In 1946, the U.S. government began to prosecute 23 National Socialist (Nazi) physicians who were accused of using the practice of medicine to hide human experimentation abuses. During the Doctors' Trial, the accused German physicians argued that what they had done was no different from abuses committed by U.S. physicians over the last century. One case in point involved eugenics.
Ernst Rüdin and the Role of Heredity in Society
Eugenics is a policy of selective breeding. Before 1933, medical ethics in Germany was noted for strict guidelines and regulations that were intended to protect human subjects from unethical experimentation. Yet, there was an undercurrent of dissatisfaction with protecting all human beings, especially those considered to be defective.
In 1916, a prominent German psychiatrist named Ernst Rüdin published a treatise on how mental illnesses such as schizophrenia were transmitted by heredity. The unspoken implication of his research was that society could remove impure hereditary influences by selectively preventing reproduction.
In 1932, the Third International Eugenics Congress elected Ernst Rüdin as its president. The consequences of this endorsement would become clear the following year.
Nazi Germany Enacts a Compulsory Sterilization Law
Shortly after Adolf Hitler was appointed Chancellor in January 1933, the German medical profession moved to endorse Nazi ideology and its aims of cleansing German society from 'impure' influences. German medical journals such as Deutsches Arzteblatt proudly displayed the Nazi flag on the front cover of its publications.
One method of purifying society was through sterilization. However, German law prohibited physicians from sterilizing patients in the absence of a medical emergency. Nevertheless, there was an economic rationale to support sterilization. A Prussian State advertisement argued that the cost of educating a child was “125 Reichsmarks for a normal pupil, 573 Reichsmarks for a slow learner, 950 Reichsmarks for an educable but mentally ill child, and 1500 Reichsmarks for a child born blind and deaf.”
Once the Nazis assumed power, Ernst Rüdin and other medical professionals drafted a compulsory sterilization law. When the law went into effect in July 1933, physicians were allowed to sterilize any individuals found to carry hereditary diseases such as alcoholism, blindness, epilepsy, depression, or feeble-mindedness.
Nazi Germany was not the first to adopt eugenics policies. Several U.S. states already had sterilization laws in place prior to 1933.
Virginia Passes the Eugenical Sterilization Act
In 1924, for example, the Commonwealth of Virginia passed the Eugenical Sterilization Act (Laws 1924, c. 394). Noting the Commonwealth's duty to promote the public welfare, the statute listed the dangers to society caused by hereditary transmission of diseases such as insanity and imbecility. Thus, “the welfare of society may be promoted in certain cases by the sterilization of mental defectives.”
Under this statute, superintendents of certain institutions were asked to evaluate the 'menace' posed by individuals under their care. If it was felt that it was in “the best interest of the patients and of society” to sterilize 'mental defectives,' then the procedure was allowed.
In order to test the statute's legality, however, an inmate needed to be sterilized.
Carrie Buck vs. Superintendent Bell
Later that year, an 18-year-old woman named Carrie Buck was committed to an institution (The Virginia Colony for the Epileptic and Feeble Minded) by her foster parents. Buck had been raped by a relative of her foster parents. In order to conceal family embarrassment over the birth of an illegitimate child, Buck was institutionalized for feeble-mindedness and sexual promiscuity. Details of the rape were kept out of the public records.
Buck allegedly had a feeble-minded mother and had herself given birth to a feeble-minded daughter. Citing the new statute, Superintendent Bell considered her a genetic menace to society and presented a petition for her sterilization.
Buck's legal guardian appealed the petition to the U.S. Supreme Court, where the case was heard on April 22, 1927. Under the law, two issues had to be answered:
- Did Virginia's statute deprive Carrie Buck of the right to due process in order to prevent her sterilization?
- Was the Virginia statute unconstitutional because it violated the 'equal protection' clause of the 14th Amendment?
Justice Oliver Wendell Holmes and Imbeciles
Despite what was at stake for one young woman, the U.S. Supreme Court wasted little time in deliberation. A quick opinion was drafted and issued about 10 days later.
Writing for the majority, Justice Oliver Wendell Holmes, Jr., affirmed that the Commonwealth of Virginia not only had the authority, but also had the obligation to sterilize the mentally handicapped. Holmes argued that as any state had the power to protect the public welfare by ordering vaccinations, then protecting the public from 'incompetence' was no different. After all, “It is better for all the world if . . . society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”
Carrie Buck's right to due process and equal protection had not been denied, as the statute granted her the right to a hearing before she could be sterilized. Buck had the opportunity to be heard, so her rights never were violated.
Brushing off Buck's legal pleas, Holmes brusquely ordered the sterilization to continue: “Three generations of imbeciles are enough.”
Virginia Repeals its Sterilization Statute
Sterilization laws continued to be used in the United States for nearly half a century. Virginia’s statute, however, was not repealed until 1974.
References
Buck v. Bell, 274 U.S. 200, 47 S. Ct. 584 (1927).
Sofair A, Kaldjian LC. 2000. Eugenic sterilization and a qualified Nazi analogy: the United States and Germany, 1930–1945. Ann Intern Med. 132:312-319.
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