Action T4: Correspondence with Families Concerning Deaths


The ‘Black Triangle’ was worn by Aktion T4 (Tiergartenstraße 4) officials. The name is taken from a villa in the Berlin district of Tiergarten which housed the operation headquarters.

In a previous post we talked about the correspondence from family members desperate to know the whereabouts of their loved ones and the form letter responses sent by the T4 committee in response. Soon after the transfer of a person from the institution to the so-called receiving center, a letter was sent to the family. Typed on the stationery of the hospital and signed by the doctor “handling” the case, this personalized form letter would announce with great sadness the death of the patient. The cause of death was explained, condolences offered,  suitable disposition of the remains discussed, and reminders issued that because the patient’s tormented life was now ended, loved ones could rejoice and be glad.

A typical example of a condolence letter from one of the receiving centers:

My Dear Frau S . . . 

We are sincerely sorry to tell you that your daughter F. S., who had to be transferred to this institution in accordance with measures taken by the National Defense Commissioner, died suddenly and unexpectedly here of a tumor of the brain, on the 5th August 1940. The life of the decreased had been a torment to her on account of her severe mental trouble. You should, therefore, feel that her death was a happy release. As this institution is threatened by an epidemic at the present time, the police have ordered immediate cremation of th body. We would ask you to let us know to what cemetery we may arrange for the police to send the urn containing the mortal remains of the deceased. Any inquiries should be addressed to this institution in writing, visits being for the present forbidden as part of the police’s precautions against infection.

Dr. Koller

And another similar letter from a different receiving institution . . .

My dear Doctor  _______:

We regret to inform you that your son, who had to be transferred to our institution, has died here unexpectedly as a result of abscessed tonsils on 17 February. We are sorry to say that all our medical efforts were in vain. He died quietly and without any pain. With his serious and incurable disease, death means relief for him.

Due to the present danger of epidemic here, the body of the deceased had to be cremated immediately according to police request. We are asking you to inform us at your earliest convenience whether you want the urn with the earthly remains interred at any special cemetery. In that case we ask you to name the cemetery and give its correct address so that we can have the urn transferred to the administration of that cemetery. If you have no special wishes as to the burying or if you fail to inform us within a month, we will have th turn buried here free of charge. The belongings of the deceased had to be burned due to the danger of spreading of disease.

We enclose two copies of the death certificate which you will carefully keep in order to submit eventually to the authorities.

Heil Hitler
by order

Dr. Meyer

T4 leadership insisted the letters be “personalized” to deflect suspicion and thwart an onslaught of questions from families. In a Top Secret document, local authorities were directed to keep the letters the same, but different – to alter form letters just enough to avoid irritation, suspicion, questions.

Cause of death proved a sticky wicket for T4 officials. To avoid questions and suspicions, physicians took great pains to find a cause of death suitable to the patient. A guide was developed by the T4 leadership committee for use by doctors and staff preparing death letters and certificates. A list of acceptable causes of death was made, complete with notes of things to keep in mind to ensure that the cause of death assigned and medical history of the patient were consistent. For example, septicemia (also called sepsis) was on the list of acceptable causes of death for the mentally ill, with cautionary notes to avoid using this particular illness as a cause of death if the patient was known to be meticulously clean. Sepsis was preferable for “young, strong patients who smear readily.”  The notes, fairly thorough in their scope, also cautioned that if septicemia was used as a cause of death, care should be taken to remember that “seven to eight days have to be allowed for the illness to take effect.”

In the Nuremberg trials, one T4 physician testified that it would not have looked right for carbon monoxide asphyxiation to be given as the cause of death for all the patients in his care. It would have been “unprofessional”, he said, indirectly suggesting that T4 physicians maintained their sense of propriety by lying, fabricating credible causes of death for the patients they murdered.

It makes my heart hurt, this kind of “logic” that allowed T4 physicians to feel noble, live with themselves, and sleep at night.

Also at the Nuremberg trials, the director of one of the receiving centers insisted that the killing program known as T4 was fully, absolutely legal. As a follow-up question he was asked, “If that was the case, why bother with false death certificates?” to which he replied, “I did not want to scare the population by not filling in a diagnosis. I could not put down on the death certificate, ‘We killed them.'”


  1. Lori East

    I cannot begin to understand what happens in a mind that rationalizes such deception in order to justify their actions. Again, I have only one word: vile.

    • whollyjeanne

      I think “vile” is the only appropriate word for this . . . until we invent a new one.

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