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‘Life Unworthy of Life’: The Lessons of T4

Stephen Unwin delves deep into the intellectual traditions and cultural mindset that produced the Nazis’ ‘wild euthanasia’ of people with disabilities, and finds we have not yet put those prejudices to rest 

Aktion T4 personnel. Photo: Topfoto

‘Life Unworthy of Life’ The Lessons of T4

Stephen Unwin delves deep into the intellectual traditions and cultural mindset that produced the Nazis’ ‘wild euthanasia’ of people with disabilities, and finds we have not yet put those prejudices to rest 

Although eugenics was created in London and enthusiastically nurtured in America and Scandinavia, it was in Nazi Germany that it found its most appalling realisation. Indeed, the persecution, forced sterilisation and subsequent murder of as many as 275,000 “useless eaters” is one of the most overlooked chapters in the whole ghastly history of the Third Reich. 

The Germans were much influenced by the American eugenicists, and the Rockefeller Foundation bankrolled the new Kaiser Wilhelm Institute in Berlin (where Josef Mengele worked before being transferred to Auschwitz). C. M. Goethe, the wealthy leader of the California Genetics movement, was delighted to learn that, within a year of Hitler coming to power, 5,000 Germans a month were being forcibly sterilised, and praised a fellow eugenicist for helping to shape “the opinions of the group of intellectuals who are behind Hitler in this epoch-making programme”.

Similarly, the virulent American eugenicist, Harry H. Laughlin (himself epileptic), boasted that his Model Sterilisation Law had been adopted by the Nazis in their 1935 Racial Hygiene Law, while one American asylum director expressed concern that “the Germans are beating us at our own game”.

It was German academics, however, who really paved the way. In 1920, Karl Binding, a senior academic lawyer, and Alfred Hoche, a professor of medicine, had produced the bluntly titled polemic Permission for the Destruction of Life Unworthy of Life. In it, Binding declared that, in addition to the terminally ill and the seriously wounded, all “incurable idiots” should be killed. Such people, he insisted, are “absolutely pointless” and impose “a terrible heavy burden upon their relatives and society as a whole and their death would not create even the smallest gap – except perhaps in the feelings of their mothers or loyal nurses”. 

Hoche, meanwhile, insisted that they were “human ballast” without any “capacity for suffering” on “an intellectual level, which we only encounter way down in the animal kingdom”. To show pity was illogical, he argued, “for where there [is] no suffering, there can be no pity”. Above all, he emphasised the cost of looking after them, contrasting “the sacrifice of the dearest human good” with “the enormous care for existences that not only are devoid of value but even ought to be valued negatively”. He also expressed a ghoulish interest in the research that such slaughter would allow. 

Although demands in Weimar Germany for such drastic action were relatively rare, more common was support for sterilisation. Thus, in late 1932, the Prussian Health Council approved “limited medically supervised and voluntary sterilisation designed to stop the breeding of genetic defectives”, and the German Parliament permitted the same, just weeks before Hitler became Chancellor.

In 1933, the new National Socialist Government passed the Law for the Prevention of Offspring with Hereditary Diseases, which sanctioned the compulsory sterilisation of people suffering from nine supposedly heritable conditions: such action (the ‘Hitler cut’) was a sacrifice made by the “defective” for the good of all. Doctors were ordered to report all such cases and could be fined for failing to do so. As a result, as many as 400,000 adults (1% of people of child-rearing age) were sterilised, many forcibly, often with disastrous health consequences. 

An Aktion T4 propaganda poster

This action was popularised on the grounds of cost, with a poster claiming that a man “suffering from a hereditary defect” cost ‘the People’s Community’ 60,000 Reichsmarks during his lifetime, while school textbooks asked students to calculate the money to be saved if support was to be withdrawn: “An idiot in an institution costs around four Reichsmarks a day. How much would it cost if he has to be cared for there for 40 years?” Indeed, after the war, a document was found in which a Nazi statistician had “worked out that 70,273 ‘disinfections’ saved the Reich 885,439,980 marks over a period of 10 years and that Germany had been saved 13,492,440 kilograms of meat and wurst”. This equates to an astonishing £4 billion in today’s values. 

The Nazis were helped by the fact that many parents of disabled children accepted these arguments. Indeed, when one sympathetic director of an asylum for backward juveniles surveyed their parents, he was appalled to discover that 73% said they would support the “painless curtailment of the life of your child if experts had established that it was suffering from incurable idiocy”, and that half of those who disagreed thought euthanasia would be acceptable if the parents “were no longer in a position to care”. This, combined with growing support from doctors, educationalists, journalists, politicians, lawyers and academics, provided fertile ground for what was to follow. 

With the outbreak of the Second World War, the persecution escalated exponentially.

Hitler’s ‘top secret’ Euthanasia Decree stated that “after the most careful assessment of their condition… those suffering from illnesses deemed to be incurable may be granted a mercy death”. As a leading Nazi doctor 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 feeble-minded and irresponsible asocial elements can have a secure existence in the asylum”.

Under Aktion T4 (the programme was based at a confiscated Jewish villa at Tiergartenstrasse 4 in Berlin), those selected were systematically assembled and transported to six converted psychiatric hospitals. Initially, lethal injections were used but soon – at Hitler’s personal recommendation – carbon monoxide and poison gas were employed. These were often supplemented by gradual starvation as well as medical experimentation. 

Appallingly, the slaughter started with children (the first, Gerhardt Kretschmar, was murdered in response to a request by his father). By early 1941, at least 5,000 children, many only a few months old, with a wide range of conditions – ‘mongolism’, ‘idiocy’, cerebral palsy, and so on – had been assessed, registered and killed. Their parents were asked for consent and a panel of three ‘medical experts’ was convened to agree on the course of action. 

Deception and social pressure were increasingly deployed, however, and such “garbage children” were soon placed in so-called “special sections”, apparently to receive medical treatment, but instead packed-off to their deaths in buses (run by a commercial company) with windows painted grey, to spare the hard-working people of the Third Reich from distressing sights. Indeed, children living near Hadamar Castle referred to these buses as “murder boxes” and were heard teasing each other, saying: “You’re an idiot! You’ll be sent to bake.” Letters were dispatched to parents expressing regret that their child had died of “natural causes”, and inquiries were greeted with the blankest of denials.

Tens of thousands of adults with a wide range of disabilities – including, of course, learning disabilities – soon followed, and the accounts of these mass killings are harrowing. 

The victims were made to strip naked and ushered into gas chambers disguised as shower rooms; their bodies were quickly cremated, with any valuables stolen to help finance the programme. There are appalling stories of the sense of pride – and evident sadism – of the perpetrators, most of whom were medical professionals (with some eager volunteers). The stench from the crematoria was such that villages near the killing centres were soon worried. Following brave protests from some family members and leading churchmen, the adult programme was officially terminated in August 1941. 

Although the killing centres were mostly closed, the informal murder of the disabled – sometimes called ‘wild euthanasia’ – continued in different but equally dreadful ways, and was caught up in the much greater genocide of the Holocaust. The techniques perfected on the disabled, especially deception and poison gas, were soon applied to these much larger populations, and about a hundred of the personnel responsible for T4 – including the loathsome Christian Wirth, later Commandant at Treblinka – were transferred to the extermination camps being constructed in Poland, where their expertise was valued. Brains and other organs of the murdered (many of whom are still nameless) were preserved and used for lucrative research, some not being buried until 2001.

As if this catalogue of cruelty and murder wasn’t bad enough, many of those responsible never met justice and, where they did, the punishments tended to be lenient: 57% of those who faced trials were found not guilty, compared with just 24% of those accused of crimes against the Jews. Of those convicted, less than 2% received life sentences, compared with 11% for genocide. Only seven individuals were sentenced to death, and several went on to have distinguished medical careers.

This is partly a reflection of the status accorded to disabled people by the Allies, but it is also because their general intentions were acceptable – not just in pre-Nazi Germany, but in the homelands of the judges. As the disabled actress and artist Liz Crow puts it, the Nuremberg prosecutors “were confused about whether killing disabled people was a public service. The prevailing attitudes about disabled people, that they were inferior, pitiable and burdensome, defined their judgement”.

Eugenics and the Intellectuals

We must be careful not to draw simplistic parallels between the grotesque cruelties of the Third Reich and the very real, but much more nuanced, injustices faced by disabled people today. However, certain lessons can be drawn. 

The first is the way that this barbarism was supported by lawyers, university professors, and other respected professionals. We can too easily dismiss eugenics as pseudo-science, but that is not how it seemed at the time, with many people – including a large number of progressives – wanting to straighten out Kant’s “crooked timbers” of humanity and improve the health, happiness and prosperity of “the race”. In other words, the animus behind this campaign wasn’t confined to Nazi Germany, but was evident in advanced societies around the world between the two wars.

Furthermore, 1945 didn’t discredit eugenics, and many of its core beliefs endured. Indeed, the much-celebrated William Beveridge, the founder of Britain’s welfare state, was a committed eugenicist.

The long-stay hospitals, which were the destiny of so many people in post-war Britain and America, treated learning disability as a medical issue and were often appallingly badly managed – resulting in dehumanising, regimented and squalid living conditions. While the worst of these places were eventually closed down in the 1970s and 1980s, hardly a week goes by without new accounts of neglect, abuse and cruelty. The dreadful roll-call of places such as Winterbourne View, Muckamore Abbey, Whorlton Hall and so many others, should make us consider whether we have moved beyond the mentality that enabled the catastrophe of T4. The appalling catalogue of bullying and violence around the learning disabled suggests we live in a society which all too readily devalues the disabled and regards them as fair game.

Appallingly, such attitudes are not confined to the poorly educated and can be found in professional and academic circles. 

One example might be the philosopher Peter Singer’s statement in 1979 that “killing a disabled infant is not morally equivalent to killing a person. Very often it is not wrong at all”. This was based on his views on the relative capacities of animals. Another example is the geneticist Richard Dawkins who in 2020 tweeted: “It’s one thing to deplore eugenics on ideological, political, moral grounds. It’s quite another to conclude that it wouldn’t work in practice. Of course, it would. It works for cows, horses, pigs, dogs and roses. Why on earth wouldn’t it work for humans?” The fact that the breeding of physical characteristics in animals and plants is quite different from ensuring intellectual capacity in human beings is one objection; another is that eugenics has been tried and made absolutely no difference. It is astonishing that such eminent figures should be spreading such pernicious nonsense.

We also have to recognise just how deeply rooted is the popular prejudice against learning disabled people, not just among a handful of ‘look at me’ intellectuals. The fact that parents internalised the views of their child’s worthlessness demonstrates just how pervasive such attitudes can be. And acknowledging that the thinking behind T4 enjoyed popular support should give us pause. After all, this was an advanced society with an enviable reputation for medicine, science and social care with a population who had absorbed a culture of contempt to such an extent that it allowed these things to happen. 

The fact that the programme of murder was carried out by medical professionals – from nurses and junior doctors right up to the most senior academics and experienced physicians of the time, and in hospitals and other medical settings – offers us the second lesson.

We rightly praise the NHS and entrust our bodies to the expert care of its staff, but medical professionals are no more immune to prejudice, often unconscious, than the rest of us. The fact that the learning disabled have suffered disproportionately during the Coronavirus pandemic for reasons entirely unconnected to their condition should make us question medicine’s hierarchy of values. Especially worrying was the National Institute for Care Excellence’s early triage advice which identified learning disabilities as an underlying health condition. This was quickly changed when it was pointed out that a learning disability is not an illness, but it is troubling that it was issued in the first place. Even more concerning was the fact that ‘Do Not Resuscitate’ notices were slapped on learning disabled residents of care homes without consent being sought.

An Aktion T4 graveyard

Thus, in thinking about T4, we need to explore the extent to which our own medical professionals sometimes regard the learning disabled as in some sense lesser. 

Thirdly, we should examine how a cost-benefit analysis was used to vindicate the murders. For, although irrational hatred no doubt fuelled this assault, it was given social and political justification by the calculation which set expenditure on such people against their productivity and concluded that they were a net loss.

Now, while most disabled people are quite capable of working, and many are eager to do so, a minority are not. Indeed, people like my profoundly learning disabled son Joey will never hold down a job or pay tax, and will require frankly expensive care throughout his life. As a parent, I have often been made aware of the costs incurred and am reliably informed that the first question asked when local authorities (under dreadful financial pressures of their own) consider an application for support is financial. But T4 shows in the most vivid way imaginable that the moment an individual’s fundamental rights are subjected to a simple cost-benefit analysis, is the moment the gates of hell open wide. 

The final lesson that can be drawn, however, is more positive, more energising and more creative, albeit tinged with tragedy and dreadful pain. It can be found in the extraordinarily courageous opposition that took shape and, astonishingly, managed to stop the adult programme. This was partly possible because (unlike the Jewish or Romany experience) it wasn’t entire families that were destined for slaughter. But the opposition provided by a handful of brave and fiercely determined relatives with a few influential and largely Catholic churchmen, is a remarkable story of courage and principle which is not widely known. 

Today, we still see families heroically battling against the many injustices that they face. These range from the endless bureaucratic tedium of fighting local authorities for basic support, to the powerful crusades for justice led by the grieving families of too many disabled people who have died entirely preventable deaths, often in the hands of badly trained and managed health and care staff. The fact that mothers like Sara Ryan, whose son Connor Sparrowhawk drowned in a bath in an NHS assessment and treatment unit in 2013, were vilified and blamed by the authorities, shows that the days of gaslighting are hardly behind us. What these committed campaigners also show, however, is just how powerful the family’s voice can be, especially when allied with the lived experience of the learning disabled themselves.

From Antigone onwards, whenever the authorities are confronted by the passionate rage of real families suffering genuine injustice, they do, eventually, have to acknowledge their shortcomings and face up to the consequences.

What is required to ensure that T4 can never be repeated? And how will we know when its lessons have been learned and we can put its dreadful example behind us? I suspect that three things are required.

The first is cultural: above all, the understanding that having a disabled family member – especially one with learning disabilities – isn’t the worst thing imaginable, and that learning disabled people are valued human beings who have so much to offer the world. But healthcare professionals still talk about the ‘risks’ of having a child with Down’s Syndrome, and hateful terms such as ‘idiot’, ‘imbecile’, ‘retard’ and ‘moron’ remain in common parlance.

Language and representation needs to change radically if the disabled – especially (though not exclusively) those like my son who find it difficult to speak up for themselves – are to be granted the dignity, respect and affection that they so manifestly deserve. 

Then, we need to stop assessing people by their productivity and earning ability, and start to create a new sense of community and belonging. That will require a reshaping of our entire system of values, wherein we stop regarding intellectual achievement as the single most important quality a human being can have.

From Plato to this day, philosophers have struggled with the problem of ‘idiocy’, with a deep anxiety about whether people with limited rational capacity, certainly those lacking speech, can be admitted into the category of the ‘human’. In my experience, however, learning disabilities provide a powerful ‘alienation effect’, turning the assumptions of classical thought on its head and insisting that the best definition of a human being is the product of two human parents, and nothing to do with intellectual ability, speech or rational powers. In other words, as Hamlet put it, we need to learn that there are more things in heaven and earth than are dreamt of in our philosophy and the time has come to rethink some of our most cherished prejudices. 

Finally, we need to develop nothing less than a new social contract, to ensure that our fellow humans, whatever their frailties and differences, are not just protected but are given the best that society can offer them.

The moment an individual’s fundamental rights are subjected to a simple cost-benefit analysis is the moment the gates of hell open wide

The extraordinary achievements of modern medicine mean that far more disabled infants survive and such advances are to be welcomed. But, if we are to help people have a decent and happy life, we have to develop a new understanding of our shared experiences and responsibilities. Profound disabilities can be found in any family, class, educational background and ethnicity, and need to be accepted as fundamental: as Rosemarie Garland-Thomson shrewdly observed, “what we call disability is perhaps the essential characteristic of being human”.

The renewed interest in the enormous challenge of social care is largely dominated by concern for the elderly, but at least half of the recipients of care are, in fact, working age adults with disabilities. Families still provide the vast majority of unpaid support, with an incalculable impact on mental and physical health, let alone prosperity and quality of life.

And so what is needed, I increasingly think, is a re-articulation of society’s fundamental duties to those people whose physical or intellectual impairments limit their ability to make a ‘full’ economic contribution. No longer can they be seen as a burden that others are expected to carry. Instead, we must recognise that they are our brothers and sisters, our mothers and fathers, our daughters and sons. We are they and they are us. And this new social contract should be built on as firm legal foundations as a child’s right to an education, an adult’s access to medicine, or a citizen’s rights to legal protection. 

As we’ve seen, the human rights of disabled people still have to be fought for and protected. But this struggle is also a cultural one, in the way that disabilities are represented and described in the media, education and everyday life. We rightly celebrate the achievements of talented and remarkable disabled people, but that too re-emphasises the old metrics by which others fail.

We need a new way of celebrating, championing and supporting those who don’t win the races that the so-called meritocracy is so eager to set. We have a long way to go before our fundamental duties to the so-called losers are unquestioned: when everyone, whatever their condition, whatever their limitations, however profound their impairments, is granted full human dignity, in all settings and at all stages in life. And when we finally do, we may be able to say that we are free of the dreadful mindset that led to this publicly endorsed, legally enabled and professionally delivered programme of mass murder. 

The challenge is clear, but who is prepared to take the lead?

This article was first published in the November 2021 print edition of Byline Times

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