In 1918, during the First World War, Binding left Germany to lecture German soldiers in Macedonia and Bulgarian intellectuals in Sofia.
The expression first occurs in the title of a 1920 book, Die Freigabe der Vernichtung Lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life) by jurist Karl Binding, retired from the University of Leipzig, and psychiatrist Alfred Hoche from the University of Freiburg, both professors.
The T4 program was influenced by a popular book written in 1920 by Alfred Hoche and Karl Binding.
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