| “Euthanasia”: Direct Medical
Killing |
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Binding’s section explored the doctor’s legal
responsibility in “death assistance” (Sterbehilfe) and the
“killing of the consenting participant,” and in the killing of
“incurable idiots” unable to consent. He advocated a carefully
controlled juridical process, with applications for killing evaluated by a
three-person panel (a general physician, a psychiatrist, and a lawyer). A
patient who had given his consent to be killed would have the right to withdraw
that consent at any time, but there was also an emphasis on the legal
protection of physicians involved in the killing process.4
Hoche, in his section, insisted that such
a policy of killing was compassionate and consistent with medical ethics; he
pointed to situations in which doctors were obliged to destroy life (such as
killing a live baby at the moment of birth, or interrupting a pregnancy to save
the mother). He went on to invoke a concept of “mental death” in
various forms of psychiatric disturbance, brain damage, and retardation. He
characterized these people as “human ballast”
(Ballastexistenzen) and “empty shells of human beings” —
terms that were to reverberate in Nazi Germany. Putting such people to death,
Hoche wrote, “is not to be equated with other types of killing. . . but
[is] an allowable, useful act” He was saying that these people are
already dead.5
Hoche referred
to the tremendous economic burden such people cause society to bear; especially
those who are young, mentally deficient, and otherwise healthy and who would
require a lifetime of institutionalization. He specifically medicalized the
organic concept of the state by his insistence that “single less valuable
members have to be abandoned and pushed out.” He added a striking note of
medical hubris in insisting that “the physician has no doubt about the
hundred-percent certainty of correct selection” and “proven
scientific criteria” to establish the “impossibility of
improvement of a mentally dead person.” But he ultimately revealed
himself to be a biological visionary: “A new age will come which, from the
standpoint of a higher morality, will no longer heed the demands of an inflated
concept of humanity and an overestimation of the value of life as
such.”6
The Binding-Hoche study
reflects the general German mood during the period following the First World
War. Hoche was considered a leading humanitarian and, in a 1917 article, had
rejected medical killing. Shortly afterward, his son was killed in the war, and
he was said to have been deeply affected by both his personal loss and the
German defeat. Like many Germans then, he felt himself experiencing the darkest
of times, and the book was an expression of personal mission and a call to
national revitalization Indeed, from the time of Jost, war had been invoked by
advocates of direct medical killing. The argument went that the best young men
died in war, causing a loss to the Volk (or to any society) of the best
available genes. The genes of those who did not fight (the worst genes) then
proliferated freely, accelerating biological and cultural degeneration.
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