Lord Winston’s warning

Last month, Lord Robert Winston delivered the Physiological Society summer lecture entitled, ‘Shall we be human in the next century?’ You can watch it in full here (the stream starts working around 5”30 onwards). In the lecture, Lord Winston discusses the history and misuse of gene science and eugenics, and points to the potential resurgence of this way of thinking, made possible by advances that would allow us to genetically enhance human beings by modifying their nonpathological traits. Winston would be classified as a ‘bioconservative’ in the contemporary enhancement debate, and below I examine the case for caution that he puts forward in this lecture.

The lecture began with a discussion of Francs Galton, the Victorian professor of eugenics at UCL. He was the half-cousin of Charles Darwin, and was highly inspired by On the Origin of Species, developing a particular interest in the heritability of intelligence. He believed that society could be improved by better breeding – that the best people should be encouraged to breed with each other, and the least able should be prevented from breeding. Winston then moved onto a discussion of Carrie Buck – a young woman who was sterilised for being “feeble-minded” under the Virginia eugenics programme, in 1924. After becoming pregnant as a result of rape, Buck was sent for sterilisation on ‘mental grounds,’ but it transpired that she was of average intelligence and there was no evidence of her impaired mental capacity. The move to sterilise her was also taken under the Racial Integrity Act, which prevented miscegenation, an indication of the ulterior and malignant motivation behind the state’s eugenics programme. The Supreme Court later ruled that compulsory sterilisation of the ‘unfit’ was not unconstitutional, with Justice Oliver Wendell Holmes stating:

“[sterilisation] is better for all the world…three generations of imbeciles are enough.”

Lord Winston poignantly noted that doctors at the Nuremburg trials cited this very judgement in their defence when they were standing trial for the mass sterilisation and murder of those who were identified as “life unworthy of life” during the Third Reich. I believe this connection was made by Winston in order to show that abominable practices can be state-sanctioned, allowing them to escape critique and gain legitimacy, as well as to indicate that we shouldn’t think of Nazi eugenics policies as being radically removed from those that we have seen elsewhere. It is important, therefore, not to think of the Nazi eugenics programme as an aberration in the history of genetic science, but rather as the continuation of existing and legitimised policies that began in the US, with California being the former epicentre of the American eugenics movement, where doctors offered advice to the Nazi eugenics programme in its nascent stages.

Wanting to further emphasise that eugenic policies didn’t only occur in distant times, Lord Winston went on to say that such ideas cropped up before Galton, and are still present in our society now, citing the recently exposed story of the illegal sterilisation of Californian inmates between 1997-2010 – a procedure that was performed without informed consent on 39 women. Wanting to emphasise that such actions also happen even closer to home, he discussed the encounters he’d had with women on whom he’d performed a reversed sterilisation procedure, in the 1970s. Many of these women had been sterilised after requesting a termination under the 1967 abortion act. In such cases, the surgeon had agreed to terminate the pregnancy only if they first agreed to be sterilised. The surgeon’s proposal constitutes a clear case of coercion, under most philosophical analyses of the concept. Coercion is typically held to involve a threat, whereby A’s proposal is coercive if and only if A threatens to make B worse off in relation to some baseline. In this case, B’s (the women seeking the abortion) baseline included the unimpeded right to request an abortion, so the doctor’s proposal (you can only have this abortion if you agree to be sterilised) makes B worse off according to this, and so is a coercive threat, giving B no reasonable alternative but to accept. Most theorists tend to argue that mere offers, in the absence of a threat, cannot coerce, as they do not threaten to make B worse-off, but rather offer to improve B’s circumstances, relative to her baseline. In reality, however, some offers appear to be similarly coercive. The offer of sterilisation to poor, rural Indian women, may serve as one such instance of a coercive offer.  In 2012, India rolled out a programme to sterilise impoverished Indian men and women as a means of population control. The UK gave India £166m to fund the programme, despite allegations that the money would be used to sterilise the poor. Many died as a result of botched operations, while others were left bleeding and in agony. It was reported people were threatened with losing their ration cards if they did not undergo sterilisation, or bribed with as little as 600 rupees (£7.34) and a sari. Some states also ran lotteries in which people could win cars and fridges if they agreed to be sterilised. A’s threat to withdraw B’s ration card unless B undergoes sterilisation is a clear case of coercion on the analysis outlined above. Yet it seems that A’s ‘offer’ of 600 rupees and a sari is similarly problematic, and is not that far removed from the coercion involved in the first case, despite comprising an “improvement” to B’s baseline. This suggests that other factors could be important in determining the coerciveness of a proposal, such as the content of the “offer” presented to B, and the sense in which B is vulnerable, or constrained in some way, making her a target for such unconscionable offers.

Winston’s interactions with the victims of sterilisation in the 70s led him to believe that medical professionals can use their power in the wrong way. His claim that all doctors are vulnerable to this misuse warns us about the precarious position various actors are in as they navigate emerging biotechnology. The above discussion of coercion is intended to suggest that such procedures and eugenics policies may be particularly vulnerable to wrongfully coercing individuals, and that coercion may sometimes be more subtle than an explicit threat. The coercive power of the state is something that history has warned us we should be wary of, and the development of new technology has placed increased power in the hands of unaccountable physicians.

Are these eugenics fears hyperbolic, invalid arguments? Is it a non sequitur to claim that because biotechnology has been misused in the past, it is bound to be misused again in the future? It may be the case that there is nothing in biotechnology that makes it necessarily open to abuse. However, we would be wise to remember that we occupy an imperfect world that is permeated by unequal power relations, and shaped and constrained by important issues such as finite resources. Citing the Israel-Palestine conflict, and speaking at a time when the kidnapped teenagers were still (potentially falsely) being reported as missing, Winston warned that we live in a time where racial tensions are not yet diminished, and that such tensions are heightened when there exist other tensions in society, such as those pertaining to scarce resources. Even just a cursory glance at one conflict yields numerous instances of biological warfare and the malevolent use of technology to curb population growth. The state of Israel has been complicit in sterilising Ethiopian Jews (whose Jewishness is questioned by some rabbis) without their informed consent in order to reduce the birth rate of a community that experiences higher poverty and unemployment rates, has used white phosphorus bombs on civilians in Gaza and Lebanon, and has been poisoning and/or severely limiting the Palestinian water supply for years (up to 95% of Gazan water is unfit for human consumption according to Amnesty International). We don’t need to look hard, therefore, to see the tensions that exist in the world, and the way in which it is possible for a state to engage in strict population control using controversial practices with impunity.

In the end, Winston seems to be cautioning against human enhancement, through a discussion of the history of eugenics, past and present. How are the two related, however? He leaves this question open, and his discussion functions more as a rhetorical device than a sustained argument. Towards the end of the lecture he argues that claims about the human genome are exaggerated, and that for the really important medical issues – heart disease, diabetes and cancer, the impact of genomic research has been slight. Single gene defects, as seen in his work, are not treatable by any genetic medicine, to a large extent. This is because single mutations causing a particular disease have different expressions in different people, and scientists risk exaggerating the impact of such research. He also calls for researchers to be careful and interpret all possible uses of their work. Winston went on to invoke the oft-recited argument that we should be focusing on societal interventions first and foremost, stating that the life expectancy in Glasgow is 54, a figure lower than in Mali and Mozambique, while five miles away in Lenzie has one of the highest life expectancies in the world (82). The genetics of these populations are not fundamentally different, he argues, what is much more likely is that there is some difference in the environment, and this should be of more concern, as opposed to having such a myopic focus on genomics. Concluding with the case of supermouse – a genetically enhanced mouse that is able to run at a constant speed for four hours, he finally addresses the question that is hinted at in the title of his lecture. If we can enhance a mouse, why not enhance a human? Winston concludes that given the power of the market, the frictions in society, and the history of eugenics, we can see how such technology could be seriously misused – “If we made super humans, what price would be our humanity?” he ends.

Is bioenhancement really as related to eugenics as he warns? Perhaps. One particular strand of bioenhancement involves looking into improving our cognitive abilities, such as ‘intelligence’, through gene therapy. I have argued elsewhere about the dangers of research into links between genes and intelligence, particularly when it spills over into discussions of ‘race.’ Research that does not sufficiently interrogate these categories could have detrimental social effects, and is particularly susceptible to reinforcing the prejudices from which controversial categories such as ‘race’ are derived. Ultimately, eugenic bioenhancement necessarily creates a hierarchy of the value of human life, a practice which is fundamentally discriminatory and at odds with relational equality. Intelligence, or a particular conception of it, is seen as the ultimate ideal – in such research there is a specific, cognitively enhanced version of a human being that is explicitly viewed as being objectively desirable, a practice that would be be problematically legitimised by science and policy. It is when we consider the pursuit of human enhancement in this light, that comparisons with the Nazi conception of ‘Übermensch’ do not seem so hyperbolic or hysterical after all. This, combined with the very recent abuses of biotechnology conducted by various states showing us what we are capable of, should make us continually mindful of the potential misappropriation of genetic research.