According to historical records, before what is now known as the Holocaust in Germany, nurses during the regime of the National Socialist Party actively participated in the execution of mentally, physically and emotionally ill German citizens under the Euthanasia Program between 1939 and 1945, a period known as the "Aktion T4".
As front line caregivers, nurses were in direct contact with patients during euthanasia. As many as 250,000 patients died in mental institutions and care homes, of which 70,000 of these deaths were authorised by Hitler using gas chambers and lethal injections.
The NMC Code, 2018, section 35 - 41, states that the primary responsibility of nurses is to deliver care based on the most recent evidence or best practices, continuously update their skills and knowledge, and engage in suitable learning and practice undertakings to sustain and enhance their and effectiveness. The underlying rationale is that nurses are bound to adhere to these ethical standards as a framework for shaping the type of care they deliver and ensuring the welfare of their patients while emphasising values such as empathy and honesty. Understanding the actions of the nurses in Nazi Germany can help inform current nursing students of unethical practices, so they can develop their moral code for care.
In Nazi Germany, nurses were tasked with identifying and administering lethal injections to individuals to be euthanised based on records of hereditary, mental and physical disabilities. This put nurses in a confusing position, where many struggled with guilt and moral distress as they were forced to betray their patients’ trust.
By studying this history, nursing students and professionals can better understand the development and significant advancements in nursing practices. This knowledge helps to inform modern nursing practices about the importance of ethical decision-making, emphasising informed consent, patient autonomy, and evidence-based practices.
Today, nurses are educated to prioritise their patients' needs and preferences, foster trust and partnership in the care process, and uphold moral codes of conduct. Through continuous education and reflection, nurses can provide compassionate, empathetic, and person-centred care that honours every individual's humanity and inherent worth.
Knowledge of nurses’ involvement in Aktion T4 is a powerful lesson in the ethical responsibilities of our professions, patient advocacy, and the boundaries of professional responsibility. It challenges nursing students to critically reflect on their moral obligations and the profound impact of their actions in both ordinary and extraordinary circumstances. By understanding how nurses' professional roles were distorted during the Nazi regime, nursing students can better appreciate the need to uphold ethical principles, safeguard vulnerable populations, and ensure that the trust placed in healthcare professionals is never compromised.
The effect on areas such as research and evidence-based in today’s nursing is a reminder of the importance of upholding ethical standards and conducting research responsibly and compassionately, emphasising informed consent, patient autonomy, and the constant safeguarding of human rights in healthcare settings worldwide.
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