Ibrahim, Jussuf 156 IG Farben 30 seq. Inbona, Jean-Marie 58 – 63, 65, 75 Institut für Zeitgeschichte 97 International Center for Health, Law and Ethics (Haifa University) 209 International Commission on War Crimes 315 International Military Tribunal 30, 73, 90 International Physicians for the Prevention of Nuclear War / IPPNW 176, 244, 251, 277, 286 seq., 291 International Scientific Commission on Medical War Crimes / ISC 29, 34, 38, 200 Israel Medical Association / IMA 54, 133, 205 seq., 243 seq., 285 Israel Medical Union / HMU (Hahistadrut harefuit haivrit, also: Jewish Medical

Index of Persons and Selected Institutions

Association of Palestine, or Hebrew Medical Union) 22, 52, 54 seq., 58, 69, 73, 75, 78 – 80, 196 – 200, 203, 315 – 318, 320, 326 Israeli, Itzhak 52 Ivy, Andrew 32, 34 – 41 Jachertz, Norbert 15, 135 seq., 139, 178, 243, 250 – 258, 269, 272 seq., 290 Jamous, Haroun 50 Jenner, Harald 243, 266 Jennings, Herbert Spencer 236 Jewish Agency 196, 202, 206 Joint Distribution Committee / JDC 202 Joppich, Gerhard 151 – 155, 161, 168, 175 Journal of the American Medical Association / JAMA 37, 39, 62, 243 Journal Officiel (Official Gazette) 49, 183, 185, 187, 190 Jütte, Robert 15, 89, 244, 246 seq., 250, 256 – 258, 260, 263 – 266, 268, 273 – 275 Kaelber, Lutz 16 Kaiser Wilhelm Gesellschaft / KWG 88 Kämmerer, Prof. (Munich) 164 Kanzlei des Führers (Chancellory of the Führer) 142, 303 Kassenärztliche Vereinigung (Association of Statutory Health Insurance Physicians) 131, 155, 244, 268 Kater, Michael H. 15, 133 – 135, 249, 255, 257, 281 – 286, 290 seq., 299 Katz, Jay 41, 45 Katzenelbogen 201 Keller, Walter 152 Kennedy, James 20, 23, 213, 305, 363 Kennedy Institute of Ethics, Georgetown University 40 Keshev-Klugman, Shabtai 73 – 75 Kipfelsperger, Tanja 141 seq., 144 Klee, Ernst 96, 98, 108, 141, 152, 249 seq., 258, 303, 323, 357 Kleinschmidt, Hans 152 seq., 168 Klemm, Ernst 151 Klitzsch, Wolfgang 260

Index of Persons and Selected Institutions

375

Kloiber, Otmar 266, 271, 288 seq., 292, 296 – 298 Klotz, H. P. 193 Koch, Hans Hellmuth 132 Koch, Robert 196, 247 Kochen, Michael M. 132, 134, 281, 285, 287 seq., 291 – 293, 299 Kogon, Eugen 248 seq. Kolbe, Manfred 127 Köttgen, Ulrich 156 seq., 163 seq., 178, 180 Krieger, Moshe 73, 79 – 81, 201 seq., 316 seq. Krischer, Markus 131, 137, 139 seq., 142 – 145 Kröner, Peter 253 Kudlien, Fridolf 249 seq., 253 Kujath, Gerhard 168 Kümmel, Werner F. 253 Kupat holim clalit (General Sick Fund) 52, 54 seq., 71, 76, 79, 200

Lepicard, Etienne 11, 16 seq., 22 seq., 32 seq., 37 seq., 47, 91, 131, 147, 243, 269, 315, 364 Leriche, Ren¦ 183 seq., 187 seq., 190 seq., 194 L¦vy-Solal, Edmond 191 Lifton, Robert 45, 199 Lilienthal, Georg 253 Lindeboom, Arie 216 seq., 219, 225 Linden, Herbert 95 Loeschke, Adalbert 161, 165, 167 seq. Lorber, John 170 seq. Lossa, Ernst 45

Lafont, Max 231 – 235, 239 Lamarck, Jean-Baptiste de 236 Lancet (The Lancet) (British medical journal) 13, 21, 37, 135, 149, 243, 245, 251, 282, 286, 296, 306, 309 Landesamt für Wiedergutmachung (Regional Office for Compensation) 111 Landesärztekammer / LÄK (German regional medical association) 131 seq., 254, 260, 286, 310 Landespflegeanstalt Grafeneck (T4 killing center) 108 – 111, 353, 367 Lanzman, Claude 250 Laval, Pierre 234 Lavall¦e, Georges 54 Leenen, Henk 214, 229 L¦ger, Lucien 190 seq. Legmann, Eric 188, 194 Legmann, Michel 194 Leibbrand, Werner 266, 355 Lemierre, Andr¦ 190 Lemke, Thomas 329 Lemkin, RaphaÚl 33, 61, 65 Lemoine, Patrick 232 seq.

Mai, Hermann 152, 163, 165 – 167 Maimonides (Rabbi Moshe ben Maimon) 52 Mann, Gunter 156, 253 Marcelli, Aline 194 Maritain, Jacques 34 Marlet, Johannes Jacobus Canisius 219 Marrus, Michael 13, 61, 78, 91, 183, 186 Martel, Pierre Henri 237 Maspero, FranÅois 232, 239 Mauz, Friedrich 258, 352 Max Planck Gesellschaft (Max Planck Society) 23, 42, 88 McHaney, James M. 36, 45, 62 Medical Association of South Africa 135, 285, 299 Medico-Psychological Society (Soci¦t¦ M¦dico-Psychologique) 235 Medisch Contact (Dutch medical journal) 217, 221, 225, 227 Meer, Cornelis van der 220, 224 Meerman, Dick 216 Mengele, Josef 13, 247, 257 Menges, Jan 226 Meyer, Joachim-Ernst 357 Michelsohn, Jacob 200, 315 Mielke, Fred 32, 47, 87, 154, 160, 248, 251, 259, 355 Mikhtav le-haver (Israeli medical journal) 16, 52, 55, 73, 75, 79, 196 – 202, 206, 315 seq. Milch, Erhard 30

376 Mildenberger, Hermann 170 – 172, 174 Mildt, Dick de 12, 89, 92 Ministry for State Security of the German Democratic Republic 156, 160, 261 Ministry of Health (Israel) 52, 54, 208, 244 Ministry of Justice of Baden-Württemberg 111, 367 Mitscherlich, Alexander 9 seq., 32, 35, 38, 87, 145, 154, 160, 251, 259, 355 Mitscherlich, Margarete 145 Mitterand, FranÅois 51 Mochel, Henk 220, 224, 226 Montgomery, Frank-Ulrich 277, 295 Morstatt, Paul 110 Moulin, Anne-Marie 51 Mourik Broekman, Michiel van 217 Mrugowsky, Joachim 60 Muller, Herman J. 67 Müller-Hill, Benno 232, 236, 249 seq. Münsingen district administration (Landratsamt Münsingen) 111 Muntendam, Piet 223, 229 Mutters, Tom 164 Nachtsheim, Hans 116 seq. Nadav, Daniel S. 13 seq., 32, 47, 91, 160, 199, 204 seq., 208 seq., 248, 317 National coordinating office for Nazi crimes at Ludwigsburg (Zentrale Stelle der Landesjustizverwaltungen zur Aufklärung nationalsozialistischer Verbrechen in Ludwigsburg) 98, 165 Nationalsozialistischer Deutscher Ärztebund / NSDÄB 151, 166 Natzschka, Jürgen 177 Niederland, William 44 Nieuwe Revu (Dutch magazine) 220 Nitsche, Hermann Paul 93 Nora, Pierre 17 Nowak, Klara 262, 352 Nuremberg Medical Trial / NMT 12 seq., 16 seq., 21, 29 seq., 32 seq., 35 seq., 47 seq., 56 seq., 59, 63, 65 seq., 70 – 75, 82 seq., 90 seq., 248, 257, 259, 274,

Index of Persons and Selected Institutions

283 seq., 293, 296 – 298, 304, 318, 321 seq. Olbing, Hermann 156, 166, 169, 171 – 174, 176 Olitzky, L. (Aryeh Leo) 198 Oppenheim, Friedrich Carl von 83 Ordinariat des Erzbistums München 140 Ordre des m¦decins / FMA (French Medical Association) 19, 49, 53 seq., 56, 66, 68, 183 – 189, 191 – 194, 363 Outshoorn, Joyce 221 seq. Pagniez, Philippe 56 Panse, Friedrich 258, 352 Paris Medical School 66, 71, 76, 79 seq., 315 Park, Roswell 62 Parliamentary Committee for Compensation 116 – 118 Pasteur Institute (Paris) 34, 200 Pasteur Vallery-Radot, Louis 54, 190, 325 Paul the Apostle (Saul of Tarsus) 164 Paxton, Robert 183, 186 Pelz, Lothar 147 seq. Pertsikovitch (later Peretz), Aaron 197, 207 P¦tain, Philippe (Marshal) 184, 234, 240 Peter, Jürgen 141, 154 seq., 251 Peters, Uwe Henrik 149, 357 Peukert, Detlev 120 Pfannmüller, Hermann 143 Philanthropic Society (Paris) 325 Pierrard, Pierre 192 Pinel, Philippe 79 Pingel, Falk 97 Planche, Henri 54 Platen-Hallermund, Alice 266 Pohl, Oswald 30 Pokorny, Adolph 61 Portes, Louis 49, 53 seq., 191 Postma-Van Boven, Truus 226 – 228 Pouillard, Jean 184 Presse M¦dicale (French medical journal) 16 seq., 49, 53 seq., 56 – 58, 63, 65 – 67, 70 seq., 73, 75 seq., 79, 84, 201, 319

377

Index of Persons and Selected Institutions

Projektgruppe für die vergessenen Opfer des NS-Regimes 121 Pross, Christian 44, 127 Provisional Committee for Victims of Human Disasters 45 Psychiatrisches Landeskrankenhaus Schussenried 106 – 109, 111 seq. Püschel, Erich 175 Qu¦tel, Claude

232

Radbruch, Gustav 355 Rapoport Faculty of Medicine (Technion – Israel Institute of Technology) 51, 209 Rascher, Sigmund 257 Rau, Wilhelmine (“Mina”) 107 Ravina, Andr¦ 57 seq., 63 – 65, 75, 84, 319 Red Cross 60, 241 Reich, Jens 43 Reich Committee for the Scientific Registration of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden) 147 Reis, Shmuel 209 seq., 243 seq., 277 Remmelink, Jan 217, 306 Remy, Steven P. 88 Richet, Charles, Jr. 56, 58, 70, 80, 315 Richter-Reichhelm, Manfred 243, 268 Ritter, Robert 354 Robbins, Jack W. 62 Rockefeller Institute for Medical Research 240 Roelcke, Volker 11, 15, 21 – 23, 83, 89, 131, 147, 243, 256, 260, 262 – 265, 268 – 271, 299 seq., 337, 358 seq., 364 Roelen, Michael 286 – 288 Roscam Abbing, Pieter Johan 224, 226 Rose, Gerhard 61 Rotzoll, Maike 14, 42, 141, 265 seq., 363 Rousso, Henry 232, 237, 239 Rowe, Alan J. 298 Rozenkier, Simon 44 Rudder, Bernhard de 159, 162 Rüdin, Ernst 248, 351 Rutenfrans, Chris 215, 225

Rüther, Martin 256 – 258 Rütten, Thomas 34, 272 Sachse, Carola 358 Sadegh-Zadeh, Kazem 253 Samuel, Maximilian 199 Sander, Sabine 253 Savatier, Ren¦ 54 Sawade, Fritz (see Heyde, Werner) Scalettar, Raymond 135 Scharfetter, Erich 323 Scherrer, Pierre 232 Schlabrendorff, Fabian von 161, 166 seq. Schlossmann, Arthur 341 Schmidt, Eberhard 177 Schmidt, Gerhard 92, 143, 249, 355 seq. Schmidt, Ulla 268 Schmidt-Jortzig, Edzard 270 seq. Schmiedebach, Heinz-Peter 253 seq., 358 Schmuhl, Hans-Walter 275, 357 seq. Schneider, Carl 42, 354 Schneider, Frank 349, 359 Schönbrunn, see Assoziationsanstalt Schönbrunn Schott, Heinz 243, 253, 262 Schreiber, Georg 166 Schröder, Klaus Theodor 268 Schumann, Horst 199 Schwarberg, Günther 41 seq. Schweier, Paul 175 seq. Schweitzer, Albert 166 Second Conference on “Nazi Medical Atrocities” (Paris, 1946) 66 Second World Congress of Jewish Physicians (Jerusalem, 1952) 75, 78, 81 Secours National 241 Secretary of Agriculture and Provisions (French Ministry) 234 Se’erit ha-Pletah (Jewish organization for displaced persons) 317 Seidel, Michael 270, 335 Seidelman, William E. 13, 22 seq., 68, 131, 134 – 136, 255, 281, 286 – 289, 291, 293 seq., 296 seq., 364 Seidler, Eduard 148 seq., 152, 154, 161, 171, 173 – 178, 253, 274

378 Seret, Abraham 225 S¦rieux-Bonnafous, H¦lÀne 234 Servatius, Robert 96 Sewering, Hans Joachim 15, 18 seq., 22, 131 – 141, 143 – 145, 254 seq., 258, 274, 281 – 300, 367 Shasha, Shaul 209 Sher, Neal 289 Shiloh, I. 205 Shneorsohn, Fishel 206 Singer, Peter 11 seq. Sluis, Isaac van der 225 Soci¦t¦ M¦dico-Psychologique / MedicoPsychological Society 235 Society for Social Pediatrics and Adolescent Medicine, see Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin Sommer, Evelyn 289 Soviet Military Administration 93 SPD (Social Democratic Party of Germany / Sozialdemokratische Partei Deutschlands) 98, 119, 122 Special Children’s Wards (Kinderfachabteilungen) 143 seq., 147, 151, 160, 163, 168, 338 Spenser, Tomi 206, 209 seq. SPIEGEL / Der SPIEGEL (German weekly magazine) 133 seq., 139, 152 seq., 254 seq., 258, 282, 367 Sporken, Paul 214, 217 seq. SS / Schutzstaffel 30, 34, 42, 57, 87, 132 – 134, 138, 152, 166, 198 seq., 205, 248 seq., 251, 254, 258, 266, 274, 281 seq., 284, 288, 290, 293, 316, 323, 354 Staatsanwaltschaft München I 137 Stähle, Eugen 108 Steinberg, Elan 288 seq. Steininger, Josef 139 – 145 Stiftung Erinnerung – Verantwortung und Zukunft / EVZ 46 „Stille Hilfe” (“Silent assistance for prisoners of war and interned persons”) 96 Stock, Ulrich 253 seq.

Index of Persons and Selected Institutions

Straßburg, Hans-Michael 270, 343 Streicher, Julius 74 Süddeutsche Zeitung (German national newspaper) 133, 140, 243, 289, 292 seq., 329 Suffert, Georges 192 Surmann, Rolf 18, 113, 364 Süssmuth, Rita 263 SVE (Voluntary Euthanasia Foundation, Netherlands) 224 – 226 Swiss Society of Psychiatry 238 Syllepse (French publishing house) 233 Taylor, Telford 31 seq., 35 seq., 45, 57, 61 seq., 73, 87 Tel Aviv University 209, 281 Teppe, Karl 15, 94, 97, 99 The Hastings Center 12 The Lancet, see Lancet Th¦venin, Etienne 49, 56 Thiel, Adolf 95 Third World Congress of Jewish Physicians (Haifa, 1955) 205 Thompson, John West 29, 33 – 35, 38 seq., 44, 90, 365 Tiedemann, Sibylle von 143 Till-d’Aulnis de Bourouill, Adrienne van 226 seq. Todd, James S. 136, 286 seq., 297 Todt, Karl 95 Toellner, Richard 253 seq., 259, 331 Topp, Sascha 11, 16, 19, 22 seq., 131, 147, 243, 269, 274, 364 Treffers, Flip 224 Tr¦fouel, Jacques 190 Uflacker, Hanna(h) 151 seq., 163, 165 seq. Ullrich, Aquilin 98 UNESCO 13, 33, 39 Union of Mental Hospital Physicians (Union of Hospital Psychiatrists) (France) 231, 238 United Nations (UN) 33, 44, 49, 80, 93, 116 University of Vilnius 316

Index of Persons and Selected Institutions

US government

30, 91

Vallat, Xavier 186 – 188 Vanja, Christina 264 – 266 Verhagen, Eduard 307 Vetter, Helmuth 30 Villinger, Werner 117, 164, 258, 352, 356 Vilmar, Karsten 21, 131 seq., 136, 250 – 258, 263 seq., 266 seq., 269, 271 seq., 276, 287, 290 – 292, 294 seq., 331 Vincent, Armand 187 Virchow, Rudolf 196 Voncken, Jules 66 Wade, H. (Colonel) 200 Waitz, Robert 57, 59 Wallon, Henri 238 Wangh, Martin 44 seq. Weber, Gerhard 159, 165, 167, 180 Wehner, Herbert 119 Weindling, Paul J. 16, 23, 29, 36, 62, 90, 275, 358, 365 Weingarten, Michael 135, 281, 285, 299 Weinke, Annette 17, 48, 87, 365 Weitbrecht, Hans-Jörg 356 Weizsäcker, Viktor von 9, 154 Wentzler, Ernst 147, 151, 165 seq., 168, 175 seq. Westermann, Stefanie 15, 116, 175, 245 Whitney, Craig 133, 288 Wiedemann, Hans-Rudolf 168 seq., 175 Wieviorka, Olivier 183, 186, 233, 237, 239 Winau, Rolf 34, 253, 259 seq. Wischer, Gerhard 353

379 Wolff, Joachim 155, 157, 161 – 163, 165, 167 World Congress of Jewish Physicians 52, 75, 78, 81, 205 World Jewish Congress 22, 135, 255, 258, 288 World Medical Association / WMA (Association M¦dicale Mondiale / AMM) 15, 17 seq., 22, 38, 41, 49, 55, 67 – 71, 73, 75, 78 – 83, 133 – 136, 200 – 202, 255, 269, 271, 277, 281 – 288, 290 – 292, 294 – 299, 315 – 317, 319 World’s Medical Corporation, see World Medical Association Wunder, Michael 22 seq., 262, 270, 301, 365 Wynen, Andr¦ 287 Yad Vashem (The Holocaust Martyrs’ and Heroes’ Remembrance Authority, Jerusalem) 55 seq., 68, 73, 76, 79, 83, 199, 316 seq., 319, 323, 326, 364 Yishai, Ram 285 Zalashik, Rakefet 20, 23, 33, 73, 80, 82, 195, 205, 208, 315, 358, 365 Zentrale Stelle der Landesjustizverwaltungen Ludwigsburg, see National coordinating office for Nazi crimes at Ludwigsburg Zepp, Fred 149, 270, 337, 345 Zinn, Georg August 98 Zionist Socialist Workers Party (Vilnius) 317 Zonneveld, Robert Jacques van 222