Action T4



Action T4 (German: Aktion T4) was a program in Nazi Germany officially between 1939 and 1941, during which the regime of Adolf Hitler systematically killed between 75,000 to 250,000 people with intellectual or physical disabilities. Performed unofficially after 1941, the killing became less systematic. The codename T4 was an abbreviation of “Tiergartenstraße 4”, the address of a villa in the Berlin borough of Tiergarten which was the headquarters of the General Foundation for Welfare and Institutional Care (Gemeinnützige Stiftung für Heil- und Anstaltspflege). This body operated under the direction of Philipp Bouhler, the head of Hitler’s private chancellery, and Dr Karl Brandt, Hitler’s personal physician. This villa no longer exists, but a plaque set in the pavement on Tiergartenstraße marks its location.

The T4 program developed from the Nazi Party’s policy of “racial hygiene,” the belief that the German people needed to be “cleansed” of “racially unsound” elements, which included people with disabilities. The program set important precedents for the later Holocaust of the Jews of Europe: the historian Ian Kershaw has called it “a vital step in the descent into modern barbarism.”

Background
The idea of enforcing “racial hygiene” had been an essential element of Hitler’s ideology from its earliest days. Hitler seems to have had a lifelong horror of mental illness and physical deformity. In his discussions with Bouhler and the head of the Reich Chancellery, Hans Lammers, Hitler referred to people who “perpetually dirtied themselves” and who “put their own excrement in their mouths.” More generally, Hitler frequently used medical metaphors for those he sought to remove from the German “racial community” – he referred to the Jews as a bacillus which must be killed or a cancer which must be excised. Likewise, he saw the disabled as a “diseased element” in the German racial body. In the minds of Hitler and other Nazis, the need to “cleanse” the German race was inseparable from the rest of the Nazi project.

In his book Mein Kampf (1924), Hitler wrote:


 * He who is bodily and mentally not sound and deserving may not perpetuate this misfortune in the bodies of his children. The völkische [racial] state has to perform the most gigantic rearing-task here. One day, however, it will appear as a deed greater than the most victorious wars of our present bourgeois era.

The Nazi regime began to implement racial hygienist policies as soon as it came to power. The July 1933 “Law for the Prevention of Hereditarily Diseased Offspring” prescribed compulsory sterilisation for people with a range of conditions thought to be hereditary such as schizophrenia, epilepsy, Huntington’s chorea and “imbecility”. Sterilisation was also mandated for chronic alcoholism and other forms of social deviance. This law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (Erbgesundheitsgerichten), which examined the inmates of nursing homes, asylums, prisons, aged care homes and special schools to select those to be sterilised.

It is estimated that 360,000 people were sterilised under this law between 1933 and 1939. The law was used punitively in some cases, against women convicted of prostitution, for example (although the regime may have been concerned with eliminating congenital syphilis ). Some people with non-hereditary disabilities were also affected, despite the lack of logic this entailed. There were some suggestions that the program should be extended to people with physical disabilities, but such ideas had to be expressed carefully given that one of the most powerful figures of the regime, Joseph Goebbels, suffered from congenital club foot. Philipp Bouhler himself was very lame as a result of war wounds to his legs. After 1937 the acute shortage of labour in Germany arising from the crash rearmament program meant that anyone capable of work was deemed to be “useful” and was exempted from the law, and the rate of sterilisation declined.

It may be noted that racial hygienist ideas were far from unique to the Nazi movement, although Hitler expressed them in an extreme form. The ideas of social Darwinism were widespread in all western countries in the early 20th century, and the eugenics movement had many followers among educated people, being particularly strong in the United States. The idea of sterilising those carrying hereditary defects or exhibiting what was thought to be hereditary anti-social behaviour was widely accepted, and was put into law in the United States, Sweden, Switzerland and other countries. Between 1935 and 1975, for example, 63,000 people were sterilised on eugenicist grounds in Sweden.

Towards a policy of killing


Hitler had always been in favour of killing those whose lives he judged to be “unworthy of life.” Both his physician, Dr Karl Brandt, and the head of the Reich Chancellery, Hans Lammers, testified after the war that Hitler had told them in 1933, at the time the sterilisation law was passed, that he favoured killing the incurably ill, but recognised that public opinion would not accept this. In 1935 he told the Reich Doctors’ Leader, Dr Gerhard Wagner, that the question could not be taken up in peacetime: “such a problem could be more smoothly and easily carried out in war,” he said. He intended, he wrote, “in the event of a war radically to solve the problem of the mental asylums.”

The outbreak of war thus opened up for Hitler the possibility of carrying out a policy he had long favoured. The war also gave this issue a new urgency in the eyes of the Nazi regime. People with severe disabilities, even when sterilised, still needed institutional care. They occupied places in facilities which would soon be needed for wounded soldiers and people evacuated from bombed cities. They were housed and fed at the expense of the state and took up the time of doctors and nurses. All this the Nazis found barely tolerable even in peacetime, and totally unacceptable in wartime. As a leading Nazi doctor, Dr Hermann Pfannmüller, said: "The idea is unbearable to me that the best, the flower of our youth must lose its life at the front in order that feebleminded and irresponsible asocial elements can have a secure existence in the asylum."

Even before the Nazis came to power, the German eugenics movement had an extreme wing, led by Alfred Hoche and Karl Binding, who as early as 1920 had advocated killing those judged to be “unworthy of life” (lebensunwertes Leben). Germany in the years after World War I was particularly susceptible to ideas of this kind. They interpreted Darwinism to suggest that a nation must promote the propagation of "beneficial" genes and prevent the propagation of "harmful" ones. Lifton notes: "The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration." The state, the eugenicists argued, must intervene to prevent this.

These views had gained ground after 1930, when the Depression caused sharp cuts in funding to state mental hospitals, creating squalor and overcrowding. Most German eugenicists were already strongly nationalist and anti-Semitic, and embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes, and their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and left-wing doctors were soon purged.

During the 1930s the Nazi Party carried out a campaign of propaganda in favour of “euthanasia.” The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), The Victim of the Past (Opfer der Vergangenheit, 1937), which was given a major premiere in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941), which was based on a novel by Dr Helmut Unger, a consultant for the child euthanasia program. Catholic institutions, which could be expected to bitterly resist the killing of their patients, were progressively closed and their inmates transferred to already overcrowded state institutions, where the squalid conditions provided further ammunition for campaigns in favour of euthanasia.

Killing of children
In May 1939, when Hitler had already determined to attack Poland in the summer or autumn of that year, the parents of a severely deformed child born near Leipzig wrote to Hitler seeking his permission for their child to be put to death. Hitler approved this, and authorized the creation of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden), headed by Karl Brandt, his personal physician, and administered by Herbert Linden of the Interior Ministry and an SS officer, Viktor Brack. Brandt and Bouhler were authorized to approve applications to put children in similar circumstances to death.

This precedent was used to establish a program of killing children with severe disabilities from which the guardian consent element soon disappeared. From August the Interior Ministry required doctors and midwives to report all cases of newborns with severe disabilities. Those to be killed were "all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and mongolism (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions." The reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed.

Various methods of deception were used to gain consent – particularly in Catholic areas where parents were generally uncooperative. Parents were told that their children were being sent to “Special Sections” for children where they would receive improved care. The children sent to these centres were kept for "assessment" for a few weeks and then killed by lethal injection, their deaths recorded as "pneumonia". Autopsies were usually performed, and brain samples were taken to be used for medical research. This apparently helped to ease the consciences of many of those involved, since it gave them the feeling that the children had not died in vain and that the whole program had a genuine medical purpose.

Once war broke out in September 1939, the program became less rigorous in its process of assessment and approval. It expanded to include older children and adolescents. The conditions covered also expanded and came to include "various borderline or limited impairments in children of different ages, culminating in the killing of those designated as juvenile delinquents. Jewish children could be placed in the net primarily because they were Jewish; and at one of the institutions, a special department was set up for 'minor Jewish-Aryan half-breeds'". At the same time increased pressure was placed on parents to agree to their children being sent away. Many parents suspected what was really happening, especially when it became apparent that institutions for children with disabilities were being systematically cleared out, and refused consent. They were threatened that they would lose custody of all their children, and if that did not suffice the parents themselves could be threatened with call-up for "labour duty." By 1941 over 5,000 children had been killed.

Killing of adults
Brandt and Bouhler soon developed plans to expand the program to adults. In July 1939, they had held a meeting attended by Dr Leonardo Conti, Reich Health Leader and state secretary for health in the Interior Ministry, and Professor Werner Heyde, head of the SS medical department. This meeting had made preliminary arrangements for a national register of all institutionalised people with mental illnesses or physical disabilities.

The first adults with disabilities to be killed by the Nazi regime were not however Germans but Poles, as the SS men of Einsatzkommando 16 cleared the hospitals and mental asylums of the “Wartheland”, a region of western Poland which was earmarked for incorporation into Germany and resettlement by ethnic Germans following the German conquest of Poland. In the Danzig (now Gdańsk) area, some 7,000 Polish inmates of various institutions were shot, while 10,000 were killed in the Gdynia area. Similar measures were taken in other areas of Poland destined for incorporation into Germany. At Posen (now Poznań), hundreds of patients were killed by means of carbon monoxide gas in an improvised gas chamber developed by Dr Albert Widmann, chief chemist of the German Criminal Police (Kripo). In December 1939, the SS head, Heinrich Himmler, witnessed one of these gassings, ensuring that this invention would later be put to much wider uses.

The idea of killing “useless” mental patients soon spread from occupied Poland to adjoining areas of Germany itself, probably because Nazi Party and SS officers in these areas were most familiar with what was happening in Poland. These were also the areas where Germans wounded from the Polish campaign were expected to be accommodated, creating a demand for hospital space. The Gauleiter of Pomerania, Franz Schwede-Coburg, dispatched 1,400 patients from five Pomeranian hospitals to Poland, where they were shot. The Gauleiter of East Prussia, Erich Koch, likewise had 1,600 patients killed. In all, more than 8,000 Germans were killed in this initial wave of killings. These were carried out on the initiative of local officials, although Himmler certainly knew and approved of them.

The program for killing adults with mental or physical disabilities began with a letter from Hitler issued in October 1939. The decree charged Bouhler and Brack with “enlarging the authority of certain physicians, to be designated by name, in such a manner that persons who, according to human judgement, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.”. The letter was backdated to 1 September to provide “legality” to the killings already carried out, and to link the program more definitely to the war, giving it a rationale of wartime necessity. It is important to note that this letter, which provided the sole legal basis for the program, was not a formal "Führer decree", which in Nazi Germany had the force of law. For this reason Hitler deliberately bypassed Health Minister Conti and his department, who were held to be not sufficiently imbued with National Socialist ruthlessness and who might have raised awkward questions about the legality of the program, and entrusted it to his personal agents Bouhler and Brandt.

The program was administered by Brack’s staff from Tiergartenstraße 4, under the guise of the General Foundation for Welfare and Institutional Care, supervised by Bouhler and Brandt. Others closely involved included Dr Herbert Linden, who had been heavily involved in the children's program, and Dr Ernst-Robert Grawitz, chief physician of the SS. These officials chose the doctors who were to carry out the "operational" part of the program. They were chosen for their political reliability, professional reputation, and known sympathy for radical eugenics. They included several who had proved their worth in the child-killing program, such as Unger, Heinze, and Hermann Pfannmüller. The new recruits were mostly psychiatrists, notably Professor Carl Schneider of Heidelberg, Professor Max de Crinis of Berlin and Professor Paul Nitsche from the Sonnenstein state institution. Heyde became the operational leader of the program, succeded later by Nitsche.

In early October all hospitals, nursing homes, old-age homes, sanatoria were required to report all patients who had been institutionalised for five years or more, who had been committed as “criminally insane”, who were of “non-Aryan race”, or who had been diagnosed with any of a list of specified conditions. These included schizophrenia, epilepsy, Huntington’s chorea, advanced syphilis, senile dementia, paralysis, encephalitis and “terminal neurological conditions generally”. Many doctors and administrators assumed that the purpose of the reports was to identify inmates who were capable of being drafted for "labour service". They therefore tended to overstate the degree of incapacity of their patients, to protect them from labour conscription - with fatal consequences. When some institutions, mainly in Catholic areas, refused to co-operate, teams of T4 doctors (or in some cases Nazi medical students) visited them and compiled their own lists, sometimes in a very haphazard and ideologically motived way. At the same time, all Jewish patients were removed from institutions and were killed during 1940.

As with the child inmates, the adults had their cases assessed by a panel of "experts," working at the Tiergartenstraße offices. The experts were required to make their judgments solely on the basis of the reports, rather than on detailed medical histories, let alone examinations. Sometimes they dealt with hundreds of reports at a time. On each they marked a + (meaning death), a - (meaning life), or occasionally a ? meaning that they were unable to decide. Three "death" verdicts condemned the person concerned. As with the children, over time these processes became less rigorous, the range of conditions considered unsustainable grew broader, and zealous Nazis further down the chain of command increasingly made decisions on their own initiative.

At first patients were killed by lethal injection, the method established for killing children, but the slowness and inefficiency of this method for killing adults, who needed larger doses of increasingly scarce and expensive drugs and who were more likely to need restraint, was soon apparent. Hitler himself recommended to Brandt that carbon monoxide gas be used. At his trial, Brandt described this as a "major advance in medical history". The first gassings took place at Brandenburg an der Havel in January 1940, under the supervision of Widmann and Christian Wirth, a Kripo (criminal police) officer who was later to play a prominent role in the “final solution” extermination of the Jews. Once the efficacy of this method was established, it became standardised and was instituted at a number of centres across Germany. As well as Brandenburg, these included Grafeneck in Baden-Württemberg, Schloss Hartheim near Linz in Austria, Sonnenstein in Saxony, Bernburg in Saxony-Anhalt and Hadamar in Hesse. As well as killing patients from mental homes, nursing homes and sanatoria, these centres were also used to kill prisoners transferred from concentration camps in Germany and Austria.

Patients were transferred from their institutions to the killing centres in buses operated by teams of SS men wearing white coats to give an air of medical authenticity. To prevent the families and the doctors of the patients tracing them, they were often sent to "transit" centres in major hospitals where they were allegedly "assessed" before being moved again to "special treatment" centres. (The expression "special treatment" (Sonderbehandlung) was later widely employed as a euphemism for killing during the extermination of the Jews.) Families were sent letters explaining that owing to wartime regulations it would not be possible to visit relatives in these centres. In fact most of these patients were killed within 24 hours of arriving at the centres, and their bodies cremated. For every person killed, a death certificate was prepared, giving a false but plausible cause of death, and sent to the family along with an urn of ashes (random ashes, since the victims were cremated en masse). The preparation of thousands of falsified death certificates in fact took up most of the working day of the doctors who operated the centres.

During 1940, the centres at Brandenburg, Grafeneck and Hartheim killed nearly 10,000 people each, while another 6,000 were killed at Sonnenstein. In all about 35,000 people were killed in T4 operations that year. Operations at Brandenburg and Grafeneck were wound up at the end of the year, partly because the areas they served had been “cleared” and partly because of public opposition. In 1941, however, the centres at Bernberg and Sonnenstein increased their operations, while Hartheim (where Wirth and Franz Stangl were successively commandants) continued as before. As a result, another 35,000 people were killed before August 1941, when the T4 program was shut down. Even after that date, however, the centres continued to be used to kill concentration camp inmates: eventually some 20,000 people in this category were killed.

In 1971 the Hungarian-born journalist Gitta Sereny conducted a series of interviews with Franz Stangl, who was in prison in Düsseldorf after having been convicted of co-responsibility for killing 900,000 people as commandant of the Sobibór and Treblinka extermination camps in Poland. Stangl gave Sereny a detailed account of the operations of the T4 program based on his time as commandant of the killing facility at the Hartheim “institute.” He described how the inmates of various asylums were removed and transported by bus to Hartheim. Some were in no mental state to know what was happening to them, but many were perfectly sane and for them various forms of deception were used. They were told they were at a special clinic where they would receive improved treatment, and were given a brief medical examination on arrival. They were then induced to enter what appeared to be a shower block, where they were gassed with carbon monoxide (this ruse was later used on a much larger scale at the extermination camps).

Opposition
Hitler and his colleagues were aware from the start that a program of killing large numbers of Germans with disabilities would be unpopular with the German public. Although Hitler had a fixed policy of not issuing written instructions for policies relating to what would later be classed as crimes against humanity, he made an exception when he provided Bouhler and Brack with written authority for the T4 program in his confidential October 1939 letter. This was apparently to overcome opposition within the German state bureaucracy – the Justice Minister, Franz Gürtner, needed to be shown Hitler’s letter in August 1940 to gain his co-operation.

Hitler told Bouhler at the outset that “the Führer’s Chancellery must under no circumstances be seen to be active in this matter.” There was a particular need for caution in Catholic areas, which after the annexations of Austria and the Sudetenland in 1938 included nearly half the population of Greater Germany, and where public opinion could be expected to be hostile. In March 1940 a confidential report from the SD in Austria warned that the killing program must be implemented with stealth “in order to avoid a probable backlash of public opinion during the war.”

Opposition persisted within the bureaucracy. A district judge, Lothar Kreyssig, wrote to Gürtner protesting (correctly) that the T4 program was illegal (since no law or formal decree from Hitler had authorised it); Gürtner replied, “If you cannot recognise the will of the Führer as a source of law, then you cannot remain a judge,” and had Kreyssig dismissed.

The Catholic Church had agreed to withdraw from all political activity in the Concordat of 1933 between Germany and the Holy See, but the prospect of state-sanctioned mass killing of German citizens had naturally not occurred to the Church in 1933, and such a challenge to fundamental Catholic belief in the sanctity of human life posed a serious dilemma for German Catholics. In 1935 the Church had protested in a private memorandum against proposals to pass a law legalising euthanasia (in the true sense of the word): this was one reason the law was not proceeded with.

In January 1939, however, Brack commissioned a paper from Dr Joseph Mayer, Professor of Moral Theology at the University of Paderborn, on the likely reactions of the churches in the event of a state euthanasia program being instituted. Mayer – a longstanding euthanasia advocate – reported that the churches would not oppose such a program if it was seen to be in the national interest. Brack showed this paper to Hitler in July, and it may have increased his confidence that a “euthanasia” program would be acceptable to German public opinion. (When Gitta Sereny interviewed Mayer shortly before his death in 1967, he denied that he had approved of killing people with disabilities, but since no copies of this paper are known to survive, this cannot be determined.) This turned out not to be the case. In fact the T4 program was the sole example of an action by the Nazi regime which provoked large-scale public protests.

It was impossible to keep the T4 program secret, given that thousands of doctors, nurses and administrators were involved in it, and given that the majority of those killed had families who were actively concerned about their welfare. Despite the strictest orders to maintain secrecy, some of the staff at the killing centres talked - sometimes when drunk in bars - about what went on there. In some cases families could tell that the causes of death notified were false, as when a patient was said to have died of appendicitis when he had no appendix. In other cases several families in the same town would receive death certificates on the same day. In the towns where the killing centres were located, many people saw the inmates arrive in buses, saw the smoke from the crematoria chimneys, and drew the correct conclusion. In Hadamar ashes containing human hair rained down on the town. In May 1941 the Frankfurt County Court wrote to Gürtner describing scenes in Hadamar where children shouted in the streets that people were being taken away in buses to be gassed.

During 1940 rumours of what was taking place spread, and many Germans withdrew their relatives from asylums and sanatoria to care for them at home – often with great expense and difficulty. In some places doctors and psychiatrists co-operated with families to have patients discharged, or, if the families could afford it, had them transferred to private clinics where the reach of T4 did not extend. (The class aspect of T4 should be noted: it was mainly working-class families whose relatives were in state institutions. Wealthy families could protect their disabled relatives by keeping them at home or in private clinics.) Other doctors agreed to "re-diagnose" some patients so that they no longer met the T4 criteria, although this ran the risk of exposure when the Nazi zealots from Berlin conducted inspections. In Kiel, Professor Hans Gerhard Creutzfeldt managed to save nearly all of his patients. For the most part, however, doctors co-operated with the program, either out of ignorance as to its true nature or out of agreement with Nazi eugenicist policies.

During 1940 protest letters began to arrive at the Reich Chancellery and the Ministry of Justice, some of them from Nazi Party members. The first open protest against the removal of people from asylums took place at Absberg in Franconia in February 1941, and others followed. The SD report on the incident at Absberg noted that "the removal of residents from the Ottilien Home has caused a great deal of unpleasantness," and described large crowds of Catholic townspeople, among them Party members, protesting at the removal. Opposition to the T4 policy sharpened after the German attack on the Soviet Union in June 1941, because the war in the east produced for the first time large-scale German casualties, and the hospitals and asylums began to fill up with maimed and disabled young German soldiers. Rumours began to circulate that these men would also be subject to “euthanasia,” although in fact no such plans existed.

During 1940 and 1941 some Protestant churchmen protested privately against T4, but none made any public comment. Theophil Wurm, the Lutheran Bishop of Württemberg, wrote a strong letter to Interior Minister Frick in March 1940. Others who privately protested were the Lutheran theologian Friedrich von Bodelschwingh, who was director of the Bethel Institution for epileptics at Bielefeld, and Pastor Paul-Gerhard Braune, director of the Hoffnungstal Institution in Berlin. Both used their connections with the regime to negotiate exemptions for their institutions: Bodelschwingh negotiated directly with Brandt and indirectly with Hermann Göring, whose cousin was a prominent psychiatrist. Braune had meetings with Justice Minister Gürtner, who was always dubious about the legality of the program, and later wrote a strongly worded letter to Hitler protesting against it: Hitler did not read it, but was told about it by Lammers. In general, however, the Protestant church was deeply enmeshed with the Nazi regime and was unwilling to criticise its actions.

The Catholic Church, which since 1933 had pursued a policy of avoiding confrontation with the Nazi regime in the hope of preserving its core institutions intact, became increasingly unable to keep silent in the face of mounting evidence about the killing of inmates of hospitals and asylums. Leading Catholic churchmen, led by Michael Cardinal von Faulhaber of Munich, wrote privately to the government protesting against the policy. In July 1941 the Church broke its silence when a pastoral letter from the bishops was read out in all churches, declaring that it was wrong to kill (except in self-defence or in a morally justified war). This emboldened Catholics to make more outspoken protests.

A few weeks after the pastoral letter was read out, the Catholic Bishop of Münster in Westphalia, Clemens August Graf von Galen, publicly denounced the T4 program in a sermon, and telegrammed his text to Hitler, calling on “the Führer to defend the people against the Gestapo.” "It is a terrible, unjust and catastrophic thing when man opposes his will to the will of God," Galen said. "We are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live?" Robert Lifton says of this sermon: "This powerful, populist sermon was immediately reproduced and distributed throughout Germany - indeed, it was dropped among German troops by British Royal Air Force flyers. Galen’s sermon probably had a greater impact than any other one statement in consolidating anti-“euthanasia” sentiment." Another Bishop, Franz Bornewasser of Trier, also sent protests to Hitler, though not in public. In August Galen was even more outspoken, broadening his attack to include the Nazi persecution of religious orders and the closing of Catholic institutions. He attributed the heavy allied bombing of Westphalian towns to the wrath of God against Germany for breaking His laws. Galen’s sermons were of course not reported in the German press, but they were widely circulated in the form of illegally printed leaflets. Local Nazis asked for Galen to be arrested, but Goebbels told Hitler that if this happened there would be an open revolt in Westphalia.

By August the protests had spread to Bavaria. According to Gitta Sereny, Hitler himself was jeered by an angry crowd at Hof – the only time he was opposed to his face in public during his 12 years of rule. Despite his private fury, Hitler knew that he could not afford a confrontation with the Church at a time when Germany was engaged in a life-and-death two-front war, a belief which was reinforced by the advice of Goebbels, Martin Bormann, head of the Party Chancellery, and Heinrich Himmler, head of the SS. Robert Lifton writes: "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." Himmler said: "If operation T4 had been entrusted to the SS, things would have happened differently,” because “when the Führer entrusts us with a job, we know how to deal with it correctly, without causing useless uproar among the people.”

On 24 August 1941 Hitler ordered the cancellation of the T4 program, and also issued strict instructions to the Gauleiters that there were to be no further provocations of the churches for the duration of the war. The invasion of the Soviet Union in June had opened up new opportunities for the T4 personnel, who were soon transferred to the east to begin work on a vastly greater program of killing: the “final solution of the Jewish question.” But the winding up of the T4 program did not in fact bring the killing of people with disabilities to an end, although from the end of 1941 the killing became less systematic. Lifton documents that the killing of both adults and children continued to the end of the war, on the local initiative of institute directors and party leaders. The methods reverted to those employed before the gas chambers were employed: lethal injection, or simple starvation. Kershaw estimates that by the end of 1941 75,000 to 100,000 people had been killed as a result of the program, but that further tens of thousands of concentration camp inmates, and people judged incapable of work, were killed in Germany between 1942 and 1945 (this figure does not include the Jews who were deported to their deaths in 1942 and 1943). Hartheim, for example, continued to kill people sent to it from all over Germany until 1945.

Postwar events
In December 1946, an American military tribunal (commonly called the Doctors Trial) tried 23 doctors and administrators for their roles in war crimes and crimes against humanity. These crimes included the systematic killing of those deemed "unworthy of life," including the mentally retarded, the institutionalized mentally ill, and the physically impaired. After 140 days of proceedings, including the testimony of 85 witnesses and the submission of 1,500 documents, in August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death and executed on 2 June 1948. They included Dr Karl Brandt and Viktor Brack.

The indictment read in part:


 * 14. Between September 1939 and April 1945 the defendants Karl Brandt, Blome, Brack, and Hoven unlawfully, willfully, and knowingly committed crimes against humanity, as defined by Article II of Control Council Law No. 10, in that they were principals in, accessories to, ordered, abetted, took a consenting part in, and were connected with plans and enterprises involving the execution of the so called "euthanasia" program of the German Reich, in the course of which the defendants herein murdered hundreds of thousands of human beings, including German civilians, as well as civilians of other nations. The particulars concerning such murders are set forth in paragraph 9 of count two of this indictment and are incorporated herein by reference.

Also in 1945, seven staff members of the Hadamar institute were tried for the killing of Soviet and Polish nationals, but not for the large-scale killing of German nationals at the institute. Alfons Klein, Karl Ruoff and Wilhelm Willig were sentenced to death and executed, the other four were given long prison sentences.

Philipp Bouhler and Leonardo Conti killed themselves in captivity in May 1945, while Dr Ernst-Robert Grawitz killed himself shortly before the fall of Berlin. Dr Friedrich Menneke died in 1947 while awaiting trial. Paul Nitsche was tried and executed by an East German court in 1948. Werner Heyde, after having escaped detection for 18 years, killed himself in 1964 before being brought to trial. Dr Heinrich Gross escaped justice.

T4 and euthanasia
The program is commonly described as one of “euthanasia,” and this expression was used at the time by some of the officials responsible for carrying the program out, but it had little in common with euthanasia as this term is usually defined. It was not motivated by concern for the welfare of the people concerned or by a desire to release them from suffering – most of those killed were not suffering. It was carried out primarily according to the dictates of “racial hygiene” ideology, and secondarily to reduce the cost to the state of maintaining people with disabilities at a time when the overwhelming financial priority of the regime was rearmament. It was nearly always carried out without the consent of the people concerned or their families.

Professor Robert Lifton, author of The Nazi Doctors and a leading authority on the T4 program, makes clear the difference between this program and genuine euthanasia. He explains that the Nazi version of "euthanasia" was based on the work of Adolf Jost, who published The Right to Death (Das Recht auf den Tod) in 1895. Lifton writes: "Jost argued that control over the death of the individual must ultimately belong to the social organism, the state. This is in direct opposition to the Anglo-American concept of euthanasia, which emphasizes the individual’s “right to die” or “right to death” or “right to his or her own death,” as the ultimate human claim. In contrast, Jost was pointing to the state’s right to kill."

Dr Stuart Stein of the University of the West of England writes:

The consistent use of the term "euthanasia" in this context is somewhat misleading. The Chambers Dictionary includes in its definitions "the act or practice of putting painlessly to death, esp in cases of incurable suffering." The Shorter Oxford Dictionary refers to "a quiet and easy death," and the "action of inducing" the same. However, the "incurable suffering" that the underlying ideology that rationalized the killings referred to was not that of the patient-victims, but that of the policy originators, their willing bureaucratic assistants, and those who directly handled the victims... Their demise was not painless, quiet or easy. Many were not suffering from any mental or physical dysfunction aside from the physical consequences arising from having fallen into Nazi hands... The dying rituals and procedures applied under the auspices of this "programme" were invariably identical to those that obtained in the extermination camps. The underlying objective was the same - the eradication of unwanted segments of the populace. In both instances no term other than murder is congruent with the circumstances.