Aktion T4 (German, pronounced [akˈtsi̯oːn teː fiːɐ]) was a Nazi-era programme for the systematic mass-murder of people with disabilities and the mentally ill using poison gas, lethal injections, starvation, and other means. The terms "T4" or "Aktion T4" were first used in post-war trials against the perpetrators.
The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in early 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated with Aktion T4. Certain German physicians were authorised to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death" (Gnadentod). In October 1939, Adolf Hitler signed a "euthanasia note", backdated to 1 September 1939, which authorised his physician Karl Brandt and Reichsleiter Philipp Bouhler to begin the killing.
Although the T4 programme officially ended in August 1941, killings took place from September 1939 until the end of World War II in Europe in 1945. Between 275,000 and 300,000 people were murdered in psychiatric hospitals in Germany, Austria, occupied Poland, the Protectorate of Bohemia and Moravia (now the Czech Republic), and the Soviet Union. The number of victims was originally recorded as 70,273 but this number has been increased by the discovery of victims listed in the archives of the former East Germany. About half of the victims were taken from church-run asylums. In June 1940, Paul Braune and Fritz von Bodelschwingh, who served as directors of sanatoriums, protested against the killings, being members of the Lutheran Confessing Church.
The Holy See announced on 2 December 1940 that the policy was contrary to divine law and that "the direct killing of an innocent person because of mental or physical defects is not allowed". Bishop Theophil Wurm of the Lutheran Confessing Church "wrote an open letter denouncing the policy." Beginning in the summer of 1941, protests were led in Germany by the Roman Catholic bishop of Münster, Clemens von Galen, whose intervention led to "the strongest, most explicit and most widespread protest movement against any Nazi policy since the beginning of the Third Reich", according to Richard J. Evans.
Several reasons have been suggested for the killings, including eugenics, racial hygiene, and saving money. Physicians in German and Austrian asylums continued many of the practices of Aktion T4 until the defeat of Germany in 1945, in spite of its official cessation in August 1941. The informal continuation of the policy led to 93,521 "beds emptied" by the end of 1941. Technology developed under Aktion T4, particularly the use of lethal gas on large numbers of people, was taken over by the medical division of the Reich Interior Ministry, along with the personnel of Aktion T4, who participated in the mass murder of Jewish people under Operation Reinhard. The number of people killed was about 200,000 in Germany and Austria, with about 100,000 victims in other European countries. Following the war, a number of the perpetrators were tried and convicted for murder and crimes against humanity.
Background
At the beginning of the twentieth century, the sterilisation of people carrying what were considered to be hereditary defects and in some cases those exhibiting what was thought to be hereditary "antisocial" behaviour, was a respectable field of medicine. Canada, Denmark, Switzerland and the United States had passed laws enabling forced sterilisation. Studies conducted in the 1920s ranked Germany as a country that was unusually reluctant to introduce sterilisation legislation.
The policy and research agenda of racial hygiene and eugenics were promoted by Emil Kraepelin. The eugenic sterilisation of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Eugen Bleuler, who presumed racial deterioration because of "mental and physical cripples" in his Textbook of Psychiatry,
The more severely burdened should not propagate themselves... If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate.
The German eugenics movement had an extreme wing even before the Nazis came to power. As early as 1920, Alfred Hoche and Karl Binding advocated killing people whose lives were "unworthy of life" (lebensunwertes Leben). Darwinism was interpreted by them as justification of the demand for "beneficial" genes and eradication of the "harmful" ones. Summarising their views, Robert Lifton writes, "The argument went that the best young men died in war, causing a loss to the Volk of the best genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration". In his book Mein Kampf (1924), Hitler wrote that one day racial hygiene "will appear as a deed greater than the most victorious wars of our present bourgeois era". The advocacy of eugenics in Germany gained ground after 1930, when the Depression was used to excuse cuts in funding to state mental hospitals, creating squalor and overcrowding.
Many German eugenicists were nationalists and antisemites, who embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes. Their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged. In the 1930s, the Nazi Party had carried out a campaign of propaganda in favour of euthanasia. The Nazi Party Office of Racial Policy (RPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), Victims of the Past (Opfer der Vergangenheit, 1937), which was given a major première in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941) which was based on a novel by Hellmuth Unger, a consultant for "child euthanasia".
In July 1933, the "Law for the Prevention of Hereditarily Diseased Offspring" prescribed compulsory sterilisation for people with conditions thought to be hereditary, such as schizophrenia, epilepsy, Huntington's chorea and "imbecility". Sterilisation was also legalised for chronic alcoholism and other forms of social deviance. The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (Erbgesundheitsgerichte), which examined the inmates of nursing homes, asylums, prisons, aged-care homes and special schools, to select those to be sterilised. It is estimated that 360,000 people were sterilised under this law between 1933 and 1939.
Within the Nazi administration, the idea of including in the programme people with physical disabilities had to be expressed carefully, because the Reich Minister of Propaganda, Joseph Goebbels, had a deformed right leg. After 1937, the acute shortage of labour in Germany arising from rearmament, meant that anyone capable of work was deemed to be "useful", exempted from the law and the rate of sterilisation declined.
Implementation
Karl Brandt, Hitler's doctor, and Hans Lammers, the head of the Reich Chancellery, testified after the war that Hitler had told them as early as 1933—when the sterilisation law was passed—that he favoured the killing of the incurably ill but recognised that public opinion would not accept this. In 1935, however, Hitler told the Leader of Reich Doctors, Gerhard Wagner, that euthanasia would be easier to deal with during wartime and he intended "in the event of a war radically to solve the problem of the mental asylums."
Wagner informed the heads of a number of relevant medical institutions of Hitler's intentions and several responded enthusiastically. Hermann Pfannmuller, director of the Eglfing-Haar mental hospital near Munich, had already been conducting tours of his institution since 1933 to show the SS and other visitors those patients who he considered to be unworthy of life.
The first centralised Nazi euthanasia programme involved infants. In 1939 Hitler instructed Brandt to evaluate a petition sent by two parents for the "mercy killing" of their infant son, Gerhard Kretschmar who was blind and had physical and developmental disabilities. Following Brandt's investigation, the child was killed in July 1939. Hitler instructed Brandt to proceed in the same manner in all similar cases.
Brandt and the head of the Chancellery of the Führer, Philipp Bouhler, subsequently founded the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses as a front organisation for the child euthanasia programme. On 18 August the committee issued an order to relevant health authorities requiring them to register infants up to the age of three with specified disabilities and medical conditions. The first child killed in special children's wards under the centralised programme was in summer 1940, although officials in some institutions had already begun killing children. By the end of the war more than 5,000 children had been killed.
In the summer of 1939, Hitler called a conference with Leonardo Conti, Reich Health Leader and State Secretary for Health in the Interior Ministry, and Hans Lammers, Chief of the Reich Chancellery, where he gave verbal authorisation for adult involuntary euthanasia. In October Hitler signed an unofficial decree (backdated to 1 September) authorising Brandt and Bouhler to set up a programme for the "mercy killing" of incurable adult patients. Brandt and Bouhler established a number of front organisations, including the Reich Cooperative for State Hospitals and Nursing Homes (Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten), to maintain its secrecy. The programme later became known as Operation T4, after the address of its headquarters at Tiergartenstraße 4 in Berlin.
Killing of children
Brandt and Bouhler assigned the management of the child euthanasia programme to Chancellery official Viktor Brack and his subordinates such as Hans Hefelmann and Richard von Hegener.
From August 1939 the Interior Ministry registered children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the 'guardian' consent element soon disappeared. Those to be killed were identified as "all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and Down syndrome (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 transferred to a "special children's ward" for extermination. The first of these wards was established in the summer of 1940. Eventually 30 were established in various hospitals throughout the Reich.
The Ministry used deceit when dealing with parents or guardians, particularly in Catholic areas, where parents were generally uncooperative. Parents were told that their children were being sent to "Special Sections", where they would receive improved treatment. The children sent to these centres were kept for "assessment" for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as "pneumonia". Autopsies were usually performed and brain samples were taken to be used for "medical research". Post mortem examinations apparently helped to ease the consciences of many of those involved, giving them the feeling that there was a genuine medical purpose to the killings.
When the Second World War began in September 1939, less rigorous standards of assessment and a quicker approval process were adopted. Older children and adolescents were included and the conditions covered 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'.
— Lifton
More pressure was placed on parents to agree to their children being sent away. Many parents suspected what was happening and refused consent, especially when it became apparent that institutions for children with disabilities were being systematically cleared of their charges. The parents were warned that they could lose custody of all their children and if that did not suffice, the parents could be threatened with call-up for 'labour duty'. By the end of the war, more than 5,000 children had been murdered under the programme. The last victim of child euthanasia in Germany was Richard Jenne on 29 May 1945, in the children's ward of the Kaufbeuren-Irsee state hospital in Bavaria more than three weeks after US Army troops had occupied the town.
Killing of adults
Invasion of Poland
Brandt and Bouhler developed plans to expand the programme of "euthanasia" to adults. In July 1939 they held a meeting attended by Conti and Professor Werner Heyde, head of the SS medical department. This meeting agreed to arrange a national register of all institutionalised people with mental illnesses or physical disabilities. The first adults with disabilities to be killed en masse by the Nazi regime were Poles. After the invasion on 1 September 1939, adults with disabilities were shot by the SS men of Einsatzkommando 16, Selbstschutz and EK-Einmann under the command of SS-Sturmbannführer Rudolf Tröger, overseen by Reinhard Heydrich, during Operation Tannenberg.
All hospitals and mental asylums of the Wartheland were emptied. The region was incorporated into Germany and earmarked for resettlement by Volksdeutsche following the German conquest of Poland. In the Danzig (now Gdańsk) area, some 7,000 Polish patients of institutions were shot. 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany.
In October 1939, the first experiments with the gassing of patients were conducted at Fort VII in Posen (occupied Poznań), where hundreds of prisoners were killed by means of carbon monoxide poisoning, in an improvised gas chamber developed by Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, Reichsführer-SS Heinrich Himmler witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.