Ethical Issues

To what extent are there continuities, parallels, and trajectories between past eugenic ideas and practices, and current and pending developments with genetic testing and screening, prospective gene therapies, and the increasing utilization of sperm banks and egg donations? To begin to answer these questions, it is imperative to distinguish between state-sanctioned eugenic programs on the one hand, and private, individualized,personal decisions that are socially patterned, on the other. In the former case eugenic goals are usually explicitly articulated, and thus easy to identify, examine, and oppose or support. In the latter the eugenic implications are often unarticulated and subterranean—only exposed by a review of statistical patterns of what are otherwise perceived as individual choices. In matters of public policy and market choices, emphasis upon individual intent can camouflage the collective eugenic force of personal decision-making.

One heuristically useful attempt to distinguish between different kinds of contemporary eugenic forms can be found in Philip Kitcher's The Lives to Come (1996). Kitcher makes a distinction between laissez-faire eugenics, a hands-off approach that presumes that everyone will make their own individual choices—and a utopian eugenics, where as a matter of public policy there is an attempt to make available to all sectors of a society the information and technology to make those choices. While no public policy can ever deliver such information and technology evenly across all sectors, this provides an analytic device for assessing the degree of success of such an attempted distribution. The major difficulty surfaces with an empirical problem generated by the molecular genetic revolution itself, the fracture of the public health consensus of what constitutes the public good. Allen Buchanan and his associates, in From Chance to Choice (2000), argue that an assessment of the consequences for the general public good are vital to a discussion of the treatment/ enhancement distinction. Before 1960 it was possible to achieve consensus that the public good was well-served by an elimination or mitigation of such diseases as smallpox, cholera, tuberculosis, yellow fever, typhoid, and sexually transmitted diseases. However, with the discovery that genetic disorders are located in risk populations that do not place the general population at risk, a new set of issues and new kinds of eugenic concerns have been generated regarding who has control over genetic screening and testing.

While it is true that individuals make choices, they do so in a social and economic context that can be demonstrably coercive. While relatively obvious when looking at other societies, it is less understood when examining one's own— substantially obscured because individual choice is deeply embedded in the taken-for-granted assumptions about decision-making. For example, long before the advent of prenatal detection technologies, preference for a male child in India and China was so great that a notable fraction of the population practiced infanticide of newborn females. While sex selection does not qualify as a eugenic strategy (unless the purpose is to prevent a gender-linked disorder), the practice in India and China does illustrate how and why a focus on individual choice can obscure the dramatically collective aspect of socially patterned individual choices.

Once technologies for prenatal determination of sex became available, the quest for disclosure of the sex of the fetus took a momentous turn for public policy in India. In 1971 India passed the Medical Termination of Pregnancy Act, which stipulates that a woman can be given an abortion only if there is a life-threatening situation, or grave injury to her physical or mental health. Amniocentesis use began in India in 1974, but there were early reports that the test was being used less to detect birth defects than to determine the sex of the fetus. In August 1994 the Indian Parliament passed a new law that stiffened the penalties for screening the fetus to determine the sex. However, there was a large loophole in the law that made it practically unenforceable—and the practice has continued at such a high rate that in 1994 New York Times reported that Haryana, a populous northern state, had an astonishingly low sex ratio of874 females to every 1,000 males.

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