This downward slide to the Holocaust was explained dramatically by Dr. Leo Alexander in an article in the New England Journal of Medicine, written in 1949. Dr. Alexander was a consultant to the Secretary of War in the Nuremberg Trials. He had extraordinary access to accused Nazi war criminals in the medical community. Writing from that unique perspective, Dr. Alexander argued that so-called "compassionate killing" of the terminally ill inevitably set the stage for the Holocaust. He wrote:

Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude ... that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.

Before his death, Dr. Alexander told a friend that trends in our country were "much like Germany in the '20s and '30s. The barriers against killing are coming down."