Action T4: From “Euthanasia” to the Final Solution


Review by Claudia Moscovici, author of Holocaust Memories: A Survey of Holocaust Memoirs, Histories, Novels and Films (Rowman & Littlefield Publishing Group, 2019)

Action T4: From “Euthanasia” to the Final Solution

by Claudia Moscovici 

Since the late 5th century BC up to current times, the Hippocratic Oath has been taken by doctors to ensure the ethics of the medical profession. Above all, the Hippocratic Oath forbids doctors from causing deliberate harm to their patients. Doctors pledge: “I will prescribe regiments for the good of my patients according to my ability and my judgment and never do harm to anyone. I will give no deadly medicine to anyone if asked, nor suggest any such council.” The most egregious violation of medical ethics was perpetrated by Nazi doctors. “Euthanasia,” as practiced by Third Reich physicians, set the precedent for the Final Solution. From September 1939 to August 1941, when he began facing objections from German religious leaders, Hitler started experimenting in Germany with Action T4. The program was euphemistically described as “euthanasia”. In practice, however, it entailed the extermination of individuals in psychiatric institutions deemed “mentally incurable”. Over 70,000 patients in mental hospitals were killed under this program. Even when Hitler officially ended it in 1941, the practice continued until the end of the war. In concentration camps, it took an even more dangerous and deadly form.

“T4” is an abbreviation of Tiergarten Street Number 4 in Berlin, the address of the Charitable Foundation for Curative and Institutional Care, directed by Philipp Bouhler and Karl Brandt, Hitler’s personal physician. As Robert Jay Lifton explains in The Nazi Doctors, the “euthanasia” program initially employed lethal injection. Later, in order to kill people in greater numbers and more efficiently, Nazi physicians began using carbon monoxide. This method of killing was also implemented later to kill Jews, Gypsies and Poles in concentration camps.

In 1939, Christian Wirth (featured in the picture), one of the SS officers in charge of exterminating the Jews in Poland, designed a gas chamber that was disguised as a public shower. Instead of water, patients were inundated by a toxic gas. Witnesses describe Wirth as a malicious sadist, similar to Dr. Josef Mengele, the notorious “Angel of Death”. Corporal Franz Suchomel recalls: “From my activity in the camps of Treblinka and Sobibor, I remember that Wirth in brutality, meanness, and ruthlessness could not be surpassed. We therefore called him ‘Christian the Terrible…” (Arad Ytzhak, Belzec, Sobibor, Treblinka: The Operation Reinhard Death Camps, p 183-186).

The gas used at first was carbon monoxide, but that was deemed as too slow acting. The Nazis then turned to Zyklon B—a cyanide based pesticide—to murder 1.2 million people in gas chambers. The process, deemed a quicker and “more humane” method of killing (compared to shooting or carbon monoxide), in actuality caused a slow and excruciating death. In The Diary of Petr Ginz: 1941-1942, Chava Pressburger pays homage to her brother Petr, who died in Auschwitz at the tender age of 16. She is particularly pained by the thought that her brother died such a gruesome death:

“I ask readers to forgive me for returning to that terrible description. The witness in question worked in the gas chambers. His task was to wait for the people shoved into the gas chamber to suffocate; then he had to open the chamber and transport the heaps of corpses to the ovens, where they were to be burned. This man could barely speak for tears. He testified that the position of corpses suggested what went on inside the hermetically sealed chamber, when it began to be filled with toxic gas. The stronger ones, led by an overpowering instinct for self-preservation, tried to get to the top, where there was still some air left, so that the weaker ones were trampled to death” (131).

Conceptually, the distance between the Action T4 program practiced in German mental hospitals and the mass murder in concentration camps was not so great.  The T4 program offered the framework for the killing machine implemented in the Final Solution. As Allan Bullock observes in Hitler and Stalin: Parallel Lives, Action T4 set the following precedents for mass extermination:

1)    it established an atmosphere of secrecy, shrouded in a language filled with codes and euphemisms to describe torture and murder;

2)    it implicated doctors in murder through a procedural façade of professionalism (including physical examinations, diagnoses, and the administration of “medicines” or “operations”);

3)    from the very beginning, it set Jewish patients apart from others for “special treatment”. Jews did not have to meet the T4 criteria—namely, of being diagnosed with incurable diseases or mental disorders—in order to be killed. They could be killed simply because they were Jewish. (Hitler and Stalin, 746)

Perhaps the most valuable lesson Hitler learned from the T4 program was to take the killing machine outside of his own country. Following vocal protests by the Protestant pastors Paul-Gerhard Braune and Fritz von Bodelschwingh and by Cardinal August Count von Galen, Hitler decided to bide his time and kill more covertly: not on German territory, where he wanted to remain popular, but elsewhere. The opportunity presented itself when he attacked Russia in Operation Barbarossa, beginning on June 22, 1941. With the onset of war, all bets were off. The Nazis used war against “the Bolshevik empire” as a justification for putting into practice everything they had learned from the more limited Action T4 “euthanasia” program: this time to kill Jews, Gypsies and Poles on an unprecedented mass scale.

Claudia Moscovici, Literature Salon


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