Goldberg Guest Post on Sterilization

The following is a guest post from my friend Daniel Goldberg of East Carolina University's Bioethics and Interdisciplinary Studies Department.  I hope we'll hear some more from him as the discussion about compensation of victims of North Carolina's sterilization program moves forward:

Thanks much to Al for the invitation to contribute to TFL.  I am a peculiar academic creature; about 60% of my work involves public health ethics and population-level bioethics, and about 30-40% of my work is original research in the history of medicine and public health.  Although I am no historian of eugenics, my period of the mid-to-late 19th c. (and into the early 20th), and my interest in the history of public health, combined with my work on race, class, inequities, and the social determinants of health means that I cannot afford to be entirely ignorant about the enmeshment of fin-de-siècle and progressive public health activities and eugenics.

Having moved to North Carolina just a few years ago, and now living in eastern North Carolina (which is substantially poorer, sicker, more rural, and more African-American than the Piedmont), I have taken a particular interest in the activities of the sterilization task force and the history of involuntary sterilization here in my adopted fair state and in my region.

 I am at heart an intellectual historian, and one of the things I find fascinating is the way in which ideas are social actors.  That is, ideas can have a powerful effect on material history, and one of the most obvious ways in which this happens in context of health is the importance of individual agency.  The conventional view that American political culture is highly individualist turns out upon close scrutiny to be exactly correct, and there is virtually no doubt that this individualism has had and continues to have a profound impact on our ideas about health, our causal attributions of disease and health, and on our ideas about the remedies we should implement to ameliorate poor health.

 Thinking about the sterilization program, and communicating with peers, colleagues, and community members on its history in eastern North Carolina in particular, what has become plain is the complexity of some of the issues underlying it.  Not, of course, that this complexity serves to diminish either the horror of involuntary sterilization or its class and race-based applications.  But there is ample social epidemiologic evidence showing that single parentage is a significant determinant of all sorts of adverse health outcomes, as is having multiple dependents.  Moreover, social disadvantage tends to cluster, which means that across a population, those who are single parents are more likely to suffer from other disadvantages (low income, low educational attainment, exposures to violence, racism, discrimination, etc.)  So persons experiencing deleterious social and economic conditions often face the enormous obstacles posed by compound disadvantage.

What interests me about the role of individualism in thinking about the sterilization program is the way in which the problem to be solved -- reproduction that creates all sorts of problems and burdens for the mother, larger family, children, etc. -- is read according the script of that individualism.  In other words, the very real problems posed by the deleterious social and economic conditions in which many of the victims of the program lived and worked are reformulated as problems of the individual body, of the woman for whom sterilization was sought.  If the social problems for which reproduction is a proxy are in fact recast as pathologies of the individual body, then the obvious remedy is to eliminate the pathology, in this case, surgically.

But note that under this interpretation, the intervention alleviates the pathology on both the individual and the collective level -- through sterilization, the pathology inscribed within the individual woman’s body is eliminated, but so too is the pathology inscribed on the body politic.

 Lest this seem far-fetched, we have very good evidence in the history of eugenics that this kind of thinking was critical, that what Robert Jay Lifton terms a ‘biocracy’ had an enormous amount to do with the breadth and social power of scientific racism and eugenicist interventions.  Individual ‘degeneracy’ -- a key term of art in eugenicist thought -- was a stain on the society itself, analogized to a lesion which should properly be excised or alleviated in some manner provided through the instrumentarium of biomedicine and science.

 But the individualism of American culture is of course contingent.  What if a different social imaginary dominated the way we think about health, disease, and disadvantage? What if the problems posed by adverse socioeconomic conditions, single parentage, and multiple dependents were seen as failures in the social safety net, as social problems that were both fundamentally caused by breaches in social and collective policies (whose effects accumulate over generations) and sustained, as Engels might surmise, by continued failures to provide material assistance and break what Madison Powers and Ruth Faden term ‘densely-woven patterns of disadvantage’?  If that were the case, and the problem was seen as a social problem than as one of individual bodies and their pathologies, then the solution would hardly seem to be sterilization of any kind, but amelioration of the social and economic conditions that caused and sustained the destitution and suffering the proponents of the program sought to ameliorate.

 

Comments

[Kevin Lee, Associate Professor, Campbell Law School]

On Friday, March 30, at Campbell Law School in Raleigh, Victoria Nourse (Georgetown) spoke on her book, In Reckless Hands (on Skinner v. Oklahoma), as part of our lecture series, "The Eugenics Movement, History and Legacy." Professor Nourse is a very cautious and insightful scholar who suggests that the eugenics era jurisprudence and its aftermath might reflect a shift (dare I say "evolution") in rights discourse. Her voice was joined by Steven Selden, (University of Maryland) and Phillip Thompson (Executive Director of the Aquinas Center on Theology at Emory University).

Reading Prof. Goldberg's post in the context of these presentations makes me wonder whether more than an emphasis on "individualism" was at stake in the eugenics period. It seems to have implicated the devaluing of the body, a characteristic feature of twentieth-century thought. That is at least part of the reason that religious thinkers (particularly but not exclusively Roman Catholics), who resisted the reduction of the person to the mind, were among the strongest and most consistent objectors to the eugenics movement.

Clearly, the movement would provoke a strong response from communitiarian theorists today, but it seems the critique would go beyond the standard liberal/communitarian debate. Thoughtful social scientists admit that the roles of the physical, social, and cultural environments play in shaping something so vaguely defined as intelligence are not well understood. And the view of the brain that is emerging in cognitive science suggests that it is an embodied dynamic system that interacts with the physical, social, and cultural environments in ways that are not well understood or predicted. These new developments call for broadly reconsidering a number of foundational beliefs about how meaning is formed and what might be most significant in shaping authentic human freedom.

[David Bernstein]

Goldberg's views on the relationship between individualism and eugenics strike me as highly implausible. American eugenics theory, of course, found it's greatest fans in Nazi Germany. Were the Nazis individualists, too?
How about the views of British Socialist and enthusiastic eugenicist Sidney Webb. "No consistent eugenicist can be a ‘Laisser Faire’ individualist unless he throws up the game in despair. He must interfere, interfere, interfere!"
How about the Michigan judge, dissenting for himself and two others form a decision upholding sterilization, who A Michigan supreme court justice, dissenting for himself and two colleagues, who accused eugenicists of "invit[ing] atavism to the state of mind evidenced in Sparta, ancient Rome, and the Dark Ages, where individuality counted for naught against the mere animal breeding of human beings for purposes of the state or tribe."
I could go on.

[Alfred Brophy]

Depends on what one means by individualism, I suppose. For instance, a primary justification of sterilization was that it reduced the costs to the rest of society. The taxpayers did not want to pay for support of disabled individuals or their children. That's about reducing costs to the rest of us; disabled individuals whose family had resources were not subject to the same scrutiny. If you had resources you were not subject to sterilization; if you didn't have resources, you were more likely to be sterilized. By contrast, a robust social welfare state would have not been critical of those who were perceived as (not sure this was actually true) likely to need additional support. I think that's part of what Daniel was suggesting, though I'll let him speak more to this.

But this thread feels like we're reading some kind of conflict about libertarianism back on the issues of the 1920s, 1930s, and 1940s. What bothers me about sterilization is that it was an extraordinary interference with personal autonomy and done following a cost-benefit analysis. What was plugged into that cost-benefit equation were the costs to society of support of the individual and their children and the economic benefit they generated. That's it. There was no sense of the value of the autonomy of the individual, -- and certainly no sense that there are some things that should not be for sale at all. As had happened at other times in our history (like the era of slavery), the people in power made up the equation and then -- completely unsurprisingly -- had a result that justified sterilization in many cases (or slavery in many more cases).

Nourse's book is one of the best works of legal history I've read in a very long time.

[Kevin Lee, Associate Professor, Campbell Law School]

I agree that it is misleading to read the complex history of this period through the lens of today's "rights discourse." Nourse makes this point and clearly is right about it. There were connections between the progressive era and eugenics. Here's a link to an article by Thomas Leonard that draws some specific connections.

http://www.princeton.edu/~tleonard/papers/retrospectives.pdf

The individual v. group is a proper trope for thinking about these issues. It is worth noting that some of the progressives thought they were celebrating "group" autonomy by allowing groups to choose their fates. Eugenics, after all, is simply an implementation of Spencer's Social Statics (aka Social Darwinism). Some link the doctrine of freedom of contract to Spencer, as Holmes did in his dissent in Lochner. It was later studies of evolution that showed that natural selection applies to individuals, not groups.

It concerns me when the concept of "autonomy" (freedom to choose absent coercion?) is set out as the exclusive value in the individual. Picking out autonomy as the source of human value continues the devaluation of the body. What value do our physical bodies have? Why do we so easily devalue persons whose bodies displease us? And this opens to a slippery slope. What value do persons have who lack autonomy? The Eugenicists thought they were valueless--Hitler called them "Lebensunwertes leben" (lives unworthy of living). And are any of us really as autonomous as our theoretical commitments might presuppose? (Certainly Robert Gazzaniga's Whose in Charge? raises some questions that may become more urgent in the not too distant future). My question, then, is their anything intrinsic in our bodies that resists commodification? Can I sell my arm or my kidney if I choose to? Doesn't commodification of the body even when done with autonomy offend the value of persons?

[Alfred Brophy]

Thanks for this, Kevin -- and I'm sorry to have missed Nourse's talk. If you have other talks scheduled in the eugenics movement and history series please let us know. I'd like to seem them.

[Patrick S. O'Donnell]

We should be careful about how we employ the concept of autonomy, of which, there are many conceptions: Kantian, Millian, etc. (sometimes, for example, inferences are made to the effect that the idea necessarily entails some notion of an atomistic self, which it does not, or that it implies something on the order of expressive individualism, which it need not), the notion of "moral autonomy" being probably the most important if not most misunderstood. See, for instance, the three entries related to autonomy in the Stanford Encyclopedia of Philosophy.

And there are at least four examples of fairly nuanced discussions of this notion within healthcare ethics/medicine and law that I highly recommend to anyone wanting to invoke the concept in these discussions: Onora O'Neill's Autonomy and Trust in Bioethics (2002); Elyn R. Saks, Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002); Carl Schneider's The Practice of Autonomy: Patients, Doctors, and Medical Decisions (1998); and Alfred I. Tauber's Patient Autonomy and the Ethics of Responsibility (2005). No doubt there are others, but these came quickest to mind.

[David Bernstein]

"By contrast, a robust social welfare state would have not been critical of those who were perceived as (not sure this was actually true) likely to need additional support."

Or it could be the opposite. "Defective" children would be a burden on the welfare state, and therefore must be eliminated before they can suck up resources that go to "normal" children.

[Alfred Brophy]

I robust welfare state -- that is, one that actually cared about its citizens -- wouldn't behave like that, David. What you're talking about is a state that focuses on cost/benefit analysis.

[David Bernstein]

Al, I disagree. There's no conflict between having a "robust" welfare state, and drawing a line between who "deserves" to have the benefits of that welfare state. We can agree that Sweden is known for having among the most robust modern welfare states, right? But Sweden was also the European country most enthusiastic about eugenics and sterilization, after Nazi Germany. And it's not an illogical connection: if the "public" is going to be financially responsible for your family, the "public" should get to decide whether your worthy of having kids that might require public assistance.

[Daniel S. Goldberg]

Thanks for the rich discussion, all.

Just for the record, I don't really disagree with David's point, and I think it is compatible with my own. American eugenics cannot simply be equated with any of the various strands of eugenics that prevailed in Europe at the time or later. So if it were the case that there was an individualist ethos that permeated American eugenics, the fact that communitarian or collectivist concepts were more influential in German or other European countries of the time does not in any way disprove that idea.

(It may or may not be accurate. But the fact that eugenics in Europe was different in some ways is no proof of its implausibility in describing what happened in the U.S.).

That said, I agree with David that collectivism is hardly proof positive against eugenicist thought, and he is certainly correct regarding eugenics in Sweden. My intended point was nothing as crude as equating individualism with eugenics, but rather that the version of eugenics that seemed to take hold in some parts of American society reflects a distinctly American individualist ethos. Eugenicist ideas and acts that took place elsewhere would be expected to reflect different ideas.

[Alfred Brophy]

David, I don't know enough about Sweden in the era when it practiced eugenics to have an informed opinion on this. I usually try to confine my comments to something I know a little bit about. To the extent that Sweden was a welfare state when it adopted eugenics, then that was a departure from what most people would think is a welfare state model in two ways. First, it excluded people from the care of the state and secondly it drew distinctions based on a fairly narrow cost-benefit analysis, apparently.

One key point I'm making is that the cases that upheld sterilization often did so (perhaps always in the US, I haven't read all of the 1920s/1930s eugenics cases yet) based on a fairly narrow cost-benefit analysis that did not take the value of the sterilization victim's right to procreate into account. In looking to assign culpability for the tragedy of sterilization I think one ought to be looking not at the welfare state proponents, but at a different set of people, like E.S. Gosney, the California businessmen who wanted to reduce the cost of care of his fellow humans.

[disabled]

what if you stopped objectifying people? what if you stopped treating them as externalities; as dolls to be dressed up so that our vision of their suffering was diminished? what if we just stopped treating those who suffer from an internal malady or suffer from external circumstances as if their suffering were one- dimensional, and best comprehended and addressed by the self-appointed saviors whose primary qualification to address such maladies is never having suffered them? there is not proximity in your speech - it's 'them' - those groups out there. as a member of one of those groups, let me just say, we don't like your kind. our worth is inherent and indestructible. your lack of vision doesn't affect a change in the real. fix the plank in your eye, buddy.