JMS Pearce
Hull, England, United Kingdom

 

Moral judgments, changing ethical criteria, and the broader concepts of good and evil are always controversial, and often dangerous. Prominent amongst such judgments are those relating to population control and the wider, ill-defined field of eugenics. Hidden, and often ignored or denied in these conversations, is the underlying conflict between social conformity and individual liberty.

Fig 1. Francis Galton (1850’s). from Karl Pearson’s The Life, Letters, and Labors of Francis Galton. Public domain.

The polymath Francis Galton FRS (1822-1911) (Fig 1.), a cousin of Charles Darwin, made important contributions to statistics, anthropology, and to the hereditary nature of intelligence. He introduced the word eugenics (Greek εὐγενής) meaning “well-born” in 1883, which he defined:

. . . human eugenics, that is, of the conditions under which men of a high type are produced.¹

And in his Eugenics: Its Definition, Scope and Aims, (1904):

Eugenics is the science which deals with all influences that improve the inborn qualities of a race; also with those that develop them to the utmost advantage.

Positive eugenics meant manipulating heredity or breeding to produce superior people; negative eugenics was improvement by eliminating or excluding those deemed biologically inferior. At its inception, the field of eugenics was neither the work of fanatics nor the product of fringe science. However, while the aim to eradicate social ills by getting rid of the genetically “unfit” were plausible, some of its practices produced grave ethical and moral arguments. At the peak of the movement in the 1920s, eugenics was not only popular but ultimately led to the forced or coerced sterilization of thousands of Americans.² Sterilization laws superseded individual human rights, holding them subordinate to the greater public good. Prominent scientists of the day were supporters, such as Charles Davenport (1866-1944), a Harvard biologist and anthropologist.

 

Population control

Many of the problems of poverty, housing, malnutrition, and shortage of clean water would be drastically diminished if there were fewer people on our planet. Do we have the right—moral or ethical—to try to forcibly enact this? Many attempts have been made to control human reproduction.

To this end, India, with its 1.339 billion people in 2017, used state-sponsored population control, often targeting the poor and underprivileged. By 1976, millions of men and women were subjected to sterilization, with state inducements of land and money. Camps for forced sterilizations were reported. Many countries had similar policies where state interest suppressed individual freedom of choice. From 1978 to 2015 China operated a one-child policy with compulsory sterilization, especially for the poor and less privileged. Despite widespread criticisms of such policies, China’s population was 1.404 billion in 2017. Conversely, in Romania from 1967 to 1990 under Nicolae Ceaușescu, contraception and abortion were banned.

 

Galton and selective breeding

Overpopulation was not the only problem argued by eugenicists. Selective breeding, a related concept sparked by Galton, attempted to increase the proportion of persons who were considered to have better than average genetic endowment, physical and mental. Eugenicists argued that socially disadvantageous characteristics could be bred out of populations by limiting reproduction of “the unfit”—the feebleminded, the poor, disabled, and the weak. Though Charles Darwin was not an outspoken advocate of this policy, Galton applied Darwin and Alfred Russel Wallace’s concept of survival of the fittest and evolution by natural selection to Galton’s man-made schemes. Ignoring human rights of choice, Galton summed up altruistically:

Man is gifted with pity and other kindly feelings; he has also the power of preventing many kinds of suffering. I conceive it to fall well within his province to replace Natural Selection by other processes that are more merciful and not less effective. This is precisely the aim of Eugenics.³

Galton proposed selective breeding by a system of arranged marriages between men of distinction and high intelligence and women of wealth, which would eventually produce an improved race. His plans gradually fell into disrepute, but his ideas, exploited by Hitler and other racist dictators, were highly influential; many followed his example. A few are here selected.

Auguste-Henri Forel (1848–1931), Professor of Psychiatry in Munich, was famed for major works on neurone theory.⁴ Aside from his neuroscience, in his book on the social life of ants compared with man, he concluded that society should prevent all those suffering from hereditary disease from having children by persuading them to use contraception or to be sterilized voluntarily.⁵

Reginald Ruggles Gates FRS (1882-1962), a Professor of Botany at King’s College London, became notorious for his views on interracial marriage. His studies in physical anthropology prompted him in 1923 to state:

As regards world eugenics, it would appear that intermixture of unrelated races is from every point of view undesirable, at least as regards race combinations involving one primitive and one advanced race . . . ⁶

His mistaken conclusion, which showed his antagonism to interracial mixing, was that a single definition of species, such as interfertility, was insufficient:

Various human populations ought to be considered as species rather than races.

Charles Darwin’s son, Major Leonard Darwin (1850-1943) was another enthusiastic eugenicist, author of The Need for Eugenic Reform in 1926 and the popular What is Eugenics? Like many proponents of eugenics, his theories were intellectually driven, devoted to the idea of improving the lives of people by selectively reducing their numbers.

 

Ethics and morality

Karl Pearson, who founded modern statistics, held the first Galton Chair of Eugenics at University College London. His eugenic views were more radical than Galton’s. For instance, in 1901 he stated that:

Superior and inferior races cannot coexist; if the former are to make effective use of global resources; the latter must be extirpated.⁷

The Nobel prize winner Sir Macfarlane Burnet, FRS (1899–1985) in 1978 advised the abortion of defective fetuses, infanticide of children with severe genetic disorders, euthanasia for patients with incurable diseases, and the death penalty for those who were a danger to society.¹⁰ As recently as 1999, Sir Robert Edwards FRS,^a another Nobel prize winner and council member of Eugenics Society, advocated in London’s Sunday Times on 4 July 1999:

Soon it will be a sin of parents to have a child that carries the heavy burden of genetic disease. We are entering a world where we have to consider the quality of our children.

Many philosophers, churchmen, and scientists considered that Galton and his followers, though probably well-intentioned, had crossed the ethical divide between scientific knowledge and its general application to society. The rights of the community often conflict with individual liberty and are often predicated on uncertain grounds: because criteria of severe defect, disability, quality of life, or intelligence are subjective. How do we define the conflict between social conformity, individual liberty, and human rights?

 

Mental impairment

How to deal with mental illness or impairment was another question faced by eugenicists, often using derogatory terms. Sir James Crichton-Brown, advising the 1908 Royal Commission, recommended the compulsory sterilization of those with learning disabilities and mental illness—“our social rubbish” which should be “swept up and garnered and utilized as far as possible.” Many, including Hitler, have commended the elimination of those with low IQ, a form of ethnic cleansing.⁸ James Watson of DNA fame has claimed a difference on average between “blacks and whites” on intelligence tests that was genetic. He was promptly stripped of many academic honors.

The American eugenics movement in the 1920s and 1930s inspired the Nazi program.⁹ At that time twenty-seven states had passed laws defining “unfit”: the mentally defective, feeble-minded, imbeciles, idiots, habitual criminals, and epileptics. This led to an estimated 60,000 sterilization procedures.⁹ In addition to racial genocide, the Nazis promoted forcibly sterilizing or executing thousands of people reclassified by religion as mentally ill, disabled, or feeble-minded.

These may seem extreme, eristic policies today, but eugenics was espoused by some of the most accomplished, respected scientists of the day. The renowned economist Maynard Keynes, the biologist Julian Huxley, the pioneer of birth control Marie Stopes, and the statistician RA Fisher were all members of the Eugenics Society; the authors HG Wells and George Bernard Shaw also expressed eugenic sympathies. Few would doubt that clinical intervention may be desirable in individual instances, but a fair and just definition of those instances is problematic because: How severe is defective? What is incurable? How do we define dangerous? How do we define extreme instances? And above all, where are the boundaries?¹⁰

 

The rights of the community versus the individual

The conundrum remains: how bad is a major defect, and how severe should be its consequent disabilities to justify interference? Crucially, should such decisions be made in the interests of the individual and family, or should possible benefits to the state be allowed as the determining factor?

An editorial in the New England Journal of Medicine in 1934 admitted that forced sterilization of those deemed unfit to reproduce was:

A very complicated problem . . . because it is an invasion of personal rights, but even so, the general scheme of civilization is the right of the community as against that of the individual, and as a general proposition, the individual must give way before the greater good.¹¹

Ethical values change. And we should respect religious objections to restriction of population; this apart, few now oppose voluntary, informed contraception or abortion in carefully regulated circumstances. But the choice should lie with person concerned.

The variable severity of disabilities caused by Down’s syndrome highlights such a dilemma. Some encourage prenatal testing and abortion of the fetus if trisomy is demonstrated; many oppose this view. Several American states have legally banned abortions requested by parents, again denying their liberty to choose.

The major criticism of eugenics is not that its aims were racist or wicked in intent, but that its attempts to improve on nature are prone to misuse and subject to prevailing arbitrary political values. Abuse may be driven by nationalist and pseudoscientific racist ideologies conjoined with advanced technology and publicity. Furthermore, such efforts may eventually lead to a loss of genetic diversity by disruption of aeons of evolution and natural selection.

 

Biotechnology

The application of biotechnology for social engineering has become popular among leading scientists.⁹ Distinct from population control, it can detect fetal defects in utero of such magnitude that they would lead to overwhelmingly severe disabilities and early death. Pre-implantation genetic diagnosis of certain hereditary diseases can lead to selection and implantation of embryos without the faulty gene, for example in cystic fibrosis. Properly regulated, such techniques can prevent disease and are considered ethical.

CRISPR (clusters of regularly interspaced short palindromic repeats) is a way of finding a specific bit of DNA inside a cell, which if faulty could be followed by genetic editing, in which the faulty gene segment is excised or replaced by a “healthy” one. CRISPR technology ¹² could potentially treat and prevent many diseases, but currently it can also produce unpredictable, potentially hazardous off-target mutations. When proved safe, such measures may benefit patients, families, and society without ethical concerns.

Are we prepared to pursue, accept, and regulate applications of genetic enhancement or genetic parenting toward these types of goals?¹³ A recent paper in the Journal of Medical Ethics includes the not too reassuring statement:

Henceforth reproductive autonomy could involve the liberation of parenting roles from the constraints of biological generations in vivo, allowing multiple individuals to engage in genetic parenting together, thus blurring the distinction between biological and social generations. Finally prospective parents will be able to choose among a hitherto unimaginable variety of potential children.¹⁴

This intentional modification of the human genome to “improve” healthy individuals i.e., genetic enhancement is an issue beset with dilemmas of ethics and policy that must be resolved. It is possible to use biotechnology to produce “designer-babies,” who might be tall or short, highly intelligent, blonde or dark-haired, extrovert or introvert, and so forth. In effect, certain modern-day eugenic practices adopt a morality that refutes the idea that all humans are born equal, replacing it with genetic fitness—a vague if superficially attractive concept that defies delineation. The innate worth of a person is not measurable by science. Should we therefore not refute such arbitrary criteria, which might abolish or permit basic human rights of survival, or violations of choice—to bear or not bear a child, to continue or abort a pregnancy, or even the will to continue to live or die in the face of grave illness?

After the Nazis’ discriminatory doctrines of racial hygiene, the Galton Institute’s “exploring human heredity” replaced previous objectives of the Eugenics Society. Adopting more enlightened ethical standards it eschewed Galton’s advocacy of selective breeding. The Galton Institute now commendably “supports the scientific exploration of all aspects of human heredity through: education, public debate . . . and relevance to human well-being.”¹⁵

More fundamentally, the unsolved, and perhaps unsolvable conflict remains: what is best for the individual and what is best for society? Specific programs can be justified on public health grounds when freedom of choice is not threatened. If taken too far we face the hideous specter—the “incontestable rights of the state,” as advocated by Henry Fairfield Osborne, President of the 2nd International Congress of Eugenics:

The right of the state to safeguard the character and integrity of the race or races on which the future depends is, to my mind, as incontestable as the right of the state to safeguard the health and morals of its people. . . . Science must also enlighten government in the spread and multiplication of worthless members of society, the spread of feeblemindedness, of idiocy, and of all moral and intellectual as well as physical diseases.¹⁶

Attempts by the State to improve quality, worthiness, health, or intelligence though sometimes “beneficial,” carry significant risks of both discrimination and unintended consequences, of a divergence between the welfare of one person and that of the populus. Rival benefits to man and society arise and can be irreconcilable.¹⁰

This is a complicated subject in which finite conclusions would be simplistic. Scientific research and technology must progress unimpeded. But it must also be subject to scrupulous ethical examination, supervision, and regulation.

 

End notes

1. Edwards with Patrick Steptoe founded in vitro fertilization (IVF). The resulting implanted embryos led to the 1978 birth of Louise Brown—the world’s first “test tube baby.”

 

References

1. Galton F. Inquiries into human faculty and its development. 44 London: Macmillan 1883.
2. Deutsch JI. The Eugenics Crusade, Journal of American History 2019;106:284–285. https://doi.org/10.1093/jahist/jaz330
3. Galton, F.  Memories of my life. London: Methuen. 1908.
4. Pearce JMS. Forel, Auguste-Henri (1848–1931). Encyclopedia of the Neurological Sciences 2E (NLG2) 2014. Pp.344-345.
5. Forel A. Le monde social des fourmis du globe comparé à celui de l’homme. Genève: Kündig (5 vol.), 1921-1923.
6. Ibid pp. 231-3.
7. Pearson K. (1901) cited by: Paul, D.B., & Moore, J.  In: The Oxford Handbook of the History of Eugenics. P. Levine & A. Bashford (Eds). Oxford: Oxford University Press. 2010
8. Anomaly, J. “Defending eugenics: From cryptic choice to conscious selection.” Monash bioethics review vol. 35,1-4 (2018): 24-35.
9. Spiegel AM. The Jeremiah Metzger Lecture: A Brief History Of Eugenics In America: Implications For Medicine In The 21st Century. Trans Am Clin Climatol Assoc. 2019;130:216–234.
10. Pearce JMS. Patients And Society: The Big Divide. Hektoen International, 2015: 7, Issue 2 – Spring 2015.
11. Sterilization and its possible accomplishments. N Engl J Med 1934;211, 379-80.
12. Anzalone, A.V., Randolph, P.B., Davis, J.R. et al. Search-and-replace genome editing without double-strand breaks or donor DNA. Nature (2019) doi:10.1038/s41586-019-1711-4
13. Friedmann, T. Genetic therapies, human genetic enhancement, and … eugenics?. Gene Ther 2019;26:351–353.
14. Palacios-González C, Harris J, Testa G. Multiplex parenting: IVG and the generations to come. J Med Ethics. 2014;40(11):752–758.
15. Galton Institute. http://www.galtoninstitute.org.uk/about/membership/membership-form/
16. Osborn, HF.  The Second International Congress Of Eugenics.  Science. 1921; 54(1397):311-3.

 

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JMS PEARCE, MD, FRCP, is emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England.

 

Fall 2019  |  Sections  | Ethics