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When caring turned to killing

An Australian academic is at the forefront of groundbreaking research piecing together the role of nurses in the Third Reich. Linda Belardi reports.

Curtin University’s Professor Linda Shields is concerned that the role of nurses in the Nazi era has been airbrushed from history and with it the lessons to be learnt from the past.

“There has been a great deal of scholarship on the role of doctors and what they did in Nazi-occupied Europe, what has been neglected or overlooked is the role of nurses,” Shields says.

“And yet most of the killings that we are looking at occurred in hospitals where nurses made up the bulk of the workforce. Nurses were very much involved in the killings and the camp experiments,” she says.

Indeed, survivor testimonies and available documents reveal that nurses were active and voluntary participants in the Nazi euthanasia programs, killing more than 10,000 people, many of them children (some estimates are as high as 30,000 victims).

While it’s impossible to come up with an exact figure on the number of nurses that were involved, (as most of the evidence was destroyed after the war), Shields says it was a minority of nurses but most have never been held accountable for their crimes.

“The bulk of nurses working in Nazi-occupied Europe cared for their patients appropriately, but there were a handful of nurses who chose, and the word is chose, to follow the regime that declared that some of their patients should be killed.

“These nurses were not forced to do it. The nurses who did these things did them of their own free will,” says Shields, who will be inducted into the Honor Society of Nursing, Sigma Theta Tau International’s international nursing hall of fame in August, in part, because of her historical research into the Nazi era.

There are records of dissenting nurses who were granted permission to move to another hospital because they disagreed with the objectives of the programs. “There is no record of anyone being sent to a concentration camp. There is no record of anyone losing their job over refusing to participate in the sterilisation or euthanasia programs,” Shields says.

To bring this past to the fore, Shields along with a number of international collaborators including historians and philosophers, have been mining the archives to unlock this silent history. In research trips to London, Shields has personally read hundreds of survivor testimonies of individuals from the concentration camps, scanning for references to nurses. Her fellow researcher, Dr Susan Benedict from the University of South Carolina, has interviewed some of the perpetrators.

German researcher Anja Peters has also recently begun studying the untold story of midwives involved in the child euthanasia and Lebensborn programs.

In 2004, Shields was the conference organiser of the first public airing of the role of nurses in Nazi Europe since the Nuremburg trials.

“It’s really important that what we see as the very dark side of nursing’s history is not ignored. It’s got to be discussed. It’s got to be aired,” she tells Nursing Review. And this past, she says, continues to resonate with contemporary nursing as the profession navigates modern ethical dilemmas.

“It’s really important that we discuss this as a profession because unless we do, we’re not being faithful to ourselves, we’re not doing the profession any good by trying to ignore it and the profession might only grow and develop if we discuss the issues that brought these nurses to think that killing was a legitimate part of their nursing role.”

In Nazi Germany nurses participated in both the child and adult illegal euthanasia programs but it was the children’s euthanasia program which actually began first.

In 1936, a secret Reich committee was established in Hitler’s chancellery for the organised killing of children who were born with mental or physical disabilities. Personnel from the committee visited various German psychiatric institutions and successfully set up 30 “Special Children’s Units” staffed by doctors and nurses who voluntarily consented to assist in the killing program.

At this time, it also became compulsory for doctors, midwives and hospitals to register all disabled newborn children with the Reich committee for admission into one of the inpatient pediatric clinics.

Doctors and midwives were also paid for every child they reported and risked fines for failing to report.

The Reich committee promised the parents that their child would be treated by specialists in the clinic, which lulled many into believing that they were acting in the best interests of their children. Nurses betrayed these children by administering lethal drugs or by intravenous injection.

In 1939, the euthanasia program was subsequently expanded to include mentally ill adult patients in German psychiatric hospitals and involved the transportation of patients to killing centres and then their remains were disposed of in crematoria linked to the gas chambers.

“The biggest killing hospital was Hadamar, which is still a psychiatric hospital in Germany today. They had the most patients and carried out the most killings,” Shields says.

In August 1941, a public outcry led by church groups forced Hitler to formally stop the gassings in the adult euthanasia program. However, the killings continued covertly in many hospitals throughout the Reich as part of an underground or “wild” euthanasia program which went on to kill more victims than in the preceding years.

In this phase, killings were done by individual lethal overdose rather than by mass gassings.

Meanwhile, the children’s euthanasia program children continued uninterrupted.

Camp experiments

In addition to the euthanasia programs throughout Germany, nurses were also employed by hospitals in the Nazi concentration camps and become involved in sterilisation programs and camp experiments.

In particular, Shields has studied the experience of the “lapin”, the female prisoners from the Ravensbruck concentration camp who were forced to undergo horrific operations. They transplanted legs from one woman to another and inflicted severe wounds in order to test the effectiveness of various drugs.

In August, Shields will present a conference paper in Denmark on the role of nurses in these experiments.

Nazi propaganda

While not morally excusable, Shields says it’s important to understand the social and political conditions of the time and in particular, the complete saturation of state propaganda.

To be a nurse in Nazi Germany, they pledged an oath of allegiance to Adolf Hitler as part of their training. “They were locked into what they should believe,” Shields says.

“The propaganda said that anyone with a mental illness, alcoholism or any disability was ‘life unworthy of life’ and the other term they commonly used was ‘useless feeders’. It was everywhere, even to the point where the arithmetic exercises of school children were around how much these ‘useless feeders’ were costing society.”

The propaganda infiltrated the whole society. “So it’s not surprising that some of these nurses believed that what they were doing was right. They believed they were killing off the ‘useless feeders’ or carrying out mercy killings by relieving people who were ‘life unworthy of life.’ It was all pervasive.”

But were the circumstances that allowed these acts to take place exceptional; never to be repeated?

When asked if it could happen again, Shields lists a number of contemporary examples of nurses who have killed their patients as part of their caring role. Nurses have participated in the Rwandan massacre in 1994, and killed elderly patients in the aftermath of Hurricane Katrina. In some jurisdictions nurses also perform procedures for capital punishment.

“I’m certain it could happen again, that’s why I keep studying it. If nurses come to think that something is a legitimate part of their caring role, they will do it. These nurses in Nazi Europe thought killing was a legitimate part of their caring role.

“If you look at things that are happening now, for example, maternal fetal screening programs – whether you believe in abortion or not doesn’t matter – but the principles behind this are that nurses are involved in helping these women decide whether or not to terminate a child with something wrong with it.”

Nurses in Belgium and in the Netherlands are also involved in legalised euthanasia. “I’m not saying that they are right or wrong in being involved in that - that’s their choice - but my concern is that if they believe that what they are doing is a legitimate part of their caring role, is that any different to what the nurses in Nazi Germany believed when they became involved in these killing programs?” Shields asks.

“I think it’s really important that we study this and make people think about what they are doing. It’s only if they can critically think about what they are doing and think it through then we can say that we are a truly adult profession.”

These issues confront nurses with the question: is it ever right for nurses to come to see killing as a part of their role?

Just last month international headlines reported that two male nurses in Uruguay were charged with murder for killing at least 16 of their patients. One defence lawyer said the acts were “mercy killings” to relieve the prolonged suffering of patients. The Uruguayan government has launched an investigation into the deaths.

Trials and accountability

As the occupied countries were liberated and the allied forces moved through, a small number of nurses were arrested. During the trials three nurses were convicted for their involvement in Nazi-operated hospitals and camps. One chief male nurse, Heinrich Ruoff was hanged and two female nurses served short prison sentences before being allowed to return to nursing.

Shields says the perceived “holiness and sanctity” of nurses means that nurses have been largely glossed over in this tracing of history. When recounting these events in public forums, individuals have refused to believe the veracity of this history, she says.

“Because nursing is a female dominated profession, people would never countenance the fact that women could be just as brutal as the men. Very few nurses were held to account for what they did.”

But nurses have a responsibility to acknowledge their culpability in this past in order to be wise enough to not let it happen again, Shields says.

The resisters: The story of Maria Stromberger

But among the obedience, compliance and the ceaseless propaganda were examples of heroism and resistance.

During their historical inquiry, Shields and Benedict uncovered the story of Maria Stromberger whose quiet courage and bravery saved the lives of many prisoners but whose actions have received little attention.

After hearing about the horrors of Auschwitz filter into the community, Stromberger, a devout Catholic, relocated from occupied Poland in 1942 to become head nurse of the SS hospital at the now infamous concentration camp.

“The hospital geographically overlooked the crematorium and the gas chambers so she could see exactly what was going on,” says Shields.

“She purposefully got herself a job there and then began to record what she saw. She smuggled food, medicine and weapons to the prisoners and smuggled diaries and photographs out so that the world knew what was happening.”

Despite her acts of defiance across a period of two years, Stromberger was never caught.

However, she was later mistakenly imprisoned by the liberating forces when the camp was shut down but Polish and Jewish prisoners later testified to her innocence and she was freed. Stromberger chose never to nurse again.

Shields and Benedict will release a book on their research later this year.

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