Nazis, Sterilization and Deaths of People with Disabilities

Introduction

In Nazi Germany the, 'sterilization law,' explained the importance of removing genetic defects from the entire German gene pool. The law stated;

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'Since the National Revolution public opinion has become increasingly preoccupied with questions of demographic policy and the continuing decline in the birthrate. However, it is not only the decline in population which is a cause for serious concern but equally the increasingly evident genetic composition of our people. Whereas the hereditary healthy families have for the most part adopted a policy of having only one or two children, countless numbers of inferiors and those suffering from hereditary conditions are reproducing unrestrainedly while their sick and asocial offspring burden the community.'

• Sterilization - (sterilisation) - Defined as any of a number of medical techniques that intentionally leave a person unable to reproduce. It is a method of birth control. Sterilization methods include both surgical and non-surgical, and exist for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult or impossible.
• Compulsory sterilization - (also known as forced sterilization, compulsory sterilisation or forced sterilisation), refers to governmental policies put in place to control a country's population or as a form of eugenics (improving hereditary qualities of a race or breed by controlling mating) to prevent certain groups of people from reproducing.

Some doctors and scientists were opposed to the involuntary aspect of the law, while other pointed to potential flaws. Yet the designation of specific conditions as inherited, as well as the desire to remove forms of disabilities or illnesses from the population, generally reflected the medical and scientific thinking of Nazi Germany - and elsewhere.

Nazi Germany was not the only or the first country to sterilize human beings considered to be, 'abnormal.' Prior to Hitler, the United States of America led the entire world in forced sterilizations. Between the years of 1907 and 1939 more than 30,000 people in twenty-nine states were sterilized, a number them against their will or unknowingly, all while they were incarcerated in institutions or prisons for the mentally ill. Almost half of the operations were carried out in the State of California. Advocates of sterilization policies in America and Germany were influenced by eugenics. A socio-biological theory took Charles Darwin's principle of natural selection and applied it to society. Eugenicists believed the human race could be improved through controlled breeding.

The fact is - no nation carried out sterilization as far as Hitler's Germany. The forced sterilizations started in January of 1934 and altogether an estimated 300,000-400,000 people were sterilized under the law at the time. A diagnosis of, 'feeble-mindedness,' was enough grounds in most instances, followed by schizophrenia and epilepsy. The common method of sterilization was ligation of ovarian tubes or vasectomy. Irradiation was used in a small number of instances. Thousands of people died due to the operations, women more than men because of the risks of tubal ligation.

The majority of the people targeted by the law were people in mental hospitals and other types of institutions. Most of these people were sterilized between the ages of 20 and 40, around equally divided between women and men. Most were, 'Aryan,' Germans. The sterilization law did not target racial groups such as Gypsies and Jews, although Gypsies were sterilized as, 'deviant asocials;' homosexuals were as well. Approximately 500 teenagers of mixed German and African parentage were sterilized due to their race by secret order and outside of the provisions of the law.

While the sterilization law at times functioned arbitrarily, the semblance of legality underpinning it was important to the Nazi's. More than 200 Hereditary Health Courts were established across Germany and later on - annexed territories. Each was comprised of two doctors and one district judge. Doctors were required to register with these courts every known instance of hereditary illness. Appeals courts were also established, yet few decisions were ever reversed. Exemptions were at times given to artists or other talented people who experienced mental illness. The sterilization law was followed by the, 'Marriage Law,' of 1935, which required for every marriage proof than any children from the union would not be afflicted with a disabling hereditary disease.

Only the Roman Catholic Church opposed the sterilization program on a consistent basis. The majority of German Protestant churches often cooperated and accepted the policy. Popular films at the time such as, 'Das Erbe,' or, 'Inheritance,' helped to build public support for government policies by stigmatizing people with mental and physical forms of disabilities while highlighting the costs of their care. School math books of the time presented questions such as, 'The construction of a lunatic asylum costs 6 million marks; how many houses at 15,000 marks each could have been built for that amount?'

From Sterilization to Euthanasia

Forced sterilization in Germany was the precursor to systematic killing of people with forms of mental illnesses and the physically disabled. In October of 1939, Hitler initiated a decree empowering doctors to grant a, 'mercy death,' to, 'patients considered incurable according to the best available human judgment of their state of health.' The intent of the euthanasia program; however, was not to relieve the suffering of people who were chronically ill. The Nazi's used the term as a euphemism; its goal was to exterminate people with mental illnesses and the physically disabled to achieve, 'cleansing,' of the, 'Aryan,' race. People with Disabilities were considered to be genetically defective and a financial burden to society.

The idea of killing people considered to be incurably was presented well prior to 1939. In the 1920's, debate on the issue centered on a book co-authored by Alfred Hoche, psychiatrist as well as Karl Binding - a prominent scholar of criminal law. Alfred and Karl argued that economic savings justified the killing of, 'useless lives,' such as, 'congenitally crippled,' or those considered to be, 'idiots.' Economic deprivation during WWI provided the context for the idea. During the war, people in asylums ranked low on the list for rationing of medical supplies and food. As a result, many people died from disease or starvation. More generally, the war undermined the value attached to individual human life and - in combination with Germany's humiliating defeat, led many nationalists to consider ways to regenerate the nation as a whole; even at the cost of individual rights.

The year of 1935 found Hitler stating in private that, 'in the event of war, [he] would take up the question of euthanasia and enforce it,' because, 'such a problem would be more easily solved,' during wartime. War would provide not only a cover for killing, it would provide a pretext as well; hospital beds and medical personnel would be available for the war effort. War and the diminished value of human life during wartime would also, according to Hitler, silence expected opposition. In order to make the connection to the war explicit, Hitler's decree was backdated to September 1, 1939 - the day Germany invaded Poland.

Afraid of public reaction, the Nazi's never proposed a formal, 'euthanasia,' law. Unlike the forced sterilizations, the killing of people in mental asylums and other types of institutions was carried out secretly. The code name was, 'Operation T-4,' which was a reference to, 'Tiergartenstrasse 4,' the address of the Berlin Chancellery offices where the program was headquartered.

Nazi doctors were the key to the success of T-4 because they organized and carried out almost all aspects of the operation. One of Hitler's personal doctors, Dr. Karl Brandt, led the program in conjunction with Hitler's Chancellery chief, Philip Bouhler. T-4 targeted adults in all government or church-run sanatoria, as well as nursing homes. The institutions were instructed by the Interior Ministry to collect questionnaires concerning the state of health and capacity to work of all of their patients.

The completed questionnaires were sent to assessor physicians, often times psychiatrists, who made up, 'review commissions.' These doctors marked each name with a, '+,' in red pencil to signify death, or a '' in blue pencil meaning life, or a, '?' for cases requiring more assessment. These medical experts rarely examined any of the patients and made their decisions based on the questionnaires alone. At each step, the medical authorities involved were usually expected to rapidly process large numbers of the forms.

Mass Killings of People with Disabilities

People with Disabilities who were doomed to die were bused to killing centers in Germany and Austria in walled-in fortresses, mainly former psychiatric hospitals, castles and a former prison - at Sonnenstein, Hartheim, Bernburg, Grafeneck, Brandenburg and Hadamar. When the killing began, people were killed using lethal injections. By the year 1940, Hitler, on the advice of Dr. Werner Heyde, suggested that carbon monoxide be used as the preferred means of killing. Experimental gassings were first carried out at Brandenburg Prison in 1939. At Brandenburg Prison, gas chambers were disguised as showers - complete with fake nozzles to deceive victims; prototypes of killing centers' facilities built in occupied Poland later on in the war.

Following procedures that would later be used in extermination camps, workers removed the dead bodies from the chambers, removed gold teeth and then burned large numbers of bodies together in crematoria. Urns filled with ashes were prepared in the event a family member of the deceased requested their loved one's remains. Doctors using phony names prepared death certificates with false causes of death and sent letters of condolences to relatives.

Meticulous record found after the war documented 70,273 deaths by gassing at the six euthanasia centers between January of 1940 and August of 1941, a total that included up to 5,000 Jews. All Jewish mental patients were killed despite their ability to work, or the seriousness of their illness. A detailed report also recorded the estimated savings from the killings of people in institutions.

The secrecy surrounding the T-4 program broke down rapidly. Some staff members were indiscreet while drinking in pubs after work. Despite precautions, errors were made. For example; hairpins turned up in urns sent to family members of male victims, the cause of death was listed as appendicitis - even though the person who was killed had their appendix removed years beforehand. In the town of Hadamar, school students called the gray transport buses, 'killing crates,' and threatened one another with the taunt, 'You'll end up in the Hadamar ovens!' The thick smoke from the incinerators was said to be visible each day over Hadamar. In Hadamar, staff members celebrated the cremation of their 10,000th person with wine and beer served right in the crematorium.

A few church leaders, local judges and parents of victims protested the killings. One judge, Lothar Kreyssig, instituted criminal proceedings against Bouhler for murder - Kreyssig was retired. A few doctors protested; Karl Bonhoffer, a psychiatrist, as well as his son, Dietrich a Protestant minister who who actively opposed the Nazi regime, urged church groups to pressure church-run institutions not to release their patients to T-4 authorities.

In response to pressure, Hitler ordered an end to Operation T-4 on August 24, 1941. Gas chambers from some of the euthanasia killing centers were taken apart and then shipped to extermination camps in occupied Poland. In late 1941 and 1942, the chambers were rebuilt and used for the, 'final solution to the Jewish question.' Redeployed from T-4 were future extermination camp commandants Franz Stangl, Christian Wirth, Franz Reichleitner, Dr. Irmfried Eberl, along with approximately 100 doctors, male nurses and clerks who used their skills in Belzec, Sobibor and Treblinka.

The euthanasia killings; however, continued under a different and decentralized form. Hitler's regime continued to send to doctors and the general public the message that people with mental health disabilities were, 'useless eaters,' and therefore, 'unworthy of life.' In 1941 the film, 'Ich klage,' or, 'I accuse,' in which a professor kills his incurably ill wife was viewed by 18 million people. Doctors were encouraged to decide on their own who should live or die. Killings became part of hospital routine as infants, children and adults were put to death by poisoning, starvation and injections. Killings even continued in some of Germany's mental asylums such as Kaufbeuren weeks after Allied troops had occupied surrounding areas.

Between the middle of 1941 and the winter of 1944-45 in a program known under code, '14f13,' experienced psychiatrists from the T-4 operation were sent to concentration camps to weed out prisoners who were too sick to work. Following superficial medical screenings, designated inmates, Jews, Gypsies, Poles, Russians, Germans and other people were sent to euthanasia centers where gas chambers had not been dismantled at Hartheim and Bernburg where they were gassed. A minimum of 20,000 people are believed to have died under the 14f13 program.

Outside of Germany, thousands of mentally ill people in the occupied territories of Russia, Poland and East Prussia were also killed by the, 'Einsatzgruppen,' squads or SS and special police units that followed the German army. Between September 29 and November 1, 1939 these units shot around 3,700 people with mental illnesses in asylums in the region of Bromberg, Poland. In December of 1939 and January of 1940, SS units gassed 1,558 people from Polish asylums in specially adapted gas vans to make room for SS and military barracks. While regular army units did not officially participate in, 'cleansing,' actions as general policy, some instances of their involvement have been documented.

In total, between 200,000 and 250,000 mentally and physically disabled people were murdered between 1939 and 1945 under the T-4 and other euthanasia programs. The incredible magnitude of these crimes and the extent to which they prefigured the, 'Final Solution,' are still being studied. In an age of genetic engineering and renewed controversy over mercy killings of people who are incurably ill, moral and ethical issues of concern to doctors, scientists and lay persons remain vital.

As a person with epilepsy, I am fortunate not to have lived in Nazi Germany. The implications related to government in general; however, finds me with a complete lack of trust for any government. If a government is capable of such horrific acts, how can trust on the parts of People with Disabilities exist? Bear in mind the fact that the United States of America also practiced sterilization of People with Disabilities. Despite the Americans with Disabilities Act and America's signing, yet failure to ratify, the Convention on the Rights of Persons with Disabilities (CRPD) - I can only wonder how long it will be before people who experience a wide range of disabilities end up being scapegoated, treated with contempt and even possibly killed for the sake of a government that is largely run by non-disabled persons.

In May 2014, the World Health Organization, OHCHR, UN Women, UNAIDS, UNDP, UNFPA and UNICEF issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement. The report references the involuntary sterilization of a number of specific population groups. They include:

• People with disabilities, often perceived as sexually inactive. women with intellectual disabilities are "often treated as if they have no control, or should have no control, over their sexual and reproductive choices". Other rationales include menstrual management for the benefit of carers.
• Women, especially in relation to coercive population control policies, and particularly including women living with HIV, indigenous and ethnic minority girls and women. Indigenous and ethnic minority women often face "wrongful stereotyping based on gender, race and ethnicity".
• Transgender persons, "as a prerequisite to receiving gender- affirmative treatment and gender-marker changes".
• Intersex persons, who "are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved", often as a "sex-normalizing" treatment.

The report recommends a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability and access to remedies.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida. Explore Thomas' complete biography for comprehensive insights into his background, expertise, and accomplishments.

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