Tuesday, April 21, 2009

Eugenics: Past and Present (Re-posted)

A few people have brought this article in yesterday's Globe to my attention [and there is a nice response here from one of my colleagues at Queen's]. So I felt it appropriate to re-post this earlier post on "Eugenics: Past and Present".

Eugenics is the study of ways to improve the genetic constitution of humanity.

Historically, eugenics has inspired egregious social practices such as the sterilization of those deemed "unfit" for reproduction. Canada’s own Tommy Douglas, voted by the CBC as Canada’s “greatest Canadian”, espoused such unjust eugenic policies.

The most abhorrent example of eugenics gone awry was the Nazi regime, which lead to the murder of millions deemed a threat to the purity of the gene pool.

It is important to reflect back on past eugenic movements, for the lessons of the past can help us address the challenges we now face as new genetic technologies (e.g. tests for genetic disease) become available.

Is eugenics, understood as the aspiration to improve humanity’s heredity, necessarily unjust?

I believe it is not. In fact, justice can, in certain circumstances, *require us* to pursue measures that can be accurately described as “eugenic”. But to see how we must be clear about what was unjust about past eugenic policies. And that is my exclusive focus today.

The problems with past eugenic policies were basically two-fold. Firstly, the ends such practices sought to achieve were not morally or empirically sound. So aspirations such as “racial hygiene”, for example, are not morally defensible aspirations. Nor were past eugenic policies grounded in sound science. Assumptions about the heredity of criminality, work ethic, etc. were based on prejudice and dogma, not scientific evidence. So the particular ends of past eugenic movements were not defensible. This does not mean that any aspiration to improve humanity’s heredity is invalid. But those premised on prejudice and pseudoscience will fail the test of being defensible societal goals.

Secondly, past eugenic policies violated an important moral dictum: *the end cannot justify the means*. Even if one could articulate a laudable eugenic goal- like the reduction of disease- it does not follow that any means for achieving that end will be justified. So much more thought must be given to the *means* for achieving these ends. They must be rationally connected to the end, and proportionate, for example. Past eugenic policies also failed this second test.

But we do not need to look to the past to see how these lessons are still pertinent today. To set the context for the discussion that follows, I want you to ask yourself how you would respond to the following scenario.

A couple is at a higher than average risk of having a child with a genetic disorder or disability. Furthermore, let’s assume that society has decided that the goal of reducing the prevalence of disease and disability is a laudable goal. And thus they are considering what action, if any, should be taken to either encourage, or possibly compel, the at-risk couple from giving birth to a child with this condition.

So the government considers many possible measures of varying degrees of intrusiveness. Some legislators propose encouraging prospective parents, who are known to be at an increased risk, of undergoing genetic counseling. The government could even offer this service for free. Maybe even offer at-risk couples a small financial incentive for undergoing genetic counseling. Other legislators take a more harsh stance. They believe we should require at-risk parents to undergo genetic counseling. And some go yet even further, claiming such parents should be required to undergo genetic counseling and genetic tests. And some worry that even if these parents undergo the test, and it turns out they do have a high risk of passing on a genetic disorder, or are actually pregnant and prenatal tests indicate the child has a condition or disorder, the parents do not have to avoid conception or birth. So one hardliner says we should go even further yet. “Let’s make it illegal for these people to have a baby!” cries one excited law maker. “Heck, let’s put them in jail for having intercourse!”.

I suspect none of us will share the fanaticism of this final hardline proposal. Of the possible forms of intervention which are up for consideration, gross violations of reproductive freedom (like compelled abortion or the criminalization of intercourse) would be easily ruled out. For such a policy violates the second point raised above- that the ends cannot justify the means. While it is laudable to take preventative steps to ensure healthy children are born, we cannot pursue this aim in a zealous fashion that unjustly infringes on the liberties of prospective parents. While it is tricky to say precisely where we draw the line, the proposal of our excited hardliner clearly crosses that boundary.

Well, the reality is that many countries, including my own country (Canada), actually have laws on the books that do precisely what this hardliner proposes. We actually threaten to imprison people who have an increased risk of creating children with genetic abnormalities! Few people realise this. If you travel over to here, you will see Canada’s Criminal Code. And under Section V, titled SEXUAL OFFENCES, PUBLIC MORALS AND DISORDERLY CONDUCT, you will see that incest is a criminal offence punishable by up to 14 years in prison.

What is the justification for criminalizing incest (among consenting adults)? The most obvious justification would be a eugenic justification. And while the aim of reducing the prevalence of genetic diseases and abnormalities can be a laudable goal, criminalizing the sexual behavior of those who might be at an increased risk of conceiving children with a disorder or disability is not justified. Such a law suffers the same defects as past unjust eugenic policies. It is based on poor empirical evidence (e.g. concerning the increased risk and severity of the harm of inbreeding) and the harms of the law are disproportionate compared to any purported benefits.

In the latest issue of The Journal of Medical Ethics I have this short piece which addresses incest and the case of Patrick Stübing and his sister Susan Karolewski. See this video for details of their particular case.

The case of criminalizing incest raises many difficult questions. And grappling with these issues are important for they could determine how we respond to other scenarios where analogous stakes might be at risk. Many couples that are free to procreate under current law might actually have a higher risk of passing on a severe genetic disorder or disability. And if we can justify criminalizing the procreative choices of those closely related to each other, are we not lead down the path prescribed by the overzealous hardliner I noted above?

Perhaps there are other justifications one might invoke to make the case for criminalizing incest. Protection of the family, for example. I believe these arguments will also face difficult challenges, though I won’t pursue these points here.

But I think the case of incest law is an interesting example to consider for it illustrates how the concerns of past eugenic movements are still alive today.