Sterilization & Heredity

When is sterilization socially and morally justified to prevent the transmission of feeblemindedness or other handicaps to offspring? No answer is universally agreed upon, because medical geneticists do not know with certainty what defects can be passed on from generation to generation. There is even doubt, in many cases, whether the children of mentally defective parents are themselves mentally defective because of the unfavorable background of their early life or because of defective genes. In the U.S. 28 states have laws permitting sterilization for the mentally ill or defective confined in institutions. In Scandinavia the situation is notably different. Denmark has the most aggressive program of sterilization for persons (whether in institutions or not) believed likely to produce defective offspring, and in London's Eugenics Review Professor Tage Kemp of Copenhagen spells out how the plan works.

Geneticist Kemp is careful to distinguish Denmark's "genetic hygiene," which he insists is a "purely medical subject," from Nazi ideas of selective breeding: "It rests definitely on the principle of voluntariness. Genetic-hygiene measures are taken exclusively at the desire of the persons concerned. Experience shows that patients, after having been informed on the significance of the hereditary taint, nearly always follow their doctor's advice." He does not explain how a mentally defective patient can understand the medical and social considerations involved, or how "voluntariness" can be achieved.

Changing Definitions. Denmark was the first nation in Europe to enact sterilization laws (1929) ; Norway, Sweden, Finland and Iceland have followed suit. In the first 25 years of Denmark's plan, there were 8,600 sterilizations (in a population of 4,500,000). More than two-thirds were performed on mental defectives, of whom two-thirds were women. Of the 3,663 patients sterilized for reasons other than mental deficiency (e.g., physical deformities, deaf-mutism), seven-eighths were women. In recent years the number sterilized for feeblemindedness has dropped sharply (from 283 to 165 a year), partly because the backlog of cases adjudged to need sterilization has been reduced, but partly, Kemp admits, "because the definition of feeblemindedness has changed during recent years."

Indicating the confusion among the lay public and some doctors over what defects are hereditary, Dr. Kemp lists an amazing variety of conditions on which "genetic counseling"--at least some of it leading to sterilization--has been given. Among them are many, such as harelip, clubfoot and similar malformations, which may be congenital (in that a child has them at birth) but which are not, so far as is known, the result of defective genes, and therefore are not predetermined at conception. They are caused by events, still unknown, occurring during life in the womb, and some of them can be repaired by surgery. Many have no proved relation to heredity, e.g., eczema, psoriasis, allergic diseases, migraine, stuttering. Others are known to occur more commonly in some families than in others, such as diabetes and nearsightedness. "Another large group," Kemp notes, "includes psychopathy, psychopathic or abnormal personalities often associated with criminality, alcoholism, asociality, vagrancy, suicide or sexual perversion." Prevailing medical opinion is that none of this last group of conditions is hereditary; all are believed to be caused by environmental factors.

Denmark's genetic counselors may recommend sterilization in many cases where they know that the condition is not truly hereditary, but where they consider the parent or parents so handicapped that any offspring would have a poor chance of normal development. "Every case," says Kemp, "has to be submitted to individual expert estimation."

Control Evolution? How well has Denmark's plan worked? Kemp believes that it has reduced the blight of hereditary feeblemindedness by 50% or more. It will take generations, Kemp concedes, to prove that hereditary diseases are in fact reduced by genetic hygiene. But he is hopeful: "The time draws near when man to an increasing extent can control his own biological evolution."

U.S. opinion sharply questions whether this is a desirable goal, on moral as well as medical grounds. In the 28 states with statutory sterilizations, 1,065 operations were performed in 1955, giving a proportionate national rate only about one-twentieth of Denmark's.

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