REVIEW ESSAY

POLITICALLY CORRECT EUGENICS

ABSTRACT. As knowledge of biology grows, so does our power to determine our biological nature by means of genetics. The disastrous character of eugenics has resulted in a certain reluctance to face the problem of what to do with this power. Here eugenics is re-examined in the light of the recently published Eugenics and the Welfare State (Broberg and Roll-Hansen eds.). It is argued that eugenics is not only still with us, but desirable, in the revamped form of a libertarian reform eugenics. This book and The Perfect Baby by bioethicist Glenn McGee are at opposite poles of the debate about whether moral knowledge may be moulded by scientific knowledge. It is argued that bioethical expertise is possible by virtue of the power of knowledge derived from science to inform moral conceptions of the world.

Gunnar Broberg and Nils Roll-Hansen (eds.), Eugenics and the Welfare State, Sterilization Policy in Denmark, Sweden, Norway and Finland, East Lansing, Michigan: Michigan State University Press, 1996 (294 pages). Glenn McGee, The Perfect Baby: A Pragmatic Approach to Genetics, Lanham, Maryland: Rowman and Littlefield, 1997 (166 pages).

Eugenics, it must be agreed, has not generally been a force for good this century, but why exactly? Why should anyone object to the idea per se of improving humanity by any means, genetic or otherwise? Among the numerous reasons for disapproving of 20th Century eugenics programmes are the fact that they were typically not only authoritarian, but also based on an inadequate understanding of human genetics, particularly before the Second World War. Then there was the special place of eugenics in the deranged ideology of German National Socialism. Arguably, Nazi atrocities justified in terms of eugenics (principally the Holocaust) are more the consequence of the brutal, totalitarian and at times insane character of Nazism, than the desire to promote human well-being through genetics. These failings of eugenics are historically contingent and do not necessarily follow from the idea of promoting human genetic well-being. Yet there remains another reason for disapproving of eugenics that stems from its basic aims: positive eugenics promotes human enhancement, which raises the sinister prospect of the creation of supermen, or a master race. It is open to debate whether the possibility of genetically based human enhancement should be approved or condemned. What surely is a mistake is to conflate these four elements - authoritarianism, fallacious biology, criminal misapplication, and enhancement, with the application of genetics to ensure the birth of healthy babies; and an open question remains: is the pursuit of eugenic ends necessarily a bad idea?

1. LESSONS FROM THE PAST: EUGENICS IN SCANDINAVIA

Oh, there's a tremendous difference between the poodles and the mongrels amongst us men.
An Enemy of the People (1)

Since the introduction of their first sterilization law in 1929 (in Denmark), around 40,000 Scandinavians have been sterilized for eugenics reasons. The story of the Nordic sterilization programmes, described in Eugenics and the Welfare State, is highly complex, and rich with ambiguity. Their conception was driven by eugenic theories based to some extent on unsound biology; their passage into law oiled by an eagerness to remove social undesirables and to save money. Their initial consequence was the sterilization of a large number of the institutionalized mentally handicapped and mentally ill. This progressed into a policy of sterilizing disadvantaged young women who were seen as at risk of producing illegitimate children, and then a more extensive and largely voluntary use of sterilization for contraceptive purposes. By 1970 over 170,000 Scandinavians had been sterilized under these programmes.

It is interesting to read Eugenics and the Welfare State keeping in mind the question of how in future mistakes resulting from legislation based on human genetics can be avoided. Significantly, eugenics was not the only driving force behind the inception of the Nordic sterilization laws. Their real appeal lay in their potential for social control and for saving money. The overall picture it paints is one of politicians being happy that eugenic ideas gave a legitimacy to sterilization, while not really caring whether the proliferation of social undesirables was a matter of genetic or cultural heredity. Either way, sterilization was a cheap and simple means for reducing the numbers of the socially undesirable and marginalized, and reducing welfare spending in a time of global economic depression (2).

Besides this tendentiousness, the other unpleasant feature of eugenic legislation was its authoritarianism. An insidious element of the Nordic sterilization laws was that sterilization was ostensibly never compulsory (apart from in Finland), leaving the false impression that these programmes were humane. They were not, for several reasons. Firstly, many of the mentally ill and retarded were incapable of giving or withholding consent; as legal incompetents, decisions were taken on their behalf by relatives. Secondly, sterilization was often a condition for teenagers to be released from schools for children with learning difficulties. For example, between 1937 and 1956, 36% of all girls leaving Swedish special schools were sterilized. Similarly, sterilization was sometimes specified as a prerequisite for obtaining an abortion, or permission to marry. Sterilization orders requiring consent are potentially unethical even where good faith is shown by the authorities with regard to understanding the wishes of confused or not very intelligent subjects. In fact, the Swedish authorities, at least, in their eagerness to prevent dysgenic conceptions, could be quite slippery in this respect, as seen in these recommendations for dealing with resistance to sterilization issued by the Swedish Board of Heath in 1947:

Thus, if a [legally incompetent] person who, it is felt, should be sterilized is asked in advance and refuses to consent, no attention should be paid to his decision; the documents should be prepared and sent in. If, once sterilization has been approved, he definitely refuses to submit to the operation, it must not be carried out by force, however. Often, it appears, the knowledge that a decision has been taken by the National Board of Health will convince those who were previously reluctant to submit to the operation. As a rule, the best way to treat such patients would seem to be to consider it more or less self-evident that the operation is to be performed once the Board has given permission; should they ask outright, however, it must not be kept from them, of course, that it will not be carried out by force. (p.116)

This is a thoroughly researched, valuable and timely study of an important part of the history of eugenics which should take its place alongside with such other major studies as those of Daniel Kevles (3) and Michael Burleigh (4). Yet this book leaves one hungry with questions, particularly with regard to ethical evaluation of the events in question. When thinking about crimes, two questions that arise are: how heinous exactly is the crime, and how was it possible that someone could commit it? From this criminological standpoint, the general impression is that, of the Nordic countries, it was Sweden that was the principal villain; for example, it is only here that any racially motivated sterilization occurred. Yet the lack of relevant statistical data makes this difficult to gauge. Around 18,600 people, predominantly women, were sterilized on eugenic or 'social' grounds under the 1935 Swedish sterilization law before its repeal in 1975. What we do not know is how many of these sterilizations were coercive, how many motivated by racism, and so on. It is not possible, therefore, to get a clear picture of just how much wickedness actually occurred.

Why did the Scandinavian countries all introduce eugenic sterilization laws (Iceland and Estonia had similar laws) while other European countries on the whole did not? Roll-Hansen comments on the fact that European sterilization laws largely occurred in Protestant countries. It is tempting lay the blame for the apparent passion of some communities for sterilization of the marginalized at the door of the work ethic - hence the Lutheran connection (5).

While the book describes in some detail how sterilization laws came to be passed it does not try to resolve the mystery of why the Swedes were apparently more zealous in the application these laws. The Swedes' apparent taste for persecutory eugenics is illustrated by their invention of an inferior racial group - the so-called "Tattare", who were essentially Swedish itinerant agricultural workers. These the authorities imagined were a degenerate race of Swedish-Gypsy miscegenates, immoral and idle, and unwholesomely "dark" and "southern" looking.

Another reason for the slight lack of ethical location in these studies is the sparsity of references to the victims of sterilization except as statistics, while the advocates of sterilization are often described in detail. A rare exception is this description from a Swedish poor law board application for the sterilization of a 21 year old woman:

A blonde of Tattare extraction, well aware of the importance of the [intelligence] test in relation to the application for sterilization. Tense and quite nervous facing the test situation but tries to make her inadequate answers sound knowledgeable by means of a ready tongue and a great many words. Movements uncoordinated, speaks vulgarly and nasally in a nonchalant tone... Suggested step: Her extremely glib attitude in combination with her previous antisocial life motivate sterilization, in spite of an IQ of 73. Apparently she has none of the qualities required for motherhood and the responsibility it entails. (p.129)

Fortunately, in this case the no operation was performed since the woman was smart enough to refuse to consent to it.

2. LIBERTARIAN EUGENICS?

While 'eugenics' is a dirty word, genetic counseling is generally held to have a place in the panoply of techniques of enlightened modern medical care. However, few are unaware of a certain hereditary relationship between the two - a common source of unease. In the 1980s, the Windscale nuclear waste reprocessing plant in the northwest of England - the target of years of anti-nuclear protests - changed its name to Sellafield, presumably in the hope that the stigma of radioactive fires and glow-in-the-dark Cumbrian sheep would disappear with the old name. Is 'genetic counseling' in the same fashion a euphemism for eugenics? Should we be worried?

Since its beginnings in the 1860s, eugenics has undergone two major transitions: the first was the shift from 'mainline' to 'reform' eugenics (6), and the second from reform eugenics to contemporary medical genetics. Mainline eugenics can be understood as the product of the first meeting of Darwinism and medicine: the realization that evolution is ongoing, and the emerging concern that the human evolutionary process be rationalized and guided by the ideal of progress, and the human stock protected from harm. The gaping lacuna in 19th Century evolution theory was the absence of any knowledge of the mechanism of heredity. Although Mendel described the laws of genetics in 1866, their significance was not appreciated until the turn of the century. It is one of the general principles of knowledge that when the proper understanding of a thing is not possible, some theory or other, often founded on little more than local prejudice and ideology, will invariably spring up to fill the gap. Knowledge abhors a vacuum. Mainline eugenics had very much this character: at times Lamarckian (assuming the inheritance of acquired characteristics), it failed clearly to distinguish between cultural and biological heredity, and greatly overestimated the determinative contribution of the latter. Thus, it was seen as imperative to act against the proliferation of degenerate families, and effect counter-measures against the more rapid reproduction of inferior stocks (e.g. the lower classes, foreigners). Mainline eugenics also included racial theories, ostensibly grounded in physical anthropology (e.g. ascribing inferiority to Jews, 'Negroes' etc.), and the idea of the harmfulness of miscegenation.

The explanatory power of Darwin's theory of evolution was greatly enhanced by its combination with genetics. In the light of the more rigorous understanding arising from neo-Darwinism and human genetics from the 1920s onwards many of the notions of early eugenics were clearly wrong. Consequently, mainline eugenics gave way to 'reform' eugenics which was based on human genetics, and directed towards the prevention of specific genetic diseases.

In terms of the biological concepts underlying it, reform eugenics is not all that different to genetic counseling. Apart from a somewhat greater readiness in the past to ascribe human differences to genetic rather than environmental variation, the major change in the interim is associated with the shift from the 1960s onwards from 'traditional', more collectivist values to the more individualistic, more libertarian ones that are the norm today. By the same token that one Scandinavian woman in the 1940s might have been asked to consent to sterilization if she was believed to be of poor stock or a liability as a mother, another would have been denied the right to an abortion. So, for example, in 1936 the Swedish Population commission 'found the idea that every person should be free in all respects to determine the use of his or her own body to be "an extremely individualistic view" ' (Roll-Hansen, p. 265). This aside, the underlying aim of reform eugenics - the prevention of the birth of children with genetic diseases - has changed little. Thus, one may draw the distinction between the somewhat authoritarian, collectivist reform eugenics of the 1930s-1960s, and the more individualistic, more libertarian reform eugenics of today.

But can we really say that genetic counseling has eugenic aims? Arguably, what is definitive about eugenics is its identification of the welfare of the gene pool, or the genetic health of the nation as a good that may be placed above the rights of individuals. In this sense, eugenics is largely a thing of the past in liberal democracies, and quite distinct from genetic counseling.

Today something similar to collectivist eugenics is very much present in the shadows, and potentially ready to make a comeback. The relationship between State, society and individual has changed considerably in recent history. We have seen a shift from a somewhat authoritarian collectivism (1930 - 1960), through a reactive period of selfish, libertarian individualism (1960 - 1990), followed, arguably, by the emergence of a somewhat less selfish individualism, and a greater readiness of individuals to serve the needs of others, of society, as reflected by the recent replacement of right wing, conservative governments with more centrist ones in the USA, the UK and elsewhere. This new, weak collectivism differs from the collectivism of the past in that it is driven more from the bottom up than from the top down. In this light, the following scenario may be imagined: a young couple visit a genetic counselor, who has the results of extensive genetic tests on their unborn child. Having considered their own wishes for their prospective child, the couple express a desire to do their duty in producing a child in the best interests of the community, society, humanity and posterity: what are those best interests? And what can the science of human genetics contribute to the answer to this question? The genetic counselor could only give advice in collectivist eugenic terms. However, this sort of eugenics would differ from the old collectivist reform sort in that it would be reactive rather than proactive. In the modern context it is not the doctor that drives the process of determining the genotype of children, but the parents, who do so in a manner somewhat akin to that in which consumers mould the market place. The value of this sort of reactive eugenic advice exists where the desires and aspiration of parents for their children is at odds with the needs of society or posterity.

This switch to a reactive role for eugenics would lead to further reversals in its role: in future placing duty over self-interest could potentially lead parents to raise children with the genetically-determined potential to become ill. An increasing number of genetically-determined illnesses are being understood as reflecting the presence alleles of genes which in other contexts may be valuable. Thus, healthy carriers of a single copy of the mutation a double dose of which produces the blood disease thalassemia have some resistance to malaria. Thus, while prospective parents from families carrying the thalassemia mutation might opt for eliminating heterozygous embryos, a genetic counselor might conceivably argue against this, taking into consideration the possibility of benefits to future generations during malaria epidemics. Another possibility is that some types of mental illness are extreme instances of traits whose more common, lesser versions (or formes frustes) (7) may be advantageous, as in the relationship between manic depression, which is undesirable, and cyclothymia, which may enhance creativity (8). What in moderation is a virtue may in excess be a defect. In curing the defect, a greater amount of virtue may be lost to society. Thus, for example, should it one day be possible to identify genes predisposing towards cyclothymia, genetic counselors might try to dissuade parents afraid of having children with manic depression from opting for termination of pregnancy. Similarly, eugenic arguments might be made to try to convince parents not to abort presumptive gay children.

Another change that we may expect in the future is the reappearance, with ever increasing power to control the genotype of our offspring, of something resembling positive eugenics, with its aim, not only of preventing disease, but of producing better people (whatever that means). However, in the current context this would be something quite new: not the mainline positive eugenics of the past, but libertarian positive eugenics; not the State prescribing the production of better people, but large numbers of individual parents making choices about the sort of children they want. Again, the type of eugenic advice that the genetic counselor may end up dishing out is not so much to suggest possible improvements parents may incorporate in their children, but to suggest that out of a sense of duty to others, they do not incorporate this or that "improvement". So, again, we can see that where it is parents that are the drivers of decision-making about the genotypes of their offspring, the role of collectivistic eugenics becomes one of constraining the selfish eugenic aspirations of parents for their children, where parents volunteer the desire to act in a fashion that is dutiful to society.

We can conclude, then, that eugenics - of a libertarian reform kind - is very much still with us, and furthermore, that the need for eugenic advice of a more collectivistic character is bound to increase as the power of parents to mould the genotype of their children increases. However, while there may be good reasons for worrying about the new eugenics, they are not the same as those for which we condemned the old.

3. PRAGMATIC VERSUS LIBERAL BIOETHICS

Increasing public involvement in the human genetics debate is Glenn McGee's stated aim in writing The Perfect Baby, A Pragmatic Approach to Genetics. Given the increasingly consumer-driven nature of genetic counseling, it is appropriate that McGee should focus on the ever more complex process of decision-making facing prospective parents about the genetic constitution of their offspring.

The book begins with a brief history of human genetics, and eugenics, and moves on to review the writings of various modern critics or suspect enthusiasts of medical genetics, whose ideas he then debunks, in a chapter entitled Debunking the Myths. Actually, McGee shows remarkable restraint in faithfully setting out the ideas of some of these people which are, at times, plainly dotty. One such is radical feminist Shulamith Firestone, author of The Dialectic of Sex which advocates the use of artificial wombs in order to "abolish" childhood and the "artificial" intimacy between woman and child; another is one Jean Rostand, who in 1959 advocated the creation of a system of genetically distinct castes. McGee's decision to refer extensively to Brian Stableford's Future Man (1984), including a page and a half long discussion of the book, raises the question of whether there does not exist some degree of silliness in a book beyond which it ceases to be worth discussing, even in a treatment of popular ideas on a subject. This is especially true of a book which one assumes few people have taken seriously (i.e. this argument could not be applied to asinine books taken very seriously by many, such as Hitler's Mein Kampf). Stableford is a moderately successful English science fiction writer, author of over 40 works, including his popular novel The Werewolves of London. Future Man is a sort of science faction coffee table book: a collection of facts about human genetics, interspersed with fantasies about men genetically engineered to live in space, on the ocean floor, or with wings, replete with vivid artist's impressions.

What comes next is an attack on "the ideology of genetic determinism", and an advocation of a pragmatic approach to genetics. The last chapters deal with more practical matters: genetic testing, the sort of genetic defects it may show up, the possible types of genetic intervention, followed by a discussion of biological enhancement, and of how to be a good parent.

Unlike many areas of philosophy, which deal with generalities, ethics - particularly the effectiveness of ethical decision-making - is highly sensitive to the exact circumstances of the case in question. This makes bioethics difficult: a subtle change in scientific knowledge can make ethical conundra appear or disappear, therefore a thorough and up to date understanding of medicine and genetics is required. Glenn McGee is a rather unusual case in this respect in that his view both of science in general, and genetics in particular, is distinct from that of most biologists. To put it in a nutshell, McGee appears to hold a highly instrumentalist view of science, and on top of that rejects genetic determinism as an unfounded ideological construction.

McGee's pragmatic bioethics is derived from the philosophical pragmatism of John Dewey, which involves a view of knowledge as an instrument for action, rather than an object of disinterested contemplation. As I understand it, the gist of McGee's view is as follows. The public should be kept informed about advances in genetics, yet the ethical decisions about how to apply this genetics to producing children should be taken entirely by parents according to their own pre-existing cultural beliefs, social attitudes and ideology. There is no possibility of ethical expertise based either on general theories of ethics or knowledge of biology. While this is a laudably anti-authoritarian approach, empowering parents does not, in my opinion, require this sort of pragmatism.

The denial of any role for biology in informing or moulding bioethical understanding that is inherent in this pragmatism is, in my view, an impoverished view of biology in particular and science in general with regard to its power to provide us with a clearer and richer picture of the world, and enlighten all aspects of understanding, including ethical understanding. By contrast, McGee seems to view genetics merely as the provider of the technological means to achieve pre-existing aims which are derived from some magical fountain of pre-existing social and cultural wisdom. According to this view, ethical opinions are essentially culturally relativistic, and not founded on any sort of objective knowledge of the world. Thus he argues:

In what sense [...] is genetic technology a harbinger of a new future? In what sense are these new choices? The answer seems clear: we do not need new wisdom - we need the historical and social context of old wisdom in order to make new choices.(9) (Author's emphasis)

The theoretical conceptions developed by science are interpreted as constructs of human imagination with no descriptive relation to the real world. They may be useful for manipulating our experiences but give no deeper insight and understanding of the world.(10)

Together, the instrumental interpretation of scientific theory and the insistence on a fundamental break between our ideas about what is and what ought to be drive us toward a picture of science as an esoteric and magical activity which mysteriously produces powerful technology. (11)

...fundamentally a cultural activity aiming to gain knowledge of the world. According to this view science is a main source of our understanding of the human condition and a main factor in forming the specific values and aims of our social activities, including politics. It is not merely a means to achieve aims that have other sources. (12)

The possibility of deriving improved value judgments from a good knowledge of biology is further diminished in McGee's thinking by the manner in which he rejects genetic determinism. Here he draws on the ideas of, among others, the geneticist R.C. Lewontin. Considering contemporary genetics, Lewontin sees an insidious political agenda geared towards maintaining the status quo of inequality. This he call the "ideology of biological (or genetic) determinism", which is made up of three ideas:

...that we differ in fundamental abilities because of innate differences, that those innate differences are biologically inherited, and that human nature guarantees the formation of a hierarchical society... (13)

Ideology, whether meant in the political sense, or more broadly as the set of beliefs of a given class or culture, is generally defined in opposition to objective knowledge, such as that resulting from scientific investigation. Thus, there are certain similarities in the view of biology as ideology, and in terms of an instrumentalist pragmatism, and we can seen the appeal for McGee of Lewontin's ideas, and he imports them in bulk into The Perfect Baby (15). While Lewontin's haranguings against biology as ideology must be salutary in effect when aimed at biologists, to some others his opinions seem to be less beneficial - resulting in McGee's case in a literal rejection of genetic determinism that is at times quite crazy. This leads him to some incredible conclusions; for example, he dismisses outright the potential dangers of germ-line gene therapy (the use of genetic engineering to produce heritable alterations in genetic constitution) since:

...It depends on genetic determinism [...] The only danger of germ-line engineering that is unique involves the possibility of utter control over the body that a child will inhabit. We have argued that no such power exists. (16) (Author's emphasis)

The disease seems to occur in most patients where the f508 allele is present, regardless of environment and behavior. (17) (My emphasis)

We have suggested an alternative way to reconstruct both biology and culture to take account of new genetic technologies. It is incumbent on us now to bring that reconstruction to the context where it matters. Just as the failures of current media discussions and cultural criticism about genetics are primarily attributable to a poor understanding of genetics and of social history, the test for us is whether the pragmatic account of genetic can return to the ethos where genetic interventions are used. (18)

A little of this sort of puff is quite acceptable, but McGee really overwhelms the reader with it, to the extent that sometimes one has the sensation of unwrapping a parcel consisting of layer upon layer of packaging with nothing inside. But most importantly, the basic formulation of arguments is shoddy, such that one is perpetually struggling against overstatements, vagueness, repetition, vapid generalizations and numerous minor biological inaccuracies. Together, all of this made having to read the whole book, short though it is, a painful task.

NOTES

1. Ibsen, H., An Enemy of the People. Act IV.
2. The desire to save money was a major factor behind Nazi sterilization and murder of the handicapped and mentally ill. See Burleigh, Michael, Death and Deliverance, "Euthanasia" in Germany c. 1900-1945. Cambridge University Press, 1997.
3. Kevles, D. J., In the Name of Eugenics, Genetics and the Uses of Human Heredity. Cambridge, Massachusetts: Harvard University Press, 1985.
4. Burleigh, ibid..
5. The country where the greatest eagerness to pass sterilization laws was seen was the United States, the nation of the workaholic, where to this day the sins of those that do not work and the existence of 'welfare scroungers', particularly single mothers, is almost an obsession in some quarters.
6. The distinction between 'mainline' and 'reform' eugenics was first drawn by Daniel Kevles, ibid., p.88, p173-176.
7. For an account of the relation between full blown mental illnesses and their formes frustes, see Kramer, P.D., Listening to Prozac. London, England: Penguin Books, 1993, p 197-249.
8. For a discussion of the links between manic depression and creativity, see Jamison, K. R., Touched with Fire: Manic-depressive Illness and the Artistic Temperament. Free Press/Macmillan, 1993.
9. McGee, G., The Perfect Baby: A Pragmatic Approach to Genetics, Lanham, Maryland: Rowman and Littlefield, 1997, p.56.
10 Broberg, G. and Roll-Hansen, N. (eds.), Eugenics and the Welfare State, Sterilization Policy in Denmark, Sweden, Norway and Finland, East Lansing, Michigan: Michigan State University Press, 1996. p.151.
11. Ibid. p.152.
12. Ibid..
13. Lewontin, R.C. The Doctrine of DNA: Biology as Ideology. London, England: Penguin Books, 1992, p.23.
14. The fact is that, as Lewontin himself says: "we know nothing about the heritability of human temperamental and intellectual traits." (Ibid., p.96.) Perhaps as long as this chasm in our self- knowledge exists it will echo with ideologically-driven overstatements, coming from both the political right and left.
15. However, Lewontin is no Dewey-style pragmatist: "Science is more than an institution devoted to the manipulation of the physical world. It also has a function in the formation of consciousness about the political and social world." Ibid., p.103.
16. McGee ibid., p.107.
17. Ibid., p.90.
18. Ibid., p.76.

DAVID GEMS,
University College London, U.K.
Theoretical Medicine and Bioethics (1999) 20, 199-211.

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