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PubMed1993

'Collective fictions': similarities in reasons for accepting maternal serum alpha-fetoprotein screening among women of diverse ethnic and social class backgrounds.

We analyzed the decisions of an ethnically and socioeconomically diverse group of women to accept or refuse a prenatal diagnostic test. We found that how women were informed about the test and the kind of information they were given determined their decisions more than their ethnic or social class background. To explain this, we argue that the women and their health care providers created a 'collective fiction' which situated the testing within the domain of routine prenatal care and denied its central connection to selective abortion and its eugenic implications.

Abortion, Eugenic↗
PubMed2005

"Yea, I have a goodly heritage": health versus heredity in the Fitter Family contests, 1920-1928.

By the 1920s, the future of the middle-class family had become a topic of great concern for mainstream Americans. This widespread concern led to a new acceptance of the discussion of sexual and marital issues in print and in public. Within this public discussion, eugenicists, physicians, clerics, sociologists, and various others offered solutions to the questions and concerns of their rapidly changing society. The Fitter Family contests, sponsored by eugenicists and held at state fairs in the 1920s, reflected these public and professional anxieties. Though infused with eugenic ideas about race betterment through better breeding, the contests were equally concerned with improving the health of individuals and strengthening American families.

Eugenics↗
PubMed2000

Psychiatric research and science policy in Germany: the history of the Deutsche Forschungsanstalt fur Psychiatrie (German Institute for Psychiatric Research) in Munich from 1917 to 1945).

The Deutsche Forschungsanstalt fur Psychiatrie (DFA) in Munich, one of the most important research institutes in the field of theoretical and clinical psychiatry, was founded in 1917 by Emil Kraepelin. Its financial existence between the world wars was assured by generous donations from the Jewish American scholar and philanthropist James Loeb. The scientific work done by Walther Spielmeyer (neuropathology), Felix Plaut (serology), Kurt Schneider (clinical psychiatry) and Ernst Rudin (psychiatric genetics) earned the DFA a reputation as an international center for psychiatry and neurology. During the 'Third Reich' Ernst Rudin cooperated with the National Socialist health system. His genetic concepts provided support for eugenic programmes such as forced sterilization of individuals with psychoses. These complex interactions underscore the importance of the DFA in understanding the recent history of medicine in Germany.

Academies and Institutes↗
PubMed2005

The 1942 'euthanasia' debate in the American Journal of Psychiatry.

This paper discusses and analyses three articles appearing in a 1942 issue of the American Journal of Psychiatry. In the first, neurologist Foster Kennedy argued that 'feebleminded' people should be killed (an act which he referred to as 'euthanasia'). The rebuttal was written by psychiatrist Leo Kanner, who argued against 'euthanasia'. An unsigned editorial discussing these positions clearly sided with Kennedy: that 'euthanasia' would be appropriate in some cases, and that parents' opposition to this procedure should be the subject of psychiatric concern. The arguments are analysed and discussed within the context of eugenics and the murder of mental patients in Germany. Finally, the author points out that currently ascendant genetic theories in psychiatry could be a precursor for future proposals similar to Kennedy's.

Adult↗
PubMed2000

Genetic enhancement technologies and the new society.

So long as procreation continues to remain a central driving force in a marital relationship, and the family the very core of progressive society, efforts will be undertaken to expand the period of fecundity and combat infertility. Genetic planning and eugenic programming are more rational and humane alternatives to population regulation than death by famine and war. Genetic enhancement technologies and the scientific research undertaken to advance them should be viewed as not only aiding (or, sometimes resolving) the tragedy of infertility in family planning, but as a tool for enhancing the health of a Nation's citizens by engineering man's genetic weaknesses out of the line of inheritance. Put simply, healthier and genetically sound individuals have a much better opportunity for pursuing and achieving the "good life" and making a significant contribution to society's greater well being.

Eugenics↗
PubMed2003

Selection assisted by a BoLA-DR/DQ haplotype against susceptibility to bovine dermatophilosis.

Bovine dermatophilosis is a severe skin infection of tropical ruminants inducing a severe loss in productivity and a 15% mortality rate. This disease is caused by the actinomycete bacterium Dermatophilus congolensis associated with the tick Amblyomma variegatum. Currently there are no prospects for a vaccine, and acaricide or antibiotic control is hampered by the development of chemoresistance. Animal breeders have observed that dermatophilosis susceptibility seems to be determined genetically, and we previously identified a BoLA-DRB3-DQB class II haplotype marker for high (R2= 0.96) susceptibility to the disease. With this marker, we developed a successful eugenic selection procedure for zebu Brahman cattle in Martinique (FWI). Over a period of five years, a marked reduction in disease prevalence, from 0.76 to 0.02 was achieved, and this low level has been maintained over the last two years. The selection procedure, based on a genetic marker system targeting the highly polymorphic BoLA locus, eliminates only those individuals which are at the highest risk of contracting the disease. In the present work, we discuss the properties of this system, including the "heterozygote advantage" and the "frequency dependence" theories, and examine their involvement in the biological mechanisms at the host/pathogen interface. We speculate on the exact role of the MHC molecules in the control of the disease, how the natural selection pressure imposed by the pathogens selectively maintains MHC diversity, and how our results can be practically applied for integrated control of dermatophilosis in developing countries.

Actinomycetales Infections↗
PubMed2006

Human dignity in the Nazi era: implications for contemporary bioethics.

BACKGROUND: The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. DISCUSSION: Social Darwinism was foremost amongst the philosophies impacting views of human dignity in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans.A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. SUMMARY: Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread acceptance today would similarly lead to much human death and suffering. A different ethic is needed which views human dignity as inherent to all human individuals.

Animal Rights↗
PubMed2004

A duty to kill? A duty to die? Rethinking the euthanasia controversy of 1906.

This essay seeks to chronicle the controversy surrounding euthanasia that came to a head in the United States around 1906, and to situate that debate in a meaningful historical context. An extensive examination of newspaper coverage of the legislative proposals to legalize the practice in Ohio and Iowa reveals that (1) the discourse occurred in a context in which both supporters and opponents of euthanasia generally agreed that the practice already occurred with frequency; (2) the discussion was heavily influenced by a simultaneous controversy surrounding eugenics; and (3) most of the opponents of legalization relied upon practical rather than religious or moral arguments to further their cause.

Eugenics↗
PubMed2005

The hefty penalty on marriage facing many households with children.

Over the past seventy years Congress has enacted dozens of tax and transfer programs, giving little if any attention to the marriage subsidies and penalties that they inadvertently impose. Although the programs affect both rich and poor Americans, the penalties fall most heavily on low- or moderate-income households with children. In this article, Adam Carasso and Eugene Steuerle review important penalties and subsidies, explain how they work, and help fill a big research gap by beginning to provide comprehensive data on the size of the penalties and subsidies arising from all public programs considered together. Marriage penalties arise because of the combination of variable U.S. tax rates and joint, rather than individual, filing by married couples for benefits and taxes. If graduated taxes were accompanied by individual filing or if all income and transfers were taxed at a flat rate, there would be no marriage penalties. Specifically, the penalties are a result of policymakers' efforts to achieve the goal of progressivity--giving greater tax and welfare benefits to those with lower income--while trying to keep down program costs. Thus benefits in transfer programs fall, sometimes steeply, as households earn more income. Combining the direct tax rate in the tax code and the benefit reduction rates in the transfer system can result in extremely high effective marginal tax rates for many low- to moderate-income families-rates far higher than those of families earning over 90,000 dollars. These high rates lead to the marriage penalties because additional income brought into a household by marriage thus causes other benefits to be reduced or lost altogether. In extreme cases, households can lose a dollar or more for every dollar earned. In recent years lawmakers have begun to try to reduce marriage penalties, primarily by reforming welfare and cutting taxes, but huge penalties remain. The authors offer several options for reducing or eliminating the marriage penalty and recommend two in particular. The first is to set a maximum marginal tax rate for lower-income individuals, similar to the maximum rate set for highest-income individuals. The second is to provide individual wage subsidies to lower-income earners, so that such workers who marry can combine their income with that of their spouse without incurring penalties.

Adult↗
PubMed1993

Bioethics and anti-bioethics in light of Nazi medicine: what must we remember?

Only recently have historians explored in depth the role of the medical profession in Nazi Germany. Several recent works reveal that physicians joined the Nazi party in disproportionate numbers and lent both their efforts and their authority to Nazi eugenic and racist programs. While the crimes of the physician Mengele and a few others are well known, recent research points to a much broader involvement by the profession, even in its everyday clinical work. Analogous activities existed in the German legal and industrial communities; disruption of the medical ethic thus sprang from the broader social contexts of Nazi Germany. The new United States Holocaust Memorial Museum, now opening on the Mall in Washington, D.C., will have an opportunity to educate the public about both the great crimes at Auschwitz and other camps, and the gradual but thorough degradation of ethics in the German medical profession. From this presentation, contemporary bioethics can ponder the proper use of the Nazi analogy in bioethical debate.

Attitude of Health Personnel↗
PubMed1997

Ethical issues in cochlear implant surgery: an exploration into disease, disability, and the best interests of the child.

This paper examines ethical issues related to medical practices with children and adults who are members of a linguistic and cultural minority known as the DEAF-WORLD. Members of that culture characteristically have hearing parents and are treated by hearing professionals whose values, particularly concerning language, speech, and hearing, are typically quite different from their own. That disparity has long fueled a debate on several ethical issues, most recently the merits of cochlear implant surgery for DEAF children. We explore whether that surgery would be ethical if implants could deliver close to normal hearing for most implanted children, thereby diminishing the ranks of the DEAF-WORLD. The ethical implications of eugenic practices with the DEAF are explored, as are ethical quandaries in parental surrogacy for DEAF children, and their parallels in transracial adoption.

Adoption↗
PubMed2003

Ethical issues raised by genetic testing with oligonucleotide microarrays.

Because genes and alterations within them determine the identity, characteristics, and inheritance of every individual, the application of genetic science to humans has long been surrounded by apprehension, controversy, and real or perceived potential for abuse. Crude eugenics practices of the past now find a theoretical rebirth and transformation through the use of modern molecular genetic technologies for mutation detection, predictive and prenatal diagnosis, and, ultimately, gene replacement. The advent of oligonucleotide microarray analysis, in which hundreds or thousands of genes and mutations can be tested in parallel, offers tremendous promise for more accurate, sensitive, and efficient genetic testing. At the same time, however, this powerful technology dramatically increases the number and scope of ethical concerns accompanying each individual test request. This article considers the evolution and implications of these concerns, from the initial ordering of a microarray test by the physician to such issues as informed consent, privacy, confidentiality, clinical utility, discrimination, stigmatization, ethnic and population impact, and reimbursement.

Confidentiality↗
PubMed1997

[From race to health in Master and slave].

The article analyzes how Gilberto Freyre addresses health-related issues in his book Master and slave. the first point of focus is how the sanitation movement that emerged in the sertão region in the late 1910s influenced Freyre's essay. The article next endeavors to understand the relation between Freyre's emphasis on the problem of syphilis in Brazil and the issues of race and miscegenation, both of which are constants in his works. Lastly, the article endeavors to situate Freyre's ideas within the ideological framework of eugenics that was in fashion in Brazil at the time his works were written.

Brazil↗
PubMed2005

Sterilized in the name of public health: race, immigration, and reproductive control in modern California.

In exploring the history of involuntary sterilization in California, I connect the approximately 20,000 operations performed on patients in state institutions between 1909 and 1979 to the federally funded procedures carried out at a Los Angeles County hospital in the early 1970s. Highlighting the confluence of factors that facilitated widespread sterilization abuse in the early 1970s, I trace prosterilization arguments predicated on the protection of public health. This historical overview raises important questions about the legacy of eugenics in contemporary California and relates the past to recent developments in health care delivery and genetic screening.

California↗
PubMed2003

On the relation between moral, legal and evaluative justifications of pre-implantation genetic diagnosis (PGD).

In Germany the question whether to uphold or repeal the judicial prohibition on Pre-implantation Genetic Diagnosis (PGD) is being debated from quite different standpoints. This paper differentiates the major arguments according to their reasons as a) moral, b) evaluative (i.e. cultural/religious), and c) legal. The arguments for and against PGD can be divided by content into three groups: arguments relating to the status of the embryo, focusing on individual actions in the implementation of PGD, and relating to the foreseeable or probable consequences of PGD. In Germany, from a legal perspective, the status of the embryo does not permit the intervention of PGD; from a purely moral perspective, a prohibition on PGD does not appear defensible. It remains an open question, however, whether the moral argument permitting PGD should be restricted for evaluative (cultural) reasons. The paper discusses the species-ethical reasons, for which Jurgen Habermas sees worrisome consequences in the wake of PGD to the extent that we comprehend it as the forerunner of a 'positive eugenics'. It would so disrupt the natural preconditions of our universal morality. The question of whether to prohibit or allow PGD is not merely a question of simple moral and/or legal arguments, but demands a choice between evaluative, moral and (still to be specified) species-ethical arguments, and the question remains open.

Embryo, Mammalian↗
PubMed2005

The seduction of science to perfect an imperfect race.

The author reflects on the lessons of the Holocaust Memorial Museum's exhibition "Deadly Medicine: Creating the Master Race." The exhibition is about problems universal to science and medicine. Eugenics was not a crazed Hitlerian fantasy, and eugenicists were within the scientific mainstream. To the extent that American science pursues an openness and transparency that was absent from Nazi science, it may insulate itself from ethical dangers. But "Deadly Medicine" diagnoses patterns of thought that persist in science and social thinking. The exhibition reminds us that when faced with fears and anxieties similar to those that led to Auschwitz, we have scientific, historical, legal, and social precedents that can turn us toward an ethical confusion and uncertainty that is healthier than the certainty with which Nazi science proceeded down its grisly road.

Bioethics↗
PubMed1985

Genetic screening of prospective parents and of workers: some scientific and social issues.

Genetic screening programs are based on assumptions and values that reflect the history of racial and social eugenics in the United States and Europe. They stigmatize individuals by shifting the focus from social, economic, and political decisions that affect the health of prospective parents, newborns, and workers to "bad genes," that is, intrapersonal factors that are given the status of "causes" of disease. Prenatal screening, at best, can help the relatively few individuals who know that their future children are at risk for a particular inherited disease or disability; it has little positive value for the average person. Workplace genetic screening has not been shown to reduce occupational disease, but it has led to employment discrimination and has drawn attention away from controlling exposures to toxic chemicals in the workplace.

Amniocentesis↗
PubMed2005

Medical selection and the debate over mass immigration in the new state of Israel (1948-1951).

This paper examines the discourse regarding medical selection of immigrants to Israel during the years 1948-51, which was a period of mass immigration in which approximately 700,000 people immigrated to the State, thereby doubling the Jewish population in only three years. The paper focuses on the debate the preceded the Israeli Government's eventual acceptance of a selection policy. We assert that the debate was shaped to a large extent by a combination of Zionist ideology and eugenic influences - two intellectual forces that had interacted well before the creation of the Israeli State in the first half of the 20th century.

Emigration and Immigration↗