Aktion T4

Aktion T4
Hitler's order for Aktion T4
Also known as	T4 Program
Location	German-occupied Europe
Date	September 1939 – August 1941
Incident type	Forced euthanasia
Perpetrators	SS
Participants	Psychiatric hospitals
Victims	70,273[1]

Aktion T4 (German, pronounced [akˈtsi̯oːn teː fiːɐ]) was the postwar designation for a programme of mass murder through involuntary euthanasia in Nazi Germany.^{[2][lower-alpha 1]} The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in the spring of 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated with T4.^{[3][4][5][lower-alpha 2]} Under the programme certain German physicians were authorized to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death" (Gnadentod).^[6] In October 1939 Adolf Hitler signed a "euthanasia decree" backdated to 1 September 1939 that authorized Reichsleiter Philipp Bouhler, the chief of his Chancellery, (not the Reich Chancellery Reichskanzlei) and Karl Brandt, Hitler's personal physician, to carry out the killing,

Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [menschlichem Ermessen], are considered incurable, can be granted mercy death [Gnadentod].

— Adolf Hitler^[7][8]

The programme ran officially from September 1939 to August 1941, during which the recorded 70,273 people were killed at various extermination centres located at psychiatric hospitals in Germany and Austria, along with those in occupied Poland.^[9][10][1] About half of the victims were from church-run asylums.^[11]

Several reasons for the programme have been offered, including eugenics, compassion, reducing suffering, racial hygiene, cost effectiveness and pressure on the welfare budget.^[12][13] After the nominal end of the programme, physicians in German and Austrian facilities continued many of the practices of Aktion T4, until the defeat of Germany in 1945.^[14] The unofficial continuation of the policy led to additional deaths by medicine and similar means, resulting in 93,521 beds "emptied" by the end of 1941.^{[15][16][lower-alpha 3][lower-alpha 4]} Technology that was developed under Aktion T4, particularly the use of lethal gas to commit mass murder, was taken over by the medical division of the Reich Interior Ministry, along with personnel who had participated in the development of the technology and later participated in Operation Reinhard.^[18] The technology, personnel and techniques developed were instrumental in the implementation of Nazi genocides.^[19]

Background

The term "Aktion T4" came into use after the war; before that German terminology included Euthanasie (euthanasia) and Gnadentod (merciful death).^[7] The T4 programme stemmed from the Nazi Party policy of "racial hygiene", a belief that the German people needed to be cleansed of racial enemies, which included people with disabilities as well as anyone who was confined to a mental health facility.^[20] The euthanasia programme was part of the evolution of the policy of administrative murder that culminated in the extermination of Jews of Europe during the Nazi genocides. In his book Mein Kampf (1924), Hitler wrote that one day racial hygiene, "will appear as a deed greater than the most victorious wars of our present bourgeois era".^[21][22]

The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary "antisocial" behaviour was widely accepted. Canada, Denmark, Switzerland and the US had passed laws for the coerced sterilisation of people before Germany. Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation.^[23]

The policy and research agenda of racial hygiene and eugenics were promoted by Emil Kraepelin.^[24] The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugene Bleuler, who presumed racial deterioration because of mental and physical cripples in his Textbook of Psychiatry,

The more severely burdened should not propagate themselves… If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate.^[25][26][27]

In July 1933 "Law for the Prevention of Hereditarily Diseased Offspring" prescribed compulsory sterilisation for people with conditions thought to be hereditary, such as schizophrenia, epilepsy, Huntington's chorea and "imbecility". Sterilisation was also legalised for chronic alcoholism and other forms of social deviance. The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (Erbgesundheitsgerichte), which examined the inmates of nursing homes, asylums, prisons, aged-care homes and special schools, to select those to be sterilised.^[28]

It is estimated that 360,000 people were sterilised under this law between 1933 and 1939. Within the Nazi administration, some suggested that the programme should be extended to people with physical disabilities but such ideas had to be expressed carefully, given that one of the most powerful figures of the regime, Joseph Goebbels, had a deformed right leg.^{[lower-alpha 5]} After 1937 the acute shortage of labour in Germany, arising from rearmament, meant that anyone capable of work was deemed to be "useful" and thus exempted from the law and the rate of sterilisation declined.^[29]

Implementation

Dr. Karl Brandt, personal physician to Hitler and Hans Lammers, the head of the Reich Chancellery, testified after the war that Hitler had told them as early as 1933—when the sterilisation law was passed—that he favoured the killing of the incurably ill but recognised that public opinion would not accept this. In 1935, Hitler told the Leader of Reich Doctors, Gerhard Wagner, that the question could not be taken up in peacetime, "Such a problem could be more smoothly and easily carried out in war". He wrote that he intended to "radically solve" the problem of the mental asylums in such an event.^[30]

Although officially started in September 1939, Aktion T4 was initiated with a "trial" case in late 1938.^[31] Hitler instructed Brandt to evaluate a family's petition for the "mercy killing" of their blind, physically and developmentally disabled boy.^{[lower-alpha 6]} The child, born near Leipzig and eventually identified as Gerhard Kretschmar, was killed in July 1939.^[33][34] Hitler instructed Brandt to proceed in the same manner in all similar cases.^[35] On 18 August 1939, three weeks after the killing of the boy, the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses was established. It was to prepare and proceed with the registration of sick children or newborns identified as defective. Secret killing of infants began in 1939 and increased after the war started. By 1941 more than 5,000 children had been killed.^[36][37]

Hitler was in favour of killing those whom he judged to be lebensunwertes Leben (Life unworthy of life). In a 1939 conference with Leonardo Conti Reich Health Leader and state secretary for health in the Interior Ministry and the head of the Reich Chancellery, Hans Lammers—a few months before the "euthanasia" decree—Hitler gave as examples the mentally ill who he said could only be "bedded on sawdust or sand" because they "perpetually dirtied themselves" and "put their own excrement into their mouths". This issue, according to the Nazi regime, assumed new urgency in wartime.^[38] After the invasion of Poland the leading Nazi doctor, Dr. Hermann Pfannmüller, said

Für mich ist die Vorstellung untragbar, dass beste, blühende Jugend an der Front ihr Leben lassen muss, damit verblichene Asoziale und unverantwortliche Antisoziale ein gesichertes Dasein haben. (It is unbearable to me that the flower of our youth must lose their lives at the front, while that feeble-minded and asocial element can have a secure existence in the asylum.)^[39]

and advocated gradual decrease of the food rations rather than death by medicine, which he believed was more merciful than poison injections.^[40][41]

The German eugenics movement had an extreme wing even before the Nazis came to power. As early as 1920, Alfred Hoche and Karl Binding advocated killing people whose lives were "unworthy of life" (lebensunwertes Leben). Darwinism was interpreted by them as justification of the demand for "beneficial" genes and eradication of the "harmful" ones. Robert Lifton wrote, "The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration".^[42]

The advocacy of eugenics in Germany gained ground after 1930, when the Depression was used to excuse cuts in funding to state mental hospitals, creating squalor and overcrowding.^[43] Many German eugenicists were nationalists and antisemites, who embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes. Their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged.^[44]

During the 1930s the Nazi Party carried out a campaign of propaganda in favour of euthanasia. The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), The Victim of the Past (Opfer der Vergangenheit, 1937), which was given a major première in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941), which was based on a novel by Hellmuth Unger, a consultant for "child euthanasia".^[45]

Killing of children

In mid-1939 Hitler authorized the creation of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden), headed by Dr. Karl Brandt, his physician, and administered by Herbert Linden of the Interior Ministry as well as SS-Oberführer Viktor Brack. Brandt and Bouhler were authorized to approve applications to kill children in relevant circumstances,^[46][47] though Bouhler left the details to subordinates such as Brack and SA-Oberführer Werner Blankenburg.^[48]

Extermination centres were established at six existing psychiatric hospitals: Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein.^[20][49] One thousand children under the age of 17 were killed at the institutions Am Spiegelgrund and Gugging in Austria.^[50][51] They played a crucial role in developments leading to the Holocaust.^[20] As a related aspect of the "medical" and scientific basis of this programme, the Nazi doctors took thousands of brains from 'euthanasia' victims for research.^[52]

From August 1939 the Interior Ministry began registering children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the 'guardian' consent element soon disappeared. Those to be killed were identified as "all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and Down syndrome (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions".^[53] The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed.^{[lower-alpha 7]}

The Ministry used various deceptions when dealing with parents or guardians particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to "Special Sections" for children, where they would receive improved treatment.^[54] The children sent to these centres were kept for "assessment" for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as "pneumonia". Autopsies were usually performed, and brain samples were taken to be used for "medical research". This apparently helped to ease the consciences of many of those involved, since it gave them the feeling that the children had not died in vain, and that the whole programme had a genuine medical purpose.^[55] The most notorious of these institutions in Austria was Am Spiegelgrund, where from 1940–1945, 789 children were killed by lethal injection, gas poisoning, and physical abuse. Their brains were preserved in formaldehyde jars and stored in the basement of the clinic and in the private collection of one of the institution's directors, Heinrich Gross, until 2001.^[51]

Once war broke out in September 1939, the programme adopted less rigorous standards of assessment and a quicker approval process. It expanded to include older children and adolescents. The conditions covered also expanded and came to include

...various borderline or limited impairments in children of different ages, culminating in the killing of those designated as juvenile delinquents. Jewish children could be placed in the net primarily because they were Jewish; and at one of the institutions, a special department was set up for 'minor Jewish-Aryan half-breeds'.

— Lifton^[56]

At the same time, increased pressure was placed on parents to agree to their children being sent away. Many parents suspected what was really happening, especially when it became apparent that institutions for children with disabilities were being systematically cleared of their charges, and refused consent. The parents were warned that they could lose custody of all their children, and if that did not suffice, the parents could be threatened with call-up for 'labour duty'.^[57] By 1941 more than 5,000 children had been killed.^{[37][lower-alpha 8]} The last child to be killed under Aktion T4 was Richard Jenne on 29 May 1945 in the children's ward of the Kaufbeuren-Irsee state hospital in Bavaria, Germany, more than three weeks after U.S. Army troops had occupied the town.^[58][59]

Killing of adults

Invasion of Poland

Brandt and Bouhler developed plans to expand the programme of euthanasia to adults. In July 1939 they held a meeting attended by Conti and Professor Werner Heyde, head of the SS medical department. This meeting agreed to arranging a national register of all institutionalised people with mental illnesses or physical disabilities. The first adults with disabilities to be killed en masse by the Nazi regime were Poles. After the invasion on 1 September 1939, disabled adults were shot by the SS men of Einsatzkommando 16, Selbstschutz and EK-Einmann under the command of SS-Sturmbannführer Rudolf Tröger, with overall command by Reinhard Heydrich, during the genocidal Operation Tannenberg^{[60][lower-alpha 9]} All hospitals and mental asylums of the Wartheland were emptied. The region was incorporated into Germany and earmarked for resettlement by Volksdeutsche following the German conquest of Poland.^[62] In the Danzig (now Gdańsk) area, some 7,000 Polish patients of various institutions were shot and 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany.^[63] The first experiments with the gassing of patients were conducted in October 1939 at Fort VII in Posen (occupied Poznań), where hundreds of prisoners were killed by means of carbon monoxide poisoning, in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, Reichsführer-SS Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.^[64]

The idea of killing adult mental patients soon spread from occupied Poland to adjoining areas of Germany, probably because Nazi Party and SS officers in these areas were most familiar with what was happening in Poland. These were also the areas where Germans wounded from the Polish campaign were expected to be accommodated, which created a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, sent 1,400 patients from five Pomeranian hospitals to undisclosed locations in occupied Poland, where they were shot. The Gauleiter of East Prussia, Erich Koch, had 1,600 patients murdered out of sight. More than 8,000 Germans were killed in this initial wave of killings carried out on the orders of local officials, although Himmler certainly knew and approved of them.^[37][65]

The legal basis for the programme was a 1939 letter from Hitler, not a formal 'Führer's decree' carrying the force of law. Hitler deliberately bypassed Health Minister Conti and his department, who might have raised questions about the legality of the programme and entrusted it to Bouhler and Brandt.^{[8][lower-alpha 10]} The programme was administered by Viktor Brack and his staff from Tiergartenstraße 4, disguised as the "Charitable Foundation for Cure and Institutional Care" offices which served as the front and was supervised by Bouhler and Brandt.^[66][67]

The officials in charge included Dr Herbert Linden, who had been involved in the child killing programme; Dr Ernst-Robert Grawitz, chief physician of the SS; and August Becker, an SS chemist. The officials selected the doctors who were to carry out the operational part of the programme; based on political reliability as long-term Nazis, professional reputation and sympathy for radical eugenics. The list included physicians who had proved their worth in the child-killing programme, such as Unger, Heinze and Hermann Pfannmüller. The recruits were mostly psychiatrists, notably Professor Carl Schneider of Heidelberg, Professor Max de Crinis of Berlin and Professor Paul Nitsche from the Sonnenstein state institution. Heyde became the operational leader of the programme, succeeded later by Nitsche.^[68]

Listing of targets from hospital records

In early October all hospitals, nursing homes, old-age homes and sanatoria were required to report all patients who had been institutionalised for five years or more, who had been committed as "criminally insane", who were of "non-Aryan race" or who had been diagnosed with any on a list of conditions. The conditions included schizophrenia, epilepsy, Huntington's chorea, advanced syphilis, senile dementia, paralysis, encephalitis and "terminal neurological conditions generally". Many doctors and administrators assumed that the reports were to identify inmates who were capable of being drafted for "labour service" and tended to overstate the degree of incapacity of their patients, to protect them from labour conscription. When some institutions refused to co-operate, teams of T4 doctors (or Nazi medical students) visited and compiled the lists, sometimes in a haphazard and ideologically motivated way.^[69] During 1940 all Jewish patients were removed from institutions and killed.^{[70][71][72][lower-alpha 11]}

As with the child inmates, the adult cases were assessed by a panel of experts, working at the Tiergartenstraße offices. The experts were required to make their judgements on the reports, not medical histories or examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (death), a - (life), or occasionally a ? meaning that they were unable to decide. Three "death" verdicts condemned the person and as with reviews of children, the process became less rigorous, the range of conditions considered "unsustainable" grew broader and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.^[73]

Gassing

The first gassings in Germany proper took place in January 1940 at the Brandenburg Euthanasia Centre. The operation was headed by Brack, who said: "the needle belongs in the hand of the doctor."^[74] Bottled pure carbon monoxide gas was used. At trials, Brandt described the process as a "major advance in medical history".^[75] Once the efficacy of the method was confirmed, it became standardised, and instituted at a number of centres across Germany under the supervision of Widmann, Becker, and Christian Wirth – a Kripo officer who later played a prominent role in the extermination of the Jews as commandant of newly built death camps in occupied Poland. In addition to Brandenburg, the killing centres included Grafeneck Castle in Baden-Württemberg (10,824 dead), Schloss Hartheim near Linz in Austria (over 18,000 dead), Sonnenstein Euthanasia Centre in Saxony (15,000 dead), Bernburg Euthanasia Centre in Saxony-Anhalt and Hadamar Euthanasia Centre in Hesse (14,494 dead). The same facilities were also used to kill mentally sound prisoners transferred from concentration camps in Germany, Austria and occupied parts of Poland.

Condemned patients were 'transferred' from their institutions to newly built centres in the T4 Charitable Ambulance buses, called the Community Patients Transports Service. They were run by teams of SS men wearing white coats, to give it an air of medical care.^[76] To prevent the families and doctors of the patients from tracing them, the patients were often first sent to transit centres in major hospitals, where they were supposedly assessed. They were moved again to "special treatment" (Sonderbehandlung) centres. Families were sent letters explaining that owing to wartime regulations, it was not possible for them to visit relatives in these centres. Most of these patients were killed within 24 hours of arriving at the centres, and their bodies cremated.^[77] For every person killed, a death certificate was prepared, giving a false but plausible cause of death. This was sent to the family along with an urn of ashes (random ashes, since the victims were cremated en masse). The preparation of thousands of falsified death certificates took up most of the working day of the doctors who operated the centres.^[78]

During 1940 the centres at Brandenburg, Grafeneck and Hartheim killed nearly 10,000 people each, while another 6,000 were killed at Sonnenstein. In all, about 35,000 people were killed in T4 operations that year. Operations at Brandenburg and Grafeneck were wound up at the end of the year, partly because the areas they served had been cleared and partly because of public opposition. In 1941, however, the centres at Bernburg and Sonnenstein increased their operations, while Hartheim (where Wirth and Franz Stangl were successively commandants) continued as before. As a result, another 35,000 people were killed before August 1941, when the T4 programme was officially shut down by Hitler. Even after that date, however, the centres continued to be used to kill concentration camp inmates: eventually some 20,000 people in this category were killed.^{[lower-alpha 12]}

In 1971, Gitta Sereny conducted a series of interviews with Stangl, who was in prison in Düsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibor and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 programme based on his time as commandant of the killing facility at the Hartheim institute.^[80] He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane, and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (the ruse was also used at extermination camps).^[80]

Technology and personnel transfer to death camps

After the official end of the euthanasia programme in 1941, most of the personnel and high-ranking officials, as well as gassing technology and the techniques used to deceive victims, were transferred under the jurisdiction of the national medical division of the Reich Interior Ministry. Further gassing experiments with the use of mobile gas-chambers (Einsatzwagen) were conducted at Soldau concentration camp by Herbert Lange following Operation Barbarossa. Lange was appointed commander of the Chełmno extermination camp in December 1941. He was given three gas vans by the RSHA, converted by the Gaubschat GmbH in Berlin,^[81] and already before February 1942 killed a total of 3,830 Polish Jews and around 4,000 Gypsies under the guise of "resettlement".^[82] After the Wannsee conference, implementation of gassing technology was accelerated by Heydrich. Beginning in spring 1942 three industrial killing centres were built secretly in east-central Poland. The SS officers responsible for the earlier Aktion T4, including Wirth, Stangl and Irmfried Eberl, had important roles in the implementation of the "Final Solution" for the next two years.^{[19][lower-alpha 13]} The first killing centre equipped with stationary gas chambers modelled on technology developed under Aktion T4 was established at Bełżec in the General Government territory of occupied Poland. Notably, the decision preceded the Wannsee Conference of January 1942 by three months.^[83]

Death Toll

Death toll of Aktion T4 (official data), 1940 – September 1941^[84]

T4 Center	Operation		Number of victims
	From	To	1940	1941	Total
Grafeneck	20 January 1940	December 1940	9,839	—	9,839
Brandenburg	8 February 1940	October 1940	9,772	—	9,772
Bernburg	21 November 1940	30 July 1943	—	8,601	8,601
Hartheim	6 May 1940	December 1944	9,670	8,599	18,269
Sonnenstein	June 1940	September 1942	5,943	7,777	13,720
Hadamar	January 1941	31 July 1942	—	10,072	10,072
Total by year:			35,224	35,049	70,273

Voices of opposition

In January 1939 Brack commissioned a paper from Professor of Moral Theology at the University of Paderborn, Joseph Mayer, on the likely reactions of the churches in the event of a state euthanasia programme being instituted. Mayer – a longstanding euthanasia advocate – reported that the churches would not oppose such a programme if it was seen to be in the national interest. Brack showed this paper to Hitler in July, and it may have increased his confidence that the "euthanasia" programme would be acceptable to German public opinion.^[47] Notably, when Sereny interviewed Mayer shortly before his death in 1967, he denied that he formally condoned the killing of people with disabilities but no copies of this paper are known to survive.^[85]

There were those who opposed the T4 programme within the bureaucracy. Lothar Kreyssig, a district judge and member of the Confessing Church, wrote to Gürtner protesting that the action was illegal since no law or formal decree from Hitler had authorised it. Gürtner replied, "If you cannot recognise the will of the Führer as a source of law, then you cannot remain a judge", and had Kreyssig dismissed.^[43] Hitler had a fixed policy of not issuing written instructions for policies relating to what could later be condemned by international community, but made an exception when he provided Bouhler and Brack with written authority for the T4 programme in his confidential letter of October 1939 in order to overcome opposition within the German state bureaucracy. Hitler told Bouhler at the outset that "the Führer's Chancellery must under no circumstances be seen to be active in this matter."^[66] The Justice Minister, Franz Gürtner, had to be shown Hitler's letter in August 1940 to gain his cooperation.^[67]

Exposure

In the towns where the killing centres were located, many people saw the inmates arrive in buses, saw the smoke from the crematoria chimneys and noticed that the buses were returning empty. In Hadamar, ashes containing human hair rained down on the town. The T4 programme was no secret. Despite the strictest orders, some of the staff at the killing centres talked about what was going on. In some cases families could tell that the causes of death in certificates were false, e.g. when a patient was claimed to have died of appendicitis, even though his appendix had been surgically removed some years earlier. In other cases, several families in the same town would receive death certificates on the same day.^[86] In May 1941 the Frankfurt County Court wrote to Gürtner describing scenes in Hadamar where children shouted in the streets that people were being taken away in buses to be gassed.^[87]

During 1940, rumours of what was taking place spread and many Germans withdrew their relatives from asylums and sanatoria to care for them at home, often with great expense and difficulty. In some places doctors and psychiatrists co-operated with families to have patients discharged or if the families could afford it, transferred them to private clinics beyond the reach of T4. Other doctors "re-diagnosed" patients so that they no longer met the T4 criteria, which risked exposure when Nazi zealots from Berlin conducted inspections. In Kiel, Professor Hans Gerhard Creutzfeldt managed to save nearly all of his patients.^[88] Many doctors collaborated with the killings, either from ignorance, agreement with Nazi eugenicist policies or fear of the regime; Lifton listed a handful of psychiatrists and administrators who opposed the T4 murders.^[88]

Protest letters were sent to the Reich Chancellery and the Ministry of Justice, some from Nazi Party members. The first open protest against the removal of people from asylums took place at Absberg in Franconia in February 1941 and others followed. The SD report on the incident at Absberg noted that "the removal of residents from the Ottilien Home has caused a great deal of unpleasantness" and described large crowds of Catholic townspeople, among them Party members, protesting against the action.^[89] Similar petitions and protests occurred throughout Austria as rumors spread of mass killings at the Hartheim Euthanasia Centre and of mysterious deaths at the children's clinic, Am Spiegelgrund, where from 1940–1945 approximately 800 sick and disabled children were killed by lethal injection, gas poisoning, disease and abuse. Anna Wödl, a nurse and mother of a disabled child, vehemently petitioned to Hermann Linden at the Reich Ministry of the Interior in Berlin to prevent her son, Alfred, from being transferred from Gugging, where he lived and which also became a euthanasia center. Wödl failed and Alfred was sent to Am Spiegelgrund, where he was murdered on February 22, 1941. His brain was preserved in formaldehyde for "research" and stored in the clinic for sixty years.^[90]

Church protests

The Lutheran theologian Friedrich von Bodelschwingh (director of the Bethel Institution for Epilepsy at Bielefeld) and Pastor Paul-Gerhard Braune (director of the Hoffnungstal Institution near Berlin) protested privately. Both men used their connections with the regime to negotiate exemptions for their institutions; Bodelschwingh negotiated directly with Brandt and indirectly with Hermann Göring, whose cousin was a prominent psychiatrist. Braune had meetings with Justice Minister Gürtner, who was always dubious about the legality of the programme. Gürtner later wrote a strongly worded letter to Hitler protesting against it; Hitler did not read it but was told about it by Lammers.^[91] The leaders of the Protestant church were more involved with the Nazi regime than Catholics and they were unwilling to criticise its actions.^[92]

During 1940 and 1941 some Protestant churchmen did protest against T4. Bishop Theophil Wurm, presiding the Evangelical-Lutheran Church in Württemberg, wrote a strong letter to Interior Minister Frick in March 1940 and the same month a confidential report from the SD in Austria, warned that the killing programme must be implemented with stealth "in order to avoid a probable backlash of public opinion during the war".^[93] On 4 December 1940, Reinhold Sautter, the Supreme Church Councillor of the Württemberg State Church, reproached the Nazi Ministerial Councillor Eugen Stähle for the murders in Grafeneck Castle. Stahle retorted with the Nazi government opinion, that

The fifth commandment: Thou shalt not kill, is no commandment of God but a Jewish invention." and no longer had any validity.

— Eugen Stähle^[94]

Bishop Heinrich Wienken of Berlin, a leading member of the Caritas Association, was selected by the Fulda episcopal synod to represent the views of the Catholic Church, in meetings with T4 operatives. According to Michael Burleigh,

Wienken seems to have gone partially native in the sense that he gradually abandoned an absolute stance based on the Fifth Commandment in favour of winning limited concessions.

— Michael Burleigh^[95]

Catholic churchmen, led by Cardinal Michael von Faulhaber of Munich, wrote privately to the government protesting against the policy and the theologian Bernhard Lichtenberg protested to the Nazi chief medical officer.^[96] In July and August 1941, the Bishop of Münster, August von Galen, gave three sermons criticizing the Nazi state, for arresting Jesuits, confiscating church property and for the euthanasia program.^[97] Galen telegrammed the text of his sermon to Hitler, calling on

...the Führer to defend the people against the Gestapo. It is a terrible, unjust and catastrophic thing when man opposes his will to the will of God....We are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live?

— August von Galen^[98]

The Nazi leadership was angered by the sermon's wide circulation. The text was dropped by Royal Air Force pilots over German troops.^[11][99] In 1986, Lifton wrote,

Nazi leaders faced the prospect of either having to imprison prominent, highly admired clergymen and other protesters – a course with consequences in terms of adverse public reaction they greatly feared – or else end the programme.

— Lifton^[100]

Later historians have deprecated the importance of the role of the Church; Burleigh dismissed assumptions that the sermon affected Hitler's decision to suspend the T4 program as "wishful thinking" and noted that the various Church hierarchies did not complain after the transfer of T4 personnel to Operation Reinhard.^[101] Henry Friedlander stated that it was not the criticism from the Church but rather the loss of secrecy and "general popular disquiet about the way euthanasia was implemented", that caused the suspension of the program.^[102]

Galen had detailed knowledge of the euthanasia program in July 1940 but did not speak out until almost a year after Protestants had begun their protests. Beth A. Griech-Polelle explained the delay by Galen and the Catholic hierarchy,

Worried lest they be classified as outsiders or internal enemies, they waited for Protestants, that is the "true Germans", to risk a confrontation with the government first. If the Protestants were able to be critical of a Nazi policy, then Catholics could function as "good" Germans and yet be critical too.

— Griech-Polelle^[103]

Bishop Franz Bornewasser of Trier also sent protests to Hitler, though not publicly. In August, Galen was even more outspoken, broadening his attack to include the Nazi persecution of religious orders and the closing of Catholic institutions. He attributed the heavy Allied bombing of Westphalian towns to the wrath of God against Germany, for breaking His laws. The sermons were not reported in the German press but were widely circulated in the form of illegally printed leaflets. Local Nazis asked for Galen to be arrested but Goebbels told Hitler that such action would provoke open revolt in Westphalia.^[104] Hitler decided to wait for revenge on Galen until after the war.^[11]

Suspension of T4 killings

On 24 August 1941, Hitler ordered the suspension of the T4 killings. The invasion of the Soviet Union in June provided new opportunities to use the T4 personnel and many were transferred to the east to begin work on the final solution to the Jewish question. The projected death total for the T4 program of 70,000 deaths had been reached by August 1941.^[105] The termination of the T4 programme did not end the killing of people with disabilities; from the end of 1941, the killing of adults and children continued less systematically to the end of the war on the local initiative of institute directors and party leaders. After the bombing of Hamburg in July 1943, occupants of old age homes were killed. In a post-war trial of Doctor Hilda Wernicke. Berlin, August, 1946, testimony was given that "500 old, broken women" who had survived the bombing of Stettin in June 1944 were euthanized at the Meseritz-Oberwalde Asylum.^[106] The Hartheim, Bernberg, Sonnenstein and Hardamar centres continued in use as "wild euthanasia" centres to kill people sent from all over Germany, until 1945.^[105] The methods were lethal injection or starvation, those employed before use of gas chambers.^[107] By the end of 1941, about 100,000 people had been killed in the T4 programme.^[108] From mid-1941, concentration camp prisoners too feeble or too much trouble to keep alive were murdered after a cursory psychiatric examination under Action 14f13.^[109]

Post-war

Doctors' trial

After the war a series of trials was held in connection with the Nazi euthanasia programme at various places including: Dresden, Frankfurt, Graz, Nuremberg and Tübingen. In December 1946 an American military tribunal (commonly called the Doctors' trial) prosecuted 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed "unworthy of life", including the mentally disabled, the institutionalized mentally ill, and the physically impaired. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948, including Brandt and Brack.

The indictment read in part:

14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, willfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called "euthanasia" program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference.

— International Military Tribunal^[110]

Earlier, in 1945, American forces tried seven staff members of the Hadamar killing centre for the killing of Soviet and Polish nationals, which was within their jurisdiction under international law, as these were the citizens of wartime allies. (Hadamar was within the American Zone of Occupation in Germany. This was before the December 1945 Allied resolution supporting prosecution of "crimes against humanity" for such mass atrocities.) Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed; the other four were given long prison sentences.^[111] In 1946, newly reconstructed German courts tried members of the Hadamar staff for the murders of nearly 15,000 German citizens at the facility. Adolf Wahlmann and Irmgard Huber, the chief physician and the head nurse, were convicted.

Others involved

• August Becker, initially sentenced to three years after the war, in 1960 was tried again and sentenced to 10 years in prison. He was released early due to ill-health and died in 1967.
• Werner Blankenburg lived under an alias and died in 1957^[112]
• Philipp Bouhler committed suicide in captivity, May 1945.^[112]
• Werner Catel was cleared by a de-nazification board after World War II and was head of pediatrics at the University of Kiel. He retired early after his role in the T4 program came to light.
• Leonardo Conti hanged himself in captivity, 6 October 1945^[113]
• Dr. Ernst-Robert Grawitz killed himself shortly before the fall of Berlin in April 1945^[114]
• Dr. Herbert Linden committed suicide in 1945. Overseers of the program were initially Herbert Linden and Werner Heyde. Linden was later replaced by Hermann Paul Nitsche.
• Dr. Fritz Cropp d. 6 April 1984, Bremen. A Nazi official, in 1933, in Oldenburg, Cropp was appointed the country medical officer of health. Two years later, in 1935, he transferred to Berlin, where he worked as a ministerial adviser in the Division IV (health care and people care) in the Ministry of the Interior. In 1939, he became Assistant Director. Fritz Cropp was involved in the Nazi "euthanasia", the so-called action T-4, in 1940. He was Herbert Linden's superior. He was responsible for patient transfers.^[115]
• Dr. Werner Heyde^[109] after having escaped detection for 18 years, killed himself in 1964 before being brought to trial.
• Dr. Heinrich Gross was tried twice. One sentence was overturned and another was suspended; he died in 2005.
• Lorenz Hackenholt vanished in 1945.^[116]
• Erich Koch served time in prison from 1950 to his death in 1986^[117]
• Erwin Lambert died in 1976.^[116]
• Dr. Friedrich Mennecke died in 1947 while awaiting trial.
• Philipp, Landgrave of Hesse, the governor of Hesse-Nassau, was not tried for his part in the T4 programme; he died in 1980.

• Paul Nitsche was tried and executed by an East German court in 1948.
• Professor Carl Schneider hanged himself in his prison cell in 1946, while awaiting trial.
• Franz Schwede was sentenced to 10 years in prison in 1948 and was pardoned in 1956; he died in 1960.
• Dr. Ernst Illing was the director of the Vienna Psychiatric-Neurological Clinic for Children Am Spielgrund, where he killed about 200 children, sentenced to death on 18 July 1946^[118]
• Dr. Marianne Türk was a doctor at Vienna Psychiatric-Neurological Clinic for Children Am Spielgrund where, together with Ernst Illing, she killed 200 children. She was sentenced to 10 years prison on 18 July 1946.^[118]

The Ministry for State Security of East Germany stored around 30,000 files of the T4 project in their archives. Those files became available to the public only after the German Reunification in 1990, leading to a new wave of research on these wartime crimes.^[119]

Memorials

The German national memorial to the people with disabilities murdered by the Nazis was dedicated in 2014 in Berlin.^[120][121] It is located in the pavement of a site next to the Tiergarten park, the location of the former villa at Tiergartenstrasse 4 in Berlin, where more than 60 Nazi bureaucrats and doctors worked in secret under the "T4" program to organize the mass murder of sanatorium and psychiatric hospital patients deemed unworthy to live.^[121]

See also

Nazi doctors (list) Nazi eugenics, the racially based social policies that placed the improvement of the Aryan race at the heart of Nazis ideology. Nazi medical experimentation Operation Reinhard, men of Aktion T4 provided expertise for building the extermination camps during the Holocaust. Aktion 14f13 (1941–44), a Nazi extermination operation that killed prisoners who were sick, elderly, or deemed no longer fit for work Racial hygiene T4-Gutachter experts selecting victims killed by gas in "euthanasia" centers

Killing centers Am Spiegelgrund clinic Bernburg Euthanasia Centre Brandenburg Euthanasia Centre Grafeneck Euthanasia Centre Hadamar Euthanasia Centre Hartheim Euthanasia Centre Soldau concentration camp Sonnenstein Euthanasia Centre Jewish skeleton collection Nazi euthanasia and the Catholic Church

Notes

Footnotes

References

Further reading

Books

• Bachrach, Susan D; Kuntz, Dieter (2004). Deadly Medicine: Creating the Master Race. United States Holocaust Memorial Museum Washington D.C.: University of North Carolina Press, Chapel Hill, NC. ISBN 978-0-8078-2916-5. 
• Benzenhöfer, Udo (2010). Euthanasia in Germany Before and During the Third Reich. Münster/Ulm: Verlag Klemm & Oelschläger. ISBN 978-3-86281-001-7. 
• Binding, K.; Hoche, A. (1920). Die Freigabe der Vernichtung lebensunwerten Lebens: Ihr Mass u. ihre Form [The Release of the Destruction of Life Unworthy of Life: Their Mass and Shape]. Leipzig: Meiner. OCLC 72022317. 
• Burleigh, M.; Wippermann, W. (1991). The Racial State: Germany 1933–1945. Cambridge: Cambridge University Press. ISBN 978-0-521-39114-6. 
• Burleigh, M. (1997). Ethics and Extermination: Reflections on Nazi Genocide. Part II. Cambridge: Cambridge University Press. pp. 113–152. ISBN 978-0-521-58211-7. 
• Burleigh, M. (2001) [2000]. "Medicalized Mass Murder". The Third Reich: A New History (pbk. Pan ed.). London: Macmillan. pp. 382–404. ISBN 978-0-330-48757-3. 
• Friedlander, Henry (1995). The Origins of Nazi Genocide. From Euthanasia to the Final Solution. Chapel Hill: University of North Carolina Press. ISBN 978-0-8078-2208-1. 
• Klee, Ernst (1986). Was sie taten. Was sie wurden: Ärzte, Juristen und andere Beteiligte am Kranken- oder Judenmord [What They Did. What They Became: Doctors, Lawyers and other Partners in the Murder of the Ill and Jews] (in German). Frankfurt am Main: Fischer Taschenbuch. ISBN 978-3-596-24364-8. 
• Klee, Ernst; Cropp, Fritz (2005). Das Personenlexikon zum Dritten Reich. Wer war was vor und nach 1945. Fischer Taschenbücher. Frankfurt am Main: Fischer-Taschenbuch-Verlag. ISBN 978-3-596-16048-8. 
• Ley, Astrid; Hinz-Wessels, Annette (eds.). The "Euthanasia Institution" of Brandenburg an der Havel: Murder of the Ill and Handicapped during National Socialism. Schriftenreihe der Stiftung Brandenburgische Gedenkstätten. 35. Berlin: Metropol. ISBN 978-3-86331-086-8. 
• Werthman, Fredric (1967). A Sign for Cain. New York: Macmillan. ISBN 978-0-02-625970-5. 

Journals

• Ost, Suzanne (April 2006). "Doctors and Nurses of Death: A Case Study of Eugenically Motivated Killing under the Nazi 'Euthanasia' Programme". The Liverpool Law Review. 27 (1): 5–30. ISSN 0144-932X. PMID 17340766. doi:10.1007/s10991-005-5345-2. 

Websites

• Webb, Chris (2009). "Otwock & the Zofiowka Sanatorium: A Refuge from Hell". Holocaust Research Project. Holocaust Education & Archive Research Team. Archived from the original on 11 July 2011 – via Internet Archive. 

External links

Wikimedia Commons has media related to Action T4.

• Website with photo of Philipp Bouhler and facsimile of Hitler's letter to Bouhler and Brandt authorising the T4 programme
• United States Holocaust Memorial Museum Final Solutions: Murderous Racial Hygiene 1939–1945
• United States Holocaust Memorial Museum Euthanasia programme
• Nazis euthanasia files made public by the BMJ/British Medical Association: files relating to the 200,000 euthanasia crimes