In parallel with the regime’s measures against the Jews, from an early stage the National Socialists targeted individuals suffering from supposedly hereditary diseases as well as the mentally and physically handicapped. It was through the implementation of these policies that many of the individuals who later participated in the Holocaust became desensitised to and trained in mass murder. It could even be said that the measures introduced against the sick and disabled in the 1930s set the Third Reich on the route to the “final solution of the Jewish question” in the 1940s. SS personnel were involved from the start, although the euthanasia programme was officially the responsibility of Hitler’s private office, the Kanzlei des Führers (Führer Chancellery).

There is a sense in which National Socialism was “politics as applied biology.” The movement’s theorists genuinely believed that it might be possible to resolve social and political problems by biological means. The first manifestation of this ideology—and the model for German eugenic legislation thereafter—was the Sterilisation Law of July 1933. Eugenicists had been advocating the sterilisation of “inferior and degenerate types” for decades, and proposals for voluntary sterilisation had already reached state legislatures in Germany. But the new law introduced a new element: compulsion. Its preamble read: “Any person suffering from a hereditary disease can be sterilised if medical knowledge indicates that his offspring will suffer from severe hereditary physical or mental damage.” The following conditions were classified as “hereditary” under the law:

1. Congenital feeblemindedness.

2. Schizophrenia.

3. Manic depression.

4. Epilepsy.

5. Huntington’s chorea.

6. Blindness.

7. Deafness.

8. Severe physical deformity.

9. Severe alcoholism.1

The structure for enforcement was straightforward. If a person with one of these conditions did not voluntarily apply for sterilisation, it could be sought by health service doctors and directors of hospitals, care homes and prisons. A system of hereditary health courts was instituted, consisting of three members: a judge and two doctors. A more senior appeal court was structured in the same way.

In the first year in which sterilisation was in operation, some 388,400 people were reported to the hereditary health courts, 75 per cent of them by their own doctors. This was too much work for the courts to handle: just over 80,000 of these cases were reviewed, with 62,000 resulting in a sterilisation order. Of these people, just under half were actually sterilised (usually by vasectomy for men and Fallopian ligation for women) because of a lack of capacity in hospitals. It seems the system did not manage to clear the backlog even by 1939.2 But this was not due to a lack of enthusiasm in the medical community: on the whole, German doctors welcomed the sterilisation scheme. It gave them enhanced prestige as implementers of government policy as well as a much greater range of paid tasks to perform—such as filling out forms and giving evidence to hereditary health courts.

However, the “science” underpinning the Sterilisation Law was flimsy, at best:

The sterilisation measures could never have been successful: seen from a biological point of view, they are useless, absolutely nonsense, because they do not calculate spontaneous mutations, environmental poisons and things like that. So it was a measure that would never have led to real success even if they had practised it more harshly than they did.

So it was senseless from the beginning, but it was an important part and a kind of sign for the biological takeover that National Socialism was planning…They had more than 350,000 people sterilised between 1933 and 1945, so it was also a kind of discrimination against people who didn’t fit into the picture of National Socialist society. So everything else, looking bad, looking ill, looking strange, had to disappear.3

To some extent, the number of people who could potentially be affected by the Sterilisation Law was finite. For instance, there were only so many hereditarily blind or deaf people in Germany, and objective medical analysis was needed before they could be placed on the sterilisation lists. However, “congenital feeblemindedness” and “alcoholism” were far more open to subjective interpretation. “Intelligence tests” were introduced supposedly to determine the former, but in reality they were no such thing. Rather, they simply examined acquired learning. Moreover, many subjects passed the test but were still sterilised because they allegedly displayed “feebleminded appearance and behaviour.”

A popular joke in Germany in the 1930s summed up the paradox of the senior National Socialists’ enthusiasm for eugenics and racial classification in its definition of an Aryan: “He must be blond, like Hitler; thin, like Goering; handsome, like Goebbels; virile, like Röhm—and called Rosenberg.” Discriminatory laws based on eugenics continued to be enacted throughout the decade and were eventually complemented by laws that confined Asozialen (antisocial individuals) to state hospitals or asylums, imposed protective custody on habitual criminals, and restricted the right of Gypsies to travel and trade. (The latter law effectively classified Gypsies as antisocial criminals purely on the basis of their race.) These measures brought all such individuals within the purview of the SS security apparatus, and eventually led many of them to suffer the same fate as the Jews.

The next groups to be targeted were those who were considered a drain on society. Just as the National Socialists’ faith in eugenics led them inexorably towards compulsory sterilisation of people with “hereditary” diseases, so their warped social theories soon led them to attack anyone with an incurable disease or a permanent disability.

The issue of euthanasia had been raised in Germany even before the First World War. Back then, liberal progressives had argued that scarce resources should be directed towards the healthy workforce rather than unproductive cripples. At the time, this argument garnered little support in a society that still espoused Christian values and conventions. However, the brutal experience of war soon changed that. The mass slaughter of the First World War had a devastating impact on the moral climate in Germany. By the end, the German people were all too familiar with death on an industrial scale, and in a sense they abandoned their traditional views on the sanctity of human life and adopted a much harsher view of the world. Karl Bonhoeffer, the chairman of the German Psychiatric Association and father of Dietrich Bonhoeffer, a theologian and prominent opponent of Hitler, said in 1920:

It could seem as if we have witnessed a change in the concept of humanity. I simply mean that we were forced by the terrible exigencies of war to ascribe a different value to the life of the individual than was the case before, and that in the years of starvation during the war we had to get used to watching our patients die of malnutrition in vast numbers, almost approving of this, in the knowledge that perhaps the healthy could be kept alive through these sacrifices. But in emphasising the right of the healthy to stay alive, which is an inevitable result of periods of necessity, there is a danger of going too far: a danger that the self-sacrificing subordination of the strong to the needs of the helpless and ill, which lies at the heart of any true concern for the sick, will give ground to the demand of the healthy to live.4

In the same year as Bonhoeffer made this speech, Karl Binding, a lawyer, and Alfred Hoche, a psychiatrist with a morbid interest in the brain activity of recently guillotined criminals, wrote a pamphlet entitled “Permission for the Destruction of Life Unworthy of Life.” Both men were right-wing German nationalists who put loyalty to the “national community” above any notion of individual rights. Binding died before their article was published, but Hoche went on to become an aggressive apostle of euthanasia.

In the article, they stressed that the Judaeo-Christian tradition of respect for human life was a relatively recent phenomenon in human history. To back up this claim, they cited the example of the Spartans, who had routinely killed weak infants and the Inuit, who had killed their ageing parents. Taking this argument further, they suggested that society should also kill off “incurable idiots,” the terminally ill and the critically injured. Perhaps in a feeble bid to display compassion, they said that the latter two groups should be given the right to choose to die on their own terms through a painless, medically administered procedure. (Then, as now, doctors routinely eased the final agonies of terminally ill cancer patients with overdoses of painkillers, but Binding and Hoche argued that such treatment should be enshrined as a right, and that the doctors who carried it out should never have to worry about legal consequences for their actions.) However, the crux of the pamphlet was the claim that certain individuals were “unworthy of life.” By this, Binding and Hoche meant people who were so “inferior” that there was no value in their continued existence. The argument they put forward was rooted in both eugenics and economics:

If one thinks of a battlefield covered with thousands of dead youth…and contrasts this with our institutions for “idiots” with their solicitude for living patients—then one would be deeply shocked by the glaring disjunction between the sacrifice of the most valuable possession of humanity on one side and on the other the greatest care of beings who are not only worthless but even manifest negative value.5

It is easy to find the source of this fury: Hoche’s only son had been killed at the Battle of Langemarck, and he never recovered from his loss. But underlying his and Binding’s argument was something much more sinister than the death of a loved one: the suggestion that the “feebleminded” and “idiots” were not fully human. The claim was that their minds were so degenerate that they could not be said to have human personalities. In conclusion, Binding and Hoche argued that patients themselves, their relatives and/or physicians should be able to apply for euthanasia when the patient’s life had become “unworthy,” and that the state should then be the arbiter of whether it should be carried out.

This pamphlet was widely debated in inter-war Germany, but it received no official approval or acceptance during the Weimar era. It was only when the National Socialists came to power that euthanasia started to be seriously discussed as a state policy. Paradoxically, in part this was facilitated by a revival in mainstream psychiatry.

The psychiatric profession had lost a good deal of its prestige during and shortly after the First World War—partly because of the misdiagnosis of “shell-shock,” partly because of the appalling state of Germany’s wartime asylums, in which around seventy thousand patients died from starvation, and partly because certain psychiatrists had been happy to label post-war revolutionaries “insane” with no basis in fact. However, during the 1920s, occupational therapy was introduced and proved highly successful in Germany’s asylums, and community clinics were established throughout the country. Leading these reforms were Gustav Kolb and Hermann Simon, who were quick to point out the economic—as well as the medical—benefits of what they were doing. For instance, the new community clinics could treat far more patients for much less money than the old, grim asylums. At the same time, great claims were being made, initially at least, for new types of treatment, such as electro-convulsive therapy and insulin coma therapy. All of this changed the mood in the psychiatric profession from pessimism to optimism in a few short years. Moreover, asylums and institutes for the mentally ill started to be widely viewed as hospitals with a range of treatments at their disposal, rather than as warehouses for the storage of the permanently handicapped.

However, all of these improvements in the care of many mentally ill patients started to draw attention to the few who remained stubbornly unresponsive to any form of therapy. This latter group was now pushed even further to the margins of what was already a very marginalised sector of society. They started to be criticised for their inability to work, and euthanasia started to worm its way back onto the agenda of the medical profession.

Hitler followed the euthanasia debate closely, as is clear from a speech he gave in 1929 at an NSDAP rally:

If Germany was to get a million children a year and was to remove 700–800,000 of the weakest people then the final result might be an increase in strength. The most dangerous thing is for us to cut ourselves off from the natural process of selection and thereby rob ourselves of the possibility of acquiring able people. The first born are not always the most talented or able people. Sparta, the clearest case of a racial state in history, implemented these racial laws in a systematic way. As a result of our modern sentimental humanitarianism we are trying to maintain the weak at the expense of the healthy.6

While at first sight this appears to be an argument for eugenic infanticide, another interpretation is that Hitler was actually suggesting a trade-off between healthy infants and the sick, weak and disabled.

Hitler returned to the subject on numerous occasions. For instance, Hans Lammers—an honorary SS officer—recalled that Hitler introduced the topic of euthanasia when he was being advised on the details of the Sterilisation Law in 1933. And Dr. Karl Brandt, one of Hitler’s personal physicians, remembered him saying two years later, “if war should break out, he would take up the euthanasia question and implement it,”7 because resistance from the churches and other bodies would be diminished in wartime. Notwithstanding these private conversations, euthanasia initially remained too controversial to form any part of the official National Socialist programme. But it was clearly on Hitler’s mind, and he had no problem in telegraphing his feelings to those subordinates who were in a position to do something about it.

THE START OF the euthanasia programme can be traced to a specific event that occurred in Leipzig. In the winter of 1938–39, a baby was born to a family called Knauer. The infant was blind, missing one leg and part of an arm, and was, according to Karl Brandt, “an idiot—at least, it seemed to be an idiot.”8 Apparently encouraged by the baby’s grandmother, the Knauers petitioned Hitler to grant permission for their child’s doctor to perform a “mercy killing.”

This petition was submitted to the Führer Chancellery, which had been established as a forum for ordinary party members to present their problems directly to Hitler. This allowed him to play the part of the conscientious leader, even though, of course, he rarely dealt with any of the letters personally. On this occasion, however, it seems that Philipp Bouhler* did actually consult with Hitler before passing the case on to Brandt, who recalled:

[Hitler] ordered me to talk to the physicians who were looking after the child to find out whether the statements of the father were true. If they were correct, then I was to inform the physicians in his name that they could carry out euthanasia…I was further ordered to state that if these physicians should become involved in some legal proceedings because of this measure, these proceedings would be quashed by order of Hitler.9

There were at least two other appeals for euthanasia around the same time: a middle-aged woman dying of cancer; and a labour service official who was terribly injured in an industrial accident. These cases all seem to have been widely discussed (although there are no records of any of the meetings), and the end result was a directive from Hitler to Bouhler, dated 1 September 1939, in which he states that “authorised doctors” should be permitted to carry out “mercy killings.”

The first victims of the euthanasia programme were children. From the autumn of 1939, doctors and healthcare workers were ordered to register all children with Down’s syndrome, micro- and hydrocephaly, serious physical deformities (such as missing limbs and late development of the head and spine) and cerebral palsy. Once registered, these children—who ranged in age from newborn infants to teenagers—had their records examined by three “referees”: Werner Catel, the director of the University of Leipzig paediatric centre; Hans Heinze, director of the asylum at Brandenburg-Görden; and Ernst Wentzler, an eminent paediatrician. Each man was paid an allowance of 240 marks a month for his contribution. If all three doctors agreed, the Reich Committee for Hereditary Health—a secret body that was subordinate to the Führer Chancellery—directed the relevant local public health authority to arrange for the child to be admitted to a designated regional clinic. Then the child was killed.

It is worth noting that Catel, Heinze and Wentzler assessed each case purely on paper, without conducting any physical examination of the children themselves. It is also worth noting that most of the children were killed by pseudo-medical means: they had their nutrition withdrawn or were given overdoses of sedatives in order to induce respiratory problems, bronchitis and pneumonia. The doctors and nurses who carried out these “procedures” swore an oath of secrecy and were paid extra to ensure their silence. Many of them undoubtedly found this work disturbing, and a number demanded transfers out of the designated clinics. Equally, however, many others simply got on with the job without complaint. It seems that they were prepared to accept that the good health of the nation required this slaughter of the innocents.

As in the case of the Knauer family, it is likely that a number of the parents welcomed, even if they did not actively seek, their children’s deaths. Nevertheless, the National Socialists never felt sufficiently confident about this policy to sanction it in German law, nor did they ever make it public. That meant the whole operation had to be carried out by subterfuge. Parents might be persuaded to part with their child after promises that they were being taken away to receive specialist medical treatment. Once the child was in a killing centre, spurious reports of their progress were often issued by doctors to reassure the parents. Then the tone of the reports would change, to indicate that the child had taken a turn for the worse. Shortly afterwards, inevitably, there would be a confirmation of death.

In all, some six thousand children were murdered between 1939 and 1945 in the children’s euthanasia programme,10 with some of these deaths taking place after Germany’s unconditional surrender. Many more were killed as part of the wider “T-4” programme that is described below.

For adult incurables, Bouhler and Brandt set up a secret-service-style operation to ensure that everything ran smoothly. The headquarters were in a villa at Tiergartenstrasse 4 in central Berlin; hence, the operation became known as T-4. Bouhler and Brandt’s first task was the recruitment of personnel. Initially they turned to friends and students of the senior T-4 officials, who learned of the new operation through word of mouth. Others were recruited from the wider medical profession, because this was to be mass murder disguised as medical procedure. Finally, police officers and SS men joined the operation to perform the actual killing. One such was Franz Stangl.

Stangl was an Austrian policeman and National Socialist Party member who was summoned to Berlin by Himmler. His superior, Detective Werner, told him what he would be required to do in his new role:

Werner told me that it had been decided to assign me to a very difficult and demanding job. He said that both Russia and America had for some considerable time had a law which permitted them to carry out euthanasia—“mercy-killings”—on people who were hopelessly deformed. He said this law was going to be passed in Germany—as everywhere else in the civilised world—in the near future. But that, to protect the sensibilities of the population, they were going to do it very slowly, only after a great deal of psychological preparation. But that in the meantime the difficult task had begun, under the cloak of absolute secrecy. He explained that the only patients affected were those who, after the most careful examination—a series of four tests carried out by at least two physicians—were considered absolutely incurable so that, he assured me, a totally painless death represented a real release from what, more often than not, was an intolerable life.11

After receiving this explanation, Stangl accepted the new position and became a “security officer” at Hartheim Castle, one of the main killing centres of the euthanasia programme. He was one of a number of SS personnel who joined T-4. Around Christmas 1939, SS-Sergeant August Becker, a professional chemist, was sent to meet SS-Senior Leader Viktor Brack, who had been an SS and party member since 1929 and had been working for Bouhler since 1932. Brack, who would later become the day-to-day administrator of T-4, explained that all incurable “idiots” and mental patients were to be eliminated from Germany. It had already been agreed that the best means to achieve this was poison gas, so the acting head of the chemistry department of the Criminal Technical Institute of Kripo, Dr. Albert Widmann, had been asked to find a suitable agent.

This was a highly significant development. In effect, the SS was preparing to implement National Socialist ideology: Himmler had taken it upon himself and his organisation to “improve” the German race. He conceived of the SS as the Staatsschutzkorps (state protection corps), whose role had previously been to protect the state against external and internal ideological enemies. Now it also included protecting Germany against biological enemies.

Widmann had decided that the best poison for his purposes was carbon monoxide, so fifty steel canisters were dispatched to IG Farben in Ludwigshafen and filled with the gas. These were then transported to the former castle of the dukes of Württemberg at Grafeneck, which was being used as an asylum by the Evangelical (Protestant) Church in Stuttgart. The building was requisitioned from the church in October 1939, and shortly afterwards a group of ten SS NCOs who had been seconded from Death’s Head units arrived. They were dressed in civilian clothes and were supposedly working for the Gemeinnutzige Stiftung für Anstaltspflege (Charitable Foundation for Institutional Care)—T-4’s cover designation. Using local craftsmen and labourers, the unit quickly began the process of turning the castle into an extermination centre: they converted an old coach shed into a gas chamber and installed two crematorium furnaces in a nearby hut.

In mid-January 1940, the gassing process was tested at the old prison in Brandenburg, near Berlin. Among the spectators were Widmann, Brack, Brandt, and a former Stuttgart detective, Christian Wirth—a coarse bully who had been selected as head of administration at the Hartheim killing centre, near Linz, Austria.* A group of fifteen to twenty naked men were escorted into the gas chamber and sealed in, and then either Becker or Widmann released the carbon monoxide. Within a few minutes, all of the men were dead. Later that day, Widmann injected eight men with scopolamine and curare, two highly toxic paralysing agents, but these failed to kill the men, so all eight were placed in the gas chamber to be murdered. A further gassing was then carried out, this time with Dr. Irmfried Eberl operating the controls.

In the weeks following these tests, Becker travelled to the other killing centres to demonstrate installation and operation of the equipment. Perversely, considering that this process was as far removed from medical treatment as it was possible to get, Brack decreed that only qualified doctors should be allowed to turn on the gas.

As with the children’s euthanasia project, the murder of adult incurables remained entirely extralegal, and it was carried out by deception and subterfuge. In September 1939, the Reich Doctors’ Leader, Leonardo Conti, had written to all public and private asylums in Germany, requesting general statistical information and asking them to register all patients who were “(1) suffering from schizophrenia, epilepsy, senile dementia, therapy-resistant paralysis, feeblemindedness, encephalitis and Huntington’s Chorea, who were incapable of anything other than purely mechanical work; (2) patients who had been in the asylums for more than five years; (3) the criminally insane, foreign nationals and ‘racial aliens.’”12 This last group is worth noting, because the simple fact of being Jewish overrode any medical considerations: virtually every Jew within the German asylum system was murdered during the course of the first year of T-4 in 1940.

The recipients of Conti’s letter were told that the registration process was “economic planning,” and most hospital, asylum and clinic directors accepted this at face value. They assumed that the government was merely trying to identify additional sources of labour from among their patients. Tragically, this led some doctors to exaggerate some of their more able patients’ symptoms in the misguided belief that this would save them from being used as forced labour. Of course, in reality, it served as a death sentence.

Once the completed forms had been returned to T-4, they were copied before being sent on to “expert referees” for scrutiny. Again, each form supposedly required three referees to agree before the victim was marked for death. However, the referees were each expected to process some 3,500 cases per month, in addition to their normal duties, so it is highly unlikely that they gave any of the forms more than a cursory glance. Nevertheless, they were paid 400 marks a month for their time. Each and every form was then supposedly checked by Professor Werner Heyde, the senior referee, before the lists of victims were passed on to the Patients’ Community Transport Service—T-4’s transport fleet, driven by SS men in civilian clothes. They collected the patients from their “home” asylums and took them either to a “transit” asylum or directly to one of the killing centres. Even at this stage, the medical pretence was maintained. Typically, when the victims arrived, they were met by doctors, nurses and orderlies in medical garb and taken to changing rooms, where they were stripped, sometimes photographed, and given a further cursory examination, often to ascertain whether their corpses might be used later for scientific dissection or autopsy. Only when all this had been done were they led into gas chambers disguised as shower rooms. The doors were then sealed and the carbon monoxide was released to kill them.

This method of killing was anything but “merciful” or “humane.” Acute carbon monoxide poisoning typically causes headache, dizziness, nausea, confusion and convulsions, and even at relatively high concentrations death is unlikely to occur before fifteen or twenty minutes have elapsed. Usually, the victims were left in the gas chambers for an hour to ensure that they were all dead before extractor fans were turned on and the bodies were removed by teams of “burners” (or “disinfectors,” as they termed themselves). Any gold teeth were extracted before the corpses were carted to nearby furnaces for cremation. Later, an urn of ashes was sent to each victim’s family (of course, any ashes would do, as far as the killing centres were concerned), together with a letter of condolence and a death certificate that gave a plausible cause of death.

Notwithstanding all of this deception, T-4’s attempts to keep the programme secret were doomed to failure almost as soon as it got under way. When the first group of patients left the asylum at Kaufbeuren-Irsee for Grafeneck, few of the asylum staff suspected that their charges were about to be executed. However, a few days later, the victims’ clothing and personal effects—stained with vomit, blood and faeces—were returned to the asylum. The medical staff instantly guessed what had happened to them, and word soon spread among the rest of the staff and the patients about the true destination of the grey buses. This pattern was repeated in all of the other asylums. Scared patients often tried to hide when the transports arrived and physically resisted being loaded aboard. Some were then manacled to their seats to stop them escaping. This should come as no surprise. Although National Socialist propaganda attempted to portray incurable psychiatric patients as frightening, sub-human monsters, in reality only a small minority could not comprehend what was happening to them. And many of the groups that were targeted—such as epileptics and paralytics—were not reason-impaired at all. At least one of the eighty or so patients who were forced onto the second transport from Kaufbeuren-Irsee asked for a priest so he could make his final confession.

Word of what was happening also spread in the localities of the killing centres as the personnel talked freely in pubs and cafés. And, of course, the local residents saw the buses arriving, followed shortly afterwards by smoke and fumes from the crematoria chimneys. It was so obvious what was going on that railway workers at Grafeneck removed their hats out of respect as transport trains passed through their station.

Furthermore, some of the victims’ families knew that the authorities were lying to them. Inevitably, mistakes were made by the administrators, so, for example, a sister might be told that her brother had died of acute appendicitis, even though he’d had an appendectomy fifteen years before. But even more importantly, the vast majority of the incurables were much-loved sons and daughters, brothers and sisters, mothers and fathers. Their families genuinely cared for them, were concerned about their fate and did not want them arbitrarily killed at the whim of the state. Therefore, as the death toll grew, so did resistance to the euthanasia programme. This reached surprisingly vociferous levels, given that it took place in Hitler’s Germany.

At first glance, this might be interpreted as an indication of pure compassion among the citizens of the Third Reich, as evidence that they were not prepared to accept the wholesale slaughter of innocent people purely because they were different from the rest of society. However, before drawing this conclusion, it should be remembered that there were no comparable demonstrations when the extermination of the Jews got under way. And there is nothing to suggest that the general population of Germany held particularly enlightened views about how the disabled and the mentally ill should be treated. In fact, they seemed to take issue with the manner in which the killing was carried out, rather than with the killing itself: no law had been passed to authorise the programme; relatives were not informed of the victim’s true fate; and the process appeared to have no rules. It may well have been the arbitrary nature of the programme that caused most concern, with many people understanding that anybody might need psychiatric treatment at some point in their life or might suffer an injury that leaves them permanently disabled. This would have been especially appreciated in Germany in 1940, because so many people had been through the horrors of the First World War and had seen friends and family members wounded or struck down by “shell-shock.”*

Whatever it was that motivated the protesters, they made their voices heard. Some organised rallies outside the killing centres. Others took their concerns directly to the asylums and managed to extricate their relatives from the clutches of T-4. Others, ironically, petitioned Hitler through the Führer Chancellery, not realising that this organisation was orchestrating the whole project. However, the most effective protests came from members of the Catholic Church. Foremost among these was the Bishop of Münster, Clemens August Graf von Galen.

Von Galen was a member of an old aristocratic family—ultraconservative, snobbish, racist and reactionary. A Jesuit, he had long publicly opposed the National Socialist regime, but principally because he thought it was led by social upstarts and foreigners. He first received information about T-4 as early as July 1940, but was dissuaded from denouncing the project by Cardinal Bertram, the Archbishop of Breslau. However, the following year, the Gestapo seized Jesuit property in Münster and von Galen decided to act. On 3 August, he delivered a ferocious sermon from his pulpit in the Lambertikirche, which concluded:

We are not dealing with machines, horses and cows whose only function is to serve mankind, to produce goods for man. One may smash them, one may slaughter them as soon as they no longer fulfil this function. No, we are dealing with human beings, our fellow human beings, our brothers and sisters. With poor people, sick people, if you like, unproductive people. But have they forfeited the right to life? Have you, have I the right to life only so long as we are productive, so long as we are recognised by others as productive?13

The sermon attracted attention both outside and inside Germany. It was reported by the BBC and in British newspapers, and transcripts were dropped by the RAF as propaganda pamphlets.*

Other representatives of the Catholic Church had been in secret negotiations to stop the killings since late 1940, but von Galen’s open denunciation spurred further public criticism. The disquiet reached such a pitch that even Himmler recommended that the killings should be stopped. Later in August 1941, Hitler duly ordered Brandt to call a “temporary” halt to the killings. However, by that stage, more than seventy thousand victims had already been murdered, and T-4 had almost achieved its original goal of killing one “incurable” patient for every thousand of the general population. So it seems likely that, rather than being swayed by public opinion, Hitler merely thought that this particular project had reached its conclusion.

Furthermore, although the centrally organised killing of psychiatric patients was now wound down, the euthanasia programme per se did not end. The children’s programme continued, T-4 still collected data and registered “incurables,” and the killing centres at Bernburg, Sonnenstein and Hartheim remained open.† Now, though, they focused on the sick from the original concentration camps. Although the latter were models of brutality, where the murder of inmates was routine, they were not equipped for mass killing.

The killing of concentration camp prisoners was organised by “Operation 14 f 13,” a name derived from the code used by camp administrations for inmates who died in custody. (14 f 5 indicated a prisoner killed while trying to escape; 14 f 8 a prisoner who committed suicide; 14 f 14 an executed prisoner; and so on.) From mid-1941, T-4 doctors toured the camps and made selections from preliminary lists of prisoners that had been drawn up by the SS camp administrators. This meant that the T-4 extermination net started to spread wider, because, in addition to the sick, these lists of those deemed unable to work included: antisocials (defined as “human beings with a hereditary and irreversible mental attitude who, due to this nature, incline towards alcoholism and immorality, have repeatedly come into conflict with government agencies and the courts and thus appear unrestrained and a threat to humanity”14); political prisoners; criminals; and Jews.

The launch of 14 f 13 caused some problems for the SS. By March 1942, the Inspectorate of Concentration Camps had seen such a decline in the number of prisoners available for work that it ordered the camps to select for extermination only those who weregenuinely unfit.15 Nevertheless, by the next year, the labour shortage was still so acute that Himmler ordered the end of 14 f 13. Thereafter, the killing would be confined only to inmates with mental problems who could be dealt with within the camps themselves. The gas chambers at Bernburg and Sonnenstein were duly dismantled. The Hartheim killing centre continued to operate until December 1944, primarily to murder prisoners from the nearby Mauthausen concentration camp. These victims were selected by the camp authorities, without any involvement of T-4 staff.

Adult euthanasia, however, continued on a decentralised basis, in a similar way to the children’s programme, with a number of doctors authorised to kill selected patients in designated hospitals. As with the children, the adult victims were starved or overdosed until a fatal condition was induced, then cremated to destroy the evidence. Finally, a bogus death certificate was issued. According to Henry Friedlander: “In fact, more victims of euthanasia perished after [Hitler’s] stop order than before.”16 Long-term mentally ill patients from the asylum system continued to be murdered, but now the victims also included many Germans who had more recently succumbed to mental illness under the pressure of Allied bombing raids and other aspects of the war, as well as foreign labourers who had been conscripted into the service of the Third Reich from the occupied territories of Europe. Any forced labourer who became sick—either physically or mentally—was vulnerable: they were only in Germany to provide labour at minimal cost, so their long-term medical care was deemed economically prohibitive. Consequently, if their condition suggested they would not make a speedy recovery, they were killed.

THE STERILISATION AND euthanasia programmes are key elements in the history of the SS, even though the organisation itself played only a supporting role in them. Ever since details of the programmes first came to light, sociologists have attempted to explain how so many members of the medical profession—traditionally regarded as an essentially altruistic group—were so quickly and easily converted into enthusiastic mass murderers. Partly, it seems, they were stimulated by the idea of working in supposedly revolutionary times. The National Socialists constantly emphasised the need to “improve” the German Volk and rid Germany of other races and associated “inferior” elements. By taking part in the sterilisation and euthanasia operations, doctors and nurses placed themselves in the front line of this “national improvement” project, which not only gave them a sense of importance and prestige, but allowed them to continue to believe in their own altruism: to their minds, they were no longer caring merely for individuals, but for the whole of German society.

More prosaically, they were materially rewarded for taking part. In addition to extra pay and allowances, they had access to, for example, a “rest centre” at a castle near Salzburg, which provided meals that were not available to the heavily rationed ordinary people. Such VIP treatment contributed to their sense that they constituted an elite.

Even those with moral qualms about the programmes could manage to convince themselves that there was some scientific benefit from what they were doing. An unprecedented supply of corpses became available for dissection as a result of the euthanasia programme, and physicians were in the novel position of being able to combine clinical and pathological observations. In practice, this meant that doctors like Julius Hallervorden, of the Kaiser Wilhelm Institute for Brain Research in Berlin, would visit the killing centres and personally select individuals. Once they were killed, Hallervorden would remove their brains and take them back to Berlin for dissection.

The “mercy killing” of the incurably ill still attracts adherents to this day. So, especially given the moral and ideological context of the Third Reich, it is scarcely surprising that well-educated, intelligent doctors and nurses became advocates of it. However, in reality, the overwhelming majority of the killings were far from merciful: gassing and starvation, the two principal means of death that were employed, inflicted great suffering on the victims. Moreover, as the programmes progressed, it is clear that those involved lost any moral compass they may previously have possessed.

This is well illustrated by the case of Dr. Valentin Faltlhauser, director of the Kaufbeuren-Irsee asylum. In the early 1930s, Faltlhauser was a leading figure in the renaissance of German psychiatry and a vocal opponent of euthanasia. However, his position began to change after the National Socialists took power. Soon, he became one of the regional experts in sterilisation. He appeared before the hereditary health courts and initiated sterilisation proceedings, and his theories changed to accommodate National Socialism and eugenic thought. By the late 1930s, when funding for asylums and psychiatry was being drastically reduced, he was differentiating between those patients who could be cured and those who could not—directing resources towards the former at the expense of the latter. The euthanasia programme “solved” many of his financial difficulties as an asylum director. And after Hitler’s stop order, Faltlhauser was an enthusiastic advocate of differential diets—starving the incurable to death while feeding those who responded to treatment. His ultimate moral bankruptcy is revealed by the case of Ernst Losser.

Ernst’s father was an itinerant pedlar who was classified as “asocial” and sent to Dachau (he was suspected of being a Gypsy), while Ernst himself and his two siblings were put into orphanages. But Ernst was poorly behaved at the orphanage—refusing to attend school and stealing from the other children—so at the age of ten or eleven he was referred to Kaufbeuren-Irsee for psychiatric evaluation. The psychiatrist took the view that Ernst could not be changed by education, and recommended that he should be transferred to the children’s unit at Kaufbeuren, even though he had neither psychiatric problems nor learning difficulties.

The transfer was duly made, and the staff at Kaufbeuren soon grew fond of Ernst: he responded much better to adult company, was friendly and liked to play. At least one member of staff even went so far as to take him home for the weekend, because they felt he should never have been in the asylum in the first place.

Before long, Ernst discovered that many of the patients at the asylum were being starved, so he started to sneak down to the kitchens at night to steal food—bread, apples and other staples—and then distributed them to the grateful inmates. When this came to the attention of Faltlhauser and the other psychiatrists, they determined that Ernst was a “bad character” and decided to eliminate him. A T-4 nurse was instructed to carry out the killing. Ernst was too streetwise to drink coffee laced with sedatives, but he was eventually given a lethal injection after being woken up in the middle of the night. He was dead within a few hours.

Faltlhauser was also responsible for the last death in the euthanasia programme. Four-year-old Richard Jenne was killed at Kaufbeuren on 29 May 1945, twenty-one days after Germany’s unconditional surrender and thirty-three days after United States troops had occupied the local area. The Americans had not occupied the hospital because they had been warned that it might contain typhus patients, so Faltlhauser and his staff had simply got on with their work.

Faltlhauser was a well-educated, intellectual, previously moralistic doctor who became a remorseless mass killer in the context of the Third Reich; and he was far from the only member of the medical establishment to follow this path. Such men and women were easily persuaded that euthanasia and sterilisation were not only acceptable but positively desirable, so it should come as little surprise that much less sophisticated, “ordinary” people were willing to staff the concentration camps, special task groups, police battalions and extermination camps that carried out the Holocaust. The propaganda that convinced the doctors they were doing the right thing worked just as well—if not better—on the camp guards.

The euthanasia programme also provided the SS with the technical expertise that would soon be used in the extermination of the Jews. Even as the first victims of T-4 were being gassed, large numbers of Jews—and other supposed enemies of Germany—were being shot by SS special task groups in German-occupied Poland. This was time-consuming, manpower-intensive and stressful for the killers, so an alternative, more efficient means of mass murder was sought, and the euthanasia programme pointed the way. To a large extent, the procedures that had been used in the killing of the mentally ill were applied without adaptation in the killing of Jews. For instance, the gas chambers at Grafeneck and at Auschwitz were disguised as shower rooms for precisely the same reason—to try to preserve order among those who were about to be murdered. Moreover, many of the personnel from the T-4 killing centres were subsequently redeployed to the death camps: for instance, Christian Wirth, Franz Stangl and Irmfried Eberl all had roles in the extermination centres on the River Bug.

There is one final parallel between the euthanasia programme and the Holocaust. There can be little doubt that the former was a long-held dream of Adolf Hitler: he discussed eugenic measures in Mein Kampf, and mentioned the subject on several occasions in the late 1920s and 1930s. However, the only practical measure he took towards implementing it was to secretly authorise “mercy killings” in October 1939. Partly this was because he feared a public backlash (in Germany as much as abroad) if he were ever to legalise euthanasia. For similar reasons, while he maintained a bitter hatred of the Jewish people and certainly welcomed their annihilation as a race, any instructions that he gave for the commencement of the extermination programme were kept entirely secret.*

* Bouhler was born in 1899. The son of an army officer and a veteran of the First World War, he was an early member of the NSDAP and became the party’s “second secretary” in the autumn of 1922. He was made Reich Secretary three years later and head of the Führer Chancellery in November 1934. He committed suicide after being arrested by the Americans in 1945.

* In addition to Hartheim and Brandenburg, the other major T-4 killing centres were at Hadamar in Hesse, Sonnenstein in Saxony, Grafeneck in Baden-Württemberg and Bernburg in Saxony-Anhalt.

* There is little concrete evidence that German soldiers were killed in the euthanasia programme, but it does appear to have happened. At the trial of a T-4 nurse in 1948, it was alleged that she had given lethal injections to soldiers who had gone “mad” during the winter of 1941–42.

* Von Galen’s status and popularity among the devout meant that the regime was wary of moving against him, but he was kept under virtual house arrest until the end of the war.

† Brandenburg and Grafeneck ceased operation.

* Some participants in the Holocaust, such as Eichmann, have claimed that Hitler did give such an order and indeed that they saw it on paper. But no documentary evidence has ever been found to prove these claims.

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