Despite the widespread acceptance of this narrative, there are many reasons to question whether it accurately portrays the motivations and hopes of some Progressive-Era reformers. In a 2005 article in the Journal of Economic Perspectives, “Eugenics and Economics in the Progressive Era,” the economist Thomas C. Leonard offered a completely new historical account of the sources of Progressive-Era labor legislation and the intentions of its supporters. Leonard’s work, including an important 2009 article coauthored with legal scholar David E. Bernstein for Law and Contemporary Problems, “Excluding Unfit Workers: Social Control Versus Social Justice in the Age of Economic Reform,” indicates that lurking behind what many people see as humanitarian reforms was something much uglier.

Leonard and Bernstein argue that some of the most prominent of the Progressive reformers were “partisans of human inequality.” They supported interventions as ways to forward their eugenic goal of a purer (that is, whiter) human race by eliminating the opportunities for the “unfit” to get meaningful work. The “unfit” here included not just nonwhites (especially African-Americans) but also the “insane,” immigrants (especially from central and eastern Europe), and in a somewhat different way, women.

In other words, what we today think of as the unintended consequences of laws supported by today’s well-meaning but economically uninformed Progressives were actually the intended goals of some of their intellectual ancestors a century ago. Early Progressive economists understood the effects of these interventions, but they thought those effects were desirable.

The Progressive economists of the late nineteenth and early twentieth centuries saw social science not merely as a means of inquiry and understanding but as a guide to social management and control. The advent and broad acceptance of Darwinism in the late nineteenth century, combined with a more general belief in the power of science and scientific management to solve social problems, led to a fascination with eugenics and the possibility of using public policy to ensure the “survival of the fittest” and the purity and strength of the human race. In the hands of many thinkers at the turn of the twentieth century, Darwinian theory became a rationale for using the power of government to weed out the “undesirable” and “unfit” in much the way that the new understanding of evolution was changing agriculture and animal husbandry. Eugenics clubs and societies grew rapidly and many of the leading intellectuals of the early twentieth century, including a number of well-known economists (such as John Maynard Keynes and Irving Fisher, perhaps the most famous American economist of the time), were active in these groups and saw their work through the lens of eugenics.

Eugenics and Intended Consequences

We look back on the eugenics movement with proper horror. Yet the same ideas that led to forced sterilization also led to restrictions in the workplace, because labor markets were one place where eugenics-oriented economists could combine their two interests. They recognized early on that legislation which  excluded the “unfit” from labor markets would advance their eugenic goals. Most of these laws were enacted at the state level during this period, but the New Deal era saw many of the same arguments applied at the national level.

Consider minimum wage laws, for example. Today we tend to think people support them because they believe a minimum wage is a free lunch that will help the poor. Classical-liberal economists have long criticized such regulations, arguing they are a perfect example of the law of unintended consequences and of the disconnect between intentions and outcomes. In a competitive labor market any worker who can produce value is hirable at some wage up to that value. Even workers with limited skills are employable. What the minimum wage and other mandated benefit laws do is create a minimum productivity criterion for hiring, closing off the labor market to workers whose productivity is too low to justify that cost.

Leonard’s work shows that some advocates of the minimum wage, including many giants of the early days of the economics profession, such as John R. Commons and Richard T. Ely, understood exactly what minimum wage laws would do and liked it. In addition, various Progressives and socialists who were not economists, such as Eugene Debs and Beatrice and Sidney Webb, also supported minimum wage laws and other interventions into the labor market precisely because they would weed out those who were deemed too stupid or lazy to compete in a market economy—in particular, women, immigrants, and blacks.

Leonard writes, “the progressive economists . . . believed that the job loss induced by minimum wages was a social benefit, as it performed the eugenic service ridding the labor force of the ‘unemployable.’” He quotes the Webbs’ statement that “this unemployment is not a mark of social disease, but actually of social health.” Further, he quotes Henry Rogers Seager of Columbia University, who suggested that minimum wages were necessary to protect workers from the “wearing competition of the casual worker and the drifter.”

A. B. Wolfe, who would one day be a president of the American Economic Association, wrote in the American Economic Review in 1917 (quoted in part by Leonard and Bernstein): “If the inefficient entrepreneurs would be eliminated [by minimum wages,] so would the ineffective workers. I am not disposed to waste much sympathy upon either class. The elimination of the inefficient is in line with our traditional emphasis on free competition, and also with the spirit and trend of modern social economics. There is no panacea that can ‘save’ the incompetents except at the expense of the normal people. They are a burden on society and on the producers wherever they are.”

In the context of the early twentieth century this group largely included nonwhites, immigrants, and women, as well as white males with physical or mental disabilities—the very same groups the Progressive eugenicists thought were diluting the quality of the human gene pool. Unlike their modern successors, these supporters of minimum wage laws were under no illusion about the effects of their proposed policies; they understood and intended the negative consequences that economists now go to great lengths to argue will be the outcomes of the policies favored by contemporary Progressives. A great irony of the Progressive movement for a minimum wage is that while it aimed at eliminating the “unemployable,” it in fact created a group of “unemployables.”

Leonard’s research shows that even professional economists, including some for whom distinguished prizes and lectures are named today, engaged in a manner of thinking about issues like minimum wages that was profoundly—even obscenely, given their explicitly racist goals—anti-economic. According to some Progressives, wages were determined not by marginal productivity but by the living standards to which a particular worker was accustomed. Competition from women, children, and members of “low-wage races” threatened the dignity of white male heads of households, the robustness of the white genetic stock, and ultimately the social fabric. Leonard and Bernstein quote sociologist Edward A. Ross, who wrote that “the coolie, though he cannot outdo the American, can underlive him.” If society was to endure, white male breadwinners needed protection from outside competition.

Economists today sometimes argue that subsidies or expansion of negative income tax programs like the earned income tax credit are far more efficient ways to help the poor than policies like minimum wages. Leonard and Bernstein point out that according to Progressive economist Royal Meeker, wage subsidies were undesirable precisely because they would create more employment, particularly among “unfortunates.” The virtue of the minimum wage was that it increased the supposed dignity of white labor while separating “unfortunates” and “defectives” from jobs they would have otherwise had. Minimum wages were supported by explicit racists seeking explicitly racist ends.

Fast-forward a few decades and the results are still the same even if the intentions are more noble. In a recent paper, “Unequal Harm: Racial Disparities in the Employment Consequences of Minimum Wage Increases,” William Even and David Macpherson argued that in states fully exposed to the most recent minimum wage increases, the law cost young African Americans more jobs than the recession has. We should judge policies by results, not intentions. As the economist Thomas Sowell might say, whether a policy is deemed “compassionate” or not should depend on its effects rather than the stated goals of its advocates.

Other Labor Market Interventions

Eugenics provided an allegedly scientific pretext for protectionist legislation—specifically, restrictions on immigration. The eugenicists supported immigration restrictions because they believed that members of “low-wage races” would compromise not only whites’ living standards but also whites’ genetic stock through miscegenation. According to them, immigrants and other outsiders (read: African-Americans) would degrade the labor force and debauch the species. The Progressives proceeded on a model of society in which a (white male) breadwinner earned a “family wage” sufficient to support a (white) wife and (white) children. Women were to fulfill their roles as “mothers of the race,” and children were to be trained to do the same in the following generation.

In his 2005 article Leonard pointed out that restrictions on child labor were enacted specifically to prevent the lower classes from putting their children to work. Presumably this would then cause them to think twice about procreating as well as limit their incomes.

The Progressives used the same techniques to reduce the labor market opportunities of women. Women were seen both as fragile—in need of protection from the rigors of the workplace—and as having a special role in bearing children and managing the household as “mothers of the race.” This was in contrast to the perceived “overbreeding” of nonwhites and immigrants from places like eastern and southern Europe. Progressive reformers tried to keep women out of the labor force by enacting a variety of “protective” legislation at the state level, including maximum hours and minimum wage laws for women, both of which were set differently from those for men. Such laws made women less desirable and more expensive employees, which limited their labor force participation—precisely the goal of the reformers.

The perils of the 1930s provided an opening for additional burdens on the labor market designed to exclude “unfit” workers. Leonard and Bernstein report that the Davis-Bacon Act, for example, was “passed with the intent of preventing itinerant African American workers and others from competing with white labor unionists for jobs on federal construction projects.” The amplification of interest-group politics was evident in the relatively transparent attempts by New Deal Progressives to protect special interests from low-wage competition from the South—from African-Americans and other “low-wage races.”

In the 1930s U.S. Rep. John Cochran (D-Mo.) said he had “received numerous complaints in recent months about southern contractors employing low-paid colored mechanics getting work and bringing the employees from the South.” Rep. Clayton Allgood (D-Al.) joined in: “Reference has been made to a contractor from Alabama who went to New York with bootleg labor. This is a fact. That contractor has cheap colored labor that he transports, and he puts them in cabins, and it is labor of that sort that is in competition with white labor throughout the country.”

The disemployment effects, for example, of the National Industrial Recovery Act (NIRA) were stark. Leonard and Bernstein cite one estimate that the NIRA’s “wage provisions directly or indirectly led to the dismissal of 500,000 African American workers.” They also write that “the American Federation of Labor took credit for the failure of the FLSA [Fair Labor Standards Act] to provide for a lower minimum wage in the South,” preventing southward capital flows.

The Progressives, the Modern Left, and the Dismal Science

This history can be read as the American version of what happened earlier in England. David Levy has shown that economics became known as the “dismal science” because classical-liberal economists (such as J. S. Mill) favored racial equality in a free labor market. Reactionary, elitist British Romantics such as Thomas Carlyle and John Ruskin argued that the free market, with its underlying assumption of equality, would eliminate racial hierarchies and bring a “dismal” future of racial mixing. It was the classical-liberal economists who were providing the intellectual support for that future.

The moral of the story is that, despite the modern left’s continued claim that the pro-market philosophy is racist, sexist, and xenophobic, history demonstrates that classical liberals/libertarians were proponents of equality and opponents of racism, and that those who viewed the races as unequal were likely to seek backing from the State, particularly in labor markets. The historical record of the left on these counts is much more mixed than it is willing to acknowledge.

Despite their odious views on race and the use of the State to enforce their eugenically informed vision of the future, Progressive-Era reformers were ahead of their modern liberal counterparts in one important way. They understood that free markets, especially free labor markets, are the enemy of racism.

Economists Sandra Peart and David Levy have written a deeply interesting but ultimately unsatisfying book. While the work uses a major episode in the history of economic thought to cast light on an issue still of great importance today, I believe that the authors’ methodological predilections and their misunderstanding of the proper relationship between scientific theory and practical life result in their dancing around the periphery of that issue.

Peart and Levy’s central argument is that, under the sway of the racist views current during the late-nineteenth and early-twentieth centuries, economists abandoned the axiom of human equality held by earlier practitioners, such as Adam Smith, David Ricardo, and John Stuart Mill. The authors make a convincing case that what the leading opponents of “classical” economics chiefly rejected was its assumption that human nature is the same everywhere and that people differ primarily due to their unique life history and the particular circumstances and incentives they confront. This implies that an “expert” is unlikely to make better choices for some individual than he is for himself. That egalitarianism was anathema to intellectuals like Charles Dickens, Thomas Carlyle, Francis Galton, and John Ruskin, for whom the white race had the mission of directing the lives of their genetic inferiors. A logical extension of racist thought, especially when coupled with the new understanding of evolution proposed by Darwin and Wallace, was eugenics, which advocated top-down control over human breeding in the interest of “improving the species.”

Evangelical Christians rejected white racial dominance based on their belief that, after the Fall, all people were incapable of self-perfection and stood equally in need of God’s grace. Therefore, they allied with the classical economists in a number of prominent public debates. For example, both groups demanded the prosecution of the white governor of Jamaica, Edward Eyre, for indiscriminately killing over 400 of his black subjects to quell an episode of civil unrest, and were opposed by the racists, who lauded Eyre for dealing resolutely with “savages” who refused to appreciate the benevolent tutelage of their white masters.

Unfortunately, racist ideas eventually triumphed even in economics, as Peart and Levy demonstrate with quotes from leading economists, including Alfred Marshall, F. Y. Edgeworth, Frank Fetter, and A. C. Pigou. As a consequence, the assumption that each person should count equally when evaluating the merit of some policy was replaced by the idea that certain people may have a significantly greater capacity for happiness than do others, entitling them to preferential consideration.

The authors having persuaded me that the demise of classical economics was closely tied to the increasing weight given to race in explaining human affairs, I kept expecting to reach their debunking of those racial doctrines themselves. But the nearest thing they offered was a mathematical analysis of how folk wisdom could possibly compete with scientific models in guiding decisions.

I found this disappointing for two reasons: First, the proper outcome of scientific research is not practical advice but theoretical understanding, and so trying to measure a scientific model on the same scale as a proverb represents a categorical confusion. Second, it isn’t even that near to the discussion I hoped to find—in fact, their defense of folk wisdom strikes me as being irrelevant to their central concern, because it could be true both that folk wisdom is often a match for scientific experts and that the racists were right in that the folk wisdom, say, of the Lithuanians is superior to that of the Latvians.

But Peart and Levy do not merely avoid examining the evidence for racist views: they disparage any effort to do so, asserting that the danger of taking such theories seriously outweighs the value of any scientific truth they possibly contain. Here again, I think the authors suffer from same fundamental confusion as did the eugenicists: theoretical understanding is not a rival of, or potential substitute for, practical judgment. No genuinely scientific theory should be declared beyond the pale because it is politically incorrect. The best safeguard against such horrors as Nazism and Stalinism lies in realizing that even if their key theories were scientifically sound, it would not justify the policies they were said to imply, for such matters can never be resolved based solely on scientific facts but involve ethical judgments as well. For example, there is nothing incoherent in a scientist’s hypothesizing that race is an important factor in human action while still regarding racial persecution and discrimination as immoral.

While Peart and Levy have written a fascinating and well-researched book that successfully illuminates an important factor in the transition from classical to neoclassical economics, their work falls short of its promise due to the authors’ failure to recognize the gulf separating theoretical speculation from practical reasoning.

Science, let us stipulate at the outset, has been of inestimable value to the human race. Because of science we live longer and healthier lives (to the dismay of the Social Security bureaucrats); we have devices that make life easier, more pleasant, and more fun: think of our reliable automobiles, small computers, PDAs, cell phones, portable DVD players, and iPods (the latest thing I can’t live without); we have inexpensive ways to keep in touch with distant loved ones. All of us quickly take for granted revolutionary inventions that would have astounded our grandparents and in some cases even our parents.

But science, like anything else, can be twisted into something inimical to human welfare. I see two threats. One comes from scientism. This is the use of the procedures of the physical sciences in the study of human action, especially economics. When human beings are looked on as objects rather than persons, trouble brews. Properly conceived, science gives us life-serving control over our physical environment. Improperly conceived, it emboldens social engineers to control us. Beware those who view the economy as a machine. Statistical aggregates and simultaneous equations conceal flesh-and-blood individuals with preferences, values, and aspirations. Social engineering would meet with more skepticism if this were kept in mind.

The other threat is the subject of Crichton’s appendix: the politicization of science, or the union of scientific research and state. By now, of course, government has tainted much of science, especially medicine and climatology. There is no neutral government funding of research. Every benefit is a tether. Each grant creates a desire for future grants, which means the findings had better not offend the grant-making agency, which always has an agenda.

Crichton, who has anthropology and medical degrees from Harvard, begins his brief essay by looking back at two notorious cases of politicized science: eugenics and Lysenkoism. In both cases a preconceived “public policy” objective drove and therefore corrupted the “science.” What occurred had the appearance of science (unless one looked carefully), but in fact bore no relation to actual scientific activity. Essential terms weren’t even defined, so most of what was said was meaningless, except for its power to further the objective.

As Crichton points out, in the early twentieth century eugenics was presented as a scientific answer to a purported crisis—the enfeebling of the human race: “The best human beings were not breeding as rapidly as the inferior ones—the foreigners, immigrants, Jews, degenerates, the unfit, and the ‘feeble minded.’ ” What was the answer? In the United States, it was compulsory sterilization; in Germany, it included extermination by gas. Yet eugenics was the vogue among “progressives.” Prestigious foundations—Carnegie, Rockefeller—poured money into it. Prominent figures were eager to associate themselves with the movement, including Theodore Roosevelt, Woodrow Wilson, Winston Churchill, Alexander Graham Bell, Luther Burbank, Leland Stanford, H. G. Wells, George Bernard Shaw, and Margaret Sanger (founder of what became known as Planned Parenthood). The first president of the American Eugenics Society was the well-known Yale University economist Irving Fisher. As Crichton notes, after the Nazis gave eugenics a bad name, biographers neglected to mention their subjects’ former enthusiasm for the cause.

Regarding the scientific status of eugenics, Crichton writes, “But in retrospect, three points stand out. First . . . there was no scientific basis for eugenics. In fact, nobody at the time knew what a gene really was. The movement was able to proceed because it employed vague terms never rigorously defined. . . . Second, the eugenics movement was really a social program masquerading as a scientific one. What drove it was concern about immigration and racism and undesirable people moving into one’s neighborhood or country. . . . Third, and most distressing, the scientific establishment in both the United States and Germany did not mount any sustained protest. Quite the contrary. In Germany scientists quickly fell into line with the program.”

In the second case, the Russian peasant T. D. Lysenko’s claim that he had discovered how to make crops grow better by treating seeds and thereby altering offspring seeds had no scientific foundation whatsoever, but it fit with the anti-genetic prejudices of Josef Stalin. “Lysenko was portrayed as a genius, and he milked his celebrity for all it was worth,” Crichton writes. He eventually joined the Supreme Soviet. “By then, Lysenko and his theories dominated Russian biology. The result was famines that killed millions, and purges than sent hundreds of dissenting Soviet scientists to the gulags or the firing squads.”

Politicized science ruins and destroys lives.

The Banning of DDT

In a speech to the Commonwealth Club in San Francisco in 2003, Crichton provided another lesson in the lethality of politicized science: the ban of the insecticide DDT. In the early 1960s Rachel Carson’s book Silent Spring set off a movement to rid the world of the insecticide. As a result, the long and promising effort to defeat the scourge of mosquito-carried malaria in the developing world was reversed and the deadly disease made a tragic comeback.

In his brief discussion of this episode, Crichton pulled no punches:

I can tell you that DDT is not a carcinogen and did not cause birds to die and should never have been banned. I can tell you that the people who banned it knew that it wasn’t carcinogenic and banned it anyway. I can tell you that the DDT ban has caused the deaths of tens of millions of poor people, mostly children, whose deaths are directly attributable to a callous, technologically advanced western society that promoted the new cause of environmentalism by pushing a fantasy about a pesticide, and thus irrevocably harmed the third world. Banning DDT is one of the most disgraceful episodes in the twentieth century history of America. We knew better, and we did it anyway, and we let people around the world die and didn’t give a damn.

Crichton’s speech covers much more than this, and I commend it highly. (It is online at the PERC website, www.perc.org/publications/articles/Crichtonspeech.php.)

In the State of Fear appendix, Crichton emphasizes that he is not claiming that the global-warming scare is exactly like the fear-mongering about the supposed threat to the human gene pool. “But the similarities are not superficial,” he writes. “And I do claim that open and frank discussion of the data, and of the issues, is being suppressed. Leading scientific journals have taken strong editorial positions on the side of global warming, which, I argue, they have no business doing. Under the circumstances, any scientist who has doubts understands clearly that they will be wise to mute their expression.”

That kind of atmosphere is the death knell of genuine science and the benefits it is capable of producing. The lives and liberty of everyone are in jeopardy. “[T]he intermixing of science and politics is a bad combination, with a bad history,” Crichton concludes. “We must remember the history, and be certain that what we present to the world as knowledge is disinterested and honest.”

Today we are concerned about issues such as doctor-assisted suicide, abortion, the use of fetal tissue, genetic screening, birth control and sterilization, health-care rationing and the ethics of medical research on animals and humans. These subjects are major challenges in both ethics and economics at the end of the twentieth century. But at the beginning of the twentieth century the desire to create a more scientific medical practice and research had already raised the issues of euthanasia, eugenics, and medical experimentation on human subjects. In addition, the increasing involvement of the German government in medical care and funding medical research established the government-medical complex that the National Socialists later used to execute their extermination policies.

The German social insurance and health care system began in the 1880s under Bismarck. Ironically, it was part of Bismarck’s “anti-socialist” legislation, adopted under the theory that a little socialism would prevent the rise of a more virulent socialism.

By the time of Weimar, German doctors had become accustomed to cooperating with the government in the provision of medical care. The reforms of the Weimar Republic following the medical crises of World War I included government policies to provide health care services to all citizens. Socially minded physicians placed great hope in a new health care system, calling for a single state agency to overcome fragmentation and the lack of influence of individual practitioners and local services. The focus of medicine shifted from private practice to public health and from treating disease to preventable health care. During the German “economic consolidation” of 1924-1928, public health improved under new laws against tuberculosis, venereal disease, and alcoholism, with new advisory centers for chemical dependency and counseling bureaus for marriage and sexual problems.

Medical concerns which had largely been in the private domain in the nineteenth century increasingly became a concern of the state. The physician began to be transformed into a functionary of state-initiated laws and policies. Doctors slowly began to see themselves as more responsible for the public health of the nation than for the individual health of the patient. It is one thing to see oneself as responsible for the “nation’s health” and quite another to be responsible for an individual patient’s health. It is one thing to be employed by an individual, another to be employed by the government.

Under the Weimar Republic these reforms resulted in clearly improved public health. However, the creativity, energy, and fundamental reforms found in social medicine during the Weimar Republic seem in retrospect a short and deceptive illusion. Medical reformers had wanted to counter the misery inherited from the first World War and the Second Empire on the basis of comprehensive disease prevention programs. In the few years available to the social reformers, they had remarkable success. But in connection with these reforms the doctor’s role changed from that of advocate, adviser, and partner of the patient to a partner of the state.

Where traditional individual ethics and Christian charity had once stood, the reformers posited a collective ethic for the benefit of the general population. Private charity and welfare were nationalized. The mentally ill, for example, having been literally released from their chains in the nineteenth century and placed in local communities and boarding houses in regular contact with others (the so-called “moral therapy”), were returned to state institutions to become the ultimate victims of state “solutions.”

With the world economic crisis of 1929, welfare state expenditures had to be reduced for housing, nutrition, support payments, recreation and rehabilitation, and maternal and child health. What remained of the humanistic goals of reform were state mechanisms for inspection and regulation of public health and medical practice. Economic efficiency became the major concern, and health care became primarily a question of cost-benefit analysis. Under the socialist policies of the period, this analysis was necessarily applied to the selection of strong persons, deemed worthy of support, and the elimination of weak and “unproductive” people. The scientific underpinning of cost-benefit analyses to political medical care was provided by the new fields of genetics and eugenics.

Genetics and Eugenics

At the same time as these economic and political developments, the application of nineteenth- century scientific discoveries began to make their way into twentieth-century public health and medical practice. Charles Darwin’s studies on natural selection were of course based upon animal populations living in nature and not human populations living in complex societies. But the biological basis of natural selection gave rise to a concept of “survival of the fittest” in human civilizations. This term was coined by the British social anthropologist Herbert Spencer, and the concept led to “Social Darwinism.”

Darwin’s theories (developed in parallel with Alfred Russel Wallace—another British natural scientist) had been published prior to full elucidation of the principles of genetics. With subsequent understanding and acceptance of the science of genetics, the underlying basis of natural selection could more completely be described. While scientists still did not understand what made up the gene (awaiting Watson and Crick’s discovery of DNA in the 1950s) they began to search for outward expression of inner genetic tendencies. In the absence of being able to pinpoint individual genes, they sought outward expression of genetic “types.” These “typologies” were largely based upon external measurements of the body.

Much of this work was carried out by German anthropologists and physicians (often one and the same at that time) in newly acquired colonies in German East and Southwest Africa, prior to the loss of these colonies to Allied protectorates in World War I. Such work resumed following the war, however, and by 1927 the opening of the Kaiser Wilhelm Institute of Anthropology, Human Genetics, and Eugenics was celebrated in Berlin as the advent of the “German Oxford.” The annual report of the Institute in 1932 stated: “The term eugenics means to establish a connection between the results of the studies in human genetics and practical measures in population policy.”

Under the new “scientific understanding” of human biology provided by genetics and its implementation under eugenics, poverty, for example, would become merely an expression of degeneracy (Entartung) and genetic inferiority. “Inferior” and “superior” became natural terms used by persons of nearly all political persuasions, as readily as the terms “handicapped,” “impaired,” “socially dependent,” or “disadvantaged” are used today.

Life Unworthy of Living

Following World War I there had been concern among some in Germany that the war had decimated the ranks of the qualified and strong while weak, unqualified, and inferior people had been spared. Many felt that scant resources should not be wasted on the sick and suffering. The philosophy of the unimportance of the individual in favor of the people (das Volk) led to the belief that individuals who had become “worthless, defective parts” had to be “sacrificed or discarded.”

Alfred Hoche, a neuropathologist (as Freud had been) and Karl Binding, a lawyer, published a pamphlet in 1922, The Sanctioning of the Destruction of Life Unworthy of Living. Binding relativized the legal and moral prohibition, “Thou shalt not kill,” and Hoche alternated between economic and medical arguments. Neurologists in Saxony formally discussed the topic, “Are Doctors Allowed to Kill?” A physician in Dresden pointed out “the contradiction that many persons (reformers) demand an end to the death penalty for crimes, but the same people are for putting imbeciles [sic] to death.” By the time the National Socialist Party came to power in Germany, the mentally ill and the mentally retarded had begun to be sterilized and to be subjected to euthanasia in large numbers in German government institutions.

National Socialism and the Nation’s Health

No profession in Germany became so numerically attached to National Socialism in both its leadership and membership as was the medical profession. Because of their philosophical orientation toward finding a more scientific basis for medical research and practice, government funding for research, and the practical benefits of acquiring university positions and medical practices from the many banned and exiled German Jewish doctors, many physicians supported Nazi policies. One of the first Nazi laws, passed July 14, 1933, was the “Law for the Prevention of Progeny of Hereditary Disease,” intended to “consolidate” social and health policies in the German population and prohibit the right of reproduction for persons defined as “genetically inferior.” After 1933, the connection between the theory and practice of politicized medicine advocated by many in Weimar Germany became actual in Nazi Germany.

A “Genetic Health Court” consisting of judges and doctors made decisions about forcible sterilization. As “advocates of the state,” doctors prosecuted those persons charged with being “genetically ill” in sessions lasting generally no more than ten minutes and from which the public was barred. In 1935, an adjunct law allowed forcible abortion in such cases up to the sixth month of pregnancy. A total of 300,000 to 400,000 were sterilized and approximately 5,000 (nearly all women) died as a result of these operations. After 1945, it was argued to the Restitution Claims Commission of the German Bundestag that the “Law for the Prevention of Progeny of Hereditary Disease” not be considered in the same category as subsequent National Socialist race laws and other Nazi abuses. The sterilization law had been drafted earlier under the Weimar Republic as part of progressive health reform, and as late as 1961 was defended by an expert at the Max Planck Institute on the basis that “every cultured nation needs eugenics, and in the atomic age, more so than ever before.”

German Youth and Euthanasia

Following the sterilization laws, the National Socialists next implemented a strategy of euthanasia to solve the remaining problem of those whose conception and birth had preceded these laws. The pediatrician Ernst Wentzler, while developing plans to improve care in the German Children’s Hospitals in Berlin, personally decided (as consultant to Hitler’s Chancellery) on the deaths of thousands of handicapped children. Hans Nachtsheim placed delivery orders for handicapped children for his pressure chamber experiments on epilepsy. Joseph Mengele delivered genetic and anthropological “material” from Auschwitz to the Kaiser Wilhelm Institute and conducted his infamous twin experiments on the child victims of the Holocaust.

Julius Hallervorden at the Kaiser Wilhelm Institute for Brain Research at Berlin-Buch carried out several research projects based on euthanasia programs. Hallervorden and others systematically collected the brains of their patients who had been killed, taught the murdering doctors how to dissect, and cooperated closely with institutions where murdered children had previously been given thorough examinations and tests. During interrogation by an American officer in 1945, he stated, “I heard that they were going to do that . . . and told them . . . if you are going to kill all these people, at least take the brains . . . . There was wonderful material among these brains beautiful mental defectives, malformations and early infantile disease. I accepted these brains, of course. Where they came from and how they came to me, was really none of my business.” The collection was until recently kept by the Max Planck Institute (formerly the Kaiser Wilhelm Institute) in Frankfurt and used for brain research.

In a system in which so many were routinely condemned to die, the temptation proved strong to use human subjects in medical experimentation prior to their tragic and terrible deaths.

The Luftwaffe had developed aircraft which could climb to altitudes of nearly 60,000 feet, altitudes unattainable by Allied fighter aircraft. However, tolerance of these altitudes on the part of pilots had not yet been tested. Trials on volunteers at altitudes above 36,000 feet had to be discontinued due to severe pain. For this reason, lethal altitude experiments in pressure chambers were conducted on 200 victims held prisoner in Dachau concentration camp in a program called: “Trials for Saving Persons at High Altitude.”

Many German ships were also being sunk in the North Atlantic and North Sea, and the same group of medical investigators conducted painful ice bath experiments on 300 Dachau prisoners in a research program entitled “Avoidance and Treatment of Hypothermia in Water.” Other medical experiments were carried out with chemical and biological warfare agents and infectious diseases.

Following World War II much of this data was kept classified by Allied military authorities on the basis of national security. Debate continues to this day on the validity of these experiments and the ethical implications of any use of such data.

The Banality of Evil

We now know the end of this historical horror story of massive crimes against humanity and the leader of the thousand-year Reich burning in a bunker in Berlin. But it is not so easy to recognize the steps on the path down the slippery slope when we don’t yet know the end of the story—as today we do not know which social health reforms in combination with which new medical technologies have the potential to plunge modern society over a brink in which disaster might result. Is legalized abortion a new form of medicide? Is doctor-assisted suicide a step toward positive euthanasia? Is modern genetic testing and the Human Genome Project the first step to a new eugenics? Is health care rationing, which is always a result of government involvement in medical care, a step toward the new definition of”life unworthy of living” ? Is our present “quality of life index” a new way of saying it?

Nazi medicine was implemented by a political-medical complex—on the basis of political health care—a scientific and social philosophy imposed by a totalitarian regime. It should never happen again, but could it ever happen again?

In the United States the medical profession operates in a mixed (not a national socialist) economy which does not yet have the institutionalized mechanisms of control and regulation of Weimar Germany and in a democratic political system which thankfully does not have the political ideology of the Third Reich. But the “banality of evil” described by Hannah Arendt in the Third Reich may stem largely from a government bureaucracy in which 90 percent of the people think 90 percent of the time about process—not purpose. Does the modern bureaucratization of medicine hold any real risk for a possible return with new health reforms and new medical technologies—to some of the horrors of National Socialist medicine? Removal of personal responsibility (“I was only following orders”), personal authority, and personal choice in a bureaucratized system may leave less and less room for individual ethics in the conduct of medical science and practice.

Politicized medicine is not a sufficient cause of the mass extermination of human beings, but it seems to be a necessary cause. The Nazi Holocaust did not happen for some inexplicable German reason; it is not an event that we can afford to ignore because we are not Germans or not Nazis. The history of Germany from 1914 to 1945 is a telescoping of modernity from monarchy, war, and collapse to democracy and the welfare state, and finally to dictatorship, war, and death.

Medical ethics is the responsibility of all members of a society, not just doctors and scientists. Medicine and science alone do not have the answers to such questions as: When does life begin? When should it end? Are humans just the sum of their genetic parts or genetic programs? While bioethicists debate, individual medical choices are made a million times a day among doctors, patients, their families, and increasingly the government. The product of all these choices ultimately constitutes the ethical, legal, and social framework in which the practice of medicine and of medical research are conducted. In the end it is the preservation of freedom that will guide us to the best application of new health reforms and technologies in the future.

Dr. Robert Ritter of the German National Department of Health (right) and his associates carried out anthropological measurements and genealogical research. They prepared fingerprints and photographs in order to ascertain the “proportion of gypsy blood” in all of the Sinti and Roma of “Greater Germany.”

Nazi medicine was implemented by a political-medical complex, a scientific and social philosophy imposed by a totalitarian regime.

From The Exhibition, “The Value of the Human Being.”