Death and Deliverance Michael Burleigh

...With these ideas already in place- and they were by no means unpopular notions during the Weimar period of the 1920s-it took only the organizational and propagandistic skills of the Nazis barely a decade later to give them a savage official expression...

...All pretense of mercy was soon dropped and the program became simply a way of opening up needed institutional space for military uses and of cutting the costs of expensive chronic patients...

...They are always at risk for that most deadly of cultural combinations: lethal sentimentality, singleminded efficiency, and a capacity for organized cruelty...

...That view gained a following and was one stream...

...Many parents were by no means unhappy that their sick children were being killed and were even pleased by the way hospital authorities agreed to report the deaths as "natural," sparing the parental sensibilities and nicely obfuscating what was actually taking place...

...By the end of the nineteenth century in Germany, scattered voices could be heard calling for euthanasia in the name of personal choice and mercy, using arguments identical to those heard today...

...Daniel Callahan Not long ago, I engaged in an extended and generally friendly argument with a supporter of physician-assisted suicide...

...About half of those killed during the first phase of the program were in religious institutions, with only sporadic and ineffective opposition from those who ran them...

...It is a terrible story he tells, one whose capacity to disturb should forever be kept alive in societies that would be "modern...

...I had not noticed until then the extent to which, in recent debates, the Nazi analogy has all but disappeared from use, as if by some tacit agreement it has been judged irrelevant and inflammatory, just a nasty kind of ad hominem argument...

...In the extraordinarily high death rate from mass starvation in German mental hospitals during World War I, some early warning signs of the deadly shift official attitudes could take toward the mentally ill when resources were strained provided the first signs of still another stream...

...In the gathering drive for physician-assisted suicide, we already have the lethal sentimentality...

...Simultaneously, eugenic ideas were making their way into the intellectual and scientific culture, and that was still another stream...

...Much to my surprise, he said at one point that, while I had generally been reasonable and fair in my debate with him, I crossed the line into incivility by invoking the Nazi example of euthanasia...

...and of the ways in which economic pressures to control health-care costs can take a terrible turn...

...It was not Jews who were the initial targets of the euthanasia organizers and enthusiasts, but those Germans whose misfortune it was to be born mentally or physically handicapped...

...The euthanasia program began with the killing of institutionalized children, and then moved on to the mentally ill and mentally retarded...

...Authoritarian, established churches have more than once over the centuries tended to be deferential to authoritarian governments: in their desire for good order and discipline in the ranks, they understand each other all too well...

...Most important, Burleigh's study shows that, while the euthanasia program of the Nazis eventually fed into the systematic extermination of the Jews, it had its own, partially separable origin...

...No group in German society, and few individuals, come off well in this book, but its narrative power and telling details make clear and fully support the justice of Burleigh's harsh judgment...

...of how almost everyone can become complicit in evil given the right combination of circumstances...

...The exception to that generalization is the habit of a few prolife groups to label any and all discussion of euthanasia, allowing to die, and health-care rationing as crypto-Nazi (Nat Hentoff has said as much of some of my writings...

...With the possible exception of the present situation in Holland, it remains the great historical example of the way in which what begins with mercy can end with murder...

...While, in the end, Hitler decided for reasons of political expediency to keep the euthanasia program secret, it was in fact widely known to be taking place, certainly within the medical establishment, particularly psychiatry, but within the churches as well...

...In a passage that catches well the style and nuance of his book, Burleigh writes that "A certain degree of haggling over the fate of individuals was permitted by the bureaucrats responsible for the policies, in order to promote collusive involvement, but also to cater for the element of human bad conscience...

...Perfectly identical...

...That kind of rhetorical excess has no doubt encouraged even many of those opposed to euthanasia to avoid citing Nazi parallels...

...If it does nothing else than help us see how relevant the history of Nazi euthanasia is to our own debates many decades later, Michael Burleigh's book would be a signal contribution...

...The influential 1920 tract of a legal scholar, Karl Binding, and a psychiatrist, Alfred Hoche, "Permission for the Destruction of Life Unworthy of Life," coming at a time of great economic stress in Germany, saw the joining of two of those streams, combining a call for euthanasia on humanitarian grounds (an "act of healing") with a commendation of its efficacy as a way of controlling the cost of caring for those who are a "burden" on society...

...That it is also written with such power and insight, so resistant to cant and cover-up, only increases its value...

...Michael Burleigh's book on euthanasia in Germany, a singularly powerful, disturbing, and incisive history, should help to show what a mistake it is to doubt the current relevance of the German record...

...By dating his history, "1900-45," Burleigh-a reader in international history at the London School of Economics-wants to make clear that the intellectual pieces of the euthanasia program were being put into place in German society well before the Nazis came along, as if a number of small, seemingly insignificant streams were working their way toward a larger, more deadly river that finally made its appearance in the 1930s, and then joining the still-greater effluence that was to become the "final solution" in the 1940s...

...Daniel Callahan is president of The Hastings Center and the author, most recently, of The Troubled Dream of Life: In Search of a Peaceful Death (Simon & Schuster...