In Nazi Germany, eugenics was an accepted branch of medicine. Its purpose was to "cleanse" the German people of individuals who were considered genetically less desirable.

One would hope that this abhorrent practice would be confined to the dark history of the Third Reich. Unfortunately, that is not the case. Eugenics was well established in America in the 1930s.

Today, it is making a comeback.

More on that in a moment. First, let us listen to Frederic Osborn, a former anthropologist at the American Museum of Natural History. In the June 1937 issue of the American Sociological Review he suggested that physicians…

should keep in close touch with the eugenist so that they will understand the eugenic implications of all medical work and its effect on the distribution of births. Doctors are in a position to influence a favorable distribution of births more perhaps than any other group.

Today the practice of eugenics has taken a more "polished" form. What the Nazis called Lebensunwertes Leben, a life unworthy of living, has been replaced by a practice in modern, tax-paid health care called Haushaltsunwertes Leben.

A life unworthy of government funding.

Modern eugenics is well established in Europe's tax-paid health care systems. As tax revenues become increasingly scarce, governments put to work a tool called QALY, Quality Adjusted Life Years. Developed by health-care economists, it allows government to tell Jack that he won't have a high-enough quality life, but Joe will, so Joe gets surgery while Jack does not.

QALY calculations can also include how much taxes Jack and Joe will pay over the remaining years of their lives. The patient who is not expected to be a net taxpayer is living a life unworthy of the government budget.

As rationing becomes tougher, medical practitioners and politicians invent new ways to motivate their selective decisions. An immoral milestone was passed in March 2012 when two professors of medical ethics proposed that infanticide was morally defensible. Mothers, they said, should be allowed to kill their newborn, disabled babies in order to relieve themselves and society of the cost of caring for them.

In Britain, hospitals practice a special form of infanticide. Children whose lives are too costly to save, are given "end of life care" where they are starved and dehydrated to death over a period of up to eleven days.

In Scandinavian countries, eugenics is practiced by means of abortion: almost all babies with cleft palate or Downs Syndrome are terminated.

Already in 2009 Governor Sarah Palin warned that the theory of Haushaltsunwertes Leben was making its way into American medicine. Now, five years later, the New York Times reports:

Five years after it exploded into a political conflagration over "death panels," the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. … Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients. But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association … One of the A.M.A.'s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

This is not eugenics at the level it is being practiced in Europe. It is obviously far away from the active racial cleansing policies in the Third Reich. But it is a small yet fundamental step across a line where death, not life, has intrinsic value. Whether that step is motivated by fiscal responsibility or racial hygiene is a matter of how far into that territory we are willing to go.