Confronting eugenics: Does the now discredited practice have relevance to today's technology?

One hundred years ago, Eddie Millard was sentenced to the Indiana Reformatory in Jeffersonville after being convicted of petty larceny. He soon met with the prison's chief physician, Harry C. Sharp, MD.

"After a great many questions," Millard later wrote, Dr. Sharp told the prisoner, "I think we shall cut your cords."

Millard refused the procedure and physically resisted the doctor in the operating room, but to no avail. He was sterilized against his will. And it was perfectly legal because earlier that year Indiana, had enacted the world's first eugenic sterilization law.

The law authorized physicians to sterilize "confirmed criminals, idiots, rapists and imbeciles" in state custody for whom "procreation is inadvisable."

Between 1907 and 1974, about 2,400 Hoosiers were sterilized without their consent. About 64,000 Americans were forcibly sterilized during the period, as 31 states followed Indiana's lead. Today, 10 states still have eugenic sterilizations laws on the books, although they are not used.

To mark the law's sordid centennial, historians, physicians and ethicists gathered at the Indiana State Library in April for a daylong symposium to discuss eugenics' history and to ponder its future. As foreign as Dr. Sharp's actions may seem to physicians a century later -- unmoored from solid science and sound ethics -- experts debate whether eugenics is merely a relic of the past or is relevant today in the wake of new medical technologies.

A marked reminder

The symposium was accompanied by the opening of a two-floor eugenics exhibit that runs through August at the state library. Also, a historical marker was unveiled to commemorate the law's passage, making Indiana the seventh state since 2002 to officially note its eugenics past in some way.

The marker now sits across the street from the Indiana State Capitol Building where politicians voted for the 1907 measure based on a widely shared understanding of the dominant role of heredity in criminality, mental retardation and mental illness.

"Indiana took pride in passing the first sterilization law," said Daniel J. Kevles, PhD, author of In the Name of Eugenics. "It was understood as a progressive social piece of legislation and also a hallmark of the use of science."

Dr. Sharp, who helped refine the vasectomy procedure, sterilized about 225 prisoners before the law even passed, according to a historical summary of Hoosier state eugenics written by Alexandra Minna Stern, PhD, also the author of Eugenic Nation.

At first, Dr. Sharp viewed vasectomy as a therapeutic measure that could reduce masturbation among the inmates. Later, he came to share the view of John N. Hurty, MD, then secretary of the Indiana State Board of Health and a leading proponent of eugenic sterilization.

"All social problems," Dr. Hurty said at the time, "which we have assiduously tried to solve by education, care, cure and relief, are fast becoming recognized to be biological problems."

Dr. Sharp sterilized about another 230 prisoners, including Eddie Millard, after the law passed but before Gov. Thomas R. Marshall suspended it in 1909 due to concerns about its constitutionality. In 1921, the Indiana Supreme Court overturned the 1907 law.

But Indiana's eugenicists did not give up. In 1915, they won funding for a Committee on Mental Defectives to study the supposed epidemic and propose solutions. While eugenicists around the country targeted immigrants from Eastern Europe, Mexico and China, the Indiana committee focused on whites in the state's poverty-stricken rural areas.

Over the next 10 years, committee workers roamed the state's country roads and riverbeds in search of criminals, poor people, people with epilepsy, the mentally ill and the mentally retarded. They catalogued them in extensive family pedigree charts purporting to track inheritable traits such as "wanderlust" and "thievery."

The committee estimated that 2.1% of Hoosiers were mentally defective, though none of its official reports called for sterilization.

Meanwhile, eugenics proceeded on another front in the guise of Indiana's Better Babies contests. The contests, administered by the Indiana Division of Infant and Child Hygiene's Ada E. Schweitzer, MD, ran from 1920-1935 and tapped into Hoosiers' understanding of the importance of breeding livestock. Just as a hog could win a blue ribbon at the state fair, so could a baby.

The babies, 12 to 36 months old, were run through a battery of mental and physical tests and judged on their physical appearance. While there were no ill consequences for babies who did not measure up, winners received medals.

"The better babies contests always cause a chuckle," said Dr. Stern, the historian. "But they are based on an ugly underlying idea. The blond-haired, Nordic-looking, symmetrically proportioned babies ... were favored. They were segregated, whites-only contests."

While much of what Dr. Schweitzer advocated would be seen today as proper infant care, she believed that only so much could be done after the child was born and that eugenic measures were necessary.

"It is certainly true that we cannot make a silk purse out of a sow's ear," she wrote. "Neither can we make a citizen out of an idiot or any person who is not well born."

In 1927 Indiana passed another eugenic sterilization law, which included some due process protections such as the right to appeal sterilization orders all the way to the Indiana Supreme Court. That law withstood challenge because in the same year the U.S. Supreme Court, in Buck v. Bell, found a similar Virginia statute constitutional.

"Three generations of imbeciles are enough," Justice Oliver Wendell Holmes famously wrote in his opinion for the 8-1 majority.

While a number of American Medical Association presidents during the first third of the 20th century also were affiliated with the eugenics movement, the AMA appears never to have adopted policy on the matter, according to a search of AMA archives. In 1928, the AMA agreed to study the matter, and a 1936 report found that "our present knowledge regarding human heredity is so limited that there appears to be very little scientific basis to justify limitation of conception for eugenic reasons."

What's in a name?

While a National Institutes of Health-funded research project on the history of eugenics in Indiana continues, any historical discussion of eugenics inevitably turns to current events, as experts debate whether the term can be applied to today's social practices or medical interventions.

Critics of ova sales, preimplantation genetic diagnosis and prenatal screening, for example, have called those voluntary practices eugenics.

"The experience of the 20th century shows that eugenics is a very powerful temptation," said Robert P. George, PhD, a Princeton law professor and a member of the President's Council on Bioethics, who did not attend the symposium. "The idea that we can have the offspring we want, designed to our specifications, is very tempting. That's why people are willing to pay thousands of dollars to female students at places like Princeton to contribute ova" for in vitro fertilization.

But others at the symposium were wary about using the term so loosely. Eugenics is a "historically-bounded concept," said Eric M. Meslin, PhD, director of the Indiana University Center for Bioethics. "The term itself should be reserved for state-sponsored programs" that are coercive, he said. "We should not let the rest of medicine off the hook. There are many profound moral issues society should address, but we shouldn't do it within the context of the eugenics discussion."

Peter Marcus, MD, associate professor of obstetrics and gynecology at the Indiana University School of Medicine, agrees that if eugenics is defined as only including coercive actions, then it is not happening in the U.S. today.

But under a broader definition, one he holds, eugenics is still with us on a "subconscious level."

"If you can make it socially unpalatable to have a Down syndrome child, then maybe that's a kind of eugenics," said Dr. Marcus, who teaches history of medicine. "Eugenics still exists in that sense and could even be more dangerous because now it's wrapped up in the package of, 'It's my personal right.' "

Edward R.B. McCabe, MD, PhD, professor of pediatrics and human genetics at the University of California, Los Angeles, David Geffen School of Medicine, said much talk about so-called designer babies is based on the kind of simplistic determinism that drove the 20th-century eugenics movement. "The belief that we can sequence a person's genome and know that person's future is incredibly naive," he said.

One important brake on a resurgence of eugenics, experts agreed, is physicians' insistence on putting the welfare of individual patients before society's interests.

"The ethical grounding of the medical profession is in treating disease and caring for people, not caring, as the Nazis did, for the state or the larger collective," said Paul A. Lombardo, PhD, author of the forthcoming Three Generations, No Imbeciles: Eugenics, the Supreme Court and Buck v. Bell. "Social engineering is not the province of medicine."