Many people are unaware that Hitler's extermination policies began with the large-scale elimination of people with disabilities. Proponents of physician- assisted suicide are offended when allusions are made to this piece of disability history in the course of debate over the so-called "right to die". The fact is that Hitler stole most of his ideas on eugenics from publications originating in the USA.

Popularity of eugenics and social Darwinism continued in the USA during WWII. In 1942, the American Journal of Psychiatry published a "debate" on the ethics of killing children with severe disabilities. The following was written by Foster Kennedy:

I believe when the defective child shall have reached the age of five years - and on the application of his guardians - that the case should be considered under law by a competent medical board; then it should be reviewed twice more at four-month intervals; then, if the board, acting, I repeat, on the applications of the guardians of the child, and after three examinations of a defective who has reached the age of five or more, should decide that that defective has no future or hope of one; then I believe it is a merciful and kindly thing to relieve that defective - often tortured and convulsed, grotesque and absurd, useless and foolish, and entirely undesirable - of the agony of living.

In an unsigned editorial in the same issue, Kennedy's views were enthusiastically endorsed in this official publication of the American Psychiatric Association. It is probable that the opening of the concentration camps (built by a regime devoted to eugenics) was a major factor in driving this sentiment underground.

That was over 50 years ago. Proponents of physician assisted suicide would argue, as many would, that times have changed.

Perhaps, on the other hand, they haven't.

Below is an excerpt from an invited "Commentary" by Peter Singer that appeared in a 1983 issue of Pediatrics. Singer is a philosopher whose contributions to the field of "bioethics" have included the assertion that there is no justification for regarding infants as having any more rights than animals and that parents of babies with certain disabilities be given the right to order the death of the infant within those first 30 days. First, on the issue of treatment withdrawal or refusal:

Although many doctors would sharply distinguish the active termination of life from a decision not to treat a patient for whom the foreseen outcome of this decision is death of the patient, the distinction is a tenuous one, and the claim that it carries moral weight has been rejected by several academic philosophers.

Singer complains in this same article that the "right" to release from pain (through euthanasia) will be denied to individuals unable to espress themselves.

This was a bad year for people with disabilities in Pediatrics. Three issues later and article appeared with the title Early Management and Decision Making for the Treatment of Myelomeningocele. A medical team at Oklahoma Children's Memorial Hospital used a "quality of life" formula to decide whether to give parents of infants with spina bifida an "optimistic" or "pessimistic" prognosis. Parents given an optimistic prognosis were informed of all available treatments and urged to start them immediately. All parents so informed agreed to treatment. The parents of children given "pessimistic" prognoses were advised to forego intervention and treatment as the child would be too disabled to ever enjoy life even if they survived. Most parents, having been told this was in the best interest of their children, agreed. A very few did not. Here are the results in the authors' own words:

The "untreated survivor" has not been a significant problem in our experience. All 24 babies who have not been treated at all have died at an average of 37 days.

Ignored were the implications of the fact that three out of the five babies who were given treatment (surgery and antibiotics) were alive and doing well at the time the article was written. It could be fairly assumed that a majority of children deprived of treatment would also have been alive and well with appropriate medial intervention.

The trail on this issue in professional journals is clear. There is a ready acceptance of the physician's "duty" to judge the quality of life of patients, to deem when it will be unacceptable, and to act as executioner when it is felt to be desirable according to professionally determined criteria. None of the current debate is really new. It just took 50 years to come back out in the open.

References

Gross, R.H., et al. (1983). Early Management and Decision Making for the Treatment of Myelomeningocele. Pediatrics, 72 (4), 450-458.

Kennedy, F. (1942). The problem of social control of the congenital defective - Education, sterilization, euthanasia. American Journal of Psychiatry, 99, 13-16.

Singer, P. (1983). Sanctity of life or quality of life? Pediatrics, 72 (1) 128-129.