A-Infos (en) France, UCL AL #363 - History - Action T4: When Capitalist Barbarism Sorted Lives (ca, de, fr, it, pt, tr)[machine translation]

Eugenics, long before transforming into mass killings under Nazism, was 
conceived and applied as a tool of social management by the ruling 
classes. Experimented with in asylums and hospitals, it became, with 
Nazism, the laboratory for the Holocaust. But far from belonging solely 
to the past, this logic of sorting "useful" and "useless" lives is 
resurfacing today in health and old age policies. A feature article 
proposed by CHLEE, an anti-ableist collective. ---- The process that led 
to the genocide of European Jews, the massacre of Roma, homosexuals, 
civilians, politicians, and the disabled did not appear overnight. An 
ideology prefigured these horrors, emanating, among other things, from 
19th-century ideas: eugenics[1].

The working classes of the industrial era worried the bourgeoisie and 
the powers that be because of their revolutionary potential. Rural 
migrations to urban and industrial centers, appalling living and hygiene 
conditions, promiscuity, and the diseases that accompanied them 
(syphilis, tuberculosis, etc.) led doctors to think about health from a 
social and hygienic perspective in England, France, Germany, 
Switzerland, and Sweden, as well as in Denmark and the United States.

Psychiatric illnesses, "asocial" behavior, alcoholism, vagrancy, 
homosexuals, and Jews were seen as "burdens" on capitalist society. The 
overall idea was to transform modern man into a being who met the 
biological and racial criteria of the white man, devoid of physical or 
psychological "defects."

Demonization of Disability
In Nazified Germany, the eugenic theories prevalent for a century in 
Europe and the United States led to a policy of marginalization, then 
the massacre of people with disabilities. Beginning in 1933, the Nazi 
state apparatus launched a propaganda campaign to gain acceptance for 
the euthanasia of people with disabilities by presenting them as an 
economic and social burden. Posters, films, and school textbooks 
depicted the "cost" of the sick and contrasted their maintenance with 
the needs of a "healthy" society.

Films such as "Erbkrank" and "Ich Klage an," widely screened in 
theaters, called for the elimination of lives deemed useless and 
romanticized the euthanasia of the disabled. Asylum visits were 
organized to portray the sick as "monsters" to be eliminated. Even 
education participated in this propaganda, transforming mathematics into 
a tool for justifying eugenics. Thus, in the primary school textbook, 
one could find: "The construction of an insane asylum costs six million 
marks. How many new homes costing 15,000 marks could be built with this 
sum?"

This 1938 propaganda poster reads: "60,000 Reichsmarks is what the life 
of this person suffering from a hereditary defect costs the working 
class. Dear fellow citizens, this is also your money. Read the Neues 
Volk, the monthly publication of the NSDAP's racial policy office."
German Historical Museum
The Beginning of a Massacre
In order to combat "inferior" elements, the Nazi regime promulgated the 
so-called "Prevention of Hereditary Diseased Offspring" law on July 14, 
1933, which imposed compulsory sterilization for the sick (psychiatric, 
deaf, mute, etc.). It was implemented in early 1934, and 400,000 people 
were sterilized, most of them forcibly[2].

As for the most disabled-those unfit for work-whose lives were deemed 
"unworthy of living," special treatment was to be reserved for them. In 
October 1939, Hitler signed a secret document, backdated to September 1, 
authorizing the granting of a "Gnadentod" ("merciful death"). It stated: 
"[Doctors]may grant a merciful death to patients who have been deemed 
incurable according to the strictest possible assessment." The principle 
was to eliminate sick Germans who tarnished the purity of the Aryan race.

Aktion T4: Holocaust Laboratory
A secret project reporting directly to the Führer's Chancellery, Aktion 
T4, or Operation Euthanasia, was directed by Bouhler (a Nazi from the 
very beginning) and Dr. Karl Brandt (Hitler's personal physician) from 
the T4 Central Office (for Tiergartenstraße 4, "Zoo Street 4") in 
Berlin. Alongside propaganda campaigns, this operation was tasked with 
carrying out the extermination of physically and mentally disabled adults.

Forms were sent to treatment centers so that patients could be triaged 
and transferred by the T4 Central Office to euthanasia centers. Killing 
methods-gassing, food deprivation, injections-were tested on the 
disabled and reused in the Holocaust. Of the 500 Nazis supervising 
Aktion T4, 100 put their experiments into practice, eliminating Jews. 
This operation was officially stopped in August 1941 after its discovery 
by a section of the population and protests from the German clergy.

From the start of the war in 1939, hospitals were required to report 
children suffering from hereditary pathologies; 6,000 were killed with 
medication. It is difficult to estimate the number of people murdered, 
particularly because of death certificates: the killings were disguised 
as infectious diseases or deaths from natural causes. Until recently, 
the number of deaths in Germany was estimated at over 70,000. Since the 
opening of the East German archives, this number could be as high as 
300,000 disabled people in Germany, Austria, Poland, and what is now the 
Czech Republic.

In Germany, Hollerforden, a doctor specializing in brain research, used 
697 brains from people killed as part of Aktion T4[3]. Nazi medical 
experiments were also applied to disabled people, both living and dead.

As early as August 1941, some of the agents of Aktion T4 were redirected 
to Aktion 14f13. During this killing campaign, which lasted from April 
1941 to the end of 1944, thousands of inmates from the Buchenwald, 
Dachau, Ravensbrück concentration camps were selected by doctors based 
on medical criteria (the same forms as during Aktion T4). Patients, 
Roma, vagrants, Jews, prostitutes, politicians, and antisocials were 
gradually transferred to the T4 euthanasia program's extermination centers.

In 1944, patients were executed in extermination camps where they were 
held and which had gas chambers or used specially adapted trucks. In 
each asylum, a euthanasia policy was implemented for patients who were 
"untreatable." They were killed by drug overdose, malnutrition, or 
voluntary abandonment.

In France
Alexis Carrel, a collaborationist and innovative vascular surgeon who 
worked and gained recognition in the United States (Nobel Prize in 
1912), was the theoretician of eugenics in France. He published L'Homme, 
cet inconnu in 1935, in which we read: "The establishment through 
eugenics of a hereditary biological aristocracy would be an important 
step towards solving the great problems of the present day" (Gallica p. 
367). Carrel was able to disseminate his ideas in 1941 within the French 
Foundation for the Study of Human Problems, which Pétain entrusted him 
with the creation and direction of.

Pétainist France implemented a policy of systematic neglect towards the 
most vulnerable. The dietary restrictions imposed by the government, the 
lack of medical personnel, and Vichy's disinterest in people confined in 
psychiatric institutions caused a true silent tragedy. Between 1940 and 
1944, 45,000 psychiatric patients died of starvation due to deprivation 
in French psychiatric hospitals. The cases of Camille Claudel and 
Antonin Artaud are the most well-known. The elderly are not spared: 
50,000 die of hunger in hospices, according to historian 
Bueltzingsloewen[4].

This scale indicates the Rockwood clinical frailty score, often used in 
geriatrics. The values of 8 (total dependence and approaching the end of 
life) and 9 (terminal illness) are not shown.

Copyright-free
Relics of the past
The management of the COVID crisis today is reminiscent of the 
reorganization operation (see timeline): the use of a "frailty score" 
grid to decide who would have access to care led to a triage of 
patients. Mediapart revealed an internal document from the Perpignan 
hospital that addressed the issue of "triage" of patients, using the 
term "acceptable" deaths for "very old or multi-pathological 
patients"[5]. In April 2020, the High Council for Public Health adopted 
the ideas of the French Society of Anesthesia and Resuscitation and 
validated the use of the Rockwood frailty scale to legitimize the 
refusal of care to certain categories of the population, including 
people with disabilities.

Against a backdrop of declining access to care, France, like many 
Western countries in recent years, is currently debating in Parliament a 
bill aimed at legalizing euthanasia without naming it. Since disabled 
people are included in the euthanasia eligibility criteria in this bill, 
the social and medical context, the rise of the far right, and the 
revival of eugenicist ideas should raise questions about the ideological 
foundations truly underlying this bill[6]. The liberal press has already 
defended euthanasia on the grounds that it would save money[7].

While representations of disabled people-particularly in cinema-present 
their suicide as an altruistic act, and their living conditions continue 
to deteriorate, disabled people are seen as a burden on society. Their 
benefits are frozen, and they are increasingly monitored in the name of 
fraud[8]. Once again, the frenzy of production and eugenics combine to 
serve the interests of capital, disregarding so-called "unproductive" lives.

Collective for the Struggle and Disabilities for Equality and 
Emancipation (CLHEE)

Chronology: The Application of Eugenics in Nazified Germany
July 14, 1933: Adoption of a law on "the prevention of hereditarily ill 
offspring," known as the "sterilization law." August 18, 1939: Circular 
from the Ministry of the Interior requiring maternity wards and 
pediatric wards to report children under the age of three with 
malformations or mental illness. August 31, 1939: End of the 
sterilization program (approximately 400,000 people were sterilized, 
most against their will). September 21, 1939: Circular from the Ministry 
of the Interior ordered a census of all institutions treating "mentally 
ill, epileptic, and mentally deficient persons." October 1939, Hitler 
signed a secret document, backdated to September 1, 1939, authorizing 
the granting of a "merciful death" to patients deemed incurable. From 
1943 to 1945, the Nazi regime launched what it called "Aktion Brandt," 
or Operation Reorganization. Under the pretext of freeing up beds to 
treat wounded civilians and soldiers, hospitals were "relieved" by 
sacrificing the chronically ill, the elderly, and the disabled.

Validate

[1]For more details on eugenics, see our article from last month, 
"Eugenics: Genealogy of a Far-Right Obsession," Alternative libertaire 
No. 362, July-August 2025, 
https://www.unioncommunistelibertaire.org/?Eugenisme-Genealogie-d-une-obsession-de-l-extreme-droite.

[2]Benoît Massin, "From Eugenics to the Holocaust," Study Circle on 
Deportation and the Holocaust, December 16, 2008. 
https://www.cercleshoah.org/spip.php?article31&lang=fr

[3]Berstein Catherine, T4: A Doctor Under Nazism, 2014, documentary 
available on YouTube.

[4]Isabelle von Bueltzingsloewen, "Deaths from Starvation": Famine and 
Exclusion in France under the Occupation, Presses universitaires de 
Rennes, pp. 149-161, 2005.

[5]"Intensive care units prepare to triage patients to be saved," 
Mediapart, March 20, 2020. 
https://www.mediapart.fr/journal/france/200320/les-services-de-reanimation-se-preparent-trier-les-patients-sauver

[6]"We are not 'collateral damage'," CLHEE, September 26, 2023. 
https://clhee.org/2023/09/26/nous-ne-sommes-pas-des-dommages-collateraux

[7]Jérôme Cordelier, "Euthanasia would save 1.4 billion euros per year", 
Le Point, February 8, 2025. 
https://www.lepoint.fr/postillon/l-euthanasie-permettrait-d-economiser-1-4-milliard-d-euros-par-an-08-02-2025-2581832_3961.php. 
Pierre-Henri de Menthon, "What if assisted suicide was good for the 
Social Security accounts? ", Challenges, February 3, 2025. 
https://www.challenges.fr/economie/et-si-le-suicide-assiste-faisait-du-bien-aux-comptes-de-la-securite-sociale_597669

[8]"Bayrou plans to reduce aid for the elderly and disabled," 
L'Essentiel de l'éco, August 22, 2025, 
https://lessentieldeleco.fr/3117-bayrou-envisage-de-reduire-les-aides-aux-personnes-agees-et-handicapees.

https://www.unioncommunistelibertaire.org/?Aktion-T4-Quand-la-barbarie-capitaliste-triait-les-vies
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