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Exploring the Darker Side of Everything

Aktion T4 – Hitler’s Euthanasia Program

Just when you thought you’d heard it all about Adolf’s house of horror, yet more bubbles to the surface. Between 1939 and 1945, as Germany waged war across Europe and Northern Africa, the Nazis undertook several programs that sought to cleanse their population and that of others who fell under their rule.  

By far the most horrifying and far-reaching was their attempt to address what they called ‘the Jewish problem’ by exterminating those of the Jewish faith. Under the Final Solution, 6 million Jewish men, women and children lost their lives, while an unknown number of Roma, homosexuals, disabled, prisoners of war, criminals and many more also perished in the concentration camps. 

Our story today focuses on a program that was named Aktion T4, a Nazi euthanasia campaign in which doctors administered “mercy killings” for those deemed incurably sick – ranging from small children to the very elderly. The number of those killed within this particular program was enormous and it’s thought that between 275,000 and 300,000 people met their end at the hands of the Aktion T4 doctors or the SS that was later drafted in to do the dirty work.  

This program proved to be widely unpopular across Germany and uproar eventually led to Hitler suspending the program in 1941 – though it continued in an underground fashion within Germany and in a not so underground fashion in other countries as they fell under the Nazi banner. It’s telling that with all that was happening in Nazi Germany, from the persecution of the Jews to the lunacy that was taking on much of the known world in a fight, it was the Aktion T4 program that resulted in some of the largest protests seen in Germany during the war.

Early 20th Century 

Before we dive face-first into this particular Nazi horror show, let’s begin with the idea of compulsory sterilization that was gaining traction in many countries at the beginning of the 20th Century. A lot of what’s going to come later in this video is deeply unpleasant and it can be easy to view the actions of the T4 program, and indeed what came before it, as simply a part of the larger evil that was the Nazi organisation. 

But Germany was not alone in this at the start – far from it. Canada, Denmark, Switzerland and the US, along with numerous other countries, all passed laws in the early decades of the century that allowed for compulsory sterilization in the case of hereditary defects and even for anti-social behaviour issues. In the United States, it’s thought that around 60,000 people were sterilized based on the ludicrous theories of eugenics, an idea that emerged in 1883 which essentially aimed to breed out hereditary illnesses, criminality, mental illness and even poverty from society through sterilisation and other actions.  

Winning family of a Fitter Family contest stand outside of the Eugenics Building
Winning family of a Fitter Family contest stand outside of the Eugenics Building (where contestants register) at the Kansas Free Fair, in Topeka, KS.

As you would have it, a large number of these deemed “unfit” just so happened to be minorities and immigrants, so eugenics has quite rightly been painted with the most racist of brushes, but it went much further than many realise. Poverty proved to be an enormous factor, regardless of your colour, and thousands who would probably simply be classed as having a learning disorder today fell into this category, while in some parts of the country, people with illness such as epilepsy or “feeblemindedness” were effectively banned from marrying – and therefore procreating.         

As you would imagine, a young Adolf Hilter took to these ideas with unbridled enthusiasm and many of his notions of Aryan superiority originated from eugenics.                  

Law for the Prevention of Hereditarily Diseased Offspring 

When the Nazis came to power in 1933, it didn’t take long for them to fire off a series of new laws that would begin to reshape the new Germany of the Third Reich. Anti-sematic legislation quickly began appearing but it was soon joined in July 1933 by the ‘Law for the Prevention of Hereditarily Diseased Offspring’ – which, let’s be perfectly honest, already sounds more than a little Handmaid’s Tale. 

Between 1933 and 1939, the new German government embraced this law with a dark zeal and an estimated 360,000 people were sterilized, mostly those with illnesses such as schizophrenia, epilepsy, Huntington’s chorea and the rather ambiguous ‘imbecility’ – but it was also seen as a legitimate answer to alcoholism and other forms of antisocial behaviour that didn’t quite fit with the strapping, healthy Ayran mould. 

This was done through Hereditary Health Courts, which permitted doctors to inspect people in nursing homes, asylums, prisons, aged-care homes and special schools. Those deemed far enough gone on the absurd Nazi eugenics wall chart were sterilised to keep the healthy Aryan stock as pure and disease-free as possible.

While this practice continued well past 1939, it slowed down around 1937 as Germany began to rearm itself and suddenly there was a huge demand for workers across the country. It was clear that a disability was OK, as long as it could toil in the factories of the Third Reich.  

The First

While Adolf Hitler was firmly in favour of the path that would eventually lead from sterilization to killings – shocking I know – he knew that such a program would prove deeply unpopular during peacetime. According to those who implemented the Aktion T4 program, Hitler first mentioned his desire to have those he considered racially or physically inferior killed back in 1933, but with the Nazi party riding a wave of rabid nationalism, it was deemed the wrong time and he settled for sterilisation. 

But in 1939, with his claws now firmly embedded into Germany, he quietly ordered a test case be carried out. The first person to die under the Aktion T4 program was a five-month-old boy by the name of Gerhard Kretschmar who was blind and had physical and developmental disabilities. His father, who saw his son as little more than a monster, had approached a doctor with a request to kill his son but when the doctor refused, the man took his case to the highest power in the land and sent a personal letter to Hitler requesting that his son’s life be taken. 

Down syndrome, one of Aktion T4 targets
Down syndrome, one of Aktion T4 targets, 16.02.1934. By  Bundesarchiv, is licensed under CC-BY-SA

Hitler dispatched his personal physician, Karl Brandt, to a small village near Leipzig with the order to examine the child and to carry out the killing if the infant’s condition was as bad as the father had claimed. It soon became apparent to Brandt that yes the child was severely handicapped, and on 25th July 1939, the life of young Gerhard Kretschmar was ended by lethal injection.    

Life Unworthy of Life  

Within a matter of weeks, the implementation of a large-scale program was quietly underway and the ‘Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses’ was soon established that required all children in German-controlled lands with some kind of illness or disability to be registered. It was also around this time that a phrase that had first been coined in 1920 came to be part of the Nazi propaganda program aiming to persuade the German people of the need to cleanse their society – ‘life unworthy of life’.  

Those deemed to have serious hereditary diseases, including ‘idiocy, down syndrome, microcephaly, hydrocephaly, malformations of all kinds, especially of limbs, head, and spinal column, paralysis and spasticity’ would have their cases brought before a panel of three medical experts. A unanimous decision was needed to order euthanasia and these secret killings began almost immediately in mid to late 1939, with numbers increasing once German tanks rolled across the Polish border, effectively sparking the European conflict of World War II. 

Most were killed at purpose-built extermination centres at one of six existing psychiatric hospitals at Bernburg, Brandenburg, Grafeneck, Hadamar, Hartheim, and Sonnenstein and it’s estimated that more than 5,000 children had been killed by 1941 under this program. 

Some early cases saw parental consent, but as the practice spread and was often met with fierce opposition by families, the Nazis outdid themselves with absolute evil when they began telling parents that their children were being sent to ‘special sections’ for specialist treatment. In reality, the children were sent to units for a few weeks – officially for “assessment” – before being killed by lethal injection, gas poisoning or even physical abuse. Their deaths were often recorded as being a result of pneumonia, or other illness, with faked death certificates, sent on to the families.

And I’m sorry, but it gets even darker and even weirder. Many of the victims had their brains removed after death and preserved in jars of formaldehyde under the shadowy label of ‘medical research’ – and quite astonishingly some of these were still being stored in Germany as late as 2001. 

Once new lands came under German rule, the euthanasia program rapidly spread, as did the parameters for the killings. 

Disabled Adults   

Until this point, the majority of those killed had been children, but as the Third Reich grew in territory, so did the scope of Aktion T4. German adults with what were considered hereditary illnesses were also soon included and this quickly spread to Austria, Czechoslovakia and Poland. 

In early cases, SS squads would arrive at asylums and simply shoot all of the patients but it wasn’t long until a more clinical and quieter way of killing was needed and it was here that we see some of the earliest mass killings using gas. The first such case occurred sometime in October 1939 at an early concentration camp known as Fort VII in Posen, where hundreds of prisoners were killed by carbon monoxide poisoning. 

It’s been said that Heinrich Himmler was present at one such execution and became so intrigued he ordered the method be trialled on a much larger scale, which eventually played an infamous role in the Final Solution.  

As the war spread and hospital beds were needed for injured German soldiers, regional leaders were eager to free up room with whatever horrifying excuse could be used. In the first wave, it’s thought that around 8,000 German adults with some kind of disability were killed – but things gathered pace from there. 

Most Jews in German institutions had been killed by 1940 and a directive was sent out to all nursing homes, mental institutions, hospitals, old people’s homes and sanatoria to register anyone who had been interned for five years or more with a range of conditions, while also demanding any ‘non-Aryans’ be identified. Those unlucky enough to fall under this category were discreetly moved and usually killed within 24 hours. Just as with the children, fake death certificates would then be sent to the family, but it didn’t take long for suspicions to emerge.  


As discreet as the Nazis had tried to be, it was difficult to keep a program like this completely hidden. As early as 1940 some serious questions were being asked by relatives of the deceased. There were apparently several cases of appendicitis being stated as the cause of death, even though the appendix of the patient had been removed long before.

Even without small errors like this, it was impossible to keep up this level of deception. Many of the extermination facilities had grown into large-scale operations and soon whispers were circulating through German society regarding what was happening. People began removing family members from facilities across Germany, while some working at psychiatric units even re-diagnosed their patients so they could escape the SS squads. 

The first major protest occurred in Absberg, just south of Nuremberg in February 1941, which saw a large crowd gather to demand an end to such practices. Similar protests sprang up around Germany and Austria, while formal letters of complaint, some by Nazi party members, began arriving on the desks of regional leaders, but also those higher up. Protests of any kind under Nazi rule were astonishingly rare, but this was one topic that enraged the population enough to dare to question the Nazi hierarchy. 

A lot has been said about the Church’s role in all this – both Catholic and Protestant. By and large, they remained vehemently opposed and the angry sermons by the Bishop of Münster, Clemens August Graf von Galen against the Aktion T4 program were widely – and illegally – shared by the local population, while the German press completely ignored it. 

But while Galen and others eventually spoke out against the program, it certainly took them a while to do so, even after it was perfectly clear what was happening. In many cases, medical facilities connected with the church made little to no objections when patients were mysteriously transferred in the middle of the night never to return. It’s clear that there were plenty of ‘moral objections’ but precious little action to defend these patients.  

On 24th August 1941, Adolf Hitler ordered the suspension of the Aktion T4 program – at which point the projected death toll of 70,000 had already been reached. The air of secrecy had all but evaporated and Hitler, no doubt eager to keep a war-weary population satisfied, brought the program to its official end. 

But with Nazis being Nazis, this was of course far from the end. While Aktion T4 was officially liquidated, the practice of killing the elderly or the mentally and physically impaired continued until the final days of the war. In many ways, it simply appeared in a different form, most notably Aktion 14f13, a Nazi directive that ordered the sick, elderly and those deemed no longer fit for work in concentration camps to be killed. This practice lasted from 1941 to 1944 but the killing was not confined to the camps. In a quite shocking event, the final person known to be killed under the old directive of T4 was a young child by the name of Richard Jenne on 29th May 1945 in the town of Kaufbeuren in Bavaria – a place that had already been under American occupation for three weeks at the time of his death – and almost a month after the suicide of Adolf Hitler.  

The Trials 

When the war ended, the question of justice hung in the air. The first Nuremberg trials would prosecute the highest-ranking Nazis still alive, but countless other legal proceedings took place across Germany as the allies began digging into the death machine that had been the Nazi party. 

One of these was known as the ‘Doctors’ Trial’ which began on 9th December 1946 and included 23 defendants (20 doctors and 3 administrators) relating to their roles in war crimes and crimes against humanity. These included some of the principal architects of the entire Aktion T4 program, including, Viktor Brack, Karl Brandt and Waldemar Hoven.

In August 1947 the court pronounced 16 of the defendants guilty. Seven were sentenced to death, including Brandt, Brack and Hoven, and were executed on 2nd June 1948, while nine received prison sentences ranging from 10 years to life imprisonment, with the rest acquitted.   

However, it would take decades until the full extent of the Aktion T4 program came to light. After the partition of Germany in 1945, huge amounts of files on the program were kept by the Stasi and not released to the public until the country unified in 1990 – leading to more research into these heinous crimes. 

Somewhere between 275,000 and 300,000 men, women and children are thought to have died under the Aktion T4 program or under its later, and wider, reincarnation that spread to concentrations camps in Nazi-controlled territory. This is one aspect of the war that isn’t as frequently told. Much of what the Nazis did was to suppress or even eradicate the hated ‘other’ – whether it was the Jews, the Roma or those of a different nationality, but Aktion T4 was different. This was a shocking purge that began with German society itself before spreading to other nations. A maniacal attempt at purifying a population through the madness of eugenics.  

Forced sterilization policies in the US targeted minorities and those with disabilities – and lasted into the 21st century (umich.edu)

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