Lessons From the Third Reich: Ethics and Economics-Reply

In Reply.  —The comments from Dr Crawshaw properly call attention to the importance of economic forces in determining physician behavior, both individually and in the aggregate. The importance of such forces is not new, nor did it arise in Nazi Germany: in fact, the costs of caring for institutionalized children and adults in the United States were a lively topic of debate as early as the late 19th century.¹ The problem of cost was radicalized in the Third Reich, and provided much of the underpinning of the Nazi euthanasia program in the early 1930s.That economic forces are driving much of the current wave of change in US health care is beyond dispute, but the analogy to Nazi Germany is, I believe, overdrawn. German medicine was subverted by a number of powerful forces, including, most importantly, its incorporation as an extension of state policy and the extensive propaganda campaign that denigrated