That human beings who were incurably ill, physically or mentally, should be eliminated from German society was a central tenet of Nazi ideology from the outset and a goal that Hitler intended to achieve.  Adapting the Social Darwinist ideas of selection and survival to their aims, the Nazis sought to ensure that those deemed unworthy of life would be removed from the population.  Such an approach was deemed fair not only to the healthy Germans who were burdened by the “weak and worthless,” but also to the “weak and worthless” themselves.  Preventing such individuals from reproducing equally defective offspring was an act of humanity, Hitler argued.  Taking this view one step further, he would later claim that killing these unfortunate creatures would be an act of mercy.

In his first few years in power, Hitler decreed that people with (presumably) hereditary neuropsychiatric diseases and developmental disorders could not reproduce; the Sterilization Law was passed in July 1933.  This policy was widely publicized and packaged in the language of humanitarianism.  These laws, however, led six years later to a more violent proposition: euthanasia.  Euthanasia of the unfit was not a new idea and did not originate with Hitler; the concept had been formulated in a 1920 monograph co-authored by a professor of psychiatry and a professor of jurisprudence, and the origins of the idea in Germany go back even further. The discussion was already in active discussion in the medical community, but Hitler felt that a euthanasia program could not begin until the war was underway.

The program started with the children.  In late 1938, Hitler authorized the creation of the Reich Committee for the Scientific Registration of Serious Hereditarily and Congenitally Based Illnesses, charged with examining children with various conditions and referring those deemed unfit for life to be killed.  Approximately 5,000 children were murdered in special Pediatric Departments set up in thirty hospitals and sanatoriums across Germany.

In October 1939, Hitler expanded his euthanasia program to include incurably ill adults. The order authorizing the program was backdated to September 1, 1939, the start of World War II.  He also allowed for a change in the method of murder, to carbon monoxide gassing.  Hitler entrusted Reichsleiter Philip Bouhler and his own personal doctor, Karl Brandt, to oversee the program, code-named Operation T4 for the Berlin address, Tiergartenstrasse 4, where it was headquartered.  Those selected for death by the T4 doctors were sent in buses with darkened windows to one of six killing centers.  Upon arrival, they were stripped naked while their files were reviewed one last time by a physician, and were then led to the gas chamber.    The corpses were cremated, and the victims’ families received letters saying that their loved ones had fallen ill and died.

When Hitler stopped the program in August 1941, about 70,000 people had been killed.  Operation T4 was considered a success, and when the decision was made to murder the Jews of Europe, the technology was extended to the concentration and death camps.  Meanwhile, although the official T4 program had been halted in name, the euthanasia program (now the so-called “wild euthanasia”) continued until the end of the war.  In addition, during this latter period sick and weak concentration camp prisoners were also transported to killing centers to be murdered (Aktion 14f13).

Operation T4 invites discussion of several questions:  how the Nazis made the case for eliminating the sick and weak from society; where this aim fit into their larger goal of purifying the German population; why gassing was introduced as a method of systematic murder, first to carry out the euthanasia program and later the Final Solution; and how medical ethics were turned upside down during the Holocaust.