Reading for thought

Inspired by George Santayana

What happens when a nation embraces the idea that people bring health problems on themselves through undesirable behaviors, that the common good is greater than that of the individual, and that government determines what is best for all? When government health and medical policies are based on the inherent worth of individuals, can those who are seen as more costly or less productive be cast aside? Mark P. Mostert, Ph.D., of Regent University, examined the history of medical and healthcare policies in Germany during the early 1900s, in an article for the Journal of Special Education:

Useless Eaters: Disability as Genocidal Marker in Nazi Germany

Societal tensions generated by deprivation, war, and notions of peoples’ relative worth based on their ability to contribute to society continued to affect people with disabilities in institutions across Germany until the late 1920s, precipitating rapid and radical attitudinal changes even as the medical and psychiatric communities continued to struggle with custodial issues related to asylum inmates. It was clear, however, that extensive and expensive care could not be expended on people who could not immediately aid Germany’s economic recovery... two perceptions were firmly fixed among German medical professionals and laypeople alike.

Those individuals viewed as economic burdens were increasingly seen as threats to society and their behaviors increasingly perceived as undesirable. The slippery slope had begun:

The distinction between voluntary euthanasia and involuntary killing was thus effectively eradicated, and an ominous term was coined for the first time: “life unworthy of life.” In 1920 the concept of living beings not worthy of the life they embodied gained impetus with a tract published by two university professors, Karl Binding and Alfred Hoche. Permission for the Destruction of Life Unworthy of Life articulated key implications for people with disabilities. Binding and Hoche called for the killing of people with disabilities... the imposition of others’ will upon them. This shifted the burden of human existence from simply being alive to requiring an explicit justification for living... the right to live was to be earned, not assumed. One earned the right to live by being a useful economic contributor to society....

Chief among the individuals they saw as being useless...whose only societal function was the consuming of precious resources while contributing nothing to society in return. In Binding and Hoche’s terms, they were “useless eaters” whose “ballast lives” could be tossed overboard to better balance the economic ship of state. Furthermore, Binding and Hoche drove home the economic argument by calculating the total cost expended in caring for such people. They concluded that this cost was “a massive capital in the form of foodstuffs, clothing and heating, which is being subtracted from the national product for entirely unproductive purposes.”

His depictions of differences among people have a similarity with current discussions surrounding the ‘obese:’

Social Darwinism, which held that in humans, both biological and social traits were passed from one generation to the next. Thus, as scientists busied themselves with measurement, classification, and definitions based on physical, biological, and social similarity and difference, they not only reinforced popular social prejudices but enshrined them as irrefutable scientific fact. By the early 20th century, scientists had amassed a great deal of pseudodata portending to show differences between individuals, genders, and ethnic groups by rank ordering any population trait from superior to inferior.

Having established the concept of social heritability and its consequences for individual inequality, similar rankings of desirability were soon applied to entire groups of people, including grouping people by class. That is, the more “inferior” (i.e., lower class) the person, the more likely they would be to engage in undesirable social behavior and often criminal behavior... By 1938 the tide of public and official benevolence toward people with disabilities had begun to turn. The public mind now characterized people with disabilities as a separate, different, often criminalized group of less economic value than their counterparts without disabilities. German literature and art soon depicted lives unworthy of living in a host of propagandistic projects....

This indepth historical examines the evolution of a political and social mindset that allowed medical professionals, science, and society to do the unthinkable. The year 1939 was designated by the Nazis as the year of “the duty to be healthy.” Its historical accounting of how the lives of children and elderly were decided is chilling. Professionals can use this historical touchstone when examining perceptions of discriminated peoples, “including the role of science, the power of ideas, the convergence of macrosocietal conditions, the complicity of the medical profession, and the role of propaganda.”

A major impetus for what followed, he explained, was the claim of legitimacy based on pseudoscience, “which drove perceptions of difference from benign recognition to active genocide:”

Not only was the pseudoscientific claimed as science (i.e., as established fact, data based, and replicated over time), but it was used as an instrument of deceit... In the marketplace of ideas, eugenics was embraced largely because it served a wider prejudicial purpose, namely, to control and then rid Germany of people deemed different, inferior, and asocial. The minority who resisted were soon silenced in the tidal wave of a demand for conformity...

Currently, there is evidence of the medical community’s again being willing agents in hastening the deaths of people deemed not viable... Once again, patients, including those with disabilities who are terminally ill, now bear the responsibility of justifying their existence and their need for treatment. This being the case, and with the clear understanding that not all physicians put the greater good ahead of their individual patients, there should at least be some debate about what this means for people with disabilities, many of whom rely extensively on the assumption that their physicians have their best individual treatment interests at heart and will treat them regardless of utilitarian arguments to the contrary.

The full article here.

Poster translation: "This genetically ill person will cost our people's community 60,000 marks over his lifetime. Citizens, that is your money. Read Neues Volk, the monthly of the racial policy office of the NSDAP." [1930s Nazi poster]