Eugenics, euthanasia and physician assisted suicide are passionately debated practices. These value laden topics have polarized opinions across all segments of our society. Advances in the Human Genome Project, increased knowledge of the Nazi atrocities against persons with disabilities, and recent court decisions regarding the right-to-die have combined to foster the existing controversy. Rehabilitation professionals are noticeably absent from these discussions. Review of the literature reflects that the preponderance of scholarly or popular writing regarding these practices lies outside the field of rehabilitation. This paper is intended to provide the rehabilitation professional with a primer about eugenics, euthanasia, and physician-assisted suicide (PAS). To accomplish this task, the following topics are addressed: definitions and historical context, conceptual models, international experience, social and ethical considerations, economic aspects, implications for practice, and future research.
Definitions and Historical Context
The concept of improving the human race through selective reproduction is reflected in Plato's Republic (Barnett, 2004; Larson, 2002). The Greek word eugenes means "well born" (Mahowold, 2003). Eugenics is defined as the study of hereditary improvements of the human race by controlled selective breeding (Smart, 2001). The word was conceived in England by Sir Francis Galton, a naturalist, statistician, and Charles Darwin's cousin. Sir Galton first used the word he coined in one of his publications in 1883 (Barnett, 2004).
The eugenics movement peaked in the United States between 1900 and 1935 (Lombardo, 2003). Eugenicists adopted two approaches, referred to as positive and negative eugenics, to prevent individuals considered to have disabilities from reproducing. Public education and voluntary abstinence were considered positive eugenics. Compulsory sterilization was considered negative eugenics (Larson, 2002). Anyone the state considered socially undesirable appeared subject to involuntary sterilization, including: individuals with hereditary deafness or blindness, those considered to have mental illness or developmental disabilities, individuals with epilepsy, criminals, prostitutes, or the poor (Larson, 2002; Lombardo, 2003). Social Darwinism, an outgrowth of Darwinism, proposed that social characteristics were inherited along with biological characteristics. Social Darwinism was used as a justification to eliminate socially undesirable characteristics through eugenic practices (Mostert, 2002). In the early 1900's, almost every state had at least one institution to segregate individuals with disabilities and 32 enacted compulsory sterilization laws. Between 1907 and 1945, 40,000 eugenic sterilization procedures were performed in the United States; half were conducted in the State of California (Bachraeh, 2004). More than 60,000 people were sterilized under these laws in the United States (Larson, 2002).
The most famous case of involuntary sterilization was that of Carrie Bell, a woman from Virginia who was alleged to have had mental retardation. Ms. Bell was the first woman in Virginia to undergo compulsory sterilization in the State of Virginia after the Supreme Court affirmed the State's compulsory sterilization law (Mostert, 2002; Larson, 2002; Lombardo, 2003; Palmer, 2003). The United States Supreme Court upheld Virginia's 1924 Involuntary Sterilization Act with its 1927 decision in Buck v. Bell. This Supreme Court decision has been repudiated but it has never been overruled (Palmer, 2003). The State of Virginia repealed its sterilization law in 1974.
Eugenics became associated with the concept of racial hygiene in Europe. In 1926, Denmark, Finland, Norway, and Sweden began institutionalized sterilization programs (Barnett, 2004). Influential social and economic forces in Germany, particularly after World War I, foreshadowed the genocide of people with disabilities (Mostert, 2002; Bachrach, 2004). …