Why did so many German doctors join the Nazi Party early?

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Abstract

During the Weimar Republic in the mid-twentieth century, more than half of all German physicians became early joiners of the Nazi Party, surpassing the party enrollments of all other professions. From early on, the German Medical Society played the most instrumental role in the Nazi medical program, beginning with the marginalization of Jewish physicians, proceeding to coerced “experimentation,” “euthanization,” and sterilization, and culminating in genocide via the medicalization of mass murder of Jews and others caricatured and demonized by Nazi ideology. Given the medical oath to “do no harm,” many postwar ethical analyses have strained to make sense of these seemingly paradoxical atrocities. Why did physicians act in such a manner? Yet few have tried to explain the self-selected Nazi enrollment of such an overwhelming proportion of the German Medical Society in the first place. This article lends insight into this paradox by exploring some major vulnerabilities, motives, and rationalizations that may have predisposed German physicians to Nazi membership—professional vulnerabilities among physicians in general (valuing conformity and obedience to authority, valuing the prevention of contamination and fighting against mortality, and possessing a basic interest in biomedical knowledge and research), economic factors and motives (related to physician economic insecurity and incentives for economic advancement), and Nazi ideological and historical rationalizations (beliefs about Social Darwinism, eugenics, and the social organism as sacred). Of particular significance for future research and education is the manner in which the persecution of Jewish physician colleagues was rationalized in the name of medical ethics itself. Giving proper consideration to the forces that fueled “Nazi Medicine” is of great importance, as it can highlight the conditions and motivations that make physicians susceptible to misapplications of medicine, and guide us toward prevention of future abuse.

Introduction

Since the ancient Greeks, physicians have entered the medical profession by taking a sacred oath to first “do no harm or injustice,” an oath that affords them the privilege of trust from those who seek their help (National Institutes of Health, 2010). However, during the Weimar Republic nearly 50% of German physicians became early joiners of the Nazi Party, a greater percentage enrollment than for any other profession at the time, topping even lawyers and businessmen (Hayse, 2003). Doctors were represented in the SS seven times more often than the average employed German male (Annas & Grodin, 1992). This is a remarkable number, considering the fact that more than half of all physicians in Berlin, for instance, were of Jewish ancestry prior to WWII (Annas & Grodin, 1992). Since most Jews would have little incentive to join the Nazi Party, it is likely that the percentage of German physicians who were early joiners of the Nazi Party is actually much higher than 50%. This high percentage is also remarkable when keeping in mind that the German physicians who were early joiners in the Nazi Party were also likely trained by at least some Jewish physician-mentors, and worked alongside at least some Jewish physicians as colleagues in common and worthy tasks of daily care-giving prior to the rise of the Nazi Party.

In addition to sheer membership, the systematic planning and actions of physicians greatly contributed to Nazi power and functioning. Most significantly, physicians played an instrumental role in the notorious euthanasia program, ‘Action T4’, through which approximately 275,000 patients judged by physicians as ‘incurably sick’ were killed by starvation, medication, or gassing (Meyer, 1988, Proctor, 1988, Ryan and Schuchman, 2002). Hitler granted physicians full authority to administer these so-called ‘mercy deaths’, many of which were committed without even a personal examination of the patient (Meyer, 1988). Physicians also conducted some of the most harmful medical experiments ever documented, maiming and killing hundreds of thousands of people immediately prior to and during World War II: Nearly 100 individuals were killed at freezing temperatures, 200 at high altitudes, 220 in tuberculosis studies, 800 pairs of twins in twin experiments conducted by Dr. Josef Mengele, and over 400,000 suffered permanent injury due to forced sterilization, artificial insemination, bone, muscle and joint transplants, and numerous studies employing various viral and bacterial agents, as well as poisons, such as phosgene, phenol and cyanide (Spitz, 2005, Tyson, 2000). In light of the gap between professional values and documented atrocities, a basic question arises: why were physicians, compared to members of other professions, so likely to join the Nazi Party?

Possible reasons for the behavior of these German physicians are often difficult to comprehend in today's medical and legal environment, where explicit consent from patients and subjects is mandatory, and where any intentional, even accidental, harm inflicted by physicians is publicly condemned and brought before the law. One theory for Nazi doctors' abandonment of the ancient and most basic tenets of ethical medicine is that medical doctors tend to have an authoritarian personality, characterized by a strong adherence to rules and a weak ability to control more primitive, “id-driven,” impulses (Drobniewski, 1993). Such personality traits would presumably account for Nazi doctors' propensity to follow Hitler's orders with little or no argument. This theory may also explain how these physicians were easily persuaded to follow newly established, barbaric rules of conduct. Other possible explanations have been rooted in theories of practitioner narcissism. They include an inflated sense of self-importance in shaping the future of the nation and a desire for career advancement and public praise (Annas & Grodin, 1992).

We intend to expand upon these explanations and trace a more detailed web of professional, ideological and psychological factors that may have contributed to the creation of what is now commonly referred to as “Nazi medicine.” Specifically, we identify and explicate major vulnerabilities or sensitivities of German physicians at the transition between the Weimar Republic and the Third Reich that may have fueled their exceptionally high enrollment in the Nazi regime. These include: professional vulnerabilities among physicians in general (valuing conformity and obedience to authority, valuing the prevention of contamination and fighting against mortality, and possessing a basic interest in biomedical knowledge and research), economic factors (related to physician economic insecurity and incentives for economic advancement), and Nazi ideological and historical factors (beliefs about Social Darwinism, eugenics, and the social organism as sacred).

Most of the postwar analysis on Nazi medicine has tried to comprehend the seemingly contradictory behavior of German physicians during the Nazi regime, yet much insight can be gained by considering the specific nexus of forces that led physicians to enroll in the first place. One factor that stands out in the context of current professional and societal concerns is the use of “ethical” claims or considerations to rationalize unethical acts. Thus, this study of Nazi doctors can contribute to ongoing research and education as a case study in the misuse of medical ethics.

Section snippets

Professional vulnerabilities among physicians in general

Physicians may have been especially predisposed to assent to the authority of the Nazi regime because there were many abstract and practical objectives and orientations that the regime appeared to share with the medical profession. These commonalities included: instilling a culture of conformity and obedience; preventing contamination; providing a partial solution to the dread of helplessness in the face of existential problems (death, disability, humiliation, loneliness); and an interest in

Economic insecurity among professional elites

After the German loss of World War I, there remained a widespread desire for renewed pride. Under Hitler's rule, the Nazi Party found a scapegoat for its internal problems in the Jewish population, which became a target for German shame and a blame figure for a deteriorated economy. German-Jewish journalist Siegfried Kracauer (1998) discusses the phenomenon of the “Salaried Masses Effect,” the increased economic and existential insecurity that grows among white-collar professionals blocked from

Nazi Ideological and historical rationalizations

Examining Nazi ideologies through the looking glass of German medical practitioners of that era calls attention to factors that may have made physicians especially open to and interested in Nazi rationalizations. Through a Social Darwinist ideology, Nazism explicitly framed its methods and aims in biological terms. As Hitler's deputy, Rudolph Hess, claimed: “National socialism is nothing but applied biology” (Lifton, 1986). Through sacralizing the social whole over the individual, Nazism

Conclusion

The prominence of physicians among early joiners of the Nazi Party exemplifies the fact that the defense mechanisms (analyzed by Mitscherlich and Mitscherlich, 1967/1975; and Schlant, 1999), which prevented post-World War II Germans from fully grasping the reality of the Holocaust, were also operating before Hitler came to power. The German Medical Society was a preexisting organization, not one created by the Nazis to serve its ends. Nonetheless, the Society's involvement in the inhumanity of

Conflicts of interest

The authors declare no conflicts of interest.

Role of funding source

No funding was used toward the making of this article.

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