Echoes of Eugenics: What the Doctors Trial at Nuremberg Means for Us in the US

On the 75th anniversary of the trial of Nazi doctors at Nuremberg we examine Nazi medicine and gender-affirming care

Many of us parents in the trenches with a trans-identified child compare gender-affirming (GA) doctors—who mutilate children with drugs and surgeries—to Nazi doctors like Josef Mengele. (And not only GA doctors but the GA takeover of all institutions like schools, judges, health care and biopharma corporations, media, and politicians.)

It’s satisfying. But is it fair? Is it accurate? Study the evolution of Nazi medical practice and its roots in American eugenics and you’ll find, as Mark Twain said, that history may not repeat itself – but it does rhyme. Gender affirming medicine in the early 21st century echoes the international Eugenics movement of the early 20th century. And the depth of institutional capture is shockingly similar. We who ask How will we defeat Trans? and How will we get justice and repair society after we defeat Trans? could learn a lot from studying this era. Now, the 75th anniversary of the Doctors Trial at Nuremberg, is a good time to start. 

(And trans is not the only 21st century echo of Eugenics. There are others. As Santayana advised, let’s learn so we don’t repeat history.)

THINGS TO KNOW ABOUT THE DOCTORS TRIAL AT NUREMBERG

“The Nuremberg Trial” is well known: top Nazis like Göring and Hess were tried before international judges for war crimes and crimes against humanity. One outcome was the birth of international criminal law. What is less well known is that 12 subsequent trials were held at Nuremberg, all before US judges, each focusing on a particular category of evildoer, including noncombatants, like judges and business executives. The first of these Subsequent Nuremberg Trials, The Doctors Trial, saw 23 defendants (21 medical doctors) charged with murder under the guise of euthanasia, and with unethical medical experiments on human subjects. Some survivors testified, displaying their injuries. (Mengele was not a defendant. He escaped.)

All 13 trials were merely the tip of the iceberg of de-Nazifying German and Austrian society, culture, press, economy, judiciary, and politics of any remnants of Nazi ideology. By early 1947 two million ex-Nazis were either detained or forbidden to work any job but manual labor. The Allies felt when an entire society goes insane, then all sorts of people might share guilt. They found many ordinary German soldiers were not really guilty of a crime—and many non-soldiers were. A cartoonist was sentenced to ten years hard labor. Musicians and composers were investigated and kept from performing. A philosopher, still important and influential today, was interned and questioned for a year, then kept from ever working again. (Ask yourself: is a doctor who mutilates children the only evildoer? Could some intellectuals and artists have blood on their hands, too? The last time institutions went insane, our grandparents said oh yes.)

The medical profession has wrestled with the significance of the Doctors Trial. For instance, to observe its 50th anniversary, the British Medical Journal printed a special issue (free downloads here). The lead article “War crimes and medical science” warned that the Nazi problems were “not unique to one place or time, and could happen here” and the trial “left us with a legacy we still shrink from confronting.” It pointed to contemporary problems in American medicine and warned “there will always be imperatives that threaten the professional values we profess to hold so dear” and “the profession of medicine carries within it the seeds of its own destruction.” Yes. 

When the Doctors Trial ended on August 20, 1947, seven defendants were acquitted; nine were found guilty and sentenced to long prison terms; and seven were found guilty and hanged. Medical doctors in the most technically and ethically advanced society on earth were imprisoned or hanged for performing experimental procedures on human subjects without their informed consent—consent that the docs knew they needed. Think about that.

THE ROAD TO NUREMBERG

The Doctors Trial was the fruit of a tree that had been growing for decades in Europe and America. Let’s look closer. 

First, German doctors were not hacks. German medicine was not backwards. The contrary, it was the most advanced on Earth. Pre-WW2, German doctors won more Nobel Prizes in Medicine (9) than British (7), American (4), or any other nationality. Their medical journals and education were world-leading: in the early 20C, "Germany was well to the forefront in medical progress. The scientific approach to medicine had been developed there long before it spread to other countries, and postgraduates flocked to German medical schools from all over the world." The medical professionals who were about to go insane were the best and brightest anywhere. 

German medicine led the world in ethics, too. Modern notions of informed consent regulations originated in late 19C Germany: “Explicit directives concerned with the welfare of people subjected to medical experimentation in Germany were in place long before the Nuremberg code was devised in 1947.”

Still, doctors embraced eugenics with shocking enthusiasm and radicalism. They didn’t simply “go along” with Hitler, they were already so steeped in this quasi-scientific ideology that they were out ahead of Nazi politicians. “The German medical community set its own course in 1933. In some respects this course even outpaced the new [Nazi] government, which had to rein in the profession's eager pursuit of enforced eugenic sterilisations.” 

(He continues, “In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again [in 1996] and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.”)

Well into the 20C, Germany’s rules were the most progressive on earth and the Nuremberg defendants scolded American and British counterparts you perform unethical experimentation, too. They had a point. In Allied countries the standards were less evolved. In Germany the standards had decades to evolve, doctors simply chose to break rules their fathers had written.

Much of this came of doctors and medical associations promoting their own economic and professional interests. 

“More than half of all German physicians became early joiners of the Nazi Party, surpassing the party enrollments of all other professions. From early on, the German Medical Society played the most instrumental role in the Nazi medical program, beginning with the marginalization of Jewish physicians, proceeding to coerced experimentation, euthanization, and sterilization, and culminating in genocide...” [Haque et al 2012]

It is a “myth” that “the medical crimes of the Hitler regime [were] committed by a few demonic physicians working in isolation from the mainstream of German medicine. The success of this myth has imperiled the value system of medicine today.” [Seidelman 1995]

“Physicians were the most over-represented academic profession in the Third Reich. ... The Nazi doctrine attracted a profession in economic and political distress ... It drew physicians into its movement by appealing to the medical profession's pride and prosperity in the context of a philosophy that glorified contemporary medical practice. Physicians were attracted to ... tenets that championed biomedical solutions to social problems.” [Cohen 1998]

It worked. In just six years almost all “non-Aryan” physicians left practice, and income for the remaining doctors rocketed 67% from a pre-Hitler low to an all-time high. The crossroads of Eugenic medicine and Nazi politics was good for business, and the medical profession saw that opportunity early. [Hanauske-Abel 1996]

True believers existed then as now. Some parents gladly offered their children to the plan; those who did not were kept in the dark and lied to. Like today. “Most German parents didn't realize what was going on until it was too late. Unlike the forced sterilization campaign, the euthanasia policy remained largely secret, with parents receiving letters declaring a false cause of death. In some cases, though, the parents actually supported the murder of their own children.” (Riley 2004, p.78) "The Fuhrer had granted us the mercy of killing our son."

The events leading to the Doctors Trial showed what can happen when the healers become butchers. Those crimes did not come out of a clear blue sky; for decades Germany had excellent rules about human experimentation. When the winds shifted they simply chose to forget them. And it was not just the winds of politics blowing from the Führer; German doctors took a lead role in changing policy. 

Learning all this amazed me and only heightened the similarities to the present: a medical profession that was not just competent but exemplary, got carried away by greed and a quasi-scientific, quasi-political enthusiasm to the point that they eagerly ran to the front of the parade. So much about German eugenic doctors in the 1930s is also true of American and European GA doctors in the 2020s. 

You’re a doctor in the most advanced society on earth. You’re highly educated and skilled (and you never let people forget that). Still, your profession as you’ve known it is facing challenges. A new idea comes sweeping along, taking the whole world by storm. It promises a better, happier world. And those promises kind of make sense. Kind of. Its activists seem so confident, and it gets so much institutional support. Academia, business, entertainment… Charismatic, up-and-coming politicians... Billionaire donors… Plus lots of ordinary people. It combines elements of things you already liked with new elements. It appeals to you as a doctor, championing biomedical solutions to social problems. And, oh yeah, it offers huge professional and monetary benefits. 

FROM AMERICA TO NUREMBERG

The similarities go beyond that. It’s painful to recognize, but it’s actually helpful to our present cause, that those German doctors were simply following the lead of British and especially American eugenicists. (Why is it helpful? Because it proves that the sickness can come from within. The problem is not faraway men with funny accents and mustaches, it’s part of us. We made this mistake before, and we are making it again. And we are making it again in more ways than just Trans.)

Eugenics originated in late Victorian England but quickly took off in America with the broad support of America’s elites.

Top universities taught it: “After 1914, courses on eugenics were being offered at some of America’s leading universities [including] Harvard, Columbia, Cornell, and Brown … By 1928, eugenics was a topic in 376 separate college courses, which enrolled 20,000 students.” [Selden]

Lawmakers implemented it: “Sterilization began as a voluntary process but became involuntary in 1907 when Indiana became the first jurisdiction in the world to mandate the procedure against the mentally impaired, poorhouse residents, and prisoners. Three more states [including California] ratified similar laws in 1909. In 1911, New Jersey Governor Woodrow Wilson, who would become president the following year, signed into law a bill to join them. In 1913, former President Theodore Roosevelt announced his backing...” [Sasser 2019] Eventually compulsory sterilization laws were adopted by over 30 states.

Billionaire’s fortunes such as Rockefeller, Harriman, and Carnegie bankrolled private efforts both at home and abroad. All three funded the Eugenics Record Office at Cold Spring Harbor. That ended only in 1939 when the Carnegie Institution “became increasingly embarrassed” to find “mounting evidence of serious flaws in eugenics research ... [and the director’s] misuse of ‘data’ and almost religious belief in his version of eugenics... Knowledge of the horrors of the Nazi application of eugenics sealed the fate of the American movement, and the ERO was closed in 1939.” (PITTs take note: sloppy science and big missteps that embarrass funders can lead to reform.) Speaking of embarrassments, it was Rockefeller money that paid 25 year old Josef Mengele as assistant to the director at the Kaiser Wilhelm Eugenics Institute. [Messall 2004, p.34] As of 1956, eleven years after the war, Mengele’s old boss, Dr. Otmar Freiherr von Verschuer, was a member in good standing of the American Eugenics Society of 230 Park Avenue, NYC. 

America and Germany admired each other’s plans. “Hitler’s sterilization efforts were modeled on laws already introduced in America and upheld by the U.S. Supreme Court. Eugenics News in the United States evaluated the Nazi legislation as ‘clean-cut, direct and model. Its standards are social and genetical. Its application is entrusted to specialized courts and procedure. From a legal point of view nothing more could be desired.’” [Sasser 2019]

Eugenics grew so popular that professional groups vied over it. In pioneering Indiana in 1933, the hugely popular Better Babies Contest “positive eugenics” program was hijacked when male MD pediatricians grew jealous of the success of the public agency founded and led by a woman and staffed largely by non-doctors. [Stern 2002, p.750] “Maternalist public health workers created the demand for preventive child health services, but their success attracted male private practice physicians to take over the field from them.” [Pernick 2002] Politics intruded, too: intent on centralizing his New Deal plan and distancing himself from his Republican predecessors, the new Democratic Governor abruptly dismissed the founder, let go all her employees but one, a male MD, renamed the organization, and transferred it to the IU School of Medicine. [Stern 2002] On both sides of the ocean, eugenics offered irresistible opportunities for eager MDs and politicos.

(To clarify: Some practices that fall under "eugenics" are not necessarily wrong - like the prenatal care those Better Babies women popularized (think prenatal vitamins). Others are clearly wrong like coercive abortions in China. Today most women in America and Europe choose to abort Down Syndrome pregnancies. Is that ok? Some people think so and some not - but it is eugenic. Perhaps it is ok, early on. Is it ok after birth? (That's infanticide!) Is it ok to abort over the sex of the fetus? Where do you draw the line? Good and reasonable people can debate where to draw these lines. It is an important debate. But, unquestionably abortion is sometimes eugenic and it is something our society seeks to regulate. If they'd had the ability, Nazi doctors would have used this tool and it would have been ugly.)

American planners envisioned sterilizing four to ten percent of the population, alternatively ten million Americans. They never did, and while Germany soon overtook them, Americans still sterilized a surprising number: California sterilized the greatest absolute number (20,000) and Delaware the greatest rate, equaling one quarter of Nazi Germany at its peak. [Kaelber]

Again, this is not Germany, this is us. Eugenics was popular from the White House to middle America. To paraphrase Holocaust scholar Yehuda Bauer, because we did it once, we could do it again. This was America’s best and brightest, richest and most connected. 

(Better and brighter, truth be told, than the promoters of Eugenics 2.0. The people were more impressive: a medical degree from a German university in 1930 meant something, not like a degree in gender studies today. The money was smarter: Rockefeller and Harriman and Carnegie were titans, Pritzker is just a putz in a dress. The leaders were smarter: the presidents of top universities, great artists like Shaw and Wells, and so on. And Eugenics 1.0 was actually trying to address real, measurable things like gene frequencies, not imaginary things like gender identity.)

MORE ECHOES OF EUGENICS

Gender affirming medical care echoes the Eugenic medicine that originated in Britain, matured in America, and went overboard in Germany. But Eugenics has at least two more echoes today.

1. THE NEW EUGENICS. The old one, the grand eugenic program, never completely went away. We just stopped calling it “eugenics.” We unbundled it into smaller, non-threatening pieces like “choice” and “family planning” and “genetic counseling” and “prenatal screening” and “preventing tears” and “marrying smart” and the Weddings page of the New York Times. Now people love their piece of it. Even some scary pieces like involuntary sterilization continued in America and Europe for decades, though at a reduced level.

2. EUTHANASIA. The medicalized killing of humans was always a part of Eugenics 1.0. It also never went away, just shifted. In Canada euthanasia is up 32% since last year, to become the sixth leading cause of death, and disability experts are alarmed. In the Netherlands a 12 year old child can request to be euthanized—and a 16 year old child can without parental consent. These are highly progressive societies, the opposite of what you’d associate with Nazis. Yet here we are.

Both fall outside the purview of our group, but it’s important to recognize that Eugenics keeps echoing today in more ways than one, touching millions of lives. We PITTs are not alone when Eugenics touches us. 

INFORMED CONSENT

So if eugenic practices like abortion, sterilization, selective breeding and even euthanasia are used today, then what was the problem with Eugenics 1.0? What is the problem with gender-affirming care, “Eugenics 2.0”?

Consent. From a patient who is able to give consent. German law in 1900 introduced the idea. German law in 1931 reinforced it. The Nuremberg code in 1947 made Americans think they invented it. (Read it, it’s less than one page long.) 

When a medical procedure is experimental, the requirements for consent expand. If any procedure is experimental and given with anything less than the full and informed consent of the patient, then that violates a principal that came long before the Nazis and was proclaimed again after their fall. “They wrote the [Nuremberg] Code for the practice of human experimentation whenever it is being conducted.” (Katz, 1996)

So, the big questions: Is gender affirming medical care (GAC) experimental? Does the patient (can the patient) give full and informed consent? 

Yes, GAC is experimental, say European health ministries. “In light of available evidence, gender reassignment of minors is an experimental practice.” Gender reassignment medical interventions “must be done with a great deal of caution, and no irreversible treatment should be initiated.” [Council for Choices in Health Care (Finland), 2020] “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria,” [National Institute for Health and Care Excellence (UK), 2020] The NICE-UK studies “inform[ed] Dr Hilary Cass's independent review into NHS gender identity services for children and young people” that caused the NHS gender identity flagship to shut down this month. Sometimes even GAC doctors in the US admit that the evidence is not there. In Europe (but not yet America) we’re acknowledging that GAC treatments are not supported by evidence. 

No, young people cannot consent—not under current circumstances. “Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. ... The process [of properly conducted informed consent] is limited by: erroneous professional assumptions; poor quality of the initial evaluations; and inaccurate and incomplete information shared with patients and their parents. ... Even when properly accomplished, however, some clinical circumstances exist that remain quite uncertain.” [Levine, Abbruzzese and Mason, 2022] “As it now stands, in many settings informed consent [for GAC] is a perfunctory process creating the risk of uninformed consent” – not merely among the young but even among young, middle-aged, and older adults. [Levine, 2019] What they need is not endless drugs and surgeries but real mental health help.

The implication? Dr. Andrew Ivy, who testified for the prosecution at Nuremberg, wrote “acquiescence in or even silence before the violation of sacred professional ethics, [and] the service by medical men of any goal but truth for the good of humanity, can lead to dishonour and crime in which the entire medical profession of a country must ... be considered an accomplice.” 

WHAT’S THE PLAN?

It’s good to study the past. But our eyes are on the present and the future. What I want is to be armed, and to arm my fellow parents, to do battle. That starts with speaking confidently, What you do now is what eugenicists did a century ago. And when your program blows up like theirs, we will judge you the same. 

We need to break the sense of impunity. Make them worry. Will I get an entry in my professional record? Keep going, doc. Will I lose my license? Will I be hit with a lawsuit? Will I be thrown in jail? I hope that a few doctors will begin worrying Could I be charged with crimes against humanity? Secretary Levine, standing at the crossroads of children’s medicine and political power and himself a walking billboard, is a good choice. Maybe Dr. Szilagyi at the American Academy of Pediatrics.

Today medicine in America is going through its Crazy Years. It's not only trans and it's not only medicine, many institutions are. The past president of the American Civil Liberties Union complained that “at the ACLU but also ... other institutions” “the younger staff members in all of these organizations are becoming much more concerned about woke-type issues within the organization than about the organization’s larger mission.” That’s also happening “in theater and entertainment, also among librarians, and ... in academia and journalism.” On the next page the WSJ reported that “virtually every major medical organization” is bending over backwards and sacrificing standards in the cause of social justice. 1933 is calling... 

Freedom is no guarantee: in all three settings—20C America, 20C Germany, and 21C America—there were some who dissented, most often for religious reasons. But even today they are told there is no opting out of the grand program: everyone must comply. Prestige is no guarantee, not then, not now. The Tavistock Clinic “was prestigious—known all over the world for its professional seminars and specialized psychological treatments for mental-health patients” said a clinical nurse therapist. “We contacted one of the preeminent hospitals in the country ... not a clinic, not a backwater therapist ... a bona-fide medical facility of the highest caliber, nationally recognized and ranked” said one of us parents. But what is the meaning of “prestige” in a corrupted system? How does a demon in hell win Employee of the Month?

Do you want to bring down the program of Eugenics 2.0? Learn what brought down the program of Eugenics 1.0. Learn what alienated funders, soured public opinion, and scared off practitioners. Learn what became of its worst practitioners.

Trans and pediatric GAC must be crushed. If it isn’t crushed, it will grow. You think Eugenics 1.0 was good for business? (It was, it rescued German medicine.) Eugenics 2.0 is a business opportunity that Eugenics 1.0 could scarcely imagine. American Eugenicists spoke of sterilizing 10% of the population! That’s a lot of snipping, but sterilization is one-and-done. GAC, that’s a revenue stream. The dream of millions of Scott Newgents: the counseling, the drugs, the surgeries, the surgeries to repair the previous surgeries, the drugs to treat the last drugs—on and on and on for life, all paid for by insurance. The revenue! The revenue!

At least Eugenics 1.0 was self-limiting: where it worked, it solved its problem and moved on. Jewish eugenics (you read that right) has succeeded in reducing Tay-Sachs disease and eventually the TS gene may disappear. But Eugenics 2.0 could go on forever and even grow. 

A healthy child in a rich country is a terrible business opportunity. Don’t think of the problem just as Trans, think of it as the business of medicalizing social problems via synthetic identities. Today’s opportunity is to medicalize synthetic sexual identities. Tomorrow’s? The sky’s the limit. The key is to find ways to medicalize unhappiness. The argument for trans applies just as well to any other synthetic identity. In 2022 thousands of girls are saying I’m a boy. Make me one. (And vice versa.) What will kids say in 2032, I’m a harbor seal? In 2042? I am a small town in Northern Italy?

Where does this end? I think it doesn’t. It doesn’t end until we make it end. The Doctors Trial at Nuremberg is one model. We don’t need to dream of justice. We don’t need to start at step zero of the Movement Action Plan, to dream that the unthinkable might become thinkable. Our grandparents did the work, and were heroes for it. Maybe we just need to learn from their struggles, dust off their ideas, and learn to connect their work to our challenges.

P.S. And what about Mengele? Is it fair to call today’s gender-affirming docs that? Once I saw Josef Mengele as a boogieman who did terrible things out of thin air for no reason. Now I see him and his peers as the products of a skillful and humane institution, dedicated to helping people and society, that chose to be swept up in a combination of arrogance, greed, and the meeting of a radical medical ideology that thought it could give biomedical solutions to social problems with a radical political ideology that said okay. That medical ideology keeps echoing in today’s world, not only in GAC but in other ways, too. Sound familiar? So say Mengele all you like. And say Doctors Trial at Nuremberg. Say Hartmannbund Association of German Physicians to Protect Their Economic Interests. Say Eugenics Record Office at Cold Spring Harbor. Say Nuremberg Code. Say California Eugenics Law. Say it all.