Although officialy started in september 1939 it is stated that Euthanasia Program (Action T4) initated with a sort of trial balloon with the instruction of Hitler to Karl Brandt in late 1938 to valuate the euthanasia petition of a little boy, who was actually killed in July 1939.Hitler also instructed Brandt to proceed in the same manner in similar cases. The foundation of the Committee for the Scientific Treatment of Severe, Genetically Determined Illness in order to prepare and proceed with the massive secret killing of infants took place in May 1939 and the respective secret order to start the registration of ill children, took place in 18 August 1939, three weeks after the euthanasia of the mentioned boy.
From the official Nazi files, there is evidence that during the official stage 70,273 people were killed. The Nuremberg Trials found evidence that German and Austrian physicians continued the extermination of patients after October 1941 and evidence that about 275,000 people were killed under T4. More recent research based on files that were recovered after 1990 gives a figure of at least 200,000 physically or mentally handicapped people that were killed by medication, starvation, or in the gas chambers between 1939 and 1945.
The name T4 was an abbreviation of "Tiergartenstraße 4", the address of a villa in the Berlin borough of Tiergarten which was the headquarters of the Gemeinnützige Stiftung für Heil- und Anstaltspflege, bearing the euphemistic name literally translating into English: as Charitable Foundation for Cure and Institutional Care. This body operated under the direction of Philipp Bouhler, the head of Hitler's private chancellery,and Dr. Karl Brandt, Hitler's personal physician. This villa no longer exists, but a plaque set in the pavement on Tiergartenstraße marks its location.
The "euthanasia decree", written on Adolf Hitler's personal stationery and dated 1 September 1939, reads as follows:
" Reich Leader Bouhler and Dr. Brandt are charged with the responsibility for expanding the authority of physicians, to be designated by name, to the end that patients considered incurable according to the best available human judgment [menschlichem Ermessen] of their state of health, can be granted a mercy death [Gnadentod]."
The T4 program is thought to have developed from the Nazi Party's policy of "racial hygiene", the belief that the German people needed to be "cleansed" of "racially unsound" elements, which included people with disabilities. According to this view, the euthanasia program represents an evolution in policy toward the later Holocaust of the Jews of Europe.
The idea of enforcing "racial hygiene" had been an essential element of Hitler's ideology from its earliest days. In his book Mein Kampf (1924), Hitler wrote:
- He who is bodily and mentally not sound and deserving may not perpetuate this misfortune in the bodies of his children. The völkische [people's] state has to perform the most gigantic rearing-task here. One day, however, it will appear as a deed greater than the most victorious wars of our present bourgeois era.
Hitler was in favour of killing those whom he judged to be "unworthy of life".
The war also gave this issue a new urgency in the eyes of the Nazi regime. People with severe disabilities, even when sterilized, still needed institutional care. They occupied places in facilities which, during war, would be needed for wounded soldiers and people evacuated from bombed cities. They were housed and fed at the expense of the state, and took up the time of doctors and nurses. The Nazis barely tolerated this even in peacetime, and few would continue to support allowing it in wartime. As a leading Nazi doctor, Dr. Hermann Pfannmüller, said: "The idea is unbearable to me that the best, the flower of our youth must lose its life at the front in order that feeble-minded and irresponsible asocial elements can have a secure existence in the asylum"
Killing of children
This precedent was used to establish a program of killing children with severe disabilities from which the voluntary element soon disappeared. From August the Interior Ministry required doctors and midwives to report all cases of newborns with severe disabilities. Those to be killed were "all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and mongolism (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". 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.
Various methods of deception were used to gain consent, 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 care. The children sent to these centers were kept for "assessment" for a few weeks and then killed by lethal injection, their deaths 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 program had a genuine medical purpose.
Once war broke out in September 1939, the program became less rigorous in its process of assessment and approval. 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'". 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 out, and refused consent. They were threatened that they would lose custody of all their children, and if that did not suffice the parents themselves could be threatened with call-up for "labour duty." By 1941 over 5,000 children had been killed.
- Killing of adults
Brandt and Bouhler soon developed plans to expand the program to adults. In July 1939 they had held a meeting attended by Dr L. Conti, Reich Health Leader and State Secretary for Health in the Interior Ministry, and Professor Werner Heyde, head of the SS medical department. This meeting had made preliminary arrangements for a national register of all institutionalized people with mental illnesses or physical disabilities.
The first adults with disabilities to be systematically killed by the Nazi regime were not, however, Germans, but rather Poles, as the SS men of Einsatzkommando 16 cleared the hospitals and mental asylums of the “Wartheland”, a region of western Poland which was earmarked for rapid incorporation into Greater Germany and resettlement by ethnic Germans following the German conquest of Poland. In the Danzig (now Gdańsk) area, some 7,000 Polish inmates of various institutions were shot, while 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany At Posen (now Poznań), hundreds of patients were killed by means of carbon monoxide gas in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939 the SS head Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.
The idea of killing “useless” mental patients soon spread from occupied Poland to adjoining areas of Germany itself, 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 German wounded from the Polish campaign were expected to be accommodated, creating a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, dispatched 1,400 patients from five Pomeranian hospitals to Poland, where they were shot. The Gauliter of East Prussia, Erich Koch, likewise had 1,600 patients killed. In all, more than 8,000 Germans were killed in this initial wave of killings. These were carried out on the initiative of local officials, although Himmler certainly knew and approved of them.
The program for killing adults with mental or physical disabilities began with a letter from Hitler issued in October 1939. The decree charged Bouhler and Brack with “enlarging the authority of certain physicians, to be designated by name, in such a manner that persons who, according to human judgement, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death”. The letter was backdated to 1 September to provide “legality” to those killings already carried out, and to link the program more definitely to the war, giving it a rationale of wartime necessity. It is important to note that this letter—which provided the sole legal basis for the program—was not a formal "Führer decree," which in Nazi Germany possessed the force of law. For this reason Hitler deliberately bypassed Health Minister Conti and his department, who were held to be not sufficiently imbued with National Socialist ruthlessness and who might have raised awkward questions about the legality of the program, entrusing it to his personal agents Bouhler and Brandt.
The program was administered by Brack’s staff from the villa at Tiergartenstrasse 4, under the guise of the General Foundation for Welfare and Institutional Care, supervised by Bouhler and Brandt. Others closely involved included Dr Herbert Linden, who had been heavily involved in the children's program, and Dr Ernst-Robert Grawitz, chief physician of the SS. These officials chose the doctors who were to carry out the "operational" part of the program. They were chosen for their political reliability, professional reputation, and known sympathy for radical eugenics. They included several who had proved their worth in the child-killing program, such as Unger, Heinze, and Hermann Pfannmüller. The new 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 program, succeeded later by Nitsche.
In early October all hospitals, nursing homes, old people's 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 of a list of specified conditions. These included schizophrenia, epilepsy, Huntington’s chorea, advanced syphilis, senile dementia, paralysis, encephalitis and “terminal neurological conditions generally”. Many doctors and administrators assumed that the purpose of the reports was to identify inmates who were capable of being drafted for "labour service". They therefore tended to overstate the degree of incapacity of their patients, to protect them from labor conscription - with fatal consequences. When some institutions, mainly in Catholic areas, refused to co-operate, teams of T4 doctors (or in some cases Nazi medical students) visited them and compiled their own lists, sometimes in a very haphazard and ideologically motives manner. At the same time, all Jewish patients were removed from institutions and were killed during 1940.
As with child inmates, adults had their cases assessed by a panel of "experts" working at the Tiergartenstrasse offices. The experts were required to make their judgments solely on the basis of the reports, rather than on detailed medical histories, let alone examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (meaning death), a - (meaning life), or occasionally a ? meaning that they were unable to decide. Three "death" verdicts condemned the person concerned. As with the children, over time these processes 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.
- Patients were transferred from their institutions to the killing centers in buses operated by teams of SS men wearing white coats to give an air of medical authenticity. To prevent the families and the doctors of the patients tracing them, they were often sent to "transit" centers in major hospitals where they were allegedly "assessed" before being moved again to "special treatment" centers. (The expression "special treatment", Sonderbehandlung, was later widely employed as a euphemism for killing during the extermination of the Jews). Families were sent letters explaining that owing to wartime regulations it would not be possible to visit relatives in these centers. In fact most of these patients were killed within 24 hours of arriving at the centers, and their bodies cremated. For every person killed, a death certificate was prepared, giving a false but plausible cause of death, and 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 in fact took up most of the working day of the doctors who operated the centers.
In 1971 the Hungarian-born journalist Gitta Sereny conducted a series of interviews with Franz Stangl, who was in prison in Düsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibór and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 program based on his time as commandant of the killing facility at the Hartheim “institute”. 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 then induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (this ruse was later used on a much larger scale at the extermination camps).
Action T4 was described as euthanasia by some of the officials responsible for carrying the program out. At the Nuremberg trials the program was determined to be illegal and punishable as murder under the law, even if it was called euthanasia, and moreover the Nuremberg Tribunal concluded that under the German law, euthanasia as such was illegal and punishable as murder, and also was a war crime and a crime against humanity.
Some commentators deny that Aktion T4 was a "euthanasia" program, comparing its activities with dictionary definitions of this term claiming that euthanasia is the assistance of suicide motivated by concern for the welfare of the people concerned or by a desire to release them from suffering – and Aktion T4 cannot be described in those terms.As Aktion T4 was carried out primarily according to the dictates of "racial hygiene" ideology, and secondarily to reduce the cost to the state of maintaining people with disabilities at a time when the overwhelming financial priority of the regime was rearmament, it was nearly always carried out without the consent of the people concerned or their families. And most of those killed were not even suffering.