Death's accomplices
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* Diana Mansell

**Nurses in Nazi Germany: moral choice in history** Bronwyn Rebekah McFarland-Icke Princeton University Press, Princeton; 1999 343 pp. US$35 (cloth) ISBN 0-691-00665-2

Nurses killed or were involved in killing 70 000 mentally and physically handicapped people in Nazi Germany. How can this be so, when the ideals of nursing are to help and to heal? The Nazi years continue to attract the attention of researchers seeking to understand a time when certain lives were deemed "unworthy of living." Over the past decade this historiography has focused on ordinary people in an attempt to understand, as Bronwyn Rebekah McFarland-Icke puts it, "how and why Germans under National Socialism behaved as they did in a time of moral crisis — what mobilized or immobilized them — and how their choices, regarded collectively, produced institutionalized barbarism"(p. vii).

In her meticulously researched and disturbing study, *Nurses in Nazi Germany: Moral Choice in History*, McFarland-Icke draws on a variety of primary sources to understand the mentality of Nazi nurses. She gains insight into their training through the window of a psychiatric nursing journal, *Die Irrenpflege*, published from 1896 on, which instructed psychiatric nurses through articles written by psychiatrists, nurses, social welfare workers and members of the clergy. She examines personnel records from two psychiatric institutions to reconstruct the atmosphere created by administrative policies. Finally, she scrutinizes the postwar trial testimonies of nurses accused of involvement with the "euthanasia" measures employed by the Nazis between 1939 and 1945.

McFarland-Icke describes the developments in psychiatry that led to the "euthanasia" program and the role nurses played in the killing of mentally and physically handicapped people in Germany between 1939 and 1945. Indeed, the techniques deployed against the Jews were first tested on Germany's disabled citizens. She focuses on two areas, the professional morality of psychiatric nurses and the realities of institutional life, and sets the evolution of psychiatry and psychiatric nursing against the backdrop of World War I, the Weimar Republic, the emergence of National Socialism and, finally, World War II. Changes in psychiatry and psychiatric nursing contributed to a changing view of the psychiatric patient. The roots of this change lie in World War I and the emerging concept of the *Volk*, "the people," to which individuals ideally subordinated themselves through sacrifice. During the economic hardships of the thirties, the moral value of "the people" superseded that of the individual, thus contributing to a situation in which the patient receded from view as an object of moral concern for nurses.

Psychiatric nurses in Nazi Germany generally came from working- or lower-middle-class backgrounds and had only a rudimentary education. Formal nursing training did not exist; some nurses were promoted into psychiatric practice from housekeeping or the kitchen. The group examined by McFarland-Icke was very different from the professional nurses of today. That being said, psychiatric institutions in Nazi Germany did not differ greatly from psychiatric institutions around the globe at the time. Although administrative policy paid lip service to the notion of nurses' training, it became increasingly difficult to obtain qualified nursing staff during the National Socialist years. The characteristics that governed the profession, however, remained the same. As members of a respectable calling, nurses were expected to exercise moral abstinence, confidentiality, patience, economy and self-control.

It was within a changing institutional and political climate that nurses became supporters of the National Socialist euthanasia program. As McFarland-Icke notes, "formal changes and rituals designed to promote National Socialist ideals cultivated an acceptance of structured authority, a readiness to contribute to a collective effort, and the habit of taking orders from superiors without asking for reasons" (p. 202). In psychiatric institutions nurses were discouraged from establishing friendships with their patients, felt powerless to influence or make decisions and were surrounded by the probing eyes and ears of potential denunciators. Was this how their moral deliberation and sense of responsibility were destroyed? For McFarland-Icke, "the National Socialist regime's most devastating power lay not in its ability to mobilize people against its victims through propaganda but rather in its ability to deploy propaganda in conjunction with specific physical, discursive, and hierarchical arrangements so that the desire for psychological comfort would prevail over courage" (p. 264).

Nazi nurses did not see the violence and blood associated with the deaths of patients, who were sent away in buses, "fell asleep" following an injection administered by a nurse, or simply wasted away from hunger. The author concludes that these "ordinary" nurses, previously trained to care for patients, became mass murderers for complex reasons that cannot be reduced simply to their willingness to follow orders. Among these were fear of reprisals, isolation from one another and their patients, a sense of powerlessness and an enforced moral paralysis. Some had an "unpleasant feeling" but did not act upon it. One nurse testified that she suffered unbearable conflicts of conscience but did not feel guilty about her assistance in the murder of adults because she was not directly involved (p. 255). A troubling comment indeed.

This research poses the unanswerable question: How would we behave in similar circumstances? The distance between Nazi nurses and nurses in Canada may not be as great as we would wish to imagine. The first nursing school in Canada opened with the motto, "I see and am Silent." At what point do obedience and professional detachment become dangerous? McFarland-Icke identifies 1933 as the year in which "strategies of eugenic management suddenly became the cornerstone of a new authoritarian regime" (p. 130). The result was the passage of the Law for the Prevention of Hereditarily Diseased Progeny. Alberta's Sexual Sterilization Act came into effect in 1928, and nurses played a significant role in its execution. Do nurses continue to remain silent today when they ought to speak out?

I thank Carolee Pollock for her comments on a draft of this review.