T4 - Euthanasia Programme

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T4 - Euthanasia Programme

                           Organised Slaughter - The T4 Programme

"If you establish and apply the principal that you can kill 'unproductive' human beings, then woe betide us all when we become old and frail! If one is allowed to kill unproductive people, then woe betide the invalids who have used up, sacrificed and lost their health and strength in the productive process. If one is allowed forcibly to remove one's unproductive fellow human beings, then woe betide loyal soldiers who return to the homeland seriously disabled, as cripples, as invalids."   -Sermon from Bishop von Galen. 3rd August 1942

Karl Brandt: Doctor Death 

Hitler's personal physician, and future Reich Commissioner for Health and Sanitation, and an architect of Hitler's Euthanasia programme, Karl Brandt, did not arrive at the conclusion that the state should operate an involuntary euthanasia programme on his own. During his training to become a doctor, Brandt attended lectures where euthanasia was discussed, and was greatly influenced by the likes of Alfred Hoche, a psychiatrist who openly advocated the killing of the severely handicapped during the Weiner years. Hoche and an associate, Karl Binding, both had published a book entitled 'Permission for the Destruction of Life Unworthy of Life' which had been published in 1920. In this book, Binding had argued that economically, it made no sense to pay to keep those people [the mentally and physically handicapped] alive, because they didn't contribute anything worthwhile to the body politic. 

Hoche, and later Brandt, agreed with the concept devised by Herbert Spencer, a British sociologist, that the state was an organic entity and that the mentally ill were a part of that body which needed to be exorcised by surgical means, and by doing so, would make the whole body politic healthy.

Its difficult to say, that without the concept of enforced euthanasia concept peddled by the likes of Hosch, Binding and Spencer, that Brandt would have adopted such a view as well, however, by the time he had already met Hitler, his opinions concerning euthanasia had already been embedded within his own mindset. Hitler's T4 Programme would need one more jolt to get it underway, and that jolt came in 1939 when Reichsleiter Philip Bouhler, acting as Hitler's chief of Chancellory of the NSDAP received a letter which had been sent to Hitler from a father of a severely disabled child, requesting the state's permission to euthanise his son. This letter would put the motions that would end with thousands of men, women and children being murdered by the state.

Brandt and Bouhler: Architects of the T4 Programme

In October 1939, Hitler entrusted Philip Bouhler, head of the Chancellery of the Führer and Karl Brandt to begin implementing the country's euthanasia programme. Germany's involuntary euthanasia programme was later dubbed (postwar) 'Action T4' after the street (Chancellery department on Tiergarten 4, Berlin) from where it was set up and run from.  

Gerhardt Kretschmar: First Victim of Involuntary Euthanasia

The first victim of enforced euthanasia within Germany was a severely handicapped infant, Gerhardt Kretschmar, although his murder was committed before the programme was officially sanctioned by Hitler, it may well have been the case which may have helped make it a reality. Gerhardt was born blind and was missing some limbs. It was also reported that he suffered from convulsions. Some doctors also regarded the child as 'an idiot'. Gerhardt's father (or possibly someone else close to the family), had written to the Reich's Chancellery (possibly in the spring of 1939) requesting permission for a 'mercy killing' for his son after his request had been denied on legal grounds by the head of a children's clinic in Leipzig, where the child was placed. The letter ended up on the desk of Hans Hefelmann, head of the department within the Reichs Chancellory (Department IIb) which dealt with petitions for the Führer, whom handed the letter over to Albert Bormann (Martin Bormann's brother) who handled Hitler's private affairs from the Central Office, and who in turn, took the letter straight to Hitler. Hitler sent his personal physician, Dr Karl Brandt to Leipzig to assess the situation and if the reports were accurate, was authorized to allow the child to be euthanized. After speaking with the doctors at the clinic, as well as the child's parents, Brandt, after giving the doctors concerned guarantees that they would not be punished under the law, instructed them to go ahead and euthanize the child. The child was killed by an injection of luminal on the morning of the 25 July, 1939 and was laid to rest in a local cemetery within his home village of Pomssen, just south-east of Leipzig. The cause of death on the church register didn't mention Luminal, instead it stated that the child had died of natural causes (a weak heart). 

Lack of Legality

By going ahead with the mercy killing, the doctors must have known were that they were committing a crime as euthanasia was still illegal in the country. Hitler did not have the authority either to give instructions for this mercy killing to take place and Brandt himself was only Hitler's doctor, not the head of the medical profession within Germany and also had no authority to instruct other doctors to carry out any mercy killings. But by this stage, it no longer mattered that Hitler wasn't using the legal levers of power to implement his policies, he simply willed it to happen and his acolytes would obey, regardless of the law. 

Creation of a Committee of Death

Soon after that death of Gerhardt Kretschmar, Brandt set up a committee of experts to see how they could organise and run the euthanasia programme (just in case the führer wanted to go ahead with one undercover of war) but at the same time keep it hidden from public eyes. Paediatricians and psychiatrists alongside medical doctors were recruited. The first victims would be the country's mentally and physically disabled children. The doctors involved in the selection process would never physically examine any of the children they had decided should die. The committee would then begin authorising the killing of the country's handicapped adolescents and adults being held within state controlled asylums. 

Registration for Selection

On 18 August 1939, doctors throughout the country were informed to register all handicapped newborn infants so as to make it easier to trace those that the state deemed unworthy of life that weren't already held within the state's institutions.  

Once the euthanasia programme became operational, Werner Catel, professor of paediatrics at the university of Leipzig; Hans Heinze, a psychiatrist and director of the Brandenburg-Görden mental institution; and Ernst Wentzler, a paediatrician and director of a clinic in Berlin-Frohnau, decided who would live and who would die, by marking the childrens registration forms with ea 'plus sign' (+) meant that they wanted to child killed, whereas the 'minus' (-) meant that they felt that the child should remain alive. If a question mark (?) was added to the form, then a review would be required later on. The decisions were made on what the doctors (and midwives) had written on the registration forms. Whoever made the last decision could easily see what their colleagues had decided, and once the decision was made the form was sent to one of the clinics that already had a 'special children's ward'. Six killing centres were created within already existing psychiatric hospitals. These clinics were: Bernberg, Brandenburg, Grafeneck, Hartheim, Sonnenstein as well as the most infamous Hadamar. Patients (victims) would be transferred to these clinics of death from other psychiatric hospitals situated throughout Germany.

Time to kill the Adults

Soon after all Polish resistance was crushed on 6th October 1939 by the German armed forces, Dr Brandt was summoned to see Hitler, who then instructed him that all mentally incapable patients should be now be relieved of their suffering and be euthanized, and that to make this happen, he was instructed to liaise with Reichsleiter Bouhler. It didn't take too long to create the machinery required to implement the führer's wishes.  


To keep the euthanasia programme secret, policies were deviced and put into place, for example, the transport network that would be used to transfer victims to the clinics where they would killed were given an elaborate cover name: 'The Charitable Foundation for the Transport of Patients'. However, no matter how they attempted to camouflage their activities, it didn't take the local populace too long find out what was actually happening on their own doorstep.

Gas: The Favoured Option ?

Seeing that the state was now planning to murder tens of thousands of people, the killing method had to be cheap and effective, and which would kill the victims pretty quick. It also had to be inconspicuous, so that the victims families could be easily deceived on how their loved one's died. The idea of using carbon monoxide gas was discussed, but Brandt had shown opposition to this idea, but soon changed his mind. Brandt said:

'In this connection it was suggested that we use coal oxide [carbon monoxide]. I did not like the idea, because I said to myself that this whole question can only be looked at from a medical point of view. In my mind coal oxide had never been an instrument of medicine. I learned about it a few years ago and I had experienced a little coal oxide poisoning when I was in a room where there was something wrong with the stove. Then I remembered that at that time I went to the door, I had fallen out of the room without feeling anything and had simply passed out. So on reflection I thought that coal oxide death might be the most humane form of death. I did not come to this conclusion quickly, because it was clear to me that the moment I accepted this Idea I would be bringing into being a wholly new medical concept. I thought very hard and earnestly about this, in order to put my conscience at rest.

                  – Karl Brandt: The Nazi Doctor. Medicine and Power in the Third Reich (2008 edition) p137. Ulf Schmidt.

So Brandt believed that gassing patients was the beginning of a new medical procedure. It is hard to understand how he managed to square this concept with the Hippocratic oath. Killing his unfit patients was a gesture of his humanity, a duty in fact, a duty to alleviate their suffering even if they did not request it, nor wanted it.  

The doctors and nurses, alongside many others who became part of the killing apparatus must have known deep down that the policy to euthanize those no longer deemed worthy of life was morally reprehensible, yet they all made their excuses to justify their participation in mass murder, just like Dr Karl Brandt did. From this point forward, the killing process for adult patients would be 'death by a deadly gas'. Now all that was required was how the gassing should take place, and to ensure that the technical means to achieve such an aim could be done effectively and efficiently. 

Testing: Gas Vs. Lethal Injection

To be completely sure on the best killing method, a disused prison situated within Brandenburg-Görden was converted for the sole purpose of testing a couple of killing methods. One test was by means of injecting the victims with a drug that would kill then, another test was the use of gas. Out of the two tests, gassing was the preferred option. Now all that was required was to expand the process. It must be remembered that these handicapped 'Germans' at Brandenburg-Görden, where the first victims who died in a specially constructed gas chamber at the hands of the Nazis. 


Of course, once the killing began, especially with the amount of killing being done, it was too difficult for the authorities to keep the murders secret, and soon the rumours began to spread, and on top of this other problems arose. Children living near one of killing clinics (Hadamar), began to call the buses that transported patients to the clinic, 'Murder Boxes'. Local people also began to smell the the burning of the bodies within the clinics crematoria. Causes of death on death certificates looked highly suspicious also. Churches began to express deep concern about what was happening behind the clinics closed doors. By 1940, the euthanasia programme seemed to have become common knowledge throughout Germany. As protests to halt the programme grew, the state became alarmed. Information began to leak out off Germany itself and into the hands of Germany's enemies,i.e., Great Britain and on the 2nd December 1940, Pope Pius XII condemned what the Nazis were doing to the mentally and physically handicapped. 

A Pause in the Killing

By the 24 August 1941, Hitler's armies were already heavily engaged against Stalin's Soviet Union, and because of internal and external pressures to put an end to the euthanasia programme, Hitler decided to put the brakes on the T4 Programme, if only temporarily, for he was beginning to worry that the allies would make good use of the propaganda that could be gleaned from killing his country's most vulnerable citizens, as well has having a negative effect on morale on the home front. However, after some clarification, Hitler instructed Dr Brandt that the pause in the killing only applied to adult patients. Children and adolescents were to continue to be euthanased. 

T4 Crosses Borders

At the same time that Hitler ordered a halt to the euthanasia programme, those at the top of the killing machine had already began making plans to extend the liquidation of life, deemed unworthy of life within the German-occupied areas, however, those involved found that certain 'undesirable' groups of people could not be liquidated through T4, i.e., foreign nationals, but others could (those who were German nationals as well as 'unknown' foreign nationals as it was deemed that no-one would miss them). Jews were to be sterilised under T4 direction within those occupied territories, the order for sterilisation may have come from Heinrich Himmler. As the war with the Soviet Union progressed, Brandt found himself more and more confined to stay at Hitler's side and therefore simply left the day-to-day running of the euthanasia programme with his trusted paladins, however he ensured that he was kept updated with its progress.  

Pastor Friedrich Bodelschwingh

Of course not all who ran clinics for the mentally and physically handicapped were pro-euthanasia, one such man, Pastor Friedrich von Bodelschwingh, a founder of the Bethel psychiatric hospital tried everything to stall compulsory registration of patients, and then argued for certain exemptions from the killing. In a letter he wrote to Dr Karl Brandt on 28 August 1941, he noted:

'In the great spiritual struggle of our day, it is critically important what kind of face the German state shows to the world. Many see these intrusions into life and family context, which are carried out without a legal basis and in secret, a fearful pattern of unscrupulous brutality. The people around us are gaining the same impression. Our actions are handing to the enemies of our fatherland welcoming weapons; and a measure which might have resulted from an extreme form of racial idealism leads to a deepening of hatred among the people and to a lengthening of the war. That is why I fear that many German mothers will pay the bill for the guilt which has been placed upon our people with the blood of their sons.' (Karl Brandt: The Nazi Doctor. Medicine and Power in the Third Reich. (2008 edition) p161. Ulf Schmidt)

By the time Hitler put a stop to the killing, some 70,000 (Ibid p.162) men, women and children had been murdered by the Nazi regime.

Experts in Genocide

The individuals who were at the heart of the euthanasia programme quickly aquired experience and expertise in mass murder, and these same people would soon put their skills of logistics and organisation into play within the killing fields of the Einsatzgruppen and within the killing factories of Auschwitz, Treblinka, Sobibor, Majdanek, Chelmno and Belzec.

Aktion Brandt

When Hitler pulled the (partial) plug on the euthanasia programme, others made use of their time to prepare for a reversal of policy some time in the future. And When Dr Brandt was given such powers that made him the most powerful man within the German health system, he first began to look at ways of building new hospitals as a way to cope with more and more military and civilian casualties of the war, and this included the potential to seize buildings which could be converted into hospitals, this became known as 'Aktion Brandt', and Aktion Brandt would also look at ways to free up bed-space, conserve medical supplies and foodstuffs, which helped focus the attention back onto those mentally and physically handicapped within German institutions. Plans were put into place for new groups of inmates to be exterminated so as to free up those resources desparately needed. Some prisoners would be shipped off to concentration camps, others would have their food rations reduced so much that they simply would simply starve to death. Others would be removed by the good old fashioned way, gas or injection. Thus the second phase of the T4 programme also became part of Aktion Brandt. Up to 117,000 people may well have perished as part of the second phase of the T4 Euthanasia Programme. But the figure could even be higher.

T4 Restarts

In August 1941, Hitler had put a stop to the killing process of the euthanasia programme, except of course for those younger victims, 'children and adolescents', however the programme was back in full swing by the end of August 1942, and this time, patients wouldn't necessarily have to be transferred to killing centres to be disposed of, they could either receive a lethal injection or simply be allowed to starve to death. By the time it ended, with the end of the war, something like 187,000 men, women and children had been murdered by the state. 

Above: Doctor Karl Brandt (1904-1948) Hitler's personal physician and one of the architects of the T4 Euthanasia Pogramme.