As part of the Nazi euthanasia killings of Action T4, the State Hospital and Sanatorium Zwiefalten was an intermediate storage for the killing center Grafeneck Castle. At least 1 673 mentally ill women, men, teenagers and children were "relocated" 1939/40 on Zwiefalten in other public institutions or to Grafeneck. The so-called "gray buses" of the Gemeinnützige Krankentransport GmbH (Gekrat) were always in town in this period. The laid between patients and residents came from Ellwangen, Fußbach, Heggbach, Kaufbeuren, Konstanz, Kork, Krautheim, Liebenau, Maria Berg, Rastatt, Sinsheim and Stetten im Remstal. As part of the "euthanasia" -killing action T4, the first transport of 50 women left Zwiefalten on 2 April 1940. Until December 9, 1940 more than 1,000 patients were deported and killed in 22 transports from Zwiefalten to Grafeneck. However, the killing of patients in Zwiefalten was continued with morphine or trional syringe. In 1949 the former director Martha Fauser (Director 1940-1945) was sentenced to a prison term of only one year and six months for the "crime of manslaughter". A memorial stone in the cemetery commemorates this event.