Over the years Binding and Hoche's attitudes percolated throughout German society and became accepted widely. These attitudes were stoked enthusiastically by the Nazis so that by 1938 the German government received an outpouring of requests from the relatives of severely disabled infants and young children seeking permission to end their lives.

The key test came in late 1938 when the father of "Baby Knauer," an infant born blind and missing his leg and part of his arm, wrote Hitler requesting permission to have his child "put to sleep." As described by Lifton and other historians, Hitler was quite interested in the case and sent one of his personal physicians, Karl Rudolph Brandt, to investigate. Brandt's instructions from his Führer were to verify the facts of the baby's condition and, if found to be true, to assure the child's doctors and his parents that if he was killed, no one would face punishment. The doctors in the case who met with Brandt agreed that there was "no justification for keeping the child alive." Baby Knauer soon became one of the first victims of the Holocaust.

Hitler later signed a secret decree permitting the euthanasia of disabled infants. Sympathetic physicians and nurses from around the country--many not even Nazi party members--cooperated in the horror that followed. Formal "protective guidelines" were created, including the creation of a panel of "expert referees," which judged which infants were eligible for the program.

Beginning in early 1939, babies born with birth defects or with congenital diseases were euthanized. Their doctors would admit these unfortunate infants to medical clinics, where they would be killed. The practice quickly became systematized. Regulations made it mandatory for midwives and doctors to notify authorities whenever a baby was born with birth defects. These cases would be reviewed by the euthanasia referees to determine if the children were eligible for euthanasia. Those deemed killable were usually dispatched via an overdose of a drug, most typically a sedative called Luminal. The euphemism of choice for this murder was "treatment." Most, but not all, of this killing was done in secret.

IT IS IMPORTANT TO NOTE that throughout the years in which euthanasia was performed in Germany, whether as part of the officially sanctioned government program or otherwise, the government did not force doctors to kill. Participating doctors had become true believers, convinced they were performing a valuable medical service for their "patients" and their country.

Eventually, the "success" of the infant euthanasia program led to the infamous "T-4" project in which adult disabled German citizens were mass murdered. Hitler eventually canceled the T-4 program in the face of public protests but that didn't matter. From around 1943 until a few weeks after the end of the war, some doctors went on a eugenic killing rampage. Known today as "wild euthanasia," during the later war years German doctors killed any patient they pleased, often without medical examination, usually by starvation or lethal injection.