Children's “Euthanasia” in Nazi Germany
Susan Benedict, CRNA, DSN, FAAN
Linda Shields, PhD, FRCNA, FRSA, FRSM
Alison J. O'Donnell, MSc, BA, DipEd, DipCNE, RN, RNMH
Children with disabilities were killed during the Nazi era, often by nurses. Some nurses killed children, saying that they were
under orders. Propaganda about the need for
“racial purity” was all pervasive and influenced much of the population, including
nurses. The German people accepted the
“mercy” killing of children with disabilities. We describe the children's “euthanasia”
program, explore the influence of propaganda, ask why it was acceptable to kill children, and provide historical context
demonstrating
“slippery slopes” which can lead to abrogation of ethical principles. Discussion of such history is essential as the
ethical principles which were breached are still the cornerstone of nursing practice today. Only by openly discussing past
wrongs can we attempt to ensure that they do not happen again. Archival documents from Germany and Israel, including trial
depositions and transcripts, provided material, supplemented by secondary classic sources.
© 2009 Elsevier Inc. All rights reserved.
Key words: History; Ethics; Euthanasia; Pediatrics
T
HE WORLD TODAY is a rather unsafe place,
both from a physical perspective, with wars
and conflicts in many countries, and also from an
ethical perspective. Technology generates as many
problems as it seeks to alleviate, seen in, for
example, the ethical debate around stem cells and
drug development. Health care is a fertile field for
both new technologies and their associated ethical
dilemmas, and nurses all over the world are today
facing ethical issues which did not exist even a
decade ago. Such a climate is not new. In the first
part of the 20th century, nurses became involved in
the ethical paradoxes around a prevalent issue of the
time, that of eugenics. In Europe, in the era of
the Third Reich, some nurses, acting under the
principles of eugenics as interpreted by the Nazis,
actively killed their patients, many of whom were
children, believing that they were doing the right
thing (
Benedict, Caplan, & Lafrenze, 2007
). For
pediatric nurses in the 21st century, with its
developing technology and changing values in
health care, lessons from history cannot be ignored.
Why do we need to know about these things?
Moral dilemmas can be part of any nurse's working
day; for instance, in most countries where abortion
is legal, nurses who object are not made to
participate in them. Nurses in some countries assist
with executions (
International Council of Nurses,
), whereas nurses in Holland and Belgium are
exposed to, and often assist with, euthanasia (
Bruchem-van de Scheur et al., 2008
). Whereas
these examples are the extreme, there are many
instances where nurses embark on practices which
are on the edge of ethical acceptance and which can
lead to other, more questionable activities. A nurse
who works with children with terminal cancer may
be comfortable with providing optimum palliative
care leading to a peaceful death, but it is possible
that that nurse, given the right propaganda,
accepted practice in the hospital, and the ethical
climate might turn a blind eye when an overdose of
morphine causes the child's death or, in other
words, goes down the
“slippery slope” of ethical
paradox.
cautions about being too
From the Medical University of South Carolina, USA;
Paediatric and Child Health Nursing, Curtin Health Innovation
Research Institute, Australia; The University of Queensland, and
Wilberforce Institute for the Study of Slavery and Emancipation,
England; University of Dundee, Fife Campus Kirkcaldy,
Scotland.
Corresponding author: Linda Shields, PhD, FRCNA, FRSM,
Professor of Paediatric and Child Health Nursing.
E-mail:
l.shields@curtin.edu.au
0882-5963/$ - see front matter
© 2009 Elsevier Inc. All rights reserved.
doi:
10.1016/j.pedn.2008.07.012
Journal of Pediatric Nursing
, Vol 24, No 6 (December), 2009
506
ready to accept the slippery slope argument in
ethics in relation to the
“euthanasia” programs of
the Third Reich; however, the nurses described in
this article were certainly victims of such thinking.
Nurses are meant to advocate for their patients,
particularly if they are from vulnerable groups such
as children, but may find, particularly in a state of
heightened political activity, that they have multiple
loyalties which they have to address simulta-
neously, especially if propaganda is used in the
particular political climate. Such divisions led to,
for example, nurses in Rwanda being complicit in
the massacre of their people in 1994 (
) and to nurses in New Orleans, during
Hurricane Katrina, killing their patients who were
too old or infirm to move from the path of the
flooding (
In Europe during World War II, many children
died. Some died of direct action such as bombing,
whereas others were killed in concentration camps,
usually immediately upon arrival. Others, although
spared initially, were used as subjects in medical
experiments in the camps. These were children who
were unfortunate enough to belong to an ethnic or
racial group considered subhuman or inferior.
Whereas these young lives were lost in tragic
circumstances, there was also a group of children
who were betrayed when they were killed by nurses
and doctors to whom they had been entrusted for
care, in the so-called euthanasia programs.
A confluence of two phenomena condemned
thousands of children with disabilities to death in
Nazi Germany: the rise to power of Adolf Hitler and
the pseudoscience of eugenics. Hitler, long an
advocate of killing those with disabilities, was able
to implement the action of the killings by labeling
them as euthanasia (in this article, this word is
used; however, we suggest that it is a misnomer. It
means, literally,
“the good death,” but there was
nothing good about how these people died).
Euthanasia was able to gain acceptance in the
medical community and the general population by
portraying the killings as being necessitated by the
“science” of eugenics. Eugenics, also known as
racial hygiene, was widely accepted throughout
Europe and the United States and promised
development of a healthy master race by the
elimination of hereditary disorders through selec-
tive reproduction. The first application of eugenic
practices in Nazi Germany was the involuntary
sterilization of thousands of adults and children
who had disorders and conditions believed to be
hereditary. When the economics of keeping people
alive who were unable to contribute to the work-
force came under scrutiny, especially in time of war,
the groundwork was laid for the establishment of
the German euthanasia programs. Hitler's absolute
power allowed him to decree a policy of removing
from society those individuals who were deemed to
be inferior because of disability, race, ethnicity, or
character traits.
PURPOSE
Archival documents from Germany and Israel,
including trial depositions and transcripts, have
provided much of the material for this paper and are
supplemented by selected secondary classic
sources. We (a) describe the background of the
children's euthanasia program and, in particular,
consider the actions of personnel involved in the
killing of children with disabilities in one of the
killing units, Kalmenhof at Idstein in Germany; (b)
explore the influence of propaganda on the German
people to explicate, to some degree, the actions of
the personnel involved; (c) pose questions (still to
be answered) as to why it was considered an
acceptable practice to kill children with disabilities;
and (d) provide historical context which shows that
such ethical slippery slopes can lead nurses into
misguided value judgments from which few of us
may be immune. We start with the background to
life in Nazi-occupied Europe, discuss the actions of
some nurses, detail the concepts of the value of
children, describe the propaganda used and its
influence on society, and examine the nurses'
actions in the light of such activity. Our conclusions
are related to the work of nurses today.
BACKGROUND
A precipitating event occurred in the winter of
1938
–1939. Among several requests for euthanasia
received by the Kanzlei des Führer (Chancellery of
the Führer), one of Hitler's Berlin headquarters,
was a request from the father of a child with the last
name of Knauer (in all that has been written about
him, we have never found any use of his given
name). This child, who was a patient in the hospital
in Leipzig, was born blind, was missing parts of an
arm and a leg, and was termed an idiot (
, p. 894). Hitler ordered Dr. Karl
Brandt, his personal physician (
of War Criminals before Nuremberg Military
Tribunals under Control Council
Law No. 10
Vol. 1, p. 8), to speak with the doctors caring for
507
CHILDREN'S “EUTHANASIA” IN NAZI GERMANY
the boy to determine if this description was
accurate. If the child was as described, Brandt
was instructed to inform the doctors, in Hitler's
name, that they could
“euthanaze” him (
, p. 894). (It is important to note that
the physicians were given permission to kill the
child; they were not ordered to kill the child. They
could have chosen to not do so. This is the case in
the subsequent authorization and killings, as will be
shown.) Brandt was to ensure that the parents
would not feel incriminated by this decision nor feel
that they were responsible for the death of their
child. He was ordered by Hitler to make certain that
if there were any legal consequences incumbent on
the physicians for killing the child, the accusations
were to be quashed (
,
p. 894). Brandt traveled to Leipzig, examined the
child, and concurred with the diagnosis of
Dr. Werner Catel, director of the pediatric clinic.
The doctors were of the opinion that there was no
justification for keeping such a child alive (
, p. 894).
Upon receiving this report from Brandt, Hitler
gave permission to kill the child. Thus, the Knauer
child became the first known victim of the Nazi
euthanasia program (
). However,
according to Brandt, euthanasia may have not
been a new occurrence:
…in maternity wards under certain circumstances it
is quite natural for the doctors themselves to perform
euthanasia in such a case without anything further
being said about it (
, p. 894).
Subsequent requests for euthanasia were dealt
with at the Kanzlei des Führer and were considered
“secret state action” (
, p. 720).
In May 1939, soon after the killing of the
Knauer child, Brandt was asked by Hitler to form
an advisory committee to formulate plans for the
future killings of children with mental and
physical disabilities (
). Although
operated through Hitler's chancellery, the project
was disguised under the title, the
“Reich Commit-
tee for the Scientific Registration of Serious
Hereditary- and Congenitally-Based Illnesses
”
(Reichsausschuss zur wissenschaftlichen Erfas-
sung von erb- und anlagebedingten schweren
Leiden), known simply as the Reich Committee
(Reichsausschuss). The formation of this
“scien-
tific
” committee allowed for a distancing of the
euthanasia program from the chancellery should
the killings become known (
). A goal of the Reich Committee was
to determine the number of newborns with
problems or disabling conditions and to initiate
the killing of these children along with those
children with disabilities who were already
institutionalized (
Trial of Grossmann et al., 1947
).
Personnel from the Reich Committee visited
various psychiatric institutions to establish the
Kinderfachabteilungen (Special Children's Unit).
They were successful in setting up 30 of these units
staffed by physicians
“who voluntarily consented to
assist in the killing program
” (
, p. 67).
(Definitive numbers are difficult to find as various
authors state different numbers of Kinderfachab-
teilunger: 11,
, p. 55; 22,
, p. 47; 30,
p. 1007; and 30,
, p. 101.).
On August 18, 1939, the State Ministry of the
Interior mandated that physicians and midwives
report all newborns with observable disabilities and,
using science to give the actions legitimacy,
required that these children be registered with the
Reich Committee, supposedly to clarify scientific
questions in the field of congenital deformities and
intellectual development. Midwives had to report
infants with
“idiocy and Mongolism,” microce-
phaly, hydrocephalus, spina bifida, all deformities,
and paralysis. In addition, physicians were required
to report all children under the age of 3 years who
had these conditions. The age limit was quickly
expanded to include children up to 16 years old
(
, p. 66). Physicians and midwives
received 2 Reichmark (RM) (approximately 80 U.S.
cents) for each case reported (
). (The exchange rate was 1 RM = 40 U.S.
cents;
.) Those who failed to report a
child could be subjected to a fine of 150 RM
(approximately U.S. $60) or 4 weeks in jail
(
).
Reports received from physicians and midwives
were reviewed by the medical examiners, Professor
Hans Heinze (director of the psychiatric facility at
Brandenburg-Gorden), Professor Werner Catel
(director of the University Pediatrics Clinic in
Leipzig), and Dr. Ernst Wentzler (a pediatrician and
director of a private clinic in Berlin). These
physicians based their evaluations solely on the
reports
—at no time did they actually examine a
child. The reports were marked with a plus sign (+)
if the child was to be killed and a minus sign (
−) if
the child was to be spared (
).
508
BENEDICT, SHIELDS, AND O'DONNELL
The first Reichsausschusskinder (Reich Commit-
tee children) were those who had been previously
sterilized or who were already institutionalized.
Other children with disabilities were admitted to the
Kinderfachabteilunger after being reported by
midwives and physicians. Parents of children
with disabilities were informed that these special
units were being established throughout the
country at state hospitals and clinics. They were
persuaded to admit their children to these wards
with assurances that the children would receive the
newest treatments and best possible care. Although
it was possible for parents to refuse to relinquish
their children, to do so necessitated their signing
forms stating their responsibility for the super-
vision and care of their children. Later in the war,
mothers were often conscripted for work, thus
rendering them unable to provide care and super-
vision. These women were then forced to relin-
quish the children they had tried to keep out of
institutions (
). Thus, the
Nazis obtained authorization to
“treat” the chil-
dren. It is unlikely that any of these children were
ever returned to their homes or were transferred to
an ordinary hospital after being admitted to a
Kinderfachabteilungen (
).
Institutions which had the Kinderfachabteilun-
gen received children singly or in groups. They
arrived with a general
“authorization to treat,”
meaning approval for killing, or they were
evaluated after their arrival. On these wards, the
killings were done with large oral doses of sedatives
such as Luminal (Phenobarbital) or morphine
injections (
Trial of Grossmann et al., 1947
). In
other instances, some of these children became
victims of medical research. Experiments could be
conducted without restriction, and physical results
were evaluated immediately by autopsy. Dr. Carl
Schneider, professor of psychiatry and neurology at
Heidelberg University, stated the following:
…reaching far beyond other scientific discussion
and research in the field of psychiatry, at last the most
practical and immediate questions affecting the health
of the nation can be most comprehensively resolved
because thanks to the (euthanasia) program, a rapid
anatomical and histological clarification can be
achieved (
, p. 1009).
The killings on the Kinderfachabteilungen were
kept secret from the families, at least initially. The
death certificates and letters to the families
contained fictitious causes of death such as
pneumonia, circulatory disturbances, and so forth
(
Trial of Grossmann et al., 1947
). An estimated
3,000 to 5,000 children were killed by physicians
and nurses in the children's euthanasia program
(
Trial of Becker and Lorent, 1970
). Richard von
Hegener, an officer for the Reich Committee,
estimated that 5,200 children were killed, although
this estimate may be low because in the early years
of the children's program older children who were
killed were included in the adult euthanasia
program numbers (
KALMENHOF AT IDSTEIN
A Kinderfachabteilungen was established at
Kalmenhof at Idstein in Germany in 1942. Origin-
ally, the institution had been a part of a private
association that had as its mission the education of
“feebleminded but cultivable children through
classes and work therapy in order to turn them into
useful human beings
” (
). Today, it is still an active institution and is
located on a thousand-acre estate near Gassenbach
(
). Prior to the establishment of this
unit, the mortality rate for pediatric patients was
only one or two per month. After the unit opened,
the mortality rate rose to approximately 55 per
month. Up to six children died on some days (
Located on the third floor of the hospital, this
Kinderfachabteilungen was overcrowded, and sev-
eral children often had to share a single bed. Most
of the children arrived on transports from Hamburg,
Bonn, and the Ruhr area (
). Parents were prohibited from visiting their
children by the director who also admonished them
to not burden the staff with
“impossible written
requests
” (
, p. 105).
On August 8, 1943, a transport of children
arrived from Hamburg. As the hospital was over-
crowded, 20 of the children were put into the
nursing home. Fifteen were brought to the hospital
for intelligence testing and never returned. Wit-
nesses later testified that these children were not in
such bad condition that they could be expected to
die. The smaller children were not
“mentally
handicapped,
” and some were playing. A later
witness said,
I never had the thought that the children were
suffering from any kind of illness or were so weak that
they would have had only weeks left to live
….They
were 3 to 5 year old children who were all able to
walk and did not make the impression that they were
weak (
Trial of Grossmann et al., 1947
)
509
CHILDREN'S “EUTHANASIA” IN NAZI GERMANY
Dr. Hermann Wesse was placed in charge of
Kalmenhof's Kinderfachabteilungen. In 1943, he
was summoned to the Reichkanzlei in Berlin
where he met Richard von Hegener who informed
him that there was now a law which made
euthanasia legal (
). This law was to be made public only at the
end of the war and applied not only to adults but
also to
“juvenile mental health patients” as well,
according to von Hegener. Wesse was assured that
a specialist from the Reichsausschuss would
provide a detailed report of each child's physical,
neurological, intellectual
–psychological, and char-
acter condition along with a comprehensive
medical history. These reports would be reviewed
by three independent specialists who would then
decide whether or not each child was to be killed.
von Hegener emphasized that only when all three
of the specialists concurred on euthanasia would
the killings be ordered.
Following this description of the process, von
Hegener informed Wesse that he was to take over
the department for the Reichsausschuss at the
mental institution Kalmenhof at Idstein. There he
would have to examine every child and send the
reports to the Reichsausschuss. At the time, there
were already approximately 400 children in the
department. Wesse did not recall at any time being
asked if he wanted the position or if he would
comply with the euthanasia policy. von Hegener
informed him that the law existed and that there
would be severe consequences should he fail to
follow the order (
). According to Wesse, von Hegener asked,
“You are not considering spending your life in a
camp, are you?
” as a thinly veiled threat. Likewise,
Wesse was told that there would be severe
consequences for any breach of secrecy, although
no signature or handshake was required. Wesse was
not shown a copy of the
“law.” Wesse's salary was
to be 400 RM (U.S. $100) per month (
Wesse was 32 years old when he arrived in
Idstein a few days after this meeting and reported
to the hospital on May 10, 1944 (
). He was shown around
and introduced to the only nurse there, Schwester
(Sister) Maria Müller (
) who described to him how the
killings were done at the institution (
). At this time, there were
no Reichsausschuss children there, so Wesse
contacted von Hegener, asking him that some be
transported to Kalmenhof. Wesse began his work
by examining each child and making the requisite
reports to the Reichsausschuss. After some time,
the authorizations for killing began arriving from
the Reichsausschuss, and these were addressed to
Wesse personally. He would then either show
Schwester Maria the authorizations or would
simply give her the names (
). Within a few days of receiving the
order, 1.5
–2 g of Luminal was mixed in the child's
evening porridge, and, in most cases, this amount
was sufficient to kill the child by morning.
Schwester Maria reported the deaths to Wesse
who then certified them, usually as pneumonia or
circulatory weakness.
Bodies were buried several to a grave, often on
top of or beside other bodies. When there were
funerals, a special
“drop-door” coffin (Klappsarg)
was used. When the relatives left after the
funeral, the bottom of the coffin opened,
dropping the body into a common grave and
allowing the reuse of the coffin (
). The work could be
perceived as stressful or taxing, so at Kalmenhof
at Idstein, the killers visited the wine cellars to
mark every 50th killing with copious amounts of
wine and cider (
).
Wesse received a bonus of 125 RM (approxi-
mately U.S. $50) or 150 RM (approximately
U.S. $60) after his Christmas vacation that year
from the Reichsausschuss. He continued to work as
a physician until the day of his arrest, April 25,
1945 (
Statement of Hermann Wesse, 1946
). He was
sentenced to death in January 1947 and subse-
quently executed (
).
SCHWESTER
MARIA MÜLLER
Schwester Maria Müller not only knew what she
was doing, she even explained how she did the
killings to Dr. Wesse when he arrived at Kalmen-
hof. Another physician, Dr. Weber, testified that she
continuously warned Maria about the killings (
). Schwester Maria was,
according to Wesse, rather domineering and did not
like to follow orders.
She was not easy to manage. On the other hand, she
was an excellent nurse. I always watched her in this
respect, especially with RA (Reichsausschuss) cases.
I had to watch that she did not act on her own and did
not use any more medication than had been ordered.
I do not think that she would have killed any patients
behind my back. However, after my Christmas
510
BENEDICT, SHIELDS, AND O'DONNELL
vacation 1944/1945, I was surprised about the death
of two children on my return. But I could not find any
indication of wrongdoing. Both had been RA children
but no authorization had been received. I can imagine
that Frau Dr. Weber did not have an easy time with
her. It also is true that Schwester Maria urged me to
get rid of two other inmates who were working in the
hospital. Both of them were RA children, Liesel S.
and Erna H. Due to my more positive report on Liesel
S., the Reichsausschuss had ordered her to be
released
….Erna was rather imbecilic and I was
expecting an authorization. This was the reason for
Schwester Maria's demand to do away with her.
Liesel got worse during these weeks and she turned
into a habitual thief and was stealing continuously,
also from Schwester Maria. These were her reasons
for asking to do away with the girls. I strictly refused
to oblige her request in both cases (
Schwester Maria was also responsible for the
killings, and when she had to take sick leave for
6 weeks, Dr. Weber asked that the admission of RA
children be halted until Maria returned because
“only Schwester Maria could kill them and only she
(Dr. Weber) could cover these killings
” (
). During this 6-week period,
not a single child died, whereas the death rate began
to climb once again upon the return to work of
Schwester Maria.
ANNA WRONA
Anna Wrona came from a miner's family and
attended a Catholic school in Ochtrupp. She had
received training as a nurse at the Johannisthal
psychiatric hospital near Süchteln, passing her final
examination with high grades. She began her
employment as a nurse on the Kinderfachabtei-
lungen of Kalmenhof on June 17, 1944 after having
worked in at least one other such unit. She was
single, Catholic, and 44 years old. At Kalmenhof,
she was hired to work with the head nurse, Maria
Müller (
Trial of Grossmann et al., 1947
).
Wrona was a friend of Wesse's wife, and he
requested that she be transferred to Kalmenhof
because she was an excellent nurse, and as
Schwester Maria was the only nurse in the
hospital, another was needed. When Wrona did
arrive, Wesse explained about the RA children and
the procedure, saying that they had to be
“put to
sleep
” and she was to assist Schwester Maria.
Wrona then stated that she was prepared to act for
Maria (
Trial of Grossmann et al., 1947
). The
Reichsausschuss was to pay a 30-RM (approxi-
mately U.S. $12) monthly bonus to Wrona for
working on this unit; however, Director Grossman
stated that he was no longer able to do that and she
would have to share a 5-RM payment (approxi-
mately U.S. $2) per death with Schwester Maria.
Thus, each nurse was paid the approximate
equivalent of U.S. $1 for each murder. This was
in addition to their Christmas bonus of 30 RM
(approximately U.S. $12;
Two or 3 days prior to the arrival of the
American troops, Director Grossmann told Wesse
that the headquarters had ordered all records
related to the Reich Committee be destroyed
immediately. Thus, all authorizations and reports
were burned in the courtyard of the institution
(
Statement of Hermann Wesse, 1946
). Although
Wesse reported that he was involved in approxi-
mately 25 killings, Schwester Maria swore to an
American officer that the number of killings in
Kalmenhof during the time of the Reich Commit-
tee was approximately 50 to 60. Although it is not
possible to exactly establish the number of
children murdered there because the files were
destroyed, it is thought that 359 children were
killed at Kalmenhof between August 1942 and
mid-1945.
According to
, Anna Wrona was
not involved in any of these killings because after
she joined the killing team, Schwester Maria
became even more domineering, staying in the
hospital day and night, so Wrona never even came
close to the RA patients.
Often, the question is raised, Could the nurses
and caregivers have been excused from this
killing assignment? Nurse Schaller worked for
several months with Schwester Maria and during
this time became very depressed because she felt
that the children were not dying
“a natural
death.
” Nurse Schaller went to the administrator,
Grossmann, and told him that she could not
participate. She had no trouble leaving the
hospital when she requested to do so (
).
Dr. Weber identified only three possible ways
that as a physician she could deal with the
children's euthanasia program: (a) continue, (b)
use her health problems as a reason to leave the
institution, or (c) adjust to secure her life and to
work for the greatest welfare of the children.
She later contended that she chose the last
option and
“adjusted” by sabotaging the opera-
tion whenever possible and objecting to placing
more children in the institution. Throughout her
511
CHILDREN'S “EUTHANASIA” IN NAZI GERMANY
“adjustment,” Dr. Weber continued to receive
bonuses of 200 RM (approximately U.S. $80) to
250 RM (approximately U.S. $100) at Christ-
mas and a vacation bonus (
After examining the way the killings were done
and some of the people who did them, several
questions arise:
1. Why was it acceptable to kill children?
2. How were children valued in the Nazi regime?
3. Why did the killing of children continue
unabated after the adult programs were
(officially) halted?
THE VALUE OF CHILDREN AND THE
NAZI IDEOLOGY
In August 1941, Hitler formally stopped the
gassings in the adult euthanasia program after a
public outcry led by Bishop Clemens August Count
von Galen (
). However, the killings
continued covertly in many hospitals throughout
the Reich as the
“wild” euthanasia program
(
). In this phase, killings
were done by individual lethal overdose rather than
by mass gassings. In contrast, the killing of children
continued unabated and overtly.
The value of children is a field of extensive
study in the anthropology and sociology literature.
Children are considered valuable for a range of
reasons, including as a justification for life, that is,
the ecologically determined need to reproduce
(
). From a financial perspective,
children are valued as an asset, or a burden, or
perhaps a combination of both (
). Parenthood fulfils a psycholo-
gical need for many, so children are valued for the
role they play in the emotional lives of adults
(
). Children are
needed to care for their parents in their old age
(
Hoffman, McManus, et al., 1987
). Children
provide social cohesion within a society or
community (
), whereas children
are valued as a way of passing on genes, family
names, inheritance, and families (
).
When children are not valued, social cohesion can
suffer, as in societies such as those of sub-Saharan
Africa where much of the child population has
died or they have had to abrogate their right to
childhood as they become the caregivers in
families decimated by HIV/AIDS (
In Nazi Germany, children were valued, but only
if they were considered racially desirable, free
from disease or disability, and only if they could
contribute to society. In Nazi ideology, there was
no room for the defective or
“inferior,” and defects
were defined in myriad ways. The desirable child
was one of
“Aryan” blood, not “tainted” by
“subhuman” genetic material, and was healthy
and physically and mentally robust. All children
were mandated to join the Hitler Youth movement
(the
“League of German Maidens” for girls), where
they swore allegiance to Hitler and Germany
(
). Fascism underpinned the ethos of
the Hitler Youth and has at its core the concept that
the nation is embodied in the leader (Führer), that
the nation is paramount, that individuals have no
inherent worth, that all must be subsumed in the
state, and obedience to the leader is innate (
). As all children had to be part of the
movement, propaganda was geared to ingrain all
the tenets of fascism in their developing minds.
Children and youth were valued as the next
generation who could take National Socialism
into the future and lead and sustain the
“Thousand
Year Reich.
” They were valuable as vehicles for
ensuring conformity within society and were
taught to denounce all those who opposed the
Nazis, including their parents and family. Middle-
class
“Aryan” women were rewarded for giving
birth to large families to populate the new Reich
(
).
These principles about the value of children had
catastrophic consequences for many. The most
obvious examples were Jewish children who were
hunted down and killed as they were not just of
little value, they were also seen as perpetuators of
“malignant” Jewish genes. Gypsy children did not
fare much better and suffered similar fates to the
Jewish children, whereas
“subhuman” (Unter-
menschen) children from Poland and the Eastern
occupied countries were valued only for their
ability to provide slave labor (
).
However, in some cases, Jewish children were so
valued by the communities in which they lived
that they were kept hidden and consequently
survived (
).
There were peculiarities within these beliefs
which led to heinous crimes. Some Jewish and
Gypsy children were valuable as laboratory
“animals” for medical experiments and were
killed once the experiments were over (unless
they died during the experiments). Some children
who bore Aryan features were kidnapped in
512
BENEDICT, SHIELDS, AND O'DONNELL
Eastern occupied countries as valuable specimens.
They were taken from their biological parents and
sent to live with German families who were told
that they were orphaned ethnic Germans (
). The children were wanted and valued
in the German families, but once the war was
over, they were sent back to their original families
(
). These children suffered a double
disruption and were surely some of the most
disadvantaged children of the era.
Some children were child soldiers, valuable for
the Volkssturm (home guard of old men and boys,
aged 16 to 60 years, instituted in October 1944 as
a last ditch effort to defend Germany; (
). Many died in combat. Others were
purposely bred as Aryan children in the breeding
programs of Lebensborn (
). How-
ever, children with disabilities in Nazi Germany
were not valued; they were given the most
egregious labels and were killed as burdens on
the state.
Although public pressure caused Hitler to stop
the overt adult gassing programs, the children's
program continued unabated. This was a less
visible operation done without gas chambers and
crematoria and with some secrecy. The way in
which it was done could well have been less
repulsive to the personnel. Some Germans who
lived through the period have told us anecdotally
that the use of propaganda was so pervasive that
it completely convinced the public that these
children were suffering and that their deaths
were, indeed, merciful. An examination of
theories of propaganda may help to explain how
this was so.
PROPAGANDA
Propaganda can be constructive or destructive,
beneficent and used for the best of intentions, or
malignant and used to transform societies in
negative ways. Propaganda is defined as
1. any association, systematic scheme, or con-
certed movement for the propagation of a
particular doctrine or practice and
2. the systematic propagation of information or
ideas by an interested party, especially in a
tendentious way, to encourage or instill a
particular attitude or response. Also, the ideas,
doctrines, and so forth disseminated thus; the
vehicle of such propagation (
Propaganda can be negative, and often, in
English, the word has negative connotations, for
example, in describing the methods of political
campaigns. It can be positive, and health promo-
tion programs, for example, road safety cam-
paigns, or healthy eating programs are illustrative.
Negative propaganda can be used for positive
reasons, such as pictures of diseased lungs on
cigarette packets. Propaganda can be dangerous,
and insidious, using portrayals of negative con-
cepts (such as the Nazi portrayal of Jews as
malignant beings) to promote political messages to
the detriment of segments of societies. Propaganda
can be used for terror, often forming the
cornerstone of policies of dictators such as
Lenin, who wrote extensively on the use of
propaganda as a mechanism of terror (
). The Nazis were masters of the use of
propaganda to disseminate ideas about a plethora
of topics including the Aryan race and its
importance to the German Volk (defined as people,
folk, nation, and race). The connotation is the
German nation
“as a community defined and
unified by blood, place, history, and language
”
(
). The Nazis used
propaganda to enforce ideas about the damage
caused to the Volk by smoking, the influence of
“degenerate” art, the importance of rationing and
the war effort, the ruin of German societies by
races deemed inferior, and many other topics in
German life. Hitler appointed a minister for
propaganda, Dr. Joseph Goebbels, an expert in
mass manipulation. All media came under Nazi
control, as well as the education system, public
speaking, the country's youth, and so forth. The
aim was to saturate everyone with the required
information. Goebbels masterfully used calculated
planning based on an understanding of the
behavior of the masses and their susceptibility to
endlessly repeated simple ideas (
).
dedicated two chapters in Mein
Kampf (written while he was in prison after the
failed Munich Beer Hall Putsch in 1923 and first
published in 1925 to 1926) to propaganda. He
wrote that the art of propaganda consists of
understanding the emotion of the masses and
giving them information in a psychological form
to which they can relate. He stated that absolutes
should be used, not shades of gray, that all
messages must be
“black and white,” good–bad,
right
–wrong, and so forth. Hitler wrote that
effective propaganda uses simple ideas, repeated
thousands of times, from many different angles.
513
CHILDREN'S “EUTHANASIA” IN NAZI GERMANY
He advocated the use of short and repeatable
slogans, able to be introduced from different
perspectives, but
“the end of all remarks must
always and immutably be the slogan itself
” (
, p. 185). In Mein Kampf,
first
outlined the need to remove those with disabilities
from society to preserve the purity of the Volk and
to remove
“useless feeders” who were a burden
on society.
So what is it about propaganda that can be so
persuasive?
suggests the follow-
ing principles: attention (secure the attention of
an audience), emotional appeals (any emotion
can be garnered), credibility (seek some sort of
authoritative backing for the belief being
propagated), analogy and scope (link whatever
it is one is trying to promote with something
that is viewed favorably or unfavorably), and
morally evaluative language (the choice of
words is important).
How did this relate to the propaganda about
children with disabilities, and why was it so
accepted? To give examples, the first principle,
attention, was gained by the use of colorful
posters, graphic films of children with disabilities,
and the costs to society of their care and by
carefully choreographed visits to institutions
where the most visibly affected children were
exhibited and described as being beyond hope,
experiencing suffering and placing a financial
burden on the state (
). Emotional
appeals were made to the community to highlight
the supposed suffering of these children and their
families, with evocative words such as mercy, so
people were told that it would be a mercy to kill
these children and release them from a life of
suffering (
). The propaganda was
made credible by having doctors and scientists
make statements about the benefits to the children
of relieving their suffering, and nurses and
midwives were mandated to spread the messages
to encourage parents to put their children into
institutional care and/or to have them killed to
relieve their misery (
). The status of
such professionals gave credibility. To provide
analogy and scope in the propaganda messages,
the Nazis linked the lives of these children with
the war effort, demonstrating that resources were
taken from the armed forces to keep these children
alive. Morally evaluative language was pervasive,
and common terms such as useless feeders, life
unworthy of life, and mercy killing were common
(
CONCLUSION
The propaganda about the children was so
effective that the community accepted the
“mercy” killing of children. Wholesale killing in
the gas chambers seemed to be more repugnant
than death by overdose. Propaganda ensured that
everyone was saturated with the idea that under
Nazi ideology, the most valuable children were
those who met the stereotype of the
“Aryan”
child. Only children who were physically and
mentally robust were acceptable, and those with
handicaps or disabilities were killed. In other
words, children were valued only so far as Nazi
race ideology allowed.
The style of killings may have influenced how
people perceived them. The adult euthanasia
programs were visible
—the large buses with
painted-over windows which were used to transport
patients to the killing centers were easily identifi-
able, and the crematoria linked to the gas chambers
in the hospitals were difficult to hide. However, the
children were subjected to a more
“subtle” killing.
They were not gassed; rather, they were killed by
intravenous injection, oral administration of drugs,
starvation, and exposure and usually by nurses. The
children's deaths would have been less obvious in
that typically they were done individually and not
in large numbers. Again, the mode of their deaths
would have seemed more
“humane” or “natural”
than those in the gas chambers. Giving an overdose
of a sedative in porridge would render a more
“naturally appearing” death than killing people in
gas chambers.
This does not explain the actions of the nurses
who killed them. Schwester Maria Müller was
arrested and detained by the Americans. She
successfully escaped detention in October 1945
and was never found (
). Her motiva-
tions are lost to history.
Anna Wrona was tried along with Drs. Wesse
and Weber in Frankfurt am Main in January 1947.
Wrona denied ever having killed a child or even
participating in the killings. However, she was sent
to Kalmenhof explicitly as a nurse representing the
Reichsausschuss and was instructed in writing that
she was not to reveal her assignment to her
colleagues. Wrona received a monthly payment of
30 RM from the Reichsausschuss in Berlin plus a
payment of 5 RM for each death by the
institution's director (
). Thus,
the court concluded that Wrona was fully aware
of the killings and that Berlin expected her
collaboration. Witnesses described her assisting
514
BENEDICT, SHIELDS, AND O'DONNELL
the physicians with the killings (
). The court found Wrona to be
complicit in the murders in that she collaborated
generally in the routine of the unit, with the full
knowledge of its work and with the will to assist
the physician if called upon. The court found that
Wrona had assisted Wesse and Grossman in the
execution of an unknown number of murders and
had done so knowingly, also carrying out secret
burials. In considering her sentence, the court
acknowledged that until that point her life had
been favorable. She had courageously defended a
Catholic priest who was accused of making
derogatory remarks about National Socialism,
and she had not pushed to be present at the
killings. On the other hand, the court noted that
Wrona had made no attempts to help anyone and
that the likely reason she was not more involved in
the killings was that Schwester Maria so eagerly
committed them (
Trial of Grossmann et al., 1947
Wrona was sentenced to 8 years in prison but was
retried and acquitted in February 1949 for lack of
evidence (
deMildt, 1996; Anonymous, 1949
Wrona was tried also for her role in the killings at
the site of her previous employment, Waldniel
Kinderfachabteilung, where she was head nurse. In
this trial, her guilt was firmly established, and she
admitted to killing 25 children with Luminal. For
this, she received a sentence of 4 years but again
was acquitted by the Supreme Court of the British
Zone who decided that she had not been aware that
what she was doing was wrong. Wrona contented
that she believed that the killings were authorized
by law. Despite being a professionally trained and
experienced nurse at the time of the killings, she
was viewed as a
“simple person” by the court
, p. 187).
Although we know that some nurses in other
euthanasia trials said that they were being kind
(
), we must ask what
brought these nurses to accept that killing was a
legitimate part of their caring role. Most of the
nurses have now died, others are aged, and so we
may never really understand what happened. Can
we determine where to draw the line for the
nurses who killed those children, given that they
believed in both the legality and ideology of what
they were doing? Or was this just a stated belief
for their legal defense? Some argue that these
killings were different from those of today in
countries permitting voluntary euthanasia
(
). With numerous
guidelines and safeguards in place, nonconsensual
killing is hopefully less likely than that which
occurred in both the adults' and children's
euthanasia program of Nazi Germany. At this
distance of time, we can only surmise the
unknowable and try to use it to inform debate
about the ethical issues surrounding the health of
children and families. By knowing what has
happened before, nurses today can make balanced
and informed judgments on ethical issues and
may be more skeptical to the prevalent propa-
ganda (which is far more subtle now than it was
during the Third Reich). Such healthy skepticism
can only be developed through education about
ethics and moral imperatives and what has
happened in the past.
ACKNOWLEDGMENTS
This study was funded by a grant from the
National Institute of Nursing Research, National
Institutes of Health (Susan Benedict, principal
investigator); a fellowship for Research on
Medical Ethics and the Holocaust (Susan Bene-
dict) by the Research Institute of the U.S.
Holocaust Memorial Museum funded by the
Merck Company Foundation; and a grant from
the Greenwall Foundation (Susan Benedict,
principal investigator).
The authors gratefully acknowledge the assis-
tance of Traute Lafrenz Page, MD. Dr. Page
accompanied Susan Benedict to the archives in
both Wiesbaden and Jerusalem and translated many
of the documents.
No known conflict of interest exists for any of
the authors.
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