Paul Nitsche was born the son of a psychiatrist in Colditz in 1876. He was awarded his medical degree after taking his state exams and graduating in 1901. He then worked as an assistant and senior physician at various psychiatric institutions before assuming the management of the Leipzig-Dösen Hospital in 1918. In 1928, he became a director at the Pirna-Sonnenstein Hospital. Even before 1933, Paul Nitsche was one of the advocates of psychiatry based on racial hygiene. At the same time, he pursued new psychiatric concepts such as occupational therapy and outpatient care. After 1933, he supported without reservation the National Socialist ideology of racial hygiene and, as a director of the institution, ensured that patients unfit for work received worse care than curable patients.
As of 1939, he was involved in the planning of the murder of patients. For »Aktion T4«, he worked first as an expert and later as a senior expert and deputy medical director. At the end of 1941, he ran the medical side of T4, subsequently campaigning heavily for reorganizing psychiatry according to the principle of »healing and annihilation«.
In the »euthanasia« trial held in Dresden, Nitsche was sentenced to death in 1947 and executed on 25 March 1948.