Nazi propaganda: This image, from a high school biology textbook, is an example of Nazi propaganda on the need to prevent births of the “unfit.” The text reads: “You are sharing the load! A hereditarily ill person costs 50,000 Reichsmarks on average up to the age of sixty
Courtesy US Holocaust Memorial Museum

Our sketchy understanding of genetics in the early 1900s led many people to believe that heredity strongly predicted traits and behavior including intelligence, vagrancy/poverty, criminality, mental illness, ‘feeblemindedness,’ cleanliness, vocational attraction, etc. And if bad genes were the problem, then careful breeding was the solution. Leading statisticians (Galton, Karl Pearson, RA Fischer) supported the new eugenic science, which drew on many disciplines. But there was also opposition.

Policies proposed by eugenicists included marriage counseling and restrictions, segregation, sterilizing criminals and people with disabilities, and even killing the “unfit” (W. Duncan McKim, MD, PhD, proposed this in the US in 1900). “The human garden needs weeding” said Minnesota eugenicist Charles Freemont Dight. Today we see eugenic policies were more about discrimination than sound science.

Thousands of people considered “unfit” were forcibly sterilized in the US (including in Minnesota), a policy upheld by the US Supreme Court in Buck v. Bell in 1927. Tight immigration quotas minimized “undesirable” populations. State fair exhibitions and competitions encouraged “fitter families” to have more children.

The National Socialists (Nazis) took up eugenic ideas pioneered in England and the US, combined with anti-Semitism and concepts of ‘race hygiene,’ to justify sterilizing and then murdering people with disabilities (Aktion T4). Technology and personnel were transferred east, ending in genocide against the Jews and other groups. After World War II, disgust at the Nazi genocide led to widespread rejection of eugenic ideas.

Today advances in genetics and technology are raising eugenic questions again. Is it ever OK to select or modify a person’s genes? Would that cross an ethical line? What if individuals choose instead of the state? If we have the ability to prevent impairment, are we obligated to do so (including prenatal elimination)? And how do we balance the rights of individuals with the needs of society? What about costs?

Today’s thorny questions

Marriage restrictions, segregation of people with disabilities, and forced sterilization are unthinkable in this era of individualism. But there are plenty of contemporary examples that give Allison pause:

• New fertility and diagnostic techniques mean we can screen embryos for particular probabilities or traits—including sex—early in their development.
• Should parents be able to select which embryos to implant?
• Some patients with terminal illnesses fear pain, loss of capacity or dignity, or financial loss. Should it ever be legal for a doctor, on request, to facilitate or cause a patient’s death?
• With exceptions, states require that children be vaccinated against infectious diseases. But some parents worry about vaccine safety. Should the government require health interventions for citizens? Should there be limits?
• Should people be allowed, through technological or genetic interventions, to enhance human capacities beyond normal levels of functioning?