The parallels of eugenics with contemporary bioethics extend into the realm of ideology. Both movements reject equal human moral worth. Both are utilitarian based, seeking to improve overall human happiness and reduce human suffering—sometimes at the expense of individual human rights. Like today’s bioethics theories, eugenics was taught in some of the world’s most prestigious universities, quickly becoming an integral part of professional training. And, again mirroring modern bioethics organizations, most eugenics societies “were dominated by professionals such as professors, social workers, lawyers, doctors, teachers, and ministers.”12
To be fair, there are important differences between the eugenics of yesterday and bioethics today. Eugenics equated human fitness and morality with overall intelligence,13 a concept that is not accepted generally in bioethics, although the depersonalization of infants and people disabled by significant cognitive injury or illness seems a disturbing echo of the past. Moreover, absolutely unlike contemporary bioethics, the eugenics movement was overtly racist, proclaiming the white race superior to blacks and Asians. (One eugenicist pronounced perniciously that the average black person in the United States had the average mental age of a ten-year-old.14) Eugenicists were profoundly self-satisfied, promoting the racial and personal characteristics they possessed as the highest human ideal. At the same time, they degraded the characteristics they associated with the lower economic classes and “inferior” races as those to be “bred” out of the human condition through eugenic practices. (Among the many “negative” human characteristics and/or behaviors eugenicists believed were genetically caused and which they wished to eradicate were feeble-mindedness, epilepsy, criminality, insanity, alcoholism, and pauperism.15)
There were two general approaches to effectuating the eugenics theory. Proponents of “positive eugenics” sought to persuade young people who possessed worthy traits to marry among each other and procreate liberally toward the end of strengthening these characteristics within the human gene pool. Worried that the “proper” people were not procreating in sufficient numbers, eugenicists filled the popular culture with notions of the ideal family, urging the “betters” among the population to have many children. (Four per marriage was “was the number thought necessary to maintain a given stock.”16) There were even prizes given to large families thought to be promoting the best eugenic human traits.
The real tyranny that eugenics unleashed flowed out of what came to be known as “negative eugenics,” which came to dominate the field. Negative eugenicists presumed the right to prevent those with undesirable physical and moral characteristics from procreating at all. (That was a big point of Margaret Sanger’s birth control push.) And if the so-called unfit wouldn’t limit their own kind, then eugenics theory held that society could force these limitations coercively through medical acts and public policies that exploited and oppressed the weak and medically defenseless.
Although eugenics originated in England, it was soon imported to the United States. In 1899, the Journal of the American Medical Association published an article that advocated the use of the newly developed vasectomy as a “surgical treatment” to keep undesirables such as “habitual criminals, chronic inebriates, imbeciles, perverts, and paupers” from reproducing.17 In 1902, an Indiana physician named Dr. Harry Sharp urged passage of mandatory sterilization laws that would require all men in prisons, reformatories, and paupers’ houses to be sterilized. (Before any law was passed permitting it, he had involuntarily sterilized more than 500 men.18) Following Sharp’s lead, in 1907, Indiana became the first state to pass a eugenics-based sterilization law. By 1912, eight states had sterilization laws. Eventually nearly thirty states followed suit, including Virginia, leading to the oppression of Carrie Buck.
“USELESS EATERS”
Eugenics helped feed—and was itself nourished by—the particularly harsh ethos of social Darwinism, which applied Darwin’s biological theories of natural selection and the struggle for survival to the human realm and relations among people and societies. “To the social Darwinists . . . human society had always been a battleground for competing individuals and races in which the fittest survived and the unfit were cruelly eliminated; and, for the sake of human progress, this struggle for existence must be allowed to continue unchecked by governmental intervention or social reform.”19 Believers in social Darwinism, thus, viewed the exploitation of the weak as a natural process. At the same time, social Darwinistic theories worked hand-in-glove with eugenic notions of hierarchies of human worth to classify exploited people as inherently inferior and thus deserving of their fate. This explosive combination never quite reached critical mass in the United States or Canada. In Germany, however, it combusted into the conflagration known as the Holocaust.
In 1806, German physician Christoph Wilhelm Hufeland wrote presciently—and in words that remain relevant today—“It is not up to [the doctor] whether . . . life is happy or unhappy, worthwhile or not, and should he incorporate these perspectives into his trade . . . the doctor could well become the most dangerous person in the state.”20 Hufeland’s point is that the ethics of medicine are a good indicator of the moral health of society and that when medical practice is corrupted, society is soon to follow. “Physicians are central to the quality of life in any society,” agrees the American physician and notable Nazi hunter Michael Franzblau. “The minute physicians begin to see some of their patients as having greater worth than others, they will gain power over their patients that is unbelievable. That is what happened in Germany, beginning around 1910.”21
Most people believe that the medical horrors of the Holocaust were the sole creation of Adolph Hitler. In fact, the path to medical evil was laid long before Hitler was even a storm cloud on the German horizon. “Physicians in the pre-Nazi period began to view their skills as appropriate for killing as well as healing,” Franzblau says. Because of eugenic theories, social Darwinistic beliefs, and the deprivations caused by the war, half of Germany’s mental patients were starved to death during World War I. “But that was a mere prelude,” Franzblau told me. “In 1920, Binding and Hoche published their book, which really set the tone for what was to come.”22
That book was a tome entitled Permission to Destroy Life Unworthy of Life (Die Freigabe der Vernichtung lebensunwerten Leben).23 Its authors were two of the most respected academics in their respective fields: Karl Binding, a nationally renowned law professor, and Alfred Hoche, a physician and noted humanitarian. Permission to Destroy Life Unworthy of Life, in reality two extended essays—one by each author—was a full-throated assault on the Hippocratic tradition and the sanctity/equality of human life. The authors accepted wholeheartedly the concept that some humans had greater moral worth than others. The latter were disparaged as “unworthy” of life, a category that, like some contemporary euthanasia advocacy, included the dying, people who were mentally ill or retarded, and badly deformed children. People deemed life unworthy of life, the authors argued, should be allowed to be killed (euthanasia). More than that, the authors professionalized and medicalized the entire concept, making it seem compassionate by promoting medicalized killing of those deemed unworthy of life as a “purely a healing treatment” and a “healing work”; they also justified euthanasia as a splendid way to divert money from being spent on caring for unworthy life toward other important societal needs.24
Binding and Hoche listed three categories of patients who doctors should be allowed to kill ethically and legally: