The term "euthanasia" (literally, "good death") usually refers to the inducement of a painless death for a chronically or terminally ill individual who would otherwise suffer. In the Nazi context, however, "euthanasia" was a euphemism for a clandestine murder program of disabled patients living in institutional settings in Germany and German-annexed territories. The program was Nazi Germany's first policy of mass murder. Like those who planned the genocide of European Jews, the organizers of the "euthanasia" program imagined a racially pure and productive society and embraced radical strategies to eliminate those who did not fit within their vision.
On August 18, 1939, the German government issued a decree compelling medical personnel to report newborns and children under the age of three with severe disability. In October 1939, authorities began to encourage parents of children with disabilities to admit them to pediatric clinics. The clinics were in reality killing wards where specially recruited medical staff murdered their young charges by lethal overdoses or by starvation. The killing program eventually included juveniles up to 17 years of age. Planners quickly extended the killing program to institutionalized adults. In autumn 1939, Adolf Hitler signed a secret authorization to protect participating personnel from prosecution. Its functionaries called their secret enterprise "T4." T4 operatives established six gassing installations. Within hours of arrival at such centers, the victims perished in gas chambers, disguised as shower facilities, utilizing pure carbon monoxide gas. T4 functionaries burned the bodies in crematoria. Workers then took the ashes of cremated victims from a common pile and placed them in urns to send to relatives, along with a certificate listing a fictive cause of death.
In view of widespread public knowledge and protests, Hitler ordered a halt to the program in August 1941. Nevertheless, in August 1942, German healthcare workers resumed the murders. The renewed effort relied closely upon local authorities and employed lethal injection and starvation as more covert means of killing. In the German-occupied East, SS and police units also murdered tens of thousands of disabled patients in mass shootings and gas vans. Planners of the “Final Solution” drew on the gas chambers and crematoria, specifically designed for the T4 campaign, to murder Jews. T4 personnel who had shown themselves reliable in this first mass murder program later figured prominently among the German staff stationed at the killing centers of Belzec, Sobibor, and Treblinka. The murder program continued until the last days of the war, expanding to include geriatric patients, bombing victims, and foreign forced laborers. Historians estimate that the "euthanasia" program, in all its phases, claimed the lives of 200,000 individuals.