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NAZI PERSECUTION OF THE DISABLED

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MURDER OF “THE UNFIT”

The Nazi persecution of persons with disabilities in Germany was one component of radical public health policies aimed at excluding hereditarily “unfit” Germans from the national community. These strategies began with forced sterilization and escalated toward mass murder. The most extreme measure, the Euthanasia Program, was in itself a rehearsal for Nazi Germany’s broader genocidal policies.

The ideological justification conceived by medical perpetrators for the destruction of the “unfit” was also applied to other categories of “biological enemies,” most notably to Jews and Roma (Gypsies). Compulsory sterilization and “euthanasia,” like the “Final Solution,” were components of a biomedical vision which imagined a racially and genetically pure and productive society, and embraced unthinkable strategies to eliminate those who did not fit within that vision.

Throughout this Special Focus page and its related links, you will see translations of terms used during the Nazi regime; please note that although many of these terms are unacceptable or offensive today, they are included here as examples of Nazi terminology and the propaganda campaign used to justify mass murder.


AN OPEN SECRET

On July 14, 1933, the German government instituted the “Law for the Prevention of Progeny with Hereditary Diseases.” This law called for the sterilization of all persons who suffered from diseases considered hereditary, including mental illness, learning disabilities, physical deformity, epilepsy, blindness, deafness, and severe alcoholism. With the law’s passage the Third Reich also stepped up its propaganda against the disabled, regularly labeling them “life unworthy of life” or “useless eaters” and highlighting their burden upon society.

The term “euthanasia” (literally, “good death”) usually refers to the inducement of a painless death for a chronically or terminally ill individual. In Nazi usage, however, “euthanasia” referred to the systematic killing of the institutionalized mentally and physically disabled. The secret operation was code-named T4, in reference to the street address (Tiergartenstrasse 4) of the program's coordinating office in Berlin.

Ashes from cremated victims were taken from a common pile and placed in urns without regard for accurate labeling. One urn was sent to each victim's family, along with a death certificate listing a fictive cause and date of death. The sudden death of thousands of institutionalized people, whose death certificates listed strangely similar causes and places of death, raised suspicions. Eventually, the Euthanasia Program became an open secret.

On August 18, 1939, the Reich Ministry of the Interior circulated a decree compelling all physicians, nurses, and midwives to report newborn infants and children under the age of three who showed signs of severe mental or physical disability. At first only infants and toddlers were incorporated in the effort, but eventually juveniles up to 17 years of age were also killed. Conservative estimates suggest that at least 5,000 physically and mentally disabled children were murdered through starvation or lethal overdose of medication.

 

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MOSAIC OF VICTIMS

SOVIET PRISONERS

Although the Jews were their primary targets, the Nazis and their collaborators also persecuted other groups for racial or ideological reasons. Among the earliest victims of Nazi discrimination in Germany werepolitical opponents -- primarily Communists, Socialists, Social Democrats, and trade union leaders. In 1933, the SS established the first concentration camp, Dachau, as a detention center for thousands of German political prisoners. The Nazis also persecuted authors and artists whose works they considered subversive or who were Jewish, subjecting them to arrest, economic restrictions, and other forms of discrimination.

The Nazis targeted Roma (Gypsies) on racial grounds. The legal interpretations of the 1935 Nuremberg Laws (German laws which defined Jews by blood according to racist theories) were later adapted to include Roma. The Nazis termed Roma "work-shy" and "asocial"—in the Nazi framework, unproductive and socially unfit. Roma deported to the Lodz ghetto were among the first to be killed in mobile gas vans at the Chelmnoextermination camp in Poland. The Nazis also deported more than 20,000 Roma to the Auschwitz-Birkenau camp, where most of them were murdered in the gas chambers.

The Nazis viewed Poles and other Slavic peoples as inferior, and slated them for subjugation, forced labor, and eventual annihilation. Poles who were considered ideologically dangerous (including thousands of intellectuals and Catholic priests) were targeted for execution in an operation known as AB-Aktion. Between 1939 and 1945, at least 1.5 million Polish citizens were deported to German territory for forced labor. Hundreds of thousands were also imprisoned in Naziconcentration camps. It is estimated that the Germans killed at least 1.9 million non-Jewish Polish civilians during World War II.

In the German-occupied Soviet Union, the Commissar Order(issued to the Germany army by the Armed Forces High Command) targeted Red Army political officers to be murdered. During the autumn and winter of 1941-1942, German military authorities and the German Security Police collaborated on a racist policy of mass murder of Soviet prisoners of war: Jews, persons with "Asiatic features," and top political and military leaders were selected out and shot. Around three million others were held in makeshift camps without proper shelter, food, or medicine with the deliberate intent that they die.

The Nazis incarcerated Christian church leaders who opposed Nazism, as well as thousands of Jehovah's Witnesses who refused to salute Adolf Hitler or to serve in the German army. Through the so-called “Euthanasia Program,” the Nazis murdered an estimated 200,000 individuals with mental or physical disabilities. The Nazis also persecuted malehomosexuals, whose behavior they considered a hindrance to the preservation of the German nation. The Nazis imprisoned those they termed "chronic" homosexuals in concentration camps, as well as thousands of other individuals accused of so-called "asocial" or criminal behavior.

Nazi ideology identified a multitude of enemies and led to the systematic persecution and murder of many millions of people, both Jews and non-Jews.

 

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NAZI PERSECUTION OF HOMOSEXUALS

 

After taking power in 1933, the Nazis persecuted homosexuals as part of their so-called moral crusade to racially and culturally purify Germany. This persecution ranged from dissolution of homosexual organizations to internment of thousands of individuals in concentration camps. Gay men, in particular, were subject to harassment, arrest, incarceration, and even castration. In Nazi eyes, gay men were weak and unfit to be soldiers, as well as unlikely to have children and thereby contribute to the racial struggle for Aryan dominance. Follow the links on this special focus page to learn more about the Nazi campaign against homosexuals in Germany.

Friedrich-Paul von Groszheim
Born Luebeck, Germany April 27, 1906

Friedrich-Paul was born in the old trading city of Luebeck in northern Germany. He was 11 when his father was killed in World War I. After his mother died, he and his sister Ina were raised by two elderly aunts. After graduating from school, Friedrich-Paul trained to be a merchant.

1933-39: In January 1937 the SS arrested 230 men in Luebeck under the Nazi-revised criminal code's paragraph 175, which outlawed homosexuality, and I was imprisoned for 10 months. The Nazis had been using paragraph 175 as grounds for making mass arrests of homosexuals. In 1938 I was re-arrested, humiliated, and tortured. The Nazis finally released me, but only on the condition that I agree to be castrated. I submitted to the operation.

1940-44: Because of the nature of my operation, I was rejected as "physically unfit" when I came up for military service in 1940. In 1943 I was arrested again, this time for being a monarchist, a supporter of the former Kaiser Wilhelm II. The Nazis imprisoned me as a political prisoner in an annex of the Neuengamme concentration camp at Luebeck.

After the war, Friedrich-Paul settled in Hamburg.
More Personal Stories »



Richard Grune, “Solidarity.” Etching from the file “Passion des XX. Jahrhunderts” [Passion of the 20th Century], 1947.

Grune was arrested under Paragraph 175; he was sent to the Sachsenhausen camp in October 1937 and to the Flossenbuerg camp in April 1940.

DID YOU KNOW...

  • Under Paragraph 175 of the criminal code, male homosexuality was illegal in Germany. The Nazis arrested an estimated 100,000 homosexual men, 50,000 of whom were imprisoned.
  • During the Nazi regime, the police had the power to jail indefinitely—without trial—anyone they chose, including those deemed dangerous to Germany’s moral fiber.
  • Between 5,000 and 15,000 gay men were interned in concentration camps in Nazi Germany. These prisoners were marked by pink triangle badges and, according to many survivor accounts, were among the most abused groups in the camps.
  • Nazis interested in finding a “cure” for homosexuality conducted medical experiments on some gay concentration camp inmates. These experiments caused illness, mutilation, and even death, and yielded no scientific knowledge.
  • http://www.ushmm.org/museum/exhibit/focus/homosexuals/

 

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MOSAIC OF VICTIMS: IN DEPTH

Jews were one of four groups racially targeted for persecution in Nazi Germany and in German-controlled Europe. The Nazi regime also persecuted and killed members of other groups.

Among the earliest victims of discrimination and persecution in Nazi Germany were political opponents -- primarily Communists, Socialists, Social Democrats, and trade union leaders. The Nazis also persecuted authors and artists whose works they considered subversive or who were Jewish. In 1933-1934, the German central government and various local governments as well as local battalions of the Nazi SA (Sturmabteilungen; Assault Detachments) and SS (Schutzstaffel; Protection Squads) established concentration camps throughout Germany to detain political prisoners. The SS, which centralized and took control of the concentration camp system in 1934, had established its first concentration camp, Dachau, in March 1933.

RACIALLY TARGETED GROUPS 
 
While Nazi ideology targeted Jews as the primary enemy of Germany, the Nazis also targeted Roma (Gypsies) on racial grounds. The 1935 Nuremberg Laws (which defined Jews by blood) were later applied to Roma. Drawing on traditional prejudices in German society, the Nazis termed Roma as prone by race to be "work-shy" and "asocial" with an inherited inclination to engage in petty crime. Among the first killed in the mobile gas vans at the Chelmno killing center in German-occupied Poland in early 1942 were Roma deported from the Greater German Reich to the Lodz ghetto. SS and police authorities deported more than 20,000 Roma to the Auschwitz-Birkenau camp, where the camp authorities killed almost all of them in the gas chambers.

In the German-occupied parts of the Soviet Union, German military and SS-police officials shot tens of thousands of local Roma, often on trumped-up justification that the Roma were engaged in espionage for the Soviet authorities. Two of Nazi Germany's Axis partners also engaged in the mass murder of Roma. The authorities of the so-called Independent State of Croatia killed approximately 25,000 Roma, many of them at theJasenovac concentration camp complex. In Romania, the government of General Ion Antonescu killed between 13,000 and 36,000 Roma, both in Romania proper and in Transnistria.

The Nazis viewed Poles and the Slavic and so-called Asiatic peoples of the Soviet Union as racially inferior, and slated them for subjugation and forced labor. They implemented a policy of physical annihilation of the political, intellectual, and cultural elites of Poland and the Soviet Union. German occupation authorities murdered tens of thousands of members of the Polish elite classes (including intellectuals and Catholic priests) in an operation known as Ausserordentliche Befriedungsaktion (AB-Extraordinary Pacification Action). The Commissar Order, issued to German military commanders on June 6, 1941, called for shooting captured political commissars serving in the Red Army. German SS and police units received instructions to kill high-ranking and mid-level officials of the Soviet state and the Soviet Communist Party.

During the autumn and winter of 1941-1942, German military authorities and the German Security Police collaborated on a racist policy of mass murder of Soviet prisoners of war: Jews, persons with “Asiatic features,” and top political and military leaders were selected out and shot. Around three million others were held in makeshift camps without proper shelter, food, or medicine with the deliberate intent that they die. Approximately two million Soviet soldiers died as a result of this criminal neglect in the winter of 1941-1942. Even after the Germans decided to permit the remaining Soviet soldiers to survive so that their labor could be exploited, Soviet soldiers were generally incarcerated under harsher conditions -- often in concentration camps -- than any other group of prisoners of war.

Backed by willing supporters in the medical, healthcare, and social service professional communities, the Nazis viewedinstitutionalized people with disabilities perceived as congenital to be a threat to the gene pool of the so-called German master race. The Nazi leadership was determined to use the opportunity of war to physically annihilate people with disabilities living in institutions but perceived as unable to work.

Legislation passed during the 1930s required the identification of persons perceived as “useless eaters” in institutions throughout Germany. After this legislation, officials of Hitler's private chancellery -- working with officials of the German Ministry of Health and the German Criminal Police -- established plans and procedures for three killing operations. These operations fell under the general umbrella term “Euthanasia.” All three were implemented during the war:

1) some 5,000 institutionalized small children with disabilities were murdered in institutions throughout Germany and Austria

2) in “Operation T-4” (named for the address of the Führer Chancellery office in Berlin at Tiergartenstraße 4), some 70,000 institutionalized adults were murdered in six killing centers and thousands of prisoners no longer able to work were killed in the concentration camps

3) approximately 110,000 other institutionalized adults with disabilities were murdered at institutions throughout Greater Germany. The overwhelming majority of T-4 victims were murdered in gas chambers; the other victims were killed by starvation, deliberately untreated disease, poisoning, and lethal injection.

OTHER PERSECUTED GROUPS 
 
In addition to racially targeted victims, the Germans persecuted, incarcerated in concentration camps, and killedreal and perceived political opponents of the Nazi regime inside Germany. This included both Catholic and Lutheran clergy as well as persons engaged in real and perceived activities of resistance movements in German-occupied Europe. Some of the so-called anti-partisan operations, particularly in the occupied Soviet Union, were in effect efforts to depopulate the Soviet countryside. The Germans massacred hundreds of thousands, perhaps millions, of Soviet civilians in their villages. The vast majority of these victims had little or no connection to partisan resistance.

The Nazi regime also targeted Jehovah's Witnesses who refused to swear an oath to the regime or perform military service. Approximately 3,000 Jehovah's Witnesses were incarcerated in concentration camps. Nearly a third of them died there. Another 250 were shot after being convicted by a military tribunal. The Nazi regime also persecuted malehomosexuals, whose sexual behavior was considered an obstacle to the preservation of the German nation and an element of corruption and immorality for German society. Tens of thousands of homosexuals were indicted for alleged homosexual acts or behavior: some of those who could not be convicted, or who were picked up by the Gestapo (German secret state police) after serving their sentences, were imprisoned in concentration camps. Hundreds, possibly thousands died in the camps.

Finally, German Criminal Police officials arrested and incarcerated in concentration camps tens of thousands of so-called asocials as well as real or perceived repeat criminal offenders, even though they had not committed a new crime or violation. Thousands of these so-called asocial and “criminal” prisoners were murdered in the camps.

 

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DEAF PEOPLE IN HITLER’S EUROPE

Inspired by the conference “Deaf People in Hitler’s Europe, 1933-1945” hosted jointly by Gallaudet University and the United States Holocaust Memorial Museum in 1998, this extraordinary collection integrates key presentations and postconference research as renowned scholars shed new light on the ideological and practical concerns that linked the theories of race and of eugenics to the sterilization and murder of persons whom the Nazis deemed “unworthy of life.” Deaf survivors attended and addressed the conference, providing wrenching testimonies that inspired, in part, the publication of this volume.

Henry Friedlander begins “Part I: Racial Hygiene” by analyzing the assault on deaf people and people with disabilities as an integral element in the Nazi attempt to implement their theories of racial hygiene. Robert Proctor documents the role of medical professionals in deciding who should be sterilized or forbidden to marry, and whom the Nazi authorities would murder. In an essay written especially for this volume, Patricia Heberer details how Nazi manipulation of eugenics theory and practice facilitated the justification for the murder of those considered socially undesirable.

“Part II: The German Experience” commences with Jochen Muhs’ interviews of deaf Berliners, both victims and active members of the Nazi Party. John S. Schuchman describes the remarkable 1932 film Misjudged People, which so successfully portrayed the German deaf community as a vibrant contributor to society that the Nazis banned its showing when they came to power. Horst Biesold’s contribution confirms the complicity of teachers who denounced their own students, labeling them hereditarily deaf and thus exposing them to compulsory sterilization. The section also includes the reprint of a chilling 1934 article entitled “The Place of the School for the Deaf in the New Reich,” in which author Kurt Leitz rued the expense of educating deaf students, who could not become soldiers or bear “healthy children.”

In “Part III: The Jewish Deaf Experience,” John S. Schuchman discusses the plight of deaf Jews in Hungary. His historical analysis is complemented by a chapter containing excerpts from the testimony of six deaf Jewish survivors who describe their personal ordeals. Peter Black’s reflections on the need for more research conclude this vital study of a little-known chapter of the Holocaust.

Conference papers and postconference articles reconstruct a vision of the process that resulted in the sterilization of as many as 16,000 deaf people in Europe and the torture or murder of untold numbers whose only “crime” was being deaf. The contributions to Deaf People in Hitler’s Europe investigate how the Nazis acted upon previously existing theories of eugenics and “breeding” aimed at creating a “superior human race.” Such theories had enjoyed some popularity in Germany and other countries, including the United States. A series of laws and regulations, including the July 1933 Law for the Prevention of Offspring with Hereditary Diseases and the October 1935 Law for the Protection of the Hereditary Health of the German Nation, facilitated and lent a pseudolegitimacy to measures directed against deaf people and persons with disabilities. The chapters in this volume show that German physicians, teachers, and even deaf leaders endorsed and participated in the implementation of these policies.

German deaf community leaders’ efforts to differentiate deaf people from other populations with disabilities, in order to protect the deaf community from Nazi persecution, proved fruitless. Despite the portrayal of deaf people in the film Misguided People as possessing traditional German virtues in that they were industrious workers, fit both in body and mind, the Nazis suppressed the film and then persecuted, and even murdered, many deaf people.

While the impeccable research in Deaf People in Hitler’s Europe depicts the persecution of the deaf community by the Nazis and their accomplices, the stories of the deaf survivors convey both plainly and plaintively the agonizing impact this persecution had on individuals. Children at the time of their plight, the deaf survivors recall even today the crowded cattle cars and the constant presence of death. They relate starkly and in heartbreaking fashion their uncertainty of what was happening, the chaotic and unexplained separations from their mothers, fathers, sisters, and brothers. More than five decades after the events, they recount the harrowing details of their miraculous survival as they grapple with mixed emotions about living and loss. Their stories add incalculably to the poignancy of this volume.

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MENTALLY AND PHYSICALLY HANDICAPPED: VICTIMS OF THE NAZI ERA

FORCED STERILIZATIONS

The "sterilization Law" explained the importance of weeding out so-called genetic defects from the total German gene pool:Since the National Revolution public opinion has become increasingly preoccupied with questions of demographic policy and the continuing decline in the birthrate. However, it is not only the decline in population which is a cause for serious concern but equally the increasingly evident genetic composition of our people. Whereas the hereditarily healthy families have for the most part adopted a policy of having only one or two children, countless numbers of inferiors and those suffering from hereditary conditions are reproducing unrestrainedly while their sick and asocial offspring burden the community.

Some scientists and physicians opposed the involuntary aspect of the law while others pointed to possible flaws. But the designation of specific conditions as inherited, and the desire to eliminate such illnesses or handicaps from the population, generally reflected the scientific and medical thinking of the day in Germany and elsewhere.

Nazi Germany was not the first or only country to sterilize people considered "abnormal." Before Hitler, the United States led the world in forced sterilizations. Between 1907 and 1939, more than 30,000 people in twenty-nine states were sterilized, many of them unknowingly or against their will, while they were incarcerated in prisons or institutions for the mentally ill. Nearly half the operations were carried out in California. Advocates of sterilization policies in both Germany and the United States were influenced by eugenics. This sociobiological theory took Charles Darwin's principle of natural selection and applied it to society. Eugenicists believed the human race could be improved by controlled breeding.

Still, no nation carried sterilization as far as Hitler's Germany. The forced sterilizations began in January 1934, and altogether an estimated 300,000 to 400,000 people were sterilized under the law. A diagnosis of "feeblemindedness" provided the grounds in the majority of cases, followed by schizophrenia and epilepsy. The usual method of sterilization was vasectomy and ligation of ovarian tubes of women. Irradiation (x-rays or radium) was used in a small number of cases. Several thousand people died as a result of the operations, women disproportionately because of the greater risks of tubal ligation.

Most of the persons targeted by the law were patients in mental hospitals and other institutions. The majority of those sterilized were between the ages of twenty and forty, about equally divided between men and women. Most were "Aryan" Germans. The "Sterilization Law" did not target socalled racial groups, such as Jews and Gypsies, although Gypsies were sterilized as deviant "asocials," as were some homosexuals. Also, about 500 teenagers of mixed African and German parentage (the offspring of French colonial troops stationed in the Rhineland in the early 1920s) were sterilized because of their race, by secret order, outside the provisions of the law.

Although the "Sterilization Law" sometimes functioned arbitrarily, the semblance of legality underpinning it was important to the Nazi regime. More than 200 Hereditary Health Courts were set up across Germany and later, annexed territories. Each was made up of two physicians and one district judge. Doctors were required to register with these courts every known case of hereditary illness. Appeals courts were also established, but few decisions were ever reversed. Exemptions were sometimes given artists or other talented persons afflicted with mental illnesses. The "Sterilization Law" was followed by the Marriage Law of 1935, which required for all marriages proof that any offspring from the union would not be afflicted with a disabling hereditary disease.

Only the Roman Catholic Church, for doctrinal reasons, opposed the sterilization program consistently; most German Protestant churches accepted and often cooperated with the policy. Popular films such as Das Erbe ("Inheritance") helped build public support for government policies by stigmatizing the mentally ill and the handicapped and highlighting the costs of care. School mathematics books posed such questions as: "The construction of a lunatic asylum costs 6 million marks. How many houses at 15,000 marks each could have been built for that amount?"

"EUTHANASIA" KILLINGS

Forced sterilization in Germany was the forerunner of the systematic killing of the mentally ill and the handicapped. In October 1939, Hitler himself initiated a decree which empowered physicians to grant a "mercy death" to "patients considered incurable according to the best available human judgment of their state of health." The intent of the socalled "euthanasia" program, however, was not to relieve the suffering of the chronically ill. The Nazi regime used the term as a euphemism: its aim was to exterminate the mentally ill and the handicapped, thus "cleansing" the "Aryan" race of persons considered genetically defective and a financial burden to society.

The idea of killing the incurably ill was posed well before 1939. In the 1920s, debate on this issue centered on a book coauthored by Alfred Hoche, a noted psychiatrist, and Karl Binding, a prominent scholar of criminal law. They argued that economic savings justified the killing of "useless lives" ("idiots" and "congenitally crippled"). Economic deprivation during World War I provided the context for this idea. During the war, patients in asylums had ranked low on the list for rationing of food and medical supplies, and as a result, many died from starvation or disease. More generally, the war undermined the value attached to individual life and, combined with Germany's humiliating defeat, led many nationalists to consider ways to regenerate the nation as a whole at the expense of individual rights.

In 1935 Hitler stated privately that "in the event of war, [he] would take up the question of euthanasia and enforce it" because "such a problem would be more easily solved" during wartime. War would provide both a cover for killing and a pretext--hospital beds and medical personnel would be freed up for the war effort. The upheaval of war and the diminished value of human life during wartime would also, Hitler believed, mute expected opposition. To make the connection to the war explicit, Hitler's decree was backdated to September 1, 1939, the day Germany invaded Poland.

Fearful of public reaction, the Nazi regime never proposed a formal "euthanasia" law. Unlike the forced sterilizations, the killing of patients in mental asylums and other institutions was carried out in secrecy. The code name was "Operation T4," a reference to Tiergartenstrasse 4, the address of the Berlin Chancellery offices where the program was headquartered.

Physicians, the most highly Nazified professional group in Germany, were key to the success of "T-4," since they organized and carried out nearly, all aspects of the operation. One of Hitler's personal physicians, Dr. Karl Brandt, headed the program, along with Hitler's Chancellery chief, Philip Bouhler. T-4 targeted adult patients in all government or church-run sanatoria and nursing homes. These institutions were instructed by the Interior Ministry to collect questionnaires about the state of health and capacity for work of all their patients, ostensibly as part of a statistical survey.

The completed forms were, in turn, sent to expert assessors physicians, usually psychiatrists, who made up "review commissions." They marked each name with a "+," in red pencil, meaning death, or a "" in blue pencil, meaning life, or "?" for cases needing additional assessment. These medical experts rarely examined any of the patients and made their decisions from the questionnaires alone. At every step, the medical authorities involved were usually expected to quickly process large numbers of forms.

The doomed were bused to killing centers in Germany and Austria walled-in fortresses, mostly former psychiatric hospitals, castles, and a former prison — at Hartheim, Sonnenstein, Grafeneck, Bernburg, Hadamar, and Brandenburg. In the beginning, patients were killed by lethal injection. But by 1940, Hitler, on the advice of Dr. Werner Heyde, suggested that carbon monoxide gas be used as the preferred method of killing. Experimental gassings had first been carried out at Brandenburg Prison in 1939. There, gas chambers were disguised as showers complete with fake nozzles in order to deceive victims — prototypes of the killing centers' facilities built in occupied Poland later in the war.

Again, following procedures that would later be instituted in the extermination camps, workers removed the corpses from the chambers, extracted gold teeth, then burned large numbers of bodies together in crematoria. Urns filled with ashes were prepared in the event the family of the deceased requested the remains. Physicians using fake names prepared death certificates falsifying the cause of death, and sent letters of condolences to relatives.

Meticulous records discovered after the war documented 70,273 deaths by gassing at the six "euthanasia" centers between January 1940 and August 1941. (This total included up to 5,000 Jews; all Jewish mental patients were killed regardless of their ability to work or the seriousness of their illness.) A detailed report also recorded the estimated savings from the killing of institutionalized patients.

The secrecy surrounding the T-4 program broke down quickly. Some staff members were indiscreet while drinking in local pubs after work. Despite precautions, errors were made: hairpins turned up in urns sent to relatives of male victims; the cause of death was listed as appendicitis when the patient had the appendix removed years before. The town of Hadamar school pupils called the gray transport buses "killing crates" and threatened each other with the taunt, "You'll end up in the Hadamar ovens!" The thick smoke from the incinerator was said to be visible every day over Hadamar (where, in midsummer 1941, the staff celebrated the cremation of their 10,000th patient with beer and wine served in the crematorium).

A handful of church leaders, notably the Bishop of Münster, Clemens August Count von Galen, local judges, and parents of victims protested the killings. One judge, Lothar Kreyssig, instituted criminal proceedings against Bouhler for murder; Kreyssig was prematurely retired. A few physicians protested. Karl Bonhöffer, a leading psychiatrist, and his son Dietrich, a Protestant minister who actively opposed the regime, urged church groups to pressure church-run institutions not to release their patients to T-4 authorities.

In response to such pressures, Hitler ordered a halt to Operation T-4 on August 24, 1941. Gas chambers from some of the "euthanasia" killing centers were dismantled and shipped to extermination camps in occupied Poland. In late 1941 and 1942, they were rebuilt and used for the "final solution to the Jewish question." Similarly redeployed from T-4 were future extermination camp commandants Christian Wirth, Franz Stangl, Franz Reichleitner, the doctor Irmfried Eberl, as well as about 100 others - doctors, male nurses, and clerks, who applied their skills in Treblinka, Belzec, and Sobibor.

The "euthanasia" killings continued, however, under a different, decentralized form. Hitler's regime continued to send to physicians and the general public the message that mental patients were "useless eaters" and life unworthy of life." In 1941, the film Ich klage an ("I accuse") in which a professor kills his incurably ill wife, was viewed by 18 million people. Doctors were encouraged to decide on their own who should live or die, Killing became part of hospital routine as infants, children, and adults were put to death by starvation, poisoning, and injections. Killings even continued in some of Germany's mental asylums, such as Kaufbeuren, weeks after Allied troops had occupied surrounding areas.

Between the middle of 1941 and the winter of 1944-45, in a program known under code "14f13," experienced psychiatrists from the T-4 operation were sent to concentration camps to weed out prisoners too ill to work. After superficial medical screenings, designated inmates Jews, Gypsies, Russians, Poles, Germans, and others were sent to those "euthanasia" centers where gas chambers still had not been dismantled, at Bernburg and Hartheim, where they were gassed. At least 20,000 people are believed to have died under the 14f13 program.

Outside of Germany, thousands of mental patients in the occupied territories of Poland, Russia, and East Prussia were also killed by the Einsatzgruppen squads (SS and special police units) that followed in the wake of the invading German army. Between September 29 and November 1, 1939, these units shot about 3,700 mental patients in asylums in the region of Bromberg, Poland. In December 1939 and January 1940, SS units gassed 1,558 patients from Polish asylums in specially adapted gas vans, in order to make room for military and SS barracks. Although regular army units did not officially participate in such "cleansing" actions as general policy, some instances of their involvement have been documented.

In all, between 200,000 and 250,000 mentally and physically handicapped persons were murdered from 1939 to 1945 under the T-4 and other "euthanasia" programs. The magnitude of these crimes and the extent to which they prefigured the "Final Solution" continue to be studied. Further, in an age of genetic engineering and renewed controversy over mercy killings of the incurably ill, ethical and moral issues of concern to physicians, scientists, and lay persons alike remain vital.

 

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