Saturday, September 22, 2018

Case for 'death with dignity' collapses under scrutiny

This letter was written by John Kelly and published in the Berkshire Eagle on September 19.

John Kelly is director of Second Thoughts Massachusetts: Disability Rights Activists Against Assisted Suicide.

John Kelly - Second Thoughts Massachusetts
To the editor:

I write to respond to the oped by John Berkowitz and three Western Massachusetts legislators in support of assisted suicide bill H.1994 (Eagle, Sept. 11).

Unsolvable problems with assisted suicide include the fact that terminal diagnoses are often wrong. Studies show that between 13 percent and 20 percent of people so diagnosed are not dying, and may live years or even decades longer. As examples, the late Sen. Ted Kennedy lived a full year longer than his terminal diagnosis of two to four months, while Florence resident John Norton credits the unavailability of assisted suicide for decades of good life after a mistaken prognosis.

Assisted suicide is a boon to insurance companies, as it instantly becomes the cheapest "treatment." (Search for stories of Californian Stephanie Parker and Nevada doctor Brian Callister.)

Against the writers' claim that there hasn't been one documented case of abuse, I encourage readers to search for Oregonians Thomas Middleton (financial abuse), Wendy Melcher (a trans woman), and Kathryn Judson (physician pressure).

The bill requires no independent witness at the death, so the supposed safeguard of "self-administration" is toothless. Especially vulnerable will be the 10 percent of Massachusetts seniors estimated to be abused every year, almost always by family members. A caregiver or heir to an estate can witness a person's request, pick up the prescription and then administer the lethal dose without worry of investigation — the bill immunizes everyone involved.

The writers say the bill is necessary to prevent "great pain and unrelieved suffering" at the end of life, but official reports from Oregon and Washington show that the top five reasons to request assisted suicide do not include pain, but rather "existential distress" (New England Journal of Medicine) over such issues as dependence on others, loss of abilities and feeling like a burden.

We disabled people reject the prejudice that physical dependence makes our lives undignified. Assisted suicide exacerbates social class distinctions. Support is concentrated in wealthier white communities such as the Pioneer Valley, while opposition is centered in communities of color and the working class. In 2012, black and Latino voters opposed assisted suicide by more than 2 to 1, effectively defeating assisted-suicide ballot Question 2. People historically disrespected and neglected by our health care system are rightly suspicious of the power to prescribe death.

The Legislature should continue rejecting a bill that would push vulnerable people toward early deaths.

John B. Kelly,

Boston

The author is director of Second Thoughts Massachusetts: Disability Rights Activists Against Assisted Suicide.

Association of American Physicians and Surgeons oppose Palliative Care and Hospice Education Training Act.

Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

1601 N. Tucson Blvd. Suite 9
Tucson, AZ 85716-3450
(800) 635-1196 or (520) 327-4885
FAX (520) 326-3529 or 325-4230
www.aapsonline.org

September 19, 2018

Palliative Care and Hospice Education Training Act (PCHETA), S. 693 / H.R. 1676

Dear Senators,

We write today in opposition to the Palliative Care and Hospice Education Training Act, S. 693 and the companion bill, H.R. 1676, passed by the House and now before the Senate HELP Committee.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943. Our motto, omnia pro aegroto, means “all for the patient.”

While there is a place for hospice care, it is improper to dedicate $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life. To the contrary, Congress should consider rolling back existing policies that perpetuate a culture of hastening death at the expense of increasing patient access to life-saving or potentially curative treatment.

For example: Medicare payment arrangements, like Accountable Care Organizations, “have a strong incentive to adopt advance care planning for long term success,” explains a prominent health industry consulting firm. Participants in Medicare’s “Patient Centered Medical Homes” are also required to maintain advance directives.

In addition, in 2016 Medicare began paying physicians (and “non-physician practitioners”) for “end-of-life counseling.” Medicare paid out $43 million in 2016 and $70 million in 2017, to convince seniors to forgo treatment that might prolong life. Further subsidies would be inimical to the best interests of patients.

Another problematic aspect of H.R. 1676 / S. 693 is that it appears to support increased intervention in the patient-physician relationship by outsiders whose interests might not be aligned with a goal of prioritizing patient care. Furthermore, “palliative” care should not be a whole separate specialty. All physicians should be skilled in relieving symptoms in all patients, not just dying ones, and provisions in this bill would exacerbate fragmentation that is harmful to patient care.

We also summarily object to “retraining” physicians to violate the Hippocratic tradition of “do no harm.” Such a policy is indefensible on its face. No taxpayer dollars should be allocated for this unsound purpose.

Instead of passing this harmful legislation, we encourage Congress to seek solutions that will truly empower patients and their families, in consultation with physicians of their choosing, to control decisions about appropriate care without interference from politicians or policymakers in Washington, DC, or others who should not be intervening in the patient-physician relationship.

Thank you for this opportunity to communicate our concerns. Please vote “no” on S. 693 or H.R. 1676.

Sincerely,

Jane M. Orient, M.D.
Executive Director

Euthanasia Society President charged with murder of disabled man - More Information.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


Last week Sean Davison, a member of the World Federation of Right to Die Societies board, was arrested for participating in the murder of Anrich Burger, in 2014. Anich became a quadriplegic following a car.
Euthanasia activist charged in murder of disabled man in South Africa.
In September 2014 I published an article urging police to investigate Davison. I wrote:
Sean Davison, who was previously convicted in New Zealand for assisting his mother’s death, last week admitted to assisting the suicide of a South African quadriplegic man. Davison is now saying that he will never assist in euthanasia again. 
Davison should be investigated for his part in the death of Anrich Burger who became a quadriplegic in a 2005 car accident. 
Davison told the South African media that: “Anrich Burger was a very close friend. I wouldn't want to ever go through that again. It was very stressful”
Adele Redmond and Mandy Te, reporting for Stuff media in New Zealand, provide more information on the Davison case. According to the article:
He (Davison) has often spoken publicly about Burger's death in 2014, acknowledging he was with his friend in his Waterfront hotel room as he died – but said that was not a crime. "Dr Burger committed suicide," Davison said. "He wrote his own prescription; he collected it, he arranged for the hotel. I was at the end with him, but he clearly expressed his wish to die." 
But South African authorities believe the 57-year-old killed Burger – and others as well. Opposing bail, Prosecutor Megan Blows told the Cape Town Magistrate's Court during Davison's bail hearing that "new information has come to light [that] the accused might have committed similar offences". 
Because of evidence collected during a "search and seizure" operation at Davison's R3.5 million Cape Town mansion, Blows requested a postponement so new allegations and items could be investigated.
We also learn from the Stuff article that Davison was planning to move to Australia and only returned to South Africa to resign his job.

Davison is a long-time euthanasia activist. More information will be released on November 16, when he returns to court.

Friday, September 21, 2018

Rabbi's get it right! Jews for Torah Values condemn Euthanasia and Assisted Suicide.

This article was published by Euthanasia Prevention Coalition USA.

Psak Halacha

Regarding attempts to pass “Death with Dignity” legislation:
The chiyuv (Torah injunction) of “Lo sa’amod al dam re’echa”, obligates everyone to do what he or she can, to help prevent assisted suicide and/or euthanasia. 
Allowing the legalization of “assisted suicide”, even if this particular law in practice would only result in assisting a suicide and not euthanasia, is to allow shefichas-domim (bloodshed). Furthermore even rendering such actions not being subject to prosecution, is allowing shefichas-domim (bloodshed), al achas kama vekama (how much more so), in cases of assisted suicide leading to euthanasia.
Voting on the basis of this issue. This obligation would include:
1) Thus, when voting for any public official, this issue must be considered as top priority, certainly overriding financial considerations, government programs, etc. By voting for people who support these laws, we become accountable for their actions. This ruling would still apply even if these laws were to be passed, we would still be forbidden to vote for legislators who voted for these laws. This is the most important way to fulfill our obligation. 
2) Urging one’s legislators to vote against these bills, if and when they arise[1] and to urge the governor to veto such bill, were it to pass the legislature. 
3) Helping in efforts to repeal such laws, in areas[2] where such legislation was already passed.

Even a few votes can make a major difference, both by legislators and the public—sometimes the vote of a single legislator can decide the fate of these laws—as is evidenced by the recent vote in the New Jersey State Assembly (in November 2014), where an assisted suicide bill was passed by just one vote. We have seen in several recent races in Jewish neighborhoods, that even a handful of votes can make the difference in the outcome of the election[3]. Furthermore, some legislators keep track of the calls that are made to their offices on particular controversial issues, and vote according to their results.

May the Creator of all life grace us with the merit to save innocent lives, fulfilling our role as an or legoyim (light unto the nations). In that merit, may we help usher in the Final Redemption by Moshiach Tzidkeinu.

Rabbonim are listed alphabetically.

Mordechai Chaim Auerbach, Monsey

Eliyahu Ben-Haim, RIETS/Kehillah Yotzei Mashad

Haim Benoliel, Bnai Yosef/Mikdash Melech

Gad Bouskila, Netivot Israel

Yitzchok M. Braun, Shaaray Zion

Shlomo Breslauer, Bais Tefiloh

Eliyahu Brog, Bais Yisroel

Simcha Bunim Cohen, Khal Ateres Yeshaya

Yitzchok Cohen, Yeshiva University RIETS

Moshe Donnebaum, Hechel Hatorah/Adas Yisroel/Melbourne

Menachem Fisher, Vien Monsey

Noson Yermia Goldstein, mechaber of “Migdalos Noson”

Avrohom Gordimer, Coalition for Jewish Values

Shmuel Gorelick, Mesivta Ohel Torah

Moshe Green, Yeshivah D’Monsey

Yisroel Dovid Harfenes, Yisroel Vehazmanim

Boruch Hirschfeld, Ahavas Yisroel, Cleveland

Zalman Leib Hollander, Khal Nachlas Moshe, Spring Valley, NY

Shmuel Kamenetsky, Talmudical Academy of Philadelphia

Yosef Meir Kantor, Cong. Agudath Israel of Monsey

Elya Nota Katz, Stamford Yeshiva

Eliezer Langer, Cong. Israel, Poughkeepsie, NY

Yeshaye Gedalye Kaufman, Hisachdus Moetz, Kruleh Dometz

Amram Klein, Ungvar

Shloime Ben Zion Kokis, Zichron Mordechai

Grainom Lazewnik, Khal Adar Gbir

Philip Lefkowitz, Jackson, NJ; mult. congregations in US, UK & Canada

Moshe Tuvia Lieff, Agudath Israel Bais Binyomin

Shmuel Miller, Yeshiva Bais Yisroel

Avrohom Yaakov Nelkenbaum, Mirrer Yeshiva

Yechiel Perr, Yeshiva of Far Rockaway

Steven Pruzansky, Bnai Yeshurun, Teaneck

Aaron Rakeffet-Rothkoff, YU Gruss Kollel

Avrohom Reich, Hatzolas Yisroel

Dovid Ribiat, mechaber “The 39 Melochos”

Yosef Yitzchok Rosenfeld, Monsey Dometz

Chaim Schabes, Knesses Yisroel

Dovid Schustal, Bais Medrash Govoha, Lakewood

Yaakov Shulman, Talmud Torah of Flatbush

Moshe Silberberg, Shuvu/mechaber “Zichron Tzvi Meir”

Moshe Soloveitchik, Chicago

Yitzchok Sorotzkin, Mesivta of Lakewood

Tzvi Steinberg, Kahal Zera Avraham, Denver

Shlomo Stern, Debreciner Rov

Elazar Mayer Teitz, Chief Rabbi of Elizabeth, NJ

Elya Ber Wachtfogel, Yeshiva of South Fallsburg

Boruch Hersh Waldman, Siach Yitzchok, Suffern

Moshe Weissman, Ohel Moshe

Benjamin Yudin, Shomrei Torah, Fair Lawn, NJ

Yeruchum Zeilberger, Stamford Yeshiva

Gavriel Zinner, Nitei Gavriel

Institutions are listed for identification purposes only.

[1] as is currently in New Jersey [2] such as Washington state and Oregon

[3] most noticeably (demonstrated) in the Senate election between David Storobin and Lew Fidler, where Storobin won by less than 20 votes.

Sponsored by Jews for Torah Values

jewsfortorahvalues@gmail.com

Thursday, September 20, 2018

Quebec Political party pledges to extend euthanasia to Alzheimer's patients.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition


The Coalition Avenir Québec (CAQ) says that if they are elected on October 1, they will increase provincial funding for Alzheimer’s research by $5 million a year and host public consultations on advanced consent for medically assisted deaths for those with Alzheimer’s and related diseases.

René Bruemmer reporting for the Montreal Gazette that CAQ candidates Marguerite Blais and François Bonnardel announced in St-Sauveur on Monday morning the parties intention to increase funding for Alzheimer's research and extending euthanasia to people with Alzheimer's. The article states:
Bonnardel’s mother suffers from Alzheimer’s, and he has said he would support a law that would allow a person to request a medically assisted death through prior consent in a living will.
“I see my mother, today, it’s 15 years (that she has had Alzheimer’s). Do I want to die like her? No... I want the choice to decide. I think a large majority of Quebecers want this choice.” 
... we want to open this debate for the 125,000 families who live with Alzheimer’s daily,” Bonnardel said. “We will do it because we have to do it. It’s a question of dignity.”

The doctor secretly placed a soporific in her coffee to calm her, and then had started to give her a lethal injection.
Yet while injecting the woman she woke up, and fought the doctor. The paperwork showed that the only way the doctor could complete the injection was by getting family members to help restrain her.
It (the paperwork) also revealed that the patient said several times 'I don't want to die' in the days before she was put to death, and that the doctor had not spoken to her about what was planned because she did not want to cause unnecessary extra distress. She also did not tell her about what was in her coffee as it was also likely to cause further disruptions to the planned euthanasia process.
Canada's federal government announced in December 2016 that they had commissioned studies into the issues of euthanasia for children, euthanasia for people with psychiatric conditions alone and euthanasia for people with Alzheimer's/Dementia if they request euthanasia for this condition while competent.

If you permit euthanasia for people who had previously stated that they wanted to die by lethal injection, but who are now incompetent, you are denying these people the right to change their mind. 

Similar to the case in the Netherlands you cannot assume that the previous wishes of a person remain the current wish of the person.

Australia man accused of killing his wife for her Life Insurance says that his wife wanted to die.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Jennifer Morant.
Three days ago I reported that Graham Robert Morant was charged with assisting the suicide of his wife, Jennifer Morant, in Australia, to receive 1.4 million dollars in Life Insurance.

Two days ago, I reported that Morant told the court that he was innocent.
Yesterday, Jennifer Morant's best friend said that she didn't want to die, but she expressed that her only hope was to win the lottery.
Today Morant told the court that his wife wanted to die by suicide, and yet her doctor stated that she never said to him that she wanted to die.

An article written by Warren Barnsley for the Sydney Morning Herald explains:
Mr Morant told police Jennifer did not want to continue suffering chronic back pain and had attempted to kill herself three times previous.
"I had such a zest and zeal to live. She had such a zest and zeal to die," Mr Morant told police in an interview played in Brisbane Supreme Court on Thursday. 
He said he tried to talk her out of it but became desensitised to her attempts. 
"That's horrendous, but she that's just what she wanted to do. 
"She actually forbid me from stopping her taking her life." 
Mr Morant also lamented Jennifer's extravagant spending, saying she had a "gift for spending money".
The article then reports on the statements by her doctor. The article stated:
But while she had been treated for back, weight, thyroid, blood pressure, dental and mental health issues, her doctor Mariusz Zielinski told the court she suffered no terminal illness. 
Dr Zielinski said she had never made a comment to him about wanting to end her life.
The trial continues.

The Anonymous Three: Child euthanasia in Belgium and Elsewhere.

This article was published by the disability rights group Not Dead Yet on September 19, 2018

By Lisa Blumberg


The Belgium Federal Commission on the Control and Evaluation of Euthanasia in its most recent report of Belgium euthanasia statistics stated that between January 1, 2016 and December 31, 2017, three children died by lethal injection under the country’s euthanasia law. They was a nine year old with a brain tumor, an eleven year old with cystic fibrosis and a seventeen year old (probably a boy) with Duchenne muscular dystrophy. (1) 

We know nothing else about these persons. We don’t even know whether each of them had involved parents or if one or more had guardians. In both life and untimely death, they are reduced to age and general diagnosis. As individuals, they are given no backstory. They are profoundly anonymous.

It calls to mind that in 1980s America, infants who were denied basic medical care and nourishment due to disability were called “Baby Does”. (2)

Belgium’s euthanasia law, as amended in 2014, allows children of any age to opt for a lethal injection provided certain criteria are met. A doctor must state that the child is “in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term.” Another doctor who is a psychiatrist must opine that the child understands what euthanasia is and is not “influenced by a third party”. Parental consent must be obtained.

These rules have been characterized as very strict (3) but they implicitly allow the two doctors and the parents to drive the process. A child can be killed if his doctor judges that he is embroiled in hopeless suffering and will die soon, the parents agree that the child would now be better off dead, and the child buys into this enough that the second doctor – who knows the judgment of the first doctor – can attest the child is acting of his own free will. (I call this the domino theory). Did something like this happen to any of the anonymous three? We just don’t know.

All the criteria are subjective. For example, what is the dividing line between a child being influenced in her decision and not being influenced? The Conversation Project in the U.S. suggests that one way to elicit a “seriously ill” child’s views on end-of-life care is to discuss heaven. (4) Will bringing up heaven when speaking about options influence a nine year old who may view heaven as Disneyworld? Might an eleven year old be influenced if she reads an article about how much it costs to treat kids like her? Would knowing that your parents would consent to euthanasia if you wanted it influence a seventeen year old? It is enough to make a psychiatrist’s head spin. What underlines a finding of constant suffering? Would a doctor ever equate the disability associated with a condition with suffering? Would suffering associated with a lack of pain management or with treatment delivered in a needlessly invasive way ever be erroneously attributed to the child’s condition rather than to a deficiency in medical practice? Until quite recently, babies were operated on without anesthesia in the United States.

Luc Proot, a member of the Belgian Commission, said in regard to each of the anonymous three, “I saw mental and physical suffering so overwhelming that I thought we did a good thing.” (5)

Some things are strange about this statement. It suggests that Proot met each of the kids. Instead, as part of his official role, he read the case file on each child after they died – case files written by the doctors involved in the euthanasias and whose identities like the identities of the children were withheld. (6)

Proot said “we did a good thing.” This seems like an acknowledgment that the children, rather than being beneficiaries of children’s rights and in charge of their destinies, were acted upon.

Lastly, there is no mention of the kids being close to death.

In Belgium, euthanasia is available to a wide swath of the adult population. To be sure, those with terminal illness can request the needle but so can people with two or more incurable conditions, neither of which is life threatening, as well as people with dementia or psychiatric disorders. In 2017 there were 375 cases of reported euthanasia of people whose deaths were not expected in the near future or 16.2% of all cases of reported euthanasia. (7)

With children though, euthanasia is supposed to be restricted to cases where death is near. There is no way to speculate on how far along the 9-year-old’s brain tumor was but there is a good chance that the 11-year-old and 17-year-old were not inevitably dying. Today, cystic fibrosis and Duchenne muscular dystrophy are chronic, disabling diseases but with proper medical management, they don’t tend to be fatal in childhood. The median life expectancy of a child born in the United States with cystic fibrosis is now 43 years and that doesn’t factor in the scientific advances that are likely to occur. (8) Guys with Duchenne often live through their 30s and sometimes into their 40s and 50s. (9) To put this into context, the average life expectancy for men and women in the United States in 1917 was 48 and 54 years respectively and this was before the great influenza epidemic where average life expectancy really plummeted. (10)

Were their special circumstances leading the doctors of the eleven-year-old and the seventeen-year-old to conclude they were both close to death? We just don’t know. Had the children had access to reasonable and empathetic care for their condition? We just don’t know. Were these instances where the doctors conflated ongoing disability with a terminal state? We just don’t know.

Parents usually want the best for their offspring but it is naïve to assume that the need for parental consent is a foolproof safeguard. Doctors are authority figures. They steer parents just as parents steer their children. When Stephen Drake was born, the doctor who injured him through improper use of forceps told his parents that the odds were 100 to 1 against him living through the night, and the odds were a million to one against him not being a “vegetable” if he did survive. Stephen has written, “The odds the doctor cited for my survival and recovery were almost certainly made up on the spot and were aimed at getting my parents to ‘accept’ my death as a good, if not clearly inevitable, thing”. (11) Fortunately for us all, his parents rejected the suggestion but there may well have been other cases where this doctor succeeded in using a speculative prognosis to convince the parents to “let nature take its course.”

In the 1980’s, the groups who opposed any legal protections for disabled infants in hospitals -mainly medical groups – argued that parental autonomy was paramount. Nevertheless, one pediatrician told me that as long as she evidenced enough concern for child and family, she could generally get parents to agree to almost anything. She felt that parental autonomy was quite often a sham.

Of course, there have been cases like the Charlie Gard case in Britain where parents have indeed wanted life sustaining care for their child and have been opposed by doctors and hospitals.

Why was parental or guardian consent given for the euthanasia of the anonymous three? We just don’t know.

In the last analysis, all that can be said about the fate of the anonymous three is what Charles Lane said in his opinion piece in the Washington Post, “the Belgian public’s support for euthanasia remains undiminished. The precedent for euthanizing children has been established, and more will almost certainly receive lethal injections this year, next year and the year after that.”(12)

As for the Baby Doe controversy, it was never resolved, just submerged. Food, water and antibiotics in hospitals have been redefined as life support and extraordinary care, depending on the circumstances.

As a young professional woman in the 1980s, I had the wind knocked out of me when I learned there was no social consensus about the right of people with disabilities to survive early childhood. I would like to say to the young people with disabilities of today, there is a resistance. Older people with disabilities are working hard to make you safe in medical settings. We will be passing the torch to you.

FOOTNOTES
  1. http://alexschadenberg.blogspot.com/2018/08/euthanasia-in-belgium-social-experiment.html?utm_source=Euthanasia+Prevention+Coalition+Contacts&utm_campaign=bc1ff5964a-EMAIL_CAMPAIGN_2018_08_31_02_01_COPY_03&utm_medium=email&utm_term=0_105a5cdd2d-bc1ff5964a-198574557
  2. https://www.washingtonpost.com/opinions/children-are-being-euthanized-in-belgium/2018/08/06/9473bac2-9988-11e8-b60b-1c897f17e185_story.html?utm_term=.0310c1b7da8d
  3. http://www.raggededgemagazine.com/0700/0700ft1.html
  4. https://www.cbsnews.com/news/child-dies-by-euthanasia-in-belgium-where-assistance-in-dying-is-legal/
  5. https://theconversationproject.org/wp-content/uploads/2017/02/ConversationProject-StarterKit-Pediatric-English.pdf
  6. https://www.washingtonpost.com/opinions/children-are-being-euthanized-in-belgium/2018/08/06/9473bac2-9988-11e8-b60b-1c897f17e185_story.html?utm_term=.0310c1b7da8d
  7. Ibid.
  8. http://alexschadenberg.blogspot.com/2018/08/euthanasia-in-belgium-social-experiment.html?utm_source=Euthanasia+Prevention+Coalition+Contacts&utm_campaign=bc1ff5964a-EMAIL_CAMPAIGN_2018_08_31_02_01_COPY_03&utm_medium=email&utm_term=0_105a5cdd2d-bc1ff5964a-198574557
  9. https://www.cff.org/CF-Community-Blog/Posts/2017/Survival-Trending-Upward-but-What-Does-This-Really-Mean/
  10. https://www.mda.org/disease/duchenne-muscular-dystrophyhttps://www.google.com/search?ei=aH2aW-S0Os-izwKWjrrYBw&q=life+expectancy+1918&oq=life+expectancy+1918&gs_l=psy-ab.3..0l2j0i22i30l8.85101.91288..96229…0.0..0.99.366.4……0….1..gws-wiz…….0i71.HU__69ZKIfI
  11. http://notdeadyet.org/2012/03/stephens_story.html
  12. https://www.washingtonpost.com/opinions/children-are-being-euthanized-in-belgium/2018/08/06/9473bac2-9988-11e8-b60b-1c897f17e185_story.html?utm_term=.0310c1b7da8d

Euthanasia Society President Charged with Murder of Disabled Man

This media release was published by Euthanasia-Free New Zealand on September 20, 2018

Media Release

Sean Davison, a New Zealand citizen who was convicted of assisted suicide in Dunedin, appeared in a South African court on Wednesday on a murder charge.

The charge is in relation to the death of Anrich Burger, 53, who became a quadriplegic after a motor vehicle accident in 2005. He was not terminally ill.

In 2014 the accused told News24 how he helped Mr Burger, a close friend of his, end his life with lethal drugs in November the previous year. 

Mr Burger’s fiancé was not present nor informed of the plan, since she did not support assisted suicide or euthanasia.

After pleading not guilty, Mr Davison was released on R20,000 (about NZ $2,050) bail. He is scheduled to appear in Court again on 16 November.

The State alleges that the murder was premeditated and that new information suggests that the accused may have committed other similar offences.

In 2011 Mr Davison was sentenced to five months’ house arrest in Dunedin after pleading guilty to counselling and procuring his mother’s suicide.

Mr Davison, 57, is the president of the World Federation of Right to Die Societies, the international organisation of which the New Zealand End of Life Choice Society (formerly the Voluntary Euthanasia Society), is a member.

“Not all quadriplegics want to die, but those who do want to, should have the option,” said Mr Davidson after his speech at the Federation’s Conference in 2014.

On its website the Federation supports euthanasia and assisted suicide for “all competent adults with incurable illnesses” – not only those with terminal illnesses and six months to live.

“Mr Davison’s words and actions demonstrate that ‘assisted dying’ advocates don’t really want a narrow law limited to terminal illness, but one that would eventually allow virtually any competent adult with an incurable condition to be eligible, including people with disabilities,” says Renée Joubert, Executive Officer of Euthanasia-Free NZ.

The End of Life Choice Bill, which is currently before the New Zealand Parliament’s Justice Committee, proposes legal assisted suicide and euthanasia for people with terminal illnesses or other “grievous and irremediable medical conditions.”

“Disabled people would be included under both clauses of David Seymour’s Bill,” says Ms Joubert. “Terminal illness involves disability. So do many other longstanding physical and mental conditions.”

ENDS

Australian man charged with assisting his wife's suicide, her friend said she didn't want to die.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Jennifer Morant
Two days ago I reported that Graham Robert Morant was charged with assisting the suicide of his wife, Jennifer Morant, in Australia, to receive 1.4 million dollars in Life Insurance.
Yesterday I reported that Morant told the court that he was innocent.
Today, the best friend of Jennifer Morant, said that Jennifer didn't want to die, but she expressed that her only hope was to win the lottery. 9News.com reported:
"(She said) I'm afraid and I really don't want to do it," Ms Morant's friend Johanna Cornelia Dent testified in Brisbane Supreme Court on Wednesday. 
"But I made so many promises to everybody that the only way out would be to win lotto.
Morant allegedly assisted the suicide of his wife because she had 1.4 million dollars in Life Insurance that he wanted to use to purchase a property for a religious commune. According to 9News.com Dent told the court:
Ms Dent said Ms Morant stayed with her the week before she died and when she returned home, she had a "deal with Graham" to end her life. 
"If I hadn't come down here to see you, I would have already been dead," Ms Morant allegedly said. 
When Ms Dent asked her how she would do it, she claims she responded: "Don't worry, darling. I won't feel any pain. Graham says he knows a way I can do it." 
Under cross-examination, Ms Dent said she did not call the police about Morant because Jennifer eventually told her she would not go through with it.
The court case continues tomorrow.

Wednesday, September 19, 2018

Australian man denies assisting his wife's suicide for 1.4 million dollars.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Yesterday I reported that Graham Robert Morant was charged with assisting the suicide of his wife, Jennifer Morant, in Australia, to receive 1.4 million dollars in Life Insurance.

Jennifer Morant
According to a report by Warren Beansley for News.com Morant denied assisting the suicide of his wife Jennifer. Morant told the court that:

Morant claimed he found a suicide note after coming home one night in November 2014. 
The note explained Jennifer didn’t want to be a burden on anyone, especially her husband, and it would not be fair on him to care for her “24 hours a day”. 
Morant said she tried to kill herself at least twice previously, the prosecution says.
The Lynette Lucas, the sister of Jennifer Morant told the court that Morant wanted the money to buy a property to establish a religious commune and her sister feared for her life. According to the report for News.com:
Morant wanted to buy a property in the Gold Coast hinterland with Jennifer’s life insurance, worth $1.4 million, to start a religious commune to prepare for biblical rapture, Ms Lucas testified. 
“Jenny was horrified that he had all these plans. She said she didn’t want to be part of the communal environment.” 
Ms Lucas told the court her sister was “fearful for her life”. 
“(I told her) your life’s in danger with these (life insurance) policies,” she said.
Dean Wells, the lawyer for Graham Morant stated:
“I suggest to you Graham is more innocent than anybody you will hear giving evidence against him,” Mr Wells said. 
“Truth is stranger than fiction. There are ... more subplots in this particular case than you will ever see in any courtroom drama on television.”
The case continues in court.

Euthanasia activist charged with murder of disabled man in South Africa.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition.



Sean Davison, the euthanasia activist who arrested in 2010 for assisting the suicide of his mother in New Zealand. In September 2011 Davidson agreed to a plea bargain when he pled guilty to the assisted suicide of his mother and was sentenced to 5 months of house arrest.

Davison was arrested in the alleged murder of 43-year-old Dr Anrich Burger who became a quadriplegic following a car accident. IOL news reported that Davidson was charged with murder in Cape Town and released on R20 000 in bail and will return to court on November 16.

IOL news also reported that Davison may have been involved with other similar deaths:

“There was a search warrant with the Hawks involved and his laptop and cellphone were seized and he is expected to appear at the Cape Town Magistrate's Court this morning to hear on possible bail.” 
NPA spokesman Eric Ntabazalila said outside the court on Wednesday that from information obtained from the search and seizure it came to light that Davison may have committed other similar offences.
Davison has been a known euthanasia activist since he was arrested in 2010 in the death of his mother. In 2014 Davidson told the media that he would not assist in euthanasia again  while commenting on his involvement in the death of Anrich Burger. 

Davison allegedly assisted the death of Burger, not because he was terminally ill, but because he was disabled.

Tuesday, September 18, 2018

Netherlands euthanasia clinic data


Dr Mark Komrad shared the following information about the Levenseindekliniek (euthanasia clinic) in the Netherlands. It is important to note that most of the euthanasia deaths for psychiatric reasons are done at the euthanasia clinic. There are also euthanasia clinics in Belgium and Canada.

1. The Levenseindekliniek is located in the Hague. They have 55-60 physician teams who travel the country doing euthanasia—in patients’ homes.

2. The Levenseindekliniek was a private initiative by the euthanasia lobby. Theo Boer, a past member of a regional euthanasia review committee noted that “Establishing of the End of Life Clinics came fully out of the blue [originally predicted to “no longer be needed by 2018"] and has now become a necessity."

3. The doctor is ALWAYS new to the patient. These physicians are not part of a patient’s established treatment team for their condition.

4. Circumventing the treating doctors by consulting a Levenseindekliniek doctor for euthanasia evaluation (and possibly completion) is a typical scenario.

5. Approximately 750 people were euthanized at the Levenseindekliniek in 2017.

6. 77% of all psychiatric euthanasias in the Netherlands occurred via the Levenseindekiniek network in 2016. This is the predominant approach to euthanizing psychiatric patients in The Netherlands. There were 6585 reported euthanasia deaths in the Netherlands in 2017 with 11.4% of these deaths done through this peripatetic euthanasia service. Most of the euthanasia deaths are done by family physicians who are treating the patient, according to the Royal Dutch Medical Association.

Australian man had 1.4 million reasons to assist the suicide of his wife.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Jennifer Morant
The Supreme Court in Brisbane Australia is hearing the case of Graham Robert Morant (69) who has been charged for assisting the suicide of his wife Jennifer Morant (58) in 2014.

According to prosecutors, Morant encouraged and assisted his wife Jennifer, to die by suicide, in return he received 1.4 million dollars in Life Insurance. ABC News reporter MelanieVujkovic wrote:

Prosecutor Michael Lehane said the jury would hear from a number of witnesses, including Mrs Morant's sister and closest friends who would testify that he encouraged his wife to end her life, and assisted her to gas herself in her car in November 2014 by helping her buy the petrol generator.

Prosecutor Lehane said Mr Morant initially told police in his interview that he had no involvement whatsoever in his wife's suicide, but when officers questioned him about how a woman with back pain could purchase a generator from Bunnings, his story changed.

"Slowly, very slowly over the course of the next hour the accused explained he did assist his wife in her suicide," he said.

The court heard Mr Morant claimed he did not know the details of three life insurance policies Mrs Morant had taken out to the value of $1.4 million, which named him as the sole beneficiary and would be paid out even in the event of suicide. 
The document claimed Mrs Morant had been diagnosed with a terminal illness, but Mr Lehane said her general practitioner would testify during the trial that she was not fatally sick.
The ABC news article reported that the sister of Jennifer Morant stated that Jennifer wanted to leave her husband and that it was all about money for her him. The article stated:
She (her sister) said Mrs Morant expressed serious concerns for her safety, that her life was in danger and her husband openly spoke about what he would do with the money when she died.

"She said Graham had encouraged her to take them [insurance policies] out," Ms Lucas told the court.

"Jenny said, 'he was trying to encourage me to kill myself'."
The defense attorney told the jury, in a short statement, to keep an open mind. he said that in this case the truth is stranger than fiction.

The case will continue.

Monday, September 17, 2018

Leo Alexander: Medical Science Under Dictatorship.

Republished from the CHN Network website.

Commentary by Cheryl Eckstein who directed the Compassionate Healthcare Network.

In July of 1949, The New England Journal of Medicine printed an article by Dr. Leo Alexander titled: Medical Science Under Dictatorship. Dr. Alexander acted as consultant to the Secretary of war, and the Chief of Counsel for War Crimes held in Nuremberg Germany.

The paper is considered a classic, justifiably earning the highest respect through the decades since its publication. In it, Dr. Alexander explains what happens to medicine when it "becomes subordinated to the guiding philosophy of the dictatorship." That philosophy is Hegelian, or "rational utility" which Alexander said "replaced moral, ethical and religious values."

What motivated physicians to judge that there is "such a thing as life not worthy to be lived."

Leo Alexander (standing)
How did such attitudes entice the healer to become killer?

Alexander said the crimes "started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived."

The physicians were not repulsed by this new attitude, nor did they survey the oiled slope. The theory was about to be put into practice. But first they had to take care of a few minor details, as for instance, the Hippocratic Oath. They would have to reject the ethics outlined in the over 2,000 year old vow.

They rejected the "non-rehabilitable sick", the "socially unwanted", the "unproductive" the unlovely and unlovable. Seduced by so-called "Hegelian rational", physicians veered unblushingly from noble physician to ignoble technicians. Dr. Alexander introduced a new term for destroyers of life, calling the science of killing, "ktenology".

In "The Example of Successful Resistance by the Physicians of the Netherlands." It was in this particular segment that Dr. Alexander applauded the small country for having such a large and brave heart. It was the Dutch physicians who risked their lives by standing firm against a dictatorship that threatened to change the practice of medicine forever. Considering the present situation in Holland, one might find the information contained, unbelievable.



Medical Science Under Dictatorship by DR. LEO ALEXANDER

Science under dictatorship becomes subordinated to the guiding philosophy of the dictatorship. Irrespective of other ideologic trappings, the guiding philosophic principle of recent dictatorships, including that of the Nazis, has been Hegelian in that what has been considered "rational utility" and corresponding doctrine and planning has replaced moral, ethical and religious values. Nazi propaganda was highly effective in perverting public opinion and public conscience, in a remarkably short time. In the medical profession this expressed itself in a rapid decline in standards of professional ethics. Medical science in Nazi Germany collaborated with this Hegelian trend particularly in the following enterprises: the mass extermination of the chronically sick in the interest of saving "useless" expenses to the community as a whole; the mass extermination of those considered socially disturbing or racially and ideologically unwanted; the individual, inconspicuous extermination of those considered disloyal within the ruling group; and the ruthless use of "human experimental material" for medico-military research.

This paper discusses the origins of these activities, as well as their consequences upon the body social, and the motivation of those participating in them.

Preparatory Propaganda

Even before the Nazis took open charge in Germany, a propaganda barrage was directed against the traditional compassionate nineteenth-century attitudes toward the chronically ill, and for the adoption of a utilitarian, Hegelian point of view. Sterilization and euthanasia of persons with chronic mental illnesses was discussed at a meeting of Bavarian psychiatrists in 1931.[1] By 1936 extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an article published in an official German medical journal.[2]

Lay opinion was not neglected in this campaign. Adults were propagandized by motion pictures, one of which, entitled "I Accuse," deals entirely with euthanasia. This film depicts the life history of a woman suffering from multiple sclerosis; in it her husband, a doctor, finally kills her to the accompaniment of soft piano music rendered by a sympathetic colleague in an adjoining room. Acceptance of this ideology was implanted even in the children. A widely used high-school mathematics text, "Mathematics in the Service of National Political Education,"[3] includes problems stated in distorted terms of the cost of caring for and rehabilitating the chronically sick and crippled, the criminal and the insane."

Euthanasia

The first direct order for euthanasia was issued by Hitler on September 1, 1939, and an organization was set up to execute the program. Dr. Karl Brandt headed the medical section, and Phillip Bouhler the administrative section. All state institutions were required to report on patients who had been ill five years or more and who were unable to work, by filling out questionnaires giving name, race, marital status, nationality, next of kin, whether regularly visited and by whom, who bore financial responsibility and so forth. The decision regarding which patients should be killed was made entirely on the basis of this brief information by expert consultants, most of whom were professors of psychiatry in the key universities. These consultants never saw the patients themselves. The thoroughness of their scrutiny can be appraised by the work of on expert, who between November 14 and December 1, 1940, evaluated 2109 questionnaires.

These questionnaires were collected by a "Realm's Work Committee of Institutions for Cure and Care."[4] A parallel organization devoted exclusively to the killing of children was known by the similarly euphemistic name of "Realm's Committee for Scientific Approach to Severe Illness Due to Heredity and Constitution." The "Charitable Transport Company for the Sick" transported patients to the killing centers, and the "Charitable Foundation for Institutional Care" was in charge of collecting the cost of the killings from the relatives, without, however, informing them what the charges were for; in the death certificates the cause of death was falsified.

What these activities meant to the population at large was well expressed by a few hardy souls who dared to protest. A member of the court of appeals at Frankfurt-am-Main wrote in December, 1939:

There is constant discussion of the question of the destruction of socially unfit life—in the places where there are mental institutions, in neighboring towns, sometimes over a large area, throughout the Rhineland, for example. The people have come to recognize the vehicles in which the patients are taken from their original institution to the intermediate institution and from there to the liquidation institution. I am told that when they see these buses even the children call out: "They're taking some more people to be gassed." From Limburg it is reported that every day from one to three buses which shades drawn pass through on the way from Weilmunster to Hadmar, delivering inmates to the liquidation institution there. According to the stories the arrivals are immediately stripped to the skin, dressed in paper shirts, and forthwith taken to a gas chamber, where they are liquidated with hydro-cyanic acid gas and an added anesthetic. The bodies are reported to be moved to a combustion chamber by means of a conveyor belt, six bodies to a furnace. The resulting ashes are then distributed into six urns which are shipped to the families. The heavy smoke from the crematory building is said to be visible over Hadamar every day. There is talk, furthermore, that in some cases heads and other portions of the body are removed for anatomical examination. The people working at this liquidation job in the institutions are said to be assigned from other areas and are shunned completely by the populace. This personnel is described as frequenting the bars at night and drinking heavily. Quite apart from these overt incidents that exercise the imagination of the people, they are disquieted by the question of whether old folk who have worked hard all their lives and may merely have come into their dotage are also being liquidated. There is talk that the homes for the aged are to be cleaned out too. The people are said to be waiting for legislative regulation providing some orderly method that will insure especially that the aged feeble-minded are not included in the program.
Here one sees what "euthanasia" means in actual practice. According to the records, 275,000 people were put to death in these killing centers. Ghastly as this seems, it should be realized that this program was merely the entering wedge for exterminations for far greater scope in the political program for genocide of conquered nations and the racially unwanted. The methods used and personnel trained in the killing centers for the chronically sick became the nucleus of the much larger centers on the East, where the plan was to kill all Jews and Poles and to cut down the Russian population by 30,000,000.

The original program developed by Nazi hot-heads included also the genocide of the English, with the provision that the English males were to be used as laborers in the vacated territories in the East, there to be worked to death, whereas the English females were to be brought into Germany to improve the qualities of the German race. (This was indeed a peculiar admission of the part of the German eugenicists.)

In Germany the exterminations included the mentally defective, psychotics (particularly schizophrenics), epileptics and patients suffering from infirmities of old age and from various organic neurological disorders such as infantile paralysis, Parkinsonism, multiple sclerosis and brain tumors. The technical arrangements, methods and training of the killer personnel were under the direction of a committee of physicians and other experts headed by Dr. Karl Brandt. The mass killings were first carried out with carbon monoxide gas, but later cyanide gas ("cyclon B") was found to be more effective. The idea of camouflaging the gas chambers as shower baths was developed by Brack, who testified before Judge Sebring that the patients walked in calmly, deposited their towels and stood with their little pieces of soap under the shower outlets, waiting for the water to start running. This statement was ample rebuttal of his claim that only the most severely regressed patients among the mentally sick and only the moribund ones among the physically sick were exterminated. In truth, all those unable to work and considered non-rehabilitable were killed.

All but their squeal was utilized. However, the program grew so big that even scientists who hoped to benefit from the treasure of material supplied by this totalitarian method were disappointed. A neuropathologist, Dr. Hallervorden, who had obtained 500 brains from the killing centers for the insane, gave me a vivid first-hand account.[5] The Charitable Transport Company for the Sick brought the brains in batches of 150 to 250 at a time. Hallervorden stated:

There was wonderful material among those brains, beautiful mental defectives, malformations and early infantile diseases. I accepted those brains of course. Where they came from and how they came to me was really none of my business.
In addition to the material he wanted, all kinds of other cases were mixed in, such as patients suffering from various types of Parkinsonism, simple depressions, involutional depressions and brain tumors, and all kinds of other illnesses, including psychopathy that had been difficult to handle:
These were selected from the various wards of the institutions according to an excessively simple and quick method. Most institutions did not have enough physicians, and what physicians there were either too busy or did not care, and they delegated the selection to the nurses and attendants. Whoever looked sick or was otherwise a problem was put on a list and was transported to the killing center. The worst thing about this business was that it produced a certain brutalization of the nursing personnel. They got to simply picking out those whom they did not like, and the doctors had so many patients that they did not even know them, and put their names on the list.
Of the patients thus killed, only the brains were sent to Dr. Hallervorden; they were killed in such large numbers that autopsies of the bodies were not feasible. That, in Dr. Hallervorden's opinion, greatly reduced the scientific value of the material. The brains, however, were always well fixed and suspended in formalin, exactly according to his instructions. He thinks that the cause of psychiatry was permanently injured by these activities, and that psychiatrists have lost the respect of the German people forever. Dr. Hallervorden concluded: "Still, there were interesting cases in this material."

In general only previously hospitalized patients were exterminated for reasons of illness. An exception is a program carried out in a northwestern district of Poland, the "Warthegau," where a health survey of the entire population was made by an "S.S. X-Ray Battalion" headed by Professor Hohlfelder, radiologist of the University of Frankfurt-am-main. Persons found to be infected with tuberculosis were carted off to special extermination centers.

It is rather significant that the German people were considered by their Nazi leaders more ready to accept the exterminations of the sick than those for political reasons. It was for that reason that the first exterminations of the latter group were carried out under the guise of sickness. So-called "psychiatric experts" were dispatched to survey the inmates of camps with the specific order to pick out members of racial minorities and political offenders from occupied territories and to dispatch them to killing centers with specially made diagnoses such as that of "inveterate German hater" applied to a number of prisoners who had been active in the Czech underground.

Certain classes of patients with mental diseases who were capable of performing labor, particularly members of the armed forces suffering from psychopathy or neurosis, were sent to concentration camps to be worked to death, or to be reassigned to punishment battalions and to be exterminated in the process of removal of mine fields.[6]

A large number of those marked for death for political or racial reasons were made available for "medical" experiments involving the use of involuntary human subjects. From 1942 on, such experiments carried out in concentration camps were openly presented at medical meetings. This program included "terminal human experiments," a term introduced by Dr. Rascher to denote an experiment so designed that its successful conclusion depended upon the test person's being put to death.

The Science of Annihilation

A large part of this research was devoted to the science of destroying and preventing life, for which I have proposed the term "ktenology," the science of killing.[7-9] In the course of this ktenologic research, methods of mass killing and mass sterilization were investigated and developed for use against non-German peoples or Germans who were considered useless.

Sterilization methods were widely investigated, but proved impractical in experiments conducted in concentration camps. A rapid method developed for sterilization of females, which could be accomplished in the course of a regular health examination, was the intra-uterine injection of various chemicals. Numerous mixtures were tried, some with iodopine and others containing barium; another was most likely silver nitrate with iodized oil, because the result could be ascertained by x-ray examination. The injections were extremely painful, and a number of women died in the course of the experiments. Professor Karl Clauberg reported that he had developed a method at the Auschwitz concentration camp by which he could sterilize 1000 women in one day.

Another method of sterilization, or rather castration, was proposed by Viktor Brack especially for conquered populations. His idea was that x-ray machinery could be built into desks at which the people would have to sit, ostensibly to fill out a questionnaire requiring five minutes; they would be sterilized without being aware of it. This method failed because experiments carried out on 100 male prisoners brought out the fact that severe x-ray burns were produced on all subjects. In the course of this research, which was carried out by Dr. Horst Schuman, the testicles of the victims were removed for histologic examination two weeks later. I myself examined 4 castrated survivors of this ghastly experiment. Three had extensive necrosis of the skin near the genitalia, and the other an extensive necrosis of the urethra. Other experiments in sterilization used an extract of the plant caladium seguinum, which had been shown in animal studies by Madaus and his co-workers[10,11] to cause selective necrosis of the germinal cells of the testicles as well as the ovary.

The development of methods for rapid and inconspicuous individual execution was the objective of another large part of the ktenologic research. These methods were to be applied to members of the ruling group, including the SS itself, who were suspected of disloyalty. This, of course, is an essential requirement in a dictatorship, in which "cut-throat competition" becomes a grim reality, and any hint of faintheartedness or lack of enthusiasm for the methods of totalitarian rule is considered a threat to the entire group.

Poisons were the subject of many of these experiments. A research team at the Buchenwald concentration camp, consisting of Drs. Joachim Mrugowsky, Erwin Ding-Schuler and Waldemar Hoven, developed the most widely used means of individual execution under the guise of medical treatment—namely, the intravenous injection of phenol or gasoline. Several alkaloids were also investigated, among them aconitine, which was used by Dr. Hoven to kill several imprisoned former fellow SS men who were potential witnesses against the camp commander, Koch, then under investigation by the SS. At the Dachau concentration camp Dr. Rascher developed the standard cyanide capsules, which could be easily bitten through, either deliberately or accidentally, if mixed with certain foods, and which, ironically enough, later became the means with which Himmler and Goering killed themselves. In connection with these poison experiments there is an interesting incident of characteristic sociologic significance. When Dr. Hoven was under trial by the SS the investigating SS judge, Dr. Morgen, proved Hoven's guilt by feeding the poison found in Dr. Hoven's possession to a number of Russian prisoners of war; these men died with the same symptoms as the SS men murdered by Dr. Hoven. This worthy judge was rather proud of this efficient method of proving Dr. Hoven's guilt and appeared entirely unaware of the fact that in the process he had committed murder himself.

Poisons, however, proved too obvious or detectable to be used for the elimination of high-ranking Nazi party personnel who had come into disfavor, or of prominent prisoners whose deaths should appear to stem from natural causes. Phenol or gasoline, for instance, left a telltale odor with the corpses. For this reason a number of more subtle methods were devised. One of these was artificial production of septicemia. An intramuscular injection of 1 cc. of pus, containing numerous chains of streptococci, was the first step. The site of injection was usually the inside of the thigh, close to the adductor canal. When an abscess formed it was tapped, and 3 cc. of the creamey pus removed was injected intravenously into the patient's opposite arm. If the patient then died from septicemia, the autopsy proved that death was caused by the same organism that had caused the abscess. These experiments were carried out in many concentration camps. At Dachau camp the subjects were almost exclusively Polish Catholic priests. However, since this method did not always cause death, sometimes resulting merely in a local abscess, it was considered inefficient, and research was continued with other means but along the same lines.

The final triumph of the part of ktenologic research aimed at finding a method of inconspicuous execution that would produce autopsy findings indicative of death from natural causes was the development of repeated intravenous injections of suspensions of live tubercle bacilli, which brought on acute miliary tuberculosis within a few weeks. This method was produced by Professor Dr. Heissmeyer, who was one of Dr. Gebhardt's associates at the SS hospital of Hohenlychen. As a means of further camouflage, so that the SS at large would not suspect the purpose of these experiments, the preliminary tests for the efficacy of this method were performed exclusively on children imprisoned in the Neuengamme concentration camp.

For use in "medical" executions of prisoners and of members of the SS and other branches of the German armed forces the use of simple lethal injections, particularly phenol injections, remained the instrument of choice. Whatever methods he used, the physician gradually became the unofficial executioner, for the sake of convenience, informality and relative secrecy. Even on German submarines it was the physician's duty to execute the troublemakers among the crew by lethal injections.

Medical science has for some time been an instrument of military power in that it preserved the health and fighting efficiency of troops. This essentially defensive purpose is not inconsistent with the ethical principles of medicine. In World War I the German empire had enlisted medical science as an instrument of aggressive military power by putting it to use in the development of gas warfare. It was left to the Nazi dictatorship to make medical science into an instrument of political power—a formidable, essential tool in the complete and effective manipulation of totalitarian control. This should be a warning to all civilized nations, and particularly to individuals who are blinded by the "efficiency" of a totalitarian rule, under whatever name.

This entire body of research as reported so far served the master crime to which the Nazi dictatorship was committed—namely, the genocide of non-German peoples and the elimination by killing, in groups or singly, of Germans who were considered useless or disloyal. In effecting the two parts of this program, Himmler demanded and received the co-operation of physicians and of German medical science. The result was a significant advance in the science of killing, or ktenology.

Medico-military Research

Another chapter in Nazi scientific research was that aimed to aid the military forces. Many of these ideas originated with Himmler, who fancied himself a scientist.

When Himmler learned that the cause of death of most SS men on the battlefield was hemorrhage, he instructed Dr. Sigmund Rascher to search for a blood coagulant that might be given before the men went into action. Rascher tested this coagulant when it was developed by clocking the number of drops emanating from freshly cut amputation stumps of living and conscious prisoners at the crematorium of Dachau concentration camp and by shooting Russian prisoners of war through the spleen.

Live dissections were a feature of another experimental study designed to show the effects of explosive decompression.[12-14] A mobile decompression chamber was used. It was found that when subjects were made to descend from altitudes of 40,000 to 60,000 feet without oxygen, severe symptoms of cerebral dysfunction occurred—at first convulsions, then unconsciousness in which the body was hanging limp and later, after wakening, temporary blindness, paralysis or severe confusional twilight states. Rascher, who wanted to find out whether these symptoms were due to anoxic changes or to other causes, did what appeared to him the most simple thing: he placed the subjects of the experiment under water and dissected them while the heart was still beating, demonstrating air embolism in the blood vessels of the heart, liver, chest wall and brain.

Another part of Dr. Rascher's research, carried out in collaboration with Holzlochner and Finke, concerned shock from exposure to cold.[15] It was known that military personnel generally did not survive immersion in the North Sea for more than sixty to a hundred minutes. Rascher therefore attempted to duplicate these conditions at Dachau concentration camp and used about 300 prisoners in experiments on shock from exposure to cold; of these 80 or 90 were killed. (The figures do not include persons killed during mass experiments on exposure to cold outdoors.) In one report on this work Rascher asked permission to shift these experiments from Dachau to Auschwitz, a larger camp where they might cause less disturbance because the subjects shrieked from pain when their extremities froze white. The results, like so many of those obtained in the Nazi research program, are not dependable. In his report Rascher stated that it took from fifty-three to a hundred minutes to kill a human being by immersion in ice water—a time closely in agreement with the known survival period in the North Sea. Inspection of his own experimental records and statements made to me by his close associates showed that it actually took from eighty minutes to five or six hours to kill an undressed person in such a manner, whereas a man in full aviator's dress took six or seven hours to kill. Obviously, Rascher dressed up his findings to forestall criticism, although any scientific man should have known that during actual exposure many other factors, including greater convection of heat due to the motion of water, would affect the time of survival.

Another series of experiments gave results that might have been an important medical contribution if an important lead had not been ignored. The efficacy of various vaccines and drugs against typhus was tested at the Buchenwald and Natzweiler concentration camps. Prevaccinated persons and nonvaccinated controls were injected with live typhus rickettsias, and the death rates of the two series compared. After a certain number of passages, the Matelska strain of typhus rickettsia proved to become avirulent for man. Instead of seizing upon this as a possibility to develop a live vaccine, the experimenters, including the chief consultant, Professor Gerhard Rose, who should have known better, were merely annoyed at the fact that the controls did not die either, discarded this strain and continued testing their relatively ineffective dead vaccines against a new virulent strain. This incident shows that the basic unconscious motivation and attitude has a great influence in determining the scientist's awareness of the phenomena that pass through his vision.

Sometimes human subjects were used for tests that were totally unnecessary, or whose results could have been predicted by simple chemical experiments. For example, 90 gypsies were given unaltered sea water and sea water whose taste was camouflaged as their sole source of fluid, apparently to test the well known fact that such hypertonic saline solutions given as the only source of supply of fluid will cause severe physical disturbance or death within six to twelve days. These persons were subjected to the tortures of the damned, with death resulting in at least 2 cases.

Heteroplastic transplantation experiments were carried out by Professor Dr. Karl Gebhardt at Himmler's suggestion. Whole limbs— shoulder, arm or leg—were amputated from live prisoners at Ravensbrucck concentration camp, wrapped in sterile moist dressings and sent by automobile to the SS hospital at Hohenlychen, where Professor Gebhardt busied himself with a futile attempt at heteroplastic transplantation. In the meantime the prisoners deprived of limb were usually killed by lethal injection.

One would not be dealing with German science if one did not run into manifestations of the collector's spirit. By February, 1942, it was assumed in German scientific circles that the Jewish race was about to be completely exterminated, and alarm was expressed over the fact that only very few specimens of skulls and skeletons of Jews were at the disposal of science. It was therefore proposed that a collection 150 body casts and skeletons of Jews be preserved for perusal by future students of anthropology. Dr. August Hirt, professor of anatomy at the University of Strassburg, declared himself interested in establishing such a collection at his anatomic institute. He suggested that captured Jewish officers of the Russian armed forces by included, as well as females from Auschwitz concentration camp; that they be brought alive to Natzweiler concentration camp near Strassburg; and that after "their subsequently induced death—care should be taken that the heads not be damaged [sic]" the bodies be turned over to him at the anatomic institute of the University of Strassburg. This was done. The entire collection of bodies and the correspondence pertaining to it fell into the hands of the United States Army.

One of the most revolting experiments was the testing of sulfonamides against gas gangrene by Professor Gebhardt and his collaborators, for which young women captured from the Polish Resistance Movement served as subjects. Necrosis was produced in a muscle of the leg by ligation and the wound was infected with various types of gas-gangrene bacilli; frequently, dirt, pieces of wood and glass splinters were added to the wound. Some of these victims died, and others sustained severe mutilating deformities of the leg.

Motivation

An important feature of the experiments performed in concentration camps is the fact that they not only represented a ruthless and callous pursuit of legitimate scientific goals but also were motivated by rather sinister practical ulterior political and personal purposes, arising out of the requirements and problems of the administration of totalitarian rule.

Why did men like Professor Gebhardt lend themselves to such experiments? The reasons are fairly simple and practical, no surprise to anyone familiar with the evidence of fear, hostility, suspicion, rivalry and intrigue, the fratricidal struggle euphemistically termed the "self-selection of leaders," that went on within the ranks of the ruling Nazi party and the SS. The answer was fairly simple and logical. Dr. Gebhardt performed these experiments to clear himself of the suspicion that he had been contributing to the death of SS General Reinhard ("The Hangman") Heydrich, either negligently or deliberately, by failing to treat his wound infection with sulfonamides. After Heydrich died from gas gangrene, Himmler himself told Dr. Gebhardt that the only way in which he could prove that Heydrich's death was "fate-determined" was by carrying out a "large-scale experiment" in prisoners, which would prove or disprove that people died from gas gangrene irrespective of whether they were treated sulfonamides or not.

Dr. Sigmund Rascher did not become the notorious vivisectionist of Dachau concentration camp and the willing tool of Himmler's research interests until he had been forbidden to use the facilities of the Pathological Institute of the University of Munich because he was suspected of having Communist sympathies. Then he was ready to go all out and to do anything merely to regain acceptance by the Nazi party and the SS.

These cases illustrate a method consciously and methodically used in the SS, an age-old method used by criminal gangs everywhere: that of making suspects of disloyalty clear themselves by participation in a crime that would definitely and irrevocably tie them to the organization. In the SS this process of reinforcement of group cohesion was called "Blukitt" (blood-cement), a term that Hitler himself is said to have obtained from a book on Genghis Khan in which this technic was emphasized.

The important lesson here is that this motivation, with which one is familiar in ordinary crimes, applies also to war crimes and to ideologically conditioned crimes against humanity—namely, that fear and cowardice, especially fear of punishment or of ostracism by the group, are often more important motives than simple ferocity or aggressiveness.

The Early Change in Medical Attitudes

Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.

It is, therefore, this subtle shift in emphasis of the physicians' attitude that one must thoroughly investigate. It is a recent significant trend in medicine, including psychiatry, to regard prevention as more important than cure. Observation and recognition of early signs and symptoms have become the basis for prevention of further advance of disease.[8]

In looking for these early signs one may well retrace the early steps of propaganda on the part of the Nazis in Germany as well as in the countries that they overran and in which they attempted to gain supporters by means of indoctrination, seduction and propaganda.

The Example of Successful Resistance by the Physicians of the Netherlands.

There is no doubt that in Germany itself the first and most effective step of propaganda within the medical profession was the propaganda barrage against the useless, incurably sick described above. Similar, even more subtle efforts were made in some of the occupied countries. It is to the everlasting honour of the medical profession of Holland that they recognized the earliest and most subtle phases of this attempt and rejected it. When the Seiss-Inquart, Reich Commissar for the Occupied Netherlands Territories, wanted to draw the Dutch physicians into the orbit of the activities of the German medical profession, he did not tell them "You must send your chronic patients to death factories at Government request in your offices," but he couched his order in most careful and superficially acceptable terms. One of the paragraphs in the order of the Reich Commissar of the Netherlands Territories concerning the Netherlands doctors of 19 December 1941 reads as follow:

It is the duty of the doctor, through advice and effort conscientiously and to his best ability to assist as helper the person entrusted to his care in the maintenance, improvement and re-establishment of his vitality, physical efficiency and health. The accomplishment of this duty is a public task.
The physicians of Holland rejected this order unanimously because they saw what it actually meant - namely, the concentration of their efforts on mere rehabilitation of the sick for useful labour, and abolition of medical secrecy. Although on the surface the new order appeared not too grossly unacceptable, the Dutch physicians decided that it is the first although slight, step away from principle that is the most important one. The Dutch physicians declared that they would not obey this order. When Seiss-Inquart threatened them with revocation of their licenses, they returned their licenses, removed their shingles and, while seeing their own patients secretly, no longer wrote death or birth certificates. Seiss-Inquart retraced his steps and tried to cajole them - still to no effect. Then he arrested 100 Dutch physicians and sent them to concentration camps.

The medical profession remained adamant and quietly took care of their widows and orphans, but would not give in. Thus it came about that not a single euthanasia or non therapeutic sterilization was recommended or participated in by any Dutch physician. They had the foresight to resist before the first step was taken, and they acted unanimously and won out in the end.

It is obvious that if the medical profession of a small nation under the conqueror's heel could resist so effectively the German medical profession could likewise have resisted had they not taken the fatal first step.

It is the first seemingly innocent step away from principle that frequently decides a career of crime. Corrosion begins in microscopic proportions.

The Situation in the United States

The question that this fact prompts is whether there are any danger signs that American physicians have also been infected with Hegelian, cold-blooded, utilitarian philosophy and whether early traces of it can be detected in their medical thinking that may make them vulnerable to departures of the type that occurred in Germany. Basic attitudes must be examined dispassionately. The original concept of medicine and nursing was not based on any rational or feasible likelihood that they could actually cure and restore but rather on an essentially maternal or religious idea. The Good Samaritan had no thought of nor did he actually care whether he could restore working capacity. He was merely motivated by the compassion in alleviating suffering. Bernal[17] states that prior to the advent of scientific medicine, the physician's main function was to give hope to the patient and to relieve his relatives of responsibility. Gradually, in all civilized countries, medicine has moved away from this position, strangely enough in direct proportion to man's actual ability to perform feats that would have been plain miracles in days of old. However, with this increased efficiency based on scientific development went a subtle change in attitude. Physicians have become dangerously close to being mere technicians of rehabilitation. This essentially Hegelian rational attitude has led them to make certain distinctions in the handling of acute and chronic diseases. The patient with the latter carries an obvious stigma as the one less likely to be fully rehabilitable for social usefulness. In an increasingly utilitarian society these patients are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated with present knowledge has developed. This is probably due to a good deal of unconscious hostility, because these people for whom there seem to be no effective remedies have become a threat to newly acquired delusions of omnipotence.

Hospitals like to limit themselves to the care of patients who can be fully rehabilitated, and the patient whose full rehabilitation is unlikely finds himself, at least in the best and most advanced centers of healing, as a second-class patient faced with a reluctance on the part of both the visiting and the house staff to suggest and apply therapeutic procedures that are not likely to bring about immediately striking results in terms of recovery. I wish to emphasize that this point of view did not arise primarily within the medical profession, which has always been outstanding in a highly competitive economic society for giving freely and unstintingly of its time and efforts, but was imposed by the shortage of funds available, both private and public. From the attitude of easing patients with chronic diseases away from the doors of the best types of treatment facilities available to the actual dispatching of such patients to killing centers is a long but nevertheless logical step. Resources for the so-called incurable patient have recently become practically unavailable.

There has never in history been a shortage of money for the development and manufacture of weapons of war; there is and should be none now. The disproportion of monetary support for war and that available for healing and care is an anachronism in an era that has been described as the "enlightened age of the common man" by some observers. The comparable cost of jet planes and hospital beds is too obvious for any excuse to be found for a shortage of the latter. I trust that these remarks will not be misunderstood. I believe that armament, including jet planes, is vital for the security of the republic, but adequate maintenance of standards of health and alleviation of suffering are equally vital, both from a practical point of view and form that of morale. All who took part in induction-board examinations during the war realize that the maintenance and development of national health is of as vital importance as the maintenance and development of armament.

The trend of development in the facilities available for the chronically ill outlined above will not necessarily be altered by public or state medicine. With provision of public funds in any setting of public activity the question is bound to come up, "Is it worth while to spend a certain amount of effort to restore a certain type of patient?" This rationalistic point of view has insidiously crept into the motivation of medical effort, supplanting the old Hippocratic point of view. In emergency situations, military or otherwise, such grading of effort may be pardonable. But doctors must beware lest such attitudes creep into the civilian public administration of medicine entirely outside emergency situations, because once such considerations are at all admitted, the more often and the more definitely the question is going to be asked, "Is it worth while to do this or that for this type of patient?" Evidence of the existence of such an attitude stared at me from a report on the activities of a leading public hospital unit, which stated rather proudly that certain treatments were given only when they appeared promising: "Our facilities are such that a case load of 20 patients is regularly carried . . .in selecting cases for treatment careful consideration is given to the prognostic criteria, and in no instance have we instituted treatment merely to satisfy relatives or our own consciences." If only those whose treatment is worth while in terms of prognosis are to be treated, what about the other ones? The doubtful patients are the ones whose recovery appears unlikely, but frequently if treated energetically, they surprise the best prognosticators. And what shall be done during that long time lag after the disease has been called incurable and the time of death and autopsy? It is that period during which it is most difficult to find hospitals and other therapeutic organizations for the welfare and alleviation of suffering of the patient.

Under all forms of dictatorship the dictating bodies or individuals claim that all that is done is being done for the best of the people as a whole, and that for that reason they look at health merely in terms of utility, efficiency and productivity. It is natural in such a setting that eventually Hegel's principle that "what is useful is good" wins out completely. The killing center is the reductio ad absurdum of all health planning based only on rational principles and economy and not on humane compassion and divine law. To be sure, American physicians are still far from the point of thinking of killing centers, but they have arrived at a danger point in thinking, at which likelihood of full rehabilitation is considered a factor that should determine the amount of time, effort and cost to be devoted to a particular type of patient on the part of the social body upon which this decision rests. At this point Americans should remember that the enormity of a euthanasia movement is present in their own midst. To the psychiatrist it is obvious that this represents the eruption of unconscious aggression on the part of certain administrators alluded to above, as well as on the part of relatives who have been understandably frustrated by the tragedy of illness in its close interaction upon their own lives. The hostility of a father erupting against his feebleminded son is understandable and should be considered from the psychiatric point of view, but it certainly should not influence social thinking. The development of effective analgesics and pain-relieving operations has taken even the last rationalization away from the supporters of euthanasia.

The case, therefore, that I should like to make is that American medicine must realize where it stands in its fundamental premises. There can be no doubt that in a subtle way the Hegelian premise of "what is useful is right" has infected society, including the medical portion. Physicians must return to the older premises, which were the emotional foundation and driving force of an amazingly successful quest to increase powers of healing if they are not held down to earth by the pernicious attitudes of an overdone practical realism.

What occurred in Germany may have been the inexorable historic progression that the Greek historians have described as the law of the fall of civilizations and that Toynbee[18] has convincingly confirmed—namely, that there is a logical sequence from Koros to Hybris to Atc, which means from surfeit to disdainful arrogance to disaster, the surfeit being increased scientific and practical accomplishments, which, however, brought about an inclination to throw away the old motivations and values by disdainful arrogant pride in practical efficiency. Moral and physical disaster is the inevitable consequence.

Fortunately, there are developments in this democratic society that counteract these trends. Notable among them are the societies of patients afflicted with various chronic diseases that have sprung up and are dedicating themselves to guidance and information for their fellow sufferers and for the support and stimulation of medical research. Among the earliest was the mental-hygiene movement, founded by a former patient with mental disease. Then came the National Foundation for Infantile Paralysis, the tuberculosis societies, the American Epilepsy League, the National Association to Control Epilepsy, the American Cancer Society, The American Heart Association, "Alcoholics Anonymous" and, most recently the National Multiple Sclerosis Society. All these societies, which are coordinated with special medical societies and which received inspiration and guidance from outstanding physicians, are having an extremely wholesome effect in introducing fresh motivating power into the ivory towers of academic medicine. It is indeed interesting and an assertion of democratic vitality that these societies are activated by and for people suffering from illnesses who, under certain dictatorships, would have been slated for euthanasia.

It is thus that these new societies have taken over one of the ancient functions of medicine—namely, to give hope to the patient and to relieve his relatives. These societies need the whole-hearted support of the medical profession. Unfortunately, this support is by no means yet unanimous. A distinguished physician, investigator and teacher at an outstanding university recently told me that he was opposed to these special societies and clinics because they had nothing to offer to the patient. It would be better to wait until someone made a discovery accidentally and then start clinics. It is my opinion, however, that one cannot wait for that. The stimulus supplied by these societies is necessary to give stimulus both to public demand and to academic medicine, which at times grows stale and unproductive even in its most outstanding centers, and whose existence did nothing to prevent the executioner from having logic on his side in Germany.

Another element of this free democratic society and enterprise that has been a stimulus to new developments is the pharmaceutical industry, which, with great vision, has invested considerable effort in the sponsorship of new research.

Dictatorships can be indeed defined as systems in which there is a prevalence of thinking in destructive rather than in ameliorative terms in dealing with social problems. The ease with which destruction of life is advocated for those considered either socially useless or socially disturbing instead of educational or ameliorative measures may be the first danger sign of loss of creative liberty in thinking, which is the hallmark of democratic society. All destructiveness ultimately leads to self-destruction; the fate of the SS and of Nazi Germany is an eloquent example. The destructive principle, once unleased, is bound to engulf the whole personality and to occupy all its relationships. Destructive urges and destructive concepts arising therefrom cannot remain limited or focused upon one subject or several subjects alone, but must inevitable spread and be directed against one's entire surrounding world, including one's own group and ultimately the self. The ameliorative point of view maintained in relation to all others is the only real means of self-preservation.

A most important need in this country is for the development of active and alert hospital centers for the treatment of chronic illnesses. They must have active staffs similar to those of the hospitals for acute illnesses, and these hospitals must be fundamentally different from the custodial repositories for derelicts, of which there are too many in existence today. Only thus can one give the right answer to divine scrutiny: Yes, we are our brothers' keepers. 433 Marlborough Street

ENDNOTES

1. Bumke, O. Discussion of Faltlhauser, K. Zur Frage der Sterilisierung geistig Abnormer, Allg. Zischr. J. Psychiat., 96:372, 1932.

2. Dierichs, R. Beitrag zur psychischen Anstaltsbehandlung Tuberkuloser, Zischr. f. Tuberk., 74:24-28, 1936.

3. Dorner, A. Mathematik in dienste der Nationalpolitischen Erziehung: Ein Handbuch fur Lehrer, herausgegeben in Auftrage des Reichsverbandes Deutcher mathematischer Gesellschaften und Vereine. Second edition. (revised). Frankfurt: Moritz Diesterweg, 1935. Pp. 1-118. Third edition (revised), 1936. Pp. 1-118.

4. Alexander, L. Public mental health practices in Germany, sterilization and execution of patients suffering from nervous or mental disease. Combined Intelligence Objectives Subcommittee, Item No. 24. File, No. XXVIII-50. Pp. 1-173 (August), 1945.

5. Idem. Neuropathology and neurophysiology, including electro-encephalography in wartime Germany. Combined Intelligence Objectives Subcommittee, Item No. 24. File, No. XXVII-1. Pp. 1-65 (July), 1945.

6. Idem. German military neuropsychiatry and neurosurgery. Combined Intelligence Objectives Subcommittee, Item No. 24. File, No. XXVIII-49. Pp. 1-138 (August), 1945.

7. Idem. Sociopsychologic structure of SS: psychiatric report of Nurnberg trials for war crimes. Arch. Neurol. & Psychiat. 59:622-634, 1948.

8. Idem. War crimes: their social-psychological aspects. Am. J. Psychiat. 105:170-177, 1948.

9. Idem. War crimes and their motivation: socio-psychological structure of SS and criminalization of society. J. Crim. Law & Criminol. 39:298-326, 1948.

10. Idem. Madaus, G., and Koch, F.E., Tierexperimentelle Studien zur Frage der medikamentosen Sterilisierung (durch Caladium seguinum ([sic] Dieffenbachia sequina). Zischr. f. d. ges. exper. Med. 109:68-87, 1941.

11. Madaus, G. Zauberpflanzen im Lichte experimenteller Forschung, Das Schweigrohr - Caladium seguinum. Umschau 24:600-602.

12. Alexander, L. Treatment of shock from prolonged exposure to cold, especially in water. Combined Intelligence Objectives Subcommittee, Item No. 24. File, No. XXIX-24. Pp. 1-163 (August), 1945.

13. Document 1971 a PS.

14. Document NO 220.

15. Alexander, L. Treatment of shock from prolonged exposure to cold, especially in water. Combined Intelligence Objectives Subcommittee, Item No. 24. File, No. XXVI-37. Pp. 1-228 (July), 1945.

16. Seiss-Inquart. Order of the Reich Commissar for the Occupied Netherlands Territories Concerning the Netherlands Doctors. (Gazette containing the orders for the Occupied Netherlands Territories), pp. 1001-1026, December, 1941.

17. Bernal, J. D. The Social Function of Science. Sixth edition. 482 pp. London: George Routledge & Sons, 1946.

18. Toynbee, A. J. A Study of History. Abridgement of Vol. I-VI. By D. C. Somervell. 617 pp. New York and London: Oxford University Press, 1947.

(This article was taken from the July 14, 1949, issue of "The New England Journal of Medicine.")

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