Nurses' participation in the Holocaust: A call to nursing educators.

This year marks the 75th anniversary of the liberation of Auschwitz. The number of people able to provide first-person accounts of the atrocities of the Holocaust is dwindling in numbers. Prior to the mass extermination of Jews at Auschwitz and other extermination camps, nurses actively participated in the execution of tens of thousands of mentally, physically, and emotionally ill German citizens. Nursing educators must ensure that nursing students not only know about the Holocaust, but that they know that ordinary nurses were directly involved in the identification of vulnerable humans to be killed, and actually murdered them. Social, economic, and political pressures existed enabling the Nazi regime to involve nurses in this way. Similarly, social, economic, and political pressures today have the potential to encourage nurses to act in ways that violate personal or professional values. This paper provides four learning objectives that can be incorporated into existing nursing curricula to ensure that nurses do not forget how and why nurses in Germany came to murder more than 10,000 people in their care. With the passage of time comes the risk that the legacy of the Holocaust will be forgotten, nursing educators must participate in preventing that from happening.

Hans Gerhard Creutzfeldt (1885-1964) in the Third Reich: A reevaluation.

Hans Gerhard Creutzfeldt (1885-1964) is an internationally known Professor of Psychiatry and Neurology. During the time of National Socialism (1933-1945), he worked in the Charite University Hospital Berlin and moved to Kiel University as Head of the Department for Psychiatry and Neurology in 1938. Until the turn of the millennium, Creutzfeldt was considered to be of moral integrity and an opponent of the Nazi regime and its eugenics measures. Publications of the last years came to the conclusion that this depiction does not hold up. They questioned his relations to the ideas and structures of the National Socialist system, his role as a consultant in the National Socialist's forced sterilization program, a possible involvement in the Nazi euthanasia measures, and his position as a psychiatric consultant for the German navy. The article considers 2 aspects concerning the National Socialist racial hygiene in greater detail by using newly found source material. It is shown that Creutzfeldt, although he did not actively resist, was not acting in the interest of the Nazi regime, but rather was trying to save as much patients as possible by changing their diagnoses and prevent them from being killed in the euthanasia program.

[Max Nonne (1861-1959) and his attitude towards "euthanasia"]. / Max Nonne (1861­1959) und seine Einstellung zur "Euthanasie".

Max Nonne, an internationally renowned German neurologist, acted from 1918 to 1924 as president of the (first) Society of German Neurologists (GDN). Appointed honorary president in 1925, he held this position in the (second) German Neurological Society (DGN) until his death. Since 1961, this association has honored 16 neurologists with a commemorative medal named after Nonne. His outstanding findings in various fields of neurology are uncontested and some of them live on as eponyms (Nonne-Apelt syndrome, Nonne-Froin syndrome, Nonne-Milroy-Meige syndrome); however, recent archival studies and an analysis of individual publications deeply darkened the image of the "grey eminence" of German neurology. Records kept at the Hamburg State Archive prove that in a memorandum from 1941/1942 following the example of Binding and Hoche, Nonne firmly approved the killing of "life absolutely unworthy of living". In a report addressed to the District Court of Hamburg he attested in 1946 that many physicians charged with manslaughter acted in accordance with the regulations governing "child euthanasia", resulting in the withdrawal of the accusation. In a further statement from 1949 he confirmed that the killing of children and the "euthanasia program" during the NS era were consistent with the state of medical science. An earlier book chapter authored by Nonne immediately after World War I suggested that his social-Darwinistically colored concept of mankind was developed clearly before the Nazi era. Notwithstanding the arrangement to which he came with the new powers after 1933 and his acceptance of tributes to him by them, he repeatedly stood up for his Jewish colleagues. He was never a Nazi, nevertheless, he engaged in activities that fostered NS "euthanasia" going far beyond a "mentality of approval".

[Otfrid Foerster (1873-1941) and his ambivalent attitude towards National Socialism]. / Die ambivalente Haltung Otfrid Foersters (1873­1941) gegenüber dem Nationalsozialismus.

When Adolf Hitler was appointed Chancellor of the Reich Otfrid Foerster was almost 60 years old and an internationally renowned neurologist, neurosurgeon and a pioneer of localization research. Since 1922 he held the chair of neurology in Breslau (Wroclaw) and from 1925 to 1932 he was president (later honorary president) of the first Society of German Neurologists. In 1934 "his" Neurological Research Institute in Breslau was inaugurated. Biographical studies have unanimously established that he has never been a member of the party, that he found himself promptly marginalized after 1933 within his own ranks, and that he never participated in eugenic measures or "euthanasia" activities. A re-reading and analysis of his relevant papers and publications on neurology reveal however reverences paid to the Nazi state, which are surprising in this clarity. A possible explanation for Foerster's overall ambivalent attitude, he was married to a non-Aryan woman (in Nazi jargon), is the threat posed to his relatives by Nazi racial hygiene laws. On the other hand, there are clear indications of his conservative German national patriotism encouraging and supporting a restrengthened state and the National Socialist vision of the German Reich as a "great power". Further investigations will have to show how the numerous influential factors that had a bearing on his biographical characteristics, political attitude, medical research interests and private motivation should be weighted.

The fate of Jews hospitalized in mental hospitals in France during World War II.

The fate of Jewish psychiatric patients in occupied Europe during World War II is inseparable from the fate of the disabled and mentally ill, as planned by the Nazi regime. But Jews found themselves at the confluence of eugenics, Christian anti-Judaism and Nazi racist and anti-Semitic madness. They faced the twin promise of death - both as Jews and as mentally ill. They did not escape from the euthanasia programme and, if by a miracle they survived, they disappeared into the extermination camps. The modalities of annihilation of Jewish psychiatric patients are inseparable from the forms of German occupation, which differed from country to country. In this research we focus initially on various countries in occupied Europe, and then on France.

Euthanasia, medically assisted dying or assisted suicide: time for psychiatrists to say no.

OBJECTIVE: Euthanasia has been considered unethical for most of the history of medicine. Recently it has been legalised in some countries, including parts of Australasia. We describe the recent history of euthanasia, paying attention to the extension of criteria that impact on the poor, elderly and vulnerable members of society in countries that currently have legalised this. In four of the five countries where euthanasia is legalised, there have been extensions of its criteria, either by revision of legislation or changes in practice. CONCLUSIONS: We suggest that this dynamic can be halted by international agreements of medical societies to shun involvement in euthanasia, as has been the case with other legal interventions that stigmatise. We may, as we have in the past, need to work collectively to meet this ethical challenge.

The 'Poitrot Report', 1945: the first public document on Nazi euthanasia.

The aim of this paper is to shed light on the so-called 'Poitrot Report', submitted to the French Military Government in Baden-Baden, Germany, in December 1945 and published in a reduced German version in 1946. Its author was the French-Moroccan psychiatrist Robert Poitrot, who had been put in charge of the public mental asylums in Südwürttemberg after World War II. Poitrot took responsibility for restoring psychiatric care during the occupation, and was also eager to document Nazi 'euthanasia' and to start investigating the role of staff in mental hospitals during National Socialism. Focusing on the 'Poitrot Report', this paper also reflects on life in Württemberg mental hospitals and the interaction between French representatives such as Poitrot and regional German medical staff.

The genealogy of death: A chronology of U.S. organizations promoting euthanasia and assisted suicide.

In the early 20th century, a political movement to secure access to euthanasia and assisted suicide began in the United States. The multitude of organizations associated with this effort has undergone an array of mergers, splits, and name changes, channeled through two progenitor organizations-the Euthanasia Society of America and the Hemlock Society. A few chronologies mapping the metamorphoses of these organizations are available, but they are not accessible in the medical literature. Moreover, they are not comprehensive, lack consistency, and are not rigorously validated. As debates about the legalization of euthanasia and assisted suicide continue, it is important to have a common understanding of the history behind these developments, including recognition of the factors driving these adaptations. In this paper, we offer a comprehensive and definitive history to aid those interested in knowing the roots of these organizations and those that are still active today.

Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 2: Europe.

This article deals with the nine European nations which legalised non-consensual sterilisation during the interwar years, thus completing the review, the first part of which was published in an earlier issue of this Journal. Like we did for North America, Japan and Mexico, countries concerned are addressed in chronological order, as practices in one of these influenced policies in others, involved later. For each, we assess the continuum of events up to the present time. The Swiss canton of Vaud was the first political entity in Europe to introduce a law on compulsory sterilisation of people with intellectual disability, in 1928. Vaud's sterilisation Act aimed at safeguarding against the abusive performance of these procedures. The purpose of the laws enforced later in eight other European countries (all five Nordic countries; Germany and, after its annexation by the latter, Austria; Estonia) was, on the contrary, to effect the sterilisation of large numbers of people considered a burden to society. Between 1933 and 1939, from 360,000 [corrected] to 400,000 residents (two-thirds of whom were women) were compulsorily sterilised in Nazi Germany. In Sweden, some 32,000 sterilisations carried out between 1935 and 1975 were involuntary. It might have been expected that after the Second World War ended and Nazi legislation was suspended in Germany and Austria, including that regulating coerced sterilisation, these inhuman practices would have been discontinued in all nations concerned; but this happened only decades later. More time still went by before the authorities in certain countries officially acknowledged the human rights violations committed, issued apologies and developed reparation schemes for the victims' benefit.

Does the doctrine of double effect apply to the prescription of barbiturates? Syme vs the Medical Board of Australia.

The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients. Syme claimed that he prescribed the drugs with the intention of relieving their existential suffering and not to assist in suicide; he argued that the DDE could be applied. Pace VCAT, I argue that this is an illegitimate application of DDE. I argue that a close scrutiny of Syme's actions reveals that, at the very least, he intended to give patients the option of suicide. He furthermore used what on a traditional definition of DDE would be considered a 'bad' means-the prescription of Nembutal-to achieve a 'good' end-the relief of suffering. The case demonstrates the crucial importance of analysing an agent's 'intention' and the 'effects' of their actions when applying DDE. Ethicists and, indeed, the judiciary need to attend to the ethical complexities of DDE when they assess the applicability of DDE to end of life care. If they fail to do this, the doctrine risks losing its legitimacy as an ethical principle.

The Nazi Physicians as Leaders in Eugenics and "Euthanasia": Lessons for Today.

This article, in commemoration of the 70th anniversary of the Doctors' Trial at Nuremberg, reflects on the Nazi eugenics and "euthanasia" programs and their relevance for today. The Nazi doctors used eugenic ideals to justify sterilizations, child and adult "euthanasia," and, ultimately, genocide. Contemporary euthanasia has experienced a progression from voluntary to nonvoluntary and from passive to active killing. Modern eugenics has included both positive and negative selective activities. The 70th anniversary of the Doctors' Trial at Nuremberg provides an important opportunity to reflect on the implications of the Nazi eugenics and "euthanasia" programs for contemporary health law, bioethics, and human rights. In this article, we will examine the role that health practitioners played in the promotion and implementation of State-sponsored eugenics and "euthanasia" in Nazi Germany, followed by an exploration of contemporary parallels and debates in modern bioethics. 1.

Conditions of life and death of psychiatric patients in France during World War II: euthanasia or collateral casualties?

Between 1940 and 1944, an estimated 48,588 patients resident in French psychiatric hospitals died of starvation. Standard prisons, while facing similar problems, did not experience the same number of deaths by starvation, partly due to their ability to develop a black market for food and rations. Patients in psychiatric hospitals, on the other hand, were completely at the mercy of their doctors and the personnel in charge. At Hôpital du Vinatier, a psychiatric facility in Lyon, the mortality rate increased sharply from 1940 to 1944. In 1942, the worst year, 42% of patients died of hunger and exposure. In the end, more than 2,000 patients died at Vinatier. Was this due to a supposed lack of rations, or was it something more sinister? In Germany at the same time, tens of thousands of psychiatric patients died of purposeful starvation in psychiatric hospitals as part of the Nazi program of psychiatric euthanasia. Was the same thing occurring in Lyon?

Euthanasia in Belgium: legal, historical and political review.

This article describes and evaluates the Belgian euthanasia experience by considering its practice and policy, both before and after the formal decriminalisation of euthanasia in 2002. The pre-legal practice of euthanasia, the evolution of euthanasia legislation, criticism of this legislation, the influence of politics, and later changes to the 2002 Act on Euthanasia are discussed, as well as the subject of euthanasia of minors and the matter of organ procurement. It is argued that the Belgian euthanasia experience is characterised by political expedition, and that the 2002 Act and its later amendments suffer from practical and conceptual flaws. Illegal euthanasia practices remain a live concern in Belgium, something which nations who are seeking to decriminalise euthanasia should consider.

A Collection of Brain Sections of "Euthanasia" Victims: The Series H of Julius Hallervorden.

Julius Hallervorden, a distinguished German neuropathologist, admitted on several occasions that he had received some five hundred brains of "euthanasia" victims from the Nazi killing centres for the insane. He investigated the brains in the summer of 1942; however, their traces were subsequently lost. The present study shows, that the Series H, which was part of the Hallervorden collection of brain sections in the Max Planck Institute for Brain Research, comprises the brain sections of the above mentioned five hundred euthanasia victims. The provenance of 105 patients could be reconstructed and 84 are for sure euthanasia victims. Most of them were killed in Bernburg or in Sonnenstein-Pirna. Hallervorden used the brain sections of Series H until 1956 for his studies and never publicly regretted this abuse of the brains of euthanasia victims.

Hans Jacob and brain research on Hamburg "euthanasia" victims: "Awaiting further brains!"

Several neuropathologists conducted brain research on victims of so-called euthanasia programs carried out by the National Socialist (Nazi) regime in Germany from 1940 to 1945. Some published their results in German journals or books during and after the war. One of these neuropathologists was Hans Jacob of Hamburg, a former Nazi party member and the leader of the same laboratory previously run by Alfons Jakob (Creutzfeldt-Jakob disease). Though much has been published on the unethical actions of Jacob's fellow neuropathologist from Berlin, Julius Hallervorden, Jacob's actions were remarkably similar and have not been previously analyzed in the neuroscience literature. Jacob dissected at least 42 patient brains from euthanasia centers near Hamburg, and saved the specimens from at least 17 of them. He published a 1956 book chapter featuring 2 such specimens. Jacob was denazified, had a notable career, and never publicly addressed his actions during the war. His ethical violations may not have been on the same scale as Hallervorden's, but the effect of his work echoes to the modern era. As responsible researchers, we must always be conscious of the provenance of material provided and not succumb to opportunistic temptation despite the ethical consequences.

[After the Action T4 : "Regionalized euthanasia" in the Günzburg Psychiatric Hospital]. / Nach der "Aktion T4" : "Regionalisierte Euthanasie" in der Heil- und Pflegeanstalt Günzburg.

BACKGROUND: In Bavarian psychiatric hospitals approximately 15,000 people with mental handicaps and mental illnesses were killed after the so-called Action T4. The Heil- und Pflegeanstalt (psychiatric hospital) Günzburg was a so-called Zwischenanstalt (interim institution). The aim of the study was to analyze its role in carrying out "regionalized euthanasia". METHODS: Based on defined criteria the patient records of deceased patients at the Günzburg Psychiatric Hospital between July 1941 and December 1943 were analyzed to establish whether criteria for "regionalized euthanasia" were fulfilled. RESULTS: During the study period 45 patients at the Günzburg Psychiatric Hospital probably died following actions by direct or indirect intention to kill using malnutrition, neglect, medication overdose or a combination of these actions. CONCLUSION: The Günzburg Psychiatric Hospital was involved in "regionalized euthanasia".