Euthanasia in Nazi Germany - The T4 Programme

The ideological ground for the Nazi euthanasia programme had been thoroughly prepared years before, with the acceptance that some lives were not worthy of living.

  • Karl Binding, a law professor and Alfred Hoche, a doctor, published their seminal work: "Permission to Destroy Life Unworthy of Life".
  • Two cultural factors, social Darwinism and eugenics, ensured that the book had immediate influence in the medical establishment and the social sciences.
  • The benefits for German society was racial purity, and re-directing medical resources and funds to those "worthy" of support.
  • Propaganda and a compliant media were used to persuade Germans that euthanasia was a humane social policy.
  • Mentally ill and disabled "subhumans" in a series of powerful and popular films, were used to reinforce the message.

  • Link to the United States Holocaust Memorial Museum
The German experiment with euthanasia provides salutary lessons for the debate in the early 21st century.

During the Nazi's T-4 programme, an estimated 250,000-350,000 Germans were put to death. It is not commonly known that the gas chamber technology used by the Nazi's in the war years was developed when the large number of adult and child euthanasia cases required more efficient means than narcotics and starvation. Gas chambers were, in many cases, constructed on hospital grounds.

The killing ended with the surrender in May, 1945 and the leading doctors were put on trial at the Nuremberg War Crimes Trials.

Leo Alexander, an American psychiatrist, was a consultant to the Secretary of War and serving with the office of the Chief Counsel for War Crimes in Nuremberg during 1946 and 1947.

In his "Medical Science under Dictatorship", published in the New England Journal of Medicine, July, 1949, Dr Alexander observed:

"Whatever proportions these crimes finally assumed, it became evident to all who investigated them, that they started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of physicians.

"It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick.

"Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans."

"The small beginnings"
By the end of the nineteenth century in Germany, scattered voices could be heard calling for euthanasia in the name of personal choice and mercy, using arguments identical to those heard today.

The extraordinarily high death rate from mass starvation in German mental hospitals during World War I, was an early warning signs of the deadly shift official attitudes could take toward the mentally ill when resources were strained.

Before Adolf Hitler came to power and issued the executive order for the T-4 programme to be implemented, the ideological ground had been thoroughly prepared.

Years before in 1920, two eminent German academics: Karl Binding, a law professor and Alfred Hoche, a doctor, published their seminal work: "Permission to Destroy Life Unworthy of Life".

They argued that first it was acceptable for an outside agency to define what individual life was worthless, and second that in effect, an individual had to justify his existence according to criteria imposed from outside. This means proving to the agency that one's life was worthwhile).

Two cultural factors unique to Germany at the time, ensured that the book had immediate influence in the medical establishment and the social sciences. These factors were the ethos of social Darwinism and eugenics.

Social Darwinists applied Charles Darwin's theories of natural selection to human society. Social progress depended on the fittest and most powerful surviving and the weakest elements being culled to prevent infecting their betters.

Eugenics envisaged a hierarchy of human beings, the lower levels being the mentally handicapped and the disabled.

Binding and Hoche set out to undermine the Hippocratic Oath tradition. They argued that the criteria for medical practice should be utilitarian. People were valuable in terms of their contribution to society. Their "quality of life" should be the determining factor in medical treatment.

In contrast, the Hippocratic Oath assumed that an individual did not have to prove their worth. The sanctity and value of each individual human person was sacrosanct.

Binding and Hoche placed people in categories and deemed that certain individuals were "unworthy" of life: those with terminal illnesses, the disabled (including children) and the mentally ill.

There were two benefits for German society if these categories could be eliminated: racial purity and re-directing medical resources and funds to those "worthy" of support.

Such sentiments were readily accepted by influential doctors, the intelligentsia and soon wider German society. Ten years after the publication of Mein Kampf, 45 percent of German doctors had joined the Nazi party. Thus when the Nazis came to power in 1933, determined to create a new Aryan Master Race, many Germans were ready to be persuaded on the merits of "merciful" euthanasia.

The legalisation of voluntary euthanasia was a Nazi priority and the public were supposed to be reassured by a raft of safeguards. However the proposals were vigorously opposed by the churches and the Nazis retreated to wait for a more opportune time.

Within six months, "Heredity Health Courts" were established to sterilize those in the targeted categories. An estimated 350,000 Germans were sterilised under this programme, until May, 1945.

Propaganda used to persuade
Propaganda minister Joseph Goebbels, marshalled the resources of the state-controlled media to persuade Germans that euthanasia was a humane social policy, the foundation for building the Master Race. Graphic pictures portrayed mentally ill and disabled "subhumans" in a series of powerful and popular films, to reinforce the message.

In the popular film "I Accuse", an attractive woman suffering from multiple sclerosis was gently killed by her loving husband.

German school children studied maths problems and calculated how many services, how much bread, jam, and other necessities of life could be saved by killing people - the chronically sick and crippled - who were a "drain on society."

The Hippocratic Oath replaced
Before 1933, every German doctor took the Hippocratic Oath, with its famous "do no harm" clause. The Oath required that a doctor's first duty is to his patient.

The Nazis replaced the Hippocratic Oath with the Gesundheit, an oath to the health of the Nazi state. Thus a German doctor's first duty was now to promote the interests of the Reich.

Infanticide: the first legal killings
Once German doctors accepted social eugenics, the forcible sterilisation of the "unfit" became widespread. The next step was infanticide, which required the willing cooperation of doctors and midwives, who reported every birth of a child with disabilities to the authorities.

The child was sent to an institution - supposedly for treatment. A brief report on the child was then sent to Berlin where three doctors judged the child, in almost every case to be "unworthy of life." After killing the child (with the usual 'cause of death' listed as pneumonia), the body was delivered to the family, minus the brain.

Hitler appointed Dr Karl Brandt (later hanged following the Nuremberg War Crimes Trials) to head the bureaucracy and implement the infanticide programme, following a secret directive issued in 1939.

Thousands were killed at psychiatric institutions and paediatric clinics by being spoonfed lethal medicines and drugs. From infants, the categories were extended to those between three and seventeen years old. Some of the victims were non-mentally ill children whose behavior was deemed abnormal or anti-social.

New York Times reports Nazi plans for euthanasia
Headline: Nazis Plan to Kill Incurables to End Pain; German Religious Groups Oppose Move -Associated Press

BERLIN, Oct.7, 1933: The Ministry of Justice in a detailed memorandum explaining the Nazi aims regarding the German penal code, today announced its intention to authorize physicians to end the sufferings of incurable patients.

The memorandum, still lacking the force of law, proposed that "it shall be made possible for physicians to end the tortures of incurable patients upon request, in the interests of true humanity."

This proposed legal recognition of euthanasia ? the act of providing a painless and peaceful death ? raised a number of fundamental problems of a religious, scientific and legal nature.

The Catholic newspaper Germania, hastened to observe:
"The Catholic faith binds the conscience of its followers not to accept this method of shortening the suffering of incurables who are tormented by pain."

In Lutheran circles, too, life is regarded as something that God alone can take.

A large section of the German people, it was expected in some interested circles, might ignore the provisions for euthanasia, which overnight has become a widely-discussed word in the Reich.

In medical circles the main question was raised as to just when a man is incurable and when his life should be ended.

According to the present plans of the Ministry of Justice, incurability would be determined not only by the attending physician, but also by two official doctors who would carefully trace the history of the case and personally examine the patient.

In insisting that euthanasia shall be permissible only if the accredited attending physician is backed by two experts who so advise; the Ministry believes a guarantee is given that no life still valuable to the State, will be wantonly destroyed.

The legal question of who may request the application of euthanasia has not been definitely solved.

The Ministry merely has proposed that either the patient himself shall "expressly and earnestly" ask it, or "in case the patient no longer is able to express his desire, his nearer relatives, acting from motives that do not contravene morals, so request." (Source - New York Times, Sunday, October 8, 1933)

The T-4 Euthanasia programme implemented
According to Leo Alexander MD, the sterilisation and euthanasia of persons with chronic mental illness was discussed at a meeting of Bavarian psychiatrists in 1931.
By 1936, ideas for exterminating the physically or socially unfit, were openly advocated in an article published in an official German medical journal.

Alexander commented: "It is rather significant that the German people were considered by their Nazi leaders, more ready to accept the extermination of the sick, than those for political reasons. It was for that reason the that the first exterminations of the later (political) group, were carried out under the guise of sickness."

Hitler issued the secret directive to begin T-4 in late October 1939. The programme was designated a state secret, with the families of the deceased receiving falsified death certificates. The killings took place at converted hospitals when the victims entered the "showers". 

In the beginning, the categories of those to be killed were scrupulously defined, but as time went on human nature prevailed. A neuropathologist, Dr Hallenvorden, gave Dr Alexander a first-hand account of how the selection process evolved:
"Most institutions did not have enough physicians and what physicians there were, were either too busy or did not care. They delegated the selection to the nurses and the attendants. Whoever looked sick, or was otherwise a problem was put on a list and transported to the killing centre (to be gassed with Zyclon B in the 'showers')."

"The worst thing about this business was that it produced a certain brutalisation of the nursing personnel. They got to simply picking out those whom they did not like, and the doctors had so many patients that they did not know them, and simply put their names on the list."

German citizens grew increasingly uneasy about the secret T-4 programme. Rumours quickly spread about the black vans transporting the victims to the six specially designated "hospitals". The vans known as "ravens" inspired dread. People could hardly avoid drawing their own conclusions when columns of smoke would later issue from the hospital chimney.

Public concern was monitored by the Gestapo. Hitler and Heinrich Himmler were enraged when the popular Archbishop von Galen, repeatedly and openly condemned the T-4 programme from his pulpit.

On August 24th, 1941, Hitler gave verbal instructions to Dr Karl Brandt to stop the euthanasia programme, with the proviso that infanticide be continued.

Despite the official ban, German doctors carried on much as before, using mainly lethal injections in the so-called hospitals. As the war progressed, seriously wounded Wermacht soldiers were routinely euthanised.

Termed "wild euthanasia", it was halted only by the Allied Occupation. There was a case of American infantry discovering a euthanasia hospital in Bavaria, still fully functioning with the medical staff at their posts. The outraged soldiers were only just prevented from shooting them on the spot. 

A New Zealand doctor, J.E. Caughey met one of the leading Nazi doctors in 1934. He wrote an article "How Mercy Killing Expanded", published in The Southland Times, July 10, 1985. It was included in a later article "Euthanasia and the Growth of a Death Culture", by Nyall Paris, a teacher at Southland Boys School, Invercargill. Read more here

"Into that Darkness: from mercy killing to mass murder"
A unique insight into the Nazi euthanasia programme was published in Britain in 1974. "Into that Darkness: from mercy killing to mass murder" by journalist Gitta Sereny, was built around seventy interviews with Franz Stangl, former commandant of the Treblinka extermination camp in eastern Poland.

Stangl had earlier worked at one of the "institutes" in Hitler's Euthanasia programme. In 1970, many of the key figures in the programme were still alive and consented to be interviewed by Sereny, leaving for posterity first-hand accounts of what really happened.

T4's administration
The headquarters of T4 was a villa at Tiergartenstrasse 4 in an exclusive Berlin suburb. It was the nerve centre for the most secret operation in Nazi Germany, the "mercy killing" of the mentally and physically handicapped in Germany and Austria. Later, it became the administrative hub for the "Final Solution": the extermination of the Jews.

The planning and orders came from the Fuhrer Chancellery, which administered Hitler's private affairs and enabled T4 to function in secrecy.

Franz Stangl
His story is that of a decent man, who gradually becomes morally corrupted. An Austrian detective happily married to a devout Catholic and strongly anti-Nazi wife. Enjoying steady promotion in Linz, he was assigned to Berlin in November 1940. Arriving at T4, he was informed that his new role was to be police superintendent in a special institute, overseeing security and ensuring that the safeguards for the patients were strictly adhered to.

The Safeguards explained
Stangl was told that for many years Russia and America had legalised euthanasia on the severely insane and deformed. Germany was going to pass a similar law in the near future, but to protect the sensibilities of the population, the mercy killing was going to be carried out slowly and after much psychological preparation. But meantime, absolute secrecy was necessary.

The only patients affected were those who after the most careful examination ? a series of four tests carried out by at least two physicians ? were considered incurable. A painless death would be a merciful release from an intolerable existence.

The Reality
Careful medical examinations in mental institutions by travelling doctors were rare. T4 staff simply sent out a questionnaire to all institutions (under the pretext of economic planning), asking for details of those retarded and suffering various categories of disability. The responses were then graded by T4 staff who marked each case with a plus or minus sign: life or death.

Parental authorisation fraud
It has been claimed that parents gave such authority, but they were victims of a ruse. Parents were informed that eleven Special Sections were being established throughout Germany, where the children could receive advanced treatment to assist their recovery. Parents signed the authorisations in good faith, unaware that their children would be killed by lethal injection.

Stangl at Schloss Hartheim
The former small hospital was now a special institute. Patients arrived in vans and were immediately given a cursory examination. The process was explained to Stangl: "The people must not be allowed to realise that they are going to die. They have to feel at ease. Nothing must be done to frighten them." Usually, within an hour, the patients were gassed. Stangl arranged the paperwork and for their personal effects, along with the urn of ashes to be sent to the families. A bogus cause of death was put on the death certificate.

Public knowledge
An official letter from Frankfurt in May 1941, advised the Minister of Justice that the "institute" at Hadamar was public knowledge. Children followed the blacked-out buses and vans, shouting "Here's more coming to be gassed!". Corpses enter the furnace on a conveyor belt and the smoke from the crematorium is visible for miles. The medical staff drink to oblivion in the nearby Gasthof and the regular customers take care to avoid them.

Throughout 1940 and early 1941, there were public protests by some Protestant and Catholic pastors and bishops. Bishop von Galen preached his famous sermon in Munster on August 3rd 1941.

Bishop von Galen's sermon was printed on flyers which were dropped over Germany by RAF planes.

Hitler's train was held up near Nuremberg, by mental patients being loaded onto trucks. An outraged crowd had gathered and on sighting Hitler, jeered him. On August 24th, 1941, Hitler verbally advised Dr Karl Brandt to stop the euthanasia programme.

Gitta Sereny interviewed Dieter Allers, a lawyer, who in December1940, was appointed chief administrative officer of T4. He confided that his superiors had specifically stated that the programme was expected to be completed by late July 1941. 

This infers that the protests had negligible effect, as the programme had effectively met its targets. They had killed all those who they intended to kill.

Hitler's intentions
Dr Karl Brandt, Reichskommissar for Health and Hitler's personal doctor (condemned to death in August, 1947), later testified at Nuremberg that in 1935, Hitler told the then Minister of Health, Gerhard Wagner, that if war came, he would resolve this question, because it would be easier to do in wartime when the Church would not be able to put up the expected resistance.

The Euthanasia continues
The T4 programme officially closed down. But euthanasia continued from November 1941 to 1945, under the code name "14 f 13", which was the title of the forms used to establish "eligibility". The victims were concentration camp prisoners, politicals, "habitual" criminals and Jews, who were all classified as incurably insane and gassed.

The centres that remained open for "14 f 13", were Bernburg and Hartheim.

Nuremburg
57 percent of Nazis who faced trials for crimes against people with mental disabilities were acquitted, compared with just 24 percent of those accused of crimes against Jews. Of those found guilty, less than two percent received life sentences, compared with 11 percent for killing Jews.

The mentally handicapped were seen as a burden on society and so judges, and especially lay judges, did not consider their murders to be as great a crime. None of those who were given life sentences for murdering people with mental disabilities were actually made to serve their time.