Eugenics: then and now in the era of prenatal testing for Down syndrome

Prof Paul Lombardo with the historical marker re: Buck v. Bell

Prof Paul Lombardo with the historical marker re: Buck v. Bell

Is prenatal testing for Down syndrome eugenics? Let’s compare how eugenics programs were justified in the past with how prenatal testing is currently administered.

The Eugenics Movement

In March 2016, the New York Times featured a column on two books concerning the eugenics movement at the start of the 20th Century.

The first is Professor Thomas Leonard’s Illiberal Reformers: Race, Eugenics and American Economics in the Progressive Era. It covers the history of the eugenics movement: its roots and the support of the movement by those who identified themselves as politically progressives.

“Eugenics” is from the Latin root words that roughly mean “well born.” In the aftermath of Darwin’s theory of survival of the fittest, progressives thought why leave the sorting of the fittest to the randomness of nature. Instead, they sought to hasten evolution by letting man decide who were the fittest to survive. What could go wrong?

From the New York Times article:

According to Thomas C. Leonard, who teaches at Princeton, the driving force behind this and other such laws came from progressives in the halls of academia — people who combined “extravagant faith in science and the state with an outsized confidence in their own expertise.” “Illiberal Reformers” is the perfect title for this slim but vital account of the perils of intellectual arrogance in dealing with explosive social issues. Put simply, Leonard says, elite progressives gave respectable cover to the worst prejudices of the era — not to rabble-rouse, but because they believed them to be true. Science didn’t lie.

In the United States, eugenics programs took the form of what were termed “positive” and “negative” measures. “Positive” measures encouraged families considered to be of good breeding to marry and have children with similarly well-bred families. At state fairs, awards were given to those who entered into “Fittest Families” competitions–the human category for the blue ribbon for the best hog, cow, and goat shown at the state fair.

As debasing as those competitions now seem, it was the negative measures that ultimately stigmatized the word “eugenics” as something the world agreed on should happen “Never Again.”

The “negative” measures in the United States were couched as public health measures: means by which to lighten the burden on society placed by the more needful by decreasing their numbers. In the early 1900’s, prenatal testing wasn’t even a possibility. So, instead, these measures took the form of how to eliminate all reproduction by those considered of “lesser stock.” How to do that? Well, in the wisdom of the progressive era, it took the form of passing state laws to forcibly sterilize women considered “feeble-minded” or bent towards wantonness.

These laws served as inspiration and models for the start of the Nazi eugenic efforts. But, the Germans figured, if eliminating burdens were for the greater good, then why stop with eliminating the next generation? So, they started killing the current generation, starting with the disabled and culminating in the Final Solution, the Holocaust of Eastern European Jews (and Roma, and homosexuals, and political dissenters).

Buck v. Bell

The other book featured in the New York Times column is Adam Cohen’s Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck. The book tells the story of one of the greatest injustices perpetrated by the United States legal system (that has yet to be rectified).

Ms. Buck was a young lady living in Charlottesville, Virginia who had the misfortune of coming from lower economic strata and the greater misfortune of having been impregnated by a relative of a family looking after her.

Paul Lombardo has done the work of exposing the railroading process that lead to Ms. Buck being sterilized under Virginia’s eugenic laws: her defense counsel barely defended her; the examining physician and prosecuting attorney were in cahoots; the whole thing was a sham.

That was sanctioned by the United States Supreme Court.

By one of its most well-regarded justices.

And it has yet to be overturned, remaining good law.

In a very succinct opinion, Justice Oliver Wendell Holmes, Jr. wrote a phrase that has lived in infamy. Holmes likened sterilization to vaccinations performed as public health programs. In explaining that Ms. Buck’s mother was also considered feeble-minded and her daughter, too, showed signs of imbecility, Justice Holmes justified the Commonwealth of Virginia forcibly sterilizing Carrie Buck thusly:

Three generations of imbeciles are enough.

Nevermind that factually, medically, none of the Buck women were diagnosed as “imbeciles.” All but one of the nine justices signed onto his opinion.

I have purchased Mr. Cohen’s book and look forward particularly to its exposition on the Supreme Court decision.

Eugenics today

Coincidentally, in the same month that books were published on eugenics, in a separate column on a platform associated with the L.A. Review of Books, another author criticized modern-day prenatal genetic testing for being called eugenics.

In her column, Karen Weingarten, criticizes the critiques leveled by those associated with the disability rights position that prenatal genetic testing amounts to eugenics. Weingarten attempts to hoist the critics on their own petard by explaining that if it is wrong to compel women to abort because they are diminishing the amount of genetic diversity in the world, it is also wrong to compel them to continue a pregnancy for the purpose of adding to that genetic diversity.

Professor Weingarten is correct that too often women are shamed for making selective abortion decisions (though oddly she chooses to criticize the critiques of fellow writers who I expect would share much common ground with Prof. Weingarten and does not pick lower hanging fruit of overt pro-life advocates who criticize prenatal testing for being eugenic). However, she incorrectly includes me in the writers she identifies as critiquing prenatal testing as eugenic for diminishing human genetic diversity.

Now, before expressing my position here, I recognize that likening anything to eugenics typically undermines an argument the same as likening any political position to the second coming of the Nazis. The latter has become such a trope of argument that there quickly become what was known as “Godwin’s Law,” which holds that there is a finite amount of time in any online debate before someone invokes Hitler or the Nazis and immediately undermines their argument.

So, while recognizing this effect, I hope by doing so it does not undermine my argument.

My argument is not one based on a defense of human genetic diversity–though I have written extensively on how Down syndrome can and should be considered yet one more expression of humanity and preserved as such.

Also, I agree with Prof. Weingarten that it is uncaring to use the argument of eugenics on the micro- level for shaming women for their individual choices. There are many who seem to take righteous pride in feeling “right” in their position by being able to judge the choices of others as “wrong.” But just as I challenge the trolls on this blog on whether they actually know anyone with Down syndrome before stating that it is a life not worth living, I equally challenge those self-righteous enough to judge others on whether they have ever worked with or counseled an expectant mom faced with the anxiety and fear that can be overwhelming with a prenatal test result.

Hopefully, all that being said frames what I’m now about to say:

Prenatal testing for Down syndrome as currently administered is modern-day eugenics.

I mean this as a simple matter of fact, not as a matter of emotionally charged bomb-throwing. Let me explain why I believe this to simply be factual.

Modern-day eugenics

My critique is not on the micro level and I do not want an individual expectant mother to be labeled a modern-day member of the SS. That’s stupid and wrong.

My critique is on the macro level.

The eugenics of old involved state programs designed to eliminate those labeled “feeble-minded” for being burdens on society by the claims they make on the public welfare system.

The easy distinctions cited by defenders of prenatal testing not being eugenics typically are that [1] prenatal testing is not a part of a state program and [2] those being eliminated are fetuses, not persons making claims on the public welfare system.

Both of these distinctions disregard how prenatal testing is currently administered.

The fact is that prenatal testing is part of a state program. In two states it is explicitly so. In California and Iowa, these states have state sponsored prenatal testing programs specifically for identifying Down syndrome. Beyond the Golden and Hawkeye States, every other states’ Medicaid programs pay for prenatal genetic testing for Down syndrome. In some states they even pay for abortions in the case of fetal anomalies. And, some states have springing statutes such that if Roe v. Wade were ever overturned, they would permit abortions up to the minute before delivery in the case of a fetal anomaly.

Further, consider what is paid for with public funds versus what is not: Medicaid pays for prenatal screening and diagnosis but Medicaid does not pay for genetic counseling consistently, or at all, or at the full cost; does not pay for the recommended written or support services that are to accompany a test result; and in the majority of states that have passed laws requiring the provision of the balancing information, no public funds have been allocated to pay for the provision of that balancing information.

So, it is contrary to reality to say there are not state programs for prenatal testing. There are. But are they eugenic? Meaning, are they justified for diminishing the number of claimants on the public welfare system?

They are decidedly so.

Regularly are there cost-effectiveness studies conducted to determine whether the cost of paying for prenatal testing is offset by the number of lives avoided through prenatal detection and abortion, which are counted as “savings” as claimants on the public health care system that are avoided through prenatal testing. The testing laboratories publish these studies as do board members of professional organizations devoted to prenatal testing and as do representatives of private health systems who candidly admit they conduct these studies, but do not make them public. These studies are not based on how many fetuses count as costs avoided; they are based on the lives those fetuses represent if they were to be born and then would be able to access public programs. These cost-effectiveness studies are then cited as reasons to cover prenatal testing by private policies and public healthcare coverage follows suit.

This is why I say that prenatal testing as currently administered is factually eugenic.

I dare you to dispute me.

Comments

  1. Nothing to dispute, Mark. Beautifully, reasonably, and factually stated.

    Your point about resorting to Nazis or eugenics as undermining arguments is well taken, but we have to see things honestly for what they are and use the language that is most descriptive of the reality. There is enough evidence in the historical record regarding the development of prenatal testing to label is at least initially as a eugenic effort. While many are now using prenatal testing as an opportunity to prepare for birth, far more are using it to eliminate those they fear they will not be able to accept. That word “fear” is key. You and your colleagues are doing an excellent job at getting good information out there to alleviate that fear, but unless we are willing to have an honest look at the origins of prenatal testing and they way it is most often used, then we will never solve the problem and grow past this horrific stain that darkens the American character.

    Again, very well done, and thank you for this!

    • Thank you, Mark, for your gracious response and for sharing the post. Maybe the more who read it, the more who will question how and why their tax dollars are being spent in an imbalanced way that perpetuates this injustice.

Trackbacks

  1. […] took photos of Justice Oliver Wendell Holmes, Jr., a Union veteran of the Civil War, who wrote the epithet in Buck v. Bell upholding the involuntary sterilization of those deemed “feeble […]

  2. […] by their doctors to abort babies that tested positive for certain genetic conditions. I agree with the author of this post that this is modern day […]

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