Cruelty and Courage:
Nurses in the Nazi Era
‘A nurse has moral authority everywhere,’ says one expert on Third Reich
medical horrors. Sadly, most nurses managed to rationalize their complicity.
How was that possible?

By Wendy L. Bonifazi, RN, APR, CLS
October 18, 2004

During the Third Reich, home care nurses reported disabled Germans to the authorities for euthanasia because it was part of the job. Pediatric nurses earned bonuses for killing hospitalized children by slow starvation or poison. Others visited wine cellars to celebrate every 50th murder.

Yet that was years before World War II and the mass exterminations of the Holocaust.

Even so, at this nadir of modern-day nursing, some nurses risked everything to provide crumbs of food or comfort, a blanket, another day’s life, or a chance for freedom.

Nurse historians and ethicists say it’s critical to understand that some nurses embraced cruelty while others renounced it.

Physicians have extensively researched and reported atrocities by their profession, and now nurses are doing the same.

These historians interview nurses, former patients, and citizens. They read postwar trial transcripts. And they work with researchers, reviewing thousands of German nurses’ and physicians’ meticulous records and documenting everything from the mundane to murder.

In June, they shared their findings at the first international conference on nursing and midwifery in the Third Reich.

“A nurse has moral authority everywhere, or he or she shouldn’t be a nurse,” says Susan Benedict, CRNA, DSN, FAAN, professor in the College of Nursing, Medical University of South Carolina, Charleston. “Nurses who participated in euthanasia and medical experimentation set aside their individual moral authority and acquiesced to the will of the state.”

Before the war, Germany used euthanasia programs, gas chambers, and crematoria in psychiatric facilities to rid society of “useless eaters” and release them from a “life unworth living.” Children’s math problems calculated costs to keep the mentally ill and other “useless eaters” alive. Nurses helped gather, transport, and escort disabled Germans into the chambers. Eventually, these facilities became the models for the mass extermination of groups including Jews, gays, Roma, the elderly, and prisoners of war.

Gradual move toward the horrific

“We have to understand the continuum and how one set of circumstances segued to the next,” Benedict says. “Germany admired sterilization laws first passed in the United States in the 1930s and used them as a prototype for sterilizing anyone with a hereditary disease. ... [I]n 1939, they decided psychiatric patients and others should not only not reproduce, but be killed as ‘useless eaters,’ even though these patients were forced to work. Nurses and doctors bought into it and influenced others.” Nurses even helped set up gas chambers in concentration camps for the “Final Solution.”

“Nurses fell in line with belief in the state,” Benedict says. Some even swore allegiance to Hitler as part of their nursing oath at graduation. They also pledged eternal silence — and to the disappointment of researchers, it’s an oath some still maintain.

In concentration camps, according to their own records, German nurses participated in medical experiments on living people. Official Nazi correspondence report how they injected botulism and other dangerous organisms into surgical incisions, rubbed in glass and sawdust, then applied plaster casts to prevent “disturbance” of the infected sites while comparing the efficacy of potential antibiotics with untreated control subjects. Among other atrocities, they slowly froze patients to death to see what temperature they could tolerate.

“Nurses were not forced to participate in euthanasia,” Benedict says. “The worst that happened was one nurse was sent to work in the laundry. Relative to killing people, that demotion was not bad. After 60 years, nobody was discovered to have been sent to concentration camps or punished for doing anything to aid patients. One nurse brought children toys and cookies, which was used in her defense.”

Other nurses evaded killing by requesting transfers, becoming pregnant, or simply refusing. Younger nurses were not asked to participate because supervisors feared they would be distressed and reveal what they had witnessed — although it was evident, and the public soon learned, that people who were removed did not return and were soon reported dead.

Most participating nurses escaped prosecution, although immediately after the war, some were convicted and executed for the mass killings of hundreds, even thousands, of people. In 1964, 14 nurses were tried for their crimes.

“They had 20 years to prepare defenses and had seen the Nuremberg trials outcome, yet half still didn’t see anything wrong with what they did,” Benedict says. “They were socialized to devalue the lives of certain people.”

Kindness amid the killing

Other nurses saw the evil, even from afar. After learning about Auschwitz, one Austrian nurse asked to work there, then aided the Resistance, obtaining food and medications while smuggling guns.

The Jewish nurses’ philosophy was diametrically opposed to the Nazi credo. Those who were concentration camp inmates, ordered to prevent typhus epidemics and identify the weak, struggled to alleviate suffering and save fellow prisoners’ lives. And those imprisoned amid the despair of the Warsaw ghetto provided both classes and care.

“Jews have a reverence for life, a belief that to save one life is as though you’ve saved the world,” says Susan Mayer, RN, PhD, nurse historian and director of ambulatory education at North Central Bronx Hospital, N.Y. “Life was the scourge of the ghetto. They were dealing with typhoid, starvation, gunshot wounds, and burns from the fires Nazis often started.”

Before the war, the 1,200-bed Jewish hospital was considered one of Warsaw’s best. Its three-floor nursing school used the 28-month New York State University nursing curriculum.

Moved to new quarters, “surgery, internal medicine, and a children’s hospital functioned even after the ghetto was closed to the outside in 1939,” Mayer says. “They were evicted a second time in 1942, and people were shot in their beds.”

Nurse-director Luba Bielicka-Blum accelerated classes and doubled their size, Mayer says. “Students were half-starved, and everyone had diarrhea, yet they managed to travel across the ghetto, providing care to patients — many of whom had typhoid — [and] showering patients and providing clean clothes. We don’t know how much medication couriers smuggled in, but they practiced injections, and [Bielicka-Blum] insisted they attend lectures. And they frantically tried to hide children in safety.”

The Nazi net drew tighter, and food scarcer. Struggling to eke out something useful from the horror, Jewish health providers studied the effects and progress of their own starvation. Their research is used today by universities.

Of the 110 ghetto-schooled nursing students, 44 graduated, Mayer says. Most students died with the ghetto.

Compassion or collaboration?

“Several hundred nurses committed murder in institutions,” says Cheyenne Martin, RN, PhD, associate professor in the Center for Ethics, Law and Policy, University of Texas Medical Branch School of Nursing, Galveston. “But many in occupied countries resisted, especially in France, where they hid Jews in hospitals, faked surgeries and records, and rescued children. Others established MASH-like surgical units in woods around Poland and Russia. They also became masters of misinformation,” faking deaths and forging death certificates.

“When I interviewed them, they were very reticent to call themselves heroes or extraordinary. They did it because it was the right thing to do,” Martin says. “Scholars see no clear, simple reason why they would become involved. It could be personal, helping family, friends, or neighbors. Or it could be that someone asked for immediate help.” Physicians and nurses had access to medications, copying machines, and connections to the broader non-Jewish society, all of which were critical to antiwar efforts.

Historically, nurses are either participants or targets, Martin says. “In every conflict, governments see them as collaborators to enfold for skills and leadership, or targets to slaughter, destroying the infrastructure and killing off health care to enemies,” she says.

In Germany, nurses were struggling for a professional identity and lacked a single, united association. “Hitler recognized the need for nurses to carry out policies, increase health and the birthrate, and rid society of the unwanted,” Martin says. “Nurses were given lots of promises about stature and money and a professional upgrade. They were sucked into the whole notion of ethnic cleansing and persuaded to override individual and professional ethics for the greater good of Germany.”

Before the war, Jews had built some of Germany’s best hospitals, and Jewish physicians and nurses also held top positions in government-run facilities, Martin says. Nevertheless, “doctors and nurses were the first to turn in their Jewish colleagues, who were rounded up and killed,” she says. “Jewish hospitals were looted, confiscated, or burned to the ground for total annihilation.”

After the war, nurses almost never expressed remorse for collaborating, Martin says. “They could’ve had dissociation and armor toward suffering, or believed their victims would die anyway, or thought they wouldn’t want to live,” she says. But these rationalizations and issues are rarely addressed in nursing curricula.

“This is not relegated to history, long ago and far away,” Martin notes. “We need to be attentive to patterns that are repeated today. We’re hearing so many things about so many places, such as Bosnia and Rwanda. Wherever there’s war, global conflict, or ethnic cleansing, there are doctors and nurses as collaborators, resisters, or witnesses. We must be vigilant about getting co-opted as agents of the state, and maintain our ethics.”

‘Banality of evil’

“Prior to these events, these nurses weren’t obviously horrible people,” says nurse sociologist Mary Lagerwey, RN, PhD, associate professor of nursing and chair of the Institutional Review Board at Western Michigan University in Kalamazoo, Mich. “Most were ordinary, not that different from nurses today, and not without ethics training — it was a required course. Each of these nurses had the chance to say no, yet there was very, very little resistance.”

Author Hannah Arendt once spoke of the “banality of evil,” represented by the ordinariness of the Nazis’ bureaucratic dispatch of millions of lives. That banality easily describes the several common “defenses” that Lagerwey found in her review of trial transcripts. Many nurses said killing patients was a kindness they did gently, despite proof to the contrary.

“One nurse convicted in 1946,” Lager­ wey notes, “said he ‘was kind to all patients — you can ask anyone.’ The American prosecutor said, ‘But they’re all dead.’”

Others epitomized the “just a nurse, following orders” defense, Lagerwey says. At the trial for the Hadamar facility nurses, who killed 15,000 mentally ill German patients, “public health nurses said, ‘I only brought them to the hospital,’ and the head nurses said ‘I only handled medications and keys.’”

Another head nurse who participated in hospital killings testified she asked her priest how Germans could win the war while committing such crimes. “She was distraught by what they did, but not enough to stop, which makes it more appalling,” Lagerwey says. “She showed continued willingness to do what she knew was wrong.”

Nurses should understand their professional and personal vulnerabilities, she says. They must acknowledge their responsibility and accountability, maintain values consistent with ethical behavior, think critically about their orders and the larger picture, and be wary of the corrupting power of hierarchies.

“People are capable of atrocities in difficult situations,” Lagerwey says, warning that some hospital nurses abuse their power by humiliating or harming others. And until recently, nurses have whitewashed and hidden their horrible wartime behavior.

“The profession failed, not just individuals,” she says. “We can’t ignore it. Never again.”

• U.S. Holocaust Memorial Museum: www.ushmm.org
• Imperial War Museum, London: www.iwm.org.uk
• University of the West of England, Bristol: www.ess.uwe.ac.uk/genocide
• Simon Wiesenthal Center, Los Angeles: www.wiesenthal.com

Wendy Bonifazi, RN, CLS, APR, is a senior staff writer for Nursing Spectrum .