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  • Writer's pictureIlka Knüppel

Who was chosen and why?

“By late 1939, the next phase of eugenic selection - euthanasia - had already commenced:  the period of sterilization was ending, the period of the killings had begun.”

 Friedlander, Henry, The Origins of Nazi Genocide, p. 30.

In October 1939, Hitler had instructed his personal doctor, Karl Brandt, and director of the Führer’s counsel, Phillipp Bouhler, to implement the planning for the killing of ‘life unworthy of living’ in a so-called euthanasia program. 

Karl Brandt

Phillipp Bouhler 

“What is interesting and important about the killing program is not the mad-dog killers, but rather the careful, orderly, and quite methodical manner by which the full German medical and scientific establishment proceeded to kill its patients over a period of years.”

Aktion T4 personnel calculated the future expenditures saved by killing the disabled. The T4 statistician figured that 70,273 ‘disinfections’ saved the German Reich 885,439,980 RM [Reich Marks] over a period of 10 years.  And the computation of savings of food saved by killing 70,273 patients saved 13,492,440 kilograms of meat and wurst

“With the reduction of the human being to one’s economic value the central criteria for the murder of disabled people was determined:  no or meager producing and the consumption of money, resources and labor.”

Hechler, “Diagnoses That Matter”, p. 12.

Based on an economic savings forecast, their team developed the following formula for their target number:


Of every one thousand people in the German Reich... ten needed psychiatric treatment.  Five of those were institutionalized.  One of those five was assumed to qualify for what was euphemistically called euthanasia.  In fact, it was murder.  That formula – 1000:10:5:1 – yielded between sixty-five and seventy-five thousand target cases in Germany.

The patient registration form that was developed to send to the institutions was short, one page, and included a question on whether the patient had non-Aryan blood.  By the summer of 1940, almost one thousand institutions in the Reich had received such reporting forms with a cover letter. 

Here are the selection criteria for the ‘unworthy of living’:

Prerequisites therefore:

  1. Incurable mental illness

  2. Not useful for productive communal life even within the asylum.  

All illnesses to be considered:

Schizophrenia (70% of the institutions)
Disease of the central nervous system through syphilis
Congenital feeble-mindedness 
Additional pathological changes
Senile illnesses are exempted for the present.

Registration form included former illnesses, as well as persons who have been in the asylum for 5 years.

Following approval of the prerequisites, photocopies go to Public Ambulance Service, Ltd. Patients to intermediate asylums, renewed observation.  Then to liquidation asylum, which is largely closed off from the outside world. Patient dies of fabricated causes; reason:  Fuhrer’s call for secrecy.  Death certificate.  Date and cause of death incorrect…. However, a true registry will be kept.

The forms were sent to all the mental institutions.  Questionnaires by the hundred poured into asylums.  However, asylum directors were not informed of the true purpose of this questionnaire: the cover letter told institution directors that filling out the forms was a necessary statistical measure and that a mass transfer of certain patients to other institutions might be necessary because of the wartime demand for medical facilities.

"Doctors" were hired to do the assessment of each patient by examination and evaluation of the form. Teams of medical evaluators examined the forms.  They marked with a red plus sign those people to be killed; they used a blue minus sign to specify who was to be left alive.

What follows is an actual evaluation form from the Bundesarchiv in Berlin.   The patient examined on this form received a red plus sign “+”.  

Tante Ruth had two strikes against her according to the selection criteria.  She would have had a checkmark next to “incurable mental illness” and, also, “been in the asylum for five years.

One of the other questions on the form was “Does the patient receive regular visits?”  Patients who had no visitors fared far worse on the evaluation forms.  Pre-war records that do exist at Neinstedt show a pattern of regular visits to Ruth by her family, both at the facility and visits home during the summer and Christmas Holidays.  The fragmentation of German society due to the war was massively exploited by the T4 organizers.  Was Ruth’s family able to continue their visits by train to Neinstedt and have Ruth home during the war?  We cannot know for certain since that portion of the medical records did not survive but there are letters discussing how visits all the way to 1939, so we assume they did as much as humanly possible.

There were anywhere from 26 - 50 doctors who evaluated the Aktion T4 forms. It is difficult for researchers to ascertain with certainty how many doctors actually participated because they used aliases to sign the forms.  The assessors “sent thousands of patients to their death following a simple signature.”  The assessors were paid for each form, so the more they reviewed, the higher their paycheck.

In Peter Chroust’s chapter “Selected Letters of Doctor Friedrich Mennecke” in Cleansing the Fatherland: Nazi Medicine and Racial Hygiene, Mennecke brags in a letter to his wife about how many Aktion T4 forms he has been able to complete in a short period of time.  In his November 26, 1941 letter, he writes he was able to complete 105 “examinations” on patients from 1:30 p.m. until 4:00 p.m. while taking a break to listen to a speech by the Foreign Minister of Nazi Germany Joachim Ribbentrop.  Not including the break to listen to the radio, that would translate to a patient ‘examination’ every 1.43 minutes.  Most of the letter is spent excitedly telling his wife about the food and the cost thereof: 

“At noon we took a break and ate in the officers’ mess (first class! Soup, boiled beef, red cabbage, boiled potatoes, apple compote – for 1.50 marks!), no ration coupons.”  

In response to my inquiry to Neinstedt if it were known which of the assessors reviewed the forms for Neinstedt institution (which would have included the form for Ruth) I received this email response: 

[Author’s translation] "From Tiergartenstraße 4 in Berlin, the headquarters of the ‘Èuthanasia’ murders, thousands upon thousands of registration forms were sent from the institutions and facilities in question to around forty mostly external so-called ‘experts’ who had been designated or who volunteered to do so. None of these doctors signed the registration form because that would of course have absolutely contradicted the desired, unconditional secrecy of this action. We only know more details from September 1941. From this point onwards, a so-called four-person ‘Expert Commission’ was active in ‘Central German institutions’. We know this from the Stasi interrogation protocols of one of these doctors who was arrested by the Stasi in 1964 and then interrogated for months in the Stasi prison in Berlin-Hohenschönhausen. Although we know that this commission was also active in Neinstedt, Thale and Wernigerode, which of these supposed ‘expert doctors’ was in the case of the Neinstedt institutions at the time unfortunately does not appear from these interrogations."

This means we do not know which doctor ‘assessed’ Ruth.  But we do know that the black outlined box under the heading “Dieser Raum ist freizulassen” (“This space must be left free”) on Ruth’s form would have been marked with a red plus.  They sent her first to Altscherbitz (intermediate asylum) and then to Bernburg (liquidation asylum.) 

Close up view of an example of a red plus on a selection form.

After the war, of course the doctors who participated in the selection process were quick to excuse their behavior.

Teletype from Jewish Telegraphic Agency.

Here are the stories of those "doctors" and their fates. Follow the links:

Heinrich Bunke - worked at Bernburg Killing Center.


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