The "Sterilization Law" explained the importance
of weeding out so-called genetic defects from the total German gene
Since the National Revolution public opinion has
become increasingly preoccupied with questions of demographic policy
and the continuing decline in the birthrate. However, it is not only
the decline in population which is a cause for serious concern but
equally the increasingly evident genetic composition of our people.
Whereas the hereditarily healthy families have for the most part adopted
a policy of having only one or two children, countless numbers of
inferiors and those suffering from hereditary conditions are reproducing
unrestrainedly while their sick and asocial offspring burden the community.
Some scientists and physicians opposed the involuntary
aspect of the law while others pointed to possible flaws. But the designation
of specific conditions as inherited, and the desire to eliminate such
illnesses or handicaps from the population, generally reflected the
scientific and medical thinking of the day in Germany and elsewhere.
Nazi Germany was not the first or only country to sterilize
people considered "abnormal." Before Hitler,
the United States led the world in forced sterilizations. Between 1907
and 1939, more than 30,000 people in twenty-nine states were sterilized,
many of them unknowingly or against their will, while they were incarcerated
in prisons or institutions for the mentally ill. Nearly half the operations
were carried out in California. Advocates of sterilization policies
in both Germany and the United States were influenced by eugenics. This
sociobiological theory took Charles Darwin's principle of natural selection
and applied it to society. Eugenicists believed the human race could
be improved by controlled breeding.
Still, no nation carried sterilization as far as Hitler's
Germany. The forced sterilizations began in January 1934, and altogether
an estimated 300,000 to 400,000 people were sterilized under the law.
A diagnosis of "feeblemindedness" provided the grounds in
the majority of cases, followed by schizophrenia and epilepsy. The usual
method of sterilization was vasectomy and ligation of ovarian tubes
of women. Irradiation (x-rays or radium) was used in a small number
of cases. Several thousand people died as a result of the operations,
women disproportionately because of the greater risks of tubal ligation.
Most of the persons targeted by the law were patients
in mental hospitals and other institutions. The majority of those sterilized
were between the ages of twenty and forty, about equally divided between
men and women. Most were "Aryan" Germans. The "Sterilization
Law" did not target socalled racial groups, such as Jews and Gypsies,
although Gypsies were sterilized as deviant "asocials," as
were some homosexuals. Also,
about 500 teenagers of mixed African and German parentage (the offspring
of French colonial troops stationed in the Rhineland in the early 1920s)
were sterilized because of their race, by secret order, outside the
provisions of the law.
Although the "Sterilization Law" sometimes
functioned arbitrarily, the semblance of legality underpinning it was
important to the Nazi regime. More than 200 Hereditary Health Courts
were set up across Germany and later, annexed territories. Each was
made up of two physicians and one district judge. Doctors were required
to register with these courts every known case of hereditary illness.
Appeals courts were also established, but few decisions were ever reversed.
Exemptions were sometimes given artists or other talented persons afflicted
with mental illnesses. The "Sterilization Law" was followed
by the Marriage Law of 1935, which required for all marriages proof
that any offspring from the union would not be afflicted with a disabling
Only the Roman Catholic Church, for doctrinal reasons,
opposed the sterilization program consistently; most German Protestant
churches accepted and often cooperated with the policy. Popular films
such as Das Erbe ("Inheritance") helped build public
support for government policies by stigmatizing the mentally ill and
the handicapped and highlighting the costs of care. School mathematics
books posed such questions as: "The construction of a lunatic asylum
costs 6 million marks. How many houses at 15,000 marks each could have
been built for that amount?"
Forced sterilization in Germany was the forerunner
of the systematic killing of
the mentally ill and the handicapped. In October 1939, Hitler himself initiated a decree which empowered physicians to grant a "mercy
death" to "patients considered incurable according to the
best available human judgment of their state of health." The intent
of the socalled "euthanasia" program, however, was not to
relieve the suffering of the chronically ill. The Nazi regime used the
term as a euphemism: its aim was to exterminate the mentally ill and
the handicapped, thus "cleansing" the "Aryan" race
of persons considered genetically defective and a financial burden to
The idea of killing the incurably ill was posed well
before 1939. In the 1920s, debate on this issue centered on a book coauthored
by Alfred Hoche, a noted psychiatrist, and Karl Binding, a prominent
scholar of criminal law. They argued that economic savings justified
the killing of "useless lives" ("idiots" and "congenitally
crippled"). Economic deprivation during World War I provided the
context for this idea. During the war, patients in asylums had ranked
low on the list for rationing of food and medical supplies, and as a
result, many died from starvation or disease. More generally, the war
undermined the value attached to individual life and, combined with
Germany's humiliating defeat, led many nationalists to consider ways
to regenerate the nation as a whole at the expense of individual rights.
In 1935 Hitler stated privately that "in the event of war, [he] would take up
the question of euthanasia and enforce it" because "such a
problem would be more easily solved" during wartime. War would
provide both a cover for killing and a pretext--hospital beds and medical
personnel would be freed up for the war effort. The upheaval of war
and the diminished value of human life during wartime would also, Hitler
believed, mute expected opposition. To make the connection to the war
explicit, Hitler's decree was backdated to September 1, 1939, the day
Germany invaded Poland.
Fearful of public reaction, the Nazi regime never proposed
a formal "euthanasia" law. Unlike the forced sterilizations,
the killing of patients in mental asylums and other institutions was
carried out in secrecy. The code name was "Operation T4,"
a reference to Tiergartenstrasse 4, the address of the Berlin Chancellery
offices where the program was headquartered.
Physicians, the most highly Nazified professional group
in Germany, were key to the success of "T-4," since they organized
and carried out nearly, all aspects of the operation. One of Hitler's
personal physicians, Dr. Karl Brandt, headed the program, along with
Hitler's Chancellery chief, Philip Bouhler. T-4 targeted adult patients
in all government or church-run sanatoria and nursing homes. These institutions
were instructed by the Interior Ministry to collect questionnaires about
the state of health and capacity for work of all their patients, ostensibly
as part of a statistical survey.
The completed forms were, in turn, sent to expert assessors
physicians, usually psychiatrists, who made up "review commissions."
They marked each name with a "+," in red pencil, meaning death,
or a "" in blue pencil, meaning life, or "?" for
cases needing additional assessment. These medical experts rarely examined
any of the patients and made their decisions from the questionnaires
alone. At every step, the medical authorities involved were usually
expected to quickly process large numbers of forms.
The doomed were bused to killing centers in Germany
and Austria walled-in fortresses, mostly former psychiatric hospitals,
castles, and a former prison — at Hartheim, Sonnenstein, Grafeneck,
Bernburg, Hadamar, and Brandenburg. In the beginning, patients were
killed by lethal injection. But by 1940, Hitler,
on the advice of Dr. Werner Heyde, suggested that carbon monoxide gas
be used as the preferred method of killing. Experimental gassings had
first been carried out at Brandenburg Prison in 1939. There, gas
chambers were disguised as showers complete with fake nozzles in
order to deceive victims — prototypes of the killing
centers' facilities built in occupied Poland later in the war.
Again, following procedures that would later be instituted
in the extermination camps,
workers removed the corpses from the chambers, extracted gold teeth,
then burned large numbers of bodies together in crematoria. Urns filled
with ashes were prepared in the event the family of the deceased requested
the remains. Physicians using fake names prepared death certificates
falsifying the cause of death, and sent letters of condolences to relatives.
Meticulous records discovered after the war documented
70,273 deaths by gassing at the six "euthanasia" centers between
January 1940 and August 1941. (This total included up to 5,000 Jews;
all Jewish mental patients were killed regardless of their ability to
work or the seriousness of their illness.) A detailed report also recorded
the estimated savings from the killing of institutionalized patients.
The secrecy surrounding the T-4 program broke down quickly. Some staff members were indiscreet
while drinking in local pubs after work. Despite precautions, errors
were made: hairpins turned up in urns sent to relatives of male victims;
the cause of death was listed as appendicitis when the patient had the
appendix removed years before. The town of Hadamar school pupils called
the gray transport buses "killing crates" and threatened each
other with the taunt, "You'll end up in the Hadamar ovens!"
The thick smoke from the incinerator was said to be visible every day
over Hadamar (where, in midsummer 1941, the staff celebrated the cremation
of their 10,000th patient with beer and wine served in the crematorium).
A handful of church leaders, notably the Bishop of
Münster, Clemens August Count von Galen, local judges, and parents
of victims protested the killings. One judge, Lothar Kreyssig, instituted
criminal proceedings against Bouhler for murder; Kreyssig was prematurely
retired. A few physicians protested. Karl
Bonhöffer, a leading psychiatrist, and his son Dietrich, a
Protestant minister who actively opposed the regime, urged church groups
to pressure church-run institutions not to release their patients to
In response to such pressures, Hitler ordered a halt to Operation
T-4 on August 24, 1941. Gas
chambers from some of the "euthanasia" killing centers
were dismantled and shipped to extermination
camps in occupied Poland. In late 1941 and 1942, they were rebuilt
and used for the "final
solution to the Jewish question." Similarly redeployed from
T-4 were future extermination camp commandants Christian Wirth, Franz
Stangl, Franz Reichleitner, the doctor Irmfried Eberl, as well as about
100 others - doctors, male nurses, and clerks, who applied their skills
in Treblinka, Belzec,
The "euthanasia" killings continued, however,
under a different, decentralized form. Hitler's regime continued to
send to physicians and the general public the message that mental patients
were "useless eaters" and life unworthy of life." In
1941, the film Ich klage an ("I accuse") in which a
professor kills his incurably ill wife, was viewed by 18 million people.
Doctors were encouraged to decide on their own who should live or die,
Killing became part of hospital routine as infants, children, and adults
were put to death by starvation, poisoning, and injections. Killings
even continued in some of Germany's mental asylums, such as Kaufbeuren,
weeks after Allied troops had occupied surrounding areas.
Between the middle of 1941 and the winter of 1944-45,
in a program known under code "14f13," experienced psychiatrists
from the T-4 operation were
sent to concentration camps to weed out prisoners too ill to work. After superficial medical screenings,
designated inmates Jews, Gypsies,
Russians, Poles, Germans, and others were sent to those "euthanasia"
centers where gas chambers still had not been dismantled, at Bernburg
and Hartheim, where they were gassed. At least 20,000 people are believed
to have died under the 14f13 program.
Outside of Germany, thousands of mental patients in
the occupied territories of Poland,
Russia, and East Prussia were also killed by the Einsatzgruppen squads (SS and special police
units) that followed in the wake of the invading German army. Between
September 29 and November 1, 1939, these units shot about 3,700 mental
patients in asylums in the region of Bromberg, Poland. In December 1939
and January 1940, SS units
gassed 1,558 patients from Polish asylums in specially adapted gas
vans, in order to make room for military and SS barracks. Although regular army units did not officially participate
in such "cleansing" actions as general policy, some instances
of their involvement have been documented.
In all, between 200,000 and 250,000 mentally and physically
handicapped persons were murdered from 1939 to 1945 under the T-4 and other "euthanasia" programs. The magnitude of these crimes
and the extent to which they prefigured the "Final
Solution" continue to be studied. Further, in an age of genetic
engineering and renewed controversy over mercy killings of the incurably
ill, ethical and moral issues of concern to physicians, scientists,
and lay persons alike remain vital.