Eugenics and China: Where is the ethical problem?

- Ole Doering, Ph.D.
(Federal) Institute of Asian Affairs,
Rothenbaumchausee 32, D-20148 Hamburg, Germany

Eubios Journal of Asian and International Bioethics 8 (1998), 114-5.

The international critics of Chinese eugenics should be careful about whom they address and should make unmistakably that their comments are justified. This is not more than a demand of fairness and scientific honesty. I propose that the progress in ethics has nowhere reached a degree of maturity which would entitle to straightforwardly and totally abandon, both eugenics in general, and Chinese medical politics in particular. We are still struggling for good methods and inspiring questions. This is quite natural, if we understand, that ethics is delicately involved in the fields of politics, law, society, morals and science, of reason, emotion and action. But what are the criteria for such a proposed mature ethical discussion of eugenics?

At first we have to define the problem of eugenics, which is twofold: Its descriptive dimension can be circumscribed by the question: 'What can we expect to gain in health care with our biotechnological skills, and what is mere science fiction or ineffective if we balance costs and merits?'

The second dimension of the eugenics problem is prescriptive. Here we are asking: 'What shall we do with our (assumed) medical knowledge and skills, and should we encourage bioscientific progress as such?' Hans Jonas, in his popular book on 'Technology, Medicine and Ethics', holds that the very new quality of technological accomplishments is permanently creating new ends of the same new quality we do not quite comprehend. Jonas arguments rely substantially on the notion of a historical and essential Great Leap Forward towards Modernity. This New Age makes him worry whether we might finally end up in a catastrophe, caused by the exhaustion of our limited capacities, which leave us unprepared for biotechnological challenges.

Darryl Macer, on the other hand, reminds us that, in principle, biotechnology and eugenic ideas are not essentially new, but, in principle, as old as human cultures. Macer still acknowledges the limits of our understanding, expressed in the belief in a 'god of the gaps', but he encourages us to trust that ethical progress is possible.

I frankly confess that I feel more attracted to the view of Macer, which is, at least, based on a decent reading of the history of medical concepts and sciences, and ready to take the challenge. However, I still have some concern about a new quality of problems which I regard as effects of the accumulative quantity and complexity of biotechnological information and skills. Muddling through the stream of relevant information, we might get lost in perplexity, and this would be a rather undesirable, though not really inexperienced situation for ethics. I hold that neither claiming a New Age nor quoting the historical evidence of biotechnological engagement does provide a strong argument. Ethical deliberation is always depending on a careful scrutiny of the characteristics of the actual context. However, it remains doubtful whether we can approve a certain activity as ethically O.K., just from the description of an action, like 'We are implanting a certain genetic marker into this section of the gene', or if we can rely on our respective categorical labels, as vague as 'Biotechnology' or 'Eugenics'. It appears as if we are now urged to pay as much attention to empirical facts as we philosophers have rarely done before. I may remind you that even in mainstream ethics it is very often regarded odd to become involved in matters of 'trivial life' as an ethicist. Some colleagues prefer to engage in most abstract conceptual analyses, or in game theories, and even ridicule the old tradition of associating the philosopher with the physician, which still could lead us far beyond mere utilitarian reasoning, into a setting of responsibility awareness, where a bioethically significant ethics might better take place.

I further submit that there is nothing like eugenics, as such, being good or bad. We always depend on a specific definition. For example, eugenics can indicate an attempt to improve the quality of our bodily constitution, which is fine if we think of hygiene or antibiotics. Interference is inevitable for a natural being. But we wish to realize what exactly we are doing. It makes a considerable difference to kill a population of bacteria, to reanimate a gene-sequence in charge of health, or to try to design a new germline. Obviously, all of these bear a different impact on the concerned persons and on society, with the latter also effecting on future generations. But there is no general innate ethical value in any of these.

For an ethical statement we require additional conditions. We can not rely on methodological one-way streets. Instead, we are advised to combine two tracks. Track number one is to explore the ethical quality of our proclaimed intentions. A helpful device for this approach is to check our mayor motivations, or maxims, with the categorical imperative. James Buchanan has suggested a revised spelling of this device for the context of biotechnology, putting it into a paradox: 'Act so that the effects of your actions reflect the fact that you cannot predict the effects'. A concrete specification, in my reading, would be, 'In order to gain a more healthy population, can we wish that sterilization of handicapped persons becomes the regular procedure under all circumstances, at any time, and for every person?'.

After we once have decided for an answer, there ought to be a systematic counter-check, to make sure that we accurately and comprehensively understand the meaning and impact of the problem in our real world, which is track number two: to explore the practical coherence of our applied maxims. Here, not a single imperative will do. We have to look for so called hypothetical imperatives, which are defined by having not an aim in themselves and to be also consisting of empirical elements. In light of the sterilization example it may be formulated like this: 'In order to gain a more healthy population, is it effective at all to perform sterilization of handicapped people? And if 'Yes', for which particular cases would this be true. And, subsequently, can we be sure that the respective medical system is effective enough to provide the measure for the whole population? Finally, can the risks and shortcomings outweigh the costs of the respective measure?'.

If one or more of the answers is negative, as we know it is true for our example, we have reason to revise the questioned means, and may be convinced to abandon, or at least to postpone them for further investigation. After all, even in case of positive answers to all questions, we would not be licensed to give away an inch of our concern. This double track method provides mere evidence for the value of one maxim. There occur cases of a lethal collision of maxims, which have been found to be consistent within themselves, like the clash between legitimize interests of individuals and of society. Still it is possible to solve these problems if we again go through the enlightened double track process, but this requires lengthier explanations than I may perform here.

Just in order to avoid a common misunderstanding, it ought to be mentioned that there of course is no definite and certain last word in this process, neither possible, nor desirable. Ethics is an open process, regulated by abstract ideas and principles, but in the hands of humble and limited people.

Quite obviously such an ethical approach can be very promising in that it provides a refined understanding of the cluster of problems. But it also requires a very high level of interdisciplinary sophistication, at least some skills in systematics and a high degree of social and psychological sensitivity. We are yet far from educational systems and scientific or clinical practice which would encourage this sufficiently, not to mention the very poor back up in society and politics.

Just to pick up one of the issues at the heart of the matter, namely a decent comprehension of the way life goes, let us consider the history of eugenics. Historical experience teaches every European that eugenics is a very dangerous approach, at least under the guidance of narrow minded interests, and it has almost every time been abused for ill purposes. Even recently it was revealed to a greater audience that Sweden, among others, to their great respective embarrassment, has been following a eugenics policy of coercive sterilization adopted in the thirties. The more the eugenics proponents urged that a 'better race' required stern means for a few the worse the effects on more and more people turned out, with no countable gain left in the end. This is an insight the whole mankind will profit to share, and hopefully this convinces others, in China and elsewhere, to avoid trapping into the same pitfall of human hybris, of reshaping what does not seem to fit into a scheme of desirable instant-ready-for-whatever-purposes, instead of showing humaneness and understanding. There is no such thing as human dignity without diversity. And diversity depends on the existence of various genotypes and phenotypes, often including what we call diseases. Still, by no means this shall discourage our efforts in medicine and health care.

Within the context of Asia, where there is, with a few exceptions, no comparable history of eugenics reported. This lack of first hand experience can easily be compensated by studying. Still Asia also has had its 1984 Singapore experience of social engineering, which is a relatively mild form of eugenics but still influenced by some naive biologism which raises concern. The shaping of genes by biotechnological, social and even legal force should be held away from the toolbox of politics, where we can't expect pure ethical arguments to be too influential.

A general welcome to technological improvement and innovation, which has often be ascribed to Asian societies, should not hamper us to be extremely careful and open to face, name and calculate risks, and, in case, to accept the modest conservative course of interference into peoples lives, which is an advice of an ethical understanding Asian traditions are proud of. If we know we don't know what we are doing to ourselves, to others or to the next generations, it would be extremely inhumane and irresponsible to continue unless we reached a comprehensive and agreeable understanding.

All of this has a massive impact on present day's China with its practice of sterilization, selected abortion, underdeveloped infrastructure, education and a widespread poorly sophisticated body thinking. Currently the health care sector is regulated by new laws which are not without, but of unclear ethics. The eugenics issues have neither been thoroughly discussed nor embedded in proper practical and legal frameworks yet. Are we understanding this situation clearly enough, so that we are well prepared for discussing eugenics and China competently? And, is China ready for this approach to social and political maturity? In view of these questions, the problem appears not to be a special one for China, but again a challenge for humanity

I submit the following as a bottom line: Eugenics in China is primarily a political problem, and in particular a task for the developing state of right and education. This entails at the same time an ethical concern, but this ethical concern is neither restricted to China nor to politics. We ought not to confuse these two levels of discussion. Because if we did we would in effect weaken the position of Chinese ethicists and strengthen elements of ill minded or poorly informed policy beyond necessity.

Gerhold Becker, Changing Nature's course: The ethical challenge of Biotechnology; Hong Kong 1996
Chee Hengleng and Chan Cheekhoon, Designer Genes: I.Q., Ideology and Biology Selangor 1984
Ole Döring, Technischer Fortschritt und kulturelle Werte in China: Humangenetik und Ethik in Taiwan, Hongkong und der Volksrepublik China, Hamburg 1997 (including an English summary).
Hans Jonas, Technik, Medizin und Ethik: Zur Praxis des Prinzips Verantwortung, Frankfurt/M. 1985
Darryl R.J. Macer, Shaping Genes: Ethics, Law and Science of using Genetics Technology in Medicine and Agriculture; Tsukuba 1990
Stella R. Quah (ed.), The Triumph of Practicability: Tradition and Modernity in Health Care Utilization in selected Asian Countries, Singapore 1989

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