This editorial appears in the August Issue of the American Journal of Bioethics
“Better babies.” “Fitter families.” “Survival of the fittest.” “Three generations of imbeciles are enough.” These phrases are not merely historical reminders of the United States’ regrettable eugenic past but are appearing in an increasingly eugenic present. Eugenics may have seemed dormant, but has recently been reawakened by the alt-right, tech billionaires, and figures such as Robert F. Kennedy (RFK), Jr., Stephen Miller, and President Trump. Autism has become the most recent target of eugenic ideology.
The administration’s stoking fear of and offering feigned support for autistic children and their families has bolstered MAHA’s ongoing eugenic rhetoric about the “scourge” of autism. This harmful language continues despite scientific evidence supporting MAHA’s misplaced (and scientifically refuted) views about the causal roles of vaccines and Tylenol. Disastrous political ideologies of the 19th century dominate this administration’s policies, but none so perniciously as the ideology of eugenics as applied to autism.
Ridding society of disabled individuals has long been the goal of eugenics. In fact, “[t]he goal of the Nazi Euthanasia Program was to kill people with mental and physical disabilities” (Holocaust Encyclopedia). This grim eugenic history dates back to the 19th century when it was considered part of mainstream medicine and science. Scholars have argued that medicine legitimized eugenics through “expertise laundering,” whereby “unsettled expertise [is laundered] through various interdisciplinary ‘transactions’ until it appears settled”. From eugenics to Lysenkoism to MAHA, ideologies are legitimized by those in power and authority asserting a goal of improving society yet, in reality, harming public health, demonizing vulnerable minorities, and ignoring individual dignity and well-being.
Public health and eugenics share similar nomenclatures. Both focus on society, prevention, and betterment. The difference between the two, however, is in intent. Public health seeks to improve the lives of individuals by improving the lives of the community. This contrasts with the crude consequentialism of eugenics, which seeks to eliminate the lives of some to decrease economic burdens, thereby purportedly improving the lives of many. Eugenics seek to serve the powerful; public health seeks to empower the marginalized.
Historically, those promoting eugenics have often couched their agenda in terms of public health, which is precisely what RFK, Jr. and his MAHA cronies have been doing through their rhetoric around autism. They are utilizing a public health rationale to peel back decades of laws and regulations aimed at increasing vaccination rates to reduce communicable disease globally with one narrow and bogus goal: eliminating autism. This is problematic because reducing vaccination rates will not eliminate autism. It will, however, greatly harm many individuals while endangering public health. And it will ultimately lead to an increase rather than decrease in morbidity and mortality—exactly what MAHA claims it wants to prevent.
The U.S. eugenics movement of the early 20th century served as the blueprint for the Nazi regime that espoused a similar mission of exterminating the disabled. In the oft-quoted Supreme Court case of Buck v. Bell, which has notably never been overturned, Justice Oliver Wendell Holmes, Jr. asserted that
It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.
This claim by Holmes continues to have life among contemporary leaders, highlighting the fact that eugenics in America has never really gone away, but merely has been hiding in plain sight. For instance, RFK, Jr. erroneously describes autism as a monolith, describing it in its most severe expression, which notably accounts for about a quarter of autistic individuals. He makes his assertions about autism using the language of public health by referring to autism as an epidemic, based on more faulty reasoning about the increasing number of autism diagnoses. The tenor and tone of his rallying cry eerily echo the explicitly eugenic language of Holmes:
Autism destroys families. More importantly, it destroys our greatest resource, which is our children. These are children who should not be suffering like this … These are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go out on a date. Many of them will never use a toilet unassisted. And we have to recognize we are doing this to our children. and we need to put an end to it.
Both statements rely on the language of public health and public welfare to mask economic and ableist motivation. In describing the ableist notions that fed into the Nazi elimination of 300,000 disabled individuals, historian Dagmar Herzog writes that both mental impairment and/or mental illness
destabilize the idealized notion of the autonomous subject and, not least and most enduringly, because of the challenge that these impairments have raised for the expectation of being able to contribute labor to one’s community, rather than requiring the labor of care and support from others.
Interestingly, both Holmes and Kennedy discuss vaccination—Holmes uses it as a metaphor, whereas Kennedy blames vaccinations for causing autism as part of his public health subterfuge. Both assert the state’s power and authority to promote the public welfare; however, neither acknowledges the significant difference between communicable disease and disability, with one being contagious and capable of rapid spread to many and the other being a much more amorphous concept that can be inborn, acquired, or simply created as a medical condition. The interest in the state in stemming communicable diseases such as measles or COVID-19 is in the prevention or eliminating a disease vector rather than the prevention of the existence of a human being.
A 1997 American Journal of Public Health article comparing and contrasting eugenics and public health in the wake of the Human Genome Project reasons that “[s]ome of what was done in the name of eugenics was also done in the name of infection control and public health. Eugenics was not an isolated movement whose significance is confined to the histories of genetics and pseudoscience”. The conclusion is relevant to the current debate about autism “prevention”: “Past similarities between eugenics and public health serve as an alarm clock for all the health sciences”.
The response to disability should never be the elimination of people with disability but should rather be a collective response to helping those individuals participate as fully in our communities as possible. Autism is not the scourge on society that RFK, Jr. would have us believe; rather, it is rampant elite ableism that is the true epidemic. In fact, one could argue that an ableist classism has animated much of the policy decisions to eliminate vaccine recommendations—tools that in the absence of a universal health care system have greatly benefited marginalized groups. The tools and language of public health would be better applied in preventing and reducing the burden of this narrowmindedness rather than being bastardized to promote harmful, dangerous, and bigoted ideology.
Nanette Elster, JD, MPH, Kayhan Parsi, JD, PhD, HEC-C, and Art Caplan, PhD