Eugenics then and now

Public Discourse has posted part two of Sherif Girgis's interview with leading liberal bioethicist Art Caplan of the University of Pennsylvania and me.  The focus of this part is on eugenics.  Here's a portion of the exchange:

Robert George: The problem with eugenics is eugenics itself. It’s not just that the eugenics practiced by the Nazis was coercive. The idea predated the Nazis. The book Die Freigabe der Vernichtung Lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life) was not written by Nazis. It was written by German progressives in the Weimar period, Karl Binding and Alfred Hoche, who were, respectively (as I recall), a jurist and a medical doctor. And they weren’t thugs like the Nazis; they were well-educated, well-intentioned, polite people. . . . But I believe they embraced a very bad idea that was easily taken by the Nazis as a justification for the atrocities that they committed. So I would like to see eugenics itself, and not just the Nazi version of it, relegated to the ash-heap of history. Today we are seeing a revival in eugenics, this time under the cover of (and often in the name of) autonomy.  People say, for example, that so long as it is parents who are choosing to abort a Down syndrome baby, or failing to treat a handicapped newborn, and it’s not the state mandating it, then it’s okay. That, I believe, represents the abandonment of something precious in our civilization and in our polity. And that’s the idea of the equality and dignity of all human beings. This treasure of our civilization is the idea that, in some fundamental sense, all of us are created equal.

Art Caplan: I think that the coercion is, historically, really what made the Nazis’ position absolutely wrong. They practiced government-mandated negative eugenics. They killed involuntarily as social policy to improve the German genome. So put that aside, that’s just an issue of making sure you know when you’re going to use the metaphor—it’s not just eugenics, it’s that kind of eugenics. So to me, I think that intervening to try to improve health and function is part of what medicine does. And there’s some role for medical engineering and cellular engineering to achieve those goals. I think when you start to slide into the aesthetic and cosmetic improvements—I’m not sure that’s something that society or the public has to fulfill. But do I think we will someday try to alter a genetic message to get rid of certain diseases? Yes. Do I think that we’re likely to see the selection of certain types of gametes that might avoid certain clear-cut disease states? Yes. Do I think that the state has to be in the business of affording the opportunity for everyone to have a 6’5” basketball-playing mathematician? No. For me, there is some role for what I’ll concede as eugenics—if you want to take eugenics as just trying to improve the overall hereditary health of the public. For example, if you could fix the child with Tay-Sachs, I don’t think it takes away from the dignity of the child with Tay-Sachs.

RG: I agree. But would you draw the line at trying to enhance intelligence?

AC: I do. I think intelligence is so complicated that you don’t know what the hell you’re doing. If someone came to me and said, “Well, I’m going to try to enhance memory,” that may be good and that may be bad. It’s tricky business, number one. And number two, that isn’t a disease. So I’ve never been a proponent of allowing sex selection. We don’t allow it at Penn, actually. We could do it instantly. It’s not that hard. And other places do it. But gender is not a disease. If you come to us and say, “Could I use gene therapy”—as I said, “for Tay-Sachs, or to try to improve muscular dystrophy”—I’d be first in line to say, “I think that’s great, and we have to test it, and there may be some risk to that, but I’m okay with it,” even though some in the disability community might say, “Well, then, your goal is to get rid of disability, isn’t it?” And I might concede at that point, “Yes—if I could do it.”

RG: But not by getting rid of the disabled.

AC: Oh, no, no, no.

RG: Because that’s the key distinction.

(The complete transcript is available here:  http://www.thepublicdiscourse.com/2011/04/3156)