- Luzitano B. Ferreira1 & Henry P. Novion21Pos-Graduate Program, University of Sčo Paulo, Brazil.
2Department of Genetics and Morphology, University of Brasília, BrazilEubios Journal of Asian and International Bioethics 13 (2003), 206-7.
Social Darwinism and Human ResearchSocial Darwinism can be defined as an attempt to apply the principles of biological evolution to social theories and to the moral codes of society. The fundamental principle of this thought is that human beings must follow the behavior patterns that occur in nature where the "fight for survival" prevails. The equivocal utilization of the evolutionary theory to society gave "scientific and ethic sustentation" to certain practices like racism and authoritarianism. It gave strength to the idea of biologically superior and inferior human races, trying to justify the segregation, exploration and discriminatory application of ethical principles to human beings. The application of inferior ethical principles to the less favored social classes is extremely antique, as well as the attempt to justify it. Under the influence of social Darwinism, this practice was broadly utilized and justified in several areas, including the medical sciences. This theory had great support in the United States and Europe in the beginning of the twentieth century, more because of its political application than for its scientific side. It was a failing attempt to scientifically justify the social competition, class stratification and imperialism (1). To the social Darwinists, there would be not only the "fight for survival" individually, but also among ethnic groups and even among nations, which was not only natural but healthy, for the competition and war were ways by which the biologically capable groups would eliminate the less qualified, thus improving humanity. There was the belief in the evolution of populations and that the transformations would be the passage to a superior stage. The "white race" was superior to the others because of the "success" of the occidental civilization (2). Ethnic mixture, considered extremely hazardous, was strongly discouraged (3). The same way of mixed races, the African, Amerindian and Asiatic societies were considered to be delayed, primitive and biologically inferior when compared to the European. The idea of the "survival of the fitness" was also used to explain the difference between rich and poor, fortifying the theories of racial and class superiority. To the social Darwinists, efforts to improve the conditions of poor people were considered frivolous, nonsense and a dangerous interference with natural processes and laws (4). In accordance with these theories, the rich people had this condition because they were stronger and managed to "fight for survival". The idea of biologically determined and naturally selected superior and inferior human beings, as well as the belief that intelligence, criminality and other characteristics were genetically determined and could not be changed with the environment favored the flourishing of the eugenic movement (5). It can be considered that the modern Eugenia arose in the end of the nineteenth century and in the beginning of the twentieth century. This movement that intended to "improve" the quality of the populations had great acceptance in the United States, England and Germany. In the United States, the Restriction Act to Immigration, instituted at 1924 made the immigrants from Eastern Europe, considered genetically inferior, to be forbidden to get into the country, with the justification of protection to the politics, culture and biological characteristics of Americans (6). In 1931, there were laws of voluntary and involuntary sterilization in 27 American states for people considered insane, idiot, epileptics, criminal and "morally perverted" (7). Some of these laws were struck off the books for being unconstitutionals. Programs based on concepts of Eugenia influenced nations like Canada, Norway, Finland, France and Japan. In Sweden, between the decades of 1930 and 1970, with the purpose of diminishing the number of births of children with genetic disorders, thousands of people were sterilized, mostly women (8). Eugenic ideas flourished also in developing countries. Brazilians geneticists inclined to Eugenia defended the classification of some races as hereditarily superior, whereas others were considered inferior and had no value to the society (9).
This movement had its peak and showed the greatest atrocities in Germany. Efforts were made to apply the principles of natural selection to human populations on the basis of the idea that racial integrity was threatened because medical care had begun to destroy the natural struggle for existence and the numbers of poor persons and misfits were threatening to overwhelm the talented and able (10). During the Second Great World War, Nazi physicians and scientists participated actively of experiments without any ethical commitment. Prisoners from the concentration camps were exposed to several experiments that tested the limits of human beings to mustard gas, extreme coldness, great heights and elevated pressures (11). The Nazi physicians that had as their basis Eugenia and social Darwinism, for the most part were not coerced, but carried out an action with which they sympathized politically (12).The application in the medical sciences of a theory with such negative aspects like social Darwinism does not belong only to the past. It still survives in some contexts, like in the belief that the survival of people with chronic diseases could diminish the level of health of human beings preserving less capable people, when economists defend a competitive market for health system reforms (13) or the belief that the increase of poor people with less education could diminish the intelligence level of the species. Another subtle way of this theory that emerged during the last years is that one found in some scientific researches with the acquired human immunodeficiency syndrome in developing countries.
The publication of an article in The New England Journal of Medicine, was the initial point for the discussion of the distinct medical treatment for human beings in accordance to their social-economic condition. Lurie and Wolfe (14) denounced the performance of 15 researches without ethic, in developing countries like Uganda, Ethiopia, Zimbabwe and South Africa, where patients received inadequate treatment or no treatment at all.Cases like these and others reported in developing countries were compared with one of the most known episodes of researches without ethics with human beings, the Tuskegee case. This occurred during 40 years, between 1932 and 1972, when even after the knowledge that the penicillin was effective against syphilis, 412 Afro-Americans were not treated to determine the natural history of the disease. The defenders of the researches with HIV in developing countries argue that exist several ethical principles applied in all the cases of researches with human beings, but the interpretation and application of these principles should be inherent to cultural, social and economical situations (15). Nevertheless, medicine should have responsibilities about the vulnerable ones and the objectives of a research should always be secondary to the welfare of the subjects, particularly when the researches are conducted in developing countries (16), where the subjects are in conditions of extreme vulnerability. The attempt to apply inferior ethical patterns to subjects of developing countries is exactly the other side of what should be expected, where the more vulnerable people should be the ones to receive more caring. The pandemic caused by AIDS and its repercussions, especially in developing countries are well known. Only in the year of 2000, there was an increase of 5.3 million people infected with the HIV and more than 20 million HIV-positives do not have access to the medications (17). In some developing countries, the number of people infected and the deaths because of this disease are alarming. It is evident that there are great differences in relation to the access, utilization of services and technology between developed and developing nations. It also seems clear that these absurd differences are far away of being solved. Nevertheless, according to Lie (18), recognizing that there could be limitations to what could be done in the sense of improving the social conditions is entirely different from giving an inferior treatment when we could do it in a different way. At times where economic rationalism and the capitalism are dominant, the researches are more inclined to economy than to ethical principles (19). Possibly because of these aspects, years before the publication of the article that gave origin to this discussion about distinct ethical treatment to human beings in accordance to their social-economical conditions, Angell (20), talking about the possibility of an ethical imperialism, called attention for the fact that the researched subjects should have some fundamental rights and that if we accepted that the ethic in research is relative, there could be created situations where the populations of the third world were utilized in researches considered unethical in developed countries. The prediction seems to have come true. Ethical imperialism in the attempt to deny the equality of research subjects, created distinct categories of subjects, or "under subjects" (21), that remember ideas to the social Darwinism. The "scientific" utilization to do a hierarchy and justify the application of distinct ethical patterns to human beings always existed. To justify slavery, the African descendants were considered biologically inferior, based upon "scientific" evidences that proposed that moral characteristics, intellectual capacity and social differences between "white" and "black" were inherited. During the colonization of the United States, the native Americans were considered lazy, not civilized, savages and with no possibility of changing, to justify the explorations of their lands (22). Evidently, there were great differences between the researches developed with minorities in the Nazi concentration camps and African descendants in Tuskegee or the ones performed nowadays in developing countries. Nevertheless, they have at least one thing in common: the utilization of vulnerable people in scientific researches with little ethical worries, no matter if the justification to this attitude was a consequence of an inexpressive and arbitrary genetic difference, a morphologic characteristic like the color of the skin, or even the social condition of the subjects. The attempt to apply inferior ethical patterns to research subjects from less favored social classes does not represent only a retrace in the conquests delineated by the Helsinki Declaration, but the return one century backwards to a doubtful theory like social Darwinism. Unfortunately, these old ideas come by new ways, still influence some medical research.