The Extermination of Mentally Ill and Handicapped People Under National Socialist Rule

Summary

Between 1939 and 1945 an estimated 300,000 mentally ill and handicapped people were murdered in the German territory under the guise of "euthanasia".  Aktion T4” and “Aktion 14f13” are the best-known aspects of this policy. The article describes the history of the idea of ​​“life unworthy of life”, its radical and cruel implementation during the time of National Socialism in the German Reich

Original article in German – Die Vernichtung Von Psychisch Kranken Und Geistig Behinderten Menschen Unter National Sozialisticher Herschaft

Date:  May 6, 2016 Author:  Gerrit Hohendorf

This article is published with the support of the Fondation pour la Mémoire de la Shoah. See Editor’s note at the end for details of the translation from German and changes in the original text. 

Summary

Between 1939 and 1945, an estimated 300,000 mentally ill and disabled people were murdered in German territory under the guise of “euthanasia.”” 

“Aktion T4” and “Aktion 14f13″ are the best-known aspects of this policy. The article describes the history of the idea of ​​”life unworthy of life,” its radical and cruel implementation during the time of National Socialism in the German Reich and in the occupied territories, differentiates the various forms of action of the “euthanasia” program, describes the perpetrators and their motives and tries to remember the murdered people. 

CONTEXT AND HISTORY: “EUTHANASIA” DEBATES IN GERMANY SINCE 1895

Between 1939 and 1945, under the guise of “euthanasia,” an estimated 300,000 mentally ill and disabled people, women, men and children were murdered in Germany.  

Under the guise of “euthanasia,” they were killed in specially equipped killing centers by carbon monoxide gas, even through food withdrawal, neglect, and overdosed medication.

In the occupied territories of Poland and the Soviet Union, they were shot, gassed, or otherwise brutally killed by SS special and Einsatzkommandos. Doctors, nurses, administrators, and SS members took part in the extermination campaigns.

Even if the organization and responsibility differed in the murders, the common goal was the more or less systematic destruction of “life unworthy of life” under the premise of releasing the allegedly incurably sick from their suffering and “to cleanse the national body of ballast existences.”

Therefore, the murders of institutional patients in the German Reich and the territories occupied during the Second World War cannot be understood without taking into account the debate about “euthanasia,” the medical salvation of the terminally ill, which has arisen since the end of the 19th century. 

In 1895, philosophy student Adolf Jost published a book entitled “The Right to Death.” The individual should have the right to autonomously dispose of his death if life has become worthless through illness or disability. In addition, there is the motive of compassion, which obliges doctors and society to grant redemption from suffering through killing:  

 “When we see an incurably ill writhing on his bed in unspeakable pain, with the bleak prospect of perhaps months of infirmity, with no hope of recovery, when we walk through the rooms of a madhouse, and the sight fills us of the madman or the paralytic with all the compassion that man is capable of, then despite all the prejudices that have been sucked in, the thought must stir in us: ‘These people do not have a right to death, human society does not have a duty to give them this death as painlessly as possible? ” 2

The ambiguity of the “euthanasia” idea is already expressed in Jost: The individual’s right to death should also relieve society of those lives that are no longer of any use to them. Before the First World War, the debate about “euthanasia” was limited to individual voices and circles that were shaped by social Darwinist ideas.

In the economic hardship of the immediate post-war period in Germany, the debate’s terms and point of attack became radicalized. In 1920, the work of the critical criminal lawyer Karl Binding and the well-known psychiatrist Alfred Hoche appeared with the programmatic title: “The release of the destruction of life unworthy of life.” The starting point was the question:

“Are there human lives that have lost the property of legal interest to such an extent that their continued existence has permanently lost all value for the bearers of life as well as for society?” 3

The terminally ill who so wished, the unconscious who would wake up to a nameless misery, and the “spiritually dead” “ballast existences” in the sanatoriums and nursing homes were to be redeemed from their suffering through death. The “spiritually dead” have neither the will to live nor to die, and so their killing is not wrong. This devaluation of weak human life in need of help and care, expressed in the term “unworthy of life,” should have a disastrous effect.

This is all the more so as economic arguments are brought into the field to justify the state-ordered destruction of the life of the “mentally completely dead” among institutional patients. Hoche throws the “enormous chapter” into the scales, which the national wealth through the care of about 30,000 idiots and “ballast existences,” including 3,000 to 4,000 “spiritually completely dead,” withdrawn for an unproductive purpose 4. He concludes that we may mature one day to the conclusion “that the elimination of mentally wholly dead, no crime, no immoral act, no emotional rawness, but a permissible applicable act is 5 “.

The demands of attachment and high were discussed controversially in the Weimar Republic among doctors, lawyers, and politicians. One saw him in the writing by Binding and Hoche, “a right child of our ambiguous time 6,” and surprisingly little was bothered by the terminology that derogates mentally ill and mentally handicapped people. The survey carried out by the head of an evangelical education and care facility for mentally weak children in Saxony among the parents of his protégés at the beginning of the 1920s is informative. When asked whether they would consent to a painless shortening of the life of their child if experts established that it was incurably stupid, 119 answered with “yes” and only 43 with “no” 7.

The intensity and radicalism of the debate about euthanasia and the “destruction of life unworthy of life” in the Weimar Republic proved to be dependent on the socio-economic situation. Radical cuts in welfare services and austerity measures in psychiatric hospitals, with lowering nursing care rates and cuts in staff, food and heating, worsened the living conditions for mentally ill and mentally disabled people.

At the same time, eugenic and racial hygiene positions gained influence: through sterilization and institutional custody, the hereditary inferior parts of the population were to be excluded from procreation, and so the decline of the people in intellectual, physical, and social aspects was counteracted8. With the idea of ​​”destroying life unworthy of life” and the meanwhile scientifically established eugenics, unconditional respect for life and the dignity of the individual was at stake on the eve of the takeover of power by the National Socialists in the economically and politically shattered Weimar Republic. The idea of ​​sacrificing the weak to strengthen the healthy and robust, inspired by racial hygiene and social Darwinism, became more attractive to doctors, politicians, lawyers, economists and scientists.     

After the National Socialists came to power in January 1933, racial hygiene became the leading science for population and social policy. State support and social benefits such as marriage loans should be allocated according to the racial value of the people and the nature of the genetic makeup. At the same time, the “Law for the Prevention of Hereditary Offspring” stipulated which parts of the population should be excluded from procreation through forced sterilization.

Between 1934 and 1945, 350,000 to 400,000 people were sterilized against their will because they suffered from one of eight diseases that were considered “hereditary diseases,” among them “congenital idiocy,” schizophrenia,” and “hereditary disease (epilepsy). 9 9 An elaborate racial hygiene propaganda was intended to legitimize the sterilization policy towards the population combined with a massive devaluation of people who are socially and like their genetic makeup regarded as inferior. Even if the terms “extermination” and “purification of the national body” were used, the demand for “destruction of life unworthy of life” was seldom openly expressed.

Adolf Hitler did not want to take up the question of “euthanasia” until the war began. After the austerity policy in the institutions was rigorously continued in the 1930s, the living conditions of psychiatric patients and inmates continued to deteriorate due to overcrowding and budget cuts. The term “life unworthy of life,” coined by Binding and Hoche, can be found in individual case histories. The senior physician at the Wiesloch sanatorium, Dr. Gregor Overhamm, in 1938 about 32-year-old Adelheid B., daughter of a Jewish lawyer, who was mentally disabled: “Still tricky and annoying. Life unworthy of life! “10 

In June 1939, about 47-year-old Helene N, it was said: “Keep it up. Mentally dead. The medical record should be closed because nothing will change in the future. The only entry that is still worthwhile is the note of the date of death.”  11 This dehumanization of the entrusted patients contributed to the fact that they were handed over to the National Socialist “euthanasia” program.

THE CRIME: THE MASS EXTERMINATION OF INSTITUTIONAL PATIENTS

In October 1939, Adolf Hitler, backdated to September 1, 1939, the day the war began, signed a document with the following wording: “Reichsleiter Bouhler and Dr.  Brandt are responsible for expanding the powers of doctors to be named so that, according to human judgment, incurable patients can be granted death by mercy if their condition is critically assessed.”  12

With the war of aggression on Poland, not only an “external war” but also an “internal war” should begin. This “internal war” included those parts of the population considered inferior for racial, hereditary or social reasons. Those people who no longer serve the community, who could no longer do practical work due to illness or social abnormalities, should succumb to destruction.

This destruction, however, should not appear outwardly as a cruel crime but should take on the character of a release from suffering. The destruction of the mentally ill and handicapped was directly related to the war of aggression on the Republic of Poland: Immediately after the start of the war, SS special commandos executed German and Polish hospital patients in occupied Poland by mass shootings and gassings and cleared individual institutions for the SS and the Wehrmacht. Patients from Pomeranian institutions were also shot and buried in mass graves in a forest near Neustadt in West Prussia by the SS special command Eimann from October to December 1939.13 The Lange Sonderkommando, responsible for the murders of patients in the Warthegau, used mobile gas chambers.

In this way, from May to June 1940, patients from East Prussian institutions were also gassed. The number of victims of this action amounts to around 1,600 people. 14 A total of at least 17,000 Polish psychiatric patients were murdered in Poland during the German occupation, not counting the victims of hunger and inadequate care. 15thThe extermination of psychiatric patients continued in the war against the Soviet Union, where task forces of the SS and SD, in cooperation with the Wehrmacht, murdered patients in psychiatric hospitals in mass executions as well as Jewish people, Sinti and Roma, partisans and “Bolsheviks.” The vacated hospitals and the stolen food were made available to the Wehrmacht. An incomplete overview documents 17,000 murdered people. The actual number of victims is significantly higher. 16

In the German Reich, planning and preparation of the secret “euthanasia” measures probably did not begin until the spring of 1939. 17 A distinction can be made between two programs: 

1. In the context of “child euthanasia,” physically or mentally disabled newborns and toddlers up to the age of three who were not in institutional care should be recorded. The children were assigned to set up “children’s departments especially,” observed, selected, and killed.
2. The “Action T4”, named after the headquarters of the organization center for the killing of patients at Tiergartenstrasse 4 in Berlin, was about the registration, selection, and destruction of psychiatric patients who were kept in sanatoriums and nursing homes and specially equipped killing centers with carbon monoxide gas should be murdered.

Both programs, “Child Euthanasia” and “Action T4”, were organized by the Fuehrer’s Chancellery, an office headed by Philipp Bouhler and directly subordinate to Hitler, in cooperation with the Reich Ministry of the Interior. 

At the end of the 1930s, the Fuehrer’s office received several inquiries from parents asking for a “mercy death” for their severely disabled children. Among them, the “Kind Knauer case” achieved the significance of a precedent. The father of the physically and mentally disabled baby had turned to Adolf Hitler. After an examination by Hitler’s attending physician, Karl Brandt, the child was “put to sleep” in the Leipzig University Children’s Hospital. 18th

As of August 1939, all doctors and midwives were obliged to report mentally or physically disabled children to the “Reich Committee for the Scientific Assessment of Hereditary and Congenital Serious Ailments” via the local health authorities. The relatively differentiated registration forms were forwarded to the three reviewers of the “Reich Committee,” including the Leipzig University Children’s Hospital director, Prof. Werner Catel. The appraisers decided about the admission of the disabled children to a “children’s department,” where the parents were promised the best possible treatment and care for the children. Still, in reality, they were selected and killed. The children were mainly put to death with overdosed drugs (Luminal or Morphine-Scopolamine); they died of pneumonia, which the parents should pretend to be a seemingly natural cause of death.

From March 1941, those children and adolescents who were already in institutional care up to the age of 14 were to fall under the jurisdiction of the “Reich Committee.” They were to be murdered in the children’s departments. Around 30 “children’s departments” were operated by the war’s end, including in the occupied territories of Poland and Czechoslovakia.19 The number of disabled children and adolescents murdered in the children’s departments is difficult to estimate; one must assume that around 5,000 disabled children have been murdered.

In individual “children’s departments,” the children were subjected to medical experiments before they were murdered. B. for testing tuberculosis vaccines. The Führer’s office set up two research departments to research the causes of “nonsense” and epilepsy in the Brandenburg-Görden and Wiesloch asylum. In a large-scale research project to differentiate hereditary and non-hereditary causes of intellectual disability at the Heidelberg Psychiatric University Clinic under Prof. Carl Schneider, 21 children fell victim between 1942 and 1944. 20th

The “Action T4” had the character of a mass killing action that levelled the individuality of the victims. 21 From October 1939, the Reich Ministry of the Interior and the institutional authorities of the federal states and provinces sent the first registration forms with which the institution patients were to be selected for killing: All patients who had been in institution treatment for at least five years and were not treated or only with “mechanical” were affected Work “were to be employed, as well as mentally ill offenders and patients who are” not of German or related blood. ” 22nd

Based on the information on the one-sided registration form, the selection criteria of racial affiliation, the incurability of the disease (“duration of institutional treatment”), the lack of productive work performance, and “anti-social” or “criminal” behaviour can be derived. On the other hand, for reasons of political opportunity, older people, those involved in World War II, and foreigners should be put on hold. The completed registration forms were registered in the “T4” office of the Führer’s office, photocopied, and sent to three of the 42 medical experts. Based on the information in the registration form alone, they made decisions about the life and death of those affected. A red + meant kill, and a blue – meant survival. The senior reviewers made the final decision, Herbert Linden from the Reich Ministry of the Interior and the head of the medical department of the “T4” Werner Heyde.

Based on the 30,000 patient records of the victims of “Operation T4,” it was possible to prove that the lack of productive work in the institution was the decisive selection criterion for “Operation T4”. In addition, the length of the hospital stay, the need for care, and “disruptive behaviour” played a role. Only those who did productive work had a chance of survival.

Subsequently, transport lists were compiled with the names of the patients selected for death, which were sent to the institutions concerned via the higher institution authorities. A few days later, the notorious gray or red buses of the “Gemeinnützige Krankentransgesellschaft” drove up and transported the patients to one of the six killing centers that had been set up in the area of ​​the German Empire: Grafeneck on the Swabian Alb, Brandenburg on the Havel, Sonnenstein near Pirna in Saxony, Hartheim near Linz in Austria, Bernburg an der Saale and Hadamar in Hesse.

The course of “Aktion T4”, the selection procedure was modified after many fit patients had been transported away in the first few months of the year. One wanted to align the selection process more precisely: In several church institutions and Austria, “T4” medical commissions were set up to select patients on-site.24

The system of intermediate institutions was introduced in the summer of 1940: the transports no longer went directly to the killing institutions but initially to intermediate institutions, where the patients waited several weeks or even months for the definitive transport to their death. These intermediate institutions obscured the transport routes and were located near the killing centers to allow a flexible and more effective organization of the industrially operated machinery of the killing centers. Some of the doomed patients suspected their fate and defended themselves; they were given tranquillizers when they were transported away.

When they arrived at the killing center, they were received by the nursing staff there, had to take off their clothes, and were then presented individually to the killing doctors. Who verified the identity of the victims and identified a plausible cause of death for the death certificate. Before the killing, the victims were photographed. Then, they were led in groups into the gas chamber disguised as a shower room. The killing doctor opened the valve on the gas bottles, and the inflowing carbon monoxide led to death by suffocation. After about two hours, the gas chamber was ventilated, and the corpses were taken out through the “burner”; the gold teeth of the specially marked corpses were broken out.

The death of the victims was handled in a bureaucratic manner. 25 About two weeks after the killing of the relatives received a so-called comfort letter with the forged death certificates: “To our regret, we have to inform you that your …, laid the on … on ministerial order according to the instructions of the Reich Defense Commissioner in the local institution had to be, unexpectedly on … as a result of … died. In his severe and incurable disease, his death means salvation for him. “26

For the period between killing and certification of death, usually two weeks, the central clearing office of the “T4” collected care allowances so that several million Reichsmarks could be earned with the killing program.

Despite all the secrecy measures, there was considerable concern among the population about the murders. After the public protest sermon given by the Münster bishop, Count von Galen, Hitler ordered the cessation of the gassings as part of “Action T4” on August 24, 1941. Hitler did not want to weaken the already battered morale of the German population by continuing the now public and controversial “euthanasia” campaign. 27

According to internal statistics from the central office, 70,273 prison patients had been killed in the six gas-killing centers by August 1941. In the regions that were included in “Aktion T4” at an early stage – such as Baden, Württemberg, Bavaria, and Austria – the proportion of institutional patients killed was 50% and more.

When “Aktion T4” stopped, it was a tactical decision: The organizational structure of “T4” was retained, registration forms for institutional patients were continued, and “child euthanasia” was carried out by raising the age of the children and adolescents to 16 years until the end of the war continues unabated. The Bernburg, Hartheim, and Sonnenstein, gas murder institutes did not immediately cease operations either. In some cases, until the end of 1944, the killing of incapacitated, sick, and racially or politically undesirable concentration camp inmates whom the “T4” expert committees had selected. About 20,000 prisoners from many nations fell victim to this so-called “Aktion 14f13” between 1941 and 1943 alone. 28

At the same time, the killing of adult institutional patients continued in a decentralized manner. The victims were no longer killed based on a selection decision by the “T4” but instead were brought to death in individual institutions by the directors of the institution through overdosed medication, systematic starvation, and neglect. Historical research calls this form of patient murder “decentralized euthanasia” to make it clear that the “T4” headquarters did not organize this form of patient murder. In contrast, the initiative and responsibility lie with the institutional authorities of the federal states, provinces, and institution directors. The decision as to which patient should be killed was made on the spot.

During “Aktion T4,” it was already in different regions, such as B. in Saxony, poor nutrition and targeted use of overdosed medication led to a significant increase in mortality in the institutions. In the Oldenburg institution in Wehnen, hunger has played a decisive role as a killing method since the beginning of the war.29 In the Bavarian institutions, especially in Eglfing-Haar near Munich and in Kaufbeuren, the directors of the institution used systematic food deprivation, the so-called e-food, in specially equipped hunger houses as a killing agent based on a decree by the Bavarian Ministry of the Interior. 30th

The central office of the “T4”, which appeared under the cover name “Reichsarbeitsgemeinschaft Heil- und Pflegeeanstalten,” tried to bring the decentralized forms of patient killing under its control after the stop of “Aktion T4” and determined the willingness of the institution directors to do so to participate in further “euthanasia” measures and also supplied the necessary killing drugs (morphine and scopolamine) to selected institutions. Still, it did not succeed in resuming the centrally controlled killing of the sick.

With the increasing air war against German cities, the need for civilian hospital beds in the air-endangered areas of western and northern Germany increased significantly from 1942 31. It reached a peak in the summer of 1943. On August 24, 1941, the day when “Aktion T4” stopped, Karl Brandt, Hitler’s “euthanasia” commissioner and, from 1942, his general commissioner for civil and military health care, was given the task of dealing with the cities particularly affected by the air war to create replacement hospitals and also to involve the sanatoriums and nursing homes. 32

Together with the “Reich Commissioner for Hospitals and Nursing Agencies,” the Ministerial in the Reich Ministry of the Interior, Herbert Linden, who in turn was in close contact with “T4” headquarters, it was up to Karl Brandt to ensure that psychiatric patients were quickly relocated from areas at risk from the air if required in northern Germany, in the Rhineland, in Westphalia and the greater Berlin area to make space for alternative and auxiliary hospitals for physically ill and bomb victims. The initiative for these relocations came from the city and regional health authorities as well as the Gauleiter, who wanted to get as many old, chronically ill, and psychiatric patients as possible out of their area of ​​responsibility.

The psychiatric patients were at the bottom of the hierarchy of medical care and were subject to deadly cut-throat competition. The reception regions and institutions in central, eastern, and southern Germany, as well as in the occupied territories of Poland, solved the problem of overcrowding in their way. If the transferred psychiatric patients did not die of starvation and neglect anyway, doctors and nurses killed them in the asylums with overdosed drugs. B. in Kaufbeuren-Irsee in Swabia, Meseritz-Obrawalde in Pomerania, Tiegenhof in occupied Poland, Wiesengrund or Kosmanos in 1938 occupied Czechoslovakia.

From 1943 to 1944, around 8,000 psychiatric patients were relocated from the Rhineland alone, most of them perishing. Hadamar asylum in Hesse, After it had served as the T4 gas murder facility in 1941, it was reactivated as a killing facility in 1942 under the direction of the Wiesbaden District Welfare Association: Killing was now carried out as part of a seemingly ordinary facility with overdosed medication. In consultation with the “T4” and the Reich Ministry of the Interior, the patients were moved from Northern Germany, the Rhineland, Baden-Alsace and Brandenburg to Hadamar to make space for alternative hospitals in these regions.

Of the 4,861 patients admitted to Hadamar, 4,411 had been put to death by March 26, 1945, or 91%. Kills were now carried out in what appeared to be normal hospital operations with overdosed medication. 33

The number of institutional patients killed in the German Reich alone (excluding Austria) after the “euthanasia campaign” was stopped in August 1941 is estimated at around 90,000. 34 This also includes forced labourers suffering from tuberculosis or mental illness, mainly from Poland and the Soviet Union. From 1944 onwards, when their ability to work could not be restored, they were admitted to sanatoriums and nursing homes, such as Kaufbeuren or Hadamar, and systematically murdered with overdosed drugs. 35

The “euthanasia” campaign is closely related to the genocide of European Jews: From the spring of 1940, institutional patients of Jewish origin were concentrated in specific collection centers and killed indiscriminately in the gas murder centers of “Aktion T4” solely based on their origins. Their killing was motivated both economically and racially. The systematic murder of institutional patients of Jewish origin can be understood as a first step toward genocide against European Jews. 36

In the genesis of the Holocaust, the experience of industrial mass extermination gained in “Aktion T4” played a decisive role: The three extermination camps of “Aktion Reinhard” Bełżec, Sobibor, and Treblinka were developed and operated by around 120 T4 men, including Christian Wirth, office manager in various T4 killing institutes, rose to the position of inspector of “Aktion Reinhard,” which killed around 1.6 million Jews, mainly Polish, from October 1941 to November 1943. 37

The fate of psychiatric patients during the Second World War in the Western European countries occupied by Germany is still largely unexplored. The first work on starvation in the Netherlands started in Dutch sanatoriums and nursing homes. 38 In occupied France, including the parts of the country under the Vichy government, between 1940 and 1944, from a statistical point of view, 40,000 to 45,000 more institutional patients died than would have been expected under peace conditions. There are different opinions as to whether the significantly increased death rates are due to deliberate food deprivation 39or can be traced back to the food situation, which has deteriorated considerably as a result of the war and occupation. 

Isabelle von Bueltzingsloewen shows how the food supply in the institutions became increasingly precarious despite some efforts by the institution directors and the prefects. Due to rationing, rising prices, bureaucratic obstacles, embezzlement and the inability to supply themselves on the black market, the institutions were unable to provide adequate nutrition for the patients: they were disadvantaged due to their social isolation and, in many cases, had to be emaciated and Die malnutrition. 40

THE PERPETRATORS AND THEIR MOTIVES

The two “euthanasia” agents, Hitler’s Reichsleiter Philipp Bouhler, head of the Führer’s chancellery, and Karl Brandt, Hitler’s attending physician and later General Commissioner for Sanitary and Health Care, are among those primarily responsible for the Nazi patient murders. While Philipp Bouhler committed suicide in 1945, Karl Brandt was indicted in the Nuremberg Doctors’ Trial in 1946 and sentenced to death. He defended his participation in the “euthanasia” program as follows: Euthanasia was not about eliminating a person at all, “[…] it was about making him accessible from suffering lying on top of him. “41

Karl Brandt stylized himself as an idealist with humane intentions in the Nuremberg medical trial 42 Philipp Bouhler and the Führer’s office were responsible for the operational implementation of the “euthanasia” program. The “Euthanasia” department “T4” was headed by Viktor Brack, an industrial engineer with a close relationship with Reichsführer SS Heinrich Himmler. Viktor Brack was also sentenced to death in the Nuremberg doctors’ trial and, like Karl Brandt, executed in 1948.

The “T4” machine, headquartered at Tiergartenstrasse 4 in Berlin, comprised around 60 – 80 people: doctors, administrative employees, craftsmen, and drivers. Two doctors, nurses, administrative and office staff, registrars, drivers, guards, and corpse burners worked in each of the killing centers of the “T4”, a total of 60-100 people. The staff was recruited by the “T4.” In some cases, he was also obliged to serve through the NSDAP Gauleiter and enjoyed numerous privileges: you didn’t have to go to the front, company outings, and celebrations were organized regularly.     

The 42 medical experts, including well-known professors in psychiatry, were subordinate to the medical department of “T4”, which was headed by Prof. Dr. Werner Heyde from Würzburg and then headed by Prof. Hermann Paul Nitsche. Among the “T4” experts, there are convinced race hygienists, opportunistic and ambitious careerists like the Eichberg institution director Friedrich Mennecke, and meticulous officials used to obedience and the fulfillment of duties like the director of the sanatorium Eglfing-Haar, Hermann Pfannmüller. In advance obedience, he suggested to his superior authority, the government of Upper Bavaria, a “real austerity measure”: “At this point, I consider it appropriate to point out the need to that we doctors also draw the ultimate conclusion in terms of eliminations about medical care for life unworthy of life. “43

Many psychiatrists felt that they were participating in a great “work of salvation” through the “euthanasia” program. Among the older “T4” psychiatrists, Hermann Paul Nitsche and Valentin Faltlhauser from Kaufbeuren advocated reform efforts in open welfare, family care, and early discharge in psychiatry during the Weimar Republic. 44 

The already mentioned Heidelberg professor Carl Schneider advocated active patient treatment and occupational therapy in the 1930s. For him – as for many other “T4” psychiatrists – healing and destruction were not mutually exclusive. 45 The funds saved by destroying the terminally ill should be used for intensive therapy of curable patients with the methods of modern shock therapies (insulin coma, cardiazole or electroconvulsive therapy) and occupational therapy. In a memorandum on the state of psychiatry from 1943 written by Carl Schneider, Hermann Paul Nitsche, and Ernst Rüdin, it says:

“But the measures of euthanasia will also find general understanding and approval all the more when it is ensured and known that in everyone If, in the case of mental illness, all possibilities are exhausted to cure the sick or at least to improve them to such an extent that they are given valuable economic activity, be it in their professions or in another form. ” 46

But not only for the “T4” doctors was the ideology of “destroying life unworthy of life” a decisive motive for their participation in the murders of patients. The personnel directly involved in the execution of the murders had also internalized the racial and economic devaluation of the people affected. Georg Frentzel, who was involved in the extermination of psychiatric patients in Mogilew / Belarus as a member of Einsatzkommando 8, testified in the investigative proceedings against him in the GDR: “Due to their illness, these people were afflicted with ‘unhealthy genetic makeup’, thus inferior, unable to work and also represented useless eaters.”  47

THE VICTIMS

The victims of the National Socialist “euthanasia” were among the weakest members of society. Because of a mental illness or mental handicap, they would have needed care and support. Still, de facto, they were torn out of their familiar surroundings through years or decades of imprisonment and often also estranged from their families. The victims were women, men, and children, from infants to significantly older adults; they came from all walks of life.

For the victims of “Aktion T4,” it can be proven that their origin according to social class corresponded to the class composition of the population of the German Reich. People from the lower classes were not disproportionately represented among the “T4” victims. 48 Among the “T4” victims, women (54%) outnumbered men (46%). Because of their gender, women were at higher risk of being selected for killing. 82% of the “T4” victims were single, divorced or widowed, significantly more than in the general population: many “T4” victims were socially isolated because they were often in prison for years or even decades.

Two groups were particularly at risk in the context of “Action T4” to be selected for killing: On the one hand, the chronically ill long-term patients with the diagnosis of schizophrenia, who have been described as “final states,” as “expired cases” in which therapy was no longer worthwhile and which are considered to be “unusable” looked at because they – in the institutions – did not do any “productive work,” on the other hand, the patients diagnosed with “nonsense” whose intellectual disability was considered particularly pronounced, which was therefore viewed as “spiritually dead.”

At the beginning of “Aktion T4”, the patients who had been admitted to the courts for criminal offences were the focus of the selection process: They were deported indiscriminately from individual institutions such as Bedburg-Hau or Waldheim to the killing centers. They had a chance of survival due to their often good work performance; from 1944 onwards, they were used in the concentration camps for “extermination through work.” 

In the course of the war, the circle of victims of “euthanasia” measures in the sanatoriums and nursing homes expanded. Confused older adults increased, e. Some of the bomb victims, welfare children and mentally or physically ill forced labourers were admitted to sanatoriums and nursing homes. They died there from neglect, hunger, and overdosed medication.

Contrary to the annihilation program of the “T4” organizers, which wiped out the individuality of the people, each victim had their own story, like Benjamin Traub from Mühlheim an der Ruhr, who came from a Baptist family of preachers and at the age of 16 after a deep mental crisis Bedburg-Hau sanatorium came where he felt better at times and was able to maintain contact with his family. He was murdered on March 13, 1941, in the Hadamar gas chamber. 49

The “T4” victims often suffered from fears and lived in their world, like the 35-year-old telegraph manipulator Leopoldine from Vienna, who was killed in the gas chamber in Hartheim in Upper Austria. The photo taken before her killing reveals the profound and existential anxiety that had already dominated her limited life in the Steinhof sanatorium in Vienna. 50

Some may feel comfortable and secure in their facility, like Wilhelmine Haußner, who was admitted to the Schönbrunn Catholic nursing home in Upper Bavaria at the age of 5 because of restlessness and a delay in her intellectual development and who often received visits from her family. In 1941, she had to leave Schönbrunn. She came in a collective transport to the Eglfing-Haar sanctuary and nursing home, where she was murdered in the “children’s department” with overdosed medication in 1942. 51

Some tried to escape the hopeless conditions in the institution, such as the actress Emmy R. from Hamburg, who was imprisoned for making derogatory comments about the Nazi regime and was admitted to the Eglfing-Haar sanatorium and nursing home due to incapacity. In 1944, she was taken to the women’s hunger house and was put to death from food deprivation. 52 

Grigorij S. was one of the forced labourers murdered as part of the “euthanasia” campaign. He came from Ukraine and had to work for the IG Farben concern in Wiesbaden. Because of open tuberculosis, she was brought to Hadamar on March 2, 1945, and killed a few days later with overdosed medication. 53

THE REACTIONS OF LOVED ONES, SOCIETY, AND RESISTANCE

Contrary to all attempts to keep “Operation T4” secret, the families affected and in church circles soon learned about the natural causes of the increased number of deaths among institutional patients. In individual cases, relatives managed to save their family members from the gas chamber at the last minute. Alfred N.’s mother from Ulm, who suffered from the consequences of a head injury from World War I, sent a telegram to Adolf Hitler to ensure that her son was brought back from the Grafeneck killing center to the Schussenried center. 54

But all attempts to bring the threatened family members home from the institution and letters of protest were unsuccessful. In contrast, a more significant proportion of the relatives will have accepted the news of the sudden death of their family member without expressing any external reaction. On the other side of the spectrum are statements from relatives who took up or even endorsed “deliverance from suffering” in a facilitated manner. The parents of Katharina W. from East Prussia wrote to the Saxon intermediate institution Zschadraß on August 23, 1941:

“Yesterday, we received your dispatch with the news of the passing of our dear only daughter Katharina, who more than died for us 22 years ago because knowing a loved one as incurably mentally ill in an institution is more painful than his death. That is why we are now, of course, full of grief, but we feel the dying of our daughter first and foremost as finite salvation for her.”  55

 Overall, the relatives of the victims show a broad spectrum of reactions to the patient murders, ranging from acceptance, protest, and approval, without this spectrum being quantifiable according to the current state of research. 56 In the case of “child euthanasia,” in addition to the protests of the parents, there are also express requests for the redemption of their disabled children. The father of two-year-old Heinz F. wrote to the head of the Eichberg children’s department on October 25, 1941:

“We only have one request for you if there is no rescue or improvement, or a cure over time, So don’t let the dear little boy endure his grave suffering for too long. 57

Resistance to the “euthanasia” campaign was only offered by individuals, such as the Viennese nurse Anna Wödl, ​​who organized a small demonstration in front of the sanatorium at Am Steinhof, the local resistance group around the Schuhmann brothers who published leaflets about the “euthanasia” murders in the Hartheim killing center or the Brandenburg magistrate Lothar Kreyssig, who forbade the transfer of the patients he cared for as official guardian. In 1940, the Protestant pastor and director of the Hope Thaler Institutions, Lobethal Paul Braune, in consultation with Friedrich von Bodelschwingh, the director of the Bethel Institutes, wrote a memorandum containing detailed information against the killing of the institutional patients, which he had sent to the Reich Chancellery. The State Secret Police then arrested him for three months. While the representatives of the Protestant and Catholic Church mostly limited themselves to non-public, diplomatic efforts to discontinue or modify the “euthanasia” campaign, it was the public protest sermon of the Münster bishop, Clemens Graf von Galen, on August 3, 1941, which was essential for the adjustment who contributed to patient murders.58 In the sermon, the fact of the murder of the sick was described in detail. It condemned: “Now the 5th commandment: ‘You shall not kill’ is being set aside and violated under the eyes of the bodies obliged to protect the legal order and life because it is being broken takes the liberty of deliberately killing innocent, albeit sick people, just because they are ‘unproductive,’ can no longer produce goods.”  59 The text of the sermon was secretly copied and spread throughout the German Empire. The bishop, who was very popular in the Catholic Münsterland, remained untouched, but people who spread the sermon were persecuted and arrested. There is no evidence of active resistance from the psychiatrists to the “euthanasia” campaign; at best, the directors of the institution allowed themselves to retire in order not to be involved in the murders of the patients. The German judiciary covered the murders of prison patients, even though these were criminal offences under current law.   

POST-WAR HISTORY: THE REACTIONS OF THE JUDICIARY

American and German courts came to unequivocal judgments in the legal assessment of the National Socialist “euthanasia” crimes in the years immediately after the war: it was the murder of innocent people and crimes against humanity. So was z. B. In 1947, the chief expert and medical director of the “T4” central office, Hermann Paul Nitsche and other doctors and nurses from Saxony were sentenced to death in the Dresden “euthanasia” trial and executed. But from 1948/49 onwards, the medical perpetrators could hope for astonishing leniency, especially from the West German judiciary, and were partly excused concerning the high moral problem of euthanasia. In addition, the perpetrators could invoke a mistake in the prohibition or a conflict of duties as reasons to exclude guilt, which leads to acquittal.

Although the “destruction of life unworthy of life” was considered illegal, the doctors could not have recognized the illegality of their actions or they would have stayed at their post to prevent worse and to save some of those affected. In many cases, the investigations were stopped or not started at all. So Prof. Werner Catel, one of the prominent people responsible for “child euthanasia,” remained unmolested and in 1954, he was able to become a professor of pediatrics in Kiel.

It is thanks to the commitment of the Hessian public prosecutor Fritz Bauer that the Frankfurt public prosecutor’s office attempted at the beginning of the 1960s to deal with the complex of “euthanasia” crimes legally, but those primarily responsible evaded responsibility mainly through suicide or the inability to negotiate.

The legal processing of the “euthanasia” crimes reached its low point with the acquittal of three doctors from the killing centers of “Aktion T4” by the Frankfurt am Main district court in 1967. Due to their inexperience, the doctors could not have recognized their victims’ will to live, and they Believed in the legitimacy of “euthanasia” in the sense of Binding and Hoche. The Federal Court of Justice’s revision ruling 1988 with shallow prison terms didn’t improve matters.

Due to their inexperience, the doctors could not have recognized a possible will to live on the part of their victims and believed in the legitimacy of “euthanasia” in the sense of Binding and Hoche. The Federal Court of Justice’s revision ruling 1988 with shallow prison terms didn’t improve matters.

The gentleness of the West German judiciary towards the perpetrators is reflected in the lack of compensation for the victims of the National Socialist racial hygiene and “euthanasia” policy. Neither the people deprived of their reproductive ability according to the law for the prevention of hereditary offspring nor the relatives of the “euthanasia” victims received financial compensation for the suffering they had suffered. Despite a hardship regulation, the forcibly sterilized people and the families of the “euthanasia” victims are not on an equal footing with the other groups of Nazi persecution. 61

THE LEGACY OF THE VICTIMS

In a climate of lack of social recognition and ongoing stigmatization of mentally ill and mentally disabled people, the forcibly sterilized people and the “euthanasia” dead have long been among the “forgotten” or repressed victims of National Socialism, both in the official culture of remembrance and in those affected Families themselves.

In recent years, there has been an increasing need of the subsequent generations to remember people who have disappeared from family memory, to research their fate, and to name the injustice suffered.

Examples are Sigrid Falkenstein’s research on the life and murder of her aunt Anna Lehnkering, who was deported to the Grafeneck killing center in 1940. 62 The memorial and information center for the victims of the National Socialist “euthanasia” murders set up in 2014 at the historic location of the organization of the patient murders in Berlin’s Tiergartenstrasse 4 is a late sign of public commemoration of the “euthanasia” victims. It complements the memorial plaque that has existed there since 1989: a blue glass wall stands for the memory of the murdered people, and a barrier-free open-air exhibition offers information on the history, implementation, and aftermath of the National Socialist patient murders. The texts are also available in easy language, which is not only used by people with learning difficulties. 63

What remains is the memory of extraordinary people who often spent their lives in sanatoriums and nursing homes for decades and tried there to preserve their dignity under the conditions of the institutional regulations, as the Mecklenburg coachman Karl Ahrendt did in 1933 in a letter to the management of The Berlin-Buch sanatorium and nursing home expressed: “I will stop in front of my few as the human existence in mier select excites.” At the age of 87, he too was a victim of the National Socialist “euthanasia.” 64

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