Hitler had announced internally to his confidants in 1935 that, in the event of a war, he would tackle the annihilation of so-called »life unworthy of life«. The systematic murder of people with mental illnesses and intellectual disabilities began in Germany with the Second World War. A »Führerermächtigung« (»authorization of the Führer«) backdated to the day the war began and with which Hitler charged the head of the »Chancellery of the Führer«, Philipp Bouhler, and his accompanying physician, Karl Brandt, »to expand the powers doctors to be specifically determined in such a way that patients who were, as far as is humanly possible to judge, terminally ill with the most critical assessment of their disease state may be granted a mercy killing« served as legitimation for this. This document was intended to legitimise the planned murder of patients and to present it as an act of relief.

The preparation and execution of the murder campaign was assumed by the »Chancellery of the Führer«, a private office that was directly subordinate to Hitler. Within the »Chancellery of the Führer«, Viktor Brack, Bouhler's deputy, was in overall charge of administration of the patient murders.

Various front organisations were set up to keep the »euthanasia« programme secret. The »Reich Cooperative for State Hospitals and Nursing Homes« (Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten – RAG) served as a front for the »euthanasia head office«. Other front organisations were the »Charitable Ambulance Service GmbH« (Gekrat – Gemeinnützige Krankentransport GmbH), which transported patients to the intermediate and killing centres, the »Charitable Foundation for Institutional Care« (Gemeinnützige Stiftung für Anstaltspflege), which appeared as an employer of »euthanasia« staff and, finally, the »Central clearinghouse for hospitals and nursing homes« (Zentralverrechnungsstelle Heil- und Pflegeanstalten), only founded in April 1941, which took over the financial management with the funding agencies.