Nuremberg, 1947

20th Century German medicine offers a cautionary tale that we do well not to forget.

In the 1930s, German medicine and German healthcare institutions were widely considered the most advanced in the world. However, subtle but enormously consequential shifts had been underway decades before Hitler came to power, starting with the rise of the eugenics movement in the late 19th and early 20th centuries. In 1922, Alfred Hoche and Karl Binding, a psychiatrist and a lawyer, published an influential book, On the Destruction of Life Unworthy of Life. A metaphor from this and other influential works captured the imagination of the German medical establishment, undermining the traditional Hippocratic ethic that had governed medicine since antiquity. Instead of serving the health of the individual patient presenting for treatment, German physicians were encouraged to be responsible for the “health” of the “social organism”—the volk—as a whole.

Instead of seeing afflicted individuals as sick and in need of compassionate medical care, German doctors became agents of a socio-political program driven by a cold and calculating utilitarian ethos. If the social organism was construed as healthy or sick, some individuals (e.g., those with cognitive or physical disabilities) were characterized as “cancers” on the volk. And what do doctors do with cancers but eliminate them?

The first people gassed by the Nazis were not Jews in concentration camps (that came later), but disabled patients in psychiatric hospitals, murdered under the Third Reich’s “T4 Euthanasia Program.” Each of these death warrants was signed by a German physician. Even after the lethal regime turned its attention on Jews and other ethnic minorities, they continued to deploy quasi-public health justifications: Recall that the Jews were routinely demonized by the Nazis as “spreaders of disease.” If physicians serve not the needs of sick and vulnerable patients, but are agents of a social program, the German example shows us what happens when that social program is misdirected by a corrupt regime.