Eugenics in Our Day

Researchers have now developed a technique for doing genetic testing of a fetus by using cells circulating in maternal blood, avoiding the more invasive and dangerous technique of amniocentesis.   These new technical capabilities hail the dawn of a new age of eugenics, or the pursuit of “good (eu) genes.”  With these new technical achievements, physicians can gain knowledge of the child’s genetic makeup as early as 7 weeks after conception.  This can mean a new opportunity for interventions earlier in the pregnancy for the sake of the health of the child or it may provide doctors with more information to inform a decision to abort the child.

Arthur Caplan helped develop guidelines for organ transplants in the 1980s and has for some time pressed for similar oversight of the “wild west” of reproductive medicine, largely because of its eugenics implications.  He is very aware that genetic testing could be used for selecting athletic ability, eye color, or gender.  Sex selection using abortion is already something practiced in countries like India and China, and genetic testing using maternal blood would only make it easier.  However, Caplan is firmly pro-choice, saying that there are good and bad reasons for an abortion.  As Caplan puts it,“Sexism is not a good reason for ending a pregnancy.”

What is missing in this discussion is our response to those with diseases and abnormalities.  To many, a chromosomal defect like Down Syndrome or a physical abnormality like malformed limbs is a good reason for ending a pregnancy.   Too often our attitude to those with abnormalities and diseases is to consider them as unfortunate mistakes rather than opportunities to live in fellowship with another human being.  We think getting rid of the mistake solves the problem, especially when it involves fetal tissue out of our line of sight.  If our drive for perfection bumps into human autonomy, we back off.  If it does not, we proceed in getting rid of the patient if we can’t get rid of the disease.  This is a serious misunderstanding of the ethos of medicine.  An improvement in our ethical strategies will not come from a new set of protocols to use in the clinic.  It will only come about if physicians adopt a new value system concerning the purpose of medicine and develop their character accordingly.

Henri Nouwen, well-known for living in the L’Arche community for adults with disabilities, articulated  a vision of such an ethic when he said, “When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

Click here for a video of Art Caplan discussing gender selection.

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John Kilner
John Kilner
8 years ago

Helpful post, Cody. All this talk of autonomy begs the question the status of fetuses and embryos, doesn’t it? What about their autonomy? You are right to suggest that until we can appreciate people with disabilities more, we are less likely to give the preborn person with disabilities a voice–a choice–in whether or not the abortion should occur.

Jon Holmlund, M.D.
Jon Holmlund, M.D.
8 years ago

I also agree with Cody’s post and with Dr. Kilner’s comment. Not to toot my own horn, but to promote linkage among our blog posts, I would also point to my June 13 post on this subject. Since then, I believe a second paper has been published, describing the fetal genome sequencing without reference to the father’s DNA. (The paper I read used maternal/fetal plus paternal samples.)

Add to our concerns the question of whether Western society at large is wise to think that using pre-implantation or pre-natal genetic diagnosis (PGD) to eliminate certain genetic diseases from the population will have an unambiguously good effect. Sure, as I believe Brent Waters has argued, PGD may be justifiable in the cases of the most extreme genetic disorders (and Dr. Hughes, the PGD expert, has a long list), but extend that not just to Down syndrome, but, say, to BRCA mutations (about which Dr. Hughes says he’s debated Francis Collins), and one must ask when we will incur what I might call “Lewis’s revenge” (cf. The Abolition of Man). And, again, why are these techniques being pursued in the first place?