Although the public at large associates Nazi crimes with the death-camp guards and execution squads of East Europe, the contributors to Hitler's empire of death were, as Verena Christ reminds us in her new book, extraordinarily and appallingly diverse. Her subject is the mass murder of the mentally ill carried out under the bland euphemism Operation T-4, a so-called euthanasia program that would eventually claim the lives of 296,000 victims (as cited by Christ) throughout Europe by the war's end. A circle of government officials closely allied with Hitler recruited physicians and state health officials as accomplices to their murder of the disabled. From its beginning in the fall of 1939, T-4 was cloaked in secrecy. Its operatives employed an arsenal of deceptions to camouflage their actions, among them the creation of so-called transit centers to which patients designated for killing might be sent before their final, fateful trip to the killing centers.

Christ drills further down into T-4 perpetration by focusing on four physicians implicated in euthanasia at the state ministerial and transit center levels. All of them were indicted and prosecuted after the war in a Tübingen courtroom, charged with assisting in the murders of patients at the Grafeneck mental hospital in Württemberg. The four were Dr. Otto Mauthe, chief medical officer and medical reporter for the state interior ministry in Stuttgart; Dr. Max Eyrich, psychiatrist and pediatrician for the state of Württemberg; Dr. Alfons Stegmann, director of the mental hospital of Zwiefalten (which became a T-4 a transit center); and Dr. Martha Fauser, deputy director of the Zwiefalten facility. Offering a thick description of the careers of each physician, Christ argues that a criminal profile (Tätertyp) can be assembled for them, much as profiles have been developed for other categories of Nazi killers.

Drawing on acclaimed studies by historians Ulrich Herbert (Best [1997]) and Michael Wildt (Generation des Unbedingten [2003]), both of whom examined their mid-level perpetrators as a generational and ideological cohort, she proposes that a similar analysis discloses the common denominators shared by the four perpetrators she studies. Christ is particularly beholden to Wildt's notion of a “war youth generation” (Kriegsjugendgeneration), a theory based on the high percentage (74 percent) of Germans old enough to remember World War I but too young to participate in it, who later became involved in the crimes of the Reich Security Main Office (RSHA), the main executory organization of the Final Solution. According to Wildt, this war generation had experienced the stability of Imperial Germany and its negation through war, revolution, postwar upheaval, and hyperinflation. These traumatic experiences led to a “generational homogeneity” (214) among the war youth generation, breeding in them a cynical detachment from ethical compunctions and paving the road to their complicity in Nazi crimes. Christ argues that their encounters with World War I as young people predisposed each of her four doctors to participation in Operation T-4.

The scarring experiences of the war form one of the axes around which Nazi criminality turned. The other axis was Nazi ideology. During the Weimar Republic, a crassly utilitarian attitude conditioned by the privations of World War I crept into the attitudes of German medical professionals toward the incurably mentally ill. Although eugenics was a worldwide phenomenon at the time, in Germany it assumed the form of a unique metaphor, the Volkskörper (“body of the people”). Under the brutalizing influences of the war, the German medical profession—including German psychiatry—came to interpret medical treatment as seeking to cure the ailments of the German people as a collective organism. The good of the individual patient—a value dating back at least to the time of Hippocrates in fifth-century Greece—was subordinated to the health of society. The Volkskörper became a central idea of Nazi eugenics, ultimately underpinning Hitler's efforts to sterilize the mentally ill and, by 1939, murder them as “lives unworthy of life.” Christ shows that all four euthanasia doctors were advocates of Nazi eugenic policies, at the core of which lay nestled the animating concept of the people's body as the supreme value of medical intervention. The twin effects of World War I and Nazi eugenic ideology transvalued the Hippocratic Oath; the racial purity of the Volk, and not the well-being of the individual patient, became primary.

The transvaluation of medical ethics made possible by World War I is a general feature of the crimes committed by Christ's perpetrators. The author does try to balance her largely structural account of euthanasia criminality by examining situations at Grafeneck when perpetrators (such as Otto Mauthe) “were compelled to reconsider their behavior, in which the strict sequence of killing was interrupted and they were forced to make individual decisions” (15). This individualizing effort notwithstanding, her findings tend to favor structural factors over personal agency. In the end, Christ's subjects were led to their crimes by their commitment to treating the Volkskörper rather than patients as concrete, suffering human beings.

Some readers of Christ's book may be struck by her apparent belief that gender played little or no role in the motives of the one female killer she profiles, Martha Fauser. It should be noted that Christ is far from oblivious to gender in her approach to euthanasia crimes. In her Introduction she recapitulates the dramatic changes in scholars' views over the past forty years of the Holocaust's female perpetrators. Prior to the 1970s, the prevailing opinion was that women implicated in Holocaust crimes were either deviant sadists or unjustly accused. Today researchers acknowledge that numerous women were involved in Nazi crimes. For Christ, however—and this contention may be surprising for readers—many of the same theories that explain the motivations of male perpetrators apply equally to women. In short, the scarifying effects of World War I and the conviction that treatment of the Volkskörper required the annihilation of the mentally ill were as determinative of Martha Fauser's crimes as they were for those of her male counterparts.

From the standpoint of justice, the outcome of the 1949 Grafeneck trial and its sequels were disappointing. Mauthe and Stegmann were convicted of aiding and abetting murder and Fauser of manslaughter while Eyrich was acquitted. Because the statute of limitations had run out on the offense of manslaughter, Fauser, although convicted of it, had to be acquitted. At his denazification proceeding, Eyrich was deemed “exonerated,” a designation that allowed him to resume his work as a state pediatrician. By 1953 he had received a lifetime appointment as a civil servant. Sentenced to a two-year prison term, Stegmann meanwhile was pardoned in 1951. Mauthe was able to elude his prison term by pleading “incapacity for imprisonment,” a status supported by medical attestations until 1951, when his punishment was remitted. Incredibly, in 1954 he received two-thirds of his state pension. In this manner, all four of the Grafeneck defendants avoided punishment for their contributions to mass murder.

Christ has written a solid monograph that extends to Nazi euthanasia doctors the premises of mainstream perpetrator research. Her finding that T-4 accomplices such as Eyrich, Mauthe, Stegmann, and Fauser were members of the war youth generation, motivated to their criminality by factors (i.e., the effects of World War I on this generation and their internalization of Nazi ideology) they shared with RSHA killers, is an intriguing contribution to perpetrator studies. Conversant with both the historical data and the theoretical literature, she addresses “big picture” questions that transcend mere accidents of time and place. Although her thesis is not boldly original (previous scholars, among them Henry Friedlander, Michael Burleigh, and Wolfgang Wippermann, covered this ground decades before Christ's study), she has nonetheless demonstrated its relevance to the biographies of four T-4 accomplices. The thick description she employs is both a strength and a limitation of her book: a strength because of its attention to the fine-grained details of her subjects’ careers, a limitation because it is such a modest sample size. It is to be hoped that additional research into the profiles of other medical perpetrators belonging to this generational cohort will be pursued in coming years, either by Christ or by scholars inspired by her methods in order to deepen our understanding of euthanasia killers.