Canadian euthanasia doctors struggle with euthanizing vulnerable patients.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Maria Cheng and Angie Wang reported for the AP Press on October 16 that some Canadian euthanasia doctors struggle with euthanizing vulnerable patients. The authors report:

A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meager government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and each sparked private debate among doctors and nurses struggling with the ethics of one of the world’s most permissive laws on the practice, according to an Associated Press investigation.

As Canada pushes to expand euthanasia and more countriesmove to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas.

Some doctors fear moving forward even with cases that meet Canada’s legal requirements, which allow euthanasia for people with “irremediable suffering” from serious but nonfatal medical conditions and disabilities. On private forums, doctors and nurses have expressed deep discomfort with ending the lives of vulnerable people whose deaths were avoidable, according to messages provided to AP by a participant on condition of anonymity due to their confidentiality.

Some of the requests from the forums were approved and acted upon. Others were denied. But the discourse about patients who are poor, disabled or lonely shows a fraught process where medical professionals test the limits of what conditions warrant euthanasia. The controversial cases in the forums have never been disclosed through Canada’s oversight system, even in an anonymized manner.

Euthanasia is becoming the solution to every kind of suffering. The authors reported:

But experts tasked with delivering euthanasia to people who aren’t dying have called it “morally distressing” and say the legal provisions are too vague to be protective, obliging doctors and nurses to at times end the lives of people they believe might otherwise be saved.

“I don’t want (euthanasia) to become the solution to every kind of suffering out there,” a physician wrote to colleagues on one of the private forums.

Euthanasia doctors debate their euthanasia cases on a private forum. The authors report:

When euthanasia was legalized, doctors and nurse practitioners set up email discussion groups as confidential forums to discuss potentially troubling cases, with limited patient details for privacy. They’re now run by the Canadian Association of MAiD Assessors and Providers.

Association President Dr. Konia Trouton told AP via email that providing euthanasia for vulnerability or financial reasons alone is “completely forbidden.” Trouton said doctors and nurse practitioners consult with one another on the forums “to gain insights and learn from the experiences of others.”

One of the forum participants shared dozens of messages with the AP reporters.

A middle-aged worker whose ankle and back injuries made him unable to resume his previous job told his doctor that the government’s measly support was “leaving (him) with no choice but to pursue MAiD.” His doctor told forum participants the patient met legal criteria, with severe pain, strained social relationships and inability to work. Others agreed and assured the doctor the man was clearly in pain. But the doctor was hesitant because the man cited reduced government payments as a key factor.

Cases of homelessness appear regularly and spark some of the most heated debate.

One doctor wrote that although his patient had a serious lung disease, his suffering was “mostly because he is homeless, in debt and cannot tolerate the idea of (long-term care) of any kind.” A respondent questioned whether the fear of living in the nursing home was truly intolerable. Another said the prospect of “looking at the wall or ceiling waiting to be fed … to have diapers changed” was sufficiently painful.

The man was eventually euthanized.

One provider said any suggestion they should provide patients with better housing options before offering euthanasia “seems simply unrealistic and hence, cruel,” amid a national housing crisis.

Physicians said keeping their opinions out of assessments was difficult — and painful, given patients’ emotions and desperation.

The reporters learned that euthanasia deaths are more prevalent among people with disabilities.

Critics have long warned that Canada’s policies have led to euthanasia among disadvantaged people whose deaths weren’t imminent. Despite publicized cases of people asking to be killed because of insufficient support, government officials have largely refuted the idea that socially disadvantaged people are being euthanized.

But in Ontario, more than three quarters of people euthanized when their death wasn’t imminent required disability support before their death in 2023, according to data from a slideshow presentation by the province’s chief coroner, shared with AP by both a researcher and a doctor on condition of anonymity due to its sensitive nature.

The article states that Canadian officials have examined some of the worrisome cases. The authors report:

A document from the Ministry of the Solicitor General in Ontario sent to all euthanasia providers in the province in May noted two cases of “lessons learned” in nonterminal cases. The document was shared with AP by a doctor on condition of anonymity because it wasn’t authorized for release.

In one, a 74-year-old patient who’d suffered high blood pressure, a stroke and blindness, among other difficulties, was increasingly dependent on their spouse and “expressed their interest in MAiD to their family physician, due to their vision impairment and loss of hope for improvement of their vision and quality of life.”

The report cited three instances where legally mandated safeguards were not met. Among them: No assessor or expert versed in the nonterminal condition was involved, and efforts to discuss alternatives to death were “limited.”

The report also said the procedure was scheduled “based on the spouse’s preference of timing.” Officials questioned whether “the patient’s death was genuinely voluntary and free of coercion.” Independent legal experts said those breaches could constitute violations of criminal law.

The authors uncovered several other cases that were debated in the forum.

Some of that reflection is happening in the confidential providers’ forums.

They’ve debated whether it’s valid to euthanize people for obesity in several cases. One woman with severe obesity described herself as a “useless body taking up space” — she’d lost interest in activities, became socially withdrawn and said she had “no purpose,” according to the doctor who reviewed her case. Another physician reasoned that euthanasia was warranted because obesity is “a medical condition which is indeed grievous and irremediable.”

When a health worker inquired whether anyone had euthanized patients for blindness, one provider reported four such cases. In one, they said, an elderly man who saw “only shadows” was his wife’s caregiver when he requested euthanasia; he wanted her to die with him. The couple had several appointments with an assessor before the wife “finally agreed” to be killed, the provider said. She died unexpectedly just days before the scheduled euthanasia.

Providers on the forum were divided over ending the lives of people in mourning. One case involved a woman in her 80s who required dialysis and lost her husband, sibling and cat in a six-week period. Her assessor said her suffering and request to die were tied to her husband’s death rather than any medical conditions.

Some doctors said because she lost her husband — the protective factor that would make the other losses and suffering bearable — she qualified. Others recommended grief counseling instead.

A provider referenced a similar case, in which a widow requested euthanasia within weeks of her husband’s death: “Her whole life system crashed. I felt much ease in providing for her and had no pushback from the coroner.”

Ellen Wiebe

The authors refer to comments by Canada's most prolific euthanasia doctor, Ellen Wiebe who stated:

while poverty inevitably exacerbates suffering, improved housing and social situations have never changed a patient’s mind.

“The idea that because I’m disabled, I should lose my rights that undisabled people have is outrageous,” said Wiebe, who suffers from heart disease and uses a wheelchair.

She predicted legal consequences if officials introduce more safeguards for euthanasia: “We’ll just be back in court with somebody saying, ‘You interfered with my basic human rights.’”

The authors conclude the article by stating:

On euthanasia forums, doctors and nurses continue to struggle with cases of patients who aren’t fatally ill, lamenting that Canada’s health and social services can seem woefully inadequate.

“I have great discomfort with the idea of MAiD being driven by social circumstances,” one provider said. “I don’t have a good solution to social deprivation either, so I feel pretty useless when I receive requests like this.”

More articles on this topic:

• Canadian doctor considers euthanasia the best work she has done (Link).
• Insight into the cautionary tale of Canada's euthanasia regime (Link).
• The Rise of Euthanasia in Canada. From Exceptional to Routine (Link).

Man who was declared brain dead, woke up before organ retrieval.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

TJ Hoover on left.

Rob Stein reported for NPR on October 17 that TJ Hoover was declared brain dead but woke up before his organs were retrieved. Stein reported:

Natasha Miller says she was getting ready to do her job preserving donated organs for transplantation when the nurses wheeled the donor into the operating room.

She quickly realized something wasn’t right. Though the donor had been declared dead, he seemed to her very much alive.

“He was moving around — kind of thrashing. Like, moving, thrashing around on the bed,” Miller told NPR in an interview. “And then when we went over there, you could see he had tears coming down. He was crying visibly.”

The donor’s condition alarmed everyone in the operating room at Baptist Health hospital in Richmond, Ky., including the two doctors, who refused to participate in the organ retrieval, she says.

“The procuring surgeon, he was like, ‘I’m out of it. I don’t want to have anything to do with it,’ ” Miller says. “It was very chaotic. Everyone was just very upset.”

The brain death declaration and organ donation incident happened in October 2021 resulted in some of the organ donation workers quitting their job.

The family was told that his movement was just a common reflex. Stein reported:

Donna Rhorer of Richmond, Kentucky, told NPR that her 36-year-old brother, Anthony Thomas “TJ” Hoover II, was the patient involved in the case. He was rushed to the hospital because of a drug overdose, she says.

Rhorer was at the hospital that day. She says she became concerned something wasn’t right when TJ appeared to open his eyes and look around as he was being wheeled from intensive care to the operating room.

“It was like it was his way of letting us know, you know, ‘Hey, I’m still here,’ ” Rhorer told NPR in an interview.

But Rhorer says she and other family members were told what they saw was just a common reflex. TJ Hoover now lives with Rhorer, and she serves as his legal guardian.

The US Uniform Law Commission have debated changing the organ donation dead donor rule to not require a person to be brain dead, but rather that the person have an irreversible medical condition for organ donation.

Organ donation researchers claim that people have not been declared brain dead, who were not brain dead, nonetheless, I have reported on several cases on this blog over the past few years of similar cases.

More articles on this topic:

• No to killing for organs (Link).
• Organ donation procedure violates the Dead Donor Rule (Link).
• Proposed changes to the UDDA will cause more litigation (Link). 
• Are people who are declared brain dead always dead? (Link).

Dutch Professor: British proposed assisted death criteria are similar to how Canada's law began.

"When you legalise euthanasia, we see that all over the world, it will set in motion a new dynamic where supply will create demand."

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Theo Boer

Professor Theo Boer who was a member of a Netherlands Regional Euthanasia Review Committee, was interviewed on October 16 by the Times Radio (UK) concerning the upcoming assisted suicide bill that will be debated in the UK.

Kim Leadbetter, MP was to introduce the - Terminally Ill Adults (End of Life) Bill but we are informed that the language of the bill will not be available until sometime in November.

In his interview with the Times Radio, Boer responds to the proposed outline of the bill by comparing it to the Canadian and Netherlands experience with euthanasia:

When you legalise euthanasia, we see that all over the world, it will set in motion a new dynamic where supply will create demand.

What you are now saying about these British criteria is just about exactly the same as how Canada started. It said, it was for terminal illness, for only a physical illness and now we are way down the path because there were patients in Canada that said this is so unjust, a chronic patient, and I agree with that, a chronic patient can suffer so much more than a terminal patient.

Question: Was it a kind of a legal challenge that mean't that they could expand it?

Yes, In Canada it worked through litigation, through court cases. So they had the Truchon/Gladu case, where I was an expert witness for the Canadian government in 2018. It started with a court case, that was the litigation, and then, so it is really a matter of justice and I think that is inevitable.

As I said, how can you defend rights to a swift death to someone who is terminally ill, while there are people with chronic illnesses that suffer all the much more?

Question: Would that be anyone with a chronic illness?

Well, personally I think this is a slippery slope, so I'm very hesitant. But I think the most heartbreaking cases now in the Netherlands are young psychiatric patients. We have ground breaking cases.

A 17-year old girl who had psychiatric illness for five years and suffering unbearably.

It is so heartbreaking, not only the fact that they die, but also the suffering that they undergo. So really I don't know. And we don't know in the Netherlands where this will stop. So we are also, of course as you know, discussing a law that will grant anyone over 74 the right to euthanasia on the basis of a completed life.

Question: What did you say? A completed life?

Completed life means that old age is the only reason that you, I should say, a sufficient reason. You don't even need to be sick. That is a law that has been discussed for years, and now that we have a little more populist government in the Netherlands, I think they are more hesitant. But we were almost on the brink of having this "completed life" law.

Question: Do you agree with that?

No, No. As you may hear between the lines, I was advocating for the euthanasia law, but as I have seen the practice developed from euthanasia being an exception to euthanasia becoming a rule.

I now actually think that doctors, for example in Britain, when there's really unbearable suffering at the end of life, perhaps they should help the patient to die, for example, with an extra dose of morphine, but not legalising it because when you legalise euthanasia, we see all over the world, it will set in motion a new dynamic where supply will create demand.

Previous articles by Theo Boer:

• Euthanasia is impossible to police once legal (Link). 
• Let's not romanticize the Dutch euthanasia experiment (Link). 
• Be careful what you wish for when you legalise active killing (Link).
  

Suicide Attempts: A Cry for Help

The following article is based on the article by Pat McGeehan that was published by the Fayette Tribune on October 10, 2024.

Vote YES on West Virginia Amendment 1 for protection from assisted suicide (Link).

For every suicide in our country, there are an estimated 25 non-fatal suicide attempts. Most people who survive a suicide attempt do not try to take their lives again: “nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date.”

Suicide attempts aren’t always about seeking death—they often express deep misery and are a cry for help. People who attempt suicide are usually looking for an end to their suffering, shame, and depression—not life itself. These attempts often prompt the intervention of loved ones and the medical community, and in the majority of cases, life, not death, is the final outcome.

 
Assisted Suicide: A Misleading Assumption

It is a mistake to think that a request for medically-assisted suicide is different from other suicide attempts. When a loved one expresses suicidal thoughts, we are advised to restrict their access to lethal means, like medication or firearms. However, in places like California, if someone opts for medically-assisted suicide, a highly lethal cocktail of poisons, sedatives, and painkillers (DDMA or DDMP) is mailed directly to their home.

Unlike other suicides—where the person is clearly torn between life and death—medically-assisted suicide is often assumed to be a rational, unchanging decision. This is a dangerous assumption.

Michael Freeland’s Story

Consider the case of Michael Freeland, as recorded by the National Council on Disability. At age 62, with a 43-year history of depression and suicide attempts, Michael was diagnosed with terminal lung cancer. He requested assisted suicide, and Dr. Peter Reagan, an advocate for Compassion & Choices, prescribed him lethal drugs. However, Michael later reached out to Physicians for Compassionate Care (PCC), who provided emotional support and medical care. With this help, his cancer symptoms improved, and he reconciled with his estranged daughter. Ultimately, Michael lived two more years and died naturally—having abandoned his wish for assisted suicide.

A Missed Opportunity for Intervention

Michael’s story shows that medically-assisted suicide, like other suicide attempts, stems from an ambivalent desire. In his case, support from friends and caregivers led him to choose life. But what if his desire to live had surfaced only after taking the lethal pills?

In states where assisted suicide is legal, there is no opportunity for a life-affirming intervention. The drugs used are designed to be maximally lethal, ensuring that survival isn’t an option. Assisted suicide becomes an irreversible decision with only one outcome: death.

Ignoring Underlying Causes of Despair

Proponents of assisted suicide often believe it is a clear-headed choice, but they fail to acknowledge the underlying hopelessness and neglect that drive many of these requests. In Oregon, for example, the time between a patient’s first request for assisted suicide and their death has shrunk significantly, from 18 weeks in 2010 to just five weeks in 2022. Only 1% of patients are referred for psychiatric evaluation, even though depression is a common factor in suicide.

West Virginia: A State of Hope

Here in West Virginia, when someone expresses a desire to end their life, we don’t ignore the cry for help by handing them lethal drugs. Instead, we offer support. Our doctors do not respond to despair by recommending death. This is a trust that we must protect.

Without rejecting medically-assisted suicide, we could follow Canada’s path, where it is now the fifth leading cause of death. That’s why it is crucial to vote for Amendment One this November. It will protect West Virginia from medically-assisted suicide and uphold our commitment to suicide prevention. It sends a message that our state values hope over despair.

Euthanasia in the Castle: Inside Europe’s Museums of Nazi Medical Crimes

This article was published by The Public Discourse on October 14, 2024.

Amanda Achtman

By Amanda Achtman

Today we might instinctively look at Nazi criteria for death as utterly baseless, but at the time seasoned medical professionals regarded them as reasonable. To have a sense of history is to grasp the arbitrariness of such criteria. When it comes to killing patients, there is no way to get the criteria just right because the stamp of medical approval sends a social message that there is a category of persons who should not exist.

On a visit to Hartheim Castle, a 400-year-old Renaissance fortress not far from Mauthausen concentration camp, I found myself examining a skull-measuring device from 1940. The sinister metal calipers and two measuring scales are on loan from Vienna’s Museum of Natural History; across from the glass display case is a 1930 poster from the UK Eugenics Society featuring a strong, tall man scattering seeds in a field. It reads: “Only Healthy Seed Must Be Sown: Check the Seeds of Hereditary Disease and Fitness by Eugenics.”

Nearby is a 1927 American movie poster: “Youth has its fling—and then comes the burning question—Are you fit to marry?”

In the spring of 2022, I visited one of eight former Nazi euthanasia centers—what Simon Wiesenthal called “regular schools of murder.” Five are in Germany: Brandenburg is just outside Berlin; Hadamar is between Cologne and Frankfurt; Sonnenstein is close to Dresden; Bernburg is in Saxony, and Grafeneck is near Stuttgart. The remaining three are in Austria; Hartheim Castle is in the small village of Alkoven, near Adolf Hitler’s childhood town of Linz.

All but one—Brandenburg—served as psychiatric hospitals or homes for persons with disabilities before being converted to euthanasia centers by the Nazis. Today, Hartheim houses an exhibit on modern eugenics alongside a memorial to the tens of thousands of people killed within its walls.

The link between Nazism and eugenics is often noted only in passing. But it was precisely this link that enabled Simon Wiesenthal to answer questions that bothered him for years. As he writes in his 1967 memoir, The Murderers Among Us:

How were people selected and trained to carry out the murder of 11 million people, and how did they keep their secrets so well that they were not known for years after the end of the war? Obviously, men assigned to the gas chambers, who had to watch the deaths of tens of thousands of people day after day and week after week, would have to be trained technically and psychologically, otherwise they might collapse under the continuous stress. . . . Machines broke down, but the people handling them never did.

Wiesenthal wanted to understand how people could become so hardened to the cries of victims that they had less chance of cracking than even a machine. “Castle Hartheim and the other euthanasia centers were the answer,” he concluded.

“Hartheim was organized like a medical school—except that the ‘students’ were not taught to save human life but to destroy it as efficiently as possible,” Wiesenthal observed. Death was studied clinically, with a patina of medical authority; victims were “precisely photographed, scientifically perfected.” Before the death camps were established, euthanasia sites served as research facilities for what Nazis called Gnadentod, or mercy killings; physicians with stopwatches observed dying “patients” through a peephole in Hartheim’s cellar door and measured the length of the death struggle to one-tenth of a second. As Wiesenthal pointed out, “Nothing was left to chance.”

In a section of his memoir focused on his own visit to Hartheim, Wiesenthal pieced together a set of seemingly unrelated facts. Christian Wirth, the notorious leader of Operation Reinhard—the program to exterminate Polish Jewry—got his start supervising the Reich’s euthanasia program. Beginning in 1939, Wirth “troubleshot” extermination techniques at euthanasia centers. He would lure mentally ill or disabled “patients” to so-called showers or changing rooms, locking them in and exposing them to different fatal gas combinations in an attempt to observe which were most efficient. Following his tenure as chief of staff of Hartheim, Wirth went on to serve as commandant of the Belzec concentration camp, which became fully operational in March 1942.

Other SS officers followed suit; after a stint leading Hartheim, Franz Stangl became commandant of Treblinka. Gustav Wagner directed Hartheim before going on to lead Sobibor. A great many SS men who did technical work manning gas chambers and crematoria in the camps first worked at one or another euthanasia clinic. During his final weeks at Mauthausen, Wiesenthal recalled that “experts from Hartheim” were sent for to fix broken ovens or other machinery.

The questions that spurred me to visit were related to, but distinct from, Wiesenthal’s: how are victims of Nazi euthanasia remembered? How should we study and teach about their dehumanization, which differed from how Jews were dehumanized? For a time, Jews were formally banned from being “treated” at Nazi euthanasia sites. At least at first, it was understood that euthanasia was reserved not for Jewish enemies, but for German citizens whose death would be a mercy, both for them and for the country.

It is only recently that museums have been established at Nazi euthanasia sites. My work often takes me to Europe and, over the course of a couple of years, I went on solo trips to three: Hartheim, Hadamar, and Sonnenstein. What follows is not a thorough history of Nazi euthanasia under the Aktion T4 and Aktion 14f13 programs, but a travel diary of sorts, driven by questions that continue to trouble me.

The euthanasia memorials do not receive nearly the volume of visitors that flock to the more notorious death camps; most people are unaware of the links between them. But euthanasia victims often passed through multiple concentration camps before being deported and ultimately killed at euthanasia centers; and as noted, many euthanasia employees were later assigned to high positions within the death camps. How eugenics and euthanasia were both instrumental to and constitutive of the Nazis’ broader campaign of dehumanization deserves to be better understood.

First, Hartheim

The day I traveled to Hartheim Castle, I was struck by the juxtaposition of the bucolic setting and the site’s grim history. The castle seemed deserted, but fortunately, a receptionist at the front desk was on hand. She gave me a pamphlet explaining that chronically ill and disabled people—“useless eaters” in Nazi parlance—began arriving at Hartheim to be killed by the thousands in 1940. Later, from 1941 to 1944, thousands more prisoners and forced laborers from Mauthausen, Dachau, Ravensbruck, and Gusen were murdered there as well.

I made my way upstairs to Hartheim’s permanent “Value of Life” exhibit, which occupies much of the second floor. A sign at the entrance told an ugly story:

The murder of tens of thousands of people here, in this castle, during the National Socialist period formed the starting point for reflections on the value of life. This was narrowed to focus on the questions of how those deemed “useless” have been dealt with: What are the criteria used to define people as “useless”? Who sets the criteria? What have been the consequences of this judgment for those affected?

The exhibit doesn’t definitively answer these questions, but begins with an interesting yet cursory history of ideas ranging from Christianity—the viewpoint of which is succinctly summarized as “no one is useless”—to industrial rationality, utilitarianism, and capitalism, with panels explaining how each ideology contributed to the poor, weak, and disabled being deemed useless.

The next room in the Value of Life exhibit traces the rise of the modern eugenics movement. Pioneered by men like nineteenth-century scientists Charles Darwin and his cousin Francis Galton, eugenics quickly rose to prominence in highly developed countries including the U.S., Canada, and England. It took a variety of forms; on display, for example, are “Better Babies” medals. These were designed by famed American sculptor Laura Gardin Fraser and, beginning in 1913, were awarded at state fairs across the country to the most “scientific” babies, with an eye toward improving infant mortality and overall health among children. The national magazine Woman’s Home Companion explained the contests this way: “underneath the inviting charm of the idea is a serious scientific purpose—healthy babies, standardized babies, and always, year after year, Better Babies.”

Eventually, these gave rise to the 1920s “Fitter Family Contests,” which were more explicitly aimed at improving America’s gene pool. Also on display is a copy of Margaret Sanger’s 1929 work Motherhood in Bondage, a collection of letters from poor urban and rural mothers meant to illustrate the “socio-economic rationale for birth control.”

Around the corner was a large reproduction of a 1941 Nazi actuarial table detailing government savings should some number of people with disabilities be prevented from living ten years more. Daily and annual costs of caring for these citizens were meticulously calculated in Reichsmarks, making the case that the state would fare better if they did not exist. This type of formalized dehumanization of those living with disabilities and mental illness, under the guise of medical or actuarial science, contributed to the widespread desensitization and moral degradation of the “educated class.” By degrees, this emboldened people to dehumanize Jews under the pretext of racial hygiene.

The Value of Life exhibit underscores the “ordinariness” of the employees responsible for the sterilization and killing of those sent to Hartheim: kitchen and administrative staff, security guards, drivers, orderlies, technicians, and of course doctors and nurses. As far as we know, they generally worked for the euthanasia programs willingly and without compulsion. Once entrenched, however, they were sworn to secrecy and could not easily leave. But the pay was good, there were plenty of perks, and many were ideologically motivated to carry out their lethal work in the belief that it was beneficial.

It is also important to note that the Nazi euthanasia campaign involved multiple phases. First came the killing of children with physical and intellectual disabilities, then a wider range of patients with mental illnesses and, later, the so-called “Special Treatment” murder of political prisoners. Although Jews were initially kept away from the more “professional” environments of the euthanasia facilities, they were eventually included among the victims of Nazi euthanasia. At the Brandenburg euthanasia center, Jewish psychiatric patients were systematically killed. Some Jewish children were euthanized at Hadamar, and Jews were also among the prisoners euthanized under the “Special Treatment” campaign. The effort to distinguish medical euthanasia centers from the death camps became blurred.

In his memoir, Simon Wiesenthal quotes Bruno Bruckner, a photographer responsible for taking pictures of patients’ “death struggles” and autopsies. Bruckner candidly admitted that he enjoyed the food and abundant liquor at Hartheim and was glad to make “300 marks a month and . . . a little money on the side.” He also noted that “there were lots of parties. Everybody was sleeping with everybody else.”

Bruckner’s attitude seems to have been more the norm than the exception. Few in Germany or Austria resisted the Nazi euthanasia effort; as one plaque noted, “it took a long time for this resistance to be acknowledged in society. It was not until the 1990s when the history of Nazi euthanasia was researched in greater depth in Austria as well, that it found more widespread recognition.”

The main resistance figure recognized at Hartheim is Clemens von Galen, the Catholic bishop of Münster during the Nazi years. His resistance is also alluded to at Yad Vashem, where one display notes that Churches were instrumental in shutting down an early iteration of the program: “When the Euthanasia institutions were closed, their medical and operational personnel were sent to Poland, where they engaged in establishing and commanding the extermination camps for Jews.”

Another resistance figure commemorated at Hartheim is Franz Sitter, a nurse who left Hartheim almost immediately after being hired. He faced no repercussions for walking away, and his example damns all those who made a different choice. Sitter and a small handful of others are presented by the museum as ethical exemplars for visitors, inviting them to probe their own character and conscience as they reflect on what happened here.

The Value of Life exhibit concludes with a display titled “Breaks and Continuities,” containing items or images related to abortion, contraception, in vitro fertilization, surrogacy, genetic testing, disability aids, prosthetics, and more. These are presented without much commentary; it is left to viewers to consider the extent to which any of them relate to the ideology of eugenics and what that might mean for medical practice today.

I returned to the ground floor and Hartheim’s foundational exhibit, which includes the original “killing rooms.” I looked at photographs of victims and a selection of their belongings. When I walked into the gas chamber and crematorium, I felt the emptiness of a world in which so many innocents have been unjustly eliminated.

Later, just outside the castle’s courtyard, I started a conversation with a group of Austrian high school students during their lunch break. I asked if they thought there are ever circumstances in which euthanasia is appropriate. To general agreement, one student answered, “Only if the person asks for it.”

I have continued to reflect on this and other persistent, uncomfortable questions. The students, I realized, freely agreed that no one is qualified to determine the value of anyone else’s life. Clearly the Nazis had profoundly failed to recognize the value of the lives of their neighbors. But do we run the risk of wrongly assessing the worth of our own lives, or becoming convinced our lives are less worthy due to some perceived deficit along medicalized or other standardized lines? If medical practitioners could err so profoundly in their judgments of life’s value, couldn’t I, couldn’t any of us, err similarly? Could “consent” merely corroborate an assessment of a life’s value that is fundamentally inaccurate or untrue? And might others who support a faulty assessment, perhaps out of a misguided sympathy, wrongly encourage people to end their own lives?

The doctors, nurses, and other staff at Hartheim Castle appear to have been driven by personal conviction; their views had become a matter of widespread professional consensus. For years, the judgment of assessors and providers of euthanasia were considered to be beyond reproach. Now, we recognize that their devaluation of human life was abhorrent and unjustifiable. But on what basis can we scrutinize this assessment of the value of life and deem it false?

I often think about how an estimated 30,000 persons were euthanized inside that elegant European castle. Many people participated out of a belief that this was for the good of the victims and for society at large. Hartheim Castle is a reminder that the insidious ideology of Nazism included a specific form of dehumanization that made it easier for modern, technocratic, and prosperous countries to do horrifying things.

Next, Hadamar

In February 2023, several months after my visit to Hartheim, I made my way to a second Nazi euthanasia memorial, Hadamar, located roughly between Cologne and Frankfurt. Usually, public museums are built in city centers for ease of access; concentration camps and euthanasia sites, of course, were deliberately out of the way.

Formerly an ordinary public psychiatric hospital, Hadamar was converted by the Nazis into their sixth euthanasia center as 1940 came to a close. Beginning in January 1941, patients with disabilities and mental illness were regularly bused to Hadamar, led into the main building, told to undress, registered by administrative staff, and then directed to the basement gas chamber, where they were killed. As at Hartheim, they were then incinerated; smoke could be seen from afar and locals reported smelling it. Some at Hadamar received lethal injections or were starved to death. Relatives of the euthanized were sent “comfort letters,” which included false information about the circumstances and time of death and, sometimes, the place of death. If the relatives so requested, they were sent urns containing ashes—though not the ashes of their loved ones.

Beginning in 1942, a more diverse array of “patients” was sent to Hadamar: forced laborers with tuberculosis, former SS soldiers suffering from shell shock, half-Jewish “mixed children.” More than 15,000 people were euthanized at Hadamar from 1941 to 1945, and many more had been sterilized there over the years.

Hadamar physicians were apparently enthusiastic about their work; staff celebrated the death of the 10,000th victim with beer and revelry, with one employee mockingly impersonating a priest. Hadamar staff received perks similar to those of Hartheim’s workers: excursions, concert tickets, even vacation homes. Eventually, it was the employees of Hadamar who went on to build the extermination camp, Treblinka.

The photos of victims especially drew me in. One young woman, identified as Selma K. [Klein], wore her short hair parted to the side, and faced the camera with a slight smile and her right arm folded over her left. According to the exhibit panel, Selma’s mother died when she was young, and she was raised in a Jewish girls’ home. At twenty-one, she got pregnant and, according to her medical records, was judged to be “destitute.” Despite an order banning Hadamar from receiving Jewish patients, Selma was sent there in 1936 and subjected to a sterilization order prior to Hadamar’s becoming a euthanasia center. After Selma was sterilized on the grounds of “not being able to satisfy expectations in life,” her father fought to no avail to get her released. Selma was later deported to Ravensbrück concentration camp, where she is likely to have died in 1942.

There was also Minna Heinze, an elegant-looking middle-aged mother of two, who had helped a Jewish family flee the country after Kristallnacht. Subjected to interrogation concerning her involvement with the Jewish refugees, Minna began to experience anxiety attacks and insomnia and was institutionalized. She was ultimately sent to Hadamar in 1943 and died in March 1944, at around the age of fifty, either from severe deprivation or lethal injection. Her family was prevented from visiting and received no news of her until her reported death from “influenza.” I thought about the Jewish family that fled and may have descendants living today because of Minna’s courage.

Despite Jews’ being occasionally banned from admission to Hadamar, there were exceptions. It was also at Hadamar that the Nazis designated “an Educational Home for Jewish half-breeds of minority age.” Children who had one Jewish parent were sent to Hadamar under the pretense of receiving social welfare education.

Among them were brothers Wolfgang and Günther. According to the boys’ medical files, they were deemed “incapable of being educated,” “inclined toward criminality,” and “morally neglected.” The boys had been growing up without their father; the Nazis had tortured and killed him for being half Jewish and alleged that he was communist. The brothers were admitted as “Jewish half-breeds” to Hadamar’s “educational institution.” They were both killed in the summer of 1943 and given false causes of death. About thirteen-year-old Wolfgang, the medical records said: “Skilled, can be used for domestic work and light gardening. Like his brother, he disturbs the sleeping hall at night and tells the most cock-and-bull stories.”

There is a photo on display of Wolfgang and Günther with their mother, Helene, whose protective expression reveals she knows something dreadful awaits her children. As usual, the doctor at Hadamar invented fictitious causes of death. But Helene also reported that the doctor told her directly: “Mrs. H. You have to accept that you will not see your children again, since Jewishness has to be eliminated.” Of the forty-three children enrolled in the “educational home,” thirty-eight were killed.

I descended to Hadamar’s former gas chamber with the somber realization that these walls were the last thing seen by the victims whose stories I had been learning upstairs.

The Hadamar memorial opened to the public in 1983. In 1991, they created a permanent exhibit. Gradually, the number of visitors, their countries of origin, and the languages in which the material is offered are increasing. The main visitors seem to be German students, but there are also professionals, such as nurses, doctors, and police officers.

According to a Hadamar pamphlet, “The Hadamar Memorial Museum is a place of remembrance, historical enlightenment, and political education and is aimed at children, young people, and adults. Its task is to provide visitors with information about the Nazi euthanasia crimes and to discuss current issues and political education.”

Though the causes of death were often fabricated, my visit made me realize the extent to which ostensibly scientific criteria and an air of medical authority had been wielded to rationalize ending the lives of “inconvenient” innocents. The unspoken logic of the criteria is that it qualified patients to be killed.

The medical records of the euthanasia victims list such things as: “congenital feeble-mindedness,” “social nonconformity,” “anxious relational psychosis,” “unable to work,” “incurable,” “danger to the public,” “unstable and dishonest,” “sullen and unapproachable,” “senile dementia,” etc., as conditions that obviously warranted death.

Ambiguous as these criteria are, they were used to reduce people to conditions that disqualified them from belonging in the world. The person with a name became the mere instance of a type. Doctors would refer to patients by their illness, disability, or inner struggle as a kind of shorthand that eclipsed the person. This is a particularly insidious form of dehumanization, when a person’s entire identity is reduced to a diagnosis, prognosis, or accessibility aid.

In short, a consensus arose around a social valuation of life, which became difficult to dispute. The rationale for killing people became entrenched under the guise of general agreement. The precedent became part of the argument. If the general presumption becomes that the rationale is logical, if there is a sense that fungible criteria are legitimate, then people are susceptible to being classified within them, regardless of whether they would have put themselves in that category.

Today we might instinctively look at Nazi criteria for death as utterly baseless, but at the time seasoned medical professionals regarded them as reasonable. To have a sense of history is to grasp the arbitrariness of such criteria. When it comes to killing patients, there is no way to get the criteria just right because the stamp of medical approval sends a social message that there is a category of persons who should not exist.

Finally, Sonnenstein

In December 2023, I visited a third Nazi euthanasia center: Sonnenstein, in eastern Germany, not far from Dresden in a little town called Pirna. Earlier that morning, I had taken a stroll nearby to the former home of Victor Klemperer, the Jewish chronicler of Dresden, who stored his diary at a home at Maxim Gorki Street No. 16. In the diary, he quotes a friend named Annemarie Kohler, a doctor from Pirna:

The Sonnenstein is no longer the state mental asylum. The SS has it. They built their own crematorium. Disagreeable people are brought here in a kind of police car. Here it is generally called the “whisper carriage.” The relatives then receive the urn. Recently a family received two urns at once.

The euthanasia center at Pirna was located on the grounds of the Sonnenstein Castle. As with Hadamar, the site had been an ordinary psychiatric hospital since 1811, before being converted by the Nazis. There, an estimated 13,720 persons living with disabilities and mental illness were euthanized under Aktion T4. In 1941, more than a thousand concentration camp prisoners from Auschwitz, Buchenwald, and Sachsenhausen were killed there.

Among the more recent locations to become a memorial site, Sonnenstein was inaugurated as such in 2000. The site documents the ways in which the eugenics movement distorted the founding aims of the Sonnenstein Asylum, which once served as a model for the care and treatment of patients.

In the memorial exhibit, there is a first-edition copy of a 1920 book, The Destruction of Life Unworthy of Life, by the German professors and eugenicists Karl Binding and Alfred Hoche; a record of the Nazi-enacted Law for the Prevention of Hereditarily Diseased Offspring, also known as the Sterilization Law, from 1933; and a copy of the private letter signed by Hitler to his physician, Karl Brandt, triggering Aktion T4—the initial phase of the Nazi euthanasia project, authorizing the killing of those with disabilities.

The Sonnenstein memorial team put together a series called “Giving Victims Back their Names,” biographical portrait booklets commemorating some of those killed. Among these is a profile of the rabbi and academic Arnold Grünfeld, who was born in 1887 and killed at Sonnenstein in 1941. A concentration camp prisoner deported to Pirna to be euthanized, Arnold was one of eighty-five Jews from Buchenwald murdered on either July 14 or 15 in 1941.

Born in a Moravian town that had had a significant Jewish community since the fourteenth century, Arnold had lost both his parents by the age of fifteen. He is presumed to have lived with other family members until he finished school; there’s a record of a school trip he took to Vienna to meet Theodor Herzl, during which students gave Herzl donations they had collected.

Arnold served his community as a rabbi and wrote his doctorate on the divine will. His daughter Edith managed to flee Europe in a youth Aliyah. Arnold was deported first to Dachau and then to Buchenwald, before being brought before a medical commission and deported to Sonnenstein, where he was probably gassed on arrival.

After his murder, he was given a false cause of death, and his wife in Prague was told she could receive his urn for a fee.

Whether his ashes were actually in the urn is unknown, but the urn was buried in the Jewish cemetery in Prague. As at Hadamar, families were provided with ashes that could have belonged to anyone, and had no means of knowing whether they had been those of their loved ones. Reportedly, the only differentiation the Nazis made was the amount of ash put into an urn of a child versus that of an adult.

As for the fabricated causes of death, my guide informed me that relatives began to be suspicious upon, for example, receiving a death certificate listing the cause of death as appendicitis for a “patient” whose appendix had already been removed years before.

In a museum pamphlet, I read that about “one-third of those employed at the Sonnenstein killing center were later assigned, most in higher positions, to the extermination camps Belzec, Sobibor, and Treblinka in 1942 and 1943. Those camps were responsible for the murder of about 1.75 million Jews.”

The booklet also includes a photograph of two employees of the Sonnenstein killing center having a beer at the Belzec concentration camp. It is related as a historical fact that the ethical callousness of the euthanasia killings and the corresponding radical desensitization contributed to the mass murders in the concentration camps. But it was also noted that there were between sixty and seventy people on site at all times and that not all of them were ideological National Socialists. Other motivations for their participation included career aspirations, higher salaries, a sense of authority and prestige, and protection from being called up for frontline military service.

Meeting with a young educator there, I asked her about the reactions of the students who visit. “What is it that really hits them?” I asked. My guide explained that what really gets to students is when they realize they could be selectively discarded. Oh wow, I could have been one of those ones who got killed.

When I heard this, I was pleased. I think it is a realization that makes a healthy presumption: that the world would be at a loss without you because the world is better with you in it. Whenever we discard someone, even in our minds, it unwittingly damages our own sense of self-worth because we will have made ourselves more precarious by their dismissal.

As noted, euthanasia, which is already a euphemism, was sometimes referred to by the Nazis as “mercy killings.” However, as with many things, the Nazis got this terribly wrong. Mercy is to be patient with ourselves and others in our weakness. Euthanasia ends a person’s life prematurely; it is an expression of impatience. Callousness can be shown quickly; expressing mercy takes time.

Having visited these three memorials, I am grateful that it is now possible to pay tribute to these lesser-known victims of Nazi euthanasia and eugenics. These sites are worth visiting; these victims deserve our remembrance and commemoration.

Exploring these memorial sites revealed to me the ways in which the euthanasia centers existed in a bizarre, liminal space: sometimes they were regarded as healthcare facilities, sometimes as killing centers. Jews were usually banned from them, but sometimes they got sent to them; many doctors and nurses were true believers in “mercy killing” but they also operated in top secrecy, falsifying death certificates and deceiving patients’ relatives; death was sometimes rationalized as being in the patient’s interest, other times it was a wartime necessity in the interest of the state; propaganda films and posters suggested that the public needed to be convinced, but the prevailing helplessness and fear experienced amid the war naturally limited pushback.

This fog of motivations and perceptions obscures the study of Nazi euthanasia and eugenics. And this is why this history is so crucial to confront: the Nazis surely hoped we would forget it, but the victims of Nazi euthanasia are not just a footnote; the dehumanization against which we need to be on guard is any instance in which a person is deemed “unworthy of life.” To study or visit these sites, I think, is to become responsible in this regard.

At the same time, my travel to these sites showed me that historical facts alone cannot teach us morality. Rather, these facts must be reckoned with and interpreted through a sincere wrestling with our own fears, insecurities, ideals, and hopes.

More articles on this topic:

• Grafeneck T-4 killing centre killed more than 10,000 people (Link)
• Hartheim Castle T-4 killing centre killed more than 30,000 people (Link).
• Hadamar T-4 killing centre killed approximately 15,000 people (Link).

Canadian cancer patient was "offered" euthanasia in the operating room.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article by Cameron Henderson that was published in The Telegraph on October 14 is an example of how aggressive the MAiD teams / euthanasia doctors and nurses are in Canada as they provide euthanasia but also promote it.

A 51-year-old Nova Scotia woman felt pressured to ask for euthanasia. Henderson reports:

Speaking anonymously, the 51-year-old cancer patient said of the moment she was offered death instead of surgery: “It floored me... [it was] the most vulnerable I’ve ever felt in my life”.

The patient, a married grandmother from Nova Scotia, explained she was set to undergo a mastectomy operation for breast cancer when a physician asked her if she knew about medical assistance in dying (MAID).

Henderson continues:

“I was sitting in two surgical gowns, one frontways and one backwards, with a cap on my hair and booties on my feet. I was shivering and in a hard plastic chair and all alone in a hallway,”

“The [doctor] sat down and went through all the scary things with me. Then he asked ‘Did you know about medical assistance in dying?’

“All I could say was, ‘I don’t want to talk about that’.

“I was scared and I was alone and I was cold and I didn’t know what was coming.

“Why was I being asked about assisted dying, when I was on my way into what I truly believe was life-saving surgery?”

The woman said that she was offered euthanasia again, nine months later, before undergoing a second mastectomy and then asked about MAiD a third time while in recovery from her second mastectomy.

The woman said that she felt - Better Off Dead - when she was asked multiple times. Henderson reported:

She said the repeat offers made her feel like a burden to doctors and that people in her position “were better off dead”.

“I felt like a problem that needed to be [gotten] rid of instead of a patient in need of treatment.

“I don’t want to be asked if I want to die,”

Dr Leonie Herx

Dr Leonie Herx, a palliative medicine consultant in Calgary, told Henderson that

staff-shortages are so bad in some Canadian hospitals that patients who are not at risk of imminent death are offered MAID before they’ve even had a chance to see a palliative care consultant.

In one instance, she claimed that one of her patients saw a MAID consultant first, and when she came back to check on him the next day, he had already been given an assisted death.

“In some cases, MAID has become the only therapy provided, which is completely horrific from a medical perspective,” Dr Herx said, in what will serve as a stark warning to the UK, where the NHS is facing a £37 billion funding gap with acute shortages in palliative care.

Herx's last comment concers the fact that the UK is debating the legalization of assisted suicide while the National Health Service is facing a massive funding gap. 

The Euthanasia Prevention Coalition has received multiple complaints concerning family member or friends being asked if they want MAiD on multiple occasions. One woman asked us how to get the MAiD team to stop asking her husband if he wants MAiD. She said, he had already said NO five times.

Scotland's assisted suicide bill is dangerous.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Professor Allan House

Assisted suicide bills will be debated in Scotland and the UK this year. An article by Professor Allan House was published in The Herald on October 14. House examines Scotland's assisted suicide bill and concludes that the:

Bill falls far short of containing the sort of safeguards we would expect in any other area of care for people with serious physical illness or those who are suicidal. In my view, it is a danger to vulnerable people and should not be allowed to pass into law.

House provides excellent insight. He states:

Throughout my career, I’ve worked to help people struggling with the impact of serious illness who may feel overwhelmed, unsupported, or suicidal. My profession has had a united approach on this. We seek to alleviate suffering while protecting the vulnerable and suicidal.

In the debate about assisted suicide a common concern, even among those who support the idea in theory, is whether a particular piece of legislation can have sufficient safeguards to protect vulnerable people. I’ve studied McArthur's proposals closely and concluded that the safeguards outlined fail to offer any real reassurance to those worried about the risks.

House brings up a good example of how assisted suicide legislation fails. He writes:

To understand why, it helps to consider a case study. Picture a 45-year-old woman who’s lived with multiple sclerosis for ten years. She has had two relapses since her diagnosis but lives independently and uses a wheelchair for trips outside her house. Going to see her doctor one day, she says she feels like ending her life. How should the doctor respond?

Under our current approach, a doctor would seek to understand more. He or she would discuss the reasons for their patient’s thinking, her personal circumstances, and consider her history of physical or mental health problems. They would want to involve others such as a partner or next of kin. They may then advise a referral to a psychiatrist – especially if the doctor did not have expertise in responding to suicidal thoughts. Work towards a more hopeful outlook and rewarding life would follow.

House explains the problem with doctors assisting suicides. He writes:

There is an unresolvable dilemma at the core physician-assisted suicide legalisation: it requires doctors to prescribe fatal medication and oversee the resulting deaths while they are not responsible for the recipient’s healthcare more generally – with no apparent requirement to follow best medical practice, exercise a duty of care, and work to prevent suicide.

Professor Allan House is an emeritus professor of liaison psychiatry and a supporter of Better Way.

When MAiD starts, its relentless, it goes after every part of society and affects everyone

This article was published by the Compassionate Community Care blog.

Calls have been steady on the CCC helpline. Some, callers are looking to help loved ones turn away from assisted suicide, others need assistance regarding advocacy or ensuring their loved one’s needs are being met and they have not been treated wrongly. 

This article captures one caller’s response, her reality and experience with MAiD being drawn on around her, for her one family member and to those vulnerable in her community.

Quotes from Laura*, one women’s experience (Ontario, Canada):

I was shocked when I first heard about MAiD, I was volunteering at a hospital and we were ordered not to talk about it; this was just before Covid. Then more and more people were talking to the patients about it, yet volunteers could not object and say anything to dissuade patients or their family members from choosing it: it was completely one-sided. I decided I was not going to go back to volunteering; I’m not going to comply with that.

When you find your own family members are talking about it, it hits a whole new level. “Yikes” – is my first line of thought, it’s creeping all over the place. My brother has terminal cancer, and he flew out the euthanasia term once while speaking to us: “when the time comes, I would go for MAID”, I was in shock. I didn’t know what to say. My query is when should we talk about? His comment caught me by surprise, I was not prepared and I did not know how to respond. Now I’m better equipped to deal with it.

It’s insidious, a friend of mine was all for having MAID done for her husband, ‘there’s nothing wrong with it.’ And yet, she goes to church all the time. It’s creeping into every element of society.

When I first called the CCC helpline, and was told about what actually happens when you get euthanized, the injections you get -- it’s not necessarily pain-free, no suffering, and the easy exit people assume it is. There are accounts and publications that share the experience of it each injection does something else: the first immobilizes you, then the second injection feels like an “internal inferno,” followed by a “drowning sensation,” and then finally, the heart stops beating, a cardiac arrest. All of it can last anywhere from 5-30 minutes. I’ve never heard of what the process may feel like, I liked knowing this so I can share it with others.

What so many who are desperate at end-of-life don’t realize, is that there is always a cure for the pain. Not long ago, a person was in hospital and getting treatment, after the staff approached her about her considering getting euthanized and she refused, they made it so she had another week in the hospital and after that she would be charged $800/day. She went through with and got MAiD, instead of being charged.

Recently at a local organizational meeting, one of the meeting members threw out the idea of MAID for her own husband (he was sick since 2009), I was shocked and saddened she would wish this for her own husband. I believe it was her sharing she needs helps, respite care and support as she’s probably burned out. She doesn’t have anybody and this is not a way for her to spend the last years of her life.

The bottom line is, MAiD/euthanasia - it’s not about caring for someone, it’s about money. The hospitals see this as a cost saving, and provide it readily to anyone for any reason.”