Implementing Ideology: Hitler’s Secret Euthanasia Program

Implementing Ideology: Hitler’s Secret Euthanasia Program

Patrick Gage

Patrick Gage is a junior studying International History in the School of Foreign Service at Georgetown University.  A dedicated abolitionist, he has spoken about human trafficking at the White House, United Nations, U.S. Capitol, and Vatican, co-chairs the Nexus Human Trafficking and Modern Slavery Working Group, and serves on the Scalabrini International Migration Network’s Advisory Board and Nomi Network Board of Directors.  He is also developing several initiatives related to hotels, which sex traffickers often use as points of transaction.  In addition Patrick has written extensively about American politics, possesses considerable academic research experience, and is fluent in Brazilian Portuguese.


Every political movement begins with an all-encompassing philosophy from which doctrines emerge and maxims take shape. Germany’s National Socialists were no exception. With Mein Kampf their scripture, the Nazis rose to prominence in the late 1920s and early 1930s, dominating German political thought for nearly two decades. The party’s rise begs a critical question, one asked of all governments: Did the ideology match the implementation, that is, did Hitler’s beliefs inform the policies he pursued as Führer? Surprisingly, academics disagree, with some going so far as to deem Nazi ideology “meaningless”; according to the likes of Eugen Weber, Hitler “came to power in spite of it and, once in power […] never really carried [it] out.”[1] In answering these critics, one must consider National Socialism and the deeds it inspired.

Nazi doctrine, as defined in Mein Kampf, addressed myriad political issues, from education and the economy to militarization and expansion. Nevertheless one principle in particular – racial hygiene – formed the crux of Hitlerian thought. The desire to purify German blood inspired the Führer’s philosophy and governed his vision of the perfect State. As such, with respect to ideology, this investigation shall focus on race, a cornerstone of German National Socialism. As for a case study – a policy consistent with Hitler’s pursuit of Aryan purity – one in particular stands out.

The Nazis’ covert euthanasia program played a crucial role in their ‘purification’ of Germany, silently destroying ‘life unworthy of life.’ Rather than targeting Jews, it singled out mentally and physically handicapped Germans who ‘befouled’ Aryan blood by spreading disease in future generations (via their offspring). Euthanasia, cheap and easy, ensured the cripple did not “perpetuate his misery in the body of his child.”[2] In Hitler’s mind, exterminating such people “cleansed” German blood and checked its “further bastardization.”[3] Accordingly, ‘mercy-killing’ presents a compelling case in favor of this paper’s thesis.

The presented analysis, which focuses on German National Socialism’s ideological obsession with racial hygiene and euthanasia, clearly answers the question posed above. The realities of Nazi ‘mercy-killing’ prove Hitler’s ideals informed the policies he pursued after rising to power.

Before examining the Führer’s euthanasia program, one must justify his supposed racial focus. Fortunately, the man’s words make that task fairly simple.

For Hitler, race meant everything. The State was not “an assembly of commercial parties in a certain prescribed space for the fulfillment of economic tasks,” but rather “the organization of a community of physically and mentally equal human beings for the better possibility of the furtherance of their species.”[4] It was, according to Nazi ideology, an engine of purification, nothing more, nothing less: “The folkish State has to make up for what is today neglected in this field in all directions. It has to put the race into the center of life in general. It has to take care for its preservation in purity.”[5] To be clear,


“The State is a means to an end. Its end is the preservation and the promotion of a community of physically and psychically equal living beings […] States that do not serve this purpose are faulty specimens, even miscarriages […] Thus the highest purpose of the folkish State is the care for the preservation of those racial primal elements which, supplying culture, create the beauty and dignity of a higher humanity. We, as Aryans, are therefore able to imagine a State only to be the living organism of a nationality which not only safeguards the preservation of that nationality, but which, by a further training of its spiritual and ideal abilities, leads it to the highest freedom.”[6]


In simpler terms, Hitler cared almost exclusively about ensuring the propagation of sound racial stock; economic growth, prioritized by most political leaders, was only useful insofar as it bolstered Germany’s drive toward racial utopia. Thus, in a country that emphasized national purity above all else, killing disabled individuals seemed reasonable, even good. It was only a matter of time before Nazism met the syringe.

Hitler’s eventual support for a centralized euthanasia program was not unique. On the contrary, the concept of ‘mercy killing’ as justifiable medical procedure found its origin in the late nineteenth and early twentieth centuries, when ‘scientific racism’ plagued much of the international medical community.[7] With the rise of eugenics in the Western world, euthanasia became a key point of contention.

The suggestion that doctors should terminate incurable patients gained popularity in German intellectual circles around 1900. Swayed by a strong sense of nationalism and deeply influenced by Social Darwinism, academics stressed “the integrity of the organic body of the Volk – the collectivity, people, or nation as embodiment of racial-cultural substance […] One views one’s group as an ‘organism’ whose ‘life’ one must preserve, and whose ‘death’ one must combat, in ways that transcend individual fate.”[8] This idea, also advanced by Hitler – “We, as Aryans, are therefore able to imagine a State only to be the living organism of a nationality”[9] – emphasized submission and justified euthanasia (in that it made protecting Germany the highest possible good). Anything, regardless of ethics, was acceptable so long as it contributed to the wellbeing of the German Volk (people or ‘nation’). Medical theorists seized on the idea.

In 1895, German thinker Alfred Jost published The Right to Death, in which he called for “direct medical killing” and concluded that control over patients’ lives belonged to the State.[10] In essence, political bureaucrats could kill patients with or without their consent. Intellectuals embraced Jost’s contentions, shocking though they were to Anglo-American sensibilities (the United States, however, had no problem with forced sterilization). Euthanasia, far from being barbaric, protected the State and ensured its racial/national purity.

Following World War I, arguments in favor of euthanasia grew stronger. German professor Alfred Hoche, a leading proponent of “medical killing,” claimed many of those possessing the “best available genes” had fought and died at Allied hands.[11] Those who had not died, presumably possessing ‘the worst genes,’ were thus left with the task of birthing Germany’s next generation. The professor looked to euthanasia as a means of purifying the nation’s soiled gene pool and protecting Germany’s long-term health.

In 1920, Hoche and another well-known German professor, Karl Binding, published The Permission to Destroy Life Unworthy of Life.[12] In it, they went even further than Jost, expanding the definition of “unworthy life” to include the permanently handicapped – “ballast lives” and “empty human husks.”[13] Hoche and Binding concluded euthanasia was “an allowable, useful act.”[14]

Medical scholars like Jost, Hoche, and Binding clearly influenced Nazi thought. Although he never directly addressed euthanasia in Mein Kampf, Hitler implicitly communicated his willingness to pursue such a program time and again: “The prevention of the procreative faculty and possibility on the part of physically degenerated and mentally sick people […] would not only free mankind of immeasurable misfortune, but would also contribute to a restoration that appears hardly believable today.”[15] Furthermore, the State had a responsibility to “declare unfit for propagation everybody who is visibly ill and has inherited a disease and it has to carry this out in practice.”[16] While these passages deal with sterilization, it would be naïve to think Hitler did not also consider more cost-effective methods like euthanasia.

By the early 1930s, Berlin’s future support for ‘mercy-killing’ began to materialize. According to Karl Brandt, the Führer’s doctor, “Hitler decided even before 1933 that he would one day try to eliminate the mentally ill.”[17] On becoming chancellor, he made his goal abundantly clear: “The measures for racial hygiene that are now being implemented may show their full effect only after centuries. What we have to do today is build a firm foundation for the genetic development of the nation.”[18]

Hitler did not clarify his opinion on euthanasia – namely how and when such a program would be implemented – until the 1935 Nazi Party Congress in Nuremberg. At that meeting, Reich Doctors’ Leader Gerhard Wagner presented a speech in which he reviled the theory of human equality, claiming it “led one ‘to value the sick, the dying, and the unfit on a par with the healthy and the strong’” and lamented the fact that the population of “inferiors” was growing more rapidly than that of Germany as a whole.[19]

Wagner’s solution – mass killing – matched one Hitler himself had pondered for some time. The Führer subsequently pledged to “‘take up and carry out the questions of euthanasia’ in the event of a war. He was [per Brandt] ‘of the opinion that such a problem could be more smoothly and easily carried out in war’ […] He intended, therefore, ‘in the event of a war radically to solve the problem of the mental asylums.’”[20] During peacetime, the German public simply would not have allowed Hitler to approve such a controversial program. In the midst of conflict, however, he believed resistance would be weak.

Encouraged by the Führer’s private endorsement, Wagner “pushed forward discussions on how the population should be prepared for such action.”[21] The Nazis soon began indoctrinating Germany’s medical profession, which supported the party in droves.[22] While Jewish students were discharged from the medical school in Vienna, physicians across Germany “had to endorse race hygiene as the basis for direct medical killing, justified by the concept of ‘life unworthy of life’” in order “to obtain a civil or military post.”[23] Thus, when Hitler acted, Germany’s doctors would stand behind him.

Hitler’s catalyst came in the fall of 1938, when he received a letter from the father of a handicapped child asking for permission to have his son euthanized. Upon reading the letter, the Führer sent Karl Brandt to the University of Leipzig, where the boy was staying, to assess the situation.[24] Brandt said the following about his orders: “If the facts given by the father were correct, I was to inform the physicians in [Hitler’s] name that they could carry out euthanasia.”[25] Furthermore, he was to assure the doctors that if they chose to euthanize the child, their actions, though illegal, would not be prosecuted. Upon arriving in Leipzig, Brandt confirmed the child’s deformed state; born “blind, retarded, and without an arm and a leg,” he was subsequently euthanized.[26]

Upon hearing of the operation’s success, Hitler instructed Brandt to “appoint an advisory committee to prepare for the killing of deformed and retarded children.”[27] In May 1939, Brandt relayed this information to Hans Hefelmann, who would run the office responsible for the child euthanasia program. Managed by Hitler’s Chancellery, the operation proceeded under the auspices of a ‘Committee for the Scientific Treatment of Severe, Genetically Determined Illness.’[28] It was to remain a secret; no one, other than those directly involved (supportive physicians along with high-ranking leaders like Hitler, Brandt, and Hefelmann) were to know what was happening.

The committee, bearing a seemingly innocuous name (note the word ‘treatment’), quickly distributed a report to “all state governments” demanding midwives and doctors record the names of children born with “congenital deformities” and register them with “local health authorities.”[29] As lists made their way to Hefelmann’s office, pediatricians and psychiatrists like Ernst Wenztler, Hans Heinze, and Werner Catel marked patients with pluses or minuses. The former were euthanized and the latter were spared. By the end of the war, the program had overseen more than 5,000 murders.[30]

Tragically, child euthanasia represented a mere fraction of Hitler’s secret program. “No later than July [1939],” the Führer asked Dr. Leonardo Conti, who had recently been appointed Reich Health Leader and State Secretary for Health in the Reich Ministry of the Interior, to “investigate the feasibility of [an adult euthanasia] programme.”[31], [32] Karl Brandt and Philipp Bouhler, both involved in the child euthanasia program, replaced Conti a few weeks later.[33] Together they created three strategically named organizations to carry out the operation: the Reich Association, Hospital, and Nursing Establishment, “which located patients by the use of questionnaires”; the Charitable Foundation for Institutional Care, “which handled finances for the project”; and the Non-Profit Patient-Transport Corporation, “which moved the patients to the euthanasia institutions.”[34]

Hitler’s T-4 program, named for the Non-Profit Patient-Transport Corporation’s headquarters, euthanized its first victims during Germany’s 1939 invasion of Poland; at the time, most were shot, not poisoned. In January 1940, however, Brandt, Bouhler, Conti, and Viktor Brack, who officially managed the adult euthanasia program, met near Berlin to discuss alternative methods of execution.[35]. [36] Upon witnessing the successful use of carbon monoxide on a group of patients, they decided to employ gas in all subsequent procedures.

In October 1939, after two months of killing and in an effort to convince collaborators that their actions were legitimate (despite their illegality), Hitler signed a document that, though never promulgated and lacking legal force, officially authorized the deaths of Germany’s ‘incurables.’ The letter, backdated to September 1 “to emphasize that war would not only alter the international status of the Reich but also herald ‘domestic purification,’” stated the following:


Berlin, 1. Sept. 1939

Reich Leader Bouhler and Dr. med. Brandt are charged with the responsibility of enlarging the competence of certain physicians, designated by name, so that patients who, on the basis of human judgment, are considered incurable, can be granted mercy death after a discerning diagnosis.

(signed) A. Hitler.[37]


In the same month, “euthanasia applications” were sent to psychiatric institutions for the first time.[38] Similar to the child euthanasia program, ‘applicants’ were either sentenced to death or spared. Throughout Germany, those selected by their asylums were put to death. Physicians and nurses, none of whom were under pressure to participate, executed thousands of patients. By the time sanctioned killings stopped in 1941, due in large part to intense scrutiny from religious communities, between 70,000 and 90,000 adults and children had been murdered.[39], [40] Yet the program’s demise did not deter local doctors. Though Hitler immediately ceased central operations – his office relinquished direct responsibility for further deaths and gas chambers were shut down – psychiatric institutions continued euthanizing patients until the end of the war. In fact, “defunct” arms of the T-4 program assisted asylums long after 1941, providing transportation for victims and even supplying “the large quantities of sedatives used to overdose them.”[41] By some accounts, an additional 70,000 to 90,000 people were executed between 1941 and 1945.[42] All told, Hitler’s euthanasia program claimed more than 140,000 lives. Pediatrician Werner Catel said it best: “What we are doing here is murder.”[43]

Hitler advocated for euthanasia on economic and racial grounds. Considering his ideological background, the latter certainly took precedence.[44] As Michael Burleigh notes, though the program “was conceived as an economy measure, a means of creating emergency bed-space,” it mirrored “the linkages between ‘resettlement’ and murder later evident in the Holocaust.”[45] It was all a façade. The economy was but a tool, used to convince the few who challenged the program’s legality.

Regardless of what his subordinates thought, Hitler saw in the economic argument a means rather than an end. He had a much ‘nobler’ goal than financial gain: saving the German people. Hugh Gallagher accurately assesses the Nazis’ inspiration:


“In terms of the ‘racial hygiene’ practiced by the German medical community during the Nazi years, the physically deformed, the handicapped, and the mentally ill constituted a threat to the body of the Volk. These flawed people were thought to have infected the collective body of the German people, and they were to be dealt with the way a physician would deal with a pathogenic infection of an individual body – by isolation and disinfection.”[46]


Motivated as such, Hitler’s euthanasia program targeted handicapped Aryans rather than handicapped Jews, that is, it specifically sought to eliminate Germans who were considered gene pool cancers – those who would pass disease onto their offspring and dirty the nation’s blood. According to Nazi philosophy, “There is only one most sacred human right, and this right is at the same time the most sacred obligation, namely: to see to it that the blood is preserved pure, so that by the preservation of the best human material a possibility is given for a more noble development of these human beings.”[47] Hitler fulfilled that obligation, at least according to his definition. He saw to it that Aryan blood was preserved ‘pure.’

The methods by which Hitler attempted to cleanse Germany were brutal. His political ideology, rooted in the pursuit of racial hygiene, found its expression in a campaign of secret terror. Overshadowed by the Holocaust, the Nazis’ euthanasia program embodied everything the Führer cared about: purity, race, and domination. To those who claim Hitler did not implement Nazism when he came to power, I submit this poignant example.



[1] Eugen Weber, Varieties of Fascism: Doctrines of Revolution in the Twentieth Century (Malabar: Krieger Publishing Company, 1968), 10-11.

[2] Adolf Hitler, Mein Kampf: Complete and Unabridged, trans. John Chamberlain, et. al. (New York: Reynal and Hitchcock, 1941), 608.

[3] Ibid., 606.

[4] Ibid., 195.

[5] Ibid, 608.

[6] Ibid., 594-595.

[7] Robert Jay Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide (New York: Basic Books, 1986), 46.

[8] Ibid.

[9] Hitler, Mein Kampf, 595.

[10] Lifton, The Nazi Doctors, 46.

[11] Ibid., 47.

[12] Noack, Thorsten, and Heiner Fangerau, “Eugenics, Euthanasia, and Aftermath,” International Journal of Mental Health 36, no. 1 (2007), 116, accessed December 7, 2013,

[13] Robert Proctor, Racial Hygiene: Medicine under the Nazis (Cambridge: Harvard University, 1988), 181.

[14] Lifton, The Nazi Doctors, 47.

[15] Hitler, Mein Kampf, 609.

[16] Ibid., 608.

[17] Proctor, Racial Hygiene, 181.

[18] Hartmut M. Hanauske-Abel, “Not A Slippery Slope Or Sudden Subversion: German Medicine And National Socialism In 1933,” British Medical Journal 313, no. 7070 (1996): 1456, accessed December 7, 2013,

[19] Proctor, Racial Hygiene, 181.

[20] Ian Kershaw, Hitler: 1936-1945: Nemesis (London: The Penguin Press, 2000), 256.

[21] Ibid.

[22] Karl Kessler, “Physicians and the Nazi Euthanasia Program,” International Journal of Mental Health 36, no. 1 (2007): 4, accessed December 7, 2013,

[23] Naomi Baumslag, Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus (Westport: Praeger Publishers, 2005), 39.

[24] Lifton, The Nazi Doctors, 51.

[25] Ibid.

[26] Proctor, Racial Hygiene, 185-186.

[27] Ibid., 186.

[28] Ibid.

[29] Ibid.

[30] Kershaw, Hitler, 259.

[31] Henry Friedlander, The Origins of Nazi Genocide: From Euthanasia to the Final Solution, (Chapel Hill: The University of North Carolina Press, 1995), 64.

[32] Kershaw, Hitler, 259.

[33] Friedlander, The Origins of Nazi Genocide, 63.

[34] Jack S. Boozer, “Children of Hippocrates: Doctors in Nazi Germany,” Annals of the American Academy of Political and Social Science 450 (1980): 88, accessed December 7, 2013,

[35] Friedlander, The Origins of Nazi Genocide, 68.

[36] Proctor, Racial Hygiene, 189.

[37] Friedlander, The Origins of Nazi Genocide, 67.

[38] Proctor, Racial Hygiene, 189.

[39] Beth Griech-Polelle, “Image of a Churchman-Resister: Bishop von Galen, the Euthanasia Project and the Sermons of Summer 1941,” Journal of Contemporary History 36, no. 1 (2001): 42, accessed December 7, 2013,

[40] Kershaw, Hitler, 261.

[41] Michael Burleigh, Death and Deliverance: “Euthanasia” in Germany c. 1900-1945 (Cambridge: Cambridge University Press, 1994), 238.

[42] Kershaw, Hitler, 261.

[43] Götz Aly,Peter Chroust, and Christian Pross, Cleansing the Fatherland: Nazi Medicine and Racial Hygiene, trans. Belinda Cooper (Baltimore: The Johns Hopkins University Press, 1994), 31.

[44] According to Nazi officials, the euthanasia program “saved the German economy an average of 245,955.50 RM per day” (Proctor 184).

[45] Michael Burleigh, Ethics and extermination: Reflections on Nazi genocide (Cambridge: Cambridge University Press, 1997), 123.

[46] Hugh Gregory Gallagher, By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich (New York: Henry Holt and Company, 1990), 60.

[47] Hitler, Mein Kampf, 606.


Works Cited

Aly, Götz, Peter Chroust, and Christian Pross. Cleansing the Fatherland: Nazi Medicine and Racial Hygiene. Translated by Belinda Cooper. Baltimore: The Johns Hopkins University Press, 1994.

Baumslag, Naomi. Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus. Westport: Praeger Publishers, 2005.

Boozer, Jack S. “Children of Hippocrates: Doctors in Nazi Germany.” Annals of the American Academy of Political and Social Science 450 (1980): 83-97. Accessed December 7, 2013.

Burleigh, Michael. Death and Deliverance: “Euthanasia” in Germany c. 1900-1945. Cambridge: Cambridge University Press, 1994.

Burleigh, Michael. Ethics and extermination: Reflections on Nazi genocide. Cambridge: Cambridge University Press, 1997.

Friedlander, Henry. The Origins of Nazi Genocide: From Euthanasia to the Final Solution. Chapel Hill: The University of North Carolina Press, 1995.

Gallagher, Hugh Gregory. By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich. New York: Henry Holt and Company, 1990.

Griech-Polelle, Beth. “Image of a Churchman-Resister: Bishop von Galen, the Euthanasia Project and the Sermons of Summer 1941.” Journal of Contemporary History 36, no. 1 (2001): 41-57. Accessed December 7, 2013.

Hanauske-Abel, Hartmut M. “Not A Slippery Slope Or Sudden Subversion: German Medicine And National Socialism In 1933.” British Medical Journal 313, no. 7070 (1996): 1453-1463. Accessed December 7, 2013.

Hitler, Adolf. Mein Kampf: Complete and Unabridged. Translated by John Chamberlain, et al. New York: Reynal and Hitchcock, 1941.

Kershaw, Ian. Hitler: 1936-1945: Nemesis. London: The Penguin Press, 2000.

Kessler, Karl. “Physicians and the Nazi Euthanasia Program.” International Journal of Mental Health 36, no. 1 (2007): 4-16. Accessed December 7, 2013.

Lifton, Robert Jay. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic Books, 1986.

Noack, Thorsten, and Heiner Fangerau. “Eugenics, Euthanasia, and Aftermath.” International Journal of Mental Health 36, no. 1 (2007): 112-124. Accessed December 7, 2013.

Proctor, Robert. Racial Hygiene: Medicine under the Nazis. Cambridge: Harvard University Press, 1988.

Weber, Eugen. Varieties of Fascism: Doctrines of Revolution in the Twentieth Century. Malabar: Krieger Publishing Company, 1964.