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Disability opposition to this ultimate form of discrimination has been ignored by most media and courts, but countless people with disabilities have already died before their time. —Not Dead Yet: The Resistance, a disability rights organization, Forest Park, Illinois, October 28, 2003

In 1920, a prominent German lawyer, Karl Binding, and a distinguished German forensic psychiatrist, Alfred Hoche, wrote a brief but deadly book, The Permission To Destroy Life Unworthy of Life. In his new book, The Coming of the Third Reich (Penguin), Richard Evans notes that Binding and Hoche emphasized that "the incurably ill and the mentally retarded were costing millions of marks and taking up thousands of much-needed hospital beds. So doctors should be allowed to put them to death."

Then came Adolf Hitler, who thought this was a splendid, indeed capital, idea. The October 1, 2003, New York Daily News ran this Associated Press report from Berlin:

"A new study reveals Nazi Germany killed at least 200,000 people because of their disabilities—people deemed physically inferior, said a report compiled by Germany's Federal Archive. Researchers found evidence that doctors and hospital staff used gas, drugs and starvation to kill disabled men, women and children at medical facilities in Germany, Austria, Poland and the Czech Republic. . . .

"The Nazis launched the drive to root out what they called 'worthless lives' [and 'useless eaters'] in the summer of 1939, pre-dating their full-scale organization of the Holocaust, in which they killed 6 million Jews." (Emphasis added).

The more than 200,000 "worthless lives" terminated by the Nazis before the Holocaust included few Jews. Most of those killed were other Germans considered unfit to be included in "the master race."

Among the defendants at the Nuremberg trials of Nazi leaders and their primary accomplices in the mass murder were German doctors who had gone along with the official policy of euthanasia. An American doctor, Leo Alexander, who spoke German, had interviewed the German physician-defendants before the trials, and then served as an expert on the American staff at Nuremberg.

In an article in the July 14, 1949, New England Journal of Medicine, Dr. Alexander warned that the Nazis' crimes against humanity had "started from small beginnings . . . merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived." That shift in emphasis among physicians, said Dr. Alexander, could happen here, in America.

Actually, the devaluing of apparent "imperfect life" had begun years before, in the United States. Various academics, in and out of the medical profession, had successfully advocated and instituted a eugenics movement—the perfecting of future generations of Americans by deciding who, depending on their hereditary genes, would be allowed to have children. The unfit would no longer be permitted to reproduce.

These American eugenicists provided German proponents of a "master race" with inspiration. As Robert Jay Lifton wrote in his invaluable book The Nazi Doctors (Basic Books), "A rising interest in eugenics [in America had] led, by 1920, to the enactment of laws in twenty-five states providing for compulsory sterilization of the criminally insane and other people considered genetically inferior." (Emphasis added).

Paying attention in Germany, Heinrich Himmler, one of Hitler's executioners, said the Nazis were "like the plant-breeding specialist who, when he wants to breed a pure new strain . . . goes over the field to cull the unwanted plants." Under the Nazis, there were eugenics courts to decide who could have children. In the United States Supreme Court (Buck v. Bell, 1927), Justice Oliver Wendell Holmes, ruling that 18-year-old Carrie Buck should be involuntarily sterilized, famously wrote:

"If instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing of their kind. . . . Three generations of imbeciles are enough." Only Justice Pierce Butler dissented.

In this country, the eugenics movement lost its cachet for a time because the Nazis had gone from sterilization of the disabled to herding the religiously, racially, and politically unfit into gas chambers.

But there has been an American revival of eugenics in certain elite circles. A few years ago, an archconservative who had talked with some of the present-day, would-be purifiers of the American stock told me they were delighted at the deaths from AIDS of homosexuals.

But to protect the disabled from "mercy" killings, as well as eugenicists, another movement was forming here. Not long before he died, Dr. Alexander read an article in the April 12, 1984, New England Journal of Medicine by 10 physicians—part of the growing "death with dignity" brigade. They were from such prestigious medical schools as Harvard, Johns Hopkins, and the University of Virginia. These distinguished healers wrote that when a patient was in a "persistent vegetative state," it was "morally justifiable" to "withhold antibiotics and artificial nutrition (feeding tubes) and hydration, as well as other forms of life-sustaining treatment, allowing the patient to die." They ignored the finding that not all persistent vegetative states are permanent.

After reading the article, Dr. Alexander said to a friend: "It is much like Germany in the '20s and '30s. The barriers against killing are coming down."

Next week: The growing conviction among American doctors, bioethicists, and hospital ethics committees that it is "futile" to try to treat certain patients, and therefore, medical professionals should have the power to decide—even against the wishes of the family—when to allow these valueless lives to end.

If the courts finally permit the husband of brain-damaged Terri Schiavo to continue to press for her death by starvation—by again removing her feeding tube—more of the barriers to killing may come down in other states. So this isn't only about Terri Schiavo. It could be about you.