Eugenics and involuntary euthanasia

As longtime readers know, I've had a longstanding interest in the Holocaust. A precursor of the Holocaust was known as the T4 euthanasia program. This was a program in which as many as 200,000 people deemed "useless eaters" or "life unworthy of life" were "euthanized" (a euphemism for "murdered," actually) by a variety of means, including starvation, overdoses of narcotics, poisoning, and early prototypes of gas chambers later used to to such lethal effect. The T4 program, which ran from 1939 to 1941, when Hitler ordered a temporary halt to the program due to protests from churches and the victims' families, provided the development and proving grounds for methods of mass murder that would later be expanded to the industrialized killings of millions from 1941 until the end of the war. Indeed, Josef Mengele himself learned his trade in this program. Of course, even this "temporary halt" was nothing of the sort. The program continued in secret.

A recent article got me thinking about the T4 program again. Why it did so will become apparent in a moment, but first I would like to list a few quotes from the article. They are quotes justifying the "euthanasia" of the "feebleminded" from around the appropriate time period:
  1. But I am in favor of euthanasia for those hopeless ones who should never have been born – Nature’s mistakes.
  2. So the place for euthanasia, I believe, is for the completely hopeless defective: nature’s mistake; something we hustle out of sight, which should never have been seen at all. These should be relieved the burden of living, because for them the burden of living at no time can produce any good thing at all. . . . For us to allow them to continue such a living is sheer sentimentality, and cruel too; we deny them as much solace as we give our stricken horse. Here we may most kindly kill, and have no fear of error.
  3. release the soul from its misshapen body which only defeats in this world the soul’s powers and gifts is surely to exchange, on that soul’s behalf, bondage for freedom.
  4. A third variety of reaction results from an accusing sense of obligation on the part of the parents towards the defective creature they have caused to be born. The extreme devotion and care bestowed upon the defective child, even with sacrifice of advantages for its normal brothers and sisters is a matter of common observation. This position is understandable, but to the impersonal observer may appear to partake of the morbid. Disposal by euthanasia of their idiot offspring would perhaps unbearably magnify the parents’ sense of guilt.
  5. It is submitted that the state of mind of the parents of an idiot may as fairly become a subject of psychiatric concern as the interrelationships in the families of psychotic patients, and the unwholesome reactions stand as much in need of correction in one case as in the other.
  6. It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified. Parents who have seen the difficult life of a crippled or feeble-minded child must be convinced that, though they may have a moral obligation to care for the unfortunate creature, the broader public should not be assume the enormous costs that long-term institutionalization might entail.
Here's an interesting question for you. What is the source for each of those quotes? They are all consistent with the rationales that Nazis used to argue for "euthanasia," namely not wasting society's resources and the supposed "mercy" that killing such children would be. They all date to the 1930's and early 1940's. They all sound as though they came from Third Reich eugenicists.

All but one of them didn't come from the Third Reich, however. Here are the sources:
  1. Kennedy, F. (1942) The problem of social control of the congenital sterilization, euthanasia. Am. J. Psychiatry, 99, 13–16.
  2. Ibid.
  3. Ibid.
  4. Anonymous (1942) Euthanasia. Am. J. Psychiatry, 99, 141–3.
  5. Ibid.
  6. Pamphlet published by Dr. Heilig, representative of the Nazi Physicians' League. From: Robert N. Proctor, Racial Hygeine: Medicine Under the Nazis, Harvard University Press, Cambridge, 1989, p. 183
Yes, the first five quotes come from Americans, the first three from neurologist Foster Kennedy, in an article based on a speech he gave to the American Psychiatric Association in May 1941. The fourth and fifth quote come from an editorial published in the same issue and seem to be considering parents who might object to the killing of their "feeble-minded" children as being worthy of "psychiatric concern." These are all discussed in a fascinating article that appeared a recent issue of History of Psychiatry. (Found via Autism Diva and Mind Hacks.)

Also appearing in the same 1942 journal was an editorial against the killing of the "feebleminded" written by Leo Kanner. Yes, that Leo Kanner, the one who published the first major work describing the condition now known as autism in 1943. Indeed, as part of his argument against involuntary euthanasia of such children, he correctly invoked the Nazis, asking rhetorically, "Shall we psychiatrists take our cue from the Nazi Gestapo?" He did, however, comment that "sterilization is often a desirable procedure" for "persons intellectually or emotionally unfit to rear children," although he did object to sterilization performed "solely on the basis of the I.Q." Even though there was a "point-counterpoint" sort of debate in this journal, it should also be remembered that the journal itself came down on the side of Kennedy, not Kanner.

When looking back at the atrocities of the Nazi regime in the name of eliminating undesirables from the Volk, it is important to realize that the ideas the fueled their quest to kill those deemed burdens on society were not unique to Germany. Far from it. As this 1942 journal shows, advocacy of various types of eugenic measures was widespread in the U.S., including among the most elite physicians in the nation. True, no one was advocating selective breeding or the killing of "lesser races" in the service of producing a "master race," as the Nazis were, but there was a disturbing similarity in the thinking of the medical elite in the U.S. with that of Nazi advocates of racial hygeine. As the History of Psychiatry article points out:
It is surprising that a debate on murder could have appeared in the most prominent psychiatric journal in the USA at the time. But as historians have noted, eugenic sterilization was legally sanctioned in the USA long before the Nazi sterilization law of 1933. The logical progression from sterilization (killing presumed genes) to ‘euthanasia’ (killing presumed gene carriers) occurred much more slowly in the USA, but accelerated in the early 1940s under German influence. The progression from sterilization to killing is ‘logical’ because, once it has been established that the state should actively participate in preventing the reproduction of ‘genetically undesirable’ people through compulsory sterilization, it eventually seems more ‘efficient’ to wipe out the alleged gene carriers themselves. In a chilling and prophetic statement in 1923, Swedish Member of Parliament and sterilization opponent Carl Lindhagen asked, ‘Why shall we only deprive these persons, of no use to society or even for themselves, the ability of reproduction? Is it not even kinder to take their lives? This kind of dubious reasoning will be the outcome of the methods proposed today’.
How prophetic were Lindhagen's words!

It was only the postwar revelation of all the atrocities the Nazis committed in the name of eugenics and racial hygeine that utterly discredited this sort of thinking in the U.S. Yet, at the eve of our entry into the war, in the most prestigious psychiatric journal in the U.S., prominent physicians were debating, in essence, whether the Nazi approach to dealing with severely disabled children was the correct one, with at least as many prominent neurologists and psychiatrists arguing that it was as arguing that it was not. (Indeed, early in his regime, Hitler himself spoke approvingly of the compulsory sterilization programs that had been implemented in several states in the U.S. by the 1930's.) We should not forget that, particularly in an era in which the genetic basis of psychiatric diseases are being discovered, lest history repeat itself.


  1. The sad thing about this is that the American beliefs all get swept under the rug--"We would NEVER do something like the Nazis" when we were major proponents of sterilization of the unfit (along with lobotomies, castration of males to prevent masturbation, and some other bits of medical history that no one believes now.... Wonder how many people will have fits about this? We so often ignore our own dark areas of history, while highlighting other nations.

  2. In medical school I did a month's rotation at a state mental hospital. Since my preceptor knew I was interested in neurology, he had me do the yearly physical exam on one of the long-term residents.
    This was a young man confined to the state hospital since early childhood for being an "epileptic." He was on medication, completely controlled, able to read and write (was delivered the daily newspaper to his room/cubicle). He had some of the mannerisms one sees in long-term mental hospital residents, but neurologically seemed intact.
    This was from a time when all it took for you to commit your child was a diagnosis of epilepsy (and not so long ago -- this was in the 1970s and this young man was about 20yo).

  3. I first read about the American Journal of Psychiatry's recommendations for killing the "defective" and "feebleminded" in some testimony to the Canadian Senate from 1994. You can read it here

    Here's an excerpt:

    "Finally, I want to speak as a parent. On September 10 this year, we held our son David's birthday party. We had pizza; there was music; everybody had a good time. It was particularly meaningful to me because of what I have learned about the relationship between the German euthanasia program and what has happened in North America.

    "It was only because of the vilification of the Nazi euthanasia program that we got sidetracked from a powerful euthanasia movement in North America in the 1940s. This is one of the things I thought about on my son's fourth birthday. The plan which was proposed for many people in North America was published as an editorial in the Journal of the American Psychiatric Association. It was a much more humane plan since we were not evil like the Nazis. It suggested that severely-handicapped children, like my four-year-old, should be killed but not until their fourth birthday. The suggestion was made for humanitarian reasons because they did not want to make any mistakes. They thought that, if they killed children as soon as they were born, they might accidentally kill some who were not severely handicapped. They would give the kids until their fourth birthday to kind of shape up.

    "However, in suggesting that, they thought of a potential complication. If these kids hung around for four years, their parents might actually get to like them. The humanitarian solution was to refer to the attachment of parents to their disabled children as "morbid obsessions". The article suggested it was the duty of every physician to do everything in their power to stop that morbid obsession because to do so, in their words, could only be good mental hygiene practice."

  4. When I teach World History, I make these connections: the Nazi program -- socially, economically, politically -- largely drew on existing ideas -- eugenics, total war economy, fascism, imperialism, racist nationalism -- that were common throught the Western world in the late 19th-early 20th centuries, and which were drawing on the "best" social science available.

    The fallacies of these ideas are obvious to us now, particularly in combination, but it's hard to overstate the importance of the Holocaust in changing people's minds about these issues.

  5. "The unnatural and increasingly rapid growth of the feebleminded and insane classes, coupled as it is with a steady restriction among the thrifty, energetic and superior stocks, constitutes a national and race danger which it is impossible to exaggerate... I feel that the source from which the stream of madness is fed should be cut off and sealed up before another year has passed"
    Mein Kampf? No. Winston Churchill, then Home Secretary, to Prime Minister Asquith in 1910. Churchill was a Vice-President of the International Congress of Eugenics. Alexander Graham Bell was one of its directors.

  6. I apologise profusely. Churchill was a Vice-President of the Congress but it was Arthur Balfour, then Home Secretary, who made the quoted statement to PM Asquith.

  7. I must stop posting when I am tired. Rereading my source once again - The September 2005 issue of Skeptical Adversaria - it WAS Churchill who said it. I guess nobody should take this on trust but check up for themselves but that is what it says. I'm off to bed...

  8. Vermont, where I live, has a proud history of civil rights, but its dark and dirty secret is that Vermont was a leader in eugenics theory and practice. See:

  9. "...
    As one might guess, a man like Popenoe with a clear plan for a better future for humanity was able to influence officials to follow his ideas. Following the Buck vs. Bell Supreme Court decision in 1927 which legalized forced sterilization of undesirable populations, in 3 years approximately 10,000 people had been sterilized without their consent . California was one of 24 states with legislated sterilization. California alone could claim more than two-thirds of that 10,000. At the Sonoma Home for the Care and Training of Feebleminded Children usually patients were not released to their families unless they had been surgically sterilized first. "Dr. Butler has always had a strong weapon to use in getting consents for sterilization," wrote Popenoe to another eugenicist in 1930, "by telling the relatives that the patient could not leave without sterilization." Popenoe was active in promoting sterilization in California and praised it’s successes in sterilizing Californians in the 1930 edition of Applied Eugenics. His influence started in California, but it didn’t just stay there. It extended overseas.

    One who worked with Popenoe on better breeding of Californians was banker and millionaire, Charles M. Goethe. He is quoted as saying, the Mexican is, "eugenically as low-powered as the Negro." Goethe kept himself up-to-date on the progress of race politics in Nazi Germany on his annual business trips there. He was a founder of the Eugenics Society of Northern California, a member of the advisory board of the Sacramento Mental Health Association, president of the Eugenics Research Association, a trustee of the Human Betterment Association, and worked closely with Popenoe. He wrote to a fellow American eugenecist with admiration:
    "You will be interested to know that your work has played a powerful part in shaping the opinions of the group of intellectuals who are behind Hitler in this epoch-making program. Everywhere I have sensed that their opinions have been tremendously stimulated by American thought. . . "

    Nazi efforts to rid Europe of all inferior people, starting with the handicapped in Germany, and moving on to include Jewish people, Poles, the Romany, homosexuals, and groups opposed to Nazi ideology; for example, communists and Bibleforscher (Jehovah’s Witnesses), is frequently thought of by Americans as a purely German invention. But that is not true. Nazi eugenics were not created from whole cloth but arose in a context of European rational thinking, unblinking faith in “science”, nationalism, a need for someone to blame for poor economic conditions, the influence of British and American standards of what made a superior human, and the influence of previous American successes with legalized sterilization of inferior humans - the state of California providing the Nazis with one of the better examples of success in this area.

    Thanks, Orac.

  10. The US-American eugenics program did not end with the defeat of the Nazis. When I was in residency, I saw a patient who had been castrated by the Iowa State Eugenics Board in the mid-1950s. He was a fairly severe bipolar and had unfortunately developed diabetes insipidus, but had a perfectly normal IQ and if he'd been born 30 years later would probably not even have needed to be institutionalized. I don't know when the Iowa eugenics board was disbanded. It could still be in existence for all I know.

  11. Well, one should consider that infanticide is nothing new, but much of it (the population-control side) is easily obsoleted by birth control.

    As far as "defectives", there are certainly some cases where there is obviously zero human potential -- total anencephaly comes to mind. But then, what about a Tay-Sach's child, doomed to die within (iirc) two or three years, the last year in a coma? A progeriac child, who will be old at ten, and dead by twenty?

    The obvious question is "where to draw the line?" But that's the wrong question, because it depends on something more basic. The more important issue is, "*who* gets to draw the line?" Whoever it is, gains ultimate power over the population in general -- and of course, power corrupts!

    Of course, there are usually one or two people who *already* have near-absolute power over any given baby. Fortunately, these same people are also the primary "stakeholders" in the child, in pretty much every respect -- cost, potential, liability, and genetic. These, of course, are the parents, and as far as I can see, they are the natural parties to make such a decision.

    Any attempt to take control of that decision on behalf of "society at large" represents a totalitarian power grab so obvious that even the Bush cronies probably wouldn't dare try this one. (But if they do launch a "Genetic Health Project", hide your wife and kids!)

  12. This is covered in Stephen Jay Gould's "The Mismeasure of Man".
    from memory, e.g. Virginia ended its sterilization program in 1970.

  13. As a Jew and a mother of a severely disabled child, I appreciate this posting tremendously. It is so important to realize that certain trends existed prior to the Nazis. Let's not, however, let the point be missed that unlike the eugenics/euthanasia ideas promulgated by the American Journal of Psychiatry, the singular focus of the Nazis primarily on eradicating Jews was not an idea that came from the United States. It is important to remember that that particular policy -- Judenrein, I believe it was called -- is a European one, with traditions from Russia under the Tsars, Poland (progroms), Spain (Inquisition), etc. Again, thank you for this illuminating post.

  14. " This is covered in Stephen Jay Gould's "The Mismeasure of Man".
    from memory, e.g. Virginia ended its sterilization program in 1970.

    Denmark didn't end its sterilization program before the seventies. I was discussing the issue with a couple of co-workers the other day, who have some knowledge about it. In the end of the program, if someone wanted to either move out of an institution or be married to someone else in the institution, they had to get sterilized. Before that, people got sterilized as a rutine matter.

  15. "It is important to remember that that particular policy -- Judenrein, I believe it was called -- is a European one, with traditions from Russia under the Tsars"

    Yes, though of course not taken to the extreme as in Nazi Germany. However, not only the Nazis were receptive to the ideas from the Russian Tsars, as the history of the Protocols of the Elders of Zion show. Originally a discarted idea from the Tsar's secret police, the book's primary promotor was Ford.

    A good description of the history of the Protocols can be found here, though it downplays Ford's role in spreading them.

  16. Orac--first of all, I'd like to say that your blog is excellent; I am particularly impressed with your interest in history and its role in shaping psychological perceptions of various cultural trends.

    This post made me wonder if you'd ever come across Edwin Black's outstanding history of the eugenics program entitled "War Against the Weak"; in it he shows how crucial the USA was in the development of pre-Nazi era eugenic "philosophy". Your juxtaposition of the Nazi T4 poster with American physicians' quotes on the value of eugenics was chillingly effective and reminded me of Black's book....

    Too many people in our moronic country are ignorant of the close ties (both economic and philosophical) between American corporations and Nazi Germany. In fact, the Nazis themselves considered American physicians to have some of the most "advanced" perspectives on the methodology of eugenics--they believed that they were walking in the tracks laid by the American medical establishment.

    Keep up the good work.

  17. "We would NEVER do something like the Nazis..."

    I am under the impression that selective abortion of handicapped children serves just this purpose, does it not?

    This post is chilling. We have a handicapped daughter, 10 now. I can't imagine life without her. But b4 her birth, had we known... would we have been strong enough to resist the doctors that tacitly/activly encourage abortion?


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