In the article titled "Medical Science Under Dictatorship" printed in the July 14, 1949 New England Journal of Medicine, author Leo Alexander, M.D. noted that "[s]cience under dictatorship becomes subordinated to the guiding philosophy of the dictatorship." Under the Nazi regime, medical science involved the "mass extermination of the chronically sick in the interest of saving 'useless' expenses to the community as a whole." Moreover, anyone considered "socially disturbing" or those "considered disloyal within the ruling group" were slated for extermination.

After 1940 extermination of the physically and socially unfit was so matter-of-fact that it barely merited comment in German medical journals. But how did such events get past the lay people?

Motion pictures and films were used to propagandize "gentle euthanasia." A widely used high-school mathematics text created scenarios that dealt with the cost of caring for the sick and the crippled with the implicit message that euthanasia was a rational solution.

The decision as to who would be killed "was made entirely on the basis of ... brief information by expert consultants, most of whom were professors of psychiatry in key universities." In fact, most of these professors "never saw the patients themselves." An organization devoted to the killing of children was "in charge of collecting the cost of the killing from the relatives, without, however, informing them what the charges were for." Furthermore, the cause of death was falsified on the death certificates.

Concerning the elderly, a member of the German court courageously wrote "whether old folk who have worked hard all their lives and may merely have come into their dotage are also being liquidated. There is talk that the homes for the aged are to be cleaned out too." 

According to records, some 275,000 people were put to death in these various killing centers. Of course, this was only a drop in the bucket since the euthanasia program was the beginning of the political program for "genocide of conquered nations and the racially unwanted." Thus Jews, Poles, Russians, and the British were all targeted for genocide. Schizophrenics and epileptics were targeted for extermination as were people with Parkinsonism, multiple sclerosis, and brain tumors.

Dr. Alexander was a medical consultant during the Nuremberg War Crimes investigations. He learned about the Nazi eugenics program and "conceived the principles" of the Nuremberg Code after World War II. Alexander asserted that "[i]t is rather significant that the German people were considered by their Nazi leaders more ready to accept the exterminations of the sick than those for political reasons." In fact, the Nazis would create an excuse of  illness when exterminating those whose politics went against the regime. Thus Czech underground fighters were diagnosed as "inveterate German haters." Moreover, heinous medical experimentation on the unfortunates was meant to aid the Nazi military forces.

Dr. Alexander maintained that "there is no doubt that in Germany itself the first and most effective... step within the medical profession was the propaganda barrage against the useless, [and] incurably sick."

Fast forward to Belgium. In 2002 "Belgium legalized euthanasia for adults." A Belgian documentary depicts a 34-year-old Belgian known as Eva who asks for help to die by euthanasia. In the segment, the viewers are informed by a lawyer named Gilles Genicot "that the law humanizes -- the deaths of terminally ill patients, on the one hand, and on the other hand, for patients who are not terminally ill but who are completely hopeless, there is a respect to the individual autonomy. I think it’s a major advance in the way society, law and philosophy see this very important issue."

In neighboring Netherlands "euthanasia is legal for children over the age of 12, if there is parental consent." How ironic that it was the Dutch whom Dr. Alexander praised during the War as they "recognized the earliest and most subtle phases of this attempt [against the 'useless' or 'incurably sick'] and rejected it."  In fact, "not a single euthanasia... was recommended or participated in by any Dutch physician." But currently, according to Bruno Waterfield "as previously controversial 'mercy killings' have become socially and medically acceptable [in the Netherlands]... the vast majority of medical euthanasia, have more than doubled over the decade [.] One explanation for the steep rise of Dutch cases is the introduction... of mobile euthanasia units allowing patients to be killed by voluntary lethal injection when family doctors refused."

Now "Belgium has become the first country in the world to remove any age limits allowing euthanasia for terminally ill children."

In a 2011 article by M. Pereira entitled "Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls" the author maintains that "legalizing euthanasia and assisted suicide... places many people at risk, affects the values of society over time, and does not provide controls and safeguards."  For example, in "the Netherlands, euthanasia for anyone over the age of 70 who is "tired of living" is... considered." In fact, according to Pereira "the United Nations has found that the euthanasia law in the Netherlands is in violation of its Universal Declaration of Human Rights because of the risk it poses to the rights of safety and integrity for every person's life." 

The idea of "life unworthy of life" was the backdrop to the National Socialist euthanasia program. One is hard pressed not to make a comparison to Peter Singer who has written "that... once we abandon those doctrines about the sanctity of human life... it is the refusal to accept killing that, in some cases, is horrific." 

Concerning the controversial philosopher, "religious critics have argued that Singer's ethic ignores and undermines the traditional notion of the sanctity of life; whereas bioethics associated with the Disability Rights and Disability Studies communities have argued that his epistemology is based on ableist conceptions of disability. Singer... believes the notion of the sanctity of life ought to be discarded as outdated, unscientific and irrelevant to understanding problems in contemporary bioethics." Singer's writings, by the way, are a constant staple in literary and ethics texts used in American universities.

Towards the end of his 1949 article, Dr. Alexander wondered "whether there are any danger signs that American physicians have also been infected with Hegelian, cold-blooded, utilitarian philosophy and whether early traces of it can be detected in their medical thinking that may make them vulnerable to departures of the type that occurred in Germany?" Dr. Alexander questioned whether "[t]his rationalistic point of view [would] insidiously [creep] into the motivation of medical effort, supplanting the old Hippocratic point of view."  

Yet a mere 66 years later, one can only imagine his dismay at the constantly emerging information regarding restrictions on medicines and treatments that are a constant meme of ObamaCare.

For example, in the world of socialized medicine, Great Britain's National Health Services "has started to ration hearing aids for the deaf -- with thousands of people being offered only one device when experts say they need two."  In fact, national health care in Britain "is going through a slow and agonizing death" with overcrowded hospitals, incredibly long wait times and surgeries being cancelled. 

American professors who once hailed ObamaCare are in an uproar as they realize that medically necessary care will be curtailed. Even menstrual pads, both disposable and reusable, are now classified as "medical devices" and will be federally regulated.

It should be recalled that Ezekiel Emmanuel, one of the principal architects of ObamaCare has asserted that "living too long is also a loss" since "it renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived."

In single payer systems such as Canada, and Great Britain the government decides what care people will receive and what they will be denied. Proponents of Obamacare allege the ACA saves billions of dollars but it can only do so by rationing Medicare services. 

With the continuing cancellations of health insurance policies as a direct result of ObamaCare, people are dying. Limited choice of doctors and hospitals is resulting in less than quality care. And with the massive "unresolved discrepancies, rules violations and technology problems" ObamaCare is decreasing medical care and innovation. And, of course, it was Harry Reid who unequivocally stated that ObamaCare is absolutely a step toward a single payer system.

It is not the choice of American doctors to curtail medical care to their patients. But as Dr. Alexander warned, when a government becomes totalitarian in nature, as is occurring under Obama, then that "[s]cience under dictatorship becomes subordinated to the guiding philosophy of the dictatorship." Furthermore, "under all forms of dictatorship the dictating bodies... claim that all that is done is being done for the best of the people as a whole, and that for that reason they look at health merely in terms of utility, efficiency and productivity." 

For example, no matter Obama's presumed enthusiasm for personalized medicine, it is ultimately ObamaCare that "stands in the way" of this innovation. Personalized medicine is "treatment from our own cells and could cure many diseases" but not when Washington will not permit it."

In a prescient warning, Dr. Alexander wrote that "American medicine must realize where it stands in its fundamental premises. There can be no doubt that in a subtle way the Hegelian premise of 'what is useful is right' has infected society, including the medical portion. Physicians must return to the older premises, which were the emotional foundation and driving force of an amazingly successful quest to increase powers of healing and which are bound to carry them still farther if they are not held down to earth by the pernicious attitudes of an overdone practical realism."

Eileen can be reached at middlemarch18@gmail.com