Program to Murder People with Disabilities

Max Cardozo
Jun 23, 2022
12 min read

The Euthanasia Program was the systematic murder of institutionalized patients with disabilities in Germany. It predated the genocide of European Jewry (the Holocaust) by approximately two years. The program was one of many radical eugenic measures aimed at restoring the racial "integrity" of the German nation. It sought to eliminate what eugenicists and their supporters considered "life unworthy of life": those individuals who—they believed—because of severe psychiatric, neurological, or physical disabilities represented both a genetic and a financial burden on German society and the state.

Child "Euthanasia" Program

Nazi physician Karl Brandt, director of the Euthanasia Program. August 27, 1942

In the spring and summer months of 1939, several planners began to organize a secret killing operation targeting disabled children. They were led by Philipp Bouhler, the director of Hitler's private chancellery, and Karl Brandt, Hitler's attending physician. On August 18, 1939, the Reich Ministry of the Interior circulated a decree requiring all physicians, nurses, and midwives to report newborn infants and children under three who showed signs of severe mental or physical disability.

In October 1939, public health authorities began encouraging parents of children with disabilities to admit their young children to one of several specially designated pediatric clinics throughout Germany and Austria. In reality, the clinics were children's killing wards. There, specially recruited medical staff murdered their young charges by lethal overdoses of medication or starvation.

At first, medical professionals and clinic administrators included only infants and toddlers in operation. As the scope of the measure widened, they had youths up to 17 years of age. Conservative estimates suggest that at least 10,000 physically and mentally disabled German children perished due to the child "euthanasia" program during the war years.

Aktion T4: Extending the Euthanasia Program

Adolf Hitler's authorization for the Euthanasia Program (Operation T4), signed in October 1939 but dated September 1, 1939.

"Euthanasia" planners quickly envisioned extending the killing program to adult disabled patients living in institutional settings. In the autumn of 1939, Adolf Hitler signed a secret authorization to protect participating physicians, medical staff, and administrators from prosecution. This authorization was backdated to September 1, 1939, to suggest that the effort was related to wartime measures. The Führer Chancellery was compact and separate from the state, government, or Nazi Party apparatuses. For these reasons, Hitler chose it to serve as the engine for the "euthanasia" campaign. The program's functionaries called their private enterprise "T4." This code name came from the street address of the program's coordinating office in Berlin: Tiergartenstrasse 4.

According to Hitler's directive, Führer Chancellery director Phillip Bouhler and physician Karl Brandt led the killing operation. Under their leadership, T4 operatives established six gassing installations for adults as part of the "euthanasia" action. These were:

Brandenburg, on the Havel River near Berlin
Grafeneck, in southwestern Germany
Bernburg, in Saxony
Sonnenstein, also in Saxony
Hartheim, near Linz on the Danube in Austria
Hadamar, in Hessen

Euthanasia Program

The "euthanasia" program targeted, for systematic killing, patients with mental and physical disabilities living in institutional settings in Germany and German-annexed territories. Historians estimate that the program claimed the lives of 250,000 men, women, and children.

Buses used to transport patients from the Eichberg hospital near Wiesbaden to Hadamar euthanasia center. The windows were painted to prevent people from seeing that inside—Germany between May and September 1941.

In Nazi usage, "euthanasia" referred to the systematic killing of those Germans whom the Nazis deemed "unworthy of life" because of alleged genetic diseases or defects. Beginning in the fall of 1939, gassing installations were established at Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein. Doctors selected patients, transferred them from clinics to one of these centralized gassing installations, and killed them. After public outrage forced an end to centralized killings, doctors administered lethal injections to those selected for "euthanasia" in clinics and hospitals throughout Germany. In this way, the "euthanasia" program continued and expanded until the end of World War II.

Robert Wagemann describes fleeing from a clinic where his mother feared he would be put to death by euthanasiaRobert and his family were Jehovah's Witnesses. The Nazis regarded Jehovah's Witnesses as enemies of the state for their refusal to take an oath of loyalty to Adolf Hitler or to serve in the German army. Robert's family continued its religious activities despite Nazi persecution. Shortly before Robert's birth, his mother was imprisoned briefly for distributing religious materials. Robert's hip was injured during delivery, leaving him with a disability. When Robert was five years old, he was ordered to report for a physical in Schlierheim. His mother overheard staff comments about putting Robert "to sleep." Fearing they intended to kill him, Robert's mother grabbed him and ran from the clinic. Nazi physicians began systematically killing those they deemed physically and mentally disabled in the fall of 1939.

Benno Müller-Hill, professor of genetics at the University of Cologne and the author of Murderous Science, describes the Nazi "Euthanasia" Program, with oral history excerpts from Antje Kosemund, Paul Eggert, and Elvira Manthey. Antje Kosemund had a disabled younger sister who was admitted to Alsterdorf Institute, Hamburg, in December 1933, at the age of three and was subsequently killed in 1944. Paul Eggert was a resident of the orphanage section of the Dortmund-Applerbeck institution from 1942-43, where he witnessed the euthanasia of fellow orphans. Elvira Manthey was taken with her sister from a large, impoverished family and placed in a children's home in 1938.

The elder of two daughters born to a Jewish father and a Catholic mother, Helene was raised as a Catholic in Vienna. Her father died in action during World War I when Helene was just five years old, and her mother remarried when Helene was 15. Known affectionately as Helly, Helene loved to swim and go to the opera. After finishing her secondary education, she entered law school.

1933-39: At 19, Helene first showed signs of mental illness. Her condition worsened in 1934, and by 1935 she had to give up her law studies and her job as a legal secretary. After losing her trusted fox terrier, Lydi, she suffered a significant breakdown. She was diagnosed as schizophrenic and was placed in Vienna's Steinhof Psychiatric Hospital. Two years later, in March 1938, the Germans annexed Austria to Germany.

Helene was confined in Steinhof and was not allowed home even though her condition had improved. Her parents were led to believe that she would soon be released. Instead, Helene's mother was informed in August that Helene had been transferred to a hospital in Niedernhart, just across the border in Bavaria. Helene was transferred to a converted prison in Brandenburg, Germany, where she was undressed, subjected to a physical examination, and then led into a shower room.

Helene was one of 9,772 persons gassed that year in the Brandenburg "euthanasia" center. She was officially listed as dying in her "acute schizophrenic excitement room."

Hartheim castle is a euthanasia killing center where people with physical and mental disabilities are killed by gassing and lethal injection. Hartheim, Austria, date uncertain.

Hospitalized in a psychiatric ward for her nonconformist beliefs and writings, she was murdered on January 26, 1944. Germany, date uncertain.

She was sterilized and sent to the Meseritz-Obrawalde euthanasia center, where she was killed after an overdose of tranquilizers on December 7, 1942. Place and date uncertain.

Kaufbeuren euthanasia facility. Killings by lethal injection took place in Kaufbeuren. Germany, 1945.

Head nurse of the children's ward at the Kaufbeuren-Irsee euthanasia facility. Kaufbeuren, Germany, 1945.

Personnel of T4, the agency created to administer the Nazi Euthanasia Program. Pictured from left to right are: Erich Bauer (chauffeur), Dr. Rudolf Lonauer, Dr. Victor Ratka, Dr. Friedrich Mennecke, Dr. Paul Nitsche,and Dr. Gerhard Wischer. Berlin, Germany, 1939–45.

Friedrich Mennecke, a Euthanasia Program physician Friedrich Mennecke a Euthanasia Program physician, is responsible for sending many patients to be gassed. He was sentenced to death in 1946. Germany, date uncertain.

Benno Müller-Hill, Antje Kosemund, Paul Eggert, and Elvira Manthey describe the Euthanasia ProgramBenno Müller-Hill, professor of genetics at the University of Cologne and the author of Murderous Science, describes the Nazi "Euthanasia" Program, with oral history excerpts from Antje Kosemund, Paul Eggert, and Elvira Manthey. Antje Kosemund had a disabled younger sister who was admitted to Alsterdorf Institute, Hamburg, in December 1933, at the age of three and was subsequently killed in 1944. Paul Eggert was a resident of the orphanage section of the Dortmund-Applerbeck institution from 1942-43, where he witnessed the euthanasia of fellow orphans. Elvira Manthey was taken with her sister from a large, impoverished family and placed in a children's home in 1938.

1940: Helene was confined in Steinhof and was not allowed home even though her condition had improved. Her parents were led to believe that she would soon be released. Instead, Helene's mother was informed in August that Helene had been transferred to a hospital in Niedernhart, just across the border in Bavaria. Helene was transferred to a converted prison in Brandenburg, Germany, where she was undressed, subjected to a physical examination, and then led into a shower room.

Helene was one of 9,772 persons gassed that year in the Brandenburg "euthanasia" center. She was officially listed as dying in her "acute schizophrenic excitement room." Hartheim castle is a euthanasia killing center where people with physical and mental disabilities are killed by gassing and lethal injection. Hartheim, Austria, date uncertain.Hospitalized in a psychiatric ward for her nonconformist beliefs and writings, she was murdered on January 26, 1944. Germany, date uncertain. She was sterilized and sent to the Meseritz-Obrawalde euthanasia center, where she was killed after an overdose of tranquilizers on December 7, 1942. Place and date uncertain.

Head nurse of the children's ward at KaufbeurenHead nurse of the children's ward at the Kaufbeuren-Irsee euthanasia facility. Kaufbeuren, Germany, 1945. Personnel of T4Personnel of T4, the agency created to administer the Nazi Euthanasia Program. Pictured from left to right are: Erich Bauer (chauffeur), Dr. Rudolf Lonauer, Dr. Victor Ratka, Dr. Friedrich Mennecke, Dr. Paul Nitsche,and Dr. Gerhard Wischer. Berlin, Germany, 1939–45. Friedrich Mennecke, a Euthanasia Program physician Friedrich Mennecke a Euthanasia Program physician, is responsible for sending many patients to be gassed. He was sentenced to death in 1946. Germany, date uncertain.

Using a practice developed for the child "euthanasia" program, in the autumn of 1939, T4 planners began to distribute carefully formulated questionnaires to all public health officials, public and private hospitals, mental institutions, and nursing homes for the chronically ill aged. The limited space and wording on the forms and the instructions in the accompanying cover letter combined to give the impression that the survey was intended to gather statistical data. The form's sinister purpose was suggested only by the emphasis on the patient's capacity to work and by the categories of patients that the inquiry required health authorities to identify. The types of patients were:

those suffering from schizophrenia, epilepsy, dementia, encephalitis, and other chronic psychiatric or neurological disorders
those not of German or "related" blood
the criminally insane or those committed on criminal grounds
those who had been confined to the institution in question for more than five years

Secretly recruited "medical experts," physicians—many of them of significant reputation—worked in three teams to evaluate the forms. Based on their decisions beginning in January 1940, T4 functionaries began to remove patients selected for the "euthanasia" program from their home institutions. The patients were transported by bus or rail to one of the central gassing installations for killing.

Hadamar Death Register

Two pages of the death registry at Hadamar listing false causes of death. Thousands of the physically and mentally disabled were killed there as part of the Euthanasia Program. Germany, April 5, 1945.

Within hours of arriving at such centers, the victims perished in gas chambers. The gas chambers, disguised as shower facilities, used pure, bottled carbon monoxide gas. T4 functionaries burned the bodies in crematoria attached to the gassing facilities. Other workers took the ashes of cremated victims from a typical pile and placed them in urns to send to the victims' relatives. The families or guardians of the victims received such an urn, along with a death certificate and other documentation, listing a fictive cause and date of death.

Two pages of the death registry at Hadamar listing false causes of death. Thousands of the physically and mentally disabled were killed as part of the Euthanasia Program. Germany, April 5, 1945.

Because the program was secret, T-4 planners and functionaries took elaborate measures to conceal its deadly designs. Even though physicians and institutional administrators falsified official records in every case to indicate that the victims died of natural causes, the "euthanasia" program quickly became an open secret. There was widespread public knowledge of the measure. Private and public protests concerning the killings took place, especially from members of the German clergy. Among these clergy was the bishop of Münster, Clemens August Count von Galen. He protested the T-4 killings in a sermon on August 3, 1941. In light of the widespread public knowledge and the public and private protests, Hitler ordered a halt to the Euthanasia Program in late August 1941.

According to T4's internal calculations, the "euthanasia" effort claimed the lives of 70,273 institutionalized mentally and physically disabled persons at the six gassing facilities between January 1940 and August 1941.

Second Phase

Hitler's call for a halt to the T4 action did not mean an end to the "euthanasia" killing operation. Child "euthanasia" continued as before. Moreover, in August 1942, German medical professionals and healthcare workers resumed the killings in a more carefully concealed manner than before. More decentralized than the initial gassing phase, the renewed effort relied closely upon regional exigencies, with local authorities determining the pace of the killing.

Using drug overdose and lethal injection—already successfully used in child "euthanasia"—as a more covert means of killing in this second phase, the "euthanasia" campaign resumed at a broad range of institutions throughout the Reich. Many of these institutions also systematically starved adult and child victims.

The Euthanasia Program continued until the last days of World War II, expanding to include an ever more comprehensive range of victims, including geriatric patients, bombing victims, and foreign forced laborers. Historians estimate that the Euthanasia Program, in all its phases, claimed the lives of 250,000 individuals.

People with Disabilities in the German-occupied East

Persons with disabilities also fell victim to German violence in the German-occupied east. The Germans confined the Euthanasia Program, which began as a racial hygiene measure, to the Reich proper—that is, to Germany and the annexed territories of Austria, Alsace-Lorraine, the Protectorate of Bohemia, and Moravia, and German-annexed parts of Poland. However, the Nazi ideological conviction, which labeled these persons "life unworthy of life," also made institutionalized patients the targets of shooting actions in Poland and the Soviet Union. There, the killings of disabled patients were the work of SS and police forces, not of the physicians, caretakers, and T4 administrators who implemented the Euthanasia Program.

In areas of Pomerania, West Prussia, and occupied Poland, SS and police units murdered some 30,000 patients by the autumn of 1941 to accommodate ethnic German settlers (Volksdeutsche) transferred there from the Baltic countries and other areas.

SS and police units also murdered disabled patients in mass shootings and gas vans in occupied Soviet territories. Thousands died, murdered in their beds and wards by SS and auxiliary police units in Poland and the Soviet Union. These murders lacked the ideological component attributed to the centralized Euthanasia Program. The SS was motivated primarily by economic and material concerns about killing institutionalized patients in occupied Poland and the Soviet Union.

The SS and the Wehrmacht quickly used the hospitals emptied in these killing operations as barracks, reserve hospitals, and munitions storage depots. In rare cases, the SS used the empty facilities as a formal T4 killing site. An example is the "euthanasia" facility Tiegenhof, near Gnesen (today Gniezno, in west-central Poland).

The Significance of the Euthanasia Program

The Euthanasia Program represented, in many ways, a rehearsal for Nazi Germany's subsequent genocidal policies. The Nazi leadership extended the ideological justification conceived by medical perpetrators for the destruction of the "unfit" to other categories of perceived biological enemies, most notably Jews and Roma (Gypsies).

Planners of the "Final Solution" later borrowed the gas chamber and accompanying crematoria, specifically designed for the T4 campaign, to murder Jews in German-occupied Europe. T4 personnel who had shown themselves reliable in this first mass murder program figured prominently among the German staff stationed at the Operation Reinhard killing centers of Belzec, Sobibor, and Treblinka.

Like those who planned the physical destruction of the European Jews, the planners of the Euthanasia Program imagined a racially pure and productive society. They embraced radical strategies to eliminate those who did not fit within their vision.