Giulia Cavaliere is a PhD in Bioethics & Society at the Department of Global Health & Social Medicine at King’s College London. Her Wellcome Trust sponsored project is titled “Preimplantation genetic diagnosis and eugenics: a social moral epistemology approach”
Before joining King’s College London she completed a joint MSc in Bioethics (funded by the Erasmus Mundus Master of Bioethics Programme) at KU Leuven (Belgium), Radboud University Nijmegen (The Netherlands) and University of Padova (Italy). She also holds a MA in Philosophy, Ethics and Politics from the University of Trento (Italy) and a BA in Philosophy from Bologna University (Italy).
Giulia’s overarching research interests include philosophical and sociological approaches to bioethics. She is particularly interested in the intersection between moral and social questions surrounding reproductive genetic technologies and the history of eugenics.
Hello, I am Nigel Warburton. Joining me today is Giulia Cavaliere, a Wellcome Trust sponsored PhD student at the Department of Global Health & Social Medicine. The topic we’re going to focus on today is eugenics and reproductive technologies. Let’s start with eugenics. What does that mean?
Eugenics etymologically means “good birth”, but it is normally connected to Nazism or at least when people hear the word eugenics they always think about Nazism and Nazi eugenics. So even if it’s just a word that means good birth it is usually understood as a really bad word.
But eugenics has got a longer history than the history of Nazism surely…
Yes, and that’s exactly one of the reasons why I am interested in the history of eugenics. Because Nazi eugenics was just one particular type of eugenics, but actually eugenic practices were much more spread around Europe, in the US and even in South America. And they were advocated by different kinds of people, so not only Nazi interested in race, but also people that were concern with the development of the population and of evolution.
But it also occurs in animal breeding generally, in breeding of plants there is a sense in which human beings have tried to control how biological organisms turn out. And one of the effective way to do is thinking about who gets to breed and who doesn’t
I think that the problem is when we go from plants and animals to human beings and this is a phenomenon that we also witness in other fields: as long as we do experiments and plants and animals, that’s considered as something expectable or inevitable. Whereas when we go from plants and animals to humans, people are concern that we either go back to the Nazi type of eugenics or that actually what we’re doing is exactly eugenics
But surely by selecting a mate, as a human being, you engage, if you then have offspring, in a kind of eugenics: you choose somebody who you like the look of, who maybe as blue eyes if you like blue eyes, who maybe has blond hair if you like blond hair. You know these things increase the likelihood that you’re offspring are going to turn out to be like that person.
I think that it’s a mixture of willing to protect humans so like considering humans as having a special status and also a sort of worry of introducing a technological spin to the kind of eugenics that you’re talking about. So even if people are ok with or is considered acceptable to look for a husband or for a wife that has blue eyes having in the back of your mind that your child might have blue eyes, when scientists do the same technically then people start to be worried.
So, could you give an example of a technology where the issue of eugenics has come out recently?
One of the most targeted technologies by the charge of eugenics is preimplantation genetic diagnosis, which is a sort of technology that allows embryos created with IVF to be tested for genetic diseases. The critique is that by screening embryos and selecting only the “best ones” to implant in utero, this equals to a sort of eugenics.
Just to get clear, what are we screening out here?
Normally, PGD is used to screen embryos to check whether they have any genetic disease. And the most commonly tested are monogenic diseases. Diseases that are caused by a mutation in one gene and are therefore quite easy to screen for. These diseases are for example Huntington Disease, one type of Alzheimer’s Disease or cystic fibrosis
So in this case you identify the gene that is the likely cause of a disease and you eliminate the embryo which carries that gene.
Exactly, so you discard the embryo, or that’s what people say: you discard the embryo, which carries the disease and you would transfer in utero only the ones that are free from the disease or at least that have a decreased risk to develop the disease.
So strictly speaking that is a kind of eugenics. There’s no problem. That is eugenics.
Most people think that this is eugenics. But the problem is not thinking that this could be a form of eugenics, but it’s in throwing the baby out with the bath water and saying that if a technology is eugenics we should not use it anymore.
But let’s get clear on what that critique is about. Is that it is wrong because is playing god for instance. That as a scientist you can decide which embryos will live?
Exactly, so this is one of the concerns. One of the concerns is that you are going to create a new breed of humans and also creating some disparities between people that are selected and have no diseases, and have maybe some superior characteristics and another group of people or another class of people that would grow up without being technologically modified. And another concern is that these technologies would create an increased stigmatization against the people that are not technologically modified or that are currently living with disabilities. So activists in the disability rights movements are arguing that if you select people without deafness, people that are actually deaf will be stigmatized more than they are already at the moment.
But that may be so. It may be true that this is a consequence of this.
Yes, that might happen and this is where I think the state should intervene. So for example the state should regulate the use of these technologies. And for example some uses of PGD are really worth pursuing whereas others might be just a waste of public money.
Isn’t there an assumption here that genetic is everything? That the environment doesn’t have a part to play?
Yes, this is exactly the assumption that is made. And what happens is that social context and environmental influence such as epigenetics (i.e. the influence of the environment on our genes) is considered to have a minor impact.
It seems to me fairly obvious that if I had an identical twin brought up in poverty, had a traumatic childhood, was beaten up, that person would turn out quite different from me despite having genetic identity.
Yes, this is one of the reasons why scientists are conducting twin studies: to understand the influence of the environment. Since the beginning of the Human Genome Project genetic is seen as something that defines our characteristics and there is much less research on environmental influence and much less media attention. So for example people are brought into believe that the environment has a minor influence on how we grow up.
The charge that a particular activity is a form of eugenics is sometimes used simply to close down debate. So it’s a rhetorical device. If you can show that something is eugenics that is treated as if it was sufficient to stop all research and to show that it is morally wrong. What do you think about that way of arguing?
Eugenics is always used as a conversation stopper and it was defined in the past as a ‘club’ and it says that no right-minded person could possibly defend eugenics because it’s such a bad practice. But instead eugenics has such an emotional power and such a bad reputation that I think that people should be very careful in using it because it influences people thinking. It says that these technologies are actually bad. So the argument they make is that PGD (preimplantation genetic diagnosis) is similar to eugenics, eugenics was bad, therefore PGD is something bad. But I think that this doesn’t tell the whole story about a technology.
But let’s tease out why it might be bad in think context where somebody describes it as eugenics. Is it that it is the first towards the kind of eugenics that Hitler engaged in? is that the argument?
Yes, this is exactly the argument that is made. So that we would start with genetic diseases and try to select embryos that are more likely to have a healthy life and then we go to selecting people with blue eyes and blond hair and creating a master race.
So this is a slippery slope argument. The idea that if you take one step down the slope, inevitably you are going to end up at the bottom
Yes, exactly. So this is what most of the people think. And I find it problematic because it distracts people’s attention to the benefits and also to the actual risks of these technologies. And it project us into a sort of dystopian scenario in which we’re going to end up where the Nazi were.
Philosophically, slippery slope arguments have quite a bad reputation because it’s a style of not thinking, really. You just make an assumption that little steps in one direction will inevitably lead to a certain conclusion. But the truth is that you have to explain why each little step will be taken. So there is no inevitability about lots of so called slippery slopes. Just as if you were a good skier there is no inevitability that getting on a slippery slope you cannot stop when you want to.
Yes, this is precisely why I think slippery slope arguments are problematic in general, but in this particular field they are even more problematic. Because the arguments put in brackets the actual aims of the parents of for instance wanting to have a healthy child and the desire of a healthy child is compromised in a way. In the sense that it doesn’t get enough attention, when the focus is on sliding down a slippery slope. And I think that we should rather build steps into slipper slopes and this is where the state should interfere into reproduction with regulations.
Your argument is that things that other people describe as eugenics, well they are eugenics, but we should avoid that word because it clouds people’s judgment in the area. But also we should recognize that it would in principle take these steps one by one and end up somewhere bad, so we need external regulation by the state, perhaps internationally, to prevent those steps going all the way to the bottom.
Yes, this could be a strategy to avoid sliding down a bad kind of eugenics and another is ethical argumentation that goes beyond calling something eugenics, but rather saying something: let’s discuss and let’s make an ethical assessment of these technologies. An ethical assessment that is done by for instance including the lived stories of the parents, of the scientists who develop these technologies and trying to build on that the regulations. And not as you said let what happened in the past cloud our judgement.
It seems to me that there is a real disanalogy between selecting a so-called healthy embryo as opposed to a diseased-embryo and imposing a state policy of doing it. So if you’re talking about individual parents making choices about the kind of baby they ought to have as opposed to Hitler making judgements about the kind of race that he thinks should be allowed to thrive. That’s quite a different activity.
It is very different. So now the focus is a lot on the individual and on state neutrality about reproductive decisions. To be honest, though, some scholars argue that we could have a eugenics coming back from the “backdoor”. A backdoor made by people freely choosing as individuals to have a healthy child. And these choices, taken together, could have the same effects that eugenics had. And I think that there is some room for state interference there. To control the potential consequences of that. For examples by allowing the use of the technologies only for some diseases and not for others, for diseased embryos and not just choosing some traits, so-called “cosmetic” traits of the embryo.
Most people, perhaps almost everybody, think that it’s great to eliminate smallpox or great to eliminate malaria if we possibly can. Why does it matter that a similar activity is done by means of genetic manipulation as opposed to inoculation or vaccination or by the destruction of mosquitoes’ habitats?
Vaccinations or other medical interventions are a very good comparison for this. Because there is a lot of faith in genetics, but there are also a lot of biases against genetics. When genetics is linked to human reproduction, people fear that we actually start to control our evolution and influence the sort of people that we’ll be having in the future. Whereas other medical interventions are focused on living individuals and not future general population.
But surely by eliminating a disease we influence human evolution not just that particular organism or whatever that have given you disease, because we eliminate it, but also we allow people who would not have otherwise survived because they are vulnerable to this particular form of a disease to live longer and to procreate. So potentially that impact on evolution too.
Yes, in a sense this is true. Many medical interventions and other interventions as for instance public health policies or environmental policies have an inevitable impact on future generation. And also if you think about it, just giving birth to a new person influences that person even without any technology involved. But there is a presumption against genetics because people are actually fearing that going from natural to technical intervention the consequences would be much worse. And I see in that a fear of past eugenics that comes up all the time in the debate on genetics. So in a way eugenics casts a shadow on any genetics intervention.
But isn’t there a sense in which technologies developed in order perhaps to minimize the risk of diseases being inherited could be used perniciously to create some kind of master race, to enhance certain features. It’s the same kind of technology involved, so there’s a genuine fear there.
That’s entirely true. So that’s why no technology is by itself completely risk-free and completely immoral or moral. So if you think for example about nuclear energy, which is a really common example, it could be used for a different range of very useful things for the population, but it could be also used to build bombs, nuclear bombs. This is something similar to what I am arguing here for pre-implantation genetic diagnosis. The technology is in itself neutral but the uses that people choose to do could be very bad from a moral perspective or good and benefits prospective parents.
Would it be fair to say that there is a rhetoric in this area, the rhetoric of eugenics that closes down thought and we ought to be sensitive to that pattern of thought which I think quite a few of us are vulnerable to the idea that if this leads in the direction of eugenics it must be a bad thing. Whereas slower thinking, more reasonable assessment of particular cases could lead to an awareness of the difference between practices that develop from new technologies and the kind of things that Hitler implemented.
Yes, that’s precisely what I am arguing here and what I think it’s important to keep in mind when we talk about new technologies and especially genetic technologies, due to the history. And I think it’s really important to learn from this history in order not to make the same mistakes. But also to make sure that history doesn’t stop every future action because we are too scared of what happened in the past.
Giulia Cavaliere, thank you very much.
Thank you, Nigel.