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Under the Euthanasia Program of Nazi Germany, more than 200,000 psychiatric patients were killed by doctors in psychiatric institutions. After summarising the historical facts and the slow and still going-on process of illuminating and understanding what happened, some ethical consequences are drawn. What can we learn from history? The following aspects are addressed: the special situation of psychiatry in times of war, bioethics and biopolitics, the responsibility of the psychiatrist for the individual patient, the effects of hierarchy on personal conscience and responsibility, the unethical "curable-uncurable" distinction and the atrocious concept that persons differ in their value.

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Objective: We intended to find out whether an intensification of outpatient care after conclusion of the deinstitutionalization era in the year 2001 had an influence on number of hospitalizations, readmission figures, length of inpatient -stay (LOS), cumulative length of inpatient-stay (cumulative LOS) and coercive measures. Method:We investigated the development of 17 inpatient and outpatient variables for 2002-10 within a district psychiatric hospital responsible for a rural catchment area of 320,000 inhabitants. The sample consisted of 31,537 inpatient admissions and 35,372 outpatients accounted on an annual basis. Some figures were compared with those at state and federal levels. Associations between aggregated hospitalization and outpatient care variables were assessed by means of robust bivariate Prais-Winsten regression models for time series.Results: Over the surveyed period, number of admissions, admitted individuals, and hospitalization rates remained stable, contrary to state and federal tendencies. Cumulative LOS and readmission figures decreased, whereas average LOS increased. Number of admissions, cumulative LOS, and readmission figures were negatively associated with number of outpatients treated which increased over the surveyed period. Number of coercive measures decreased, numbers of involuntary admissions under the guardianship law remained lower than at federal and state levels, and ambulatory activity remained three times higher than in the state in which the surveyed catchment area is located. Conclusions:Community-oriented ambulatory care on the basis of multi-disciplinary assertive teams seems to be able to reduce readmissions and cumulative length of inpatient-stay, while keeping at the same time the number of admissions and coercive measures stable. Economic and clinical effects on real inpatient care, however, cannot be definitively evaluated as long as bed provision does not decrease proportionally with the increase of ambulatory activity.