[Walter Creutz and "euthanasia" in the rhein province: between resistance and collaboration]. / Walter Creutz und die "Euthanasie" in der Rheinprovinz: Zwischen Resistenz und Kollaboration.

Over many decades Walter Creutz, medical officer in the provincial administration of Rhine Province from 1935 to 1945, was held to be one of the few psychiatrists who had actively opposed the Nazi "Euthanasia" program. In the famous "Euthanasia trial" in Düsseldorf from 1948 to 1950, Creutz was acquitted of complicity in murder; the court attested that he had done his best to sabotage the "Euthanasia" program and in so doing had saved up to 3,000 patients in the Rhineland. This rendering was circulated further in the history of science literature, so that the Rhine Province was considered to be a center of resistance to the "Euthanasia" program. Doubts about this portrayal have arisen since the 1980s. Various authors attempted to prove that Walter Creutz collaborated with the "Euthanasia" apparatus claiming there was no evidence of opposition or resistance or only to a very limited degree. However, this new perspective is based on an equally one-sided, at times grossly distorted analysis of the sources. The article provides building blocks for a more differentiated interpretation.

Use of Open Source Software in Health Care Delivery - Results of a Qualitative Field Study. Contribution of the EFMI LIFOSS Working Group.

OBJECTIVES: To assess and analyze the attitude of health IT executives towards the utilization of specialized medical Open Source software (OSS) in Germany's and other European countries' health care delivery. METHODS: After an initial literature review a field study was carried out based on semi-structured expert interviews. Eight German and 11 other European health IT executives were surveyed. The results were qualitatively analyzed using the grounded theory approach. Identified concepts were reviewed using SWOT analysis. RESULTS: In total, 13 strengths, 11 weaknesses, 3 opportunities, and 8 threats of the utilization of OSS in a clinical setting could be identified. Additionally, closely related aspects like general software procurement criteria, the overall attitude of health IT executives, users, and management towards OSS and its current and future use could as well be assessed. CONCLUSIONS: Medical OSS is rarely used in health care delivery. In order to capitalize the unique advantages of OSS in a clinical setting, complex requirements need to be addressed. Shortcomings of OSS describe an attractive breeding ground for new commercial offerings and services that need yet to be seen.

[Friedrich Mauz: T4 assessor and military psychiatrist]. / Friedrich Mauz - T4-Gutachter und Militärpsychiater.

Friedrich Mauz is one of the medical perpetrators of the second tier whose biography is difficult to comprehend. Autobiographies from three different political systems exist - Weimar Republic, the Third Reich, and postwar Germany in which he constantly reinvented himself. While after 1933 he suddenly emphasized his participation in the civil war turmoil during the early period of the Weimar Republic and his patriotism, he then depicted himself after 1945 as an apolitical person characterized by Württemberg pietism who inwardly rejected the Nazi State but had found himself prepared to accept "all sorts of humiliating concessions." He claimed that he had always remained true to his scientific code of conduct and had distanced himself from psychiatric genetics. In point of fact, Mauz was among those exonerated in the denazification trial in 1946 and was able to pursue his career in the Federal Republic of Germany. However, if the sources are read against the grain, a different picture emerges. Mauz's career stalled in the 1930s, not because he had been politically offensive, but because his scientific work was flimsy and considered lacking originality, particularly since he had chosen constitution research and psychotherapy as his main fields of interest, which were overshadowed by research in genetic psychiatry in the 1930s. Mauz tendered his services to the Nazi policy of genetic health, served as a medical assessor in proceedings based on the "Law for the Prevention of Genetically Diseased Offspring," permitted himself to be recruited for the T4 program as a medical expert, even participated in the deliberations on a future "Law on Euthanasia," and as a consulting psychiatrist for the German Armed Forces contributed to military medicine.

Towards open collaborative health informatics - The Role of free/libre open source principles. Contribution of the IMIA Open Source Health Informatics Working Group.

OBJECTIVES: : To analyze the contribution of Free/Libre Open Source Software in health care (FLOSS-HC) and to give perspectives for future developments. METHODS: The paper summarizes FLOSS-related trends in health care as anticipated by members of the IMIA Open Source Working Group. Data were obtained through literature review and personal experience and observations of the authors in the last two decades. A status quo is given by a frequency analysis of the database of Medfloss.org, one of the world's largest platforms dedicated to FLOSS-HC. The authors discuss current problems in the field of health care and finally give a prospective roadmap, a projection of the potential influences of FLOSS in health care. RESULTS: FLOSS-HC already exists for more than 2 decades. Several projects have shown that FLOSS may produce highly competitive alternatives to proprietary solutions that are at least equivalent in usability and have a better total cost of ownership ratio. The Medfloss.org database currently lists 221 projects of diverse application types. CONCLUSIONS: FLOSS principles hold a great potential for addressing several of the most critical problems in health care IT. The authors argue that an ecosystem perspective is relevant and that FLOSS principles are best suited to create health IT systems that are able to evolve over time as medical knowledge, technologies, insights, workflows etc. continuously change. All these factors that inherently influence the development of health IT systems are changing at an ever growing pace. Traditional models of software engineering are not able to follow these changes and provide up-to-date systems for an acceptable cost/value ratio. To allow FLOSS to positively influence Health IT in the future a "FLOSS-friendly" environment has to be provided. Policy makers should resolve uncertainties in the legal framework that disfavor FLOSS. Certification procedures should be specified in a way that they do not raise additional barriers for FLOSS.

[Werner Villinger and National Socialist medical crimes]. / Zwischen vorauseilendem Gehorsam und halbherziger Verweigerung Werner Villinger und die nationalsozialistischen Medizinverbrechen.

The biography of the psychiatrist and neurologist Werner Villinger reflects the ambivalence of the history of German psychiatry during the first half of the twentieth century. Politically committed to the national conservatives, he was attracted by many elements of National Socialist (Nazi) ideology. Still, he joined the party rather late and reluctantly. Villinger was a eugenist by firm conviction. While he still argued against hasty legal regulation of eugenic sterilisations in the Weimar Republic, he strongly moved for translating the law on preventing hereditarily ill progeny into reality in the institution of von Bodelschwingh in Bethel. Since 1941, Villinger, who had become a professor for psychiatry and neurology in Breslau in the meantime, acted as an expert in the framework of the National Socialist "euthanasia" programme. At the same time, however, he supported the quiet diplomacy of Rev. von Bodelschwingh in his attempt to terminate the mass murder. Villinger was also involved in criminal experiments with human beings. After 1945, he successfully continued his career in the Federal Republic of Germany. He never confronted his past during the Third Reich.