Euthanasia Module Nov 16

8/2/2019 Euthanasia Module Nov 16

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IV.THE MEDICALIZATION OF MURDER: THE EUTHANASIA PROGRAMS

Part 1: The Childrens Euthanasia Program

Susan Benedict, RN, DSN, FAAN

Professor Emerita

Medical University of South CarolinaCharleston, SC 29425

USA

[email protected]

Purpose of the Module: The purpose of this module is to describe how the euthanasia

program in Germany began with the murder of children with disabilities.

Suggested Reading:

1. Burleigh, M. (1994). Death and Deliverance. Cambridge, UK: Cambridge University

Press, p. 93-129.

2. Friedlander, H. (1995). The Origins of Nazi Genocide. Chapel Hill: University of North

Carolina Press, p. 39-61.3. Gallagher, H. (1990). By Trust Betrayed. Arlington, VA: Vandamere Press, p. 88-104.

4. Proctor, R. (1988). Racial Hygiene. Cambridge, MA: Harvard University Press, p. 177-

222.

5. Benedict, S., ODonnell, A., Shields, L. (2009). Childrens euthanasia in Nazi Germany.

Journal of Pediatric Nursing, (246), 506-516.

Suggested Video: Healing by Killing, Part I.

Objectives:

1. To identify the major historical factors leading to the children's euthanasia program

2. To describe the major beliefs of the German people and the German culture consistent

with the development of the children's euthanasia program3. To specifically appraise the roles of physicians and nurses in these killings

4. To analyze the connections between the killing of disabled children to the application of racial hygiene policy

5. To identify your feelings and thoughts about the value of the individual and society's

responsibility to protect vulnerable groups

6. To discuss the relevancy of this module to contemporary practice

Discussion Points:

1. Role of German government and policy in deciding who was "worthy" of continued life



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2. What were the socio-cultural and political factors that led to the children's euthanasia

program? Could there have been a different outcome in this place and time?3. At what point is the "line crossed" when making decisions about the termination of life

and who has the right to make these decisions?4. What is the inherent value of human life irrespective of mental and physical conditions?

5. What is the relevancy between the children's euthanasia program and contemporary

ethical issues you face today?

Synopsis:

The word Euthanasia means an easy death. The killing of the disabled and

handicapped of Germany and Austria during National Socialism was anything but easy

for the victims. It was involuntary, deceitful, cruel, unforgettable, and unforgivable. It

began with the killing of the most vulnerable: children with disabilities.

There is not a single factor that led to the killing of 3,000 5,000 of these

children. There was the strongly held belief by the German people, and especially the

German medical profession, in eugenics. A stronger and healthier race was to be

created through the elimination of inferior people. Handicapped children were seen

as positive proof that some people were genetically or hereditarily inferior. There was

the humiliating and financially devastating Treaty of Versailles which left Germany in

desperate economic straits, thus drastically cutting the resources to care for

institutionalized children and adults. There was the beginning of World War II which

necessitated reallocation of economic resources to the war effort and a call to free

hospital beds and staff to care for the wounded. There was the belief that severely

handicapped were living lives unworthy of life and to eliminate their existence was

releasing them from suffering and removing a diseased part from the healthy Volk. And



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perhaps the greatest influence came from the Führer himself who had long advocated

the elimination of the weaker elements of society.

An important event in the development of the German euthanasia programs was

the publication in 1920 of a book entitled Die Freigabe der Vernichtung lebensunwerten

Lebens (The sanctioning of the destruction of lives unworthy to be lived). 1 Written by

Alfred Hoche, a professor of psychiatry at the University of Freiburg, and Karl Binding, a

German judge and former president of the Reichsagericht, the highest criminal court,2

this book advocated the killing of people who were mentally ill or mentally defective.

It was within this book that the term euthanasia was used for the killing of people

with mental illnesses who could not give consent.3 Hoche and Binding asserted that the

right to live must be earned and justified and that those who had no capacity for human

feeling were living lives not worth living and their destruction would be humane. 4

Binding proposed that three groups of patients should be killed:

1) patients with a terminal illness who were mentally competent and who

expressed a wish to die,

(2) the incurable lunatics who had neither the will to live nor to die, and

(3) people who were formerly mentally healthy but who had sustained a illness or

injury that would make them either permanently comatose or who would

awaken to a nameless misery 5

Binder and Hoche stated that

the elimination of those who are mentally completely dead is not a crime, not an

immoral act, not brutal, but a permissible and beneficial act.6

However, by German law, this elimination was a crime.



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In a Nazi party rally held in Nuremberg on August 5, 1929, Hitler stated the

following:

If Germany was to get a million children a year and was to remove 700,000 -800,000 of the weakest people then the final result might even be an increase in

strength. The most dangerous thing is for us to cut off the natural process of

selection and thereby gradually rob ourselves of the possibility of acquiring able

people...As a result of our modern sentimental humanitarianism we are trying to

maintain the weak at the expense of the healthy. It goes so far that a sense of

charity, which calls itself socially responsible, is concerned to ensure that even

cretins are able to procreate while more healthy people refrain from doing so,

and all that is considered perfectly understandable. Criminals have the

opportunity of procreating, degenerates are raised artificially and with difficulty.And in this way we are gradually breeding the weak and killing off the strong.7

It has been long reported that the impetus for the childrens euthanasia program

came from a request to Hitlers Chancellery by the father of a severely handicapped

child by the last name of Knauer8,9,10,11 to have the child killed. The child was described

as being born blind, missing one leg and part of an arm, and possibly an idiot12. More

recently, Ulf Schmidt identified the child as Gerhard Herbert Kretschmar. He was born

on February 20, 1939 in Pomen. His parents were reported to be ardent Nazis.13 The

infants father, Richard Gerhard Kretschmar, contacted Dr. Werner Catel, the director of

the University Childrens Clinic in Lipzig, to have the child put to sleep because Richard

was concerned about the effect the child was having on the mother. Catel refused,

believing it was illegal; however, the father, or according to Burleigh14, the childs

grandmother, petitioned Hitler to grant permission to have him killed.

The petition of the Kretschmar family was not unique. In fact, one official

reported that two thousand such requests reached the Chancellery each day .15



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However, this particular request did catch Hitlers attention and he sent Dr. Karl Brandt

to Leipzig to investigate. Brandt was authorized by Hitler to allow the child to be killed if

all agreed that the infant was as described. Thus the Knauer [Kretschmar] child became

the first known victim of the Nazi euthanasia program.16

Testifying in November 1960, Dr. Hefelmann of the Führers office stated

Brandt told me later about the Knauer case. Hitler had given him unrestricted

authority to let the euthanasia take place...at least Brandt told me that the child

was put to sleep by Catel. I seem to remember that Brandt said that the

euthanasia was done with tablets. Whoever undertook the actual euthanasia,Brandt or Catel, or a different physician altogether or even a caregiver is hard to

say. I am quite certain that the euthanasia occurred at the University Clinic in

Leipzig.17

Subsequent requests for euthanasia were also dealt with at the Kanzlei des Führer and were

considered secret state action.

This childrens euthanasia program was disguised under the title of The Reich

Committee for the Scientific Registration of Serious Hereditary- and Congenitally-based

Illnesses [Reichsausschuss zur wissenschaftlichen Erfassung von erb- und anlagebedingten

schweren Leiden], known simply as the Reich Committee.18 A goal of the Reich

Committee was to determine the number of newborns with problems or conditions and to

initiate the killing of these children along with those children with disabilities who were

already institutionalized.19



6

Photo courtesy of Judy Lott.



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In 1939, a Ministry of Justice commission proposed the following:

Clause 1: Whoever is suffering from an incurable or terminal illness which is a

major burden to himself of others can request mercy killing by a doctor,provided it is his express wish and has the approval of a specially empowered

doctor.

Clause 2: The life of a person who, because of incurable mental illness, requires

permanent institutionalization and is not able to sustain an independent

existence may be prematurely terminated by medical measures in a painless and

covert manner.20

On August 18, 1939, the State Ministry of the Interior mandated that all

physicians and midwives report all newborns with observable physical and/or mental

disabilities:

RE: The duty to report deformed births etc.

1. In order to clarify scientific questions in the field of congenital deformities and

intellectual under-development [sic], it is necessary to register the relevant cases

as soon as possible.

2. I therefore instruct that the midwife who has assisted at the birth of a child -even in cases where a doctor has been called to the confinement - must make a

report to the health Office nearest to the birth place on the enclosed form,

which is available from Health Offices, in the event of the new-born [sic] child

being suspected of suffering from the following congenital defects:

i. Idiocy and Mongolism (particularly cases which involve blindness and

deafness).

ii. Microcephalie (sic) [an abnormally small skull].

iii. Hydrocephalus of a serious or progressive nature [abnormally

large skull caused by excessive fluid].

iv. Deformities of every kind, in particular the absence of limbs, spina bifida

etc.v. Paralysis including Littles disease [Spastics].

3. In addition, all doctors must report children who are suffering from one of the

complaints in (i - v) and have not reached their third birthday in the event of the

doctors becoming aware of such children in the course of their professional

duties.

4. The midwife will receive a fee of 2 RM in return for her trouble. The sum will be



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paid by the Health Office.21

Requests received from physician and midwives were reviewed by the medical

examiners: Professor Hans Heinze (Director of the psychiatric facility at Brandenburg-

Gorden), Professor Werner Catel (Director of the University Pediatrics Clinic in Leipzig),

and Dr. Ernst Wentzler (a pediatrician and director of a private clinic in Berlin). These

physicians did their evaluations based solely on the reports - at no time did they actually

examine the child. The reports were marked with a + if the child was to be killed and

a - if the child was to be spared.22

Parents of disabled children were informed that these K inderfachabteilunger

[childrens wards for expert care] were being established throughout the country.

Am Spiegelgrund Clinic Memorial, Vienna

They were persuaded to admit their children to these wards by being assured that the

children would receive the best possible care. Although it was possible for parents to

refuse to relinquish their children, to do so necessitated the parents signing forms

stating their responsibility for the supervision and care of their children. Later in the



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war, mothers were often conscripted for work thus rendering them unable to provide

care and supervision. These women were then forced to relinquish their children they

had tried to keep out of institutions.23

Thus Nazis obtained authorization to treat the children. It is unlikely that any

of these children were ever returned to their homes or transferred to an ordinary

hospital after being admitted to a Kinderfachabteilunger.24 Eventually there were 22 of

these clinics.25

Now removed from their homes, many of these children became victims of

medical experiments and research. Experiments could be conducted without

parameters and the results could be immediately evaluated by autopsy. Dr. Carl

Schneider, Professor of Psychiatry and Neurology at Heidelberg University, stated the

following:

...reaching far beyond other scientific discussion and research in the field of psychiatry, at last the most practical and immediate questions affecting the

health of the nation can be most comprehensively resolved because thanks to

the [euthanasia] program, a rapid anatomical and histological clarification can be

achieved.26

Some children were starved to death, with the process often accelerated by

mixing Luminal (phenobarbital) in their food every morning and evening. The low

caloric intake combined with the sedation predisposed the children to pneumonia and

premature death. Some children were given injections of morphine and scopolamine.27

Nurses working in these killing wards received a supplemental payment of 25



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Reichsmark per month and the physicians often received Christmas bonuses of 250

Reichsmark.28

In some clinics (notoriously the Kalmenhof at Idstein), the tensions of the job

were soothed by a visit to the wine cellars to mark every 50 th killing with copious

amounts of wine and cider.29

One of the most infamous institutions in the childrens euthanasia program was

Eglfing-Haar, located on the outskirts of Munich. During the days of National Socialism,

it was quite common to have tours of such facilities attended by members of the Nazi

Party and even the general public. At Eglfing-Haar, from 1934 onward, groups of up to

100 members of the SS, SA, Hitler Youth, League of Geman Maidens, the Nazi Womens

organization, physicians, nurses, midwives, attorneys, and teachers toured the

institution.30 One such tour, guided by the medical director of Eglfing-Haar Dr. Hermann

Pfannmüller, is described by a person present.

About 40 visitors in uniforms of various colors, from the dark gray of theWehrmacht to the light brown of the Nazi Party, to the deepest black of the SS, crowded

around Dr. Pfannmüller. After a few short remarks, Dr. Pfannmüller approached one of the 15 beds holding children.

Here we have children who range from approximately one to five years of age,

he began in a teaching manner. All these creatures represent to me as a National

Socialist is nothing but ballast existencesballast for our peopleinsofar is the action by

the Führer, to relieve the people of this overburdening of a national deed whose

dimensions can only be assessed by medical laymen after many years, if not many

decades. We do not practice this action through poison, injections or other recognizable

measures by the outside worldthe foreign press and other circles in Paris and Londonwould be breathing down our necksNo, our method is much simpler.

With these words, he single handedly yanked one child out of bed. While the fat

man showed this whimpering human skeleton around like a captured rabbit: Of course

we do not withdraw food from one day to the other. That would create too much

unrest. We cut down the food rations. Natures does take its coursewith this one, itll

be maybe 2 or 3 more days. With these words, he dropped the child back into the bed.



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Pfannmüller explained to his visitors that this systematic practice of mass murder of

debilitated children rested upon basic orders by Hitler.31

The killing of the children with disabilities continued until after the war. The last child to

be killed at one institution, Kaufbeuren, was on May 20, 1945, 21 days after the end of the war

and 31 days after the American military moved into the area.

Photo from the newspaper file of the Wiener Library, London.

One nurse employed there admitted to the Americans that she killed at least 211

children and was paid about $14 per month extra for the murders.32

An estimated 3,000 to 5,000 children were killed by physicians and nurses in the

childrens euthanasia program.33 Richard von Hegener, an officer for the Reich Committee,

estimated that 5,200 children were killed in the program. This number may be a low estimate

because in the early years of the childrens program older children who were killed were

included in the adult euthanasia program.34



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Photo of exhibit at Bernburg Hospital, courtesy of Judy Lott.



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References:

1. Müller-Hill, B. (1988). Murderous Science: Elimination by Scientific Selection of Jews,Gypsies, and Others, Germany 1933-1945, translation by George R. Fraser. Oxford,

Oxford University Press, p. 8.2. Noakes, J. and Pridham, G. (1988). Nazism 1919-1945, Vol. 3 Foreign Policy, War and

Racial Extermination. Exeter: Exeter Studies in History, (13), University of Exeter, p. 998.

3. Lapon, L. (1986). Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany

and the United States. Springfield, MA: Psychiatric Genocide Research Institute.

4. Proctor, R. (1988). Racial Hygiene: Medicine under the Nazis. Cambridge, MA: Harvard

University Press, p. 178.

5. Binding , K. and Hoche, A. (1920). Die Freigabe der Vernichtung lebensumwerten

Lebens. Ihr Mass und ihre Form. Leipzig: Verlag von Felix Meiner, p. 27-28.

6. Ibid, p. 55.7. Noakes and Pridham, p. 1002. 8. Evans, S. (2004). Forgotten Crimes: The Holocaust and People with Disabilities. Chicago:

Ivan R. Dee, p. 21.

9. Proctor, R. (1988). Racial Hygiene. Cambridge, MA: Harvard University Press, p. 185.10. Burleigh, M. (1994). Death and Deliverance. Cambridge, UK: Cambridge University

Press, p. 93.


Carolina Press, p. 39.

12. Burleigh, p. 95.

13. Schmidt, U. (2008). Karl Brandt: The Nazi Doctor. London: Hambledon Continuum, p.

118.


15. Schmidt, p. 119.16. Heberer, P. (2001).Exitus Heute in Hadamar The Hadamar Facility and euthanasia in

Nazi Germany. Dissertation University of Maryland. Ann Arbor: University Microfilms

International, p. 90.

17. Kaul, F. K. (1979). Die Psychiatrie im Strudel der Euthanasie. Kln, Frankfurt am Main:

Europäische Verlagsanstalt.

18. Trial of Hans-Joachim Becker, Landgericht Frankfurt. Urteil gg. Hans-Joachim Becker und

Friedrich Robert Lorent, KS 1/69 (GStA), 27 May, 1970, p. 719. Dokumentationsarchiv

des österreichischen Widerstandes (DÖW, Archives of the Austrian Resistance), Vienna.19. File 461/3206/23 Hessisches Hauptstaatsarchiv, Wiesbaden, Germany.


21. Ibid, p. 99-100.

22. Ibid, p. 101.



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23. Noakes, J. and Pridham, G. (1988). Nazism 1919-1945, Vol. 3 Foreign Policy, War and

Racial Extermination. Exeter: Exeter Studies in History, (13), University of Exeter, p.1007.

24. Sereny, Gitta (1983). Into that Darkness. New York: Vintage Books, p. 55.25. Friedlander, p. 46.

26. Noakes and Pridham, p. 1009.


28. Ibid, p. 104-105.

29. Ibid.

30. Burleigh, p. 43.31. Kaul, F. K. (1979). Die Psychiatrie im Strudel der Euthanasie. Kln, Frankfurt am Main:

Europäische Verlagsanstalt.

32. Bernstein, V. (1945). Nazis kept up euthanasia killings 30 days after we moved in, PM

Daily, Thursday, July 5, 1945. Obtained from newspaper file of the Wiener Library,

London.

33. Trial of Hans-Joachim Becker, p. 721.34. Noakes and Pridham, p. 1009.



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V.THE MEDICALIZATION OF MURDER: THE EUTHANASIA PROGRAMS

Part 2: The T-4 Killing Program


Professor Emerita

Medical University of South Carolina

Charleston, SC 29425

USA

[email protected]

Purpose of the Module: To describe the metastasis of murder from the childrens

euthanasia program to the gassing of adults with disabilities.

Suggested Readings:

1. Burleigh, M. (1994). Death and Deliverance. Cambridge, UK: Cambridge University

Press, p. 11-90, 162-219.


Carolina Press, p. 86-135, 151-245.3. Gallagher, H. (1990). By Trust Betrayed. Arlington, VA: Vandamere Press, p.15-87.

4. Proctor, R. (1988). Racial Hygiene. Cambridge, MA: Harvard University Press, p.177-250. 5. Gabbard, G. (2010). ³Cinematic Perspectives on Euthanasia and Assisted

Suicide´. In Medicine after the Holocaust, edited by Sheldon Rubenfeld, p. 153-161.

Suggested Videos:

1. Science and the Swastika, part 1. Available from www.historychannel.com

2. ³Healing by Killing´, part 1.

Objectives:

1. To analyze the complexity of the killing organization.

2. To appraise the factor of deceit inherent in the killing operation.

3. To discuss the influence of the killing films and propaganda on the population.

Synopsis:

Within a few months of initiating the childrens euthanasia program, a complex

organization was established in Hitlers Chancellery for the killing of institutionalized



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psychiatric patients. Especially vulnerable were patients who were unable to do even small

chores within the institutions. At the facilities, work was regarded as therapy and, in fact,

the institutions had their own gardens to supplement their meager government allowances.

One such facility even raised angora rabbits.1 All patients who could were expected to do

some form of work, even darning socks and mending hospital linens. Patients who were

totally incapable of any work were thought of as useless eaters2 who consumed resources

without contributing to the economy. Thus involuntary sterilization evolved into systematic

killing, indeed murder, which was termed euthanasia.

Hitler did not propose the systematic killing of psychiatric patients during

peacetime because he anticipated the opposition of the German people and the

churches. However, the beginning of World War II was judged to be the optimal time

for initiating euthanasia because the objections of the people would be lessened if many

thousands of German soldiers were being killed in the war. The euthanasia program

would be more palatable if it was conducted under the rationale of saving valuable

resources for the war effort.3 As early as 1935, Hitler had described his plan to initiate

euthanasia in the event of war to the Reich Doctors Leader Dr. Wagner.4

The Killing Films

As one means of producing acceptance of the idea of systematic killing of people

with disabilities, movies were produced from the mid-1930s to the 1940s to promote

the acceptance of euthanasia. Two silent documentaries, Was du ererbt [What You

Inherit] and Erbkrank [The Hereditarily Ill] were produced primarily to be seen by Nazi



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party members and supporters.5 They were among five 16 mm silent films made by the

Racial and Political Office.6

Erbkrank [The Hereditarily Ill] was produced in 1936 and was intended to

criminalize, degrade and dehumanize the mentally and physically handicapped.7 It

was approximately twenty minutes long and featured physicians in white coats behind

nurses who were leading a group of children with severe and obvious disabilities. The

film ended with the caption should it go on like this? No, no, no, never! 8

Among the captions in Erbkrank, were the following inflammatory statements:

Idiots are kept alive through medical science and the sacrifices of the nursing

staff idiots who for the entire duration of their lives cannot be taught to speak

or to make themselves understood.

Feebleminded girl with a mentally ill mother. Grandfather weak nerves, father

mentally ill and a feebleminded brother. Up to now this clan has cost the state

62,300 Reichsmark.

The prevention of hereditarily ill progency is a moral imperative. It signifies

practical love for ones neighbour and the highest respect for the God-given laws

of nature. 9

Was du ererbt [What You Inherit] (date unknown) likewise was made under the

direction of the Racial and Political Office. It too was a silent documentary. Among the

strangest content was an accusation against women who owned dogs. Was du ererbt

accused them of wrongly diverting their procreative instincts toward their pet dogs:

An exaggerated love for an animal is degenerate. It doesnt raise the animal, but

rather degrades the human being. 10



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Other films were commissioned by the government. In some, patients were

depicted in before and after treatment scenarios. Financial and caregiving were

emphasized as burdens.11 One such film was Dasein ohne Leben [Existence without

Life]. This film ended with the portrayal of a knowledgeable professor calling for a

merciful destiny to liberate these pitiful creatures from their existence without life.12

Opfer der Vergangenheit [Victim of the Past,

http://resources.ushmm.org/film/display/detail.php?file_num=3213 ] was made for the

public and was to socialize the people into the acceptance of the killings as

euthanasia. In 1937, it was shown in all 5,300 theaters in Germany.13 The premier of

the film was held in Berlin and was accompanied by a speech by Dr. Gerhard Wagner,

co-founder and head of the National Socialist Medical Association, who had

commissioned the film. The movie featured patients confined to institutions and a

discussion of the cost of keeping them alive.14

Another film, Ich klage an [I accuse, 1941], was seen by over 15 million people

and won a film award at the Venice Biennale.15 It was based on the novel Sendung und

Gewissen [Mission and Conscience] written by Hellmuth Unger. The movie featured a

young woman with multiple sclerosis who pleads for euthanasia which is eventually

implemented by her husband, a physician.16

The director of the Ich klage an, Wolfgang Liebeneiner, stated that Viktor Brack

wanted to use the film to test the publics response to the idea of euthanasia.17 A

Security Service Report from the Reich documented that the film produced great



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interest and that it was favorably received. The security report found that most

Germans approved of the films issues in principle but with some reservations.

However, both Catholic and Protestant churches totally rejected the notion of death by

request. Some Catholic priests tried to stop parishioners from seeing the film.18 The

overall response of physicians was positive, with younger physicians reacting more

favorably than older ones. Five points emerged in evaluating the publics response to

the film:

1. In order to declare a person incurable, it is essential to convene a medical committee in

the presence of the family doctor.

2. There is question about applying euthanasia to all cases of incurable illness becausesome individuals are still able to work.

3. Consent of the person is essential or, in the case of mentally disabled persons, the

consent of relatives must be obtained.

4. Standards must be adhered to in order to prevent abuse. In no case should the decision

be left to one person.

5. Only the physician should be given the right to administer euthanasia.19

Although Ich klage an had the greatest impact, other films were produced on the topic

of euthanasia including Das Erbe [The Legacy, 1935], Life Unworthy Life (1934-1935) and Dasein

ohne Leben [Existence without Life] (1940-1941).20 Dasein ohne Leben [Existence without Life]

included footage of psychiatric patients as documentation of the limits of therapy.

Accompanying remarks included:

How indescribably cruel it is to preserve the mentally dead as living corpses until

old age.21

Devaluing the Different

As appreciation for the genetically-fortunate population grew, disregard for people

with discernable imperfections increased. People institutionalized because of psychiatric



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conditions as well as infants and children with visible conditions became the foci of these

hostile feelings.

A particularly striking example of how psychiatric patients and people with

developmental conditions were singled out for disdain is seen in a high school textbook. In

this book, a mathematics text published in 1935, a problem was presented for students to

calculate: The annual cost of providing psychiatric care to one person.22 For the general

public, there were posters displayed throughout Germany depicting the burden of caring

for people with disabilities. For example, one such poster showed a healthy German man

supporting on his shoulders the weight of handicapped individuals with the saying You are

sharing the load! A genetically ill individual costs approximately 50,000 Reichsmark by the

age of sixty.23

Tours of psychiatric facilities were organized by Nazi officials to further augment the

loathing of those with mental disabilities. In 1934, Eglfing-Haar, a psychiatric hospital close

to Munich, hosted guided excursions into the wards with up to 100 tourists in each

group.24 Between 1933 and 1939, 21,000 people toured Eglfing-Haar, including 6,000

members of the SS. 25

The elderly and people with serious illnesses, too, were considered by some to be

burdens:

It must be made clear to anyone suffering from an incurable disease that the

useless of costly medication drawn from the public store cannot be justified.

And, it made so sense for persons on the threshold of old age to receive services

such as orthopedic therapy or dental bridgework; such services were to bereserved for healthier elements of the population.26



21

The young, the beautiful, and the perfectly healthy were the icons of National

Socialism. Those falling markedly outside of these groups became candidates for

elimination by the Nazis in the years prior to and during World War II.

The War Effort and Elimination of the Unfit

It was intentional that the beginning of the euthanasia program coincided with the

invasion of Poland and the beginning of World War II. The poor economy of Germany plus

the added strain of financing the war greatly affected the funding available to the

psychiatric institutions and hospitals. Food for the patients was becoming scarce and was

needed, according to the government, for individuals who were healthier or who had a

greater chance of recovery. Likewise, hospital space and health care staff became scarce

resources needed for the war wounded.27

Just as the German public was exposed to these attempts at devaluing the ill and

those with handicaps, physicians and nurses too were exposed first, as members of the

public, and second through their professional education. These dual effects led many

numbers to become accomplices in the killing of the vulnerable and many more to be

bystanders; i.e., those who witness but do nothing to intervene.

T-4 : The Adult Euthanasia Program

In the summer of 1939, Hitler issued the order to expand the euthanasia program to

adults with physical and/or mental disorders. Dr. Leonardo Conti, the state secretary

responsible for health matters in the Rich Interior Ministry, Reich Doctors Leader, and head

of the Nazi Partys Department of National Health was instructed to organize the program.28



22

Hearing this, Victor Brack, a department head in the Kanzlei des Führer (KdF) and deputy to

Bouhler, pressed Bouhler to persuade Hitler to let the KdF run the new program. Thus the

responsibility was transferred from Conti to Bouhler and the adult euthanasia program

became the domain of the KdF and the Public Health Section of the Reich Interior

Ministry.29

In August 1939, Hitler gave orders to Bouhler and Brandt to begin the program with

as much secrecy as possible. In the following weeks, many discussions took place among

Drs. Heyde, Nitsche, Heinze, and Linden who were politically loyal physicians who favored

euthanasia. The details of the killing procedures and the designated victims were discussed.

During several meetings, the question of a written law permitting the killings arose.30 Brack

reported that Hitler did not want to proclaim such a law because it could become fodder for

the propaganda of enemies.31

One such discussion took place in October 1939 in Bracks office. There were ten

people present including Brack, his assistant Blankenburg, and Drs. Hefelmann and Linden.

The purpose of the meeting was to get Hitlers written order for the killings. Blankenburg

dictated the agreed upon statement which was typed on the stationery. The document was

then backdated to September 1, 1939 to coincide with the beginning of the war and the



23

invasion of Poland. The typed document was taken by Blankenburg to Hitler who signed it:

Photo from the US Holocaust Memorial Museum, public domain.

Berlin, 1 Sept. 1939

Reichleiter Bouhler and

Dr. med. Brandt

are charged with the responsibility to extend the authorization of certain physicians

designated by name in order that patients who must be considered incurable on the

basis of human judgment may be granted the mercy death after a critical evaluation of their illness.

Adolf Hitler32

This document did not end the discussion over a need for a written law permitting

euthanasia, however. Although Hitler, as the Führer and Reichschanceller, was able to issue

Führer orders or Führermanifest which were similar to laws, these had to conform to

certain procedures. For example, they needed the countersignature of the Special Minister and

had to be announced in the state legal publication. Neither of these conditions was met in the

1939 euthanasia document.33



24

Drs. Hefelmann, Linden, and possibly Heyde continued to draft legislation permitting

euthanasia. Each draft was shown by Bouhler to Hitler and each time he opposed proclaiming a

public law before the end of the war. It was reported that Hitler said My proclamation IS the

law. I am the power of the state whenever Bouhler pushed another draft.34

The Convoluted Organization

Euthanasia was declared by Hitler to be a state secret. Under no circumstances was

the KdF to be identified as the responsible organization. In order to decrease the possibility of

a linkage, a different administrative office was established in Columbushaus, Potsdamer Platz

Iin Berlin. In early 1940, the office was moved to a private villa used solely for the euthanasia

program located at Tiergartenstrasse 4 in Berlin. From this location came the abbreviation T-

4" which was used as the code name for the entire euthanasia program.35



25

Impromptu memorial at the location of T-4. Photo courtesy of Judy Lott.

The central office of T-4 had six different departments under the leadership of Victor

Brack and his assistant Werner Blankenburg.

1. The Medical Department: This department was responsible for all administrative

and medical decisions related to the euthanasia of psychiatric patients. Questionnaires

were mailed and evaluated by this department. The transportation of the doomed

patients was organized.

2. The Bureau Department: This department coordinated all administrative details

related to the killings in the euthanasia institutions and included a courier service.

3. The Main Administrative Offices: This office was responsible for inventory, payroll, real



26

estate and other accounting matters.

4. The Department of Transportation: This department coordinated the transfer of

psychiatric patients to intermediate and euthanasia institutions.

5. The Personnel Department: This department did all hiring and firing of T-4 employees.

It was this department that explained the nature of the work to prospective employees

and swore them to secrecy.

6. The Department of Inspection: This department selected and furnished the euthanasia

institutions. Because suspicion could result from related correspondence, four sub-

departments were established:

A. Reichsworker Community of Mental Institutions (RAG)

This office dealt with transfers of patients and preparations for transports to the

euthanasia institutions.

B. Community Foundation for Care of Institutions

In this office, T-4 acted as employer of non-medical personnel and received

money from the NSDAP.36

C. The Public Transport GmbH (Gekrat)

The manager of this department was Reinhold Verberg who was the

administrator of the Transportation Department. Buses used for the transport of

psychiatric patients to the killing centers were owned and operated by this

department. This department was established to cover up the fact that the buses

were in the service of the KdF.



27

D. Central Accounting for Mental Institutions

Hans-Joachim Becker was the administrator of this office which had the

responsibility of correspondence with other organizations, psychiatric

institutions, and relatives of patients.This intricate organization served as a

cover-up for the activities of T-4.37

T-4 personnel, public domain photo from USHMM.

Targeting the Victims

With the covert and complex organization established, preparation for the killings

began. During October 1939, a proclamation was sent to every psychiatric institution and every

hospital which had psychiatric patients, patients with epilepsy, and patients with

developmental disabilities. This proclamation ordered the completion of questionnaires on all



28

patients and about the running of each institution. The questionnaires were mailed on October

9, 1939.38

There were two questionnaires which were developed by the Minister, Dr. Linden. The

white Meldebogen [questionnaire] I was designed to report all patients in the care of the

institution and the yellow Meldebogen II was designed to oversee the institution for possible

future plans. The type of building, square footage, yearly budget, the number of beds, and the

number of medical personnel were included.39

The Meldebogen I underwent some changes over time. Questions were added

about diagnosis, probability of recovery and discharge, war injuries, and ability to work. 40



29

Image from Trials of War Criminals before the Nuernberg Military Tribunals, vol.

1, October 1946-April 1949, US Government Printing Office, p. 850.

At a meeting held the same day, October 9, 1939, the following calculation of the

number to eventually be killed was presented by Brack:

The number is arrived at through a calculation on the basis of a ratio of

1000:10:5:1. That means out of 1,000 people 10 require psychiatric treatment;



30

of these 5 in residential form. And, of these, one patient will come under the

programme. If one applies this to the population of the Greater German Reich,

then one must reckon with 65,000 to 75,000 cases.43

No all went smoothly in the questionnaire process. A huge number were completed

and returned to T-4. As a result, it became necessary to recruit additional evaluators to work

under the supervision of Drs. Linden, Heyde, and Nitsche. Many questionnaires were

incorrectly completed, often because the physicians of the institutions believed that it was just

another survey. Other physicians were afraid that the purpose was to identify patients who

were capable of work so these physicians often made the patients seem worse on the

questionnaires. Suspicion also arose that there was a plan to kill psychiatric patients. This led

to some physicians refusing to fill out the forms.44

The completed questionnaires were sent to the central office where a card register was

started for each patient. Five copies of the questionnaire were made and three of these were

sent to the evaluators. Two copies were used for the eventual transfer of the patient and the

original was kept in the central office.45

Initially six or seven physicians were used to evaluate the questionnaires. Eventually

this number was increased to 30 to 40 physicians. This List of Evaluators was kept at the

Reichsworker Community of Mental Institutions [RAG], one of the subdepartments of the T-4

Department of Inspection. A copy of every completed questionnaire was sent to three

evaluators, with each evaluator receiving between 100 to 150 questionnaires. The evaluators

indicated their decision by a mark on the left hand corner of the questionnaire: a red + if the

patient was to be killed, a blue if the patient was to live, and a ?, or later a Z, for

undecided. Evaluators were to send these questionnaires back to the T-4 office where the



31

marks were copied onto the original questionnaires. The originals were sent along with the

copies completed by the evaluators to the chief evaluators, Drs. Heyde, Nitsche, and Linden. A

chief evaluator then also rendered a decision: +for death and -for life. Approximately

200,000 questionnaires were processed in this way by August 1941.46

The Methodology of Killing

Now that the issues related to the selection of the victims were resolved, the question

of how to do the actual killings was paramount. Brack discussed the proposed operation with

Arthur Nebe, the head of the Reich Criminal Police Office who, in turn, referred Brack to Dr.

Albert Widmann, the head of the chemical section of the Criminal Technical Institute (KTI).

Nebe informed Widmann that the decision to implement euthanasia had been made and that

KTI was to serve in an advisory role. Nebe quickly washed his hands of responsibility by saying

that the action had been mandated by law. Brack summoned Widmann to T-4 where the

euthanasia program was described and his advice was sought on the operationalization.

Among substances discussed for the killings were morphine, scopolamine, prussic acid, and

carbon monoxide. Being somewhat of an expert in carbon monoxide poisoning, Widmann

recommended it with the idea of pumping it into the patients wards at night.47 However, this

idea became refined with the eventual building of gas chambers at selected psychiatric

hospitals.

Questionnaires with a + as the final verdict were forwarded to Gekrat [The Public

Transport GmbH], a sub-department of the Department of Inspection. This departments

personnel compiled a list of patients to be transported and notified the patients institutions to

prepare the patients for transfer on a specified date. No reasons were provided for the transfer



32

and the director of the institution was warned to not inform the patients relatives of the

impending transfer.48 During the early months of the euthanasia program, the selected

patients were taken by bus, or occasionally by train, directly to a killing center. Beginning in the

fall of 1940, in order to better conceal the operation, patients were first transferred to

intermediate institutions and then, within a few days, to a killing center.49

The Six Killing Centers

In all, there were six institutions that functioned as the killing centers of the

euthanasia program. Four of them operated simultaneously during 1940 and 1941.

Brandenburg

The first killing center to be established was in an abandoned hard labor penitentiary in

the city of Brandenburg on the Havel, an hours train trip from Berlin.50 A gas chamber was

built for the purpose by workers from the SS Central Construction Office. A room 3 meters by

5 meters by 3 meters high had been especially prepared. The room was tiled and had benches

built around the sides. A pipe approximately one inch in diameter and with small holes was

installed around the room about 10 CM above the floor. The tanks of carbon monoxide were

outside the room but already connected to the pipe. There was a peephole in the door. Two

mobile crematoria were made available to burn the corpses. The first gassing took place at the

Brandenburg institution on January 4, 1940.51

Dr. August Becker, a chemist at KTI, described this event:

For this first gassing, about 18-20 people were led into the shower room by the

nursing staff. These men had to undress in an anteroom until they were

completely naked. The doors were shut behind them. These people went quietly

into the room and showed no signs of being upset. Dr. Widmann operated the

gas. I could see through the peephole that after about a minute the people had

collapsed or lay on the benches. There were no scenes and no disorder. After a



33

further five minutes the room was ventilated. Specially assigned SS people

collected the dead on special stretchers and took them to the crematoria. When

I say special stretchers I mean stretchers specially constructed for this purpose.

They could be placed directly on the ovens and the corpses could be pushed intothe oven mechanically by means of a device without the people carrying them

coming into contact with the corpse. These ovens and the stretchers were alsoconstructed in Bracks department...Following this successful test, Brack - who

was naturally also present and whom I forgot to mention - said a few words. He

expressed satisfaction with the test and emphasized once again that this action

must only be carried out by doctors according to the motto syringes are a

matter for doctors. Finally, Dr. Brandt spoke and reiterated that doctors alone

should carry out this gassing. With that, the start in Brandenburg wasconsidered a success...52

By summer of the same year, 1940, problems developed at the Brandenburg center.

The crematorium build to burn the bodies of the patients gassed didnt function properly and

flames often shot from the three smokestacks.53 Additionally, the smoke from the

crematorium filled the nearby town with the very noticeable smell of burning flesh. A

temporary solution consisted of burning the bodies in mobile ovens outside the city but this

was unsuccessful and Brandenburg was shut down as a killing center in September 194054 and

replaced in December 1940 by Bernburg.

Grafeneck

Grafeneck hospital, in addition to Brandenburg, became one of the first of the six killing

centers. Grafeneck was the former castle of the Dukes of Württemberg and had been a

protestant hospital for people with disabilities. The original patients were transferred

elsewhere and Grafeneck was taken over by the state. It was located atop an isolated hill in

Kreis Münsingen.55 After it was remodeled, it functioned as a killing center from January until

December 1940. The killings took place in a converted coach house located behind the

castle.56



34

By fall of 1940, there was widespread knowledge of the killings at Grafeneck and

Himmler advised Viktor Brack to shut down the killings at Grafeneck. Hadamar was its

replacement and the T-4 staff transferred there, taking their killing skills with them.

Hartheim

Photo from the photo archives of the USHMM, public domain.



35

Hartheim was the third center to become operational. Hartheim was a former

renaissance castle of the Prince of Starhemberg in Austria, near Linz,57 and had been a

psychiatric hospital since the late 1800s.58 Gassings began at Hartheim in May 194059 and

continued until December 1944.60 Patients with disabilities from Austria, Germany,

Czechoslovakia, and Yugoslavia were brought to Hartheim to be gassed. Because it was located

near Mauthausen and Dachau concentration camps, prisoners from those camps were sent to

Hartheim for gassing when they became too ill or debilitated to work.61

In November 1940, Franz Stangl, who was to eventually head one of the most notorious

death camps, Treblinka, was recruited to work as a Police Superintendent at Hartheim. He was

summoned to the - headquarters in Berlin where the program was described to him by

Kriminalrath Werner. Werner told him that both Russia and the United States had had for

some time a law permitting the killing of people who were hopelessly insane or monstrously

deformed62 and that this law was about to be passed in Germany and throughout the world.

However, the laws implementation would be done very slowly and with a great deal of

psychological preparation to the protect the sensibilities of the population.63

In the meantime, the difficult task had begun, under the cloak of absolute secrecy. He

explained [Werner] 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 deathrepresented a real release from what, more often than not, was an intolerable life.64

Stangl was assured that he would not be directly involved as the process was carried

out entirely by doctors and nurses and he was to be responsible only for the law and order

aspects which included the responsibility for seeing that the protective regulations regarding

the eligibility of patients would be adhered to, to the letter.65 Stangl was actually given the



36

choice of accepting or declining this new position. The factors that led him to decide in favor

were the fact that he had some disciplinary action pending against him, the statement that

these killings were already being done in Russia and the US, the fact that doctors and nurses

were involved , the careful examination of the patients, and the concerns for the feelings of the

population.66

Hartheim was staffed by two physicians, Drs. Renno and Lohnauer. There were

fourteen nurses, seven males and seven females.67 There were four groups of patients who

were considered exempt from the killings: the senile, veterans, recipients of the

Mutterkreuz, and relatives of T-4 staff.68

Sonnenstein

Sonnenstein was a psychiatric hospital not far from Dresden. Gassings started in

Sonnenstein in June 1940 and continued until spring 1943.69 The Sonnenstein killing center was

unique in that, for the first time, the killing center didnt occupy the entire institution. The

killing operation, including quarters for T-4 staff, was located in three buildings along the

perimenter of the hospital grounds. The other buildings continued to be a part of a working

psychiatric hospital known as Mariaheim.70

Bernburg

Bernburg functioned as a euthanasia institution until spring 1943.71 The institution is

located in the town of Bernburg near Weimar. To this day, it remains an active psychiatric

hospital and an interesting phenomenon is occurring there: A number of elderly residents of

the town of Bernburg who have Alzheimers Disease and other dementias are thrown into panic

states when attempts are made to hospitalize them at the Bernburg hospital. Their long-term



37

memory is preserved and they recall that patients were killed in Bernburg. They are afraid that

they are being led to the same fate!72

Bernburg Hospital. Photo courtesy of Judy Lott.



38

Monument to the victims of the euthanasia at Bernburg Hospital. Photo courtesy

of Judy Lott.



39

Hadamar

Nurses employed at Hadamar during the T-4 action were from two different groups:

those employed by T-4 and those already employed at Hadamar but recruited to the killings by

the Berlin Central organization and by the state of Hessen-Nassau. The T-4 nurses had been

employed at Grafeneck from January until December 1940 and had gained their experience in

the euthanasia program there. The selection of nurses ordered [dienstverpflichtung forced

mobilization for the war effort] to be part of the Stiftung [foundation] was accomplished with

the assistance of certain trustworthy contact persons from several other psychiatric

institutions. After this selection, a personal evaluation of this group of nurses including checks

for political and professional trustworthiness was done by the members of the Chancellery of

the Führer. Descriptions of the interviews do not indicate particular pressure when questioned

if the nurses wanted to partake in the killings. One nurse, Pauline Kneissler, stated

[We were told that] every creature should be allowed a merciful death. This

certainly made sense to me, although on the other hand, I was irritated that it

should be I who was asked to do this. I would have preferred to act as a Red

Cross nurse.I was asked if I wanted to participate. Whoever didnt agree could

back outWe received a few minutes to think about thingsHerr Blankenburg

had left the room during this timeWe didnt discuss the matter further

amongst ourselves. No one said that she couldnt do itWe didnt feel very good

about it, but had no moral reservations.73

Nurses involvement in the early days mainly consisted of accompanying the patients

from the different institutions to the killing center. After the transport buses arrived at

Hadamar and the other killing centers, the nurses helped the patients undress and



40

accompanied them to the office, to be seen by the physician, to be photographed, and then

to the waiting room and the gas chamber.74

Execution of Psychiatric Patients

The murder of the psychiatric patients in the most eastern parts of the German

Reich was not done by gassings in the killing centers. Included in this area were patients

from institutions in Danzig, eastern Prussia, Upper Silesia, and Poland.

The patients were generally taken out of the institution, brought to an

unpopulated area and there shot. All traces of the annihilation were carefully

covered up. At other times the patients were gassed in special motorcars. In

very few cases were they brought to an extermination camp. 75

In a trial being prepared against George Ebrecht in 1962, Kurt Eimann confessed that he

and his [Sturmbann] unit of SS men met several transports of trains bringing mental patients

from several institutions in Pomerania. The patients were taken to a secluded wooded area

between Gotenhaven and Danzig and were shot. Eimann further admitted that a group of

twelve Polish prisoners from Camp Stutthof had to dig the pits for the burial of the psychiatric

and then they, too, were shot. The order to kill the Polish prisoners also was given by

Erbrecht.76

The elderly, too, were murdered. The caregiver Anna Stosik gave the following

description in 1962 in preparation for the trial of Dr. Georg Renno:

I was sent to Tiegenhof [1942 or 1943]. One day in Tiegenhof we admittedseveral older people from an old folks home in Posen. They were not mentally

ill, only old. After two or three weeks, they were picked up by the SS in special

buses that were absolutely airtight. I asked one of the SS men why they were

built that way. He asked why I was interested and I said I was a caregiver and

just interested. He told me to mind my own business and that I had better get



41

out of his sight. I still did not quite know what all this was about but I had a real

bad feeling and from that day I tried to get away from my job as caregiver.

There was another group of patients picked up in these airtight vehicles. Maybe

two more times but I cannot state how many patients and if they were severely

ill or not. I remember that the patients fought and screamed when they were

loaded on these buses.

I remember two older women from the home in Posen who went to a window

saying, Come on, let us see Gods sun one more time before they were loaded

on those buses. Did they know that this was a trip to their death?

For me it was now clear what would happen to those loaded into those buses.

They were scantily dressed and without any provisions or luggage. There wereno seats in the bus, only some straw on the floor. The first patients were bedded

on the straw and the rest were just pushed in, falling or standing.77

Killing of Wounded German Soldiers

Reports began reaching several European and American newspapers as early as October

1941 that severely wounded German soldiers were being murdered by their comrades.

Archduke Robert of Hapsburg reported that

Before launching war against Russia the Germans poisoned all lunatics and

incurables in Austria to clear the hospitals for casualties from the Russian front. I

learn [sic], too that German N.C.O.s cover the battlefront after a days fighting

and shoot those of their own men who are too badly wounded to recover.78

In April 1942, there were reports in both the New York Post and the Evening Standard

about similar actions. On 6 April 1942, the New York Post reported the following:

France has learned, through a grapevine, that the Germans are practicing

euthanasia mercy killing on their own wounded.

Many horrible casualties return from the Russian front, where severe cold hasbeen far more cruel than Stalins armies. The Nazis are afraid to allow these men

to be seen. Frequently, such cases have rotted and gangrenous bodies.

There are two Nazi methods to dispose of them. One is the injection of air into a

vein, sending an instant lethal bubble to the heart. Or a sodium cyanide tablet is

placed on a sleeping patients tongue. He never awakes.



42

Recently, several secret train loads of horrible casualties, many of them marked

for death, entered Lyon.79

The 27 April report that appeared in the Evening Standard describes the experience of a

Swiss physician who had been to the Russian front. Professor André Balser, in a report to the

Swiss government, describes how he was attending to heavily wounded soldiers returning from

the Russian front to Brest-Litovsk on a train. The train was halted in the country-side at the

entrance to a tunnel.

The whole staff, conductors, nurses accompanying soldiers, etc., were

summoned by the train commander, and were told to put on their gas masks

and not to take them off before a special air clear signal would be given.

The whole thing was explained by the commander as an exercise. [When] Balser

asked the commander, What about the wounded?, he was told Dont you

know that they are in gas-proof compartments?

The train stopped in the tunnel for half an hour. Afterwards, Balser entered some of the train

compartments to check on the wounded and found them all to be dead.80

Later in 1942, a newspaper article reported from Stockholm that a German radio

broadcast was aired in an attempt to dispel rumors originating in Germany that the

wounded were quietly killed off by their own doctors. The speaker stated that it was false

that the wounded soldiers being sent home via Norway on the hospital ship Adolf Hitler

were mysteriously being disposed of en route whereas those transported on the hospital

ship Berlin reached Germany. The speaker explained that the soldiers aboard the Adolf

Hitler were seriously wounded and often died and were buried at sea. 81

By the summer of 1941, as knowledge of the gassings at the killing centers was

gradually becoming more widespread among the general population, Bishop Clemens



43

August von Galen delivered several homilies [sermons] about anti-Catholic abuses and the

persecution of clergy in the Münster area by the Gestapo. It was, however, his sermon on

August 3, 1941 that specifically addressed the killings of the handicapped who had been

transferred to their deaths in Hadamar.

As I am reliably informed, lists are being made up in the sanatoria and nursing

homes of Wesphaliaof those patients who, as so-called unproductive citizens, are to

be transferred and thereafter killed. The first such transport left the institution of Marienthal near Münster this past week.

German men and women! Paragraph 211 of the German penal code still has the

force of law [homicide provision]. It states that, An individual who, acting with

premeditation, kills another person shall be punished by death for murder Here we

have our brothers and sisters poor people, sick people unproductive people, if youwill. But have they thereby forfeited their right to live? Have you, have I the right to live

only so long as we are productive, as long as we are recognized to be productive by

others?...When it is once allowed that persons have the right to kill unproductive

individuals, and when it now falls first upon thedefenseless mentally ill, then

fundamentally the murder of all productive persons thus, the incurably ill, the cripples

incapable of work, the invalids of labor and war then the murder of each of us whenwe are old and infirm, and thereby unproductive is assured. 82

There was no immediate retaliation against von Galen; however, 22 other clergy

were sent to Dachau concentration camp for distributing or reading the sermon. Eleven of

these died before the end of the war.83

Von Galens brave condemnation was but one of several factors that halted the

end of T-4. The primary factor was that knowledge of the gassings was becoming

widespread. Even children knew that the special buses with the painted over windows

were taking people to their deaths.84 Mistakes were being made with relative-notification of

the deaths: appendicitis was given as a cause of death although the victim had had an

appendectomy years before; two urns purported to be the ashes of one victim were sent to

the next-of-kin, and similar blunders. But perhaps another important factor was at work:



44

the quota had been met. Seventy thousand psychiatric patients were killed in the T-4

program.85 The T-4 gassings were halted by the end of the summer of 1941 when the

target figure of killing one chronic patient per thousand inhabitants of Germany was

met.86

The halting of the T-4 gassings did not halt the killing of the disabled, however.

Killings now were individualized; e.g., individual patients were selected and killed by

starvation or lethal overdose in a phase known as wild euthanasia.



45

References:

1. Statement of Otto Freund, December 4, 1962, Staatsarchiv München Staw 33.029/3, p.

823-827].

2. Friedlander, H. (1995). The Origins of Nazi Genocide. Chapel Hill: University of NorthCarolina Press, p. 112.3. Trials of War Criminals before the Nuernberg Military Tribunals under Control Council

Law No. 10 (1946-1949) , Vol. 1. Washington, DC: US Government Printing Office, p. 801.

4. Trial of Hans-Joachim Becker, Landgericht Frankfurt. Urteil gg. Hans-Joachim Becker und

Friedrich Robert Lorent, KS 1/69 (GStA), 27 May, 1970, p. 719. Dokumentationsarchiv

des österreichischen Widerstandes (DÖW, Archives of the Austrian Resistance), Vienna.

5. Noakes, J. and Pridham, G. (1988). Nazism 1919-1945, Vol. 3 Foreign Policy, War and

Racial Extermination. Exeter: Exeter Studies in History (13), University of Exeter, p.

1004.

6. Michalczyk, J. (1994) Medicine, Ethics, and the Third Reich. Historical and

Contemporary Issues. Kansas City: Sheed and Ward, 1994, p.65.

7. Burleigh, M. (1994). Death and Deliverance. Cambridge: Cambridge University Press, p.

187.

8. Ibid, p. 183.

9. Ibid, p. 184.

10. Ibid, p. 186-187.

11. Ibid, p. 194.

12. Ibid, p. 196.

13. Ibid, p. 199.

14. Leiser, E. (1974) Nazi Cinema. New York: Collier Books, p. 89.15. Ibid, p. 90.

16. Burleigh, 1994, p. 216.

17. Leiser, p. 90.

18. Leiser, p. 92.

19. Leiser, p. 146.

20. Leiser, p. 148.

21. Amir, M. (1977). Euthanasia in Nazi Germany. Dissertation State University of New York

at Albany. Ann Arbor: University Microfilms International, p. 97.

22. Burleigh, M. (1990). Euthanasia and the Third Reich. History Today, February 1990, p.15-16.

23. Dorner, A. (1935). Mathematik im Dienste der nationalpolitischen Erziehung, cited in

Proctor, 1988, p.183-184.

24. Gross , W. (1935). Drei Jahre rassenpolitische Aufklärungsarbeitcited, Volk and Rasse,

(10), p. 335, cited in Proctor (1988), unnumbered page.



46

25. Heberer, P. (2001).Exitus Heute in Hadamar The Hadamar Facility and euthanasia in

Nazi Germany. Dissertation University of Maryland. Ann Arbor: University Microfilms

International, p. 76.26. Burleigh (1994), p. 43.

27. Proctor, 1988, p. 18328. File 461/3206/23 Hessisches Hauptstaatsarchiv, Wiesbaden, Germany.


30. Ibid.

31. Trial of Hans-Joachim Becker, p. 721.

32. Ibid, p. 722.

33. Ibid.

34. Ibid, p. 723.

35. Ibid, p. 724.

36. Ibid, p. 726.37. Ibid, p. 728.

38. Ibid, p. 729.

39. Ibid, p. 730.

40. Ibid.

41. Ibid, p. 731.

42. Ibid, p. 732-733.

43. Ibid, p. 733.44. Noakes and Pridham, p. 1010.


46. Ibid, p. 735.

47. Ibid. p. 736.

48. Noakes and Pridham, p. 1019.49. Trial of Hans-Joachim Becker, p. 736.

50. Ibid.

51. Heberer, p. 115.

52. Friedlander, p. 87.53. Noakes and Pridham, p. 1020.


55. Ibid, p. 140.





60. Trial of Hans-Joachim Becker, p. 738.61. Heberer, p. 138.

62. Ibid, p. 138.

63. Sereny, Gitta (1983). Into that Darkness. New York: Vintage Books, p. 51.

64. Ibid.

65. Ibid.



47

66. Ibid, p. 52.

67. Ibid, p. 54.

68. Ibid, p. 55.

69. Trial of Hans-Joachim Becker, p. 738.70. Heberer, p. 139.

71. Trial of Hans-Joachim Becker, p. 738.72. Personal conversation between Susan Benedict and Ute Hoffmann, Archivist of

Bernburg, September 1999).

73. Heberer, p. 222-223.

74. Steppe, H. (1991). Nursing in the Third Reich. In History of Nursing Journal, 3(4), p. 29.

75. Statement of George Ebrecht, 1962, Staatsarchiv München, Staw 33.029/8.

76. Ibid.77. Statement of Anna Stosik, November 12, 1962, Staatsarchiv München, Staw 33.029/5.

78. Daily Telegraph, October 8, 1941, file from the newspaper file of the Wiener Library,

London.

79. Henry, V., New York Post, April 6, 1942, file from the newspaper file of the Wiener

Library, London.

80. Evening Standard, April 27, 1942, file from the newspaper file of the Wiener Library,

London.

81. Ibid, July 31, 1942.


83. Ibid. 84. Trials of War Criminals before the Nuernberg Military Tribunals under Control Council

Law No. 10 (1946-1949) , Vol. 1. Washington, DC: US Government Printing Office, p. 58.


86. Burleigh, 1994, p. 180.



48

IV. THE ³MEDICALIZATION OF MURDER´: THE ³EUTHANASIA´PROGRAMS

Part 3: The Wild Euthanasia Program


Professor EmeritaMedical University of South Carolina

Charleston, SC 29425

USA

[email protected]

Purpose of the Module: The purpose of this module is to describe how the killing of

institutionalized patients continued on an individual basis even after the discontinuation

of the gassings of the T-4 euthanasia program.

Suggested Reading:

1. Burleigh, M. (1994). Death and Deliverance. Cambridge, UK: Cambridge

University Press, p. 93-129.

2. Friedlander, H. (1995). The Origins of Nazi Genocide. Chapel Hill: University of

North Carolina Press, p. 39-61.

3. Benedict, S. and Chelouche, T. (2008). Meseritz-Obrawalde: a wild euthanasia

hospital of Nazi Germany. History of Psychiatry, 19(1),68-76.

4. Benedict, S., Caplan, A., and Page, T. (2007). Duty and euthanasia: The nurses

of Meseritz-Obrawalde. Nursing Ethics, 14(6), 782-794..

Objectives:

1. To analyze how the euthanasia program continued in its evolution from the

killing of disabled children to the gassings of adult patients to the individual murder of

institutionalized adults and children.

Synopsis:

The childrens euthanasia program continued unabated until after the end of

World War II 1 although the gassings at the T-4 killings centers ceased in August 1941 for

the reasons described in Part 2 of this module. Yet psychiatric patients continued to be

killed. The killings continued on an individual basis; i.e., institutionalized patients were



49

selected by physicians and nurses to be killed. In fact, more patients were killed in this

decentralized program than had been killed in the T-4 program.2 This decentralized

individualized program was known as wild euthanasia. 3

At some of the T-4 hospitals such as Hadamar, wild euthanasia took the place of

gassings. In addition, killings soon started in many other hospitals in Germany and

Poland. One of the consequences of this was that physicians and nurses who were NOT

recruited by the government to kill, as had been the case of the T-4 personnel, swept

into the action. Employees of these institutions, many of whom had worked in these

facilities for many years, became involved in the murder of their patients.

One of the most notorious wild euthanasia institutions was Meseritz-Obrawalde,

now known as Obrzyce and located in the eastern part of Midzyrzecz, Poland.4 It is still

a working psychiatric hospital with approximately 20 buildings, each largely self-

contained, giving the overall appearance of a college campus.5

Before 1937, Meseritz-Obrawalde belonged to the German state of Prussia and

was a general hospital. In 1938, the general medical units were closed and 900

psychiatric patients remained. By 1940, there were more than 2,000 psychiatric patients

with only three physicians to care for them.6

Wild euthanasia began at Meseritz-Obrawalde at the end of 1942. Not only were

some of their own patients selected to be killed but transports brought more patients

from different institutions to be killed there by the nursing staff.

These patients were unloaded by the nurses and caregivers and were very

emaciated and dirty, in horrible condition. One of the physicians postulated that these



50

conditions enabled the staff to see the patients as less-than-human and to distance

themselves from them, making the killings easier.7

As in the T-4 euthanasia program, patients who were unable to do any form of

work were the most vulnerable. The three physicians made rounds and designated

patients to be killed. These patients were taken individually to a small room on the

designated wards and there they were killed by the nursing staff.8

The killing of patients was usually done with an overdose of Phenobarbital

[Luminal]. If the patient was unable to swallow or was uncooperative, IV injections of

morphine and scopolamine or occasionally just air were given. One nurse describes a

murder of a patient:

In general either the ward caregiver or I would sit the patient up in her bed, put

an arm around her, and talk to her consolingly. So one of us would hold the

patient in an upright position and the other caregiver would hold on to the glass

with the medication Then the patient either was able to swallow the liquid on

her own or it was given to her with a spoon. If the patient was extremely

restless, which also happened quite frequently, then three caregivers were

needed for the procedure.9

In January 1945, the Russian army arrived at Obrawalde. The staff had deserted

the institution, leaving behind 1,000 patients.10 One nurse, Amanda Ratajczak, escaped

but was captured by the Russians. She was made to do a re-enactment of a killing which

was filmed. She admitted to killing over 1500 patients herself, with the most recent on

the preceding day.11 Following a very brief trial, she along with the male caregiver

Hermann Guhlke, was shot on May 10, 1945.12 In 1947, another nurse and a physician

were executed for their roles in the killings.13 And in 1965, 14 nurses were tried for their

participation. The details of these trials are found in Module IX.



51

Although, as Friedlander14asserted, more people were killed in wild euthanasia

than T-4, the exact number is unknown but clearly was in the tens of thousands.15

References:

1. Bernstein, V. (1945). Nazi Kept Up Euthanasia Killings 30 Days After We Moved

In. PM Daily, July 5, 1945, Vol. VI (16). From the Newspaper File of the Wiener Library,

London.

2. Friedlander, H. (1995). The Origins of Nazi Genocide. Chapel Hill: University of

North Carolina Press, p. 151.

3. Ibid, p. 152.

4. Dramowicz, Waldemar (2004). Obrzyce, Midzyrzecz. This is a booklet

published by the institution which gives a history of the hospital. It is in Polish.

5. Personal observations by Susan Benedict.

6. Sagel-Grande, I., Fuchs, H., Rüter, C. (1979). Heil- und Pflegeanstalt Meseritz-

Obrawalde: Justiz und NS-Verbrechen, Vol. XX. Amsterdam: University Press

Amsterdam, p. 700.

7. Statement of Hilde Wernicke, Landesgericht, Berlin, December 7, 1945. Yad

Vashem, Jerusalem, TR10/2584.

8. Statement of Margarete Danielson, Fägelfors, Sweden, 27 January 1961.

Staatsarchiv München, file number 631A/383.

9. Statement of Luise E, Wasserburg, Germany, 19 June 1961. Staatsarchiv

München, file number 33.029/2.

10. deMildt, D. (1996). In the Name of the People: Perpetrators of Genocide in the

Reflection of their Post-War Prosecution in West Germany. The Hague: Martinus

Nijhoff, p. 65.

11. Ibid.

12. Memorial Chamber at Obrzyce, 2005.

13. deMildt, p. 65.

14. Friedlander, p. 151.

15. Gardella, J. (1999). The Cost-Effectiveness of Killing: An Overview of Nazi

Euthanasia. Medical Sentinel, 4(4), p. 134.

Documents

Euthanasia Module Nov 16