Nazi Germany - Euthenasia (Murder of Mentally and Physically Handicapped)

Smoke rising from the chimney at Hadamar, one of six facilities which carried out the Nazis' Euthanasia Program. Hadamar, Germany, probably 1941.

A castle used as a euthenasia centre

Adolf Hitler - Fuehrer of Nazi Germany "The demand that defective people be prevented from propagating equally defective offspring. . . represents the most humane act of mankind." Mein Kampf, vol. 1, ch. 10

Forced sterilization in Germany was the forerunner of the systematic killing of the mentally ill and the handicapped. In October 1939, Hitler himself initiated a decree which empowered physicians to grant a "mercy death" to "patients considered incurable according to the best available human judgment of their state of health." The intent of the so called "euthanasia" program, however, was not to relieve the suffering of the chronically ill. The Nazi regime used the term as a euphemism: its aim was to exterminate the mentally ill and the handicapped, thus "cleansing" the Aryan race of persons considered genetically defective and a financial burden to society.

The idea of killing the incurably ill was posed well before 1939. In the 1920s, debate on this issue centered on a book coauthored by Alfred Hoche, a noted psychiatrist, and Karl Binding, a prominent scholar of criminal law. They argued that economic savings justified the killing of "useless lives" ("idiots" and "congenitally crippled"). Economic deprivation during World War I provided the context for this idea. During the war, patients in asylums had ranked low on the list for rationing of food and medical supplies, and as a result, many died from starvation or disease. More generally, the war undermined the value attached to individual life and, combined with Germany's humiliating defeat, led many nationalists to consider ways to regenerate the nation as a whole at the expense of individual rights.

In 1935 Hitler stated privately that "in the event of war, [he] would take up the question of euthanasia and enforce it" because "such a problem would be more easily solved" during wartime. War would provide both a cover for killing and free up hospital beds and medical personnel for the war effort. The upheaval of war and the diminished value of human life during wartime would also, Hitler believed, mute the expected opposition. To make the connection to the war explicit, Hitler's decree was backdated to September 1,1939, the day Germany invaded Poland.

Fearful of public reaction, the Nazi regime never proposed a formal "euthanasia" law. Unlike the forced sterilizations, the killing of patients in mental asylums and other institutions was carried out in secrecy. The code name was "Operation T4," a reference to Tiergartenstrasse 4, the address of the Berlin Chancellery offices where the program was headquartered. Physicians, the most highly Nazified professional group in Germany, were key to the success of "T4," since they organized and carried out nearly, all aspects of the operation. One of Hitler's personal physicians, Dr. Karl Brandt, headed the program, along with Hitler's Chancellery chief, Philip Bouhler.

T4 targeted adult patients in all government or church-run sanatoria and nursing homes. These institutions were instructed by the Interior Ministry to collect questionnaires about the state of health and capacity for work of all their patients, ostensibly as part of a statistical survey. The completed forms were, in turn, sent to expert assessors physicians, usually psychiatrists, who made up "review commissions." They marked each name with a "+," in red pencil, meaning death, or a "" in blue pencil, meaning life, or "?" for cases needing additional assessment. These medical experts rarely examined any of the patients and made their decisions from the questionnaires alone. At every step, the medical authorities involved were usually expected to quickly process large numbers of forms.

The doomed were bused to killing centers in Germany and Austria; walled-in fortresses, mostly former psychiatric hospitals, castles and a former prison --- at Hartheim, Sonnenstein, Grafeneck, Bernburg, Hadamar, and Brandenburg. In the beginning, patients were killed by lethal injection. But by 1940, Hitler, on the advice of Dr. Werner Heyde, suggested that carbon monoxide gas be used as the preferred method of killing. Experimental gassings had first been carried out at Brandenburg Prison in 1939. There, gas chambers were disguised as showers complete with fake nozzles in order to deceive victims ---prototypes of the killing centers' facilities built in occupied Poland later in the war.

Again, following procedures that would later be instituted in the extermination camps, workers removed the corpses from the chambers, extracted gold teeth, then burned large numbers of bodies together in crematoria. Urns filled with ashes were prepared in the event the family of the deceased requested the remains. Physicians using fake names prepared death certificates falsifying the cause of death, and sent letters of condolences to relatives. Meticulous records discovered after the war documented 70,273 deaths by gassing at the six "euthanasia" centers between January 1940 and August 1941. (This total included up to 5,000 Jews; all Jewish mental patients were killed regardless of their ability to work or the seriousness of their illness.)

A detailed report also recorded the estimated savings from the killing of institutionalized patients. The secrecy surrounding the T4 program broke down quickly. Some staff members were indiscreet while drinking in local pubs after work. Despite precautions, errors were made: hairpins turned up in urns sent to relatives of male victims; the cause of death was listed as appendicitis when the patient had the appendix removed years before. The town of Hadamar school pupils called the gray transport buses "killing crates" and threatened each other with the taunt, "You'll end up in the Hadamar ovens!" The thick smoke from the incinerator was said to be visible every day over Hadamar (where, in midsummer 1941, the staff celebrated the cremation of their 10,000th patient with beer and wine served in the crematorium).

A handful of church leaders, judges and doctors, along with many parents of the victims protested vigorously and encouraged church run institutions not to release their patients to T4 authorities. In response to such pressure Hitler ordered a halt to the T4 program in August 1941.

Gas chambers from some of the euthenasia killing centres were dismantled and sent to extermination camps in Poland to be used as part of the "final solution to the Jewish question."The "euthanasia" killings continued, however, under a different, decentralized form. Hitler's regime continued to send to physicians and the general public the message that mental patients were "useless eaters" and unworthy of living.Doctors were encouraged to decide on their own who should live or die. Killing became part of hospital routine as infants, children, and adults were put to death by starvation, poisoning, and injections. Killings even continued in some of Germany's mental asylums, such as Kaufbeuren, weeks after Allied troops had occupied surrounding areas.

Between the middle of 1941 and the winter of 1944-45, in a program known under code "14f13," experienced psychiatrists from the T4 operation were sent to concentration camps to weed out prisoners too ill to work. After superficial medical screenings, designated inmates Jews, Gypsies, Russians, Poles, Germans, and others were sent to those euthanasia centers where gas chambers still had not been dismantled, where they were gassed. At least 20,000 people are believed to have died under the 14f13 program.

Outside of Germany, thousands of mental patients in the occupied territories of Poland, Russia, and East Prussia were also killed by the Einsatzgruppen squads (SS and special police units) that followed in the wake of the invading German army in specially adapted mobile gassing vans.

In all, between 200,000 and 250,000 mentally and physically handicapped persons were murdered from 1939 to 1945 under the T4 and other "euthanasia" programs. The magnitude of these crimes and the extent to which they prefigured the "final solution" continue to be studied. To this day, the ethics of euthenasia are discussed with a view to helping terminal patients.