As I have already mentioned, Aktion T4 was implemented in two very different jurisdictions – Greater Germany (Germany + Austria) and German-occupied territories of Europe and the Soviet Union (the latter was not exactly Europe).
Thus the actual processes of the implementation of the euthanasia program (i.e. of mass murders) were vastly different. And even in the Nazi Germany proper the processes for euthanizing children and adults were vastly different.
The process in the occupied territories was simple and straightforward – members of Einsatzgruppen entered the mental hospitals, hauled all patients outside and either shot them (usually) or packed them into gas vans.
Or sometimes (e.g. in Mogilev) hermetically sealed the hospital room and pumped lethal gas inside. No individual records were created – only the total number of the euthanized was included in the reports sent to RSHA headquarters.
Greater Germany lived by a very different system of laws; hence there Aktion T4 followed (or pretended to follow) some resemblance of due process. Adolf Hitler was fond of children hence euthanasia of the latter followed the most thorough and detailed process.
Doctors and midwives together with maternity hospitals, obstetric departments and children’s hospitals, were required to report in writing to the appropriate health authorities all newborns suffering from one or more mental or physical conditions on the list of certain congenital disorders considered to be both grave and incurable.
The district doctors sent the completed registration form to the National Committee where Office IIb of the Reich Chancellery (which managed Aktion T4) – more specifically, its two medical laymen, Hans Hefelmann and his deputy, Richard von Hegener, screened out cases that they considered should not be sent to a “Special Children’s Ward”, i.e. which meant that the children in question should be spared from euthanasia.
For the professional assessment of those who were not screened out (roughly 20% of the total), three experts were appointed by the National Committee who had been heavily involved in the preparatory committee, namely Werner Catel, Hans Heinze and Ernst Wentzler.
These three received the registration forms in sequence, so that the third expert knew the assessment of his two predecessors (a gross violation of generally accepted diagnostic procedures).
The decision over life or death of the child was taken only on the basis of the reporting form, without the experts having seen the child’s medical records nor the child in person (another horrendous violation of generally accepted diagnostic procedures).
If a child was assessed as a euthanasia case, the reviewers gave him or her a red “+” and conversely a blue “-” if he or she was screened out. If no clear decision was possible from the perspective of the evaluators a “B” for Beobachtung (“observation”) was entered.
The “B-marked” children were temporarily reprieved of euthanasia, but still committed to a “Special Children’s Ward” (a child euthanasia center). Following closer examination the local doctor then had to make an appropriate observation report to the National Committee.
The decisive criteria for a “positive” assessment were (obviously) the child’s projected work and education disability. According to a statement by the senior doctor, Walter Schmidt, who ran the “Special Children’s Ward” of the Eichberg Mental Hospital, 95% of children assigned to the ward came marked “treat”, a euphemism for the euthanasia. Only the remaining 5% were further investigated.
Included on these forms was a section indicating the race of the patient, for which ‘Jew’ could be entered if applicable (which amounted to death sentence).
The fundamental principle of due process for the minors required obtaining permission from the parents of the child in question. The latter, however, were deliberately misled about the actual purpose of the referral (as in most cases no sane parents would agree to let their child be killed). Parents were tricked into believing it was for the special care and treatment of their children in specially equipped medical facilities.
It is very important to note that no parents were forced to commit their children to “Special Children’s Wards” – the Nazis used deception and manipulation, not coercion.