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T4 Medical Killing Program

The camouflage organization created for the medical killing of adults was known as the Reich Work Group of Sanatoriums and Nursing Homes (Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten, or RAG). It operated from the Berlin Chancellery, at Tiergarten 4, hence the "T4" code name. In time, word of the Nazi T4 program (medical killing on a vast scale) filtered down into the general population, and resistance began to emerge. In time, after scathing denouncements by clergy, and even Werner Moelders, a Catholic Luftwaffe pilot and war hero (who threatened to return his decorations if the `euthanasia' program was not halted), the decision was made to respond...."Nazi leaders faced the prospect of either having to imprison prominent, highly admired clergymen and other protesters _ a course with consequences in terms of adverse public reaction they greatly feared _ or else end the program. The latter was essentially the recommendation of Himmler, who noted that the secret was no longer a secret, though added, `If operation T4 had been entrusted to the SS, things would have happened differently, 'because `when the Fuehrer entrusts us with a job, we know how to deal with it correctly, without causing useless uproar among the people.'<51> "Early in 1941, T4 leader Bouhler agreed to let Himmler use T4 personnel and facilities to rid the camps of `excess' prisoners _ notably those most seriously ill,' physically and mentally. Sometimes called `prisoner euthanasia' or (by prisoners) `Operation Invalid,' the resultant program was officially `Operation [or Special Treatment] 14f13.'* The designation came from the reference number for the operation in documents of the Concentration Camp Inspectorate.** That spring, `experimental psychiatrists' from T4 were sent to the camps, assured that their work in selecting out `asocial' elements had scientific importance. Their work, as in T4, was based on prior questionnaires. For this purpose, however, they were shorter, asking after a prisoner's name, race, and `health' (that is, whether incurable). *** The short form was explained by the T4 doctors' lack of time, although camp commandants or camp doctors did the initial screening. To camouflage procedures, those selected were told that they were being sent to a `rest home.' (In fact, people apparently volunteered until it was realized what was happening when personal effects, but no rested' prisoners, returned.)<6>

As low as T4 standards were, those in 14f13 were worse. `Examinations' by T4 doctors were perfunctory or non-existent, and the questionnaires frequently contained no medical information at all, but only a list of an inmate's ostensible crimes and political deviations. Ordinary SS camp personnel could construe political beliefs or rude comments about the Fuehrer as `mental deficiency' or `psychological aberration,' and the visiting doctors' commission almost never objected to an SS request for transfer' (to a killing facility). Whatever the travesty of medicine, inmates observed that `the doctors were dressed in white coats,' although other prisoners apparently assumed that they were Gestapo in disguise.<7>

Hitler apparently gave Brandt a verbal order on or about 24 August 1941 to end or at least `stall' operation T4.<52> But the killing of mental patients did not end: mass murder was just beginning. What was discontinued was only the visible dimension of the project: the large-scale gassing of patients. T4 officially ceased as a program, but that turned out to be still another deception. Widespread killing continued in a second phase, sometimes referred to in Nazi documents as `wild euthanasia' because doctors _ encouraged, if not directed, by the regime_ could now act on their own initiative concerning who would live or die.<1>

While the regime ordered most of the gas chambers dismantled (to be reassembled, as it turned out, in the East), it did nothing to stop the ideological and institutional momentum of medical killing. The regime's clear message, in fact, was that the killings were to go on, but more quietly. And more quiet killing meant more isolated, individual procedures. Doctors acted on their personal and ideological inclinations, along with their sense of the regime's pulse. That pulse emanated no longer from the Chancellery, which bowed out along with T4 itself, but from the Reich Interior Ministry and its national medical subdivision. There were changes in geographical location, but the regime continued to make transportation arrangements, required that patients' deaths be recorded centrally, and in some cases maintained T4 experts in a partially supervisory role. Patients were now killed not by gas but by starvation and drugs, the latter method in particular rendering the killing still more `medical.' The children's program was not included under the T4 `halt.'

Killing methods did not have to be changed: drugs and starvation, and not gas, had been employed from the beginning. The killing of children had been considerably less visible, taking place as it did on wards in smaller facilities without the telltale evidence of noxious smoke and odors that stemmed from large-scale gassing. The programs had been based more on presumed eugenic and scientific grounds than on direct economic ones (the children did not work and ate less) and had not created the degree of public controversy that adult killing had. If anything, the reporting methods for ostensible abnormalities became more systematic. Research efforts, mostly post-mortem studies, also became more systematic, as sometimes happened in adult `wild euthanasia.'

Not only did the regime remain closely involved, but the greater part of the killing of children took place after the official ending of the `euthanasia' project. What did become more `wild' was the method of deciding which children should be killed. Now even the pretense of review boards of `expert opinion' was abandoned: any child considered in some way impaired, and sent though the administrative system to any of the `special pediatric units' of the original project, was still fair game. Beyond that, institutional doctors could proceed according to their own inclinations.

Adult `wild euthanasia' involved more radical changes for psychiatrists. No longer operators of gas chambers, they returned to the familiar terrain of syringes, oral medications, and dietary prescriptions of achieving the same end. From the regime's medical bureaucracy came the continuing message that mental patients were `useless eaters,' burdens on the state and its war effort, `life unworthy of life.' Permission to kill was clear enough, even if a little indirect. As one psychiatrist later testified, `In conversation with other participants in the program I learned that there would be no fuss if some physician or other in an institution stood ready to kill a patient by injection or overdose, if he was convinced that the patient's extinction was desirable.' And there was a partial merger of child and adult `euthanasia' programs as the age limit of the children's program was raised to sixteen years: `to some extent this expansion was to offer a substitute for the canceled program.'<2> There were, in fact, documented cases of patients of about that age who had managed to survive the official end of the adult `euthanasia' program only to be fatally reclassified as a child.<3><52> Hefelmann testimony, 6-15 September 1960, Heyde Trial, pp. 681-82. See also p. 680<1> Ernst Klee, "Euthansie" im NS-Staat: Die "Vernichtung lebensunwerten Lebens" (Frankfurt/M: S. Fischer, 1983, p. 440)<2> Friedrich Mennecke, quoted in Alexander Mitscherlich and Fred Mielke, "Doctors of Infamy:The Story of the Nazi Medical Crimes" (New York:n Henry Schuman, 1949) p. 116

Extracted from THE NAZI DOCTORS: Medical Killing and the Psychology of Genocide.Lifton, Robert Jay, London: Papermac, 1986 (Reprinted 1990)__pp.95-97


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