Innovative Applications of Archival Institutional Ethnography: Lessons from National Socialist-Era Healthcare for Ethical Practices Today

This presentation explores nursing, patient records, and ideology within the framework of the National Socialist “euthanasia” program (Aktion T4) in Germany and Austria from 1939 to 1941, targeting individuals with disabilities for systematic killing. The ideology of the Nazi regime, which promoted notions of racial purity and the elimination of those deemed “life unworthy of life,” drove the Aktion T4 program and shaped how institutional structures, including bureaucratic systems, influenced nurses’ roles and actions. Rooted in Institutional Ethnography (IE), the study employs an innovative use of IE by utilizing Archival/Historic IE to analyze the past and inform future ethical healthcare practices.

Hannah Arendt’s concept of the “banality of evil” highlights how ordinary individuals, such as nurses, became agents of atrocity by following bureaucratic orders without critical reflection. Additionally, Jacques Ellul’s Ethics of Technology framework analyzes how National Socialist ideology manipulated technology to enhance genocidal efficiency. Propaganda’s role in garnering public support and blurring the lines between technology, ethics, and ideology is also discussed.

Archival research from documentation centers and national archives reveals the methods used to determine who would be killed, the involvement of families in medical records, and the participation of nurses in the T4 operation. The innovative use of IE through Historic IE shows how institutional structures, ethics, and ideology intersected, offering lessons for modern healthcare, particularly in the ethical use of data and technology. Three narratives of T4 victims illustrate the personal and familial impacts of these bureaucratic and ideological practices. This historical analysis underscores the need for ethical vigilance in nursing today, warning against depersonalization and adherence to institutional priorities at the expense of ethical engagement.