Background

Before the time of the genocide of millions known as the Holocaust, the German government established "euthanasia" programs for handicapped German children and adults. Nurses were participants in both. In reality, these programs had little to do with the contemporary understanding of the word "euthanasia". In actuality, the programs were the involuntary killing of handicapped children and adults that were sanctioned by the government and society.

The origins of planned euthanasia were in place earlier than the Nazi era. "The idea of ending 'lives not worth living' did not begin with the Nazis, but had been discussed in the legal and medical literatures since the end of the First World War", with supportive articles appearing in both European and American literature (Proctor, 1992, p. 24). In 1920, Dr. Alfred Hoche, a physician, and Karl Binding published a pamphlet entitled "The Sanctioning of the Destruction of Life Unworthy of Living". The emphasis of the book was on the reduction of suffering of the acutely ill and their families (Nadav, 1994, p. 45). Later, in 1935, Hitler told the Reich physician leader, Dr. Gerhard Wagner, that he would implement euthanasia once war began (US Military Tribunal, Transcripts of the Proceedings in Case 1, p. 2482, Testimony of Karl Brandt).

The German people were exposed to the idea of euthanasia through posters, movies, and books supporting the destruction of "lives not worth living". A 1936 book entitled Sendung und Gewissen (Mission and Conscience) was published in Germany by an ophthamologist and was widely read. This novel told the story of a young wife with multiple sclerosis who was euthanized by her physician-husband. This novel was important in preparing the ground for the euthanasia programs (Proctor, 1988, p. 183). It was made into a movie "Ich Klage an!" ("I Accuse") and was widely shown during these years. Two other popular movies of the time also dealt with euthanasia, Life Unworth Life (1934-1935) and Presence without Life (1940-1941) (Amir, 1977, p. 97). "Opfer der Vergangenheit (Victims of the Past, 1937) was produced under Hitler's direct order and shown by law in all 5,300 German theaters" (Michalczyk, 1994, p. 65). These films argued that keeping seriously ill people alive was against the basic principles of nature (Michalczyk, 1994, p. 65).

Posters were displayed throughout German showing a healthy German supporting on his shoulders the weight of handicapped individuals with the saying "You Are Sharing the Load! A Genetically Ill Individual Costs Approximately 50,000 Reichsmarks by the Age of Sixty" (Gross, 1935, p. 335). Even high school textbooks contained mathematical problems using the cost of caring for the mentally ill as examples (Dorner, 1935). The elderly and the ill, too, were considered by some to be burdens: "It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified" and "...it made no sense for persons 'on the threshold of old age' to receive services such as orthopedic therapy or dental bridgework; such services were to be reserved for healthier elements of the population" (Proctor, 1988, p. 183). It is important to see these attitudes as the context for nursing at that time.