CHAPTER TWO: EUGENICS AND ITS SHADOW
I. The Relevance of Eugenics
Optimism and Anxiety
The revolution in genetics, full of promise for understanding our own constitution and for the power to change human lives for the better, has nevertheless proven profoundly unsettling. Discoveries of the genes responsible for diseases and traits, and invention of new techniques for manipulating the human genome, provoke not only wonder but fear as well. Sensitive to these concerns, James Watson, first director of the Human Genome Project, found it prudent to promise a wary Congress that a significant share of funds allocated to the project would be devoted to studies of the ethical, legal, and social issues it raises. His successor, Francis Collins, has stated that concern over ethical issues, not the remaining scientific and technological hurdles, were the greatest threat to the success of the project, for the project could not continue without public support.
The source of most of this public distrust stems, no doubt, from the widespread realization that genetic information may be dangerous to physical and economic health. It takes no subtle philosophy to understand that anyone is vulnerable to exclusion from these and other economic and social arrangements should their genes be examined and found wanting. These risks have rightly occupied center stage in bioethical debates over the uses of the new genetics.
Some of this public concern, however, may be a faint echo of earlier controversy. The revolution in molecular biology is not the first, but the second large-scale attempt to modify the pattern of human heredity for the better. The eugenics movements of 1870-1950 came first. These large-scale social movements, originating in England but ultimately involving public advocates and membership organizations from Brazil to Russia, located the source of social problems in the genes of individuals and sought to alter the pattern by which these genes would be transmitted to future generations. In the United States, the movement received substantial funding from the great family fortunes, including Carnegie and the Rockefellers, and was endorsed, with greater or lesser enthusiasm, by most scientists working in the field of human genetics. Indeed, eugenics was the motivation for much of the early scientific research in this field.
Nevertheless, the history of eugenics is not a proud one. It is largely remembered for its shoddy science, the blatant race and class biases of many of its leading advocates, and its cruel program of segregation and, later, sterilization of hundreds of thousands of vulnerable people who were judged to have substandard genes. Even worse, eugenics, in the form of "racial hygiene," formed part of the core of Nazi doctrine. Hitler endorses it in Mein Kampf, and once in power expanded both eugenic research and, borrowing from U.S. models, a program of sterilization that became the first step toward the murder of handicapped "Aryans" and ultimately the millions of victims of the Holocaust.
Eugenics as a Cautionary Tale
Understood as the second of two eras in which the science of heredity was promised to offer great benefits for mankind, it is inevitable that today=s genetics proceeds in the shadow of eugenics. The current revolution in genetics, in this view, is Round Two. Given this history, anything reminiscent of eugenics is bound to be suspect. When particular uses of genetic technology and science are branded as "eugenic," the label points us to an evil that eugenics represents. It is a powerful warning.
But what is this evil? If we are to avoid the errors of the past, we must know what they were. The label "eugenics" denotes the movement of that name, but not a specific tenet or practice against which we are cautioned. In this chapter, we attempt to specify this evil, giving content to the comparison between eugenics and current and future developments in human genetics.
We begin with a short history of the movement, recounting the growth of mainstream eugenics in the United States and the United Kingdom, but taking note also of the considerable diversity of goals, beliefs, and proposed policies that could be found in eugenics movements around the globe. We then turn to consideration of eugenics as a doctrine or set of doctrines that represent the kernel of the eugenic ideal in its various manifestations. We provide a moral assessment of these doctrines, an Aethical autopsy@, identifying what was indeed evil, and what might be considered benign. Finally, we apply our conclusions to the present and future, identifying the questions that must be answered if public policy regarding genetics is to avoid the moral errors of eugenics.
In our own consideration of eugenics, benefiting both from superb reconsiderations of the movement by historians in the last decade and from primary sources, we have been impressed by the complexity of the eugenics movement and of the importance, too often unrecognized by nonhistorians, of informing our moral evaluation of past events and actors with an understanding of how the world seemed through their eyes. Indeed, the historian Leila Zenderland (1998) has warned that the history of the eugenics movement exists in two versions, an Aofficial@ story of racist, reactionary thinkers and politicians, working with a few marginal scientists, a movement which proceeded directly from Darwin to Hitler; and a Areal@ story of a bewildering array of thinkers, activists, snobs, socialists, scientific visionaries and crackpots, fascists and architects of the Scandinavian social welfare states, divided among themselves on nearly every point of doctrine and proposed intervention. The Aofficial story@ is what is taught to young geneticists, and inhabits the popular imagination; it tells us what we must not do. The Areal@ story is less tractable, less teachable, and harder to mine for bioethical insights. Attempts to draw lessons from this history require great caution.
Not all would agree, even so, that we can learn very much from the history of eugenics. In this view, the eugenics episode is chiefly a historical curiosity, one that might tell us something about the temptation for political movements to reach for the authority of science, but that sheds no light on contemporary clinical genetics or public policy in the current era.
While respecting the complexity and diversity of the eugenics movement, and also its historical remoteness, we believe that the history of eugenics is instructive for those concerned with the bioethics of the new genetics. It was marked, in its worst moments, by cruel violations of human rights; any steps, whether public or private, that might propel us in this same direction must be identified and countered. While we make a point in the following to correct the common mistake (in the literature of bioethics) of identifying eugenics generally with its Nazi variant, the magnitude of the evil waiting at this extreme terminus of the eugenics movement provides an enduring general caution for genetics in the foreseeable future.
The history of the eugenics movement prior to the Nazi period is instructive as well. While its record of mayhem was overshadowed by that of the Nazis, we can find, even given the most charitable understanding of its leaders' motives, a failure to deal adequately with the tension between social good and individual liberties, rights, and interests, which has long been the moral problem at the heart of the enterprise of public health. We situate the cardinal moral failing of eugenics within this understanding of the ethics of public health, and our book is dedicated in large measure to providing some clarity where in eugenics we find only a blind spot: the relation of genetic intervention to justice.
II. Eugenics: A Brief History
Origins and Growth
Though the literature of eugenics extends back to Plato, its modern impetus was the work of one man. Francis Galton, a cousin of Charles Darwin, was impressed by the frequency with which genius seemed to be manifested in some lineages more than others. He sought to investigate the possibility that talents and virtues of character were inherited along with other traits, offering their bearers advantages in natural selection. His research, enhanced by statistical methods developed as he needed them, convinced him that society's stock of talent could be greatly enlarged if members of favored families were to increase their rate of childbearing. The balance should be further improved, he believed, by discouraging from reproducing those who had less to offer. Galton coined the term "eugenics" in 1883 (fifteen years after publishing his first proposals), defining it as the "science of improving stock--not only by judicious mating, but whatever tends to give the more suitable races or strains of blood a better chance of prevailing over the less suitable than they otherwise would have had."
Galton's influence was nearly immediate. Darwin declared himself persuaded by his cousin's eugenic arguments, and Galton attracted a number of distinguished disciples. In Germany, the Racial Hygiene society was formed in Berlin by 1905 (Weindling 1989); the English Eugenics Education Society was founded in 1907, with Galton elected honorary president the next year (Kevles 1985, 59). In the United Kingdom and the United States, the movement drew on the middle and upper middle classes, including many professionals and academics (Rafter 1988; MacKenzie 1981; Kevles 1985; Searle; Mazumdar 1992). By 1923, when the American Eugenics Society was formed, it boasted 28 state branches (Kevles 1985). During the decades 1890-1920, eugenic ideas were advanced also in numerous non-English-speaking countries as diverse as Norway, Brazil, and the Soviet Union.
Eugenics in the United Kingdom and the United States was both a research program and a popular movement. Galton's work on heredity and statistics was continued by his successor Karl Pearson, and their coworkers in what became the Galton Laboratory, with an endowed Galton Eugenics Professorship. In the United States, the Carnegie-supported Eugenics Record Office, under sociologist Charles Davenport, employed a team of interviewers to collect information for its store of family pedigrees, which it also solicited from the public (Garland 19.., Paul 1996). Eugenics was taught at leading universities, and received attention in standard biology textbooks.
The popular eugenics movements, meanwhile, succeeded in rapidly introducing eugenic ideas into public discourse. Accounts of generations of misfits in such "white trash" family lines as the "Jukes" and the "Kallikaks" were widely publicized, warning that an unwise reproductive act could wreak havoc for generations (Rafter 1988). Following British successes at health exhibitions before the turn of the century, American eugenic organizations took a particular interest in maintaining exhibits and events at state fairs and public expositions. The Race Betterment Foundation, under John Kellogg, attracted 10,000 visitors and boasted a million lines of newspaper publicity for its contribution to the Panama-Pacific exposition of 1915 (Rydell 1993).
Eugenicists took over the American Museum of Natural History in New York for a month in 1915 (Rydell 1993 at 46), and a similar exhibit there in 1932 drew 15,000 visitors. "Fitter Families" competitions were mounted at state fairs, from Massachusetts to Oklahoma, with governors and senators handing out awards (ibid). By wedding eugenics to the ideal of the "average American" at these fairs and exhibitions, its elite supporters sought out a mass audience--though this populist turn took the movement in a direction quite different from that envisioned by Galton, whose inspiration had been the phenomenon of scientific genius.
Varieties of Eugenics
The content of the eugenic program varied considerably from country to country and within each nation's movement. There were differences, for example, in beliefs about the mechanism of transmission of inherited traits. The French and Brazilian eugenics movements were at least as concerned about neonatal care as with heredity, and their hereditarian thinking was Lamarckian--that is, they believed that parents passed on to their children characteristics acquired during their lifetimes (Schneider 1990; Stepan 1991). If the notion of a Larmackian eugenics seems an oxymoron , since eugenics is remembered as a movement which emphasized nature over nurture as both cause and remedy of human failings, a theses Lamarckians rejected, this is perhaps because our own experience (in English-speaking countries) has defined eugenics narrowly. If we look beyond the Anglo-Saxon experience, William Schneider states, we will understand eugenics as "less a pseudoscientific, failed branch of applied human genetics than a biologically based movement for social reform." Most eugenicists elsewhere accepted Galton's view, buttressed by the "germ plasm" hypothesis of August Weismann, that selection rather than environment determined heredity. Eugenicists tended to draw from this account the implication that medical care frustrated evolution by permitting the unfit to survive and reproduce (though Darwin and a number of others who held this view nonetheless continued to support humanitarian measures).
Eugenicists differed also in their practical proposals and legislative aims. Some favored "positive eugenics" (encouraging the most fit to have larger families); others accented "negative eugenics" (curbing the fertility of those judged least fit); and many wanted both. While action on behalf of positive eugenics was limited to such mild measures as family allowances, some eugenicists (particularly in the United States and, later, Germany) did not hesitate to call for coercive measures, either sexual segregation or, later, involuntary sterilization, to prevent those imagined to have undesirable genes from propagating their kind.
National experiences varied widely. Involuntary sterilization remained rare in England, but was permitted by statutes enacted between 1910 and 1930 in northern Europe, including Denmark and Germany, and in the United States. Involuntary sterilization was practiced on large numbers of people in the United States, where tens of thousands were affected during the Depression, and in Germany, where the greatly stepped-up program following the Nazi rise to power rendered several hundred thousand incapable of bearing children.
In both the United States and Germany, a number of leading figures combined eugenic interests with a focus on race (Roll-Hansen 1988); eugenicists in South American did this less (Stepan 1991, Larson 1995). Eugenicists in the United States supported restrictions on immigration, maintaining that the immigrants arriving after the turn of the century from southern and eastern Europe suffered by comparison with "old American stock" in intelligence and other virtues. They pressed also for laws forbidding interracial marriages.
In Germany, eugenics became an integral element of medical thinking, which envisioned a three-way division of health care involving medical care for the individual, public heath for the community, and eugenics for the race (Weiss 1990; Proctor 1988). Eugenics, for some, was an extension of a tradition of a social orientation in German medicine that had produced Rudolf Virchow and other pioneers of public health. In the United States, however, medical schools were slow to include any instruction in eugenics or genetics.
Eugenicists differed among themselves wherever the movement attracted a large following. Historians have generally followed Daniel Kevles's (1986) classification of eugenicists, at least in England and the United States, as either "mainline" or "reform." In the United States and Britain, mainline eugenics was largely (but not exclusively) conservative in political orientation. Galton was but the first of a long line of eugenicists who believed that the those who achieved (at least in fields such as science and literature, where social position was insufficient for advancement) were distinguished from others in their possession of great natural, inherited talent. Indeed, the mainline eugenicists tended to believe that a person's station in life reflected his or her capabilities and could thus be used as an indication of the genes likely to be passed down to subsequent generations.
The preoccupation of mainline eugenicists was the social havoc being wrought by the lower classes. Indeed, one historian of the English movement defined eugenics bluntly as "a middle-class activism focused upon the pauper class, with a biological view of human failings" (Mazumdar 1992, at 258). In both the United Kingdom and the United States, a long list of social ills, including poverty, prostitution, drunkenness, and crime, were attributed to the "unfit."
In the United States (as in Germany), this class bias was joined by a virulent racism, which warned of the effects both of miscegenation and of high birthrates among "inferior" races. These attitudes helped to win support for the drastic curbs on immigration enacted after the First World War. Theodore Roosevelt warned that a "war of the cradle" was being waged between the better and inferior social groups. To be sure, mainline eugenicists, when speaking with care, took pains to distinguish the working classes from the degenerate "social residuum," but these fine distinctions were often blurred, and they did not lessen the offense taken by their socialist opponents.
Nationalism was a third characteristic concern. Mainstream eugenicists were often prone to interpreting the degeneracy thesis in national terms, identifying nationality with "blood" and fearing that England (or Germany, or wherever) would lose in competition with nations that did a better job maintaining the quality of their germ plasm.
The "reform" contingent, often socialists, and including many of the leading figures in the science of human genetics, accepted eugenic goals, but were unsparingly critical of the mainline eugenicists' research, biases, and proposals. Hermann Muller, an American geneticist who later won a Nobel prize for demonstrating the effect of radiation on chromosomes, insisted that natural talent could not be assessed in a society such as the United States, which did not offer equal opportunities for advancement to its citizens; only under socialism could the fit be identified as such, and then encouraged to multiply.
Eugenics was often found in the political platforms of left-of-center political parties. A key proponent in Denmark, for example, was Karl Steincke, a father of the Danish welfare state (Hansen 1996), and several of the leading Norwegian eugenicists were also Social Democrats (Roll-Hansen 1980). Eugenics was adopted with enthusiasm by the Tommy Douglas, later the pioneer of Canadian social democracy in Manitoba; by Fabian Socialists in the United Kingdom; and by the Progressives in the United States, all of whom favored social programs that, with the help of science, applied resources available to the state to building a more humane society. Many of these same figures, however, were indistinguishable from their conservative counterparts in class and racial bias.
Sweden=s eugenics programs are an instructive case study, since, as Gunnar Broberg and Mattias Tydén (1996) have shown, they show the compatibility of eugenic thinking to varied political viewpoints. Until the 1930s, the movement was centered in the Institute for Race Biology in Uppsala, under the direction of a traditional eugenicist who would later profess Nazism. The work of the Institute focused on physical anthropology and was much concerned with alleged threats to the ANordic type.@ After a five-year dispute, a Social Democratic scientist took control, disavowed racism, and emphasized laboratory studies in medical genetics. But the ascendancy of the socialists proved to give eugenics a second wind. The planners of the Swedish welfare state, concerned with the Aquality@ as well as the quantity of Sweden=s then-dwindling population, were eager for the government to use natural and social science for the common good. The modernization and rational ordering of society left little room for the inferior and the deficient, and the government sought to identify and sterilize these citizens. Indeed, social democratic intellectuals maintained that these sterilizations were necessary if Sweden were to be able to afford the cradle-to-grave security they championed. Eugenics, in effect, was an instrument for reducing need. Tens of thousands of Swedes, mostly women, fell victim during the next three decades. The contrast between Aprogressive@ and Areactionary@ eugenics should not be overemphasized C Swedish eugenics targeted a population of itinerants (ATattare@, or tinkers), who were imagined to be racially different, and the eugenicists who made a point of disavowing racism and class bias tended to be academics rather than government officials. As in other countries, those who actually bore the brunt of state coercion in the name of the eugenic common good were usually the marginal, the stigmatized, and the vulnerable. But the Swedish eugenicists strenuously denied any commonality with Nazi policies of the same era, and our current tendency to view equate eugenics with Nazism distorts this historical record.
While eugenics was supported by most geneticists of the era, a number of the scientists were harshly critical of mainline eugenics. Like his Swedish counterpart, Hermann Muller recognized the movement's racism and class bias, and the worthlessness of the studies of family pedigrees that constituted its source of data. But he, too, was concerned that civilization was interfering with natural selection, and was intrigued by the possibility that humanity might sever the age-old link between biological and social parenthood in favor of "germinal choice" of superior genetic material.
A "Geneticists' Manifesto" signed by Muller and other leading scientists in 1939 insisted that encouragement of eugenic-minded reproduction be part of a wider social program that would provide economic security to parents, equal opportunities to women, public education in biology, and a "socialized organization" that ensures that "social motives predominate in society." The first goal of eugenics, in their view, was health, followed by intelligence and "those temperamental qualities which favor fellow-feeling and social behavior rather than those (today most esteemed by many) which make for personal `success', as success is usually understood at present." The goal of eugenics, they held, was "much more than the prevention of genetic deterioration"; they looked to the day, only a few generations distant, when "everyone might look upon `genius'...as his birthright. And...this would represent no final stage at all."
The labels "mainline" and "reform" do not do justice to the great variety of viewpoints and goals associated with the eugenics movements. Indeed, as Diane Paul has observed, one sign of the ubiquity of eugenic thinking was the attempt by parties on all sides of particular social disputes to further their cause by demonstrating that their recommendations would have the strongest eugenic effect. Leading figures in the American and British eugenics organizations were political reactionaries. But eugenics, seen as an avenue for the application of science to social problems, was attractive also to some of the architects of the modern welfare state, such as the Progressives in the United States and the Scandinavian Social Democratic parties.
Much of the opposition to eugenics during that era, at least in Europe, came from the right. The eugenicists' legislative successes in Germany and Scandinavia were not matched in such countries as Poland and Czechoslovakia, even though measures had been proposed there, largely because of the conservative influence in these countries of the Catholic Church (Roll-Hansen 1988). The Church opposed eugenics in principle (and they were virtually the only institution to do so), but this was of a piece with their opposition to abortion and contraception: then, as now, the Church was opposed to limitations on fertility, and their opponents were often on the left.
To be sure, early eugenicists were also opponents of birth control, since they believed that its use by the upper classes exacerbated the degeneration of the gene pool. But not all eugenicists took this position. The eugenic banner was seized also by feminists who argued that control over fertility, along with emancipation generally, permitted women to improve the race through sexual selection.
Today, few people other than historians of science, appreciate the range of political viewpoints and causes that were once proudly associated with eugenic doctrine. Historical memory of the movement is colored, perhaps permanently, by the appropriation of eugenics by the Nazi Party.
The Nazi Debacle
Eugenics in Germany, while distinctive in having a medical leadership, had been marked by much the same divergences of opinion as the movements in other countries. Though numerous prominent eugenicists were racist and anti-Semitic, others were avowedly anti-racist (and some were Jews), and a number stood on the political left (Weindling 1989). The Nazis imposed a uniformity of viewpoint, securing the allegiance of the many eugenicists who rallied to its cause for a thoroughly racist, nationalist eugenic program that recognized no limits in the pursuit of "racial hygiene."
Eugenics was central to the entire Nazi enterprise, joined with romantic nativist and racist myths of the pure-bred Nordic. The emphasis on "blood" called for a purifying of the nation's gene pool so that Germans could regain the nobility and greatness of their genetically pure forbears (Burleigh and Wipperman 1991).
As Robert Proctor (1988) and other historians have shown, the subsequent programs of sterilization, "euthanasia" of the unfit (a program that took the lives of tens of thousands of "Aryans," mostly young children), and eventually the Holocaust itself were part of the unfolding of this central idea. The sterilization and "euthanasia" programs, which did not initially target Jews and other minorities, were an exercise in negative eugenics designed to improve the native German stock from its degenerated condition. Legislation barring sexual relations between Jews and "Aryans," and ultimately the Holocaust, were intended to prevent further adulteration of the "pure" German nation with inferior genes. Jews and others who contributed evil genes were the disease afflicting the German nation, which Hitler, the physician, would cure.
These measures were complemented by a range of other genetic interventions, ranging from an elaborate system of Genetic Courts passing judgment on the genetic fitness of those thought to harbor defective genes, to marriage advice clinics, to the Lebensborn breeding program for SS men and other racially motivated initiatives in positive eugenics (Weindling 1989). The academic fields of anthropology, biology, and medicine were reformulated in racial and eugenic terms, and the profession of medicine in Germany was compromised by its participation in government programs of identification, sterilization, and murder of those deemed unfit (Aly and Prosch 1994, Weindling 1989, Burleigh 1994, Gallagher 1990, Wikler and Barondess 1994).
Nazi eugenics was distinctive in its scale and elaborateness, its ferocity, its racial orientation, and its demands for absolute submission by the individual to the interests of the group. No other eugenic program approached the Nazis' eugenics in any of these dimensions. But the Nazi eugenicists claimed (falsely, according to Weindling (1989)) the continuities between their eugenics and the programs of the regimes that had preceded theirs.
How should we understand the relation of the Nazi crimes to the doctrine of eugenics? Did the Nazis simply carry out the measures that were inherent in the eugenic program all along, but that others had been unwilling or unable to put to practice? Or was Nazi eugenics a distortion, a perversion, of eugenics, which stemmed not from any barbarism inherent in eugenic doctrine but in its adoption by Nazis, who bloodied and sullied everything they touched? These questions frame much of the debate over the shadow of eugenics.
Decline and Fall
In its first years, Nazi eugenic programs and propaganda won the acclaim of eugenic leaders in the United States. The Nazis flattered their counterparts overseas by pointing to legislation in California and elsewhere not only as precedents but also as models. It is unsettling to compare the notorious Nuremberg laws to the miscegenation and eugenics statutes of California and other states; among other elements, the determination to keep races Apure@ was carried over intact, though the races were identified differently. The authors of these statutes toured Germany and filed favorable reports upon their return (Kuhl 1994). Harry Laughlin, Director of the Eugenics Record Office and a central figure in American eugenics, was given an honorary degree by a German university, which he accepted with thanks at the German legation in New York.
After the Holocaust and the defeat of the Germans, however, eugenicists in most other countries were quick to distanced themselves from German eugenics. Since the Germans had presented themselves as the most consistent and purposeful of eugenicists, the movement itself fell into general disrepute. American eugenics organizations experienced amnesia over their prewar affinity with their German counterparts, spoke out against racism, and urged Americans to consider eugenics as a source of national strength. The Eugenical News (23:2-3, 1945) urged its readers to remember that
it can sometimes be as important to live for our ideals and to pass on a goodly heritage, as to die for them when that time comes. The heroes of Valley Forge and Gettysburg...will have died in vain if the best of our race also dies. The stork...must be kept flying, too, along with the eagle and the bombers. But it must fly to those homes where good environment will bring the best heredity to fruition, socially and biologically.
Despite these efforts, the eugenics societies soon lost their followers. The American society's journal was renamed Journal of Social Biology, and what had in prewar years been a virtual consensus in favor of eugenics among genetic scientists disappeared within a decade. The movements' offices were shut down, and the Rockefellers and other funding sources turned their attention to related but more reputable concerns, such as world population control, the prevention of birth defects--and to genetics and molecular biology (Kay 1995; Paul 1991).
There is some controversy over the explanation of the sudden disappearance of eugenics from our national consciousness. The account given in the first histories of the eugenics movement was that eugenics was abandoned as the science of genetics progressed, leaving genetic scientists increasingly dubious of the central factual claims of the movement. A revisionist tradition points to the strikingly rapid repudiation of eugenics by reputable geneticists in the mid-1940s, a period marked not by any sudden increase in scientific knowledge but by the scientist's strong interest in distancing themselves from the Nazis. Some would even maintain that the eugenicists did not in fact abandon ship, though they said they did. In this view, the Nazi connection motivated eugenicists to refuse to endorse eugenic ideas under that name, and to support eugenic beliefs and projects in other guises.
These accounts have different implications for the future of genetic policy. If eugenics succumbed to the advancement of science, perhaps the lid on its coffins is nailed as tightly shut as it needs to be. If, however, the retreat from eugenics was simply one of fashion, the movement has not been repudiated on the basis of fact or even principle, and we might unthinkingly (or, worse, consciously) return to eugenics when and if fashion changes again. Finally, if clinical genetics is simply eugenics under a different name, we must achieve a clear understanding of the morality of both.
III. Common Themes of Eugenicists
Despite the evident variety of eugenic activity, the whole of eugenics can be characterized by a core set of tenets to which the various movements and figures are related, and important currents in the eugenic stream can be identified more precisely. Though there may be few theses to which all eugenicsts subscribed, there are some which nearly all supported. In particular, most eugenicists shared two assumptions about heredity: the degeneration of the gene pool, and the heritability of behavioral traits. There was also widespread agreement on the general aims of the eugenic program.
Fears of degeneration haunted European social thought in the late nineteenth century. Before Weismann's theory of the unalterable germ plasm gained wide acceptance, the commonly accepted explanation was environmental, blaming the migration of young men from the healthy countryside to the cities during industrialization, which was claimed to have ill effects on offspring (Soloway 1990). After Weissman=s and Galton=s views had made an impact, concern shifted to the effects of Aunnatural@ selection. Darwin's Origin of Species seemed to demonstrate that competition, a process with losers as well as winners, is essential if the human race is to improve. Modern society, it was feared, rescues and nurtures the unfit, who, far from falling by the wayside, now flood society with disproportionately large numbers of offspring. The result is that damaging hereditary characters spread through the population, threatening a catastrophic loss of fitness, and hence of all human excellences, with a cumulative effect that increases exponentially by the year.
Others understood degeneration as a result of the loss of racial purity. A German study of interracial offspring among Hottentots in Africa, by a scholar who later figured prominently in Nazi eugenics, claimed that mixed-race offspring were inferior to the races of both parents. Parsifal, Wagner=s final, epic opera of degeneration among teutonic Knights of the Holy Grail, has been understood as a warning of the loss of Germanic biological superiority through the mixing of blood; one devotee who may have taken this lesson from Wagner was the young Adolf Hitler. The specter of degeneration, whether understood in racial terms or not, gave urgency to eugenic policies. Without this doomsday scenario, fewer of the movements' followers would have accepted its harsher prescriptions.
Heritability of Behavioral Traits
The belief in the heritability of behavioral traits--talents, proclivities, dispositions, and the like--has earned the eugenicists well-deserved ridicule. Davenport's list of inherited traits, for example, ranged from "pauperism" to such fanciful items as "thallasophillia," or love of the sea, the gene for which he judged to be sex-linked (since sea captains were exclusively male). For many eugenicists, the key to the transmission of character and talent was the single trait of intelligence, and eugenics was intimately associated with the rise of IQ testing and the labeling and grading of degrees of mental incompetence by Henry Goddard and others. At issue was whether the objectionable behavior of the unfit could be traced to lack of intelligence (immorality, in this view, resulting from an inability to understand right and wrong), or to the inheritance of separate incapacities, in particular lack of self-control and industry.
In view of their belief in genetic transmission of talents and temperament, almost all eugenicists believed that social problems had a biological basis, and also, at least in part, a potential biological remedy. The precise relationship between society and biology was understood very differently by, say, "mainline" British conservatives, Nazi racialists, and Marxist radicals. But we can find the same biologizing tendency in proposals as varied as segregation of the "feeble-minded" and the proposal for "eutelegenesis"--the mass insemination of women with the sperm from a small number of remarkable men, which a Soviet eugenicist insisted was necessary for fulfillment of the Five-Year Plan.
Beyond these assumptions, nearly all eugenicists agreed on the overall aim of their movements. The fundamental goal of all eugenics in those countries in which the "hard-hereditarian" genetic theories of Galton and Weismann were accepted was to "improve" the overall quality of the gene pool, whether by positive or negative eugenic means. Because eugenics antedated the current revolution in genetics and molecular biology, its proposals of necessity relied almost exclusively on changing the breeding practices of human beings. Accordingly, reproduction was seen by all eugenicists as an act with social consequences rather than a private matter.
Not all eugenicists concluded that reproduction should be controlled by the state; Galton, for example, wanted to secure voluntary acquiescence with eugenic guidelines by making eugenics a civil religion, and some eugenicists focused entirely on positive eugenics, which could scarcely be compulsory. This social understanding of reproduction was accompanied by a view of the germ plasm as a social resource, its use governed by considerations of the public good--though, once again, eugenicists of different political colorations drew very different implications from this shared premise.
If there was a core belief common to all eugenicists, it would have to be expressed in the most general terms: concern for human betterment through selection--that is, by taking measures to ensure that the humans who do come into existence will be capable of enjoying better lives and of contributing to the betterment of lives for others. This, most would agree, is an unexceptionable aim C and its general appeal helps account for at least some of the wide appeal of the eugenics program. But behind this genial promise lay a multitude of sins.
IV. Ethical Autopsy
Eugenics is remembered mostly for the outrages committed in its name. Terrible as they were, however, these wrongs do not, in themselves, tell us about the validity of eugenic moral thinking, any more than medical experimentation on human beings can be judged immoral on the basis of experiments at Dachau and Tuskeegee. For the history of eugenics to be instructive in ensuring social justice in a society with greater knowledge about genes, and perhaps some ability to alter them, the key question is whether, unlike medical experimentation on humans, eugenics was wrong in its very inception. If so, any eugenics program will be wrong. On the other hand, if the abuses done in the name of eugenics do not necessarily reflect badly on eugenic ideas themselves, then our task will be to ensure that any eugenic interventions of the future avoids these abuses. Our review, which will be simultaneously historical and prescriptive, finds that much of the bad reputation of eugenics is traceable to attributes which, at least in theory, might be avoidable in a future eugenic program. But we believe that problems of social justice and fairness, which reduced the moral stature of eugenics in the past, and will be prove just as difficult in the decades ahead.
A Creature of its Time
Eugenics is easy to ridicule. Photographs of AFitter Family Contests@, showing large families at state fairs receiving the same kinds of awards as those handed out for best cows and pigs, need no comment, and the movement=s extravagant promises and predictions are ludicrous in retrospect. Indeed, very little of the scientific basis on which the movement was premisedCfor this was fashioned as an attempt to bring the insights and methods of modern science to bear on social problemsCwithstand scrutiny.
Though the eugenicists correctly noted the social dislocations of the late nineteenth and early twentieth centuries, their biological explanation--the "degeneracy" thesis--was not correct, either in its Lamarckian or its Darwinian versions. The widespread belief among eugenicists left and right in the heritability of talents, vices, and other traits of character, has not fared much better. Though interest in the genetic basis of behavioral traits and dispositions continues unabated in today's studies of twins (Bouchard 199x) and in sociobiology (Wilson 198x, Kitcher 199x), which are hardly free from controversy, even those most strongly convinced of a genetic basis for particular behavioral dispositions find little merit in the eugenicists' research methods or specific conclusions.
Nor were the eugenicists prescriptions for genetic improvement likely to have much effect. They had no way to identify carriers of recessive genes, and so did not know whom to discourage from reproducing; thus their proposed programs could not possibly deliver the benefits they promised. Some eugenicist scientists came to appreciate the relative futility of their proposed measures in bringing about large-scale changes in the distribution of what they imagined were the genes underlying such traits as intelligence and self-control (Paul and Spencer 1995). In their more careful moments, they conceded that the effect of eugenic measures would be very small, though they considered the interventions justified even by these results. Their candor, however, was not matched by the leaders of the movement, who promised rapid, visible, social improvement.
The bigotry and racism of mainstream eugenics, like the pseudoscience, is glaring and appalling to the present-day reader. The class prejudices of mainline eugenicists are startling in their ferocity. The feminist eugenicist Marie Stopes spoke of "that intolerable stream of misery which ever overflows its banks" (Stopes 1921); others spoke of "social pests", "sewerage," and "scum" (Searle 1992). The founder of the famous Vineland Training School, E.R. Johnstone, spoke of "waste humanity" (quoted in Popenoe and Johnson 1918). And Sidney Webb, the Fabian socialist, warned of the "breeding of degenerate hordes of a demoralized @residuum@ unfit for social life."
It is chilling, in light of events to come in Germany, to encounter Charles Davenport's social Darwinist perspective on infant mortality:
We hear a great deal about infant mortality and child saving that appeals to the humanity and the child-love in us all. It is, however, always the saving of the lowest social class that is contemplated. I recall the impassioned appeal of a sociologist for assistance in stopping the frightful mortality among the children of prostitutes. But the daughters of prostitutes have hardly one chance in two of being able to react otherwise than their mothers. Why must we start an expensive campaign to keep alive those who, were they intelligent enough, might well curse us for having intervened on their behalf? Is not death nature's great blessing to the race? If we have greater power to prevent it than ever before, so much the greater is our responsibility to use that power selectively for the survival of those of best stock; more than those who are feebleminded and without moral control (Davenport 1914).
These views betray an almost visceral hatred (parading as concern for the victims who would "curse on us for their rescue"). The first step toward atrocity is the objectification, vilification, and ridicule of the victim. The comparison of "feeble-minded" people and others in the underclass to feces, waste, and animals made it thinkable to deprive hundreds of thousands of people of their civil rights, first through institutionalization and segregation, then by involuntary sterilization, and, in the singular instance of Nazi Germany, through murder.
Though the pseudoscience, bias, bigotry, and racism which abounded in eugenics make the movement=s bad reputation richly deserved, these features of the historical movement do not in themselves demonstrate that eugenics must be avoided in the future. The eugenics movement was a creature of its time. The science of genetics was in its infancy. Racism, class snobbery, and other forms of bias were openly expressed even by learned scholars; these sentiments, so obvious and objectionable today, were invisible then, because, of course, they were so widely shared. There is no shortage of class, race, and national biases today, though they are no longer displayed openly in polite society, and vigilance is needed to ensure that they do not infect social policy involving applications of genetic science (as in every area of social life). Part of the fierce opposition to the theses of Herrnstein and Murray's The Bell Curve, which occupied center stage in intellectual debate for a season, can be understood as a response to their disparaging remarks---couched, to be sure, in soothing and reasonable language--about not only the intelligence but even the moral character of both the poor and African-Americans. But, as we note below, racism and other biases were not unique to eugenics. A central concern of public health authorities who studied health among blacks was that whites might catch their diseases. For example, Dr. C.E. Terry reported that though mortality was higher for blacks, the white mortality was higher than it should be because of "a race infection" occurring as the blacks "mingle with us in a hundred intimate ways" while rendering services (Terry 1913, quoted in Muller 1985). A 1945 report of a tuberculosis control program in Memphis aimed to x ray "a large proportion of the Negro females in the community" so that housewives could check their health cards before hiring them as domestics (Graves and Cole 1945). This sorry record does not show that we should abandon public health programs, and likewise do not argue definitively against eugenics.
In short, the central theses of a social movement, including its moral premises, ought not be dismissed because of the intellectual and ethical failings of its adherents. Eugenics is recalled as the Nazis= racial doctrine, which it was, but to be a eugenicist, then or now, is not tantamount to being a Nazi. Reflexive rejection of eugenic ideas because they had unsavory advocates is neither morally nor intellectually serious. What matters is the moral defensibility of the eugenic concepts and values themselves, which must be identified and assessed.
Why Was Eugenics Wrong? Five Theses
We now consider five answers to the question, Why was eugenics wrong? Each goes beyond the movements poor science and evident prejudice to attempt to locate errors of moral wrongs inherent in any eugenic program. We endorse the fifth, the lack of a concern for the fair distribution of burdens and benefits; but several of the others come close to the mark.
Thesis 1: Replacement, not Therapy
Eugenics sought human betterment, but in a distinctive way: by causing better people to be conceived and born, rather than by directly bettering any people. Benefits to people already born would be indirect: freedom from the burdens placed on society by the unfit, sharing in the productivity of the gifted. The distinction has been drawn vividly, albeit in a different context, by Richard Lewontin:
To conflate...the prevention of disease with the prevention of lives that will involved disease, is to traduce completely the meaning of preventive medicine. It would lead to the grotesque claim that the National Socialists did more to "prevent" future generations of Tay-Sachs [a lethal genetic disease found most commonly among Jews] sufferers than all the efforts of science to date. Genetic counseling and selective abortion are substitutes for disease prevention and cure (Lewontin 1997; italics in original).
Is eugenics suspect for this reason? We believe not. There are, however, a number of reasonable concerns which might seem to condemn eugenics for this reason. Policies of any sort, eugenic or otherwise, which affect the well-being of future generations by changing the identities of those who will constitute them present a host of apparent philosophical paradoxes and conundrums, as Jan Narveson (1967, 1973) and Derek Parfit (1984) have shown to a generation of moral philosophers. We discuss these Agenethical@ uncertainties (Heyd 1992) in Chapter Five. For our evaluation of eugenics, we need only note that eugenic policies are by no means unique in having this kind of effect. So do conservation policies, macroeconomic decisions, and commercial advertising, since each affects, in ways large and small, which individuals will be conceived and born. Why, then, single out eugenics? One concern is that those who would better humankind by bringing about the conception of Abetter@ humans would make faulty judgments on what kinds of people should be conceived and born. The eugenic authorities might favor the wrong traits, and they might not appreciate the value of diversity and differences in points of view over what makes life valuable and worthwhile. A related concern is that any scale of human excellences which eugenicists might use to Aimprove@ the population would automatically stigmatize those people, both living and those yet to be conceived, whose traits put them at the bottom of the eugenicists= rankings. Both of these concerns are understandable, and we discuss them both in this chapter and in Chapter Seven. To be sure, the eugenicists of half a century ago were guilty of intolerance and disdain for those whose like they sought to "prevent" in future generations. This contempt is audible in H.G. Wells=s admonition (1905, quoted in Paul 1995) that "the way of Nature has always been to slay the hindmost, and there is still no other way, unless we can prevent those who would become the hindmost being born." Nazi eugenicists took the further step of murdering many of them. Nevertheless, this appraisal of eugenics does not point us toward its cardinal sin. In theory, eugenicists could heed concerns over diversity. Objections to the choices eugenicists made, to which we turn shortly, do not necessarily argue against any attempt to choose. And some of the same concerns about stigmatization could be raised in opposition to programs which seek to ameliorate conditions, such as deafness, among existing people: for why try to Acure@ a person of deafness unless it is undesirable to be deaf?
This critique also proves too much. As a general argument, it would condemn genetic screening even for very serious conditions, which disabilities rights organizations themselves support. The gene for achondroplasia, for example, a single copy of which produces a (usually) healthy dwarf, is dreadful in combination, and, according to Ruth Ricker (1995), former President of Little People of America, the dwarf community looks forward to the day when dwarf parents can be spared the fear of giving birth to a child with two of these genes. Advocates among the deaf have asked to appreciate the quality of life achievable with hereditary deafness (Wernimont 1997); but the argument we are considering would also condemn any interest in "preventing lives" marked by disabilities which do not permit such a high quality of life. Indeed, we consider in Chapter Five the case for the moral thesis that this form of "prevention" is not only permissible but morally obligatory for parents given the choice, at least with respect to severe disabilities.
Thesis 2: Value Pluralism
"Who was to set the criteria for ideal man? In a complex modern society no particular human type could be characterized as 'the best'" (attributed to Wilhelm Johannsen 1913, in Roll-Hansen 1989). Is the very idea of a eugenic program self-defeating? If there is no Abest@, how can eugenicists promote it? Eugenicists are rightly blamed for promoting a particular conception of human perfection, failing to appreciate the essential plurality of values and ideals of human excellence. Like others, they assumed that the ideal would be similar to themselves, or at least to those they most admired. Mainline eugenicists in the United Kingdom and the United States, largely members of the upper-middle professional classes, hoped for a society in which each person would attain his or her level of virtue, and they despised those who failed to display the proper bourgeois values. Nazi racial hygienists, many of whom considered themselves to be of "the Nordic type," valued the Nordic type. Hermann Muller, the socialist geneticist and eugenicist, extolled a wide range of models, including Lenin, Gandhi, and Sun Yat-Sen--all of whom were, like Muller himself, exceptionally brilliant men.
As the question attributed to Johannsen, a Danish geneticist and reluctant eugenicist, demonstrates, the difficulty of defining human perfection was not entirely lost on the eugenicists, but the strident rhetoric of much of the mainline eugenics literature brooked no opposition and admitted to no doubt over what constituted a "healthy" and virtuous style of life. In a word, the mainstream eugenicists tended to be snobs. Looking down on the manners and values of those they despised was not an incidental feature of their eugenic program; it was one of its driving forces, validating and supporting the self-image and pretensions of the upper middle classes (Mazumdar 1992). This intolerance and self-glorification was a notable moral failure in mainstream eugenics. A closer examination of the mainstream, pre-Nazi eugenic program, however, however, complicates the picture considerably. For though mainline eugenicists despised the underclass for not resembling themselves, the traits the eugenicists believed heritable and worthy of cultivation were ones valued by people with widely varying ideals of personal development, plans of life, and family structure. Though some eugenicists did believe there to be particular genes for drunkenness, "shiftlessness," and the like, in the main the eugenicists focused on a very short list of traits about which there is little controversy. Members of the Ahuman residuum@ they wished to eliminate would presumably have valued these traits, too. As we have seen, intelligence dominated the list, or was the only item on it; self-control and a few other very general virtues were sometimes added. There is little real dispute over the value of these all-purpose talents, even among those who might disdain the proper airs and manners of the mainline eugenicists; whatever a person's favored pursuit or style of living might be, intelligence and self-control help make the most of it.
It remains true that the mainline eugenicists were anything but tolerant of personal and social ideals that differed from their own. They favored breeding humans with an eye to intelligence and self-control because they thought that these traits were necessary if a person were to lead a proper kind of life. Claims of this kind--for instance, that the poor are too stupid to understand the difference between right and wrong, or to exercise the restraint necessary for the nuclear family--resurface today in such works as The Bell Curve. Still, we would not fault the eugenicists (or the authors of the later book) for believing that raising the level of intellectual ability in the population would result in human betterment. What deserves criticism and rejection are a series of beliefs and attitudes that accompanied this element of the eugenic program. These include the assumption that raising intellectual ability would result in more widespread adoption of bourgeois values, and that this would be a good thing; that social problems such as crime and unemployment are the result of low intelligence; and a belief that, on the whole, people of low intellectual ability are of little value to themselves or others.
For the future of genetics, however, pluralism of ideals and values may turn out to be a crucial issue. Parents who choose not to avail themselves of genetic screening or engineering for avoiding short stature in a child might be condemned by neighbors for failing to ensure that their child would be Anormal@. Less defensibly, deaf parents who wish to abort fetuses that do not test positive for inherited deafness, and dwarf parents who want only a child with the gene for achondroplasia, also hold unconventional values, and their freedom to act on them is likewise at issue in the ethics of clinical genetics. The European Parliamentary panel on genetic engineering, headed by the Green representative to the German Bundestag, R. Härlin, held that genetic screening requires us to decide what is "normal and abnormal, acceptable and unacceptable, viable and non-viable forms of the genetic make-up of individual human beings before and after birth" (quoted in Kevles 1992). And if we ever acquire an ability to influence personality and character through genetic choice or manipulation--to choose, for example between aggressive and gentle dispositions--this debate will be of crucial importance. In Chapter Six we discuss the range of choice among alternatives likely to be available in the near and medium term that should be given to prospective parents.
Thesis 3: Violations of Reproductive Freedoms
Apart from the Nazis' crimes, the involuntary sterilization of tens of thousands of Americans and Europeans was the worst stain on the record of the eugenics movements. (Other great wrongs, such as curbs on immigration and the miscegenation laws, stemmed from a variety of causes.) In many instances, those who warn us of a return to eugenics have infringements of reproductive freedoms in mind. Indeed, the eugenic program, once LaMarckian theories of heredity were abandoned, consisted largely in trying to influence (or to dictate) who would breed with whom. This was the sole technique the eugenicists had for influencing the genetic makeup of new generations. It may seem appropriate, then, to identify eugenics with violations of reproductive freedom, and in turn to condemn both on the same grounds. But is this what was wrong with eugenics? Diane Paul (1996) has pointed out that not all eugenicists favored the use of coercion. Galton did not, and surely he counts as a eugenicist. Eugenics was imposed by force, in the form of sexual segregation and sterilization, but in other instances it was entirely voluntary. Today, the eugenics-minded government in Singapore offers singles cruises to educated women in the hope that they will find husbands and reproduce. This is no violation of reproductive freedom, even if is wrong-headed.
Paul has argued that, at least in the United States, reproductive freedoms are sufficiently well-established that we need not entertain serious fears about the return of a coercive eugenics in the wake of the Human Genome Project. Surely she is correct that sterilizations on a mass scale are inconceivable in this country, at least in the near term. The same may not hold in countries with weaker traditions and which lack entrenched legal protections for reproductive freedom however; China, whose recent law on maternal and child health contains eugenic provisions, is a case in point (Nature 1995; Qiu 1998). We discuss issues of genetics and reproductive freedom in Chapter Five.
Thesis 4: Statism
In a recent address, James Watson (1997) reviewed the odious history and possible future of eugenics and concluded that the most important safeguard is to eliminate any role for the state. He provided a strong case. The great wrongs visited on vulnerable people in the name of eugenics---institutionalization, sexual segregation, sterilization, and, in Germany, murder on a mass scale---could not have occurred without state involvement. This was as true in Social Democratic regimes, such as Sweden, as under the Nazis. . In England, where the state's role was minimal, eugenics may have been offensive, but it did not violate individual rights.
Nevertheless, we take issue with Watson=s thesis, if understood as implying that the chief ethical problems of eugenics can be addressed by keeping the state out of genetic improvement. Eugenics can be pursued without the state, and arguably even as the unintended result of actions done for other reasons, but the ethical issues can be just as serious. What Troy Duster (1990) has called "backdoor eugenics" threatens to visit harm on the genetically disfavored through the cumulative effect of many private decisions on the part of employers, insurers, and prospective parents. As Robert Wachbroit (1987) has observed, government and society might conceivably switch roles, with the former intervening in private choice in order to preserve the liberties and well-being of those whose genes threaten disease or disability. In such a scenario, denying a role to the state might hasten eugenic evils rather than protecting against them. If the "backdoor" concern is justified, we ought not conclude that the wrongs of eugenics can be avoided as long as the state forswears any eugenic intent.
In any case, a strong state role is not essential for a eugenic program. True, it may be difficult to win compliance with eugenic prescriptions without the long arm of the law. That is why Galton, imagining a fully voluntary regime, mused that eugenics might have to be instated as a civil religion in order to induce members of society to make the sacrifices required. Eugenics never attained this status, whether in the UK or elsewhere (not even in contemporary Singapore, where the head of state has been an enthusiast). The British eugenics movement was no less "eugenic" for being a citizen's movement relying on voluntary measures, and from this fact it follows that statism is not a source of wrongs inherent in the core of the eugenic program.
Thesis 5: Justice
Daniel Kevles (1985) concludes his magisterial history of the eugenics movement with the observation that
eugenics has proved itself historically to have been a cruel and always a problematic faith, not least because it has elevated abstractions--the "race," the "population", and more recently the 'gene pool'--above the rights and needs of individuals and their families (pp. 300-301).
The eugenics movements of 1870-1950 insistedCwrongly, as it turned outCthat humankind faced a grave threat (degeneration) and stood to gain a large benefit (more able, more fit people) if humans would submit to the kind of breeding programs which had been used to improve plants and livestock. But who would benefit, and at whose expense? The internal logic of eugenics provides the answer. The Aunderclass@ is simultaneously the group of people whose genes were not wanted, and also the people who, through involuntary sexual segregation, stigmatization and denigration, sterilization, and even murder, paid the price. The injustice of this distribution of burdens and benefits is evident, even when we make the effort to accept, for the sake of argument, the eugenicist=s warnings about degeneration and their promise of a better society to come. Thus construed, the central moral problem of eugenics is akin to the perennial ethical quandary of public health, which seeks to benefit the public but in some cases exacts a penalty, such as quarantine or involuntary vaccination, on some individuals. The actual Typhoid Mary, for example, was forced to live out her life on an island in the East River near New York (Leavitt 1996); HIV-positive Cubans today may face restriction to a sanitorium (Bayer 199x). The search for a balance between public health and personal liberty and other interests will always figure prominently in the ethics of public health. It is notable that eugenicsts often portrayed their movement as a campaign for public health. Programs and personnel were often common to both. As Charlotte Muller noted in her insightful review of writing in the American Journal of Public Health during this period, the gross differences in health status across racial and income lines tended to be explained in terms of heredity. Martin Pernick (1997) has noted extensive overlap even in the jargon of the two fields, each of which resorted to "isolation" and "sterilization" of the individuals who were thought to pose threats to the well-being of the public. Eugenics was often described in medical terms (Kamrat-Lang 1995), e.g. as an effort to prevent the spread of (genetic) disease from generation to generation. Hitler was lauded as the great doctor of the German nation, rescuing the Aryan gene pool from the genetic disease introduced by Jewish infestation (Proctor 1988).
The Public Health and Personal Service Models
It is tempting, in trying to guard against a reversion to bad eugenic policies, to draw a bright line between eugenics as an intervention on behalf of public health and welfare, versus clinical genetics, in service to the individual. We called these the Public Health Model and the Personal Service Model, respectively, in Chapter One. The bright line would distinguish indefensible eugenics from defensible genetics, even if the latter faces moral problems of its own. In our view, the distinction is not as clear as it is alleged to be, nor is the moral difference as sharp. as with other "ethical firebreaks" examined in this book, this alleged distinction is not an appropriate substitute for moral analysis.
According to this proposal, parents do not practice eugenics when they seek "the perfect baby". The reason is that these parents presumably do not employ clinical genetics with the population's welfare in mind. Any testing, or indeed genetic engineering, which they employ will be done because they want their child to have every advantage which the new genetics can bestow. The cumulative impact of decisions like theirs may have a substantial impact on the well-being of others, and on society over time, but, in seeking clinical services, this is not their personal concern.
But can these two concerns, one for the prospective child and the other for society, be so neatly distinguished? Consider these statements:
1a. I favor a genetic intervention because I want my child to have the "best" (healthiest, etc.) genes.
1b. We favor genetic interventions (on behalf of each of us) because we want our children to have the "best" (healthiest, etc.) genes.
1c. I favor genetic interventions (for each person in our group) because I want our children to have the "best" (healthiest, etc.) genes.
If 1a is morally acceptable, it doesn't become wrong when voiced by several people (in the form of 1b). And how can one person be faulted by endorsing that group's hope (1c)? 1b and 1c are merely the aggregate of many instances of 1a. One might expect to hear 1c uttered by, say, a health official, or a legislator who sponsors a measure which would provide genetic services to large numbers of people. Concern for the welfare of large numbers of people is part of their job description.
Advocates of a bright line between clinical genetics and population eugenics might reply that the health official or legislator who enables parents to make use of genetic services is focusing not on the Aquality@ of the population but on the desires of the parents. The beneficiaries of these services, in this view, are first of all the parents, and only secondarily the offspring; any effect on the Apopulation@ is unintended and incidental. But would funds, either public or private, be allocated if the offspring did not enjoy significant benefits? Again, the difference seems not to be a matter of the principles underlying social policy so much as the vantage point of those in different roles involved in carrying out these policies.
Cost-Benefit Justifications for Genetic Interventions
The difficulty in distinguishing the population perspective of the public health model and the individual concern of the personal service model arises also in consideration of cost-benefit calculations. The Eugenics Catechism of the American Eugenics Society (1926) expresses the kind of sentiments we now seek to avoid:
Q. How much does segregation cost?
A. It has been estimated that to have segregated the original "Jukes" for life would have cost the State of New York about $25,000.
Q. Is that a Real Saving?
A. Yes. It has been estimated that the State of New York, up to 1916, spent over $2,000,000 on the descendants of these people.
Q. How much would it have cost to sterilize the original Jukes pair?
A. Less than $150.
Similar examples abounded in the arithmetic books of German schoolchildren in the 1930s, extending to the cost of keeping institutionalized, handicapped people alive; not long afterward, tens of thousands lost their lives. But cost-benefit arguments in genetics do not necessarily signal a readiness to sacrifice some for the betterment of others. If we offer a cost-benefit analysis in support of a program of genetic screening or other intervention which shows that the sum total of benefits would be greater than the costs, the intended message need not be that the genetic services should be offered to save money. The goal may instead be to ensure that as many children as possible are born with genes which make their lives go well. Given the endless competition which exists for public funds, however laudable their purpose, it always helps if one can argue that the net social cost is zero or better. This calculation has been a trump card in debates over health care allocation when played by advocates for cost-effective health services such as perinatal medical care, and it might apply equally well for a program aiming to provide better genes.
A case in point is the current debate over screening for Down Syndrome and other genetic and chromosomal abnormalities. According to Kevles (1985), a U.S. government analyst estimated in 1974 that $5 billion spent over 20 years to reduce the incidence of Down Syndrome (by voluntary screening and abortion) would, assuming a reduction of 50 percent, save the United States more than $18 billion; and other screening programs had the potential to save another $75-100 billion. A more recent proposal to extend a three-level screening program for Down syndrome to all pregnant women included an estimate of cost savings (Elkins and Brown 1993). Is this eugenics? Carlson (1996) quotes a physician who resolutely avoids the term: "Sometimes you need to abandon words that have common meanings that connote the wrong ethics or morals." Carlson adds, "But only the words have changed" .
The line, we believe, is thinner than it is bright. If, as we have argued, the central ethical problem in eugenics was one of social justice, the remedy, as we try to ensure that the genetic future is more just than the eugenic past, is not to disavow any social purpose. The distinction between social and individual perspectives is not always clear. Even where this distinction can be drawn, however, must we disavow any social purpose?
V. The Social Dimension of Genetics
In our view, the key issue in appraising the shadow cast by the eugenics movement on clinical genetics is not whether those who build programs of clinical genetics have an individual focus as opposed to a social one. The social goal is not automatically suspect. What matters is whether either goal is pursued justly. In particular, the fact that the prospect of better health--or even enhanced functioning, apart from health---in the next generation is a worthy goal, other things being equal, does not in itself show that this goal would justify restrictions on liberties, social inequalities, or other measures that are suspect from the perspective of justice. Constrained and guided by concerns of justice--the chief focus of this volume--the prospect of healthier and more able generations of human beings in the years to come is an appropriate and defensible goal of public policy on genetics. Indeed, Rawls, in the brief treatment of eugenics in his A Theory of Justice (1971), argues that genetic improvement is a social responsibility:
It is in the interest of each to have greater natural assets. This enables him to pursue a preferred plan of life....[thus] the parties want to insure for their descendants the best genetic endowment (assuming their own to be fixed). The pursuit of reasonable policies in this regard is something that earlier generations owe to later ones, this being a question that arises between generations. The eugenicists were ahead of their timeCwhich was probably a good thing. Since they lacked the means to detect recessive genes in the population, even with full compliance their proposals would hardly make a dent in the distribution of the genes they imagined to be of social importance. More important, their sole instrument of change was the blunderbuss weapon of human breeding (and in extreme cases, sterilization and euthanasia). Humans are notoriously hard to breed; we are animals with hearts and minds of our own. A few scientists, such as Muller and Haldane, permitted themselves the fantasy that people could learn to sever the age-old link between biological and social mating, choosing one person as lover and husband and another (via insemination) as biological father, but this was never to be. There is no reason to think that the eugenicists "improved" the gene pool to any appreciable degree, nor could they have.
Our powers are much more impressive, and humankind=s future abilities to rewrite our genetic code are apparently limitless. Davenport would have given anything to have been around in these times. So would have Hitler's racial hygienists.
Could eugenicists of the old school make a convincing case for reinstituting their programs, cleansed this time around of bias and pseudoscience, and respectful of individual rights? Muller's heirs might insist that now is the time to launch a program to propagate a superior version of ourselves, a Sun Yat-Sen or a Gandhi. Or should we second Elof Axel Carlson's (1981) appraisal of eugenics as "the manure from which the flower of genetics could grow," no more relevant to today's genetics than astrology is to astronomy or alchemy to chemistry?
The core notion of eugenics, that people=s lives will probably go better if they have genes conducive to health and other advantageous traits, has lost little of its appeal. Eugenics, in this very limited sense, shines a beacon even as it casts a shadow. Granted, when our society last undertook to improve our genes, the result was mayhem. The task for humanity now is to accomplish what eluded the eugenicists entirely, to square the pursuit of genetic health and enhancement with the requirements of justice. Much of this book is devoted to the pursuit of this end. These considerations of justice can be divided into two categories: constraints on genetic practice and policy, and justice as a goal of those practices and policies. We consider close by considering these briefly.
Genetics Constrained by Justice
Whether or not the state, or any other powerful institution, makes a conscious decision to use advances in genetics in the social realm, the widespread use of these increasingly powerful techniques and products will inevitably affect our relationships with each other and with the state. We can look back to the eugenics movement to educate ourselves on how we ought not to proceed, and we can try to anticipate new problems of social justice which will arise as we deploy the developing science of heredity in our very different circumstances.
Since infringements of reproductive freedoms were the most notable wrongs done in the name of eugenics, apart from crimes of Nazi racial hygiene, close attention to the effect of the new genetics on these freedoms is essential. With self-determination supported in the United States both by constitutional law and by geneticists= efforts to ensure non-directive counseling and services, it is tempting to draw another bright line and insist on complete laissez-faire. In Chapter Five, we discuss the tangled moral dilemmas involved in genetic intervention in the conception of a child, and find potential harms to these offspring which may argue against a completely permissive policy.
Natural Inequality and Self-Respect
Eugenics was inspired by the notion that not all people are created equal. Whether the individual eugenicist was inspired by the prospect of social progress brought about by increasing the number of gifted scientists and leaders, or consumed with dread over crime, disease, and sin, all eugenicists attached enormous importance to what they viewed as inequalities of endowment. Mainline eugenicists were the most vocal in pointing to and warning about the alleged lack of talent and virtue in the underclass. By the emphasis that they put on measures of IQ and other supposedly unalterable key mental and temperamental attributes, the eugenicists pounded in the message that those least endowed were of least value to their contemporaries, to the future of the race, and even to themselves, in that their lives were impoverished.
Self-respect is, to some extent, a good that can be distributed, both by the functioning of social institutions and by the public rationale for their design and operation, and its value can hardly be underestimated. Rawls observes that self-respect "includes a person's sense of his own value, his secure conviction that his...plan of life, is worth carrying out." For "when we feel that our plans are of little value, we cannot pursue them with pleasure or take delight in their execution. Nor plagued by failure and self-doubt can we continue in our endeavors" (Rawls 1971, p. 440). Although we do not yet know how much of the differences in performance and ability exhibited across and between populations will be traceable in any direct way to genetic differences, the prospect points once again to questions of justice that were addressed poorly and injuriously in the eugenics movement and that must be dealt with more adequately in the years ahead. A similar concern has been registered by disability -rights leaders who fear that programs of genetic screening and intervention which target their disabilities will have the effect of stigmatizing the people with disabilities. We discuss their concerns in Chapter Seven.
Dividing the Risk Pool
Control over genetic data is the single greatest concern among bioethicists and the general public concerning the new genetics. While this is usually conceived in terms familiar from medical ethics--that is, as a right of confidentiality and privacy--its deeper significance is one of distributive justice. As Daniels has remarked, our ignorance of the pattern of distribution of deleterious genes has put us in a single lifeboat, each feeling vulnerable to disease. As the veil of ignorance lifts through genetic testing, those who are free of a given health risk are enabled to draw lines between the vulnerable and the secure (Daniels 1994). And by forming their own risk pools, they can better their lot. Those not identified as having these genes can achieve lower insurance costs; their industries can be made more efficient by avoiding the need to clean up materials toxic only to the few; and they can avoid the prospect of children or grandchildren afflicted by certain genetic diseases. In effect, those who are, relatively speaking, genetically healthier can secede, or can exclude and ghettoize others, and profit from doing so. Where ignorance of genetic differences once provided a sense of a common fate, thus joining a personal motive of self-protection to arrangements that offered mutual support, the fruit of knowledge will require a commitment to principles of justice.
Similarly, only careful attention to the requirements of justice can inform us of the limits, if any, to a social obligation to provide genetic services to those who may want or need them. While we may believe that justice is not compatible with division of the population into different risk pools for health insurance purposes, not all genetic interventions of the future will be addressed to health. If genetic services can be used to enhance as well as to cure, does justice demand that these services be provided upon demand, at social expense? Should access to enhancements be left entirely to the market? And what if these enhancements provide "positional goods"--advantages, such as relative height--that are benefits if and only if not everyone has them? We probe these questions in Chapters Three and Four.
Genetics in Pursuit of Justice
Looking to the farther future, we may entertain the proposition that genetics be used specifically to bring about a more just society. The mainstream eugenicists pursued this goal, in their own fashion, insofar as they believed that the Aunfit@ were an unfair burden on the fit. We can reject the eugenicists notions of what is just without disavowing the possibility of using genetics to achieve greater justice. These prospects are largely speculative today, since there is little that we will be able to do in the near future to rectify social injustices. But what if we could distribute genes as readily as we can (but rarely do) distribute wealth? Would justice require that we create a society of equals? Or, if we discovered that greater efficiency and satisfaction were attainable by creating human beings in five distinct grades of overall ability, as in the society in Huxeley=s Brave New World, would this be the better choice--particularly if the added efficiency added to the well-being of even the most lowly members of society? We have a long time, perhaps measured in centuries, to deliberate about such questions. Still, they are of practical importance if they point toward any near-term policies which might affect such dimensions of social justice as overall equality. In Chapter Three we ask whether the best theories of justice entail that if we could distribute natural assets equally, we should. The conclusions reached there point toward a moral basis for long-term considerations on the demands of justice on the distribution of genes.
Eugenics casts a shadow in large part because of the way in which it was pursued. It is no surprise that Nazis would seize on such ideas as a theme and rationale for a campaign of exclusion, terror, and murder. Although lesser mayhem came from the pursuit of genetic "betterment" by zealous protectors of middle-class mores and interests bent on subduing a troublesome underclass, those unjustly sterilized and segregated in their efforts numbered in the tens of thousands. These abuses, however, do not lend themselves to condemnation of the eugenicists' every thought and goal, any more than Nazi cost-benefit thinking condemns cost-benefit thinking.
Though we agree with the need to be vigilant over any hint of a return of these abuses, our examination of the shadow of eugenics has focused on the less visible issues of morality and justice at its center. These pose questions and challenges as much as of warnings and admonitions. Reprehensible as much of the eugenic program was, there is something unobjectionable, and perhaps even morally required, to that part of its motivation that sought to endow future generations with genes that might enable their lives to go. We need not abandon this motivation if we can pursue it justly.