Journal ofMedical Ethics 1999;25:183-194 J Med Ethics: first published as 10.1136/jme.25.2.183 on 1 April 1999. Downloaded from Can we learn from eugenics? Daniel Wikler University of Wisconsin, USA Abstract engaging in careful moral analysis and assessment Eugenics casts a long shadow over contemporary of its doctrines. genetics. Any measure, whether in clinical genetics or Eugenics has many lessons: biotechnology, which is suspected ofeugenic intent is likely to be opposed on that ground. Yet there is little 1. Eugenics is a valuable case study which consensus on what this word signifies, and often only demonstrates how the prestige of science can a remote connection to the very complex set ofsocial be used to disguise the moral premises and movements which took that name. After a brief motives for a social movement, and how class, historical summary ofeugenics, this essay attempts to racial, and other biases can exert powerful and locate any wrongs inherent in eugenic doctrines. Four damaging influence over such a movement candidates are examined and rejected. The moral while remaining virtually invisible to its challenge posed by eugenics for genetics in our own advocates. And it is another illustration of the time, I argue, is to achieve socialjustice. sad thesis that good (or, at least, high-minded) (7ournal ofMedical Ethics 1999;25:183-194) intentions can lead to evil consequences. Keywords: Eugenics; genetics; ethics; justice 2. Eugenics offers a perspective on the practices of our own era, the second moment in history in the science I. Eugenics yesterday and today which the prospect for using of copyright. The word "eugenics" may be unfamiliar to most heredity to reshape society presents itself. people today, but for a period of about sixty-five Indeed, critics of certain practices in clinical years, roughly 1880 to 1945, both that term and genetics, and of some contemplated uses for the theories of human "improvement" which it the genetic technology of the future, maintain denotes were in wide currency. Francis Galton, a that these are eugenics in disguise. We must be able to evaluate this claim so that we can avoid cousin ofDarwin, invented the term and launched http://jme.bmj.com/ a movement to improve the human race, or at least the errors and wrongs of the past as we frame to halt its perceived decline, through selective public policies for genetics in the future. breeding. His ideas spread quickly, and by the 3. We should avoid an unthinking rejection of 1920s eugenics movements existed all over the every eugenic thought or value. The fact that world. Eugenics, a movement for social better- eugenicists were in favour of a particular meas- ment clothed in the mantle of modern science, ure or goal is not in itself sufficient reason to claimed the allegiance of most genetic scientists oppose it. We need a good analysis of which and drew supporters from the political right, left, eugenic aims were wrong-headed, and why. We on September 29, 2021 by guest. Protected and centre. Unfortunately for that movement, and might judge that some of the questions to indeed for much of mankind, eugenics was which eugenicists proposed answers ought not embraced by Hitler and his Nazi followers, be ignored, and indeed that they are now given tarnishing its name forever. After the fall of the too little attention, in part because of their Third Reich, eugenic ideas quickly lost their eugenic associations. cachet, becoming virtually taboo in the United States and Europe, where the term "eugenic" is This paper provides both a brief history of the now used primarily as an epithet. eugenics movement and a moral analysis of some We should not forget eugenics. Eugenics casts a of its tenets. I begin by recounting briefly the rise shadow over the use of genetics in our own era, and fall of this complex international movement. I which promises so much for health, industry, do not in any way wish to revise the very bad agriculture, and other fields. But that shadow is reputation which the eugenics movement cur- indistinct. It is often quite unclear whether a new rently suffers, and where old-style eugenics is practice in medicine or biotechnology has a advocated today, as in Singapore' and China,"' eugenic cast, and whether it ought to be opposed conventional criticisms of these ideas still apply. on that ground if it does. We can learn much by When we turn to contemporary practices in clini- studying the history of the movement and by cal genetics whose status as "eugenic" is in 184 Can we learn from eugenics? J Med Ethics: first published as 10.1136/jme.25.2.183 on 1 April 1999. Downloaded from dispute, however, the arguments must be more The popular eugenics movements, meanwhile, subtle. I argue that the label "eugenic" does in succeeded in rapidly introducing eugenic ideas some instances apply, but that when this is the into public discourse. Accounts of generations of case the "eugenic" effect or intent of the practices misfits in such "white trash" family lines as the ought not always to engender alarm or opposition. "Jukes" and the "Kallikaks" were widely publi- Though we rightly reject all of the programmes cised, warning that an unwise reproductive act practised or proposed by the eugenics movement could wreak havoc for generations.8 in its heyday, I will argue that this retrospective Following British successes at health exhibi- evaluation does not point unequivocally to a tions before the turn of the century, American rejection of any and all eugenics for the future. eugenic organisations took a particular interest in maintaining exhibits and events at state fairs and public expositions. "Fitter Families" competitions II. Eugenics past were mounted at state fairs, with governors and THE RISE OF EUGENICS senators handing out awards.8 Though the literature of eugenics extends back to The content of the eugenic programmes varied Plato, the modern movement took its cue from considerably. Eugenicists tended to agree that the biology: first, Darwin's theory ofnatural selection, human race was in decline, but they differed over with a boost later on from Mendelian genetics. both cause and remedy. The French and Brazilian Galton understood that the theory of natural eugenics movements were at least as concerned selection had important implications for under- about neonatal care as with heredity, and their standing the development of the human species, hereditarian thinking was Lamarckian-that is, and sought to investigate the possibility that they believed that parents passed on to their chil- talents and virtues of character and personality dren characteristics acquired during their were inherited along with other traits, offering lifetimes.' 12 Most eugenicists elsewhere accepted their bearers advantages in natural selection. Gal- Galton's view, buttressed by the "germ plasm" ton coined the term "eugenics" in 1883, defining hypothesis of August Weismann, that selectioncopyright. it as the "science of improving stock-not only by rather than environment determined heredity. judicious mating, but whatever tends to give the Eugenicists tended to draw from this account the more suitable races or strains of blood a better chance of prevailing over the less suitable than implication that medical care frustrated evolution they otherwise would have had".5 His research, by permitting the unfit to survive and reproduce (though Darwin and a number of others who held enhanced by statistical methods developed as he http://jme.bmj.com/ needed them, convinced him that society's stock this view none the less continued to support of talent could be greatly enlarged if members of humanitarian measures). favoured families were to increase their rate of Eugenicists differed also in their practical childbearing ("positive eugenics"). The balance proposals and legislative aims. While action on should be further improved, he believed, by behalf of positive eugenics was limited to such discouraging from reproducing those who had less mild measures as family allowances, some eugeni- to offer ("negative eugenics"). cists (particularly in the United States and, later, Galton's influence was nearly immediate. Dar- Germany and Scandinavia) did not hesitate to call on September 29, 2021 by guest. Protected win declared himself persuaded by his cousin's for coercive measures, either sexual segregation eugenic arguments, and Galton attracted a or, later, involuntary sterilisation, to prevent those number of distinguished disciples. In Germany, imagined to have undesirable genes from propa- the Racial Hygiene Society was formed in Berlin gating their kind. by 19056; the English Eugenics Education Society In Germany, eugenics became an integral was founded in 1907, with Galton elected honor- element of medical thinking, which envisioned a ary president the next year.7 In the United three-way division of health care involving medi- Kingdom and the United States, the movement cal care for the individual, public health for the drew on the middle and upper-middle classes; community, and eugenics for the race.'3 '4 Eugen- many professionals and academics were attracted ics, for some, was an extension of a tradition of a to it.'-0 During the decades 1890-1920, eugenic social orientation in German medicine that had ideas were advanced also in numerous non- produced Rudolf Virchow and other pioneers of English-speaking countries as diverse as Norway, public health. Brazil, and the Soviet Union. Both a research pro- Historians have generally followed Daniel gramme and a popular movement, eugenics was Kevles's7 classification of eugenicists, at least in taught at leading universities, and received atten- England and the United States, as either "main- tion in standard biology textbooks. line" or "reform". In the United States and Wikler 185 J Med Ethics: first published as 10.1136/jme.25.2.183 on 1 April 1999.