Saturday, March 27, 2010

The big blue census

Lately, I've been haunted by thoughts of the Holocaust, and how it all came about.  Hitler, of course, played an integral role, but his was but one of a myriad of circumstances, influences and precursors.

I've mentioned how the National Socialist Party took over Germany's healthcare industry, and gained the participation of doctors and other medical professionals.  Then, too, was the Nazi takeover of banks, lending institutions and corporations -- allowing them to control interest rates and Germany's GNP.  The control of Germany's youth was ensured by the takeover of their public education system.

But how did they know where to go and who to round up?  The answer is simple, singular and sinister:  the census.  Knowledge is power, after all...and the information given freely by a trusting and compliant populace provided the Nazis with everything they needed to establish its regime of terrifying totalitarianism, manipulate the masses, and annihilate the unnecessary.  Ultimately, the tragedy is that the Germans never saw or realized what was happening all around them until it was already too late.

History repeats itself...and I wonder:  would we, the American people, recognize the warning signs in time to avoid the fate of Germany?  Consider, if you will, the following document describing IBM's involvement in tallying the Final Solution.

Friday, March 26, 2010

Do no harm

September 21, 1986

German Doctors and the Final Solution

Before Auschwitz and the other death camps, the Nazis had established a policy of direct medical killing - killing arranged within medical channels, by means of medical decisions, and carried out by doctors and their assistants. The Nazis called this program ''euthanasia.''

'Euthanasia,'' in its Greek derivation, means ''good death.'' The word is generally used for actions taken to facilitate the deaths of those who are already dying, and has long been a subject of debate for physicians, moral philosophers and the general public.

The Nazis, however, used the term ''euthanasia'' to camouflage mass murder. Just how the Nazis were able to do that has been made clearer by recent historical research and by interviews I was able to conduct during the last decade with German doctors who participated in the killing project.

Nazi medicalized killing provided both the method - the gas chamber - and much of the personnel for the death camps themselves. In Auschwitz, for instance, doctors selected prisoners for death, supervised the killings in the gas chambers and decided when the victims were dead.

Doctors, in short, played a crucial role in the Final Solution. The full significance of medically directed killing for Nazi theory and behavior cannot be comprehended unless we understand how Nazi doctors destroyed the boundary between healing and killing.

The Nazi principle of killing as a therapeutic imperative is evident in the words of the Auschwitz S.S. doctor Fritz Klein. Klein was asked by an inmate how he could reconcile Auschwitz's smoking chimneys with his purported fealty to the physician's Hippocratic oath, which requires the preservation of life. ''Of course I am a doctor and I want to preserve life,'' replied Klein. ''And out of respect for human life, I would remove a gangrenous appendix from a diseased body. The Jew is the gangrenous appendix in the body of mankind.''

The Nazis justified direct medical killing by use of the simple concept of ''life unworthy of life'' - lebensunwertes Leben. While this concept predated the Nazis, it was carried to its ultimate racial and ''therapeutic'' extreme by them.

Of the five identifiable steps by which the Nazis carried out the destruction of ''life unworthy of life,'' coercive sterilization was the first. There followed the killing of ''impaired'' children in hospitals, and then the killing of ''impaired'' adults -mostly collected from mental hospitals - in centers especially equipped with carbon monoxide. The same killing centers were then used for the murders of ''impaired'' inmates of concentration camps. The final step was mass killing, mostly of Jews, in the extermination camps themselves.

Once in power - Hitler took the oath of office as Chancellor of the Third Reich on Jan. 30, 1933 - the Nazi regime introduced an early sterilization law with a declaration that Germany was in grave danger of Volkstod -''death of the people,'' ''nation'' or ''race'' - and that, to combat it, harsh and sweeping measures were imperative.

Mandatory sterilization of those termed the ''hereditarily sick'' was part of the Nazi vision of racial purification. No one knows how many people were sterilized; reliable estimates range from 200,000 to 350,000 people.

For a doctor, there is a large step between ligating spermatic cords, cutting fallopian tubes, even removing uteri, and killing or designating for death one's own patients. But, by the time the Nazis took power in Germany, some of the philosophical groundwork allowing for this transition had already been laid.

The crucial theoretical work was Die Freigabe der Vernichtung lebensunwerten Lebens, or ''The Permission to Destroy Life Unworthy of Life.'' Published in 1920, it was written jointly by two distinguished German professors, the jurist Karl Binding, retired after 40 years at the University of Leipzig, and Alfred Hoche, professor of psychiatry at the University of Freiburg.

Hoche argued in the book that a policy of killing was compassionate and consistent with medical ethics. He pointed to situations where doctors were obliged to destroy life - interrupting a pregnancy to save the mother, for example. He went on to claim that various forms of psychiatric disturbance, brain damage and retardation indicated that the patients were already ''mentally dead.'' He characterized these people as ''human ballast'' and ''empty shells of human beings'' - terms that would later reverberate in Nazi Germany. Putting such people to death, Hoche wrote, ''is not to be equated with other types of killing.'' It is, he wrote, ''an allowable, useful act.''

Binding and Hoche turned out to be the prophets of direct medicalized killing. Prior to the Nazis' assumption of power, such thinking was not a majority view in German psychiatry and medicine. But under the Nazis, there was increasing discussion in medical and political circles of the legitimacy of mercy killing, of Hoche's concept of the mentally dead, and of the enormous economic drain on German society caused by the large number of impaired Germans. A mathematics textbook of the period even asked students to calculate how many government loans to newly married couples could be granted for the money it cost the state to care for ''the crippled, the criminal, and the insane.''

The killing of children - indeed the entire Nazi ''euthanasia'' program - began simply with a petition to allow the ''mercy killing'' (Gnadentod, literally ''mercy death'') of an infant named Knauer, who was born blind, with one leg and part of one arm missing, and apparently an ''idiot.'' The petition was made by the baby's grandmother (some claim it was the father) but it was clearly encouraged by the regime.

In late 1938 or early 1939, Hitler ordered Karl Brandt, his personal physician and close confidant, to go to the clinic at the University of Leipzig where the child was hospitalized, to consult with the physicians there and to determine whether the information submitted about the child was accurate. If the facts about the child's condition were correct, Brandt recalled in 1947 at the Nuremberg Medical Trial (one in the series of Nazi war-crimes trials that was devoted solely to the prosecution of medical crimes), then in Hitler's name ''I was to inform the physicians . . . that they could carry out euthanasia.'' Brandt was also empowered to tell the doctors at Leipzig that any legal proceedings against them would be quashed by order of Hitler.

According to Brandt, the doctors agreed ''that there was no justification'' for keeping the child alive. In his recollection of the incident at the Nuremberg Medical Trial, he added that ''in maternity wards, in some circumstances, it is quite natural for the doctors themselves to perform euthanasia in such a case without anything further being said about it.''

On returning to Berlin, Brandt was authorized by Hitler, who did not want to be publicly identified with the project, to establish a child-killing program with the help of Philip Bouhler, chief of Hitler's Chancellery.

It seemed easier to start with the very young.

The child-killing program began with newborns, then proceeded to children up to the ages of 3 and 4 and soon to older ones. The authorization for the killing project was, at first, oral, secret and ''kept in a very narrow scope,'' covering ''only the most serious cases,'' according to Karl Brandt's Nuremberg trial testimony. It later became loose, extensive and known among a wider and wider circle of physicians and officials.

In 1939, a small group of doctors and Chancellery officials held discussions to lay out a structure for the project. A group of medical consultants known to have ''positive'' attitudes toward the project was assembled; among their number were administrators, pediatricians and psychiatrists.

It was decided that the program would be run secretly from the Chancellery, although the health division of the Reich Interior Ministry would help to administer it. For that purpose, an organization was created: the Reich Committee for the Scientific Registration of Serious Hereditary and Congenital Diseases. The name was meant to convey the sense of a formidable medical-scientific board, although its leader, Hans Hefelmann, had a degree in agricultural economics.

The impression of medical propriety was maintained in a confidential directive sent on Aug. 18, 1939, by Minister of the Interior Wilhelm F. Frick to the heads of non-Prussian state governments. The directive ordered ''the earliest possible registration'' of all children under 3 years of age in whom ''serious hereditary diseases'' were ''suspected''; included on the list of diseases were idiocy and mongolism (especially when associated with blindness and deafness), microcephaly, hydrocephaly, paralysis, and spastic conditions and malformations of all kinds, but especially of the limbs, head and spinal column. The registration was necessary ''for the clarification of scientific questions in the field of congenital malformation and mental retardation.''

Midwives were required to make these reports at the time of a child's birth, and doctors were to report all impaired children up to the age of 3. District medical officers were responsible for the accuracy of the reports, and the chief physicians of maternity clinics and wards were notified that the reports - which took the form of questionnaires from the Reich Health Ministry - were required.

By June 1940, the questionnaires were expanded to include not only a child's specific illness or condition, but details about family history - including hereditary illnesses and alcohol, nicotine or drug abuse - as well. The revised reports also required a more detailed evaluation of the child's condition by a physician, indicating possibilities for improvement, life expectancy, prior institutional observation and treatment, details of physical and mental development, and descriptions of convulsions and related phenomena.

The actual killing was done in children's institutions whose chiefs and prominent physicians were known to be politically reliable and ''positive'' toward the goals of the Reich Committee. These killing centers were grandly referred to as ''Reich Committee Institutions,'' ''Children's Specialty Institutions'' or even ''Therapeutic Convalescent Institutions.'' Doctors, administrators and Reich officials proceeded as if the children were to receive the blessings of medical science.

No such separate institutions existed, of course. The children marked for death were usually dispersed among ordinary pediatric patients at children's hospitals.

The falsification was clearly intended to deceive the children, their families and the general public. But, by expressing literally the Nazi reversal of healing and killing, the deceptions also served the psychological needs of the killers. A doctor could tell a parent that ''it might be necessary to perform a surgical operation that could possibly have an unfavorable result''; or he might explain that ''the ordinary therapy employed until now could no longer help'' their child, necessitating ''extraordinary therapeutic measures.''

The structure of the child-killing program also diffused individual responsibility. In the entire sequence - from the reporting of cases by midwives and doctors, to the supervision of the reporting by heads of institutions, to the coordination of the reports by Health Ministry officials, to the child's appearance at the Reich Committee institution for killing - there was no need for any single participant to feel personally responsible for the murder of another human being. Each participant could feel like no more than a small cog in a vast, officially sanctioned, medical machine.

Before being killed, children were generally kept for a few weeks in the institution, to convey the impression that they were to undergo some form of medical therapy. The killing was usually arranged by the institution's director or by a doctor working under him. Frequently, the order to kill a child was delivered by innuendo, rather than as a specific directive.

Killing was generally done with tablets of Luminal - a barbiturate - dissolved in tea or another liquid. Luminal would be given to a child repeatedly over two or three days, until the child lapsed into continuous sleep and then died.

For children who had difficulty drinking, Luminal was sometimes injected. If the Luminal did not kill the child quickly enough, the child would be given a morphine-scopolamine injection. An ordinary disease, such as pneumonia, would be listed as the cause of death; there was a kernel of truth within that lie, since the immediate cause of death following an overdose of a drug like Luminal often was pneumonia.

From the start of the program in 1939, the criteria for killing children continually expanded, and came to include various minor handicaps. The program culminated with the killing of youths designated as juvenile delinquents.

Jewish children could be placed in the net simply because they were Jewish. At Heyer, one of the childrens' institutions, a special department was established for ''minor Jewish-Aryan half-breeds.''

Although Hitler officially ordered the termination of the general ''euthanasia'' project in 1941, partly in response to public criticism by some German clergymen, the killing of children continued. Indeed, it probably increased, but was conducted in a more haphazard fashion. Estimates based on various trial materials and other evidence indicate that 5,000 children were killed between 1939 and 1945, but the total was probably much higher.

Extending the project from children to adults meant making medicalized killing official policy. Hitler enunciated this policy in his ''Fuhrer decree,'' issued in October 1939, only two months after the order requiring the registration of infants for the child ''euthanasia'' project.

The Fuhrer decree, a personal directive from Hitler that had the authority of law, was brief; it charged Karl Brandt and Philip Bouhler, chief of the Reich Chancellery, with ''responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment of their state of health can be granted a mercy death.''

The camouflage organization created for the adult killing project was the Reich Work Group of Sanitariums and Nursing Homes. It operated from the Reich Chancellery in Berlin, at Tiergarten 4. The project was thus given the code name of ''T4.''

Questionnaires for the T4 project were devised by a small group of psychiatrists and administrators. The questionnaires were distributed, with the help of the Health Ministry, not only to psychiatric institutions but to all hospitals and homes for chronic patients. The limited space provided on the questionnaires for biographical and symptomatic information, as well as the cover letter sent with them, gave the impression that the Government was conducting a statistical survey for administrative, and possibly scientific, purposes. But the sinister truth was suggested by the great stress in the questionnaires on the need for a ''precise description'' of the patient's ability to work.

From the start, the T4 reporting process was haphazard. Physicians and administrators were required to return the forms quickly; one institutional doctor had to fill out 1,500 questionnaires in two weeks. Early confusion about the purpose of the forms led some doctors to exaggerate the severity of their patients' conditions, in the belief that they were protecting them from a plan to release them from institutions in order to send them to work.

Four or five copies of every questionnaire were made in the Reich Interior Ministry. Three of the copies were sent to a trio of medical ''experts'' (Gutachter), who reviewed the reports independently to provide an ''expert evaluation'' of each patient. The other copies were retained and used as records prior to and after the patient was killed; the original was usually kept in the central files at T4 headquarters in Berlin.

In a thick, black frame at the lower left-hand corner of the forms, each of the ''experts'' would write an ''x'' in red pencil, meaning death; ''-'' in blue pencil, meaning life; or ''?'' sometimes accompanied with the comment ''worker.''

If anything, the evaluations by the experts were even more mercurial and superficial than those of the doctors and administrators who initially filled out the questionnaires. Each expert was sent at least 100 questionnaires at a time. During one 17-day period, one of the experts was required to complete 2,109 evaluations.

The experts did no examinations and had no access to medical histories; they made decisions solely on the basis of the questionnaires. Their occasional disagreements had only to do with definitions and policy; the pressure was always to order a patient's death. At his 1946 trial, Friedrich Mennecke, one of the experts, recalled the implicit directive that ''one should not be petty . . . but instead, liberal'' in rendering a ''positive judgment.''

Transportation arrangements for patients marked for death were a caricature of the psychiatric transfer process. The organization created for this function, the Common Welfare Ambulance Service Ltd., sent out ''transport lists'' to the hospitals from which it was to collect patients. It also issued instructions to the hospitals that patients must be accompanied by their case histories, personal possessions and lists of valuables held for them. In addition, it prohibited the transfer of patients whose lives would be endangered by lengthy transport -a show of medical propriety designed to avoid the awkwardness of a patient dying en route.

S.S. personnel manned the buses, frequently masquerading as doctors, nurses, or medical attendants by wearing white uniforms or white coats. Reports of ''men with white coats and S.S. boots'' came to characterize much of the ''euthanasia'' project.

To hide patients from the public, bus windows were covered with dark paint, fixed curtains or blinds. The medical staffs of the institutions from which patients were taken, as well as the patients themselves, of course, were not told the destination of the buses.

Six main killing centers were established between January 1940 and January 1941. Typically, the centers were converted mental hospitals or nursing homes, although one had been a prison. All were in isolated areas and had high walls. Some had originally been constructed as castles.

Initially, patients were taken directly to the killing centers. This practice was eventually discontinued, and patients were kept for brief periods at ''observation institutions'' or ''transit institutions'' - often large state hospitals near the killing centers - before being sent to their deaths. The observation institutions provided an aura of medical legitimacy, an ostensible check against mistakes. In fact, no real examinations or observations were made.

The bureaucratic mystification was furthered by letters sent to the families. First, they were notified of a patient's transfer from the psychiatric institution or hospital ''because of important war-related measures.'' When the patient reached the killing center, the family was sent a second letter, announcing his or her ''safe'' arrival; this notice also informed the families of the impossibility of visits or inquiries because of ''Reich defense reasons'' and ''the shortage of personnel brought about by the war.'' However, family members were told that they would be informed ''immediately'' of changes in a patient's condition or in the visiting policy. The second letter was signed, with a false name, by either the killing doctor or the chief of the killing center.

A third letter, again sent under a false name by the ''Condolence Letter Department,'' notified the family of the patient's death.

That death generally occurred within 24 hours of a patient's arrival at the killing center. Under T4 policy, a doctor had to perform the actual killing, in accordance with the motto enunciated by Viktor Brack, head of the Chancellery's Department II, which had responsibility for the T4 program: ''The syringe belongs in the hand of a physician.'' A syringe was the exception; it was usually a matter of opening a gas cock.

Throughout the ''euthanasia'' project, senior doctors served as consultants and experts, made policy and rendered decisions. Younger doctors did most of the killing.

At Brandenburg, one of the killing centers, for example, Dr. Irmfried Eberl was 29 years old when he learned to operate the gassing mechanism. The man later assigned to assist him, Dr. Aquilin Ullrich, was only 26.

In a 1961 investigation of the T4 program, Ullrich testified that his duties barely required any medical knowledge. He and Eberl (who later became the commandant of Treblinka, the only doctor actually to head a death camp) did no more than make a ''superficial inspection'' of the naked patients in the gas chamber's anteroom. He subsequently realized that ''the presence of the physician at that moment was used to calm the mentally ill and camouflage the killing process.''

Every death certificate had to be falsified. Medical credibility was the primary factor in ascribing a false cause of death: The disease had to be consistent with a patient's prior physical and mental state, a disease that he or she could have contracted. Designated causes of death included infectious diseases, pneumonia and diseases of the heart, lungs, brain and other major organs. Skill at this falsification process was an important part of the ''medical experience'' of the killing doctors. To help them, physicians were given written guidelines specifying which details were necessary for consistency.

One such guideline, for example, focused upon septicemia (bacteria in the bloodstream) as a cause of death; it referred to bacterial infection of the skin as a possible source of the disease, and listed the sequence of symptoms and the therapy to be cited. The document included additional useful tips, among them the fact that unclean mental patients often have boils which they scratch, causing the infection. ''It is most expedient to figure four days for the basic illness and five days for the resultant sepsis,'' read the guide. The diagnosis, it added, ''should not be used with patients who are meticulously clean.''

The bureaucracy of deception extended to the ashes of cremated patients. Families were told that quick cremation had been necessary for public health reasons, particularly during wartime. An additional directive prohibited corpses from being cremated individually. One of the T4 program's leaders, Gerhard Bohne, testified in his 1959 in Germany that he had objected vehemently, ''for reasons of piety,'' when that policy was implemented. He claimed to have told the administrator responsible for the order: ''Even if the German people forgive you everything, they will never forgive you this.''

Inevitably, there were flaws in the bureaucracy of deception. A family would receive two urns, or be told that a patient, whose appendix had been removed earlier, had died of appendicitis.

Employees of the killing centers would drink heavily at local bars and sometimes reveal elements of their work. Sometimes, patient-transfer procedures were conducted where they could be seen - even on occasion in a town marketplace - allowing local people to witness the force used on recalcitrant victims.

And, of course, there was direct sensory evidence of the killing that no bureaucratic deception could eliminate. ''The heavy smoke from the crematory building is said to be visible over Hadamar every day,'' read one 1939 report to the Reich Justice Ministry.

Nazi authorities were aware of these bureaucratic oversights; one local party official requested ''more sensitivity'' from T4 officials in conducting the killing program. But the ''mistakes'' were partly a product of the regime's own inner conflicts and contradictions about its principle of secrecy. In spite of the elaborate cover-up that existed at every level and the pledge of eternal secrecy taken by all involved in the killing project, outsiders were allowed to visit several of the killing centers and, on some occasions, permitted to witness the killing of patients.

From the beginning of the T4 operation, Jewish patients were viewed as a group apart. Under T4, Jewish inmates of German institutions did not have to meet the ordinary criteria for medical killing. Jewish mental patients were unique among all Nazi victims in that they could embody both ''dangerous genes'' in an individual medical sense and ''racial poison'' in a collective ethnic sense.

For Jews, ''no special consultations or discussions . . . were necessary,'' according to documents prepared by West German authorities for the 1961 trial of the T4 medical director Werner Heyde. ''The total extermination of this group of asylum inmates was the logical consequence of the radical solution of the Jewish problem being embarked upon.''

The systematic ''treatment'' of German Jews under T4 began in April 1940, with a proclamation from the Reich Interior Ministry that within three weeks all Jewish patients were to be registered. In June, the first gassings of Jews took place: 200 men, women and children were killed in the Brandenburg facility; they had been transported to the killing center in six buses from the Berlin-Buch mental institution. There were more killings in July. On Aug. 30, another directive from the Interior Ministry ordered that Jews were to be segregated in specific institutions. The directive explained that employees and relatives of Aryan patients had complained about being treated and housed with Jews.

In the fall of 1940, the Nazis began to transport Jewish patients to occupied Poland, as part of the policy of removing all Jews from Germany. In December, it was announced that Jewish patients would be transferred to a privately owned Jewish institution for mentally impaired children in Bendorf, in the Rhineland.

From Bendorf, Jewish patients were sent either to T4 killing centers or, beginning in the spring of 1942, into channels leading to the death camps. In the latter case, they were transported to Poland, in trains with 60 to 70 patients sealed in each freight car; the trains carried ordinary Jewish citizens as well.

Once the Jewish patients were herded into the trains, the pretense of medical treatment ended. The trains arrived in Lublin, where Polish Jews were being ''concentrated,'' and where property confiscated from Jews was processed with slave labor.

The T4 office set up a camouflage operation specifically for Jewish patients. On stationery with letterheads reading ''Cholm Insane Asylum,'' statements of condolence and death certificates were sent out. Couriers took the mail to Chelm (the Polish spelling) near Lublin, where the letters were mailed with the proper postmark. As far as can be determined, the ''Cholm Insane Asylum'' was a fiction. When Germany invaded Russia in June 1941, Einsatzgruppen troops under Reinhardt Heydrich liquidated hospital patients as well as Jews, gypsies and Communist functionaries. Reports from the field mentioned the need for beds for injured soldiers. But they also cited ''the German view'' that these were lives unworthy of life.

Psychological trauma suffered by Einsatzgruppen troops led Nazi authorities to lessen their reliance on shooting as a killing method. Explosives were tried - for example, in Russia, in September 1941, when mental patients were blown up. But this method was ineffective, and required too much cleaning up. Gassing, the killing method developed for adult T4 patients, was clearly preferable. Carbon monoxide was used -first in canisters and then, after further technological innovation, from the exhaust of vans.

In October 1941, Viktor Brack, head of the Chancellery's Department II, and Adolf Eichmann, the Reich's expert on Jewish affairs, decided to use the vans for killing all Jews ''incapable of working.'' Three vans were installed at the first pure extermination camp established by the Germans at Chelmno (Kulmhof), in what is now north-central Poland, which was opened in December 1941. The vans were used to kill gypsies, typhus victims, Soviet prisoners of war and mental patients, but mainly Jews.

In a replica of the T4 procedure, victims were told to shower while their clothing was being disinfected. S.S. officers wore white coats and carried stethoscopes. Prisoners had their valuables registered, then followed a sign reading ''To the Bath'' up a ramp and into the van. When no more noise was audible from the van, it was driven to the nearby woods where Jewish Kommandos unloaded the corpses into mass graves. Because of noxious gases, a crematorium was later installed.

Chelmno, in reclaimed German territory, was the first of the extermination camps. It was followed by Belzec, Sobibor and Treblinka, all of which even more closely resembled ''euthanasia'' killing centers in their use of stationary gas chambers and T4 personnel.

The ''euthanasia'' program prefigured the death camps not only in method and personnel but in reversing healing and killing in the name of biological purification.

While it has been estimated that 350 German doctors were involved in specific criminal acts, that figure may be, as one early observer recalled, no more than the ''tip of the iceberg.'' A few doctors, in various ways, resisted the Nazi projects, but German physicians as a profession offered themselves to the regime.

During the course of my research, I gained the impression that, among Germans as well as among survivors and scholars throughout the world, this involvement of physicians in killing was viewed as the most shameful of all Nazi behavior. No wonder that it still haunts German medicine, and has only recently begun to be confronted by contemporary German physicians. Yet it must be confronted, and not only by physicians. For this vision of killing in the name of healing was at the heart of Nazi mass murder. More than that, such a malignant vision seems to be part of virtually all expressions of genocide.

Nazi ''euthanasia,'' in fact, provides a key to an understanding of genocide as inclusive murder of the victim group in order to ''cure'' one's own. Since the disease one seeks to eliminate is ultimately death itself, the curative process can be endless. That murderous cure must be combated, interrupted, prevented everywhere.

Prioritized lives

Prioritized Lives
Written by Sandy Szwarc, BSN, RN, CCP
July 27, 2009
original article can be found here

We can never be allowed to hear good news about our health. The government won’t allow it. “Such is the strength of cultural miserabilism today that even the most smile-inducing good news stories can swiftly be turned into doom-laden tales about the terrible future humanity faces,” wrote Brendan O’Neill, editor of Spiked.

Reporting on the latest U.S. Census Bureau report, finding that advances in science, safe food production, healthcare and prosperity have allowed people, worldwide, to live longer, healthier and wealthier lives, Brendan’s article had a much deeper message. It examined our prejudices, our compassion for others and how our society is coming to view the value of human life.

His thought-provoking article, titled “Older people are more than food for worms,” was about aging, but could just as easily have been about fat people, handicapped people and everyone deserving of our kindness. It was a reminder of our shared humanness and the need for ethical behavior.

As he wrote, rather than being seen as good news, the Census Bureau’s report was treated as worrying, if not bad news:
The growth of the older population will have ‘formidable consequences’ and pose ‘widespread challenges’, we were told. There was talk of an ageing ‘tipping point’, ‘burdens’ on social services, and the need to ‘sound the alarm’ about how the presence on Earth of all these old folks might provoke ‘intergenerational conflict’. In one fell swoop, we went from the revelation that mankind has successfully extended life beyond birth-work-death to warnings of burdensome old people sucking up all of our health and social resources and possibly launching a war of attrition against the young. Nothing better captures the downbeat nature of public life today... The new fear of the old springs from today’s tendency to treat social policy challenges, which an ageing population no doubt is, as insurmountable demographic nightmares – and more fundamentally from our inability to give meaning to human life and see it as something more than a bovine, biological thing.

An ageing population is an unadulterated good thing. Throughout history we have sought to extend human life in order that people – and humanity more broadly – might realise their potential…
But when we do enjoy longer life expectancies, suddenly success is treated as a sign of doom and older people as little more than burdens.
They’re no longer thought of as wise people whose experience of life counts for something important but as individuals with ‘outdated and irrelevant’ views: they’re grumpy, a bit racist, hell they don’t even believe in global warming. The treatment of older people as burdensome and irrelevant speaks to Western society’s increasing estrangement from, and its fear and suspicion of, the ageing process…

Our fetishisation of youth is a way of erecting a barrier against the future, keeping everything in an innocent childish state in order to avoid having a grown-up debate about our potentially grown-up futures. Today’s ambivalent or outright hostile attitude towards the ageing process really reveals our inability to give meaning to human existence today.

Rather than seeing older people as an integral part of some social fabric… we see them as a drain on society’s apparently limited resources. Rather than seeing older people as individuals with hopes and aspirations like the rest of us, we see them increasingly as little more than bovine creatures with a long list of burdensome medical needs. Many now ask: ‘Who wants to live to be old when you’ll only be sick and slow and incapacitated?’ – revealing our inability to see the profounder side to life behind any health problems individuals might have to endure.
“Quality of life” as seen through the eyes of a youth-oriented society does not mean the lives of older people are any less meaningful. When older lives are no longer valued by society, at what age do they become “too old” to get medical care and use public healthcare resources that could go to healthier, younger people?

If you’re too old, no care for you

This week, news in Sweden reported a woman had been left to endure incredible pain due to a treatable condition for four years from the age of 79; then had to wait more than a year to see a specialist in the public healthcare system before being told she was too old to get a surgery she needed. She was given pain pills and turned away. ‘I can understand that the county feels it is expensive to 'fix' us elderly, there more and more of us,” she told Östgöta Correspondente, “but in general, I am healthy. We end up paying for healthcare for younger people, but we don’t get anything ourselves.”

That happened in Sweden’s government-managed healthcare, but could never happen here… could it? Readers deserve to know about Dr. Ezekiel Emanuel, M.D., Ph.D., who serves as the director of the Clinical Bioethics Department at the U.S. National Institutes of Health. He's a key creator of Obama’s healthcare reform plan and his bioethics advisor. He’s also the brother of White House Chief of Staff Rahm Emanuel.

Dr. Emanuel has been appointed to two key positions by the Administration: health-policy adviser at the Office of Management and Budget and a lead member of the Federal Council on Comparative Effectiveness Research, deciding how healthcare resources will be rationed. [After reading this, what comparative effectiveness research is really doing and its resulting spending priorities, covered here, may be clearer.]
His ex-wife, Linda Emanuel, by the way, headed the American Medical Association’s Institute for Ethics, launched in 1997, focused on assisted suicide, terminal care, genetics and managed care. One of its initial projects, was to educate doctors on end of life care, funded by Robert Wood Johnson Foundation with $1.5 million to start and which went on to fund it ($5.3 million between 2000-2003, alone). Its real purpose and disconcerting messages may help to explain why the AMA’s promotion of a new medical ethics that displaces the Hippocratic Oath has resulted in widespread rejection among practicing doctors of the AMA, as well as government-managed care. She spoke at an aging conference at RWJF two months ago, on May 21st, on reducing healthcare costs “without causing a panic by introducing explicit rationing of care.”
The Journal of the American Medical Association published a paper funded by Robert Wood Johnson Foundation and Blue Shield of California Foundation on June 18, 2008. Dr. Emanuel and co-author Victor Fuchs, Ph.D. of Stanford University, examined “overutilization” of healthcare and increases in the costs. They attributed four factors to doctors:
First, there is the matter of physician culture. Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them… In medical training, meticulousness, not effectiveness, is rewarded.

This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath’s admonition to “use my power to help the sick to the best of my ability and judgment”…
The Hippocratic Oath, the very foundation of medical ethics and the one that the Nazi doctors abandoned, is seen as a problem because it raises healthcare costs. To contain costs, Dr. Emanuel and Fuchs recommended “many more experiments [of] pay for performance, bundled payments, partial capitation, value-based payment or other payment methods that promote prudent use of resources.”

Specifically, how medical care is planned to be allocated (rationed) in the United States was described in the January 31st issue of the journal Lancet in “Principles for allocation of scarce medical interventions” by Dr. Emanuel and colleagues. In making rationing decisions, they recommend an alternative triage system they called “the complete lives system, which prioritizes younger people who have not yet lived a complete life.” Their ‘complete life’ principle also purportedly includes prognosis, lottery and instrumental value principles.

They first rejected caring for the sickest people first, writing:
Preferential allocation of a scarce liver to an acutely ill person unjustly ignores a currently healthier person with progressive liver disease, who might be worse off when he or she later suffers liver failure… [However], when interventions are persistently scarce, saving the progressively ill person later will always involve depriving others.

What is instrumental value? It “prioritizes specific individuals to enable or encourage future usefulness,” they wrote. “Responsibility-based allocation—eg, allocation to people who agree to improve their health and thus use fewer resources—also represents instrumental value allocation.”

Youngest first, they explained, directs resources to those who’ve had “less of something supremely valuable—life-years.” Their proposed ‘complete lives’ principle modifies the youngest-first principle, they wrote, by prioritizing adolescents and young adults over infants. “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments.” They supplied an age graph, showing how healthcare resources will be prioritized:

The ‘complete lives’ system also considers prognosis, since its aim is to achieve complete lives. “A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life… When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable,” they wrote. In conclusion:
When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated… the complete lives system justifies preference to younger people… Age can be established quickly and accurately from identity documents.
Remember, in the United States, the government now forces every citizen at retirement age into government managed care, Medicare. The only way to opt out is to relinquish all of the social security benefits you’ve paid into your entire life. The first proposal from the administration to “save healthcare costs” was to cut $313 billion from Medicare, which cares for seniors and disabled people. Didn’t anyone wonder how they really proposed to do that?*

The government, our government, is already working on deciding what lives are more valuable based on their usefulness and burden on the state, how long we will be allowed to live, and which of us will die.

Sixty-eight years ago, the appeals for compassion and ethical principles, and public condemnation of what was happening, sounded somewhat like O’Neill’s article, but with considerable more urgency. What is deeply disturbing is that the words spoken by Clemens von Galen at Münster Cathedral on August 3, 1941 in an effort to stop the Final Solution (ordered that fall) feel so imperative for us today:

[T]he doctrine is being followed, according to which one may destroy so-called “worthless life”… because, in the opinion of some department, on the testimony of some commission, they have become 'worthless life' because according to this testimony they are 'unproductive national comrades.' … of no further value for the nation and the state…
[W]e are dealing with human beings, our fellow human beings, our brothers and sisters. With poor people, sick people, if you like unproductive people. But have they for that reason forfeited the right to life? Have you, have I the right to live only so long as we are productive, so long as we are recognized by others as productive? ... then woe betide us all when we become old and frail!... then woe betide the invalids who have used up, sacrificed and lost their health and strength in the productive process… then woe betide loyal soldiers who return to the homeland seriously disabled, as cripples, as invalids. If it is once accepted that people have the right to kill 'unproductive' fellow humans—and even if initially it only affects the poor defenseless mentally ill—then as a matter of principle murder is permitted for all unproductive people, in other words for the incurably sick, the people who have become invalids through labor and war, for us all when we become old, frail and therefore unproductive.
Then, it is only necessary for some secret edict to order that the method developed for the mentally ill should be extended to other 'unproductive' people, that it should be applied to those suffering from incurable lung disease, to the elderly who are frail or invalids, to the severely disabled soldiers. Then none of our lives will be safe any more. Some commission can put us on the list of the 'unproductive,' who in their opinion have become worthless life. And no police force will protect us and no court will investigate our murder and give the murderer the punishment he deserves.
Who will be able to trust his doctor any more? He may report his patient as 'unproductive' and receive instructions to kill him. It is impossible to imagine the degree of moral depravity, of general mistrust that would then spread even through families if this dreadful doctrine is tolerated, accepted and followed.
© 2009 Szwarc

* That’s also why, in part, it was important to understand economics and the facts of who the uninsured really are in this country. Instead of finding a way to help the 7% of Americans who actually need our help and rather than caring for seniors at the time in their lives when they most need medical care, healthcare reform will have taxpayers pay for managed care for 18 million generally healthy young adults, 9.5 million illegal aliens, and 17 million with incomes over $50,000.



The decider of our lives

How would you feel if someone other than yourself made the decision as to whether you've still got a few more good years in you, or outlived your usefulness?

For myself, I could only hope that the decision-maker was a bit of a brighter bulb than our grammar-challenged former President Bush.

Out of the frying pan, and into the fire, I'm afraid.  Judging from our current leader, it would appear that eloquence isn't everything.  Here's a piece by one of President Obama's top advisors, Ezekiel Emanuel -- Rahm's bro -- in which he foreshadows the grand national healthcare plan they stand ready to impose upon the people of these United States of America.

Ask yourself as you read it:  Are your activities worthwhile?  Does your life feel complete?  My friends, get busy -- seize the day, and live each moment to its fullest!  For soon, someone else will determine for you whether or not you've lived a complete life and fulfilled your destiny.

Dare you not to shiver...

The Complete Lives System

Monday, March 15, 2010

The Wizard of Id - with sound

You know…for a second there, I thought Sue McMillin wasn’t going to mention the fact that the Board went into executive session to discuss the oddly-dated Memorandum of Understanding. In time she did, as was evidenced in yesterday’s Gazette – atta girl, Sue, I wasn't sure you had it in you.

But, as per usual, I found some things strangely lacking in her dry account; once again, I wonder why she is so accepting of the spun story.  Rather than denigrate them and play “he said, she said, she said” with Glenn and McMillin his trusty scribe, I figured it made more sense for you to hear it come straight from the horse’s mouth.

Here, then, is the one, the only, the Wizard of Id himself, D11’s Chief Financial Officer/Deputy Superintendent Glenn E. Gustafson, at the far end of a very long work session held on November 4, 2009…explaining how the District saved $3 million dollars by way of the school closures.

A couple of comments: boy, doesn’t the District have a tendency to save the best for last.  The subjects of this meeting were 23 action items - Glenn’s dissertation came at the end of the lengthy discussions regarding the status of each.  Folks, this meeting went on and on and on, and there’s only so much one can take - notice the last remaining soldiers begin to file out…

To follow lengthy balderdash with some more lengthy, numerical balderdash was clever.  I, myself, was simply HYPMOTIZED.  I’ll tell ya, Mr. Gustafson would not need to resort to Rohypnol with this spider; all he’d have to do is start crooning sweet numbers in my ear, and I’d be out like a light; in fact, at times I was…even though I always stay up for his center-stage solos.

Listen carefully to this smooth-talker as he deftly dances the old soft shoe - ya gotta admire a man who can keep a straight face whilst holding his head up high and going above and beyond the call of duty.  The moral of this story is to watch the Board meetings all the way through to the bitter end...because they often seem to save their best disinformation for last.

Friday, March 12, 2010

Thursday, March 11, 2010

Wednesday, March 10, 2010

Q & A

I asked some questions during a recent meeting at Hunt, but not all of these questions; that's alright, I appreciate this response from the office of superintendent Nick Gledich... 

By the way:  I filmed a whole lot of the movement of equipment into the Adams building; we're talking several crews of movers, and three or four of the large, tractor-trailer-sized moving vans - and this was over the course of several days and weeks.  I'll post some of that video soon, to help you conceptualize what I'm talking about...

In conclusion - unless they are emptying the building at night or via underground tunnels, I've not noticed any similar type of activity to move equipment out of Adams.  So, my hunch is the building is not empty yet - not by a long shot...


For Public Response

1.  The transformer was making a loud humming sound yesterday and utility trucks were at the school.  What was wrong? We were not notified of any issues. There are City electrical transformers that are located next to each building that provide electrical service to each building. It is not uncommon for them to make humming noises. The City crews could have been working on them without notifying us as these transformers belong to them.

2.  Did we or will we ever allow the Public to purchase extra furniture/equipment stored at Adams?  The disposal plan for excess furniture that was developed between Procurement and the Warehouse, and approved by Glenn, was to offer the furniture to D-11 schools, then Charter schools, then other local districts, then other governmental agencies and finally, non-profits.  Most everything is gone, but there are some tables and chairs left.  We have, in the past, used an auction service, but the value of the remaining items wouldn’t justify the expense.

3.  Are we (District 11) selling pianos?  The radio ran an announcement.  I believe that Tom Fleecs, the D-11 Fine Arts Facilitator, sells some pianos occasionally to help fund the repair of others.  I called to confirm, but couldn’t reach him.  Tom told me that we did use the Adam’s pianos for a trade with service district wide.

4.  Why are the Dumpsters still at the school?  Do we throw away furniture, etc. in the dumpsters? I assume you’re asking about Adams ES. We currently have a metal recycling dumpster and a trash dumpster at Adams ES as we are going thru the last bit of furniture that was not claimed. This furniture that is not useable is disassembled, with metal components getting recycled and the wood or particle board components are disposed of as trash. We do get some money for the recycled metal items (based on weight).

5.  What is housed at Adams at this time? A little bit of furniture that was not claimed by the list of invited agencies listed above, some audio visual equipment to include old TVs, and some copiers.  Dan Boltjes in IT is working on disposition of the A/V equipment, and Murray Basinger in Procurement is working on disposition of the copiers.

6.  Is there an issue with the exterior water facuet? Not that we are aware of. There is an exterior drinking fountain at the school, but it is “winterized” (or turned off) so it would not be working at this time. We typically turn these back on in late April or early May. This could be what the question was referring to.

7.  Does the district have a plan to address the facility needs at Hunt specifically the size of the lunchroom and the heat? The plan to address the size of the lunchroom (gym) and to replace the steam boilers involves a major capital project which I briefed you on before Christmas.  We do have an architectural concept that we have developed.  We would need approximately $5 million, and the project would be very difficult to safely do while the school is being used (project duration would be 8-10 months).  These improvements are in our Capital Plan for future funding, but without a specific funding source identified. 

8.  Is it true that our maintenance workers installed a thermostat backwards which created the condition of no heat last week at Hunt? No, our maintenance staff did *not* install a thermostat backwards. There was an electrical disconnect that provides power to a circulating pump for boiler #1 that was manually turned off. Not sure who or why this occurred. Without water circulating thru the piping, there will not be any heat throughout the building. There were also some unit ventilators that were manually turned off and one that the freezestat was tripped. When either of the two above mentioned items with the unit ventilators occurs, the heating valve goes full open so water circulates thru the coil but the fan motor will not operate to distribute heat across the room.

Table talk - U P D A T E D


I don’t know about you, but I have, at one time or another, experienced a yearning for a very long table. Perhaps it was whilst getting ready for a yard sale, or a Save Our Schools ice cream social, or to allow people to fill out surveys on what’s ailing District 11 or to sign petitions to recall fingerless-glove wearing board members.

My nimble-minded husband pointed out several possibilities I’d not considered. He mentioned, for instance, that a long table could be used as a wall, to protect you during snowball fights; it could be used to help line people up to receive the H1N1 vaccine; he also said it could be used as a “sex table.”

I can picture your quizzical expressions; indeed, for what could you use a long table? Whether it be for a family reunion, or selling Girl Scout cookies, a long table has practically limitless utility.

My husband also pointed out that, when used in conjunction with army tarps, several long tables could serve as durable, hard-top shelters for the homeless - er, I mean, "illegal campers” – low-cost, quasi-residential, modular tract housing, in a sense; it certainly wouldn’t be much more unsightly than this randomly-selected neighborhood near Security Service Stadium -- when did they stop calling it the Sky Sox Stadium, by the way?  And I could be wrong, but is that a school smack-dab in the middle of that neighborhood??

Now, my mother always taught us that wasting food was a sin, and it is -- especially when you consider all of the starving children out there who might just love to have a bite of the food you’re thinking of discarding.  Actually, there are all kinds of hungry folks out there...

But is it just the wasting of food that’s sinful – or is it waste itself that’s so wrong? My mother also happened to raise me Catholic, so at any given moment, I can be feeling guilty about a gazillion different things –- I’ve previously mentioned how when I was a tyke I'd felt badly for excluding my left hand so much, since I’m a righty.  Wisdom is scarcely found in anything extreme; it’s up to us to discern the difference between “waste not” and “want not.”  So, I’ll leave it up to you.

Disclaimer: I apologize, once again, for my shaky camera hand...though I am improving; by the way, did ya happen to notice all of those obstacles in place up there, impeding my line of sight? They must have taken a survey of the playground and the surrounding area, specifically to determine the positioning of their dumpsters! As for the people in the video:  I could be wrong, but the sense I get from the big guy in the video is he’s a long-time D11 employee, a family man, and just doing what his boss told him to do - judging from his pace, however, he seems a bit reluctant to do it. The guy with the white hair, I don’t know – this is the first time I remember seeing him. And the guy in the black jacket…well, he lives up the street from me; I’m not sure how he managed to cozy up to the right people at the Adams building, but shortly after being sent out on spider patrol around the campus, he and another neighbor loaded up at least five or six of those long tables into the back of their truck and drove off.

What am I, chopped liver? After all, in order to effectively hunt the spider, one must be able to *think* like the *become* the spider - something I'm damn good at, and the District isn't so much - and maybe if the District started giving me what I want for a change (like allowing STAR Academy to utilize the Adams building for their elementary school program), I’d not be spending my time videotaping and making a public spectacle of them.  I want to know: HOW MUCH MONEY HAS BEEN ALLOCATED IN THE BUDGET FOR SPYDRA ABATEMENT??

With my own eyes, I saw the District take a sledgehammer and destroy what looked to be a perfectly good, solid wood hutch/cabinet combo...and toss out at least 20 long tables - and that was just while I was watching. There are simply all kinds of file cabinets, desks, shelves, etc., that they're scrapping for money - and not all that much of it (money, that is).  Newsflash to District 11: there’s something called; all you’d have to do is post a free, bare-bones ad saying there’s umpteen long tables up for grabs, and those puppies would be gone by daybreak.

When the District closed Adams, there was like a weeklong period of time when the public was invited to come in and browse through the stuff they were otherwise throwing out; thanks to them, I was able to obtain an entire curriculum - English, math and science - for kindergarten through third grade; two of every item, so that each of my kids could have their own books and not need to share.  I'm talking text books, work books, as well as the teacher's manuals; grade books, number lines, that paper they use to teach kids handwriting, and all kinds of educational doo-dads and gizmos.  That's not including all of the office supplies I scored...three-ring binders, paper trays, paper clips, crayons, glue, rulers, protractors, chalk, chalkboard, etc....

My point is that one man’s trash is another man’s treasure; what purpose is served by destroying perfectly good furniture? Wasn't all of that stuff purchased using our tax dollars in the first place? Why doesn’t everyone - all taxpayers, really, but particularly those who live in the neighborhoods where their schools were wrongfully shut down...and especially the residents of the Adams area, since we have had to suffer seeing the school that was the center of our community heartlessly ravaged and then turned into a great big gigantic shed - why doesn't everyone have an opportunity to help take out some of that trash??

Maybe I just need to cozy up to the right person and mention the sex table…

Sunday, March 7, 2010

Memorandum of Understanding spite of having spider-crawled all up and down any and every thing related to last year's school closures, just looky at what suddenly turned up; this memorandum dated May 11, 2009, wasn't received by the District until February 25, 2010:

Saturday, March 6, 2010

Borrowing money for capital improvements

D-11 borrows $4 million for work at 17 schools

Comments  Recommend 

Seventeen schools in Colorado Springs School District 11 will receive capital improvements in the coming school year, even though voters did not give the district the ability to borrow $131.7 million for school maintenance and construction.
Voters did approve a $131.7 million bond sale, but because they did not approve raising the property-tax rate to pay off the bonds, the district could not issue them.
D-11 can, however, borrow roughly $4 million through the Colorado Department of Education’s Qualified Zone Academy Bonds program, because the district has room under the existing tax-rate cap to borrow the lesser amount.
The program offers schools interest-free bonds for projects at schools where at least 35 percent of students qualify for free or reducedprice lunches and the district can find a 10 percent corporate match.
Midland International Elementary can replace sewer pipes that were part of the school’s 1956 original construction. Sixteen other D-11 schools will have exhaust fans replaced, fire alarms updated and roofs fixed.
Chief Financial Officer Glenn Gustafson said Coca-Cola provided the corporate match. Work by the district’s long-range planning committee was used to decide which projects should be done.
By using the Qualified Zone Academy Bonds, the district can accomplish about $4 million worth of projects without raising the mill levy, Gustafson said.
A mill levy is a tax rate upon the value of real estate.
If the board decides to ask voters again to raise the mill cap, the amount of the increase would allow roughly $127.7 million to be borrowed. The $4 million Qualified Zone Academy loan removes that amount from the total voters authorized in 2004.
School Board members will decide whether to ask voters to raise the mill cap; in a 6-1 vote April 27 they indicated they would put a question to raise the mill cap on the ballot in November.
Congress created the Qualified Zone Academy Bonds program, which provides the investor with a federal tax credit in lieu of an interest payment from the borrower.
Because the federal government provides the credit, the district is typically only responsible for repaying the value of the bond.