Thursday, September 03, 2009

Op-Ed: Health Care Reforms are the Antithesis of Nazi Practice

By Michael Berenbaum ·
August 19, 2009

LOS ANGELES (JTA) -- It is the nuclear bomb of epithets, a shorthand way of tarnishing any opponent. In recent weeks, Rush Limbaugh and others repeatedly have compared President Obama to Adolf Hitler and his health care policies to Nazi tactics. More than one activist showed up at a town hall meeting brandishing a swastika sign and Obama's name.

"They were for abortion and euthanasia of the undesirables," Limbaugh said of the Nazis on his radio program. "As we all know, they were for cradle-to-grave nationalized health care."

Reviewing what the Nazis actually did, and why, shows that such inapt comparisons reveal more about the attackers than the current proposals by the president or Congress.

Some history: At the Nuremberg doctors’ trials in the late 1940s, the judicial process focused mainly on Nazi medical experiments. But scholars now regard standard Nazi medical practice -- the so-called euthanasia program -- as more serious, more all encompassing and more criminal.

Long before World War II, Nazi physicians began with a mass sterilization aimed at propagating a master race. Doctors sterilized mentally retarded and congenitally ill Germans, designated by Nazism as "useless eaters," consuming scarce resources of the German nation still mired in depression. Worse, much worse, was to follow.

Within the war's first six weeks, Hitler signed an order (backdated to Sept. 1, 1939 to give it the appearance of a wartime measure) giving two doctors "responsibility for expanding the authority of physicians ... to the end that patients considered incurable according to the best available human judgment of their state of health, can be granted a mercy killing."

The Nazis popularized and made into policy a concept first advanced by the eugenics movement: "life unworthy of living."

Mass murder of the handicapped began slowly. At first, authorization was informal, secret and narrow in scope -- limited to the most serious cases. From the Berlin Chancellory Tiergarten 4 (code named T-4), officials ordered a statistical survey of all psychiatric institutions, hospitals and homes for chronic patients. Within months the T-4 program enlisted virtually the entire German psychiatric community.

Three medical experts reviewed forms submitted during the survey without examining individual patients or reading detailed records. Theirs was the power to decide life or death. Patients ordered killed were transported to six killing centers: Hartheim, Sonnenstein, Grafeneck, Bernburg, Hadamar and Brandenburg. The SS donned white coats for the transports to give themselves the appearance of medical personnel.

The first killings were by starvation -- passive, simple, natural. Then injections were used. Children were simply put to sleep, never again to wake. Sedatives soon became overdoses. Gassing became the preferred method of killing. False showers were constructed. Ph.D. chemists were employed. The process was administered by doctors, who killed 15 to 20 people at a time. Afterward, black smoke billowed from the chimneys as the bodies were burned.

A few doctors protested. Carl Bonhoeffer, a leading psychiatrist, helped his son Dietrich contact church groups urging them not to turn over patients to the SS. A few physicians refused to fill out the forms. One psychiatrist, Professor Gottfried Ewald of Gottingen, openly opposed the killing.

Growing public pressure, including a sermon on Aug. 3, 1941 by Bishop Clemens August von Galen of Muenster, openly challenged the euthanasia program.

"We must oppose the taking of innocent human life even if it were to cost us our lives," he argued.

On Sept. 1, 1941, almost two years after it began, Germany appeared to discontinue the operation. In truth, it was merely driven underground. "Mercy killings" secretly continued until the end of the war. Some 200,000 Germans -- who the Nazis termed Aryans, not Jews -- were victims.

While T-4 continued in secret, mass murder was just beginning. Physicians trained in the medical killing centers graduated to bigger tasks. Dr. Irmfried Eberl, who began his career in the T-4 program, became the commandant of Treblinka. His colleagues went on to Belzec, Sobibor, Treblinka and Auschwitz, where killing took on massive dimensions.

At the Nuremberg doctors’ trial of medical personnel, the judges realized the need to enunciate ethical principles for physicians that would prevent them from ever engaging in such practices. The first principle articulated the universal right of individuals to make their own medical decisions, free from coercion.

"The voluntary consent of the human subject is absolutely essential," it reads.

Obama's health plan honors that very principle by entitling the patients to be reimbursed for consultations with their physicians to discuss end-of-life issues. That measure is the essence of humane and moral medical policy -- the antithesis of Nazi medicine and Nazi practice. (We also should consult with clergy to ensure that decisions are compatible with both science and faith.)

That is not to say there is no place for a Nazi analogy in this debate. The Nazis rose to power by mastering the art of propaganda, repeating lies so frequently and so widely that eventually people took them as truth. Hence the importance of seeking out the truth and exposing those who would engage in such deceit.

Freud taught us about projection: Those who would compare Obama to Hitler or his policies to Nazism ought to look in the mirror.

(Michael Berenbaum is a professor of Jewish studies and director of the Sigi Ziering Institute: Exploring the Ethical and Religious Implications of the Holocaust at the American Jewish University in Los Angeles. He was the project director for the creation of the U.S. Holocaust Museum and is the former director of its research institute.)