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The Nazis, however, used the term ''euthanasia'' to camouflage mass murder. Just how the Nazis were able to do that has been made clearer by recent historical research and by interviews I was able to conduct during the last decade with German doctors who participated in the killing project. Nazi medicalized killing provided both the method - the gas chamber - and much of the personnel for the death camps themselves. In Auschwitz, for instance, doctors selected prisoners for death, supervised the killings in the gas chambers and decided when the victims were dead.

Doctors, in short, played a crucial role in the Final Solution. The full significance of medically directed killing for Nazi theory and behavior cannot be comprehended unless we understand how Nazi doctors destroyed the boundary between healing and killing. The Nazi principle of killing as a therapeutic imperative is evident in the words of the Auschwitz S.

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Klein was asked by an inmate how he could reconcile Auschwitz's smoking chimneys with his purported fealty to the physician's Hippocratic oath, which requires the preservation of life. The Jew is the gangrenous appendix in the body of mankind. While this concept predated the Nazis, it was carried to its ultimate racial and ''therapeutic'' extreme by them. Of the five identifiable steps by which the Nazis carried out the destruction of ''life unworthy of life,'' coercive sterilization was the first.

There followed the killing of ''impaired'' children in hospitals, and then the killing of ''impaired'' adults -mostly collected from mental hospitals - in centers especially equipped with carbon monoxide. The same killing centers were then used for the murders of ''impaired'' inmates of concentration camps.

Sabaton - The Final Solution (Lyrics English & Deutsch)

The final step was mass killing, mostly of Jews, in the extermination camps themselves. Mandatory sterilization of those termed the ''hereditarily sick'' was part of the Nazi vision of racial purification. No one knows how many people were sterilized; reliable estimates range from , to , people.

For a doctor, there is a large step between ligating spermatic cords, cutting fallopian tubes, even removing uteri, and killing or designating for death one's own patients. But, by the time the Nazis took power in Germany, some of the philosophical groundwork allowing for this transition had already been laid. Hoche argued in the book that a policy of killing was compassionate and consistent with medical ethics. He pointed to situations where doctors were obliged to destroy life - interrupting a pregnancy to save the mother, for example.

He went on to claim that various forms of psychiatric disturbance, brain damage and retardation indicated that the patients were already ''mentally dead. Putting such people to death, Hoche wrote, ''is not to be equated with other types of killing. Binding and Hoche turned out to be the prophets of direct medicalized killing. Prior to the Nazis' assumption of power, such thinking was not a majority view in German psychiatry and medicine. But under the Nazis, there was increasing discussion in medical and political circles of the legitimacy of mercy killing, of Hoche's concept of the mentally dead, and of the enormous economic drain on German society caused by the large number of impaired Germans.

A mathematics textbook of the period even asked students to calculate how many government loans to newly married couples could be granted for the money it cost the state to care for ''the crippled, the criminal, and the insane.

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T HE KILLING OF children - indeed the entire Nazi ''euthanasia'' program - began simply with a petition to allow the ''mercy killing'' Gnadentod, literally ''mercy death'' of an infant named Knauer, who was born blind, with one leg and part of one arm missing, and apparently an ''idiot. In late or early , Hitler ordered Karl Brandt, his personal physician and close confidant, to go to the clinic at the University of Leipzig where the child was hospitalized, to consult with the physicians there and to determine whether the information submitted about the child was accurate.

If the facts about the child's condition were correct, Brandt recalled in at the Nuremberg Medical Trial one in the series of Nazi war-crimes trials that was devoted solely to the prosecution of medical crimes , then in Hitler's name ''I was to inform the physicians. According to Brandt, the doctors agreed ''that there was no justification'' for keeping the child alive. In his recollection of the incident at the Nuremberg Medical Trial, he added that ''in maternity wards, in some circumstances, it is quite natural for the doctors themselves to perform euthanasia in such a case without anything further being said about it.

The Implementation of the Final Solution |

On returning to Berlin, Brandt was authorized by Hitler, who did not want to be publicly identified with the project, to establish a child-killing program with the help of Philip Bouhler, chief of Hitler's Chancellery. The child-killing program began with newborns, then proceeded to children up to the ages of 3 and 4 and soon to older ones. The authorization for the killing project was, at first, oral, secret and ''kept in a very narrow scope,'' covering ''only the most serious cases,'' according to Karl Brandt's Nuremberg trial testimony.

It later became loose, extensive and known among a wider and wider circle of physicians and officials. In , a small group of doctors and Chancellery officials held discussions to lay out a structure for the project. A group of medical consultants known to have ''positive'' attitudes toward the project was assembled; among their number were administrators, pediatricians and psychiatrists.

It was decided that the program would be run secretly from the Chancellery, although the health division of the Reich Interior Ministry would help to administer it. The name was meant to convey the sense of a formidable medical-scientific board, although its leader, Hans Hefelmann, had a degree in agricultural economics.

The impression of medical propriety was maintained in a confidential directive sent on Aug. Frick to the heads of non-Prussian state governments. The directive ordered ''the earliest possible registration'' of all children under 3 years of age in whom ''serious hereditary diseases'' were ''suspected''; included on the list of diseases were idiocy and mongolism especially when associated with blindness and deafness , microcephaly, hydrocephaly, paralysis, and spastic conditions and malformations of all kinds, but especially of the limbs, head and spinal column.

The registration was necessary ''for the clarification of scientific questions in the field of congenital malformation and mental retardation. Midwives were required to make these reports at the time of a child's birth, and doctors were to report all impaired children up to the age of 3. District medical officers were responsible for the accuracy of the reports, and the chief physicians of maternity clinics and wards were notified that the reports - which took the form of questionnaires from the Reich Health Ministry - were required.

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  • By June , the questionnaires were expanded to include not only a child's specific illness or condition, but details about family history - including hereditary illnesses and alcohol, nicotine or drug abuse - as well. The revised reports also required a more detailed evaluation of the child's condition by a physician, indicating possibilities for improvement, life expectancy, prior institutional observation and treatment, details of physical and mental development, and descriptions of convulsions and related phenomena. The actual killing was done in children's institutions whose chiefs and prominent physicians were known to be politically reliable and ''positive'' toward the goals of the Reich Committee.

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    These killing centers were grandly referred to as ''Reich Committee Institutions,'' ''Children's Specialty Institutions'' or even ''Therapeutic Convalescent Institutions. No such separate institutions existed, of course.

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    • The children marked for death were usually dispersed among ordinary pediatric patients at children's hospitals. But, by expressing literally the Nazi reversal of healing and killing, the deceptions also served the psychological needs of the killers. A doctor could tell a parent that ''it might be necessary to perform a surgical operation that could possibly have an unfavorable result''; or he might explain that ''the ordinary therapy employed until now could no longer help'' their child, necessitating ''extraordinary therapeutic measures.

      The structure of the child-killing program also diffused individual responsibility. In the entire sequence - from the reporting of cases by midwives and doctors, to the supervision of the reporting by heads of institutions, to the coordination of the reports by Health Ministry officials, to the child's appearance at the Reich Committee institution for killing - there was no need for any single participant to feel personally responsible for the murder of another human being. Each participant could feel like no more than a small cog in a vast, officially sanctioned, medical machine.

      Before being killed, children were generally kept for a few weeks in the institution, to convey the impression that they were to undergo some form of medical therapy. The killing was usually arranged by the institution's director or by a doctor working under him.

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      Frequently, the order to kill a child was delivered by innuendo, rather than as a specific directive. Killing was generally done with tablets of Luminal - a barbiturate - dissolved in tea or another liquid. Luminal would be given to a child repeatedly over two or three days, until the child lapsed into continuous sleep and then died. For children who had difficulty drinking, Luminal was sometimes injected.

      If the Luminal did not kill the child quickly enough, the child would be given a morphine-scopolamine injection. An ordinary disease, such as pneumonia, would be listed as the cause of death; there was a kernel of truth within that lie, since the immediate cause of death following an overdose of a drug like Luminal often was pneumonia.

      From the start of the program in , the criteria for killing children continually expanded, and came to include various minor handicaps.

      The Implementation of the Final Solution

      The program culminated with the killing of youths designated as juvenile delinquents. Jewish children could be placed in the net simply because they were Jewish. At Heyer, one of the childrens' institutions, a special department was established for ''minor Jewish-Aryan half-breeds. Although Hitler officially ordered the termination of the general ''euthanasia'' project in , partly in response to public criticism by some German clergymen, the killing of children continued.

      Indeed, it probably increased, but was conducted in a more haphazard fashion. Estimates based on various trial materials and other evidence indicate that 5, children were killed between and , but the total was probably much higher.