Disabilities, People with

People with disabilities share the experience of stigma, discrimination, and segregation and, as a result, often find themselves denied the basic human rights and fundamental freedoms to work, pursue an education, live where they wish, move freely about society, and generally participate in the lives of their communities. Beyond these human rights infringements, however, lies a darker side to the reality of discrimination against people with disabilities. This includes egregious human rights abuses such as forced abortion and sterilization, coercive medical intervention and experimentation, selective euthanasia (often excused as "mercy killing") and, finally, in the case of Nazi Germany, massive extermination. The twenty-first century offers some hope for the human rights promise that has thus far gone unfulfilled for people with disabilities, as an international movement of disabled advocates gains momentum and international disability rights standards progressively develop.

Over the last two decades, the global community of people with disabilities has combated the perception that disabled people are objects of pity and charity, or that they are sick people in need of a cure by medical professionals. The goal has been to redefine people with disabilities as full members of society, with important contributions to make to their families and communities. This revised thinking, often called the social model of disability, emphasizes that disabled people are prevented from reaching their full potential not by their disabilities, but rather by the unhealthy and disempowering attitudes and actions of their society. This social perspective is concerned principally with identifying, exposing, and examining the limitations imposed on people with disabilities by the physical and social environments in which they live.

People with Disabilities in Historical Context

Historically, societies have held competing attitudes about disability, making generalizations on the subject difficult. Still, it can be said that pejorative attitudes toward people with disabilities appear across cultures and historical periods.

Evidence supports the contention that children born with disabilities in ancient Greece and Rome were killed (infanticide), although perhaps not as extensively as was once assumed. Spartan law specifically mandated that children born with visible physical disabilities be put to death. During the Middle Ages, there was a pronounced tendency to credit certain disabilities—particularly deafness, epilepsy and mental disabilities—with demonological origin. Attempts to treat disabilities in medieval times reflected then-current beliefs in the curative power of magic and religious rites. At the same time, disability was also viewed as part of the natural order, an expected manifestation of human variation.

After the seventeenth century, developments in the medical sciences and the proliferation of custodial institutions to house people with disabilities led to the segregation and isolation of disabled people from their families, communities, and, more generally, from society. Science was invoked to justify social, economic, and educational barriers that prevented people with disabilities from fully participating in community life. This social segregation reinforced generally held negative attitudes toward disabled people. In the mid-nineteenth century, a highly popular form of entertainment was the freak shows, in which people with disabilities were put on display at circuses, fairs, and exhibitions. In addition to reinforcing notions of disability as abnormal and deviant, such displays constituted a largely untold story of extreme abuse and assaults to human dignity. Indeed, such displays were very often enabled by contractual arrangements granting show organizers the right to display disabled people for the duration of their lives, in according to terms closely akin to slavery. From the social attitudes of this time came the eugenic agendas that were pursued with enthusiastic abandon by the early twentieth century.

People with Disabilities and the Eugenics Movement

The rise of the eugenics movement in America and Europe during the late nineteenth century led to the specific and widespread targeting of people with disabilities for abuses, and ultimately, to mass murder in Nazi Germany. Theories of race were couched in a biological framework, and appeals to science lent legitimacy to decidedly racist ideologies. Eugenicists warned that the birthrate of the "fit" and "talented" members of society had declined to an alarming extent, whereas less desirable members of society continued to multiply. There was a perception of racial degeneration, and it was feared that medical care for weak or unfit members of the population might compromise optimal human evolution.

In the United States, eugenic theories were applied with vigor, and populations of people with disabilities were primary targets. The infamous Eugenics Record Office (ERO), founded in 1910 at Cold Spring Harbor, New York, furthered eugenicists' goals through flawed and fraudulent research programs. The ERO received a steady stream of funding from notable philanthropists of the time, including John D. Rockefeller, Jr. and Mary Harriman. In 1914, one of the ERO's advisory committees concluded that 10 percent of the American population was defective and should be sterilized. In 1926 the American Eugenics Society (AES) was founded to build broad public support for eugenics, and forced sterilization in particular, and was financed by the Rockefeller Foundation, the Carnegie Institution, and George Eastman of Eastman Kodak, among others. In conjunction with this movement, many doctors began refusing treatment to infants born with disabilities.

The AES campaign largely succeeded in its mission. Among the world's nations, the United States stood at the forefront of forced sterilizations imposed upon disabled persons, particularly people with intellectual disabilities, as bogus studies linked this community to criminality, immoral behavior, and pauperism. Between 1907 and 1939, more than thirty thousand people in twenty-nine states were sterilized during incarceration in prisons or mental institutions. In 1927 the United States Supreme Court placed its imprimatur on forced sterilization in Buck v. Bell, where an eight to one majority upheld the constitutionality of the 1924 Virginia Eugenical Sterilization Act. Writing for the majority, Justice Oliver Wendell Holmes, Jr. stated:

We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. Three generations of imbeciles are enough.

"Racial Hygiene" in Nazi Germany

The appointment of Adolf Hitler as German chancellor in 1933 created the political context for the rapid implementation of eugenic and racial policies. Legal enactments affecting the lives of disabled people and responsive to the eugenics movement were swiftly introduced. The Law for the Prevention of Offspring with Hereditary Diseases was adopted in July 1933, and served as the foundation for successive eugenic and racial policies against Jewish and Roma populations, among others, throughout the Nazi era. This legislation authorized compulsory sterilization for persons found to have any of a broad range of physical and mental disabilities. Estimates suggest that at least 300,000 disabled persons were sterilized under the law prior to the outset of World War II, with an additional 75,000 sterilized soon thereafter.

In October 1935 the Marriage Health Law was introduced to prevent marriage by disabled persons. The law introduced mandatory screening of the entire population, and the issuance of a marriage license required proof that any offspring from the proposed union would not be affected with a disabling hereditary disease. This legislation paved the way for the enactment of similar laws barring marriage between Jews and Germans.

Nazi Targeting of Disabled Children for Extermination

Children with disabilities were targeted for systematic killing under a separate Nazi program that was implemented before the state began the mass murder of disabled adults. The origins of the program have been linked by historians to a 1938 request, by a father, that doctors perform a "mercy killing" on a child born with multiple disabilities—the request was granted by Hitler himself.

In August 1939 Hitler instructed his physicians to appoint a committee to oversee the killing of disabled children in a more systematic fashion. The Reich Committee for Scientific Research of Serious Illness of Hereditary and Protonic Origin was established, and it issued a decree mandating that all newborns and infants under three years of age born with suspected "hereditary diseases" (including, among others, Down's syndrome, deafness, blindness, paralysis, and congenital physical disabilities) be reported to a committee. Doctors were required to answer detailed questionnaires about quality of life and submit their results to the committee. Those selected by the committee for killing were transferred to one of twenty-eight official institutions, usually the wing of a regular hospital and among them some of Germany's finest hospitals.

A variety of particularly horrific killing methods were used to eliminate these patients, including massive lethal injection to the heart, poison administrated over an extended period of time, gassing with cyanide or chemical warfare agents, starvation, and exposure. The latter two methods were sometimes selected so that doctors could attribute the death to natural causes or to routine illness such as pneumonia. The program soon expanded, in the manner of other Nazi killing programs. In time, medical officials were asked to register all minor children with disabilities up to the age of seventeen. Estimates suggest that at least 5,000 disabled children were killed under the euthanasia program during World War II.

[T-4]

In 1933 the German Ministry of Justice proposed legislation authorizing physicians to grant "mercy deaths" in order to "end the tortures of incurable patients, upon request, in the interests of true humanity." The legislation was never formally enacted, yet its objectives—not euthanasia but the mass killing of people with mental and physical disabilities—were implemented in the form of a program known as Operation T-4, a reference to the address of its headquarters in Berlin: Tiergartenstrasse 4.

Under the top-secret T-4 program, patients in all government- and church-run sanatoria or nursing homes with a wide range of physical, sensory, and mental disabilities perceived to be hereditary in nature were targeted for extermination. Included were those with blindness, deafness, epilepsy, intellectual disabilities, autism, depression, bipolar disorder, mobility impairments, or congenital disabilities. The pool of victims later expanded to include sick residents of poorhouses and old-age homes.

Under the T-4 program by mandate, the Interior Ministry collected data from institutions about the health and capacity for work of all patients. Expert assessors, including psychiatrists, served in review commissions that evaluated completed forms. Forms were marked "+" in red for those designated for death, "–" in blue for those designated to live, and "?" for cases requiring additional review.

Six major sites existed where people with disabilities were killed under the T-4 program, of which Hadamar was the most notorious. At the Hadamar euthanasia center, authorities would issue death notices following mass executions of people with disabilities, with newspaper obituary columns stating the date and place of death. After the killing of its ten thousandth victim in 1941, the hospital staff at Hadamar held a celebration complete with a polka band, words of praise for the important work accomplished under the program, and a celebratory corpse burning, garnished with fresh flowers and small flags emblazoned with swastikas.

The T-4 program served as a testing ground for the Nazi killing machine. At the outset T-4 victims were killed by lethal injection, but they soon became the first victims of an experimental gas chamber at Brandenberg Prison. In a test run in January 1940, patients diagnosed with mental disabilities were gassed to death in an experiment intended to show the effectiveness of poison gas over other methods of killing. Nazi techniques of outfitting killing chambers with false showerheads and bathroom tiling were developed under the T-4 program.

The secrecy of the program became compromised on account of mistakes made by officials and because of the sheer scope of the program, which made it impossible to conceal from the public. The Third Reich officially halted T-4 in August 1941, after some seventy thousand disabled people had been killed. This halt related only to the official operation of killing centers and use of poison gas. The mass killing of people with disabilities continued through the end of World War II, in institutions as well as concentration camps.

In October 1945 the U.S. Military Commission considered the case of seven former staff members at Hadamar. They were tried for violations of international law for their role in the killing of over four hundred mentally disabled Polish and Soviet nationals. All accused in the Hadamar case were found guilty: Three were sentenced to death and summarily executed, one was sentenced to life imprisonment, and three served lengthy prison terms.

Forced Labor Programs and Medical Experimentation

Although the Nazis characterized people with disabilities as a burden on society without productive use, large numbers of disabled people were nonetheless subjected to forced labor in concentration camps, institutions, and elsewhere. Survivors were interviewed for a 2000 report by Disability Advocates, an American disability rights organization, as a part of a project to uncover and expose human rights abuses against disabled people during World War II. These witnesses described a wide array of abuses, including the threat made to factory laborers who sewed uniforms, that they would be sent to a concentration camp if they broke five needles. One such survivor, whose disability was a degree of hearing loss, reported the fierce pressure of enduring many more months of labor after having already broken four needles.

Disabled people were also subjected to horrific medical experiments during the Nazi era. On December 9, 1946, an American military tribunal opened criminal proceedings against twenty-three leading German physicians and administrators for their willing participation in these experiments, which were classified by the tribunal as war crimes and crimes against humanity. Sixteen of the accused were found guilty, and seven were sentenced to death.

Legal Implications of Nazi Persecution against People with Disabilities

In order to assess whether abuses against disabled people in Nazi Germany constituted the modern crime of genocide, it is first necessary to determine whether that law applies to disabled people as a protected group. A cursory examination of the definition of genocide suggests that it does not. Genocide, as defined in Article 2 of the Genocide Convention, is premised upon the intent to destroy, in whole or in part, a national, ethnic, racial, or religious group. Disabled persons would not fall within the parameters of a national or religious group, defined under international law, respectively as a group with a legal bond grounded in citizenship, or as a group sharing a common religious denomination or mode of worship. Nor would the majority of the disabled community appear to fall within the meaning of the term ethnic group, whose members share a common language or culture, although the German deaf community could indeed be considered an ethnic group so defined.

Significantly, in 1998, in the Akayesu case, the International Tribunal for Rwanda defined racial group as a stable and permanent group "based on the hereditary and physical traits often identified with a geographical region, irrespective of linguistics, cultural, national, or religious factors." The racial hygiene policies of Nazi Germany that targeted people with disabilities were based explicitly on an imagined threat to the national "germ plasm." Physical traits—whether real or perceived—were employed as distinguishing factors for the Nazi policy. The thinking, grounded in bogus scientific findings by some of the most respected scientists of the time, assumed that hereditary deafness and blindness, congenital physical disabilities, and mental disability represented direct threats to the racial health of the nation and to the mythic construction of a racially pure and strong people. The "intent to destroy in whole or in part," which is a core component of the legal definition of genocide, was made explicit in Nazi policies.

Forced sterilization and extermination programs targeting people with disabilities were thus directly related to the racist Nazi effort to "purify" and "cleanse" the nation. Accordingly, the Nazi "racial" policies would indeed appear to fall within the definition of racial group as understood in the Akayesu case. Significantly, the court in that case approached the definition of ethnic group not by reference to any universally accepted understanding, rather, it relied upon the usage of the term by the Rwandan people.

Even assuming that people with disabilities cannot be considered a "racial group" under the law of genocide, the tribunal recognized in the Akayesu case that genocide can indeed occur without meeting the definition of any of the four groups expressly protected, provided the group in question is a "permanent and stable group." This would appear to apply in relation to the atrocities against disabled persons in Nazi Germany. Notably, the Nazis had an array of classifications and registrations according to which disabled people were subjected. While the classification systems were ever expanding under the system, the subjective test remained constant—a group defined by a real or imagined hereditary characteristic linked to a mental, physical, or sensory disability—and was tied to the relentless pursuit of racial hygiene.

Linking the specific acts carried out against disabled people by the Nazis to genocidal acts as defined by the law of genocide is relatively straightforward. The systematic mass sterilizations of disabled people fall within one of the specifically prohibited acts under the Genocide Convention: "[i]mposing measures intended to prevent births within the group." The mass exterminations of disabled children and adults under the euthanasia programs clearly constitute killing members of the group. Medical experimentation, exploitative labor practices, and the appalling conditions in institutions, among other abuses, constitute "causing serious bodily or mental harm."

Finally, separate and distinct contraventions of international law apply to the atrocities against disabled people in Nazi Germany, including crimes against humanity. As defined in Article 7 of the Statute of the International Criminal Court, certain acts committed as part of a widespread, systematic attack directed against any civilian population, with knowledge of the attack, constitute crimes against humanity, including, among others, murder, extermination, severe deprivation of physical liberty, and enforced sterilization.

Modern Manifestations

Widespread abuses against people with disabilities are by no means confined to the Nazi era. Indeed, many of the attitudes and prejudices that fueled the Nazi mass murder against the disabled persist today, reflected in laws and policies that reinforce stereotypical perceptions of people with disabilities as passive, sick, dependent, in need of medical cure and charity, and, in the case of people with mental disabilities, dangerous. Such attitudes, while they have not led to the large-scale genocidal persecutions of the Nazis, have nonetheless supported a devaluing of the lives of people with disabilities that has real currency in an age of genetic engineering and renewed debate surrounding the "mercy killings" of disabled people.

While international humanitarian law and international human rights law are fully applicable to people with disabilities, massive human rights abuses experienced by this community remain largely unaddressed. People with disabilities are subjected to a variety of abuses, including forced abortion and sterilization. The February 2000 U.S. State Department Human Rights Report indicates that in 1997, the government of Japan acknowledged that some 16,500 disabled women were sterilized without their consent between 1949 and 1992. (Japan has denied compensation to the victims.) In Mad in America, Robert Whitaker details decades of electroshock "treatment," forced brain damaging surgery, and the coercive drugging of people with mental disabilities. In institutional settings, physical and mental abuses and gross neglect endangering the lives of people with disabilities are widespread. Reports issued by Mental Disability Rights International on conditions for people with mental disabilities warehoused in dismal and dangerous institutions detail unhygienic conditions of detention; excessive use of physical restraints; lack of adequate food, water, clothing, and medical care; and other life-threatening conditions, including instances of patients freezing to death.

Genocidal policies pursued relentlessly against people with disabilities in Nazi Germany are part of a long and persistent pattern of human rights abuses. Efforts by disability advocates to expose continuing discrimination and abuse, some of which may indeed amount to crimes against humanity, along with improved awareness about people with disabilities and law and policy reform at the national, regional, and international level, are of critical importance to the lives of some 600,000 disabled persons worldwide.

SEE ALSO Eugenics; Euthanasia; Germany; Medical Experimentation

BIBLIOGRAPHY

Biesold, Horst (1999). Crying Hands: Eugenics and Deaf People in Nazi Germany. Washington, D.C.: Gallaudet University Press.

Braddock, David L., and Susan L. Parish (2001). "An Institutional History of Disability." In Handbook of Disability Studies, eds. Gary L. Albrecht, Katherine D. Seelman, and Michael Bury. Thousand Oaks, Calif.: Sage Publications.

Burleigh, Michael (1994). Death and Deliverance: "Euthanasia" in Germany c. 1900–1945. Cambridge: Cambridge University Press.

Disability Rights Advocates. (2000). Forgotten Crimes: The Holocaust and People with Disabilties. Oakland, Calif.: Disability Rights Advocates. Available from: http://www.dralegal.org/publications.

Gallagher, Hugh Gregory (1995). By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich. Arlington, Va.: Vandamere Press.

Hinton, Alexander Laban, ed. (2002). Annihilating Difference: The Anthropology of Genocide. Berkeley: University of California Press.

Lord, Janet E. (2002). A White Paper: Understanding the Role of an International Convention on the Human Rights of People with Disabilities, Washington, D.C.: National Council on Disability.

The Medical Case, Trials of War Criminals before the Nuremberg Military Tribunals, Vol. 1, Nuremberg, October 1946–April 1949. Washington D.C.: U.S. G.P.O, 1949–1953.

Mental Disability Rights International (1997). Human Rights and Mental Health: Hungary. Washington, D.C: MDRI. Available from: http://www.mdri.org.

Mental Disability Rights International (1999). Children in Russia's Institutions: Human Rights and Opportunities for Reform. Washington, D.C.: MDRI. Available from: http://www.mdri.org.

Mental Disability Rights International (2000). Human Rights & Mental Health: Mexico. Washington, D.C.: MDRI. Available from: http://www.mdri.org.

Proctor, Robert (1988). Racial Hygiene: Medicine under the Nazis. Cambridge, Mass: Harvard University Press.

Whitaker, Robert (2002). Mad in America: Bad Science, Bad Medicine and the Enduring Mistretament of the Mentally Ill. Cambridge, Mass.: Perseus Publishing.

CASE LAW

Buck v. Bell 274 U.S. 200 (1927).

Prosecutor v. Jean-Paul Akayesu. 1998. Case No. ICTR 96-4-T (September 2).

Trial of Alfons Klein and Six Others (Hadamar Trial), Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. Vol. 1, Nuremberg, October 1946–April 1949. Washington D.C.: U.S. G.P.O, 1949–1953.

Janet E. Lord