The assault on Poland on 1 September 1939 did not just initiate an “external war”, but also a “war within”. More radically, faster and effectively than possible through sterilisation, the racial corpus of the Volk (Volkskoerper) could now become liberated from the “burdens of unproductive eaters”.
Psychiatric experts decided about the life and death of patients simply based on reports. Now the decisive criterion was no longer the genetic make-up, but rather the remaining economic value of the patient. Medical and "salvational" criteria also played a role, for instance whether the disease was incurable and also whether the patient was restless or troublesome.
The murders took place in six regional killing institutions: Hartheim near Linz, Grafeneck near Muensingen, Hadamar near Limburg, Sonnenstein/Pirna near Dresden, Bernburg on the Saale and Brandenburg on the Havel. The sick were either transported directly to the killing centres or first assembled at intermediary sanatoria.