Confession of a Eugenicist

 

I have a confession to make:  I am a eugenicist.

 

I am a family physician who provides obstetrical care.  I love taking care of moms and babies.

It has insidiously become the Standard of Care to offer to all pregnant women testing that will inform them whether there is an increased risk that their unborn children have certain genetic abnormalities or birth defects.  If I do not offer these tests to all pregnant women, I am considered to have provided substandard care, and the wrath of a society that tolerates Nothing But The Best will descend quickly upon me.  If I do offer these tests, I am practicing “Good Medicine” — and eugenics.

 

How did eugenics become Good Medicine again?

 

I don’t want to practice eugenics.  Yet I am compelled to by the Standard of Care;  and the Standard of Care is shaped by the existence and marketing of these tests.  It’s the old story in our technophilic society:  we are constrained to use a technology merely because the technnology exists.

 

Why were such tests even developed in the first place?  Was it only for diagnostic purposes,  simply to provide information to prospective parents?  Of course not.  Clearly these tests were developed to help guide therapy;  and because the primary “therapeutic” option is induced abortion of fetuses who are not up to snuff, it seems equally clear that eugenic considerations drove their development.  So, the eugenic ideal drives development of eugenic technology, which, marketed and disseminated, drives the Standard of Care, which drives what I do in my office and provides the ammunition for the licensing board — and malpractice lawyers — who are looking over my shoulder.

 

Thus am I an unwilling eugenicist.  Thus am I compelled to do the dirty work for the eugenicists of our society.

(This is not to say that all parents who opt to undergo this testing do so for eugenic purposes.  I realize that some do so solely for diagnosis.  I am writing here about the development and mandatory offering of such tests.)

 

Maybe the time has come for a new  medical association.  Instead of the AMA, perhaps we should inaugurate the HMA:  the Hippocratic Medical Association, the members of which will adhere to a different Standard, who will pledge to uphold the ideals behind the Hippocratic Oath.  The members of this association would return to the ethos of that Oath which, according to anthropologist Margaret Mead,  marked one of the great turning-points in the history of the human race, because, “For the first time in our tradition, there was a complete separation between killing and curing . . . One profession . . were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect–the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child . . .”

 

Parental Guidance Before and After Birth

 

As I sat sipping coffee and reading articles on the moral implications of genetic interventions in the germ-line (don’t yawn), a perfect picture was painted at the table across from me.  A young and boisterous child spoke of his aspirations for the future, vehemently proclaiming to a doubting adult audience, “I want to be a teacher, a singer, a dancer, a hospital man, I want to be everything.”

 

His ambitions were a bit outlandish.

 

His father, or who I believed to be his father, responded: “Do you know how you can be all of those things? You can be an actor.  This way you can be a teacher one day, and a singer another, and…”

 

“No, I want to be them all!”– Clearly the aspirations of the father were distinct from that of the son.

 

Imagine, if you will, that your direct (active) influence on your child could begin before conception. What if you could unify your aspirations before birth? No longer would you have to squelch his dreams as he bellows across Starbucks…

 

Although this is not yet in our grasp, Gender selection and disease screening are already a possibility. What if more options become available?

 

John Harris, recognizing this future possibility in his book Enhancing Evolution, avows an ethical parity in genetic interventions before conception and parental influences after birth. Could this be true?  Are encouraging your child to play an instrument and (in some future world) fashioning an embryo to be a world-class musician morally equivalent?

 

I would say there is a distinct difference between choosing for our children potential traits in embryo and guiding our children along in life. No doubt both influences are according to parental values. However, by choosing traits we are no longer discussing influence in terms of persuasion and direction, we are discussing a new kind of coercion.

 

What do you think?