• DOI:10.7326/0003-4819-132-4-200002150-00010
• Corpus ID: 6202732

Eugenic Sterilization and a Qualified Nazi Analogy: The United States and Germany, 1930-1945

@article{Sofair2000EugenicSA,
  title={Eugenic Sterilization and a Qualified Nazi Analogy: The United States and Germany, 1930-1945},
  author={Andr{\'e} N. Sofair and Lauris Christopher Kaldjian},
  journal={Annals of Internal Medicine},
  year={2000},
  volume={132},
  pages={312-319}
}

• A. Sofair, L. Kaldjian
• Published 15 February 2000
• Medicine
• Annals of Internal Medicine

During the 19th century, scientists investigated the acquisition of biological and behavioral traits. British biologist Francis Galton, who first made the nature-nurture distinction, studied the comparative worth of different races in 1883, using the term eugenics to describe the process of strengthening the human race through selective breeding (1, 2). Some 30 years earlier, French count Joseph Arthur de Gobineau had described race as the driving force of human history, arguing that there were several pure racial archetypes and attributing superior intelligence to the Aryan archetype (3). In On the Origin of Species by Means of Natural Selection (1859), Charles Darwin outlined a biological theory about how new species are formed and existing ones become extinct (4). After its publication, many anthropologists and scientists sought to apply this theory to humans. Known as social Darwinists, they explained human society in terms of natural selection (5, 6) and were presumably inspired by Darwin's candor: [O]ur medical men exert their utmost skill to save the life of everyone to the last moment . Thus the weak members of civilized societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man (7). Simultaneously, the growing prestige of science during the 19th century facilitated the reduction of social and moral problems to scientific terms. Moral decadence; crime; and such illnesses as tuberculosis, venereal diseases, and alcoholism were considered symptoms of hereditary degeneration. Eugenicists and social Darwinists believed that medical science could engineer social progress (8). The Eugenics Movement in Germany Social Darwinism was introduced into the German scientific community at the end of the 19th century. Proponents of this theory contended that medical care had interrupted the natural struggle for existence by preserving the weak and that defective persons were reproducing faster than healthy ones (9, 10). Biologist Ernst Haeckel wrote that humans are not always bound to prolong life and proposed the establishment of a commission to determine which of the chronically ill should be put to death by poisoning (11). In 1915, psychiatry professor Alfred Hoche described the end of atomistic individualism and the transformation of the nation into a higher organism, the Volk (12, 13). This quasi-mystical image, later incorporated into Hitler's world view, portrayed society as an organism with its own health and identified human beings as functional or dysfunctional parts of a larger whole (14, 15). The political, social, and economic turmoil that followed Germany's defeat in World War I radicalized many German professionals and created popular support for the idea of the Volk (15). After the war, eugenicists focused their concern on costly welfare programs, the care of injured veterans, the loss of valuable genetic stock through war, and the decline in birth rates among the elite (16, 17). In 1921, the German Society for Race Hygiene advocated a eugenics program in which voluntary sterilization was favored (18). Nazi Transformation of the Medical Profession Soon after rising to power in 1933, Hitler asked the German medical profession to address the race question (19). He took control of its professional organizations, restructured the medical schools and the Public Health Department (purging them of non-Aryans), and centralized the insurance and payment systems (20). Many physicians were attracted to Nazi ideology, and the medical profession had one of the highest rates of party membership of any profession (21). By 1936, 31% of Berlin's non-Jewish physicians had joined the Nazi party, and rates of party membership were similar elsewhere in Germany (22, 23). Financial incentives encouraged physicians to support the Nazi government. From 1927 to 1932, physicians' average annual income had fallen by 27%, and many were unemployed (24). The inability of the preceding Weimar government to address this problem was countered by Nazi promises to restore the lost status of physicians (25). By 1935, physicians' average taxable income had increased by 25% (21). Physicians were also induced to join the Nazi party because a spotless Nazi record was required for a government-sponsored practice (26). Academic appointments and salary support in German medical schools depended on loyalty to the Nazi party, and Nazis of dubious professional attainment were appointed as rectors and deans (27). Instruction in eugenics became compulsory for medical students, and by 1935, students were required to wear Nazi uniforms and undergo Nazi indoctrination. Nazi medical propaganda was also directed at practicing physicians (20). The Nazi Eugenic Sterilization Program Although eugenic thought was easily appropriated by Nazi ideology (28, 29), the early eugenics movement was disengaged from party politics. Existing German law did not support eugenic sterilization, and before 1933, physicians who performed sterilizations for other than therapeutic reasons were sporadically prosecuted (30, 31). In 1932, before the Nazis took power, discussions among the German medical associations, the Reich Minister of the Interior, and the Prussian Health Council addressed the urgent economic need for compulsory sterilization (32). Five months into their rule, the Nazis enacted a law allowing the involuntary sterilization of persons with diseases thought to be hereditary, including schizophrenia, epilepsy, alcoholism, manic depression, hereditary deafness or blindness, severe hereditary physical deformity, Huntington chorea, and congenital feeblemindedness (33). The diagnosis of feeblemindedness was left largely to the discretion of the examiner (34). Although the law did not provide for sterilization on racial grounds, healthy Jews (35) and Gypsies (36) were nonetheless targeted. Sterilization could be requested by physicians, guardians, or institutions and was authorized by hereditary health courts (29, 37). From 1933 to 1939, 360 000 to 375 000 persons were sterilized; of these operations, 37% were voluntary, 39% were involuntary (done against the person's will), and 24% were nonvoluntary (consent was granted by a guardian for persons who could not choose or refuse sterilization) (38, 39). Sustained resistance to the sterilization program by the medical profession was scarce and was largely organized by small groups of Marxist physicians (40). Although some physicians were moved by Hippocratic or religious principles to resist the program (41), others indiscriminately sought sterilization for some of their patients (21, 34, 42). The Roman Catholic church in Germany took a strong stand against the sterilization law. To avoid conflict, the Nazis decreed that Catholic judges would not be asked to preside over hereditary health courts, Catholic surgeons would not be required to perform sterilizations, and Catholic citizens deemed defective would be exempt from sterilization if they were institutionalized at the expense of family or church (43). From Eugenic Sterilization to Involuntary Euthanasia In 1920, Alfred Hoche and Karl Binding (a retired jurist and widely published legal scholar) published Permitting the Destruction of Unworthy Life as a solution to the economic burden of institutionalized mentally handicapped patients. Unworthy life referred to those irretrievably lost through illness or injury and the incurably insane. They dismissed the Hippocratic oath as a vestige of ancient times, insisting instead on the standpoint of a higher civil morality that considered the health of the state and abandoned the unconditional preservation of valueless lives (44). The Nazi regime first discussed involuntary euthanasia in 1933 (45, 46). However, it was not until 1 September 1939 that Hitler ordered a program of involuntary mercy killing to commence with the start of World War II; he knew that the upheaval of war would diminish public resistance (47). Never sanctioned by law, this program was executed in relative secrecy by using such methods as starvation, injection of morphine, and asphyxiation by gassing (48). After strong opposition by Protestant and Catholic church leaders (49, 50), the program officially ended in 1941after 70 253 persons had been put to deathbut it continued in a limited manner until the war's end (51). Karl Brandt, Hitler's personal physician and the supreme medical authority in the Third Reich, testified at the Nuremberg trials that the euthanasia program to eliminate disabled children was a natural outgrowth of the 1933 sterilization law (52). The Eugenics Movement in the United States The eugenics movement in the United States arose in the wake of three intersecting developments: a belief in scientific management and rational planning, the pressures of economic instability, and the arrival of the progressive era (53). Progressives believed that societies could make progress toward the attainment of cherished goals (54), and the science of eugenics promised to attack social ills at their core. Eugenicists argued that the birth of defective persons created too great a social burden and that the state had the prerogative to control procreation among persons likely to bear children who would be dependent on the public purse. Many advocates of eugenics in the United States were also motivated by racist fears that the survival of old-stock America was threatened by the influx of lower races; they strongly supported immigration restriction, especially from southern and eastern Europe (55-57). Sterilization Laws in the United States The history of state-sponsored sterilization in the United States began with legislation in Indiana in 1907. By 1926, 23 states had enacted sterilization laws, which were motivated mainly by eugenic and therapeutic concerns. Eighteen of these states mandated involuntary sterilization of certain mentally defective perso