#7 [MedBlog] - Medical History: Dark Sides Of Medicine During The Nazi Regime

Hello Hivers!
Today I want to talk about the dark side of medical care during the Nazi regime. This is in my opinion an important part of education for everybody – perfidious, brutal & inhuman. We will go trough some unimaginable deeds of German medicine during that period.
As you might know I am studying medicine at the Charité – Universtiätsmedizin Berlin, which invested a lot of time during the last decade (and still is) to come to terms with the atrocities of the Nazi era. For me it was a immense shock – and the unreported numbers are even higher.

Deontology & Utilitarianism

Deontology

In the beginning I want to deal with these to different ethical currents.
In deontology, which was represented by Immanuel Kant, among others, an action is measured against existing rules and prohibitions and not against the consequences of the action. Take a rapist as an example - should he be killed as punishment or not? In order to find an answer to this, the fundamental question is whether a person should kill another person or not - as a generally applicable law. Based on this answer, further actions are decided.
Existing examples for that are the Basic Laws and the 10 Commandments – e.g. the human has no

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In conclusion man has no price, but dignity and accordingly cannot be outweighed with goods or the like and must not be seen as a mere means

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Utilitarianism

The utilitarianism is a form of consequentialism - it sees the greatest possible good above the good of the individual. As a crude trivial example, we take a serial killer whose death would prevent the deaths of many other people and would take the fear away from society.
This is ultimately the principles upon which the Nazis operated during their euthanasia for the good of the “Volkskörper” (all German citizens of the Reich).

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Euthanasia during the Nazi regime describes the systematic prosecution and killing of humans of lowers class according to their Racial Doctrine – it did also include the forced sterilization of so-called people who are unworthy of reproduction

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Since the ethical concept of utilitarianism applied in the German Reich, it was difficult to convict attempts by German nationals on other Germans at the Nuremberg Doctors' Trial. The solution was a preamble to the judgment, which established the ethnic foundations of the medical practice, which are based on the ethnic ideas of the majority of nations - this Nuremberg Code is the starting point of the Declaration of Helsinki 1964 on the "Ethnic Principles for Medical Research on Humans".

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Attempts & killings of other nationals fall under the category of war crimes

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Human Experiments in Nazi Concentration Camps

There has been a ton – vaccination tests for e.g. typhus, experiments with inmates in cold environment or low pressure in Buchenwalde concentration camp or malaria vaccination trials and sea water drinking experiments in Dachau concentration camp.
Also, important to mention are the gas gangrene/clostridial myonecrosis experiments in Ravensbrück. It is a bacterial infection that produces tissue gas in gangrene. Myonecrosis is a condition of necrotic damage, specific to muscle tissue.
Soft tissue infections by Clostridium perfringens after trauma or war injuries were a massive problem and led to the death of many soldiers, which explains the interest of the Nazi regime in the resulting experiments. Due to the death of high-ranking people from this infection, the dispute between surgeons and internists intensified concerning the optimal treatment of gas gangrene – the surgeons insisted on amputation and the internists were convinced of the effectiveness of sulphonamide as a drug.
As a result, around 200 Polish women in the Ravensbrück concentration camp were intentionally inflicted with wounds and infected with C. perfringens under the direction of the camp doctor Oberheuse in order to test the therapeutic success of sulphonamide.
These attempts were initiated by Karl Gebhardt, who was therefore sentenced to death in the Nuremberg Doctor’s Trial.

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The Doctor’s Trial was the first of 12 trails for war crimes of German doctors that the United States authorities held in their occupation zone in Nuremberg

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Ethical transgressions of boundaries under National Socialism

Trials of tuberculosis immunization

Gerog Bessau was the beginning from 1932 the Professor of Paediatrics at the Charité and Director of the Children's Clinic. From 1942 he also chaired the vaccination working group of the regime focusing on tuberculosis. He dealt with the possibility of tuberculosis immunization with killed tubercle bacilli. Tuberculosis was widespread across Germany in the 1930s and 1940s, incurable, and incurred enormous costs and the loss of soldiers. From so-called "children's departments", the Reich Committee for the scientific recording of severe genetic and genetic illnesses referred children to Bessau for killing and for human experiments.
Bessau carried out vaccination experiments according to scientifically correct schemes at the time, but this was done in an uneethical manner - children were classified as unworthy of life and neither the children nor their relatives were informed about the experiments.
With his project, Bessau was firmly integrated into the infrastructure for treating mentally ill children in Berlin.

Murders in World War II & Karl Brand

Karl Brant was originally a senior surgeon in Berlin and in the course of his career he was appointed to Hitler's surgical escort doctor and Reich Commissioner for Sanitary & Health Care, so that he was ultimately responsible for the entire military and civilian health system.
Brant would give selected physicians the authority to actively euthanize seriously ill people according to “human discretion”, which was ultimately the basis for several actions to kill the sick people. In the course of the actions, some methods of extermination were tried out for the concentration camps

• Children K.: the parents allegedly wished to put their mentally handicapped child to sleep in order to raise more healthy children "for the Reich"

• Child euthanasia: Euphemistic term for the organized killing of at least 5000 children in the 30 so-called children's departments

• Aktion-T4: intil 1941, more than 70,000 patients from psychiatric hospitals were killed with gas - people were transported in so-called "gray buses"

• Aktion Brandt/decentralized euthanasia: approx. 200,000 victims of food deprivation and drug poisoning in institutions for the mentally ill - among other things to clear beds for civilians and military patients

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In the Third Reich there was no euthanasia law - the actions were secret, illegal, utilitarian and excessive

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Nuremberg Codex

The Nuremberg Code is the preamble to the verdict in the Nuremberg Medical Trial and represents the basis for reaching a verdict, as it puts individual human rights in the foreground. The well-being and protection of the individual takes precedence over scientific progress and the common good.

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In the Nuremberg Doctor's Trial there were 23 charges - 7 death sentences, 9 prison sentences (all released early) & 7 acquittals

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It is a principle of today's medical ethical ideas, which have been further developed and revised in the Helsinki Declaration. Central points are the consent of the test subject and the responsibility of the doctor for his actions.

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10 Points of the Nuremberg Code:

1. Voluntary and informed test subjects agree personally
2. The expected results cannot be obtained by any other means or method
3. The expected results justify the implementation
4. Avoidance of unnecessary physical and mental suffering and harm
5. Execution not permitted if this leads to death or permanent damage
6. Endangerment must not exceed boundaries that are predetermined by the humanitarian significance of the problem to be solved
7. Protect test persons from injury, damage and death
8. Implementation by scientifically qualified persons
9. Disengagement by the test person possible at any time
10. The investigator must be able to terminate the experiment if there is a risk of injury, damage or death for the test subject

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Euthanasia

In Germany, killing on demand is prohibited, while e.g. in the Netherlands it is allowed by law. Medically assisted suicide and passive euthanasia are to be distinguished from active euthanasia. According to the law, this assisted suicide is not prohibited and the professional code of doctors does not explicitly prohibit it. Thus one can provide the means for suicide, it is questionable whether the doctor has to intervene when he sees the patient dying.

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In the Netherlands it is being discussed whether or not there should be a “suicide pill”

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Passive euthanasia includes the omission of life-prolonging measures and is permitted and even required under certain circumstances, e.g. if this is desired in the patient decree.

Principles of the Federal Medical Association of Germany:

• A medical obligation to support life does not exist under all circumstances
• Palliative medical care comes to the fore when diagnostics and therapy are no longer indicated or limitations are required
• The obvious dying process should not be prolonged by life-sustaining therapy
• Dying may be made possible by omitting / limiting / ending medical treatment if this is in accordance with the patient's will
• Killing the patient, even if requested, is a criminal offense
• The involvement of the doctor in suicide is not a medical task

Checklist

By now ...
✅ you know the difference between Deontology and Utilitarianism
✅ you are familiar with the principles of the medical care during the Nazi regime
✅ you are informed about cruel human experiments of the Third Reich
✅ you know the fundament of the Nuremberg Codex
✅ you the know the principles of the German Medical Association regarding euthanasia

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See you soon!

Noogie 👨‍⚕‍

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Disclaimer

The content shown here is no alternative to consulting a doctor – if you have any kind of health issues bothering you, firstly consider visiting a health-expert. This is just meant to feed your personal interests. All the information given are related to the German standards