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"We must always take sides. Neutrality helps the oppressor, never the victim." —Elie Wiesel |
DOING WHAT'S RIGHT: THE ETHICS OF NURSINGKilling as caring: Could it happen again? Caring is often associated with nursing, but for nurses employed at Nazi Germany’s Hadamar Institute, caring came to mean killing. by Linda Shields
In the permanent Holocaust exhibit at the Imperial War Museum in London is a film showing a uniformed nurse helping a naked man into a gas chamber. This is a shocking reminder that nurses have not always done what is right. How did nurses justify their involvement in the murder of the sick and innocent, those people for whom they are supposed to care? For them, killing was part of doing right, and it is timely to remind ourselves that nurses’ caring role can assume a sinister aspect. Those who enter nursing usually do so through altruistic motives and a genuine desire to care for people. Occasionally, individual nurses abrogate their responsibilities and use their positions to do harm, but these individuals are usually caught, charged as necessary or, at the least, have their license to practice revoked. Education for registration in nursing is universally centered on principles of caring, and caring is seen as the essence of nursing. However, there was a time and place in history when some nurses did not care, or, to be more precise, they cared in ways that were detrimental to their patients. Much has been written about the role of doctors in the Nazi era; they were tried at Nuremberg and in subsequent war crimes trials (Annas & Grodin, 1992), but scant attention has been paid to nurses. Only a small number of nurses were tried at Nuremberg; most have never been brought to account for the awful crimes they perpetrated, and few have ever been asked to explain why. Nursing in Germany in the early part of the 20th century was inculcated with ideas of obedience and subjugation to the medical profession (Steppe, 1992). Perhaps slightly different from the development of nursing in Nightingale-influenced countries, German nursing was not seen as a middle-to-upper-class profession, where young women from “good” families became nurses for altruistic motives and no pay. Rather, it was a way for young women to gain a permanent job and some education. Implicit in their training was strict obedience, with no right to question an order. Some men joined the nursing profession as a way of gaining employment, working mainly in psychiatric institutions (McFarland-Icke, 1999). There were no prerequisites for nursing. Prior employment as a domestic or a gardener in a hospital was often enough to secure a nursing job. The quality of training programs varied, but they always contained implicit assumptions about the rightness of unquestioned obedience to orders from above and the threat of dismissal if such obedience did not occur. This model of nursing developed in a time of ideas and investigation in medicine—particularly psychiatry—that included the so-called “science” of eugenics. Two German doctors, Hoche and Binding, published a book that became extremely influential in Europe and America (Burleigh, 1995). They suggested that there were some people who should not have been born, who were “unfit for life,” and who, if they were unfortunate enough to have been born, should never be allowed to reproduce. These were the handicapped and the mentally ill. Hitler’s rise to power following massive depression in the Weimar Republic made everyone, including nurses, concerned about their jobs. Those who had been members of communist parties quickly lost their jobs and were often sent to Dachau and other concentration camps for “re-education” (Burleigh, 2000). Nursing positions could require Nazi Party membership. The Nazis developed a comprehensive community-nursing program and, in 1938, passed laws about what we today would call the “scope of nursing practice” (German Government, 1938). This document, a catalog of nursing duties, mentions the need to keep the Aryan race pure. Propaganda abounded about the drain on society caused by the mentally and chronically ill and handicapped (Burleigh, 1995). School children learned arithmetic by calculating how much “useless feeders” in asylums cost a community. Signs on billboards advocated “mercy killing” of those who were a burden to the nation. Films made by respected directors included stories in which those “unfit for life” were removed from society. One particular film, “I Accuse,” was about a young woman who gave her husband permission to kill her because she had multiple sclerosis. Soon after Hitler became chancellor, laws were passed to force sterilization of people considered unfit to procreate. Later, the euthanasia programs began (Friedlander, 1995). They were called that because “euthanasia” means “a good death,” but there was nothing good about how these people died. In 1939, planning began in a house in Berlin at Tiergartenstrasse No. 4, and the program was nicknamed “T4.” The Nazi government drafted legislation for euthanasia programs, but this was never ratified, probably because they were killing German citizens. Essentially, the programs were illegal (Burleigh, 1995). People with schizophrenia, depression and other mental illnesses; epilepsy; chronic alcoholism; and, in children, conditions such as cerebral palsy, Down syndrome and the range of incurable pediatric problems were killed. People were encouraged to institutionalize their disabled children—or dependent adults. After a time, a letter would arrive announcing the child’s death from “pneumonia” or some relatively common illness, along with a request that the recipient collect the ashes and pay cremation costs. As the war took its toll on the German economy, food and medicine went to the army first and civilians last. Diabled people—“useless feeders”—were said to contribute nothing to society and took food and resources away from the military and the fighting effort. At the beginning of the Nazi era, “useless feeders” were most often the disabled and mentally ill. Later, older people were included and, in the particularly repugnant moral turpitude of the time, soldiers who had been wounded fighting for the Fatherland were murdered. Nurses who had been hardened by their work in the euthanasia programs were sent to the Russian front to kill wounded German soldiers (O’Donnell, 2004). The killing methods changed as the war developed. Initially, lethal injections of drugs such as morphine were used, but soon all morphine was needed at the front (Burleigh, 1995). Children were given ever-increasing doses of phenobarbitone by nurses. Starvation was a cheap but slow alternative, so more efficient killing methods were devised. As buses with blocked windows traveled between hospitals, passengers were gassed with carbon monoxide. Eventually, an engineer designed air-tight chambers where large numbers of people could be gassed simultaneously, and crematoria were built in the basements of hospitals so bodies could be disposed of efficiently. These were the prototypes for the death camps, and systematic killing methods for large numbers of people were refined (Friedlander, 1995). Usually, people were treated kindly during these processes. They were given food parcels for their bus journey, helped onto the buses or into the chambers by “compassionate” nurses and told they were going to a better place (McFarland-Icke, 1992). No nurses were forced to be part of T4. Those who objected were not sent to a concentration camp or executed; rather, they were moved to another institution or another part of the hospital (McFarland-Icke, 1992). Some refused to participate, and while some were threatened with firing, no reprisals of any kind ensued. In other words, the nurses who worked in the T4 programs did so of their own free will. What was the role of nurses? Those who actively killed were few, and the majority did not know what was happening. Some thought they knew but were never sure, while others knew and objected. Still others knew and helped by holding hands, comforting people as they went to their deaths (Benedict, 1999). Why did nurses become involved? Fascism has at its core an insidious undermining of individual rights. The individual is nothing; the state is always right, and obedience to the state is paramount. Nurses involved genuinely believed they were doing it for the “good of the State” (Steppe, 1992). Many were unrepentant when asked why they took part in killing. They reasoned, “If I didn’t do it kindly, someone else might have been rough with the patient; therefore, it was better for me to do it,” or “the patients knew and trusted me,” or “it was kinder to do it gently and with dignity.” In other words, they saw killing as caring. As a result of social and cultural conditions, combined with pressure from the state to conform at all costs, many nurses in Nazi Germany truly believed that the people for whom they were caring would be better off dead, that the weak must be sacrificed for the good of the strong, and that one’s moral duty lay in delivering them from a worthless existence. Could it happen again? If so, how would I respond? These are questions every nurse should ask. RNL The views or opinions expressed in this article and the context in which the images are used do not necessarily reflect the views or policy of, nor imply approval or endorsement by, the United States Holocaust Memorial Museum. Linda Shields, PhD, FRCNA, is professor of nursing practice and education, Faculty of Health and Social Care, University of Hull, in the United Kingdom and adjunct professor, Department of Pediatrics and Child Health, University of Queensland, in Australia. An Australian, Shields is also a visiting professor at Northumbria University in England. Her background in pediatric nursing and love of history led to further investigation into the systematic killing of children in the Nazi era and her belief that this dark side of nursing’s history has never been adequately addressed. To this end, she hosted the first International Conference on Nursing in the Third Reich in Ireland in June 2004. Photo: Imperial War Museum, London References |
