NURSES' PARTICIPATION IN THE "EUTHANASIA" PROGRAMS OF NAZI GERMANY
Analytic Framework for Understanding the Nurses' Participation
It is essential to understand the societal values of the Nazi era. The concept of the "life not worthy of life" was a widely held value. The severely mentally and physically ill were considered to be living less than a human existence. This devaluation of the handicapped had its origins in the eugenics movement which was widely embraced in Europe as well as the US. The Third Reich's quest for the development of a superior race called for the elimination of those judged to be "inferior", whether because of handicap, race, or ethnicity.
Humans with severe imperfections were to be prevented from reproducing through involuntary sterilization and others were to be eliminated. The term "useless eaters" was often applied to severely handicapped and others regarded as non-productive (Friedlander, 1995, p. 61). Added to this were also the economic needs of the time. Valuable resources were to go to the war effort and to those who could work and be productive. Perhaps these nurses saw their actions as being congruent with these values.
This is similar to the view of the ethicist Dr. Arthur Caplan who stated that, in his belief, physicians did not set aside their ethics during the Holocaust but saw their actions as congruent with their ethical commitment to heal the people ("Healing the Volk") through the elimination of undesirable elements (Caplan, 1992). Furthermore, many people believed that euthanasia was not "illegal" although a law permitting euthanasia had, in fact, never been passed in Germany (Proctor, 1988, p. 183).
The belief that they were doing nothing wrong or even doing something of benefit was apparent in the statements of several of the nurses who seemed surprised that there were "legal consequences" to their actions. Two (Edith B. and Gertrude F.) Stated that they didn't see anything wrong with it and three others saw the killings as"releasing people from their suffering". Only seven of these fourteen nurses indicated feelings of some degree of guilt over their participation in the killings.
A second aspect to consider is that of the obedience. Obedience was greatly valued in Germany and nurses were to be obedient to their senior ranking nurses as well as to physicians. In the hospitals, nurses collaborated with physicians in the killings.
This collaboration was usually voluntary. The physicians were given the choice of accepting or declining, and they in turn gave that choice to their nurses. In the hierarchical German hospital system, as in that of most other counties, nurses were trained to obey physicians and often had a dependent relationship with the physicians they assisted. Although this was hardly an excuse for following orders to kill, as the refusal of some to do so proves, it does help explain the motives of some nurses" (Friedlander, 1995, p. 231). It is difficult for us, as contemporary nurses, to imagine that degree of obedience.
Perceptions of powerlessness were evident in the statements of several of the nurses who "didn't see a way around the orders, didn't have anyone to talk to, had no one trust if they told" and "was the youngest nurse on the ward". Others, however, did not remain powerless. They relocated, changed jobs, asked for transfers, became pregnant (Friedlander, 1995, p. 236). Role of Religion
Religion has had an effect on the nurses' participation in three ways: as an effect upon the individual, as an element of nursing education, and by its effects upon society. Individual religious commitment and its congruence or conflict with participation in the euthanasia program as been established in the testimony of several nurses at their trials. Several of the nurses did see themselves as religious persons and some, although not all, did admit to having guilty consciences over their killings.
During this era, nursing education was based on religion. There were Catholic and Deaconess nursing programs - both of which incorporated religion into their nursing curricula. Similarly, the religious affiliation of the institutions was a factor. Catholic hospitals were not used as euthanasia sites although patients from these institutions were transferred elsewhere for euthanasia with the knowledge of those employed at the Catholic hospital. It was religion - in the person of Bishop Galen - that is thought to have contributed to a cessation of the euthanasia program (but not an end to euthanasia). Knowledge of the euthanasia programs had become widespread among the population and, in August 1941, Bishop Galen delivered a sermon in which he described the killing of patients, including their registration and transfer. Copies of the sermon were dropped by the RAF over Germany. Shortly thereafter, Hitler ordered a stop to the gassing of patients. This order did not apply to the children's euthanasia program.
Role of Nursing Education and the Nursing Professional Organizations
The role of nursing education in the nurses' participation has overlap with both gender and religion. Nursing education was different for males and females. Most female nurses were educated in religious-based institutions. The professional nursing organizations that wee established during the Nazi era were separate for male and females nurses. The females nurses organizations included the (1) Protestant Nursing Orders, (2) Catholic Sisterhoods, (3) Red Cross Sisterhoods, (4) Federation of Professional Nurses, and (5) the Sister hood of the National Socialists. In 1939, only 9% of the nurses were members of the Nazi sisterhood. The main employment of the Nazi nurses was in community health nursing because this area could provide the greatest opportunity for influencing the population. It was not, therefore, only the Nazi nurses who were involved in the euthanasia programs.
Fear of the consequences of refusing to participate in the killings - "would be reported to the Gestapo if refused" and "afraid of losing job" - was not frequently cited by these nurses but has been given by other nurses as the reason for not refusing to help with the killings (Friedlander, 1995, p. 236). Certainly, the Gestapo were greatly feared during this era. In at least one institution, the nurses were made to sign pledges of silence under threat of death if they discussed the euthanasia program at their institution (Richarz, 1987). For the male nurses, there was always the threat of being sent to the Eastern front.
Economic factors made have been an influence for some nurses. Nurses working on the euthanasia units received additional pay and/or bonus payments. For example, the nurses in the children's euthanasia wards at Eglfing-Haar received about $80 extra per month (Burleigh, 1994, p. 104-105). Other nurses later testified that they continued to work in the euthanasia programs because they were afraid of losing their jobs (Ebbinghaus, 1987). As civil servants, the nurses had benefits not available with all other jobs.