In the early 1900s, Alfred Ploetz, the founder of the German eugenics movement, feared that medical advances were allowing "the least fit" to survive at the expense of the "fittest." To address the problem, he advocated racial hygiene--a new kind of hygiene that promoted the health of the "race" rather than the individual. Few Germans paid attention to his ideas until World War I.

During the war, hunger was widespread in Germany. Families, hospitals, schools, and other institutions had to ration what little food was available. As a result, nearly half of the patients in German psychiatric institutions died from starvation or disease. Other facilities experienced similar losses. The hard choices individuals and groups made during the war shaped attitudes toward the disabled long after the fighting ended.

In 1920, Alfred Hoche, a physician, and Rudolf Binding, a lawyer, prompted a nationwide debate on the role of the disabled in the society. In a book entitled Sanction for Destroying Lives Not Worth Living, they argued that the right to live must be justified. After contrasting "a battlefield covered with thousands of dead youth" with "our institutions for the feebleminded with their solicitude for their living patients," they expressed shock at the "glaring disjunction between the sacrifice of the most valuable possession of humanity on one side and on the other the greatest care of human beings who are not only worthless but even manifest negative value."² The two professors insisted, "The allowable killing of the incurably ill, deformed, mentally retarded, or severely damaged was a natural extension of a physician's role." Adolf Hitler was so taken with their thinking that he offered to publicly endorse their book.

Other physicians favored a more eugenic and less radical approach to the "problem" posed by the disabled. In 1923, Gustav Boeters, a district health officer, wanted the nation to sterilize the "unfit"--including the blind and deaf, the mentally disabled, and even fathers of two or more illegitimate children. Noting that the United States already had such legislation, he announced that he and his colleagues had begun to sterilize their patients.³ Although the government did not act on Boeters' suggestions, he was never prosecuted or even taken to task for illegal sterilizations. Instead officials quietly collected information on American sterilization laws.