Euthanasia in Nazi Germany - The T4 Programme

http://www.life.org.nz/euthanasia/abouteuthanasia/history-euthanasia6
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.

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:
"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.

"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).
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."
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.
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.
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.

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.
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.