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Nazi Germany and Its So-called Euthanasia Program

An overview by Derek Humphry

The most totally evil crime of the 20th century was the Holocaust because it was conducted by a civilized society which regarded itself as God-fearing and law-abiding. Germany, under Nazi rule between 1935 and 1945, ruthlessly exterminated an estimated six million European Jews. The victims were shot, gassed, starved, beaten, or tortured to death. In the guise of science, experiments on live humans were carried out in fiendishly cruel ways, causing unimaginable agony, and producing no advances in medical knowledge.

The mass liquidation of the Jews by gassing -- a method which accounted for about two-thirds of the deaths -- was secretly preceded, from 1939 to 1941, by the elimination of approximately 100,000 men, women and children, none of them Jewish, all Aryan Germans who were handicapped, physically or mentally, or both. Most were murdered with equipment which resembled show stalls; the victims were lured to their deaths under the guise of personal hygiene. Instead of water, the nozzles emitted Zyklon B gas, a cyanide derivative, especially developed for mass murder.

In the fifty years since the discovery at the Nuremberg War Crimes Trials of the extent of the Nazi's liquidation programs, the intellectual and legal progress of the legitimate euthanasia movement in the West has been seriously hampered by the haunting memory of the German atrocities. It is the cornerstone of the 'slippery slope' argument against there being lawful physician-assisted suicide for the terminally ill, although nobody has suggested that handicapped people should be included in what is clearly a purely elective action. The complete voluntariness, both on the part of the patient and the physician, is written into the proposed legislation.

There are three troubling features about the Nazi extermination programs:

  1. That a nation so highly educated and cultured as Germany, birthplace of universally venerated musicians, poets, philosophers,physicians, and theologians could permit such evil behavior;

  2. That Germany adherence to the rule of law, together with a highly efficient bureaucracy, could degenerate so far as to permit extensive and persistent violation of the basic human and legal right to life;

  3. That if such atrocities could happen in Germany, might they also happen in, say, Britain or the United States, given a change in social attitudes and the election of a tyrannical political party?

Could a small amount of justifiable, legalized, openly-conducted voluntary euthanasia permitted today become the 'thin end of the wedge' for enforced euthanasia of the handicapped, the poor and socially vulnerable tomorrow?


To understand what happened in Germany in the 1930s and 1940s it is necessary to take a longer view. There is within German racial and national ideology a very long history of obsessions with racial purity, an urge to acknowledge the Aryans as the finest, strongest race in the world -- and thus the most dominant. Hitler and his Nazi colleagues developed this historical myth into a useful propaganda mystique: a racially pure Germany would no longer lose wars, and would never again be humiliated by the rest of the world as it was during and after World War One.

Two extracts from Hitler's 1924 book, Mein Kampf (My Struggle) give a fearsome hint of what the man intended: "All who are not of good race in this world are chaff. And all occurrences in world history are only the expression of the races' instinct of self-preservation, in the good or the bad sense." Another extract said: "And if there were ever really one healthy man among the cripples, he used up all his strength just to keep the others on their feet, and in this way he himself was crippled."

It is one of the worst lessons of history that the world ignored this book containing Hitler's crazed predictions, even when he took power. One of the first laws the Nazis enacted in 1933 was compulsory sterilization of persons who had hereditary illnesses. The condemned person had no say in the matter: the court-authorized operation was forcible.

Hitler ignored whatever criticisms there were -- and they were few -- and proceeded with a shrewd programming of indoctrinating health professionals with Nazi racial ideology. Eugenics or 'race hygiene' was taught to all health workers, including those in psychiatric institutions. (The prize-winning movie, EUROPA, EUROPA, has a classic cameo on Nazi racial stereotyping by an 'expert'). Craftily, the Nazis waited for this brain-washing to sink in. Then, at the start of World War Two, they launched their so-called 'euthanasia program' at a time when people were distracted by the fighting and were also receptive to the idea that those who could not help the German nation in time of war might just as well be dead.

The concept of THE VOLK -- pure Aryan Germans, destined to rule the world -- had been bandied about by crackpots for centuries. The German term for those who stood in the way of this was 'lenensunwerten Leben' (Life unworthy of life). The Nazis now thought up a phrase more pertinent to wartime: 'unnutze Esser' (useless eater).


While the sterilization program was carried out openly and legally, the euthanasia program was top secret and cloaked with wartime furtiveness. Hitler instructed his aides that he was not to be connected officially with the program, but in late October, 1939, he signed a secret decree authorizing it, backdated to September 1 that year. (Britain and France declared war on Germany on September 3, 1939, when Hitler refused to withdraw his invasion of Poland).

The Nazis set up front organizations for the programs, the mostpowerful one being the 'Charitable Foundation for Institutional Care" which operated from an obscure office in Berlin's Tiergartenstrasse 4. Hence the infamous code name 'T4' for the extermination program. Patient shipped to the killing camps had absolutely no say in their fates, nor their families -- if, indeed, anybody but the organizers had any idea what was happening. Anyone who asked about the legality of the program was told that Hitler's decree had full legal force and the elimination of the handicapped was already being legally carried out in Russia and America. Of course it was impossible in wartime for anybody in Germany to check this.

When some physicians asked why the law was not made public, they were told by the bureaucrats that this would upset the patients who were to be killed, thus requiring the drafting of a new law.

First gassings took place at the end of 1939 and early 1940 at Brandenburg an der Havel, the first of a dozen or so institutions converted for the program in Germany and Austria. Covert organizations back in Berlin arranged the transportation of the victims, tied up their financial and legal affairs, and concocted letters to next-of-kin giving phony reasons for death. An urn containing what purported to be the dead person's ashes was forwarded to the family. Often relatives of the deceased were warned not to demand further explanations or to spread false rumors.

German public opinion was alerted to the program by the often demonstrable falsity of the death certificates. For instance, some documents claimed that death occurred during an appendectomy, when the family knew the appendix had already been removed. Some death certificates referred to a long illness, whereas the family had seen their loved one fit and well in recent times. Occasionally two urns came to the same family.

Officials, physicians, and at least fifty psychiatrists involved in the program all used pseudonyms to conceal their identities. Some of Germany's most eminent psychiatrists, holding professorial chairs, took part in the selection procedures.


There is no record of the Nazis assisting in a suicide or killing anyone suffering from a terminal illness. Nor were aged persons killed, contrary to some recent claims. It was a barbarous drive for racial purity by eliminating those whom doctors said had congenital, and perhaps inherited, physical and mental handicaps. The victims ranged from the terribly deformed to the mentally handicapped to the treatably neurotic.

Into its second year the extermination program began to become well known in Germany, and there was a growing fear that the elderly would be next, followed by seriously wounded soldiers, of which there would be many at the time. There is no evidence that the Nazis intended this but the mere fear affected German morale. Several prominent members of churches spoke out against the program and called for it to halt. The archbishop of Munich wrote to the Minister of Justice in 1940: "Even in time of war, the inalienable foundations of moral order and the fundamentals rights of the individual must not be revoked."

The effect on the morale of the German population was growing so serious that in August 1941 Hitler ordered the program to be 'stalled'. There is some evidence that it continued on a smaller scale, in greater secrecy than before, with most of the victims being handicapped children.

Hitler learned from these mass purges that he could not safely carry out the mass extermination of the Jews from bases within Germany. The special gas chambers were dismantled and shipped to Poland. The trained staff who operated the chambers went as well, for the Nazis reasoned that if they were ruthless enough to kill comparatively small amounts of their own people they would have no scruples about slaughtering millions of Jews.

Professor Lucy S Davidowicz, a historian, sociologist, and author of The War Against the Jews, 1933-1945, has argued that studying the Nazi experience does not enlighten us as to the problems we confront today about euthanasia. She writes: "Euthanasia as the Nazis used the term is not euthanasia in our terms. Euthanasia was only a code name which the Nazis used both as camouflage and euphemism for a program of murder -- killing various categories of persons because they were regarded as racially 'valueless': deformed, insane, senile, or any combination thereof."

Could it happen again? The right-to-life movement and its principal backer, the Roman Catholic Church, say it could. They distrust the constitutional, legal and voting protections that countries like the United States, Canada, and Britain, have enacted over centuries to prevent such horrors.

Perhaps what happened in Germany is more shocking to us not only because it was within our own times but because it was carried out so effectively through a well-organized bureaucracy, using modern means of mass transportation (railway trains) and modern science (poison gas). Without the efficient German train service, even operating under wartime conditions, this huge amount of people could not have been massacred.

Euthanasia supporters argue that the Nazi experience was so singular and so unusual that it should not be compared to the present crusade for legalized voluntary euthanasia for the dying. Is it logical and fair to refuse a suffering person, close to death, with help in dying by request because of what happened in Germany half a century ago? Will that patient understand and accept the relevance?


The Holocaust, by Martin Gilbert (Holt, Rinehart & Winston, New York, 1985)

Hitler and the Final Solution, by Gerald Fleming (University of California Press, 1982)

The Architect of Genocide, by Richard Breitman (Alfred A Knopf, New York, 1991)

Himmler, by Peter Padfield, (Henry Holt & Co, New York)

The Nazi Doctors and the Nuremburg Code, by George J Annas and Michael A Grodin (Oxford University Press, New York, 1992)

© Copyright 1995, Derek Humphry. All rights reserved.

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