Law for the Protection of Hereditary Health

These ideas - of eugenics and euthanasia, without calling them that - caught on with some National Socialist leaders, Adolf Hitler including, eager to assert the supremacy of the Aryan race by ridding it of any possible taint.

Beyond the theories and objectives set forth in innumerable books, the first official measure took place on July 14, 1933, barely half a year after his arrival to power in Germany, with the enactment of the Law for the Protection of Hereditary Health.

It established that those suffering from "congenital imbecility, schizophrenia, manic-depressive dementia, hereditary epilepsy, Huntington's disease [...] and acute alcoholism" were to be sterilized, and special courts were created to enforce compliance. Is this or is this not a form of euthanasia and eugenics?

In spite of complaints from the Catholic Church and some personalities, it is assumed that between 1933 and 1945, some 400,000 Germans were subjected to forced sterilization.. Other cases not provided for in the law were included, such as children of German mothers and French colonial soldiers born in the Ruhr during the Gallic occupation (1923-25).

But, as Hitler himself confessed in 1935 to Dr. Gerhard Wagner, the leader of the National Socialist Society of German Physicians, he it seemed necessary to go further, even if the situation did not yet allow it.. It was necessary to continue taking steps until the right moment arrived, and this would come at the sound of the drums of war.

The Kretchmar case

On February 20, 1939, Gerhard Kretchmar was born in the small Saxon town of Pomssen. What was supposed to be a joy for his parents, Richard and Lina, turned into despair. He was missing an arm and a leg, was blind and suffered from other pathologies. When he consulted his family doctor, he said that the best thing that could happen was for him to die.

Convinced National Socialists, The parents petitioned Hitler to that effect, since the euthanasia-eugenics euthanasia-eugenics was illegal. The Chancellor agreed to the request, sending his personal physician, Karl Brandt, to Leipzig to gather all the information and to act if he considered it appropriate. On July 25, 1939, with everyone's acquiescence, the child died after being given an injection of Luminal.

Possibly, the conviction that a large part of German society would understand that the the extension of eugenic measures prompted the regime to take a further step. A few days earlier, on account of the case, a secret meeting had taken place in a villa in Berlin's Tiergartenstrasse, 4.

The meeting, chaired by Brandt himself and Philipp Bouhler, head of the Führer's Chancellery in the NSDAP, was attended by various members of the Ministry of the Interior, as well as renowned physicians and psychiatrists.

There he set himself the goal of establishing a large-scale euthanasia-eugenics program affecting patients incurables, in Nazi slang, 'lives unworthy of being lived', so that they could be given a 'merciful death'.

Scientific registry of hereditary and congenital diseases

In the discussion, the possibility of drafting a euthanasia law was considered, but it was concluded that a large part of the population, especially the Churches, would not understand it. It was then decided to take these measures discreetly and on the sly, so that there could be no talk of murder.

One of the first was the creation of the Reich Committee for the Scientific Registration of Hereditary and Congenital Diseases, which would draw up a census of newborns with deficiencies.

The final meeting took place on September 5. At the meeting a document signed on the 1st (date of the invasion of Poland) by Hitler was exhibited which stated: "The Reichsleiter and Dr. Brandt are charged, under their responsibility, with extending the powers of certain physicians who are to be nominally appointed.

These may grant a merciful death to the sick whom they have considered incurable. according to the most rigorous appraisal possible". Everyone thought that the German public, busy with the war, would pay little attention to him.

At the same time, a campaign was orchestrated for to raise German society's awareness of the economic and social that was involved in keeping these people alive.

From books and pamphlets, we would move on to short films such as Das Erbe (The Inheritance, Carl Hartmann, 1935), and to successful feature films such as Ich klage an (I accuse, Wolfgang Liebeneiner, 1941).

Meanwhile, in the schools, the children were given problems like this: "If it costs 500,000 marks a year to maintain an insane asylum for incurable mental patients and it costs 10,000 marks to build a house for a working family, How many family homes could be built per year on what is being squandered on the asylum?".

Aktion T-4 kicks off

The operation was launched under the name Aktion T-4, after the mansion in Tiergartenstrasse where it was based. Hospitals and mental sanatoriums throughout the Reich were compelled to report those patients considered incurable..

. They had to do so through a form established by the Ministry of the Interior that included three groups:

1. schizophrenics, epileptics, syphilitics, senile, irreversible paralysis, etc.
2. sick with at least five years of hospitalization; 3) alienated criminals and foreigners.

Once the files arrived, three doctors reviewed them and checked a box that decided the future of the patient. A red cross signified death; blue, life; and a question mark, doubt with future revision.

The first ones were picked up by large gray buses, used by Deutsche Post, the postal service, which had the particularity of having the windows tinted in black.

Shortly after the patients were transferred, the families received a new letter informing them of the death.

The destination was one of six gassing centers: Grafeneck, Hartheim, Sonnenstein, Brandenburg, Bernburg and Hadamar. At these centers a cursory visual examination that spared few from immediate death. Very young children were eliminated with injections of morphine or scopolamine.

Although the family was notified of the transfer, not many details were added. Soon after, he received a new letter informing him of the death and its presumed cause, and announcing that the body had been cremated for public health reasons.

In some cases the ashes were added, and in others a short period of time was given so that they could be collected by the relatives.

The number of groups affected increased progressively. A directive obliged doctors and midwives to report children born with malformationsShortly thereafter, the parents were informed of the existence of special sanatoriums for their care and rehabilitation, requesting their authorization to transfer them to centers from which almost no one returned.

Opposition to the eugenics-euthanasia program

Letters of condolence, on the other hand, were not always convincing. Some contained errors of sex or age, and the pathologies of the deceased did not always match the cause of death. Sometimes the urn was empty, or there were two urns for the same person.

The pressure on the centers' personnel began to become excessive, and Rumors began to spread in the towns adjacent to the sanatoriums.

As early as March 19, 1940, Theophil Wurm, Protestant bishop of Württemberg, sent a letter to the Minister of the Interior asking for explanations.. Others would follow, while families were increasingly reluctant to transfer.

However, Aktion T-4 was given a kick-start by the Bishop of Münster, Clemens August von Galenin his homily of August 3, 1941.

In the sermon, which was reproduced in some parishes of the diocese, Von Galen said: "The suspicion has spread, bordering on certainty, that so many unexpected deaths among mental patients are not due to natural causesThe fact is that they have been deliberately programmed, and that officials, following the precept that it is permitted to destroy 'lives not worth living', kill innocent people, if it is decided that these lives are of no value to the people and to the State.

It is a terrible doctrine that justifies the murder of innocent peoplewhich gives carte blanche to kill invalids, the deformed, the chronically ill, the elderly who cannot work and the sick who suffer from an incurable disease".

The denunciation could not have been louder and clearer, and it made an impact. Opposition to the euthanasia-eugenic measures grew, while the nervousness of the Aktion T-4 executives increased.

Immersed in the campaign against the USSR, Hitler did not want any social unrest in the rearguard, so he had no choice but to officially' suspend the operation on August 24, 1941.

By then, 70,273 victims had been registered. However, recent studies suggest that the operation continued covertly and with other methods.

Although the transfers stopped, a lethal injection, drug poisoning or starvation replaced the gas. The number of victims will probably never be knownalthough it could very well be around 200,000.

The disease ends is the proximity of an irremediable death. It is characterized because the dying person has a "holistic or total pain". He suffers from physical, psychic, spiritual and social pain.

What is euthanasia?

It is to end the life of a sick person. It is the intentional provocation of the death of a person suffering from an advanced, chronic or terminal disease. This death can be caused by action or omission.

Physicians are pained to see how in so-called advanced societies euthanasia is being introduced to rid society of annoying people who generate costs for the state.

At the same time, we are pleased to see that in places where palliative care and home care have been established, patients and their families show deep gratitude.

In our country they have been implemented in recent years, but there is an urgent need for a broader and more homogeneous development of palliative care throughout Spain.

What strategies are used by campaigns advocating the euthanasia law?

Those who defend the euthanasia law use campaigns and mobilizations to stir people's feelings and try to demonstrate that it is not possible to 'do otherwise'.

They are based on the autonomy of the person, if he/she so desires. Autonomy that in practice does not exist, because We are all by definition vulnerable and dependent. And in a very special way, in the last moments of life, we are all vulnerable and dependent..

Palliative care

Fortunately, the humanization of health care and the control of the suffering of a terminally ill patient is today medically possible thanks to the correct application of the palliative careThese are administered according to an action guide based on ethical principles that guide clinical decision making.

Ethical principles of palliative care practice

Principle of solidarity

Solidarity with terminally ill persons and their families implies the accompaniment and application of appropriate assistance resources. No one should have to face his or her own death alone, without essential help from others.

This solidarity involves say no to neglect, disinterest and oblivion. It implies saying yes to closeness, to human warmth, to the provision of quality care. A yes also to the alleviation of social suffering.

Principle of non-maleficence

Non-maleficence arises from the Hippocratic ethics with the known, principle of Primum non nocare. Never harm the suffering human being is a prerequisite for any medical intervention.

This will involve verifying a correct diagnosis of terminality and avoiding medical measures that will not achieve the desired objectives.

Principle of fairness

It requires offering the same solutions to all patients. Guarantee the rights of the terminally ill patient and his family without discrimination..

For this purpose, it will be necessary to check the adequacy of :

• The structure.
• The capacity of the professionals.
• The process, through the correction of care protocols.
• The results of the terminal phase and the achievement of an appropriate death.
• Applying the principle of fairness also includes assessing the possibility of social futility.

The principle of autonomy

Individuals should be treated as autonomous and persons whose autonomy is diminished should be the object of care. One way of respecting autonomy is to promote in practice the participation of the patient and his or her family in decision-making.

What does this imply?

• Inform the patient and the next of kin in an understandable manner.
• To guarantee the willingness to accept treatment, through the use of informed consent, respecting the right to refuse it.
• Protect minors who are unable to make decisions for themselves, and accept parental decisions.

Principle of beneficence

It requires causing no harm. Maximize possible benefits and minimize possible harm. Palliative care performs an objective benefit-risk analysis, applies a comprehensive multidisciplinary care plan. And apply the final sedation, when it is necessary with a protocol. ethically correct.

Conclusions

In view of the foregoing, I consider:

First, that it is vitally important to awareness at all levelsand individual, medical, medical, social, family and individual, of the radical difference between "palliative care and euthanasia".

Second, that it is vitally important naturalizing and humanizing the final trance of existence, respecting the dignity of the person in each particular case. The most important moment of a person's life is the moment of death.

Thirdly, that the establishment of the law on euthanasia, the application of which is open to errors and misunderstandings, is to be rejected. And yet it is urgent to establish, as soon as possible, a law on palliative care.