After the termination of the »T4 Project« in 1941, euthanasia was continued in individual institutions until 1945. Above all, it was the Wagner von Jauregg-Heil- und Pflegeanstalt »Am Steinhof« which developed into a centre of organised mass killing in which the management and staff of the institution, the local administration of Vienna, the Viennese Gau administration, the Central Office T4 in Berlin, the Reich Commissioner for clinics and sanatoria and the Wehrmacht were the leading participants. The clinic was overcrowded, understaffed and the patients neglected. Added to this was a scarcity of drugs and food and the spread of infectious diseases such as tuberculosis, dysentery and typhoid. The combination of hunger and infectious diseases proved particularly disastrous.

Victims of these conditions were mostly those patients who were brought to Steinhof in collective transports in the course of the so-called »Brandt Project« in 1943. The main organizer was Dr. Karl Brandt, who had been put in charge of euthanasia by Hitler in 1939 and risen to become the most influential Nazi health official by 1942/43. The extension of the air war was taken as a reason to evacuate clinics and sanatoria in endangered areas. But in fact the transfers only served to disguise the increasing rate of patient mortality. Of the 550 patients transferred to Vienna-Steinhof from Hamburg, Bad Kreuznach and Mönchen-gladbach, more than 450 died by the end of 1945; this corresponds to a death rate of over 80%.

Between 1941 and 1945 more than 3500 patients at Steinhof died of hunger. Euthanasia was intensified, particularly, under the leadership of the »committed National Socialist« Dr. Hans Bertha, who became director of the institution in 1944: the mortality rate rose from 13.9% (1941) to 22.14% (1944) and reached its climax at 42.76% in 1945.

Institutional killing carried out on the initiative of the individual institutions did not only occur at Steinhof; in other Austrian clinics too, drugs, injections, withdrawal of food, etc. served as a means to murder. An especially brutal policy reigned in the Lower Austrian clinics at Gugging and Mauer-Öhling, where Dr. Emil Gelny, provisional director since 1943, killed almost 600 patients single-handedly, for instance by means of a specially constructed electric-shock device.