by Arthur L. Finkle
The program for killing adults with mental or physical disabilities began in October 1939. Hitler’s orders charged Philipp Bouhler and Karl Brandt with “enlarging the authority of certain physicians, to be designated by name, in such a manner that persons who, according to human judgment, are incurable, can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.”83 The order was backdated to September 1, 1939, in order to provide legality to the killings already carried out and to link the program more definitely to the war, giving it a rationale of wartime necessity.84 This move for Lifton proved that as early as 1933, Hitler knew that his plans were not going to be well received by the general public. It also added the intentionalist argument that Hitler meant to kill those he saw as “unfit” and “harmful” to German society whether a Jew or a mentally or physically disabled person. Hitler’s order, which provided the sole legal basis for the euthanasia program, was not a formal decree, which in Nazi Germany had the force of law. For this reason, Hitler deliberately bypassed Health Minister Conti and his department, which was held to be not sufficiently imbued with National Socialist ruthlessness and which therefore might have raised awkward questions about the legality of the program. Instead, it was entrusted to his personal agents Bouhler and Brandt.85 He chose these men because of their work with the children euthanasia program but also because he knew they would not raise objections to the program.
The program was administered by Victor Brack’s staff from Tiergartenstrasse 4 (street name) under the guise of the Charitable Foundation for Cure and Institutional Care, supervised by Bouhler and Brandt. Others involved included Dr. Herbert Linden, who had been heavily involved in the children’s program, Dr. Ernst-Robert Grawitz, chief physician of the SS, and August Becker, an SS chemist. These officials chose the doctors to carry out the operational part of the program. They were chosen for their political reliability, professional reputation, and known sympathy for radical eugenics. They included several physicians (Unger, Heinze, and Pfannmüller ) who had proven their worth and reliability in the child euthanasia program. The newest members were mostly psychiatrists such as Professor Carl Schneider, Professor Max de Crinis, and Professor Paul Nitsche. Heyde became the operational leader of the program, succeeded later by Nitsche. 
In early October all hospitals, nursing homes, old-age homes, and sanatoria were required to report all patients who had been institutionalized for five years or more, who had been committed as “criminally insane”, who were considered “non-Aryan”, or who had been diagnosed with any of a list of specified conditions such as schizophrenia, epilepsy, Huntington’s chorea, advanced syphilis, dementia, paralysis, encephalitis, and “terminal neurological conditions generally”. Many doctors and administrators assumed that the purpose of the reports was to identify inmates who were capable of being drafted for “labor service”. This misconception led many of the doctors and administrators, therefore, to overstate the degree of incapacity of their patients, to protect them from labor conscription, with fatal consequences. When some institutions, mainly in Catholic areas, refused to co-operate, teams of T-4 doctors, or in some cases Nazi medical students, visited them and simply compiled their own lists, sometimes in a very haphazard way. According to Christopher Browning, during this same time all Jewish patients were killed.
The Nazi euthanasia program was complex and often difficult to understand. Michael Burleigh, however, made it somewhat easier to comprehend in Ethics and Extermination: Reflections on Nazi Genocide. This collection of essays that Dr. Burleigh dealt with Nazi Genocide. His nine essays traced the development of the Nazi genocide and followed it though to its ultimate ending in the ‘Final Solution’. An important part of Burleigh’s argument in this book was the role of “psychiatry after the First World War” and the “interplay between economy measures and limited reform of psychiatry during the Weimar Republic.
In Death and Deliverance: ‘Euthanasia n Germany 1900-1945, Burleigh stressed the importance of understanding that Hitler enacted the euthanasia program to clear bed space for the upcoming war and for economic reasons. Most historians linked euthanasia to the creation of the Volksgemeinschaft and rightfully so. The Nazis used both eugenics and euthanasia to create the Volksgemeinschaft. Where Burleigh differed was the emphasis on the economic aspects and need for more doctors and bed space. Because the euthanasia program did not start until the outbreak of the war, Burleigh inferred that a major factor was the need for more doctors and bed space. From 1940 to 1941 over 70,000 people were murdered under the Action T4 plan (Seemann, Uwe). After the Third Reich ended the program, the killings continued in Nazi occupied institutions and care facilities until the end of World War II in 1945. This amounted to a death toll of approximately 300,000 human lives.
The war for Lebensraum in the East was ultimately about creating and sustaining the Volksgemeinschaft, so it was reasonable to believe that anything deemed as beneficial to the war effort would take precedence. As for the economic factors, timing was not so much an issue; regardless of when the war broke out, Hitler tried to save money by destroying “useless eaters.” It was a necessary step in the Nazi mind given the economic climate of the time. Burleigh did not say that the creation of the Volksgemeinschaft was not the main goal of the program. He simply stated that there were other factors involved. All these factors do, however, fit together and point to the same conclusion regardless of the primary motivation, murder.
Most historians who write on Nazi euthanasia did not mention any other factors when writing about the creation and implementation of the program. The creation of Volksgemeinschaft was the goal of Hitler and the Nazis. Euthanasia as well as eugenics were just steps in that process, albeit important steps. Most historians assumed the connection between “racial cleansing” and the construction of Volksgemeinschaft, which made Burleigh’s discussion of other factors so important, by simply stating that there were indeed other reasons. He also pointed to programmatic factors that might have been more convincing to many in the medical profession then ideological motions Racial cleansing was the goal of the euthanasia program, while these other issues may have been factors, they were not the primary reason for the program.