Abstract
The professional career of Paul Nitsche reflects the contradictory path taken by a German institutional psychiatrist who was a leader in the field at the time. During the Weimar Republic he advocated improving the institutional system based on principles of psychiatric reform, but was already receptive to concepts of racial hygiene. Shortly after the National Socialists seized power, Nitsche was already an influential proponent and participant in eugenic measures in Saxony and actively involved in implementing the "Law for the Prevention of Genetically Diseased Offspring." He increasingly appraised the value of a patient according to the person's economic performance. It was also Nitsche's opinion that the consequence of this extreme rationalization of human life was to exterminate "life unworthy of life." As a T4 appointed head assessor he decided in the last instance whether thousands of people would live or die. As the Medical Director of the T4 program, he was later directly responsible for continuing the massacre as "decentralized euthanasia." At the euthanasia trial in Dresden he was condemned to death and executed in 1948.
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