We appreciate the letter from Dr Koester, whose main point is to highlight the possibility of parallels between then and now. Often one needs to avoid the Nazi analogy in contemporary ethical debates, as this is highly charged and may render the debate more emotional than rational. There are indeed no Nazis amongst us now in contemporary Western medicine. However similarities do exist, principally in the shifting of the primary obligation of the physician from the individual patient to a third party. This shift in physician focus is also taking place in tandem with the increasing application of economic cost-benefit analysis to medical care. While such analysis has its benefit on a populationwide basis, it is often fraught with ethical difficulty at the level of the individual. In addition, Dr Koester's letter highlights the nature of the slippery slope. Individual decisions are links in a greater chain of events and it is often the prior compromise that makes the next compromise easier to make.
Shevell M. Sitting at the Top of the Slope—Reply. Arch Pediatr Adolesc Med. 1998;152(6):608. doi: