First They Came For The Children - the legacy of T4 Nurses and Doctors




It is almost a cliché to say that nurses are the most trusted professionals in society.

Everybody seems to have known a nurse, to have one in their family, or at least to have received nursing care at some stage in their life. Nurses are seen to be compassionate, caring and ethical. If a nurse goes off track and does something that causes harm to others, it makes the headlines.
People find it hard to conceptualise the idea that a nurse, whose raison d’être is to help and protect people, would intentionally hurt someone. Nurses who kill are seen as deviant and wicked, and should be locked away for life.
Of course, this is probably right, in the most simplistic sense. But, what if a nurse thought that killing patients was the right thing to do? That killing them was part of their job description, and that they were really doing the patient a favour by putting them out of their misery?
Few nurses today would subscribe to such theories (although some do – to be discussed in a later article). In one part of history, however, this subversion of nursing ethics not only existed but was state-sanctioned.

Nurses and Midwives in Nazi Germany

In 1933, Adolf Hitler became Chancellor of Germany. The philosophies of the Nazi party, of which he was head, were based on eugenics – a pseudoscience that had much traction around the world at the time.
Eugenics dictated that only the healthiest and fittest be allowed to procreate and to live. The Nazis’ racial policies, which divided human races into levels of fitness for life, synergised with eugenics to support programmes declaring certain people ‘life unworthy of life‘ or ‘useless feeders.’
Under such policies, people with mental illnesses, physical and intellectual disabilities, and conditions such as epilepsy, chronic alcoholism and a range of genetic diseases, were considered a burden on society and should be annihilated.
To this end, in 1939, Hitler, through his personal physician Dr Karl Brandt, set up the ‘T4′ programme – the systematic, state-sanctioned murder of the disabled and chronically ill. The first people to be killed were disabled children.
The main killing centres were hospitals and homes for the disabled. Parents and carers were encouraged to place their loved ones and children into institutions. They would then be moved to another institution a long way from home, and contact between child and parent ceased.
After some months, parents received a letter saying that their child had died of something like pneumonia or appendicitis and that the parents could come and collect their ashes and pay for the funeral.
Doctors would assess the patients and make a mark on a standard questionnaire that dictated whether the person was to be killed or allowed to live.
While doctors made the decisions about who should live or die, the nurses did the killing. The killings took place in hospitals. Who constitutes the largest proportion of the workforce in a hospital? It’s the nurses, and it was the nurses who killed.
They used intravenous injections, lethal doses of drugs such as phenobarbitone, or starvation or hypothermia from exposure.

What made the nurses do this, surely they were there to care for patients?

In Hitler’s Germany, propaganda underpinned everything.
Propaganda about ‘life unworthy of life’ and ‘useless feeders’ was everywhere, even in arithmetic exercises for primary school children.
Many people genuinely believed that by removing these burdens on society, Germany would be a better place. Nurses, too, succumbed to the propaganda. Many believed that they were doing the right thing, that Germany would be a better place because of these policies.
Of course, there were many who disagreed and would not take part. These nurses were not punished, nor ostracized – they were moved to another hospital or another ward.
In other words, the nurses who participated in this murder did so willingly and voluntarily.

Article 2 from the Holocaust encyclopedia  https://encyclopedia.ushmm.org/content/en/article/euthanasia-program

Nazi Germany's First Program of Mass Murder

The Euthanasia Program was Nazi Germany's first program of mass murder. It predated the genocide of European Jewry (the Holocaust) by approximately two years. The program was one of many radical eugenic measures which aimed to restore the racial "integrity" of the German nation. It aimed to eliminate what eugenicists and their supporters considered "life unworthy of life": those individuals who—they believed—because of severe psychiatric, neurological, or physical disabilities represented both a genetic and a financial burden on German society and the state.

Child "Euthanasia" Program

Nazi physician Karl Brandt, director of the Euthanasia Program. [LCID: 09539]

Nazi physician Karl Brandt

Nazi physician Karl Brandt, director of the Euthanasia Program. August 27, 1942.
  • Instytut Pamieci Narodowej
In the spring and summer months of 1939, a number of planners began to organize a secret killing operation targeting disabled children. They were led by Philipp Bouhler, the director of Hitler's private chancellery, and Karl Brandt, Hitler's attending physician. On August 18, 1939, the Reich Ministry of the Interior circulated a decree requiring 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.
Beginning in October 1939, public health authorities began to encourage parents of children with disabilities to admit their young children to one of a number of specially designated pediatric clinics throughout Germany and Austria. In reality, the clinics were children's killing wards. There, specially recruited medical staff murdered their young charges by lethal overdoses of medication or by starvation.
At first, medical professionals and clinic administrators included only infants and toddlers in the operation. As the scope of the measure widened, they included youths up to 17 years of age. Conservative estimates suggest that at least 5,000 physically and mentally disabled German children perished as a result of the child "euthanasia" program during the war years.

Extending the "Euthanasia" Program

Adolf Hitler's authorization for the Euthanasia Program (Operation T4), signed in October 1939 but dated September 1, 1939. [LCID: 67072]

Adolf Hitler's authorization for the Euthanasia Program

Adolf Hitler's authorization for the Euthanasia Program (Operation T4), signed in October 1939 but dated September 1, 1939.
  • National Archives and Records Administration, College Park, MD
Euthanasia planners quickly envisioned extending the killing program to adult disabled patients living in institutional settings. In the autumn of 1939, Adolf Hitler signed a secret authorization in order to protect participating physicians, medical staff, and administrators from prosecution. This authorization was backdated to September 1, 1939, to suggest that the effort was related to wartime measures. The Führer Chancellery was compact and separate from state, government, or Nazi Party apparatuses. For these reasons, Hitler chose it to serve as the engine for the "euthanasia" campaign. The program's functionaries called their secret enterprise "T4." This code-name came from the street address of the program's coordinating office in Berlin: Tiergartenstrasse 4.
According to Hitler's directive, Führer Chancellery director Phillip Bouhler and physician Karl Brandt led the killing operation. Under their leadership, T4 operatives established six gassing installations for adults as part of the "euthanasia" action. These were:
  • Brandenburg, on the Havel River near Berlin
  • Grafeneck, in southwestern Germany
  • Bernburg, in Saxony
  • Sonnenstein, also in Saxony
  • Hartheim, near Linz on the Danube in Austria
  • Hadamar, in Hessen
Using a practice developed for the child "euthanasia" program, in the autumn of 1939 T4 planners began to distribute carefully formulated questionnaires to all public health officials, public and private hospitals, mental institutions, and nursing homes for the chronically ill and aged. The limited space and wording on the forms, as well as the instructions in the accompanying cover letter, combined to give the impression that the survey was intended simply to gather statistical data. The form's sinister purpose was suggested only by the emphasis placed upon the patient's capacity to work and by the categories of patients which the inquiry required health authorities to identify. The categories of patients were:
  • those suffering from schizophrenia, epilepsy, dementia, encephalitis, and other chronic psychiatric or neurological disorders
  • those not of German or "related" blood
  • the criminally insane or those committed on criminal grounds
  • those who had been confined to the institution in question for more than five years
Secretly recruited "medical experts," physicians—many of them of significant reputation—worked in teams of three to evaluate the forms. On the basis of their decisions beginning in January 1940, T4 functionaries began to remove patients selected for the "euthanasia" program from their home institutions. The patients were transported by bus or by rail to one of the central gassing installations for killing.
Within hours of their arrival at such centers, the victims perished in gas chambers. The gas chambers, disguised as shower facilities, used pure carbon monoxide gas. T4 functionaries burned the bodies in crematoria attached to the gassing facilities. Other workers took the ashes of cremated victims from a common pile and placed them in urns to send to the relatives of the victims. The families or guardians of the victims received such an urn, along with a death certificate and other documentation, listing a fictive cause and date of death.
Two pages of the death registry at Hadamar listing false causes of death. [LCID: 76282]

Hadamar death register

Two pages of the death registry at Hadamar listing false causes of death. Thousands of the physically and mentally disabled were killed there as part of the Euthanasia Program. Germany, April 5, 1945.
  • National Archives and Records Administration, College Park, MD
Because the program was secret, T-4 planners and functionaries took elaborate measures to conceal its deadly designs. Even though physicians and institutional administrators falsified official records in every case to indicate that the victims died of natural causes, the "euthanasia" program quickly become an open secret. There was widespread public knowledge of the measure. Private and public protests concerning the killings took place, especially from members of the German clergy. Among these clergy was the bishop of Münster, Clemens August Count von Galen. He  protested the T-4 killings in a sermon August 13, 1941. In light of the widespread public knowledge and the public and private protests, Hitler ordered a halt to the euthanasia program in late August 1941.
According to T4's own internal calculations, the euthanasia effort claimed the lives of 70,273 institutionalized mentally and physically disabled persons at the six gassing facilities between January 1940 and August 1941.

Second Phase

Hitler's call for a halt to the T4 action did not mean an end to the euthanasia killing operation. Child euthanasia continued as before. Moreover, in August 1942, German medical professionals and healthcare workers resumed the killings, although in a more carefully concealed manner than before. More decentralized than the initial gassing phase, the renewed effort relied closely upon regional exigencies, with local authorities determining the pace of the killing.
Using drug overdose and lethal injection—already successfully used in child euthanasia—in this second phase as a more covert means of killing, the euthanasia campaign resumed at a broad range of institutions throughout the Reich. Many of these institutions also systematically starved adult and child victims.
The Euthanasia Program continued until the last days of World War II, expanding to include an ever wider range of victims, including geriatric patients, bombing victims, and foreign forced laborers. Historians estimate that the Euthanasia Program, in all its phases, claimed the lives of 250,000 individuals.

People with Disabilities in the German-Occupied East

Persons with disabilities also fell victim to German violence in the German-occupied east. The Germans confined the Euthanasia Program, which began as a racial hygiene measure, to the Reich proper—that is, to Germany and to the annexed territories of Austria, Alsace-Lorraine, the Protectorate of Bohemia and Moravia, and the Warthegau in former Poland. However, the Nazi ideological conviction which labeled these persons "life unworthy of life" also made institutionalized patients the targets of shooting actions in Poland and the Soviet Union. There, the killings of disabled patients were the work of SS and police forces, not of the physicians, caretakers, and T4 administrators who implemented the Euthanasia Program itself.
In areas of Pomerania, West Prussia, and occupied Poland, SS and police units murdered some 30,000 patients by the autumn of 1941 in order to accommodate ethnic German settlers (Volksdeutsche) transferred there from the Baltic countries and other areas.
SS and police units also murdered disabled patients in mass shootings and gas vans in occupied Soviet territories. Thousands more died, murdered in their beds and wards by SS and auxiliary police units in Poland and the Soviet Union. These murders lacked the ideological component attributed to the centralized Euthanasia Program. The SS was apparently motivated primarily by economic and material concerns in killing institutionalized patients in occupied Poland and the Soviet Union.
The SS and the Wehrmacht quickly made use of the hospitals emptied in these killing operations as barracks, reserve hospitals, and munitions storage depots. In rare cases, the SS used the empty facilities as a formal T4 killing site. An example is the euthanasia facility Tiegenhof, near Gnesen (today Gniezno, in west-central Poland).

The Significance of the Euthanasia Program

The Euthanasia Program represented in many ways a rehearsal for Nazi Germany's subsequent genocidal policies. The Nazi leadership extended the ideological justification conceived by medical perpetrators for the destruction of the "unfit" to other categories of perceived biological enemies, most notably to Jews and Roma (Gypsies).
Planners of the "Final Solution" later borrowed the gas chamber and accompanying crematoria, specifically designed for the T4 campaign, to murder Jews in German-occupied Europe. T4 personnel who had shown themselves reliable in this first mass murder program figured prominently among the German staff stationed at the Operation Reinhard killing centers of Belzec, Sobibor, and Treblinka.
Like those who planned the physical annihilation of the European Jews, the planners of the Euthanasia Program imagined a racially pure and productive society. They embraced radical strategies to eliminate those who did not fit within their vision.

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