The Persistence of Eugenics
From GenEthics News issue 22,
With the International Genetics Federation congress in Beijing looming, the issue of China's eugenics law is likely to be in the news again. A particularly sensitive issue is the relationship between genetics and eugenics. This article takes a look at the history of the relationship between genetics and eugenics, and in particular at the concept and practice of 'non-directive' genetic counselling.
David King
What is eugenics?
In discussions about the ethical and social consequences of human genetics, there is much confusion about eugenics. The association of the subject with full-scale genocide seems to produce an inability to think clearly on both sides of the debate. It is true, as geneticists often complain, that the word is sometimes used as a blunt instrument to silence those who argue for the benefits of genetic research. On the other hand, there is a converse tendency to avoid any discussion of the subject. The widely-praised House of Commons Science and Technology Committee report on human genetics, for example, does not mention the word once. When challenged on this, Anne Campbell MP argued that the omission was made in order to avoid provoking 'hysteria'.
The dominant tendency is to view eugenics as a purely historical phenomenon, and to minimise its relevance to current debates. Within the discourse of scientists, which is dominant in Britain, eugenics is seen as causing public fear of genetics, but this fear is generally seen by scientists and ethicists as due to ignorance or misunderstanding. The conventional view is that the eugenics movement of the first four decades of this century was based on 'bad science', or misunderstandings of genetics. The implication of this view is that now we know so much more about genes, and have witnessed the horrific consequences of eugenics, we will not make that mistake again.
In the conventional definition, the key aspect of eugenics is coercion of people's reproductive choices, for social ends, which may include 'improving the quality of the population', 'preventing suffering of future generations' or reducing financial costs to the state. The crucial importance of coercion is the story that after the Second World War, interference in reproductive choice was abolished and replaced with 'non-directive' genetic counselling. (Of course, as the recent scandals in Sweden and elsewhere have shown, this was far from true.) Making coercion central to the definition of eugenics suits geneticists' interests, because it allows them to make a clear distinction between current medical genetics and eugenics. However, examination of the history of eugenics reveals that coercion is certainly not one of its defining characteristics. From its very beginnings, many eugenicists, including the founder of the eugenics movement, Francis Galton, were opposed to coercion. As the historian of eugenics, Diane Paul, notes, definitions of eugenics which exclude Galton can hardly be taken seriously.
Another common supposition is that eugenics was a right-wing movement. But as Paul and many others have pointed out, from the end of the nineteenth century to the middle of the twentieth, eugenics enjoyed huge popular support amongst all sections of society. Eugenics was also supported by many socialists, feminists and anti-feminists, militarists and pacificists, as well, of course, as the majority of geneticists. In different countries eugenics took different forms, from the paternalistic social democratic eugenics of Sweden and Norway to the fascist eugenics of Germany. At present there is a eugenics law in the still officially communist China. Eugenics is a broad church that can embrace many different philosophies.
Given this, it is perhaps not surprising that discussions of eugenics that try to label some things as 'eugenic' and others as not, tend to founder on issues of definition. It may be impossible to produce a definition that everyone agrees with. Nonetheless, reflection on the history and social basis of eugenics can allow us to understand 'what it is about', and so help to assess the threat of its resurgence.
A form of technocracy
The massive popular support for eugenic ideas, even if not, necessarily, for official eugenics societies or laws, indicates that eugenics was not, as many geneticists would like us to believe, an 'aberration'. Rather, it was a movement very much in tune with the spirit of the times. One reason for this was precisely its foundation in science. The late nineteenth and first half of the twentieth century was not only the period of high modernism in the arts, but of modernism as a popular social ideology. And modernism's dream of progress and social order is founded upon the belief in science and technology. In fact, modernism simply made more explicit ideas about the role of science that had been central since the Scientific Revolution.
Since the 17th century, the key to the economic basis and vision of Western societies has been the use of science and technology to control nature. But as poets and romantics like Blake and Shelley, and later sociologists such as Weber and Foucault have noticed, parallel to the creation of new knowledge has been a gradual process of rationalisation and increasing control over society in the form of scientific management, or bureaucracy. An example from the early twentieth century is Taylorism, the attempt to apply scientific management to industrial processes. Taylor captured something crucial to scientific modernism when he argued that, 'In the past, the man has been first. In the future, the System must be first.' It is no accident that Henry Ford was a key devotee of eugenics. Harry Laughlin, the lynchpin of the US eugenics movement, stated in the Birmingham Mail in 1913 that, 'Eugenics is simply the application of big business methods in human reproduction.'
The purpose of this discussion on the role of science in modernity is to emphasise that, in our society, an important aspect of science is to enhance control and order. In the case of genetics, the managerial tendency is expressed through eugenics, which, at its root, is the urge to tidy up the accidents and mess that arise from human reproduction. What really appalls eugenicists is that the whole business of human reproduction is out of rational control, and is left to chance. The eugenicists of the early twentieth century often pointed out the care we take over the breeding of our crops and domestic animals: how can we be so careless about human reproduction, they asked. The desire to bring human reproduction under rational control is the common factor underlying the many different forms of eugenics. For most people, eugenics was a progressive and humane aspect of modernisation.
Under particular political circumstances, eugenicists' efforts will be targeted at particular groups: for example in the US in the early 20th century, a major focus was demonstrating the supposed genetic inferiority of people from Eastern and Southern Europe, in order to restrict their immigration. Arguably, eugenics always targets the working classes, particularly the poor. But in its essence, eugenics is a form of technocracy, an attempt at social management based on the knowledge of a scientifically qualified elite.
Genetics and eugenics
What then of geneticists' claim that eugenics is merely an abuse of genetics, or an aberration? At one level, the answer to this question is already clear: genetics and eugenics are inseparably linked. Some form of eugenics is an inevitable consequence of the advance of the science of genetics, although the popularity of overt eugenics programmes will vary according to social and political circumstances.
It is, however, important to note the truth in geneticists' argument that advances in the science of genetics have done much to discredit eugenics. Mainstream eugenics in the USA and Britain was based on the belief that abilities and personality traits were determined by single genes, as was 'feeblemindedness'. Socialist geneticists such as JBS Haldane and Hermann Muller succeeded by the 1930s in demonstrating the falseness of such ideas. However, this did not diminish their eugenic enthusiasm, but merely led to a more moderate reformulation, shorn of its more outrageous class and racial prejudice. Muller, later to receive the Nobel Prize for his discoveries in genetics, persisted into the 1950s in his eugenic efforts. Historians are still debating the degree to which scientists influenced the unpopularity of eugenics after the Second World War.
For our understanding of the present, what is more important is the consequence of the discrediting of simplistic Mendelian eugenics in the 1920s and 30s. Amongst the funders of eugenics research in the US, such as the Rockefeller and Carnegie Foundations, dissatisfaction with eugenics was growing, while ideological commitment on the part of the trustees persisted. According to Kay1, this was at least part of the impetus behind the Rockefeller Foundation's strategic move into supporting the development of what became known as molecular biology: dissatisfied with the woolly science of the eugenicists, the Foundation decided that the cause of eugenics would be better served by applying mathematical and physical methods, in order to make biology into a 'hard' science. It has been molecular biology, which led, via Crick and Watson, to genetic engineering in the 1970s. Kay suggests that the Rockefeller Foundation's strategic investment finally paid off in the late 1980s and 90s, with the launch of the Human Genome Project.
What this illustrates is the way that the history of eugenics is intertwined with that of eugenics. Problems in eugenics stimulated research in genetics, whilst developments in genetics informed the evolution of eugenics. This is a typical pattern in the development of any science and its practical application.
Viewed in this perspective, the popular eugenics movement of the early twentieth century was a highly damaging false start for eugenics. An particular set of political circumstances propelled it prematurely into the light, with disastrous consequences for its reputation. After the Second World War, eugenics did not disappear: it merely went underground. In Britain, the Eugenics Society continues to exist, and only changed its name to the Galton Institute in the late 1980s. Key figures, such as Francis Crick and Victor McKusick, the doyen of medical genetics, have continued to make eugenic pronouncements, but most of the efforts of eugenics activists have shifted to the issue of Third World population control.
Genetic counselling
According to the received view, the key distinction between current medical genetics and the former eugenics is in the practice of genetic counselling. In English-speaking countries and Northern Europe, genetic counsellors say that they aim to not tell their clients what to decide, and to support whatever decisions they take. This supposed non-directiveness is the cornerstone of geneticists' argument that they are not promoting eugenics. Of course, this ignores the social pressures which influence people's decisions, such as negative images of disability, lack of support for families with disabled children, cultural factors, etc., all of which tend to produce eugenic outcomes (see GEN 12, pp6-9). It might be argued that it is geneticists' duty to actively counter such pressures, but to be fair, they cannot be held directly responsible for their existence.
The standard rationale for offering genetic testing is that it allows parents to exercise informed reproductive choice, and not to 'improve' the quality of the population. But how do the attitudes and actual practice of genetic counselling measure up to the professional ideal? The most important research in this area was carried by the American sociologist and ethicist, Dorothy Wertz, and her colleague, John Fletcher2,3. In 1994-5, they conducted a survey of the attitudes and practices of nearly 3,000 geneticists and genetic counsellors in 37 countries. Taken at a global level, their results comprehensively demolish the idea that geneticists have abandoned their eugenic philosophies. Wertz often titles her talks, 'Eugenics is alive and well'.
The most consistent result from Wertz and Fletcher's survey is that only geneticists in English-speaking countries and Northern Europe (ENE) can make any claim to non-directiveness and abandonment of eugenic thinking. In Eastern and Southern Europe, the Middle East, Asia and Latin America (Rest Of the World, ROW), geneticists not only hold eugenic ideas, but see no problem in directing their clients in accordance with those ideas. Here are a few examples:
In response to the clearly eugenic suggestion that 'An important goal of genetic counselling is to reduce the number of deleterious genes in the population', 13% of UK geneticists agreed. In E. and S. Europe this rises to an average of 50%, and in China and India to nearly 100%.
An average of 20% of ENE geneticists feel that, given the availability of pre-natal testing, it is not fair to society to knowingly have a child with a serious genetic disorder. (The survey also revealed huge discrepancies between geneticists about what counts as 'serious'.) In the rest of the world, majorities of geneticists supported this view, rising to nearly 100% in some countries.
Substantial minorities of both ENE and ROW geneticists would advise voluntary sterilisation for women with fragile-X syndrome (mental handicap of varying severity) living in an institution.
Approximately 15% of ENE and majorities of ROW geneticists admit that they would provide biased pre-natal counselling (emphasising negative aspects of a condition without actually suggesting termination) for a variety of child- and adult-onset genetic diseases. For conditions judged more serious, nearly 30% of US genetics professionals would provide negatively-slanted counselling. Conversely, where the condition is viewed as less serious, more positive counselling would be given. Wertz says that giving clients biased information is worse than being directive, because it does not offer the client an opportunity to disagree with the counsellor. None of the geneticists said that they thought that giving biased information was dishonest.
Wertz and Fletcher's research details what geneticists say they think and do, in response to a questionnaire. Figures derived from such answers almost certainly underestimate the degree to which counsellors contravene their professional norms in practice. Research by Therese Marteau and her colleagues, in which genetic counselling sessions were videotaped, revealed a high level of directiveness by genetic counsellors. Most disturbingly, the level was highest when clients were from lower socio-economic groups. The same effect was seen in Wertz's survey.
A new eugenics?
This examination of the history of eugenics and genetics and the current practice of genetic counselling shows that the claim that eugenics is simply a bogeyman from the past, which we can easily avoid, is at best naive, and at worst disingenuous. Geneticists need to learn something of the real history of genetics and eugenics and examine their actions and motives a little more carefully. Eugenics is certainly alive, but what is the chance that it will become a real threat in the future?
We cannot answer this question in the abstract, but only by looking at the economic and social contexts within which overt eugenics policies become attractive. The biologist and historian, Garland Allen, has shown how the eugenics movement became popular in the US in response to fear of chaos caused by social and economic changes4. In the late 19th century, the US was undergoing major industrial expansion and restructuring of its economy, together with an influx of refugees from Europe. These conditions created major social unrest, including strikes, which often led to violence. Similar factors were also at work in Germany. The response was calls for more planning and regulation of the economy, and of society. Like Taylorism, eugenics was appealing as a modern, progressive and purportedly scientifically-based system for creating more order in society.
In the 1990s, we may be experiencing something similar. Economic globalisation is eroding people's standard of living and job security, leading to a 'New World Disorder', in which resource shortages and environmental crisis, as well as the emergence of new diseases, is leading to widespread fear and uncertainty. A crucial similarity with the early part of the century is a perceived shortage of resources for health and welfare: the widespread current discussion of healthcare rationing may fuel pressures to introduce genetic screening programmes as cost-saving public health measures.
Of course the 1990s are not the 1920s and 30s, and we have seen what eugenics and fascism can do. If there is to be a new popular eugenics in industrialised countries, it will have to come in disguise. On the other hand, the scientific basis of eugenics is a lot more plausible now. The success of genetics is also fuelling popular genetic determinist attitudes about personality and behaviour that are very similar to those common in the first part of this century.
At least initially, a new eugenics will most likely be a laissez faire eugenics. The dominant concept now is consumer choice in reproduction, an idea unheard of in the 1930s. Although we are unlikely to see a new generation of eugenic activists publicly arguing for such policies, the outcome will tend to be the same. It is rather pointless to debate definitions and whether or not we call this eugenics. The point is that the underlying drive towards control of reproductive mess is still very much alive, and scientific and social conditions are right for this drive to be expressed.
The danger we will need to guard against is the development of a kind of eugenic common sense, that it is irresponsible to refuse to undergo tests, and that every child has the 'right' to a healthy genetic endowment. It may soon become common sense that sex is for fun, but having a baby is a serious matter, not to be left to chance. We will need to be vigilant for eugenics disguised as public health measures.
It is vital that we have an informed public debate about eugenics and where we are going with the new genetics. The debate must move beyond sensationalism and self-defensive posturing by geneticists. It is equally vital that the debate begins now, while there is still time to act.
References
1. Kay, L. 1993. The molecular vision of life: Caltech, the Rockefeller Foundation, and the rise of the new biology New York: Oxford University Press.
2. Wertz, D. 1997 Journal of Contemporary Health Law and Policy 13, 299-346.
3. Wertz D. 1997 'Eugenics Around the World', talk given at the International Symposium on Eugenics at the End of the 20th Century, Israel.
4. Allen, G. 1989. Eugenics and American social history 1880-1950 Genome 31, 885-889.