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 Tuskegee. 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 very 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 that, 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, will prove just as difficult in the decades ahead.

A Creature of Its Time

Eugenics is easy to ridicule. Photographs of "Fitter 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 move merit was premised - for this was fashioned as an attempt to bring the insights and methods of modern science to bear on social problems - withstands 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 et al. 19go) and in soclobiology (Kircher 1996), 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 199 5).

In their more careful moments, they conceded that the effect of eugenic measures would be very small, although 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 192-1); others spoke of "social pests," "sewerage," and "scum" (Searle 199z).

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)

These views betray an almost visceral hatred (parading as concern for the victims who would curse 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 institu intionalization and segregation, then by involuntary sterilization, and, the singular instance of Nazi Germany, through murder.

Though the pseudoscience, bias, bigotry, and racism that 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 obviously objectionable today, were invisible then, because, of course, they were so widely shared. There is no shortage of class, race, and national biases today, although 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 Herrnstem 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 later in this chapter, 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 the mortality rate was higher for blacks, the white mortality rate 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 19113, 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 it does 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 doc trine, 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 seri ous. 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 movement's 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 Tberapy

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 involve 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 that might seem to condemn eugenics for this reason. Policies of any sort, eugenic or otherwise, that 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 "genethical" uncertainties (Heyd 1991) in Chapter 6. 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 eugen ics? One concern is that those who would better humankind by bringing about the conception of "better" 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 excellence that eugenicists might use to "Improve" 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

7.

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 that seek to ameliorate conditions, such as deafness, among exist ng peop e: for why try to cure 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

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preventing, lives" marked by disabilities that do not permit such a high quality of life. Indeed, we consider in Chapter 6 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 Joharmsen 11913, in Roll-Hansen 1989). Is the very idea of a eugenic program selfdefeating? If there is no best, how can eugenicists promote it? Eugemcists 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 joharmsen, 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 199z). This intolerance and self-glorification was a notable moral failure in mainstream eugenics. A closer examination ' of the mainstream, pre-Nazi eugenic program, however, complicates the picture considerably. For although 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. Although 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 "human residuum" they wished to eliminate would pre surnably have valued these traits, too. As we have seen, 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 selfcontrol 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 deserve 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 starure in a child might be condemned by neighbors for failing to ensure that their child would be "normal." 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 rep resentative to the German Bundestag, R. Hdrlin, 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 199z).

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 6 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 is 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 ste,rilizations 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 that 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 5. 511

Thesis 4:Statism

Ina 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 (iggo) 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 protect 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, in the United Kingdom 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 (11985) 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- 300-1)

The eugenics movements of 1870-1950 insisted -wrongly, as it turned out - that humankind faced a grave threat (degeneration) and stood to gain a large benefit (more able, fit people) if humans would submit to the kind of breeding programs that 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 "underclass" is simultaneously the group of people whose genes were not wanted and 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 and Healton 1989).

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 eugenicists 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 (KamratLang 1995), for example, 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 11988). 53