German psychiatrists actively engaged in the forced sterilization and killing of psychiatrically disabled children and adult patients. Academic psychiatrists embraced the Nazi philosophy and led the way in the "final solution" for psychiatric patients. This took place in a climate of widespread racism, virulent anti-Semitism, disillusionment with utopian social reforms, loss of medical confidentiality, devaluation of autonomy, intoxication with collectivism, injured national pride, and economic crisis. In this paper I review the impact on the physician-patient relationship of scientific, socio-economic, and political developments in the fifty years leading up to Hitler's rise to power, and explore potential implications for health care in the U.S.