T-4 and the Nazi’s Euthanasia Program

Robert Wagemann, a physically disabled Jehovah's Witness child, sits on his hospital bed.
Robert Wagemann, a physically disabled Jehovah's Witness child, sits on his hospital bed. His mother overheard doctors discussing euthanizing him and was able to successfully sneak him out of the hospital. (Photo from the United States Holocaust Memorial Museum, courtesy of Robert Wagemann)

From 1939 to 1945, the Nazi regime targeted mentally and physically disabled children and adults for “euthanasia,” a term the Nazis used to camouflage the systematic killing of those they deemed “life unworthy of life.” As part of this Euthanasia Program, the Nazis used lethal injections, drug overdoses, starvation, gassings, and mass shootings to kill an estimated 200,000 to 250,000 individuals.

Operation T-4, as the Nazi’s Euthanasia Program is generally known, began with a decree from Nazi leader Adolf Hitler on October 1, 1939 (but backdated to September 1) that granted authority to physicians to kill patients that were deemed “incurable.” Although Operation T-4 officially ended in 1941 after an outcry from religious leaders, the Euthanasia Program continued in secret until the end of World War II.

First Came Sterilization

When Germany legalized forced sterilization in 1934, they were already behind many countries in this movement. The United States, for instance, had official sterilization policies dating back to 1907.

In Germany, individuals could be chosen for forced sterilization based on any number of characteristics, including feeblemindedness, alcoholism, schizophrenia, epilepsy, sexual promiscuity, and mental/physical retardation.

This policy was officially known as the Law for the Prevention of Genetically Diseased Offspring, and was often referred to as the “Sterilization Law.” It was passed on July 14, 1933 and took effect the following January 1.

The intention behind sterilizing a segment of the German population was to eliminate the inferior genes that caused mental and physical abnormalities from the German bloodline.

While an estimated 300,000 to 450,000 people were forcibly sterilized, the Nazis eventually decided upon a more extreme solution.

From Sterilization to Euthanasia

While sterilization helped keep the German bloodline pure, many of these patients, plus others, were an emotional, physical, and/or financial strain on German society. The Nazis wanted to strengthen the German Volk and had no interest in maintaining lives they considered “life unworthy of life.”

The Nazis based their ideology on a 1920 book by attorney Karl Binding and Dr. Alfred Hoche called, The Permission to Destroy Life Unworthy of Life. In this book, Binding and Hoche examined medical ethics regarding patients that were incurable, such as those that were deformed or mentally disabled.

The Nazis expanded on Binding and Hoche’s ideas by creating a modern, medically-supervised, murder system that began in 1939.

Killing Children

The effort to rid Germany of the incurable initially targeted children. In an August 1939 memorandum issued by the Reich Ministry of Interior, medical personnel became required to report any children ages three and under who exhibited physical deformities or potential mental disabilities.

By the fall of 1939, the parents of these identified children were strongly encouraged to allow the state to take over the children’s treatment at a specially designed facility. Under the guise of aiding these overwhelmed parents, the medical personnel in these facilities took responsibility of these children and then killed them.

The “child euthanasia” program was eventually extended to include children of all ages and it is estimated that over 5,000 German youths were murdered as a part of this program.

Expansion of the Euthanasia Program

The expansion of the Euthanasia Program to all those deemed “incurable” began with a secret decree signed by Adolf Hitler on October 1, 1939.

This decree, which was backdated to September 1 to allow Nazi leaders to claim the program was necessitated by the outbreak of World War II, granted certain physicians the authority to give a “mercy death” to those patients deemed “incurable.”

Headquarters for this Euthanasia Program was located at Tiergartenstrasse 4 in Berlin, which is how it got the nickname of Operation T-4. While co-led by two individuals very close to Hitler (Hitler’s personal physician, Karl Brandt, and the director of the chancellery, Philipp Bouhler), it was Viktor Brack who was in charge of the program’s day-to-day operations.

In order to kill patients quickly and in large numbers, six “euthanasia centers” were established within Germany and Austria. The names and locations of the centers were:

  • Brandenburg (outside Berlin)
  • Hadamar (Hessen, Germany)
  • Grafeneck (Southwestern Germany)
  • Bernburg (Saxony Province, Germany)
  • Sonnenstein  (Saxony Province, Germany)
  • Hartheim (outside Linz, Austria)

Finding Victims

In order to identify individuals who fit under the criteria established by the leaders of Operation T-4, physicians and other public health officials throughout the Reich were asked to fill out questionnaires that identified patients who fit into one of the following categories:

  • Individuals suffering from chronic neurological or psychiatric diseases and disorders, such as epilepsy and schizophrenia
  • Individuals who were not classified as “good” Aryan stock
  • Individuals who were labeled “criminally insane”
  • Individuals who were long-term inhabitants of mental institutions or other health facilities, such as nursing homes, for five years or more

While the doctors who filled out these questionnaires believed the information was being collected for purely statistical purposes, the information was actually evaluated by undisclosed teams to make life and death decisions about patients. Each team consisted of three physicians and/or psychiatrists who likely had never met the patients whose fates they were determining.

Forced to process forms at high rates of “efficiency,” the evaluators noted those who were to be put to death with a red plus. Those who were spared received a blue minus next to their names. Occasionally, some files would be marked for further evaluation.

Killing Patients

Once an individual was marked for death, they were transferred by bus to one of the six killing centers. Death often occurred shortly after arrival. At first, patients were killed by starvation or lethal injection, but as Operation T-4 progressed, gas chambers were built.

These gas chambers were the precursors of those built later during the Holocaust.  The first gas chamber to be built was at Brandenburg in early 1940. As with later gas chambers in the concentration camps, this one was disguised as a shower to keep the patients calm and unknowing. Once victims were inside, the doors were closed and carbon monoxide was pumped in.

Once everyone inside was dead, their bodies were pulled out and then cremated. Families were notified that the individual had died, but, in order to keep the Euthanasia Program secret, the notification letters typically stated that the individual died of natural causes.

Families of the victims received an urn that contained remains, but unbeknownst to most families was that the urns were filled with mixed remains since the ash was scooped from a pile of ashes. (At some locations, bodies were buried in mass grave rather than cremated.)

Doctors were involved in every step of Operation T-4, with older ones making decisions and younger ones doing the actual killing. To ease the mental burden from killing, those who worked at euthanasia centers were given lots of liquor, luxurious vacations, and other benefits.

Aktion 14f13

Beginning in April 1941, T-4 was expanded to include concentration camps. Dubbed “14f13” based on the code used at concentration camps to denote euthanasia, Aktion 14f13 sent T-4 trained physicians to concentration camps to seek out additional victims for euthanasia.

These physicians culled the forced laborers at concentration camps by removing those deemed too ill to work. These prisoners were then taken to Bernburg or Hartheim and gassed.

This program petered out as concentration camps began having their own gas chambers and T-4 physicians were no longer needed to make these kinds of decisions. It total, Aktion 14f13 was responsible for killing an estimated 20,000 individuals.

Protests Against Operation T-4

Over time, protests against the “secret” operation increased as details were leaked by indiscreet workers at the killing centers. Additionally, some of the deaths began to be questioned by victim’s families.

Many families sought counsel from their church leaders and soon after, some leaders within the Protestant and Catholic churches publicly denounced Operation T-4. Notable individuals including Clemens August Count von Galen, who was the bishop of Münster, and Dietrich Bonhöffer, an outspoken Protestant minister and son of a famous psychiatrist.

As a result of these very public protests and Hitler’s desire not to find himself at odds with the Catholic and Protestant churches, an official halt on Operation T-4 was declared on August 24, 1941.

“Wild Euthanasia”

Despite the official declaration of an end to Operation T-4, killings continued throughout the Reich and into the East.

This phase of the Euthanasia Program is often referred to as “wild euthanasia” because it was no longer systematic. Without oversight, doctors were encouraged to make their own decisions about which patients should die. Many of these patients were killed by starvation, neglect, and lethal injections.

The victims of euthanasia during this time expanded to include the elderly, homosexuals, forced laborers – even injured German soldiers were not exempt.

As the German Army headed East, they often used “euthanasia” to clear out entire hospitals through mass shootings.

Transferring to Operation Reinhard

Operation T-4 proved to be a fertile training ground for numerous individuals who would go east to staff the death camps in Nazi-occupied Poland as part of Operation Reinhard.

Three of the commandants of Treblinka (Dr. Irmfried Eberl, Christian Wirth, and Franz Stangl) gained experience through Operation T-4 that proved vital to their future positions. The commandant of Sobibor, Franz Reichleitner, was also trained in the Nazi Euthanasia Program.

In total, over 100 future workers in the Nazi death camp system gained their initial experience in Operation T-4.

The Death Toll

By the time Operation T-4 was declared to have ended in August 1941, the official death count numbered 70,273 individuals. Factoring in the estimated 20,000 more who were killed as part of the 14f13 program, nearly 100,000 individuals were killed in Nazi euthanasia programs between 1939 and 1941.

The Nazis’ Euthanasia Program did not end in 1941, however, and in total an estimated 200,000 to 250,000 people were murdered as part of this program.