The Nazi Doctors

We are in the process of redefining what it is that has inherent worth in our culture from human beings just simply because they are humans that have worth, to states of existence having worth.

If you were asked to give a list of those things that have value, you might be hard pressed to do so. Very simply, value is those things that have worth. Something is valuable if it has worth. And there are actually three different categories of value. It's a helpful way to understand value theory. When we say that something has value, it can have the first type of value which is intrinsic value.

Intrinsic value is something that has value in itself. The value or worth that it has is inherent in its very existence. For example, love is something that most people would consider has intrinsic value. Love is something that is valuable in itself. Health is something that is valuable in itself. Happiness is something that has intrinsic value. Mercy or virtues or dozens of things are ends in themselves and have value. That's intrinsic value.

Then you have a separate category of value that is not intrinsic value, but it's called instrumental. You have intrinsic value, you have instrumental value. What's instrumental value? Something that has instrumental value is only valuable in that it leads to something else that has intrinsic value. A classic example of something that has instrumental value is money. Money itself is not valuable, but it's valuable in that it can get something that has intrinsic value. Money might get you happiness. Money might get you pleasure. Money might get you friendship. Money might buy you mercy. In other words, the money has value in that it leads to something else that is valuable in itself. This is very important because something that has instrumental value is valuable in a very tenuous way.

When I was in Thailand now ten years ago I worked in a Cambodian refugee camp. One of the souvenirs that the Cambodian kids would try to peddle to the relief workers were these now worthless pieces of paper called Cambodian "reil." Cambodian reil was the currency of Cambodia and when Pol Pott and the Khmer Rouge, the Communist Cambodians came into power in 1976, they obliterated the currency system and attempted to go back to the rice standard of currency. Rice was the standard of exchange, not worthless money. That's exactly what happened. When money was no longer capable of buying those things that themselves had intrinsic value--money, food, etc.-- the money itself became worthless. At one point it had instrumental value. But after it no longer could buy that which had intrinsic value it became worthless. And the kids had piles of what would have been a king's ransom of reil that was now utterly worthless because it could not purchase that which had intrinsic, innate, inherent value anymore.

Now I use this little description of types of value because there are very important things happening in our society that pertain to those two things. There is a third category that I'll mention in passing, that is those things that have intrinsic value and instrumental value. In other words, health may have intrinsic value to some, but if you're healthy you can also have other pursuits because of your health that also have value. So some things have both intrinsic and instrumental value.

But the most important thing I want to focus on is just these two concepts of intrinsic and instrumental value. Here's where it cashes out. I have contended here on this program for quite a while that there is a shift in the way people think about human value. It used to be that human beings had intrinsic value, they were valuable in themselves. Now there is a shift going on heralded by the "quality of life" argument which really places the nexus and focus of value not on human beings per se, but on experiences or conditions or states of living that human beings can have, such that pleasure or getting better, health or making a contribution to society, being happy, being fulfilled, having a meaningful life are the states of existence that themselves have inherent value. And human beings are increasingly being reduced to creatures that don't have inherent value, but instrumental value in that they are valuable to the degree that they lead to these other experiences that themselves are inherently valuable. Just like the Cambodian reil, if a human being who has instrumental value and can no longer lead to pleasure, fulfillment, satisfaction, health, making a contribution to society, once those things that do have intrinsic value have been removed, then the human being becomes worthless. This is my deep concern.

We are in the process of redefining what it is that has inherent worth in our culture from human beings just simply because they are humans that have worth, to states of existence having worth. If that's happening, and in my view it is incontestable that such a thing is happening, that is the foundation of the entire quality of life argument, it is also the foundation of the euthanasia argument, so-called mercy killing. It is also the argument that Dr. Kervorkian uses, though he brings in another aspect of medicine into this. If this is happening, then a radical shift is taking place in our thinking and our culture.

The shift is attendant with and also encouraged by a shift in language and the incorporation of the medical community in this change of philosophic notions. In other words, how do we change people's philosophic notions about this? What we do is change their language and we also use what has been considered a highly respected profession and we hitchhike on that respect and confidence that we have in the profession and we redefine something in our culture. The redefinition is going on, friends. And this is where the book The Nazi Doctors comes in. I'd like to tell you what Robert J. Lifton reflected on as he interviewed many of those people that were a part of the medical community and also victims of the medical community during the height of National Socialism in Germany.

The Nazi Doctors was published in 1986 by Basic Books. He's written a number of books. He says in the introduction of the book, "My goal in this study is to uncover psychological conditions conducive to evil." (p. 12) Then he says a couple of pages later, "My argument in this study is that the medicalization of killing--the imagery of killing in the name of healing--was crucial to that terrible step. At the heart of the Nazi enterprise, then, is the destruction of the boundary between healing and killing." (p. 14) Now this quote needs to be repeated. Here is his main thesis after all of this study from 1979 to 1986, seven years of traveling all over the world interviewing doctors that were part of the process and also those who were victims of the process. His goal is to show the psychological conditions that are conducive to evil. His thesis is that "the medicalization of killing--the imagery of killing in the name of healing--was crucial to that terrible step. At the heart of the Nazi enterprise, then, is the destruction of the boundary between healing and killing." He calls it "killing as a therapeutic imperative." [Emphasis in the original] (p. 15) He then goes on to say that "This reversal of healing and killing became an organizing principle of the work, and I came to suspect the relevance of that reversal for other genocidal projects." (p. xii-xiii) Right at the heart was a reversal of killing as killing, to killing as healing.

Now on February 14, 1992 I watched "20/20" on ABC. Dr. Kervorkian was being interviewed. Dr. Kervorkian, "Dr. Death", "Jack the Dripper", you know who he is. When he was asked about why he did this he made this very telling comment. He said, "A doctor is a servant and I'm here to serve the needs of the patient." What's curious about this remark is that traditionally doctors have been healers, care-givers. Their role has been defined in terms of giving life to their patients. When patient's needs were considered, the chief need of the patient was to stay alive. When a doctor says do what I tell you. I'm concerned with your needs. What he's saying is do what I'm telling you because I'm trying to keep you alive and that which I direct you to do will promote health. Doctors are there to keep people alive, to give care, to promote health. "Needs" used to mean saving their life. Dr. Kervorkian says that meeting a patient's needs is killing them. Dr. Kervorkian is saying that sometimes, using Robert Lifton's words, sometimes killing is a therapeutic imperative. Dr. Kervorkian has redefined what the role of doctors and the role they play in our society.

To put it simply, Lifton's goal was to discover what psychological changes or ways of thinking would ultimately result in indescribable evil. His answer was that one of the things that could cause that was turning to killing as a therapeutic imperative, thus erasing the distinction between healing and killing.

If one is encouraged, Lifton argues, to see killing as healing of any kind, whether it be a type of individual healing, a type of social healing, or a type of cultural cleansing, then you are on the threshold of indescribable evil.

Furthermore, this evil has the capability of incredibly sublime rationalization. Lifton notes the recollection of survivor physician Dr. Ella Lingens-Reiner, who pointed to the chimneys in the distance and asked a Nazi doctor, Fritz Klein, "How can you reconcile that with your Hippocratic Oath as a doctor?" He answered, "Of course, I am a doctor and I want to preserve life. And out of respect for human life, I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind." (p. 16)

Listen very carefully to what this man has said. He said that he killed Jews out of respect for human life. The tragic thing is that he really believed that he was respecting life by killing Jews. Tell me, how is that different from the rhetoric of the euthanasia issue now? We kill out of so-called respect for life.

It's no accident that the medical profession played a crucial role then and is playing a crucial role now in this shift, in this rationalization, in this destruction of the boundary between killing and healing. Doctors were the obvious choice of a profession to use to propel this transition of thinking from killing as killing, to killing as healing. Lifton notes, "It is they who work at the border of life and death, who are most associated with the awesome, death-defying, and sometimes death-dealing aura of the primitive shaman and medicine man. As bearers of this shamanistic legacy and contemporary practitioners of mysterious healing arts, it is they [the doctors] who are likely to be called upon to become biological activists." (p. 17) So even in our culture we are using doctors and the "aura of this shamanistic legacy, these awesome death-defying, and sometimes death-dealing" individuals. We are using them as biological activists.

One last observation about this whole process. Lifton identifies the sequence that led to this shift in thinking about human beings. The sequence has five steps:

  1. coercive sterilization
  2. killing "impaired" children
  3. killing "impaired" adults
  4. killing "impaired" inmates of concentration camps [notice how the numbers of people qualifying for death is broadening]
  5. mass extermination, mostly of Jews

Lifton observes that "sterilization doctrine...set the tone for the regime's medicalized approach to 'life unworthy of life.'" (p. 25)

Now I don't believe that we are following the same sequence that he identifies here because coercive sterilization does not happen in this country. Some of you may be saying that if I'm suggesting a slippery slope to the same kind of thing, logically thinking the mass extermination of people here, then why aren't we seeing that same sequence of events happening in our culture? My point is we are in fact seeing that, but we don't see it being initiated by coercive sterilization.

Lifton's point was that sterilization was a practice that set the tone for the medical approach to dealing with life that is considered unworthy of life. We don't have sterilization here, but we have something else that fits the bill, that was the first step of this whole series of events that we see in process right now. It wasn't sterilization in our country, it was abortion.

Abortion seems to fulfill the same function as coercive sterilization did but for slightly different reasons. Just as sterilization was viewed as a healing act, abortions are considered "therapeutic." Abortion is different in that it is not meant to cull out the genetically undesirable, but rather the merely unwanted. Even so, both seem to be the first step that lay the philosophic foundation for the steps that follow. For the Nazis, it was sterilization that was the first step that led to killing impaired children and then killing impaired adults. In our culture, abortion has served that function because clearly since 1973 we have moved towards the unofficial, though widespread, killing of impaired children and now the attempt to legalize the killing of impaired adults, though unofficially that is going on (Dr. Death).

There is a slippery slope, my friends, and we are on it. I hope you are thinking soberly about these issues and that you aren't merely dismissing these reflections as the wide-eyed speculations of a religious right-winger. I am trying my best to approach this in a sober fashion and to demonstrate for you that there is a very dramatic parallel in the way we view human life to what happened forty years ago. If we follow the sequence, the five step sequence of the Nazis, we are already significantly into the third stage. The kick-off was just a bit different, but nonetheless significant in that it changed the way human beings were viewed as having a life unworthy of being lived. And we are seeing human beings having less and less intrinsic value in themselves, but merely instrumental value, that which leads to something that has intrinsic value. Once that which has instrumental value does not lead to something intrinsically valuable, that thing, in this case human beings, becomes worthless, just like worthless Cambodian reil.

At least that's the way I see it.

Greg Koukl

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