Just a quick note to let you know about Alexandra Minna Stern’s recent interview on Capital Radio, discussing the California sterilization case. Her work appears frequently on Genotopia—she’s one of the smartest historians discussing this important case.
John Belmont has asked a question that deserves a separate post. This is necessarily brief and should not be mistaken for a general survey of this concept, but the concept is so general that it deserves a somewhat fuller answer than I can (or should) give in the comments. Here is John’s question:
Can you discuss Savelescu’s Procreative Beneficence in the context of these new genetic screening technologies? (Screening that then often triggers definitive diagnostic testing)
It seems normal for parents to desire healthy offspring. Is it evil or morally suspect for a couple to choose healthy offspring?
In 2001, Julian Savulescu advanced a principle he calls “procreative beneficence,” which states that “couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.” It is of that species of ethical principles called “intuitive”: on the face of it, who could argue on behalf of not providing the best possible conditions for one’s child, whether they be environmental or genetic? So no, of course it’s not evil to choose healthy offspring, so long as one is morally okay with disposing of “unfit” embryos or young fetuses. But its morality is less straightforward.
Savulescu’s idea has spawned a sizable secondary literature, especially among bioethicists, most of whom have tried various tacks to destroy his principle. A full discussion and evaluation of this literature is more than I can undertake here, but i’ll provide a starter bibliography at the bottom.
Few–including Savulescu himself–deny that PB is an element of the “new eugenics.” By this is meant an “individualized” or “liberalized” (or even “commercialized”) eugenics, rather than a state-controlled eugenics. This distinction is entirely appropriate. State-controlled eugenics is part of a specific historical context, whereas I see eugenics as a trans-historical principle (what I have more colloquially called an “impulse”). The eugenic impulse goes beyond notions of “old” or “new” eugenics: eugenics is just there, manifesting in different ways in different periods. Empirically, we appear to be driven to take control of our own evolution.
On the surface, Savulescu’s principle, like arguments in favor of “new” eugenics generally, appears not to be concerned with control over human evolution. It refers only to choices about specific individuals—a couple’s (or individual’s) choices about the genome of an embryo or fetus, it doesn’t concern the well-being of the population. However, <a href=”http://www.ncbi.nlm.nih.gov/pubmed/20047587″ target=”_blank”>Elster</a> shows that procreative beneficence is impossible to fully separate from “General Procreative Beneficence”–the idea that “couples ought to select children in view of maximizing the overall expected value in the world, not just the welfare of their future child.” Most literature advocating the new eugenics treats the individual and the population as wholly distinct, yet of course what is a population but a collection of individuals? These two principles–concern for the individual and concern for the population– are by no means mutually exclusive; indeed, the thrust of my book is that they have always coexisted. It’s naive (or cynical) to act as though one can be separated from the other.
Under this view, PB is in fact an indirect means of directing the evolution of the population. My position is that state control is not what makes a practice eugenic. What makes a reproductive practice eugenic is whether it includes a decision about the welfare of the population; whether it is subject to social (including economic) pressures. If one is “merely” choosing the “best” possible child, few of us have the luxury of ignoring racial features, for example. The “best” child is the best in a particular or anticipated environment. The literature on PB that I have read does not take this fully into account.
If the “best” environment is truly adapting, shifting, and local, then we have Darwinian conditions, in which the population is “evolving itself” with no particular end. This is morally less troubling than a Spencerian goal-directedness. I make no claim to being a moral philosopher, but as a historian, it seems morally less responsible to deny parents that freedom than to allow it. In sum, I am not persuaded by moral arguments against PB.
But I have rational arguments against it. They are two: What if it doesn’t work?; and What if it does?
What if it doesn’t work? We can tinker with genomes long before we understand them, the way one can learn a few Unix commands without fully comprehending the operating system. I worry we will make bad choices. I worry we will uncouple biological systems that have evolved together for millennia. I worry that our technology outstrips our wisdom.
What if it does? I worry that corporate control–via market pressures, advertising, and so forth–may prove even more potent than government control. I worry that PB will instantiate in our very DNA ideas of normalcy that may transcend local conditions and become general principles of human perfection. I worry that it will encourage the idea that genes are all; that we can simply “dial in” the child we want; that we will rob poorly funded social programs to pay for already amply funded research programs for the elite. Historical examples do not provide a comforting set of models for human behavior in these areas.
In short, then, it may not be “evil” to choose the genetic constitution of a child, but in doing so we are making many more choices than we are aware of.
Some references on procreative beneficence:
Savulescu, J. “Procreative Beneficence: Why We Should Select the Best Children.” Bioethics 15, no. 5-6 (Oct 2001): 413-26.
Savulescu, J. “In Defence of Procreative Beneficence.” J Med Ethics 33, no. 5 (May 2007): 284-8. doi:10.1136/jme.2006.018184.
Savulescu, J., and G. Kahane. “The Moral Obligation to Create Children with the Best Chance of the Best Life.” Bioethics 23 (Jun 2009): 274-90. doi:10.1111/j.1467-8519.2008.00687.x.
Herissone-Kelly, P. “Procreative Beneficence and the Prospective Parent.” J Med Ethics 32, no. 3 (Mar 2006): 166-9. doi:10.1136/jme.2005.012369.
Bennett, R. “The Fallacy of the Principle of Procreative Beneficence.” Bioethics 23, no. 5 (Jun 2009): 265-73. doi:10.1111/j.1467-8519.2008.00655.x.
Elster, J. “Procreative Beneficence: Cui Bono?”. Bioethics 25, no. 9 (Nov 2011): 482-8. doi:10.1111/j.1467-8519.2009.01794.x.
Herissone-Kelly, P. “Reasons, Rationalities, and Procreative Beneficence: Need Hayry Stand Politely by While Savulescu and Herissone-Kelly Disagree?”. Camb Q Healthc Ethics 20, no. 2 (Apr 2011): 258-67. doi:10.1017/S0963180110000903.
Bourne, H., T. Douglas, and J. Savulescu. “Procreative Beneficence and in Vitro Gametogenesis.” Monash Bioeth Rev 30, no. 2 (Sep 2012): 29-48.
Herissone-Kelly, P. “Wrongs, Preferences, and the Selection of Children: A Critique of Rebecca Bennett’s Argument against the Principle of Procreative Beneficence.” Bioethics 26, no. 8 (Oct 2012): 447-54. doi:10.1111/j.1467-8519.2010.01870.x.
Hotke, A. “The Principle of Procreative Beneficence: Old Arguments and a New Challenge.” Bioethics (Jul 29 2012). doi:10.1111/j.1467-8519.2012.01999.x.
Bennett, R. “When Intuition Is Not Enough. Why the Principle of Procreative Beneficence Must Work Much Harder to Justify Its Eugenic Vision.” Bioethics (Jul 10 2013). doi:10.1111/bioe.12044.
“Eugenics is old history, kind of scary to read about but reassuringly far in the past. We don’t really need to know about that, right, professor? Right???”
Sorry kids. It’s going to be on the exam. The discussion over the California prison sterilizations continues. Today, the Huffington Post carries a compassionate and well-informed historical essay by Alexandra Stern, who Genotopia readers know as a distinguished historian of eugenics and genetic counseling. “Many of the stereotypes that fueled 20th century sterilization abuse remain in vogue today,” she points out.
Dr. James Heinrich, who performed tubal ligations of women in prisons, stated that this practice saved the state money because his involuntary clients were likely to have “unwanted children as they procreated more.” Such a callous attitude could have been uttered by superintendents in the 1930s, who worried about the economic burden of “defectives,” or by the obstetrician at USC/LA County who purportedly spoke to his staff about “how low we can cut the birth rate of the Negro and Mexican populations in Los Angeles County.”
She concludes, “It is time to break the cycle of reproductive injustice in California, and to challenge the continuing potency of eugenic rationales of cost-saving and societal betterment that have undergirded compulsory or unauthorized sterilizations. The 21st century calls for a new era of human rights, institutional oversight, and the protection of vulnerable populations.” I should also point out the two excellent posts on the California sterilization fiasco over at Nursing Clio, one by Tina Kibbe, the other by Adam Turner.
At the other end of the country, North Carolina lawmakers are currently finalizing this year’s budget plan, and it includes $10M for victims of the state’s eugenic sterilization program, which reached its peak in the 1940s and 1950s. Claude Nash Herndon, a physician and medical geneticist who I feature in my book, was one of the leaders of the program. He was by all accounts a kind man and a good doctor. He also had the beliefs common to prosperous white people in the South in that period, and the paternalistic attitudes common to physicians then. The North Carolina sterilization program was a point of pride for the state. The definitive sources for this chilling story are the Winston-Salem Journal’s series of news articles “Against their Will,” and Johanna Schoen’s thorough, scholarly, and chilling account, Choice and Coercion.
Debate of course rages about this program. Some say money won’t undo the damage, while others say hell yes, it will help. Some ask where the money is going to come from, while others ask why such a small sum is being set aside. There were an estimated 1,800 people sterilized against their will under the program. Tribtown.com shows that if 1,000 come forward with legitimate claims, they will receive $10,000 each. How do you put a price tag on your fertility? Some choose not to have children voluntarily, while for others the prospect of having children is one of the things that gives life meaning.
I personally can never do the math of converting morality into money. But I do believe a cash settlement provides some compensation, gives the victims at least a small sense of justice, and exacts a penalty of public shaming–however late–on a governing body that could have known better.
Is public shaming a valid reason? Does that justify all this attention and money? You bet. Shame should never be used vindictively, but a proper sense of shame is an essential check on antisocial behavior. Aversion to shame is one of the things that ensures civility. Sadly, in the real world, that often involves money, difficult thought it may be to calculate the exchange rate.
It’s been a great week for eugenics fans. First, we learned that California has been involuntarily sterilizing pregnant prisoners for the last 15 years–a haunting coda to Alexandra Stern’s chilling research on California’s 20th century eugenics program. Then Jon Entine wrote that eugenics is coming back and that’s just fine–provoking a lively exchange with yours truly. And now Dhruti Shah publishes an article on the BBC site claiming of all things that the Nazis “undermined” eugenics. Damn! And it had all been going so well up until then!
I’m gathering my thoughts on this issue, so stay tuned. But two points immediately leap out at me. First, both Entine and Shah are either ignorant or Panglossian about the early history of eugenics. Entine writes that some imagined “negative wing” of the eugenics movement “was never widely embraced.” Historians of eugenics agree that on some level, almost everyone in the Progressive era was a eugenicist, in the sense of advocating or supporting eugenics. There was no “negative wing”–there was only positive and negative eugenics, which were seen as complimentary.
And Shah writes that the Nazis’ use of eugenics “ended up undermining its credibility as a science.” Actually, its credibility as a science had been undermined for quite some time. By 1933, few seriously trained geneticists were willing to do more than sigh longingly for the day when we would know enough to direct our own evolution without wrecking the gene pool, society, or both. Its popularity as medicine and as population control rose steadily through and beyond the Nazi period. Indeed, the Nazis’ experiment in scientifically rationalized genocide coincided with the peak in sterilization and compulsory birth control of Americans and Scandinavians, and with explicitly eugenic programs ranging from immigration control to race- and class-based family planning on every inhabited continent of the globe.
The second point that immediately comes to mind is that these reports and commentaries suggest that my argument, which I made in the conclusion of The Science of Human Perfection, about eugenics regaining respectability in the post-genome age, is correct (see also my article “The Eugenic Impulse“). Scientists, at least, really do seem to be more comfortable with the term “eugenics” as a name for what they are trying to do. And what they’re trying to do, in a nutshell, is engineer ourselves a better future. To control human evolution.
The argument is that “Sure, it was done wrong before–but that was because we didn’t understand the science well enough.” That’s always the argument. Eugenicists have always said “Now we know enough to do it right.” And the next generation always comes along and clucks its tongue at the naivete and ignorance of its forbears.
No, it’s not because we didn’t understand the science. It’s because we didn’t understand society well enough before. And for all the remarkable technological advances of the last century, there’s scant evidence that we understand society much better now.
A recent post by Jon Entine on the Forbes website leads with a complimentary citation of my book– and then goes on to undermine its central thesis. He concludes:
Modern eugenic aspirations are not about the draconian top-down measures promoted by the Nazis and their ilk. Instead of being driven by a desire to “improve” the species, new eugenics is driven by our personal desire to be as healthy, intelligent and fit as possible—and for the opportunity of our children to be so as well. And that’s not something that should be dismissed lightly.
Well, first of all, as the recent revelations of coerced sterilization of prisoners in California shows, “draconian, top-down” measures do still occur. Genetics and reproduction are intensely potent, and wherever we find abuse of power we should be alert to the harnessing of biology in the service of tyranny.
Second, there’s more than one kind of tyranny. Besides the tyranny of an absolute ruler, perhaps the two most potent and relevant here are the tyranny of the commons and the tyranny of the marketplace. The fact that they are more subtle makes them in some ways more dangerous. The healthcare industry does much good in the world, but it is naive to treat it as wholly benign.
Further, putting human evolution in the hands of humans, means accepting long-term consequences for short-term goals. The traits we value–health, intelligence, beauty–are the result of the action of many genes interacting with each other and with a dynamic environment. The entire system is contingent, inherently unpredictable. Yet we treat it as simple and deterministic. Until now, technology has been the major obstacle to guiding human evolution. It may be that now the major obstacle is our reasoning ability, our capacity for grasping contingency and probability and change. We’re tinkering with the machinery of a system whose complexity is still unfolding before us. The probability of unforeseen consequences is 100%. The only question is how severe they will be. We will only know in retrospect.
If we now have the tools to meaningfully guide our own evolution–as eugenicists have always wanted to do–we cannot take a blithe and Panglossian attitude. We have to be alert to the risks and take them seriously. That is not traditionally science’s strong suit. The public face of science is sunny, optimistic, fun. It strides boldly into the future, laughing and making striking promises. The industries behind science and health are wealthy and politically powerful. Not everything they do is benign.
To be a critic of that public-relations machine–of hype, in other words–is not to be a critic of health or knowledge or progress. Genetic science has the potential to bring us enormous benefits in health and well-being, and as they do, I stand in line with my fellow humans for my fair share. But that science also carries huge and unforeseeable risks, the root of which, perhaps, is arrogance. It’s one whose consequences are painfully evident in the historical record.
[UPDATE: Changed the link from the Sacramento Bee article to the longer report from cironline. h/t Alex Stern.] A quick note on today’s report from the Center for Investigative Reporting that at least 150 pregnant inmates in prisons in Corona and Chowchilla, CA, were sterilized against their will. Between 2006 and 2010. That’s TWO THOUSAND six. Another hundred or more may have been sterilized in the 10 or so years before that. (See also this HuffPo piece from last month.)
In an earlier post, I noted that when I applied for my marriage license in California, my betrothed and I received a state-sponsored booklet called “Your future together.” It was heavily gene-centered and mentioned that one can obtain free birth control and sterilization, paid for by the state. The historian Alexandra Minna Stern has written about the racial politics of California sterilization (see my review of her latest book–and then buy the book). Not surprisingly, the largest number of people sterilized are poor Mexicans, often illegal immigrants. Those surgeries, however, are at least nominally voluntary. Involuntary sexual surgery on prisoners sounds like something from the 1910s, not the 2010s.
In my book, The Science of Human Perfection, I note that eugenics is alive and well, though it often travels under an assumed name. The principles of informed consent can be–and as this report shows, are–used to mask persuasion. When that persuasion includes being made to “feel like was a bad mother if I didn’t do it,” it grades into coercion. Further, the ethics of sterilizing minority women in prison are even more complex than doing it outside—one wonders, for example, how many of those women were impregnated by prison guards. We should not let the drawing of apparently bright ethical lines allow us to become complacent about the gray, unlit areas where that good ol’ time eugenics can still flourish.
Just saw this clip of an interview with the inveterate science critic Hilary Rose with The Guardian. She expresses beautifully and forcefully the idea I try, however awkwardly, to trace in The Science of Human Perfection and, often more humorously, here on Genotopia. She discusses how eugenics has always had a strand of preventive medicine, and how that strand runs continuously down to today’s genetic medicine. And that doesn’t make modern genetics evil. However, we have to be honest about what it is we’re up to. E.g.:
“Preventive [genetic] medicine is eugenics. Now, I’m not going to say I’m totally against eugenics. I just think we need to say what we’re doing.”
Rose is often a fairly radical critic, but this strikes me as a balanced and fair reading. I am ordering the new book Genes, Cells, and Brains, by Hilary Rose and Steven Rose. I expect to post more on it.
How good it would be to see some momentum gather for an honest, non-polemical critique of genetic biomedicine, one in which the aim was not to strap ourselves to the gears and wheels and levers of the machine* but rather to steer it in a positive direction—one that maximally benefits those it is meant to serve.
*paraphrase of a favorite quote from my hometown history