Implementation
Although officially started in September 1939, Action T4 might have been initiated with a sort of trial balloon; in late 1938, Adolf Hitler instructed his personal physician Karl Brandt to evaluate a family's petition for the "mercy killing" of their blind, physically and developmentally disabled infant boy. The boy was eventually killed in July 1939. Hitler also instructed Brandt to proceed in the same manner in similar cases. The foundation of the Reich Committee for the Scientific Registering of Hereditary and Congenital Illnesses in order to prepare and proceed with the massive secret killing of infants took place in May 1939 and the respective secret order to start the registration of ill children, took place on 18 August 1939, three weeks after the murder of the mentioned boy.
Hitler was in favour of killing those whom he judged to be "unworthy of life". In a 1939 conference with health minister Leonardo Conti and the head of the Reich Chancellery, Hans Lammers, a few months before the euthanasia decree, Hitler gave as examples of "life unworthy of life" severely mentally ill people who he believed could only be bedded on sawdust or sand because they "perpetually dirtied themselves", or who "put their own excrement into their mouths, eating it and so on".
Both his physician, Dr Karl Brandt, and the head of the Reich Chancellery, Hans Lammers, testified after the war that Hitler had told them as early as 1933, at the time the sterilisation law was passed, that he favoured killing the incurably ill, but recognised that public opinion would not accept this. In 1935, Hitler told the Reich Doctors' Leader, Dr. Gerhard Wagner, that the question could not be taken up in peacetime: "Such a problem could be more smoothly and easily carried out in war", he said. He intended, he wrote, "in the event of a war radically to solve the problem of the mental asylums". The outbreak of war thus opened up for Hitler the possibility of carrying out a policy he had long favoured.
The war also gave this issue a new urgency in the eyes of the Nazi regime. People with severe disabilities, even when sterilised, still needed institutional care. They occupied places in facilities which, during war, would be needed for wounded soldiers and people evacuated from bombed cities. They were housed and fed at the expense of the state, and took up the time of doctors and nurses. The Nazis barely tolerated this even in peacetime, and few would continue to support allowing it in wartime. As a leading Nazi doctor, Dr. Hermann Pfannmüller, said: "The idea is unbearable to me that the best, the flower of our youth must lose its life at the front in order that feebleminded and irresponsible asocial elements can have a secure existence in the asylum".
Even before the Nazis came to power, the German eugenics movement had an extreme wing, led by Alfred Hoche and Karl Binding, who as early as 1920 had advocated killing those with lives judged to be "life unworthy of life" (lebensunwertes Leben). Germany in the years after World War I was particularly susceptible to ideas of this kind. They interpreted Darwinism to suggest that a nation must promote the propagation of "beneficial" genes and prevent the propagation of "harmful" ones. Lifton notes: "The argument went that the best young men died in war, causing a loss to the Volk of the best available genes. The genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration". The government, the eugenicists argued, must intervene to prevent this.
These views had gained ground after 1930, when the Depression caused sharp cuts in funding to state mental hospitals, creating squalor and overcrowding. Most German eugenicists were already strongly nationalist and anti-Semitic, and embraced the Nazi regime with enthusiasm. Many were appointed to positions in the Health Ministry and German research institutes, and their ideas were gradually adopted by the majority of the German medical profession, from which Jewish and communist doctors were soon purged.
During the 1930s, the Nazi Party carried out a campaign of propaganda in favour of "euthanasia". The National Socialist Racial and Political Office (NSRPA) produced leaflets, posters and short films to be shown in cinemas, pointing out to Germans the cost of maintaining asylums for the incurably ill and insane. These films included The Inheritance (Das Erbe, 1935), The Victim of the Past (Opfer der Vergangenheit, 1937), which was given a major premiere in Berlin and was shown in all German cinemas, and I Accuse (Ich klage an, 1941), which was based on a novel by Dr Helmut Unger, a consultant for the child euthanasia program. Catholic institutions, which could be expected to bitterly resist the killing of their patients, were progressively closed and their inmates transferred to already overcrowded state institutions, where the squalid conditions provided further ammunition for campaigns in favour of euthanasia.
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