Eugenics, Voluntary and Otherwise

The Chronicle of Higher Education last week published a rather odd article on the evolution of eugenics excerpted from Nathaniel Comfort’s new book The Science of Human Perfection: How Genes Became the Heart of American Medicine . It’s odd because, though it acknowledges the evils that eugenicists have historically committed, it assumes that today’s eugenics are (and will remain) entirely benign.

Here’s Comfort’s description of the twentieth-century version, whose victims are still with us :

Progressive-era eugenics sought to eliminate undesirable traits (negative eugenics) and cultivate desirable ones (positive eugenics) by population control, mostly through regulating immigration and sex. Eugenicists were interested in the genetics of disease, personality, intelligence, and race—just as we are today. Birth control, marriage restrictions, and sexual sterilization of “defectives” (a medical term still in use as late as the 1970s) were among their means of effecting genetic change. They hoped people would voluntarily do the right thing for the greater good—but if they didn’t, the state had a responsibility to do it for (i.e., to) them.

Today, on the other hand, we don’t need to use coercion. In vitro fertilization, pre-implantation genetic screening, and abortion are so widely accessible and accepted that they play the same role as state-sponsored intervention once did. Eugenics has moved from the realm of state control to individual choice—-which means, to the autonomy-maximizing liberal, that eugenics must be an unequivocally good thing.

Comfort acknowledges in passing the inevitable commoditization of human life that today’s baby-designing techniques encourage: “The standards of perfection are selected more democratically now, but they are conditioned by the perversities of market pressures and fashion.” But he sees no reason to fight it because, as he writes in his strangely blithe closing paragraphs, eugenics we will always have with us:

The eugenic impulse drives us to eliminate disease, to live longer and healthier, with greater intelligence and a better adjustment to the conditions of society. It arises whenever the humanitarian desire for happiness and social betterment combines with an emphasis on heredity as the essence of human nature. It is the aim of control, the denial of fatalism, the rejection of chance. The dream of engineering ourselves, of reducing suffering now and forever.

The question is not one of whether there ought to be such an impulse, whether it should be called eugenics, or even whether biomedicine ought to focus so much on genetics. These things just are. And besides, the health benefits, the intellectual thrill, and the profits of genetic biomedicine are too great for us to do otherwise. Resistance would be ill-advised and futile.

The important questions, rather, concern how to proceed: How do we ensure that appropriate weight is given to the environmental causes of illness? How do we minimize profiteering and racism in this age of selfishness? And above all, how do we know when we know enough to control our own evolution?

I agree in part: The eugenic impulse is indeed ineradicable and closely tied to (though not inextricable from, I’d argue) the quest to alleviate suffering.

But setting aside for now the moral issues (since we’re familiar with them) and the claim that “resistance would be ill-advised and futile” (a silly pseudo-argument that one could apply to just about any historical development, desirable or not), does Comfort truly believe that his closing questions are the only crucial ones? To me there’s a more obvious question that his historical account makes unavoidable: What are the chances that eugenics, once widely accepted by a given society, will remain voluntary?

I believe they’re slim. Historically, after all, the quest to eliminate disease usually ends in eliminating the diseased—-as Comfort should know quite well. And technocratic experts are do not look kindly upon those who would imperil their pursuit of the perfect society, for example by refusing to abort a baby with Down syndrome or demanding that their children with genetic illnesses receive adequate health care .

Don’t believe me? Spend a couple minutes browsing the literature on eugenics and you’ll come across documents like this  1998 Journal of Medical Ethics article by David J. Galton.

“A major problem for the future,” he writes, “will be where to draw the fine line between state control and personal choice for the many genetic issues that will arise with the application of the new DNA technology. This is particularly so as some of the genetic issues related to multifactorial disease are complex and may go beyond the understanding of some citizens who may be involved in such decisions.” The experts know best, after all. On the last page Galton reveals the proposal he had at first couched in euphemism:

Currently the trend for eugenics has been very much away from social coercion by various state institutions to providing more education and freedom for citizens to make their own genetic and reproductive choices. For example, mothers can choose to have a disabled child with trisomy 21 even though the state may eventually have to provide for the child’s long term care . . . . The only “cure” at present for trisomy 21 is termination of pregnancy and perhaps a state body should intervene in such cases if the mother is clearly unable to provide economically for the long term care of her handicapped child.

In short, today’s eugenicists prefer the methods of “education and freedom”; however, in certain special cases, coercion could be justifiable. Contra Nathaniel Comfort, it seems that not much has changed.