T4 Program, also called T4 Euthanasia Program, Nazi German effort—framed as a euthanasia program—to kill incurably ill, physically or mentally disabled, emotionally distraught, and elderly people. Adolf Hitler initiated the program in 1939, and, while it was officially discontinued in 1941, killings continued covertly until the military defeat of Nazi Germany in 1945.

T4 Program A former T4 killing centre in Hartheim, Austria. Dralon

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In October 1939 Hitler empowered his personal physician and the chief of the Chancellery of the Führer to kill people considered unsuited to live. He backdated his order to September 1, 1939, the day World War II began, to give it the appearance of a wartime measure. In this directive, Dr. Karl Brandt and Chancellery chief Philipp Bouhler were “charged with responsibility for expanding the authority of physicians…so that patients considered incurable, according to the best available human judgment of their state of health, can be granted a mercy killing.”

Within a few months the T4 Program—named for the Chancellery offices that directed it from the Berlin address Tiergartenstrasse 4—involved virtually the entire German psychiatric community. A new bureaucracy, headed by physicians, was established with a mandate to kill anyone deemed to have a “life unworthy of living.” Some physicians active in the study of eugenics, who saw Nazism as “applied biology,” enthusiastically endorsed this program. However, the criteria for inclusion in this program were not exclusively genetic, nor were they necessarily based on infirmity. An important criterion was economic. Nazi officials assigned people to this program largely based on their economic productivity. The Nazis referred to the program’s victims as “burdensome lives” and “useless eaters.”

The program’s directors ordered a survey of all psychiatric institutions, hospitals, and homes for chronically ill patients. At Tiergartenstrasse 4, medical experts reviewed forms sent by institutions throughout Germany but did not examine patients or read their medical records. Nevertheless, they had the power to decide life or death.

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While the program’s personnel killed people at first by starvation and lethal injection, they later chose asphyxiation by poison gas as the preferred killing technique. Physicians oversaw gassings in chambers disguised as showers, using lethal gas provided by chemists. Program administrators established gas chambers at six killing centres in Germany and Austria: Hartheim, Sonnenstein, Grafeneck, Bernburg, Hadamar, and Brandenburg. The SS (Nazi paramilitary corps) staff in charge of the transports donned white coats to keep up the charade of a medical procedure. Program staff informed victims’ families of the transfer to the killing centres. Visits, however, were not possible. The relatives then received condolence letters, falsified death certificates signed by physicians, and urns containing ashes.

A few doctors protested. Some refused to fill out the requisite forms. The Roman Catholic church, which had not taken a stand on the “Jewish question,” protested the “mercy killings.” Count Clemens August von Galen, the bishop of Münster, openly challenged the regime, arguing that it was the duty of Christians to oppose the taking of human life even if this cost them their own lives.

The transformation of physicians into killers took time and required the appearance of scientific justification. Soon after the Nazis came to power, the Bavarian minister of health proposed that psychopaths, the mentally retarded, and other “inferior” people be isolated and killed. “This policy has already been initiated at our concentration camps,” he noted. A year later, authorities instructed mental institutions throughout the Reich to “neglect” their patients by withholding food and medical treatment.

Pseudoscientific rationalizations for the killing of the “unworthy” were bolstered by economic considerations. According to bureaucratic calculations, the state could put funds that went to the care of criminals and the insane to better use—for example, in loans to newly married couples. Proponents for the program saw incurably sick children as a burden on the healthy body of the Volk, the German people. “Wartime is the best time for the elimination of the incurably ill,” Hitler said.

The murder of the handicapped was a precursor to the Holocaust. The killing centres to which the handicapped were transported were the antecedents of the extermination camps, and their organized transportation foreshadowed mass deportation. Some of the physicians who became specialists in the technology of cold-blooded murder in the late 1930s later staffed the death camps. They had long since lost all their moral, professional, and ethical inhibitions.

Like the Judenrat (“Jewish Council”) leaders during the Holocaust, psychiatrists were able to save some patients during the T4 Program, at least temporarily, but only if they cooperated in sending others to their death. The handicapped killing centres developed gas chambers like those later used at extermination camps. As the extermination camps did later, the handicapped killing centres installed ovens to dispose of dead bodies. The death camps that followed took the technology to a new level. The extermination camps could kill thousands at one time and burn their bodies within hours.

On August 24, 1941, almost two years after the T4 Program was initiated, it appeared to cease. In fact, it had gone underground and continued covertly during the war years. While the program claimed over 70,000 victims during its two years of open operation, the killing centres murdered even more victims between the official conclusion of the program and the fall of the Nazi regime in 1945. The total number killed under the T4 Program, including this covert phase, may have reached 200,000 or more. The official conclusion of the T4 Program in 1941 also coincided with the escalation of the Holocaust, the culmination of Nazi programs to eliminate those deemed an embarrassment to the “master race.”