Views of Genetic Testing for Autism Among Autism Self-Advocates: A Qualitative Study

BACKGROUND

Autism self-advocates' views regarding genetic tests for autism are important, but critical questions about their perspectives arise.

METHODS

We interviewed 11 autism self-advocates, recruited through autism self-advocacy websites, for 1 h each.

RESULTS

Interviewees viewed genetic testing and its potential pros and cons through the lens of their own indiviudal perceived challenges, needs and struggles, especially concerning stigma and discrimination, lack of accommodations and misunderstandings from society about autism, their particular needs for services, and being blamed by others and by themselves for autistic traits. Their views of genetic testing tended not to be binary, but rather depended on how the genetic test results would be used. Interviewees perceived pros of genetic testing both in general and with regard to themselves (e.g., by providing "scientific proof" of autism as a diagnosis and possibly increasing availability of services). But they also perceived disadvantages and limitations of testing (e.g., possible eugenic applications). Participants distinguished between what they felt would be best for themselves and for the autistic community as a whole. When asked if they would undergo testing for themselves, if offered, interviewees added several considerations (e.g., undergoing testing because they support science in general). Interviewees were divided whether a genetic diagnosis would or should reduce self-blame, and several were wary of testing unless treatment, prevention or societal attitudes changed. Weighing these competing pros and cons could be difficult.

CONCLUSIONS

This study, the first to use in-depth qualitative interviews to assess views of autism self-advocates regarding genetic testing, highlights key complexities. Respondents felt that such testing is neither wholly good or bad in itself, but rather may be acceptable depending on how it is used, and should be employed in beneficial, not harmful ways. These findings have important implications for practice, education of multiple stakeholders, research, and policy.

History of Eugenics in Otorhinolaryngology: Ernst Rüdin and the International Eugenics Network

Introduction  The early geneticist and psychiatrist Ernst Rüdin (1874-1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi era. His connections in the international eugenics network have played an important role in the history of eugenics. Objective  To discuss the connections between Ernst Rüdin's scientific group in Munich and Otmar von Verschuer's group in Frankfurt during the Nazi era. Methods  Otorhinolaryngological materials from Ernst Rüdin's former private library are presented, and they show Rüdin's deep involvement in the international eugenics network. These materials provide insights into early medical genetics in otorhinolaryngology. Results  One result of the present study is that eugenics groups from Munich, Frankfurt, and New York certainly influenced one another in the field of otorhinolaryngology. Karlheinz Idelberger and Josef Mengele were two scientists who performed hereditary research on orofacial clefts. Later, Mengele became deeply involved in Nazi medical crimes. His former work on orofacial clefts clearly had, to some extent, an influence on subsequent studies. Conclusion  An international eugenics network already existed before 1933. However, it becomes clear that the weaknesses of many early genetic studies did not enable its authors to draw firm scientific conclusions, suggesting that scientists lacked an accurate concept of the genetic causes of most illnesses.

Our values and our historical understanding of psychiatrists

Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s.

Revisiting Emil Kraepelin's eugenic arguments

It is widely recognized that Emil Kraepelin explicitly advocated for eugenic ideas in his academic works. Given the renewed interest in related concepts such as self-domestication and neo-Lamarckism in different contexts, this article revisits his eugenic arguments by scrutinizing a section of his seminal work, the 8th edition of his textbook published in 1909. Our analysis reveals that Kraepelin's arguments consisted of multiple theories and ideas prevalent at the time (i.e. self-domestication hypothesis, neo-Lamarckism, degeneration theory, social Darwinism, racism and ethnic nationalism), each of which presented individual fundamental claims. Nevertheless, Kraepelin amalgamated them into one combined narrative, which crystallized into an anti-humanistic psychiatry in the next generation. This paper cautions that a similar 'packaging of ideas' might be emerging now.

A Nietzschean critique of liberal eugenics

Ethical debates about liberal eugenics frequently focus on the supposed unnaturalness of its means and possible harm to autonomy. I present a Nietzsche-inspired critique focusing on intention rather than means and harm to abilities rather than to autonomy. I first critique subjective eugenics, the selection of extrinsically valuable traits, drawing on Nietzsche's notion of 'slavish' values reducible to the negation of another's good. Subjective eugenics slavishly evaluates traits relative to a negatively evaluated norm (eg, above-average intelligence), disguising a harmful intention to diminish the relative value of that norm. I then argue there is no objective form of eugenics on the Nietzschean ground that abilities are not valuable intrinsically; they are valuable only if one possesses the relative power to exercise them. Abilities frustrated by conflict with other abilities or environment are harmful, while disabilities that empower one's other abilities are beneficial. Consequently, all forms of eugenics are subject to the prior ethical critique of subjective eugenics.

'Dysgenic fertility' is an ideological, not a scientific, concept. A Comment on: 'Stability and change in male fertility patterns by cognitive ability across 32 birth cohorts' (2023), by Bratsberg & Rogeberg

Recently Bratsberg & Rogeberg (2023) presented an analysis in Biology Letters of how cognitive ability is associated with fertility in Norwegian men. Our concern relates to the theoretical framework of this paper. The analysis is framed around the concept of 'dysgenic fertility', which is treated throughout as a scientific theory, but 'dysgenic fertility' is not science, it is an ideological concept.

Toward depathologizing queerness: An analysis of queer oppression in clinical genetics

Critically examining the way that the field of clinical genetics has impacted queer communities offers the field an opportunity to strengthen our commitment to inclusive high-quality care to all patients, families, and communities. This article reviews the origins of clinical genetics and genetic counseling in the eugenics movement and how this ontology promoted harmful medical practices grounded in assumptions of what is "normal." We critically examine existing clinical genetics practices and how commonly used binary frameworks for gender, sex, and sexuality perpetuate heteronormative, cisnormative, and bioessentialist assumptions. In order to move toward queer inclusivity, the genetic counseling field must first take accountability for past injustices. Restorative justice and trauma-informed approaches offer a way to engage with the queer community and to begin to rectify the history of medical harm. Through our analysis, we advocate for expanding efforts to depathologize queerness, promote bodily autonomy, and provide equitable healthcare for the queer community.

Evolved Eugenics and Reinforcement of "Othering": Renewed Ethico-Legal Perspectives of Genome Editing in Reproduction

This article extends an exploration into renewed ethico-legal perspectives of genome editing technologies, examined from an evolved conceptualization of eugenics in contemporary human reproduction. Whilst the ethico-legal conundrums presented by genome-editing technologies in various aspects of modern medicine have thus far inspired a comprehensive trove of academic scholarship-and notwithstanding the World Health Organization's (WHO) publication of guidelines on human genome editing in 2021-the legislative landscape for these technologies remain relatively unchanged. Accordingly, this paper presents the unresolved problematic questions that still require significant reflection. First, the paper highlights these questions, which primarily center around the tension between reproductive autonomy and the legal governance of reproductive/genome editing technologies by a democratic state. Secondly, the paper interrogates the evolved conceptualization of eugenics, exercised on the part of prospective parents as part of reproductive autonomy. By this, the paper predicates that it indirectly reinforces societal and systemic problems of discrimination and "othering", increasing reproductive inequalities in excluded communities. Thirdly, the paper attempts to offer narratives of intersectionality as a facilitating tool in a continuing dialogue to build belonging, foster a healthy and balanced exercise of reproductive autonomy, and increase reproductive equalities.

An imbalanced approach to governance? An analysis of the WHO's position on human genome editing

In 2021, the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing (the 'Committee') published its policy recommendations. It proposes, inter alia, a set of nine values and principles to inform the governance of human genome editing (HGE) and makes recommendations regarding how HGE can be regulated. While these proposals contain valuable contributions to the discourse on the global governance of HGE, they also contain elements that call for heightened attention to the risks of the technology, and a countervailing focus on the potential benefits of the technology is missing. The Committee ostensibly prioritises restricting HGE technology in the interest of society as a collective but, in doing so, neglects to consider the interests and rights of individuals. In this article, we suggest that this approach is imbalanced insofar as it fails to give sufficient weight to the promise of this technology in considering the regulation of risks and disregards the importance of the fundamental liberties underlying the use of HGE in its discussion of values and principles that should guide governance. How this is problematic is illustrated with reference to the Committee's openness to using patents as HGE governance tools and its blanket rejection of 'eugenics'. It is concluded that while the Committee makes some sensible recommendations on global governance, the Committee's approach of emphasising restrictions on HGE without also giving weight to the value of an open and liberal policy space is not something that liberal democratic states ought to follow.

'Picture imperfect': the motives and uses of patient photography in the asylum

In the nineteenth century, photography became common in psychiatric asylums. Although patient photographs were produced in large numbers, their original purpose and use are unclear. Journals, newspaper archives and Medical Superintendents' notes from the period 1845-1920 were analysed to understand the reasons behind the practice. This revealed: (1) empathic motivation: using photography to understand the mental condition and aid treatment; (2) therapeutic focus on biological processes: using photography to detect biological pathologies or phenotypes; and (3) eugenics: using photography to recognise hereditary insanity, aimed at preventing transmission to future generations. This reveals a conceptual move from empathic intentions and psychosocial understandings to largely biological and genetic explanations, providing context for contemporary psychiatry and the study of heredity.

Science and pseudo science: racist eugenics in Italy

In the present article we briefly discuss the historical premises of eugenics. Differences and some analogies between the Latin and the German way of eugenics in the 20th century are presented, until the tragic antisemitic turn. The fate of some children in the South Tyrol border region is also discussed, as well as the role of several anatomo-pathologists as willing executors of autopsies on the victims of the eugenic project of eliminating mentally and physically disabled people.

From preventive eugenics to slippery eugenics: Population control and contemporary sterilisations targeted to indigenous peoples in Mexico

Eugenic ideas in Mexico were popularised after the Mexican Revolution (1910-1920) as a way of 'modernising' and 'civilising' the nation. As a result, eugenic ideas were able to linger and be maintained through different departments, institutions, and individuals from all disciplines. After eugenics was considered a pseudoscience, its practices and ideas continued through population control measures that targeted indigenous populations for sterilisation, a trend that still prevails. The purpose of this article is to explore the legacies of eugenics in current sterilizations procedures mostly targeted at indigenous communities in Mexico. I offer the term 'slippery eugenics' to account for the legacies of eugenics in Mexico which, in this specific case, resurface in the systematic forced and coerced sterilisation procedures targeted at indigenous communities.

Made, Not Begotten: IVF and the Right to Life Under Conditions

In a society in which the decoupling of sexuality and human reproduction has become normal, In vitro fertilization (IVF) has mutated into a kind of standard procedure. There is little awareness of the ethical ruptures that the mechanization of human reproduction causes. The basic ethical problem with extracorporeal fertilization in a test tube is that a child is not conceived through the personal union of a man and a woman, but is "produced" in a laboratory. In the context of human creation, this entails a series of ethical problems. The technique does not merely offer another possible option for action, but it leads to a fundamental change in the attitude towards human life as such. A look at the history of assisted reproductive technology (ART) since the 1970s reveals that ethical problems, eugenic visions as well as medical experiments on humans have been inherent to the method from the very beginning. Considering that eugenic thinking has been a driving force from the very beginning it astonishes that this delicate point has hardly been recognized and highlighted so far. Robert Edwards' (1925-2013) vision went far beyond the mere treatment of infertility through the use of IVF, which he saw as enabling the selection of so-called "unhealthy life." The article considers the risks of IVF and includes recent studies by physicians involved in reproductive medicine who are increasingly critical of their industry. Furthermore it emphasizes the core ethical question on human reproductive technology, contrasting the "ethics of procreation" with the "ethics of production."

Summary

The article highlights historical aspects, considers the risks as well as the ethical questions on assisted reproductive technology.

Behavioral genetics and genomics: Mendel's peas, mice, and bees

The question of the heritability of behavior has been of long fascination to scientists and the broader public. It is now widely accepted that most behavioral variation has a genetic component, although the degree of genetic influence differs widely across behaviors. Starting with Mendel's remarkable discovery of "inheritance factors," it has become increasingly clear that specific genetic variants that influence behavior can be identified. This goal is not without its challenges: Unlike pea morphology, most natural behavioral variation has a complex genetic architecture. However, we can now apply powerful genome-wide approaches to connect variation in DNA to variation in behavior as well as analyses of behaviorally related variation in brain gene expression, which together have provided insights into both the genetic mechanisms underlying behavior and the dynamic relationship between genes and behavior, respectively, in a wide range of species and for a diversity of behaviors. Here, we focus on two systems to illustrate both of these approaches: the genetic basis of burrowing in deer mice and transcriptomic analyses of division of labor in honey bees. Finally, we discuss the troubled relationship between the field of behavioral genetics and eugenics, which reminds us that we must be cautious about how we discuss and contextualize the connections between genes and behavior, especially in humans.

"All emigrants are up to the physical, mental, and moral standards required": A tale of two child rescue schemes

The current paper critically assesses and reflects on the ideals and realities of two major (British) child migration schemes, namely the British Home Child scheme (1869-1930) and the Kindertransport scheme (1938-1940), to add to current understandings of their place within wider international histories of child migration, moral reforms, eugenics, settlement, and identity. Specifically, we focus on constructions of "mentally and physically deficient" children/young people, informed by eugenic viewpoints and biological determinism, and how this guided inclusion and exclusion decisions in both schemes. Both schemes made judgements regarding which children should be included/excluded in the schemes or returned to their country of origin (as was the case with children in the Canadian child migration scheme) fueled by a type of eugenics oriented to transplanting strong physical and psychologically resilient specimens. By viewing the realities of the child migration schemes, including the varied experiences and narratives in relation to child migrants, in light of eugenicist narratives of difference, pathology, victimhood, and contamination, we shed a light on uneven practices, formations of power, and expectations of the times.

Critical Periods in Science and the Science of Critical Periods: Canine Behavior in America

This article offers a canine history of the "critical period" concept, situating its emergence within a growing, interdisciplinary network of canine behavior studies that connected eugenically minded American veterinarians, behavioral geneticists, and dog lovers with large institutional benefactors. These studies established both logistical and conceptual foundations for large-scale science with dogs while establishing a lingering interdependence between American dog science and eugenics. The article emphasizes the importance of dogs as subjects of ethological study, particularly in the United States, where some of the earliest organized efforts to analyze canine behavior began. Further, the article argues that the "critical period" is important not only for its lasting prominence in multiple fields of scientific inquiry, but also as a historiographical tool, one that invites reflection on the tendency of historians to emphasize a particular narrative structure of scientific advancement.

Reproductive justice for the haunted Nordic welfare state: Race, racism, and queer bioethics in Finland

The Nordic welfare state aims to offer universal healthcare and achieve good health, bar none. We discuss past and present moral blind spots in welfare state bioethics through reproductive justice and queer bioethics, particularly focusing on race and racism, based on ethnographic data from Finland. Globally portrayed as aspirational and mostly uninterrogated, it is crucial to have a thorough bioethical evaluation of a Nordic model informed by Black and queer perspectives. We have come to conceptualize the Finnish welfare state as haunted. We fear that the seemingly non-racial racial hygiene continues to haunt bioethics of the welfare state as structural racism. A key cause for this concern is the lack of racial awareness in public politics and the reluctance in discussing racism due to the national agenda of color-blindness. This crucially compounds to our findings that medical professionals prefer to think they operate on "purely medical" reasoning as opposed to nuanced ethical contemplation, the latter associated with "social issues" that allegedly cannot be resolved and are outside medical interest. We discuss how the bioethical aftermath of eugenics remains unresolved. Racist, classist, sexist, ableist, and cis- and heteronormative stratification of reproduction requires a nuanced moral compass for Nordic welfare state bioethics, not "strictly medical practice." We suggest queer bioethics as a moral theory for recalibrating this compass, joining forces with other justice movements to tackle racism in healthcare and further to interrogate racism, sexism, ableism and cis- and heteronormativity in bioethics.

You can't keep a bad idea down: Dark history, death, and potential rebirth of eugenics

"Be careful what you wish for": This adage guides both how this project came to life, and how the topic covered in this review continues to unfold. What began as talks between two friends on shared interests in military history led to a 4-year discussion about how our science curriculum does little to introduce our students to societal and ethical impacts of the science they are taught. What emerged was a curricular idea centered on how "good intentions" of some were developed and twisted by others to result in disastrous consequences of state-sanctioned eugenics. In this article, we take the reader (as we did our students) through the long and soiled history of eugenic thought, from its genesis to the present. Though our focus is on European and American eugenics, we will show how the interfaces and interactions between science and society have evolved over time but have remained ever constant. Four critical 'case studies' will also be employed here for deep, thoughtful exploration on a particular eugenic issue. The goal of the review, as it is with our course, is not to paint humanity with a single evil brush. Instead, our ambition is to introduce our students/readers to the potential for harm through the misapplication and misappropriation of science and scientific technology, and to provide them with the tools to ask the appropriate questions of their scientists, physicians, and politicians.

Demography and the rise, apparent fall, and resurgence of eugenics

Demography was heavily involved in the eugenics movement of the early twentieth century but, along with most other social science disciplines, largely rejected eugenic thinking in the decades after the Second World War. Eugenic ideology never entirely deserted academia, however, and in the twenty-first century, it is re-emerging into mainstream academic discussion. This paper aims, first, to provide a reminder of demography's early links with eugenics and, second, to raise awareness of this academic resurgence of eugenic ideology. The final aim of the paper is to recommend ways to counter this resurgence: these include more active discussion of demography's eugenic past, especially when training students; greater emphasis on critical approaches in demography; and greater engagement of demographers (and other social scientists) with biologists and geneticists, in order to ensure that research which combines the biological and social sciences is rigorous.

Triage 4.0: On Death Algorithms and Technological Selection. Is Today's Data- Driven Medical System Still Compatible with the Constitution?

Health data bear great promises for a healthier and happier life, but they also make us vulnerable. Making use of millions or billions of data points, Machine Learning (ML) and Artificial Intelligence (AI) are now creating new benefits. For sure, harvesting Big Data can have great potentials for the health system, too. It can support accurate diagnoses, better treatments and greater cost effectiveness. However, it can also have undesirable implications, often in the sense of undesired side effects, which may in fact be terrible. Examples for this, as discussed in this article, are discrimination, the mechanisation of death, and genetic, social, behavioural or technological selection, which may imply eugenic effects or social Darwinism. As many unintended effects become visible only after years, we still lack sufficient criteria, long-term experience and advanced methods to reliably exclude that things may go terribly wrong. Handing over decision-making, responsibility or control to machines, could be dangerous and irresponsible. It would also be in serious conflict with human rights and our constitution.

'Witness in White' medical ethics learning tours on medicine during the Nazi era

During the Nazi era, physicians provided expertise and a veneer of legitimacy enabling crimes against humanity. In a creative educational initiative to address current ethical dilemmas in clinical medicine, we conduct ethics learning missions bringing senior physicians to relevant Nazi era sites in either Germany or Poland. The tours share a core curriculum contextualising history and medical ethics, with variations in emphasis. Tours to Germany provide an understanding of the theoretical origins of the ethical violations and crimes of Nazi physicians. Tours to Poland address the magnitude of the Nazi physician's atrocities as well as displays of heroism by Jewish and righteous among the nations' physicians. Exemplary as well as shameful physician behaviour is analysed from an ethical perspective. A combination of unique educational methodologies maximises learning and personal growth, enabling participants to examine ethically complex clinical situations with extrapolation to modern-day medical practice. Learning is designed with relevance to contemporary medical ethics dilemmas such as beginning and end-of-life issues, providing tenets from which participants can develop as more ethical and informed physicians. Participant feedback confirms efficacy and worth of these growth-promoting ethics learning tours which should be expanded to other international groups and settings (see online film Witness in White Berlin 2019 available at https://www.youtube.com/watch?v=75VUZvo3Bec).

Medical decisions influenced by eugenics: Hungarian gynecological practices during the 1910s

This study contributes to the discussion on the development of eugenics in Central-Eastern Europe by tracing the way that eugenic ideas entered into medical decision-making in Hungary. Through a case study that reviews the professional argumentation of the gynecological management of tuberculosis pregnancies, this paper shows that the subordination of individual reproductive rights to state interests was influenced by the ideas of eugenics, which had begun to enter into the professional public health discourse. A eugenically informed morality was envisioned, to guide decision-making in the interest of the Hungarian "race." This biopolitically important morality can be viewed as an early influence on the formulation of biological citizenship. Leading figures were divided on how to ensure such morality: some scholars argued that education is the key, others thought that the state, and state actors, should act radically in the interest of the population and decide on behalf of the individual. Radical methods, such as the termination of pregnancies and sterilization of women, were among the practices of gynecologists. Although abortion and sterilization were not widespread and never became official therapeutic solutions for tuberculosis pregnancies, they were nonetheless part of a discourse that preceded the eugenic institutions of the interwar years.

"Our one great national malady": Neurasthenia and American Imperial and Masculine Anxiety at the Turn of the Twentieth Century

White upper middle-class Americans at the turn of the twentieth century were entrenched in a battle with a newly discovered, or invented, mental illness called neurasthenia. This essay examines the ways in which the medical discourse of neurasthenia reflected late nineteenth- and early twentieth-century white Anglo-Saxon men's belief in, as well as anxiety over, American values bolstered by their idea of cultural, racial, and sexual superiority and consolidated through a conjunction of medicine and politics. The idea of neurasthenia as white American men's malady functioned as a mark both of whites' racial superiority to the "new" immigrants and African Americans as well as of women's intellectual inferiority to the opposite sex of their own race. Imposing a subtle distortion on the etiology and diagnosis of neurasthenia and associating it with specific groups of people, the "American disease" constituted the era's representative pathological symptoms which addressed Anglo-Saxon American men's anxieties about overcivilized effeminacy and racial and national decadence which was originated as a response to the racial and sexual heterogeneity. This essay also argues that neurasthenia was an imagined disease which addressed late nineteenth-century American men's spatial anxiety about the decline of the American pastoral ideal caused by the closure of the frontier. Given that the treatment for neurasthenic men was an escape to the frontier in the West in which they could rejuvenate withered American masculinity, their uneasiness about barbarous, unhygienic, and prolific immigrants and unruly white women, in fact, was tied to their spatial anxiety which symptomatically signifies the crisis of American masculinity. Channeled through the medical knowledge of neurology, it made American men's racial, sexual, and spatial anxieties function to act out their racist, misogynist, nativist, and imperialist impulses which legitimized exclusionary political techniques toward the racial and sexual others such as the U.S. imperial expansion in the 1890s and 1900s and a eugenic-influenced immigration policy from the 1900s through the1920s. In this sense, the decline of neurasthenia around 1920 should not be attributed solely to the continued efforts to professionalize American medicine accompanied by recent discoveries of chemical factors such as hormones and vitamins and the rise of psychiatry and psychology which offered physicians with a more specific theory of health built on clinical laboratory science. Like its rise, the decision to move away from the neurasthenic diagnosis was rather a cultural phenomenon, which reflected the American ascendancy to global power in the early twentieth century, particularly after the First World War. Sustaining a political order rested on racial and sexual hierarchies both within and outside the American continent, American men felt that they were no longer liable to specific, time-tested anxiety and somatic symptoms of neurasthenia, which was more an ideological and cultural construct than a clinical entity that dramatizes the racial, sexual, and imperial politics of the-turn-of-the-twentieth-century America.

Posthumanism: Creation of 'New Men' Through Technological Innovation

The posthumanist project proposes directing the evolution of human beings by promoting their improvement through technological means to create a variety of entities that will have few or no common characteristics with current humans. Its agenda is extremely broad and this study mostly addresses enhancement of the human organism through genetic modification techniques. An overview of posthumanist values and a brief discussion of its philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess some claims of the posthumanist program of creating evolved humans; in particular, the capabilities and limitations of techniques for somatic and germline genome editing. Consequences of the creation of posthumans are discussed in relation to accepted current human beings and values. It is concluded that the posthumanist program rests on a large number of hypotheses without sufficient evidence and with little or no consideration of the consequences of its implementation.

[Effect of therapies for kidney-tonifying and blood-activating in treatment of anovulatory infertility in eugenics]

In the context of the new era, paying attention to maternal and child health and advocating prenatal and postnatal care can effectively improve the quality of the birth population. Traditional Chinese medicine has a long history of prenatal and postnatal healthcare with rich content, which is the theoretical basis of modern related services. With the social development and the improvement of people's awareness of prenatal and postnatal healthcare, people have gradually shifted the focus of prenatal and postnatal healthcare to the peri-pregnancy stage at present, namely that couples of childbearing age are guided to prepare for pregnancy under the premise of solving their basic diseases. Infertility is a common and refractory disease for women of childbearing age. Ovulation disorder is one of its common pathological mechanisms. Traditional Chinese medicine believes that kidney deficiency is the main cause and pa-thogenesis of anovulation infertility and blood stasis is an important factor throughout the disease course. In clinical practice, therapies for invigorating kidney and activating blood are safe and reliable to treat anovulatory infertility mainly by adjusting the hypothalamus-pituitary-ovarian axis, improving ovarian function, uterine environment and gamete quality and increasing endometrial volume. Under the guidance of the thought of prenatal and postnatal healthcare, the authors tried to explore the effect of therapies for kidney-tonifying and blood-activating in the treatment of anovulatory infertility in eugenics, with the purpose of providing ideas and basis for subsequent relevant clinical studies and contributing to prenatal and postnatal healthcare services.

The emergence of the "genetic counseling" profession as a counteraction to past eugenic concepts and practices

The emergence of the genetic counseling profession has allowed laypeople to understand and benefit from biological advances, and to make critical decisions about their application. The discipline of genetic counseling has been criticized from its very beginning, in particular because of its early association with the eugenics movement. This paper presents a critical and reflective overview of how genetic counseling is implicitly embedded in the history of eugenics but also counteracts past eugenic practices and ideas. After World War II, attempts were made to distance genetic counseling from eugenics. The first definition of genetic counseling did not position this field as a medical encounter but "as a kind of genetic social work aimed primarily to provide people with an understanding of their family's genetics problems." This approach was a reaction to the genetic and social evolutionary ideas that informed eugenic theories during the first half of the 20th century. Professionals engaged in genetic counseling during the 1940s and1950s rejected eugenic practices, but there was still support for eugenics' goals of improving heredity and eliminating disease. From the 1960s, genetic counseling underwent professionalization alongside feminization and a definition of core values. Among these values were nondirectiveness counseling and the autonomy of the counselee. The dark shadow of Nazi ideology and other eugenic practices, attempts to employ the historical responsibility of geneticists, and the dynamic medical, social, political, and educational changes of the 1960s and 1970s helped to frame approaches and delineate the goals and limits of the new profession of "genetic counseling."

Avoiding 'selection'?-References to history in current German policy debates about non-invasive prenatal testing

This article investigates the role of historical references and arguments in the current policy debate on non-invasive prenatal testing (NIPT) in Germany. It analyses major documents and opinion statements, including the recent parliamentary debate (2019). The implementation of NIPT is accompanied by concerns and strong criticism, particularly in Germany. Many perceive the new test to be a problematic step that facilitates selective practices and is reminiscent of eugenics. Analysis of the German policy discourse shows that 'eugenics', and even more strongly, 'selection', are pivotal terms for rejecting NIPT and its coverage by public health insurance. They touch on a historical dimension in public deliberation, namely the fundamental distancing from the inhuman practices of the National Socialist period and anything that resembles them. However, using these terms to criticize prenatal genetic testing is controversial, and recent discourse demonstrates their avoidance as well, with many supporters of a limited coverage by public health insurance contrasting their approach with more widespread screening. Here, 'screening' has a negative connotation, and functions to demarcate the debate in a way that may reflect distance from certain modes of historical reasoning, but still expresses a special need to reconcile prenatal testing with the principles of dignity, inclusion and diversity. This article aims to elucidate the concerns involved in the national debates on prenatal testing and to increase awareness of the historical dimensions of the language and reasoning with which such methods are negotiated today and in future.

The ethics of genetic screening for beta thalassemia in Vietnam

In this paper, I argue that genetic screening for beta thalassemia major is ethically justified in the context of Vietnam. First, I differentiate genetic screening from the moral objections commonly associated with eugenics on the basis of the primary motive for screening (avoidance of suffering) and the preservation of voluntary choice. To lay the groundwork for ethical discussion, I explain the basics of beta thalassemia biochemistry and screening and the clinical picture of beta thalassemia major. I then elaborate on a specific example of the challenges of beta thalassemia major in Cyprus before moving on to the case of Vietnam and discuss the improbability of treatment for this disorder in Vietnam and therefore, the extensive suffering that it causes the Vietnamese people. This leads to my argument that a beta thalassemia screening in Vietnam would hold up the ethical principle of nonmaleficence and also preserves and enhances reproductive choice. I then propose that Vietnam's successful COVID-19 response can be used as a roadmap for beta thalassemia screening.

Transhumanist Genetic Enhancement: Creation of a 'New Man' Through Technological Innovation

The transhumanist project of reshaping human beings by promoting their improvement through technological innovations has a broad agenda. This study focuses on the enhancement of the human organism through genetic modification techniques. Transhumanism values and a discussion of their philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess the claims of the transhumanist program of human enhancement. A succinct description of central concepts in genetics and an explanation of current techniques to edit the human genome serve to assess the capabilities and limitations of editing techniques. Potential benefits and liabilities of human enhancement through genome editing are discussed to appraise its feasibility. Ethical considerations of genome editing inform a reflection on the implications of introducing heritable changes in the genome of individuals. It is concluded that the transhumanist program is underpinned by a large number of hypotheses rather than by sufficient evidence.

Elements of a counter-exhibition: Excavating and countering a Canadian history and legacy of eugenics

Into the Light, a recently mounted collectively curated museum exhibition, exposed and countered histories and legacies of 20th-century "race betterment" pedagogies taught in Ontario's postsecondary institutions that targeted some groups of people, including Anishinaabe, Black, and other racialized populations, and disabled and poor people, with dehumanizing ideas and practices. This article advances understandings of the transformative potential of centralizing marginalized stories in accessible and creative ways to disrupt, counter, and draw critical attention to the brutal impacts of oppressive knowledge. The "counter-exhibition" prioritized stories of groups unevenly targeted by such oppression to contest and defy singular narratives circulating in institutional knowledge systems of what it means to be human. The authors draw on feminist, decolonial and disability scholarship to analyze the exhibition's curation for the ways it collectively and creatively: (1) brought the past to the present through materializing history and memory in ways that challenged archival silences; and (2) engaged community collaboration using accessible, multisensory, multimedia storytelling to "speak the hard truths of colonialism" (Lonetree) while constructing a new methodology for curating disability and access (Cachia). The authors show how the exhibition used several elements, including counter-stories, to end legacies of colonial eugenic violence and to proliferate accounts that build solidarity across differences implicated in and impacted by uneven power (Gaztambide-Fernández).

Doing history that matters: Going public and activating voices as a form of historical activism

For many of us academics, doing community-engaged research means coming to terms with the significant gaps in experience, privilege, and power, and overall access to knowledge. We are trained to learn through texts, not through direct experience. In some ways, we are even conditioned to tune out experience, or anecdote, to dilute personal subjectivities in favor of a critical analysis informed by a combination of methods and sources, and a reliance on text-based forms of evidence. Whereas for most community members, evidence is experiential. This dynamic also underscores the tremendous power and responsibility we have as historians to shape identities and legacies through the stories we tell. In the end, I believe the risks are worth the rewards.

Race, eugenics, and the canceling of great scientists

Special Issue: Race reconciled II: Interpreting and communicating biological variation and race in 2021 Francis Galton and Karl Pearson.

Race biology

BACKGROUND

The founders of Hereditas envisioned that race biology would be a major subject that had social applications with utmost importance in the near future. Anthropometrics was in this context understood to be the pure and eugenics the applied science. Sweden had a long tradition in physical anthropometry. Herman Lundborg, member of the advisory board of Hereditas, united the anthropometric and eugenic approaches in a synthesis. He was the first head of the Institute for Race Biology in Sweden. The contents of Hereditas reflect the development of race biology in the Nordic countries.

CONCLUSIONS

The initial enthusiasm for applied race biology did not last long. In the 1920's Hereditas carried papers on both physical anthropology and eugenics. Most paper dealt, however, with human genetics without eugenic content. Two papers, published in 1921 and 1939 show how the intellectual climate had changed from positive to negative. Finally only human genetics prevailed as the legitimate study of the human race or humankind. A belated defense of eugenics published in 1951 did not help; geneticists had abandoned anthropometrics for good around the year 1940 and eugenics about a decade later. In spite of that, eugenic legislation was amended astonishingly late, in the 1970's. The development was essentially similar in all Nordic countries.

'These were made-to-order babies': Reterritorialised Kinship, Neoliberal Eugenics and Artificial Reproductive Technology in Kishwar Desai's Origins of Love

This essay examines Kishwar Desai's Origins of Love (2012) in order to foreground how the novel is complexly reflective of the biomedical technologies strategically deployed by medical practitioners and prospective parents for the purpose of reinforcing caste-based bionormative notion of family that artificial reproductive technology is assumed to have problematised. The essay also demonstrates how the use of bioenhancement facilities has led to the revival of neoliberal eugenics enmeshed with state-led biopolitics. The essay draws on the concept of renaturalisation discussed by Tamar Sharon in order to examine how the schizophrenic or deterritorialising potential of reproductive technology is reconfigured and domesticated by the medicolegal practitioners in order to reterritorialise the normative structures of kinship and family formation within a capitalist consumerist culture.

"They love death as we love life": The "Muslim Question" and the biopolitics of replacement

This article approaches the analytic of the "Muslim Question" through the prism of the discursive and conspiratorial use of demographics as an alleged threat to Europe. It argues that concerns about "Muslim demographics" within Europe have been entertained, mobilized, and deployed to not only construct Muslims as problems and dangers to the present and future of Europe, but also as calls to revive eugenic policies within the frame of biopower. The article begins by sketching the contours of the contemporary "Muslim Question" and proceeds with a critical engagement with the literature positing a deliberate and combative strategy by "Muslims" centered on birth rates-seen by these authors as a tactical warfare-to allegedly replace European "native" populations. The analysis continues by focusing on two images juxtaposing life and death as imagined within the replacement discourse, and that capture that discourse in powerful albeit disturbing ways. Finally, the article proposes reading the population replacement discourse as a deployment of biopolitics and one of its many techniques, namely, eugenics.

"Une plus brillante moisson de citoyens sains et robustes": Eugenic Discourses in French Canada (1902-10)

The Association des médecins de langue française d'Amérique du Nord (AMLFAN) was founded in Québec at the turn of the twentieth century. The physicians who convened at the Association between 1902 and 1910 shared a concern for the degeneration of the French-Canadian "race" under the effects of alcoholism, tuberculosis, and syphilis. For hygienists such as Arthur Rousseau and Charles-Narcisse Valin, this state of degeneration called for hygienic measures that would help regenerate and improve the French-Canadian race. While their suggestion that marriages be matched scientifically in order to prevent the transmission of hereditary and acquired defects from parent to offspring may be reminiscent of eugenics, French-Canadian physicians seemed to have no knowledge of Sir Francis Galton - eugenics' "founding father" - and his work on the topic. This article compares French-Canadian eugenic discourses with Galtonian eugenics in order to shed light on the particularities of the French-Canadian case.

"Why do we measure mankind?" Marketing anthropometry in late-Victorian Britain

In the late nineteenth century, British anthropometrists attempted to normalize the practice of measuring bodies as they sought to collate data about the health and racial makeup of their fellow citizens. As the country's leading anthropometrists, Francis Galton and Charles Roberts worked to overcome suspicion about their motives and tried to establish the value of recording physical dimensions from their subjects' perspective. For Galton, the father of the eugenics movement, the attainment of objective self-knowledge figured alongside the ranking of one's physique and faculties against established norms. The competitive tests at Galton's anthropometric laboratory were meant to help subjects identify their strengths and weaknesses, ultimately revealing their level of eugenic fitness. Roberts, on the other hand, saw the particular value of anthropometric data in informing economic and social policy, but capitalized on parents' interest in their children's growth rates to encourage regular monitoring of their physical development. While both Galton and Roberts hoped that individuals would ultimately furnish experts with their anthropometric data to analyze, they both understood that the public would need to have explained the practical purposes of such studies and to familiarize themselves with their methods. This article argues that while anthropometry did not become a fully domestic practice in this period, it became a more visible one, paving the way for individuals to take an interest in metrical evaluations of their bodies in the coming years.

Care haunts, hurts, heals: The promiscuous poetics of queer crip Mad care

Care is a dirty word for many in our communities. "Caregiving" has become a euphemism for often-indifferent, under-funded labor that is done to our bodies to (barely) enable our continued survival. Care is a dirty word in many of our leftist-feminist communities. Care work is a classification of highly gendered and racialized labor that remains largely unpaid, underpaid, and deeply devalued. Care is a dirty word in our Mad, disability, queer activist communities. "Taken into care" often refers to indefinite confinement, forced extraction from communities and families, and the removal of one's right to self-determination. Is care even worth reclaiming? In this creative duo-ethnography, a Mad fat femme and a crip ill non-binary queerdo wander through various moments when care has most impacted our lives, our relationships, and our communities. We have each held one another with care on the precipice of dying. Our bodies have shouldered the love-labor of care in the most intimate, exigent, and banal of moments: consensual and playful medication reminders, postsurgery tampon changing, literally squeezing out another's breath to stay alive-and then repeating-hundreds of times an evening. We have also experienced care that was much too careful, and anything but full of care. We have shared care promiscuously with our crip and Mad (arts) communities in ways that have been life affirming, life changing, sometimes life making, other times life threatening. Through this wandering with ideas, moments, and communities, we reflect upon multiple dimensions of Mad, queer, crip care. Whom is the caring for? What is our care about? And how can our care be given or giving, taken or shared, offered, enabled, and co-created with flourish?

Involuntary Sterilisation, Eugenics, and Physician-assisted Dying: Lessons for New Zealand

Opponents of physician-assisted dying (PAD) view it as modern eugenics and a significant risk to people with disabilities. The involuntary surgical sterilisation (ISS) of girls and young women with intellectual disabilities is an example of eugenics in practice. This article reviews the social and political attitudes toward ISS and PAD in New Zealand, England, and the United States. The attitudes were compared to determine if they demonstrated any indicators of potential PAD-related harm for people with intellectual disabilities. The research identified several issues, which need to be considered to ensure the safety of people with intellectual disabilities if New Zealand was to legalise PAD.

Illuminating nursing's shadow side through a Jungian analysis of the film Fog in August

Fog in August is a German film based on Robert Domes' historical novel of the same name. The film provides a fictionalized account of the institutionalization and eventual killing of children and adults labelled as a burden on the State and unworthy of life. On one level, this is a story of good versus evil, where innocent patients are manipulated by callous doctors and nurses. At a deeper level, however, it is possible to read the characters as more complex and such a reading gives an insight into the paradox of how a genocidal policy was able to be systematically implemented by health care professionals who had previously taken an oath to provide care to all people. Carl Jung argued that powerful stories, told across generations, contain mythical archetypes that help drive the plot and convey beliefs about humanity. The aims of this paper are to explore Jungian ideas within Fog in August that help the historical story it is based on resonate with viewers today, and demonstrate how the application of these insights can help health care professionals more fully understand morally distressing events and, as a result, support and improve the safety of patients.

Person and ethics of a psychiatrist during National Socialism: Friedrich Meggendorfer (1880-1953)

Evaluation of sources not previously considered makes it possible to describe Friedrich Meggendorfer's role as a National Socialist university psychiatrist. Relevant archive material and literature were both assessed. The gene-hygiene affinity promulgated by Meggendorfer was based on his own scientific interests, early academic influences, and also positive reinforcement from his career choices. His application of scientific knowledge in the legitimization of National Socialist jurisdiction reflects a dark facet in Meggendorfer's life. One can also criticize his ethics in failing to use his eugenics expertise to stop 'euthanasia'. Future studies into the history of the ethical aspects of Nazi psychiatry should benefit from the setting up of criteria for the collection of biographical data. This would render comparisons and contrasts fairer and more stable.

Prenatal testing: Does reproductive autonomy succeed in dispelling eugenic concerns?

Traditionally, two main rationales for the provision of prenatal testing and screening are identified: the expansion of women's reproductive choices and the reduction of the burden of disease on society. With the number of prenatal tests available and the increasing potential for their widespread use, it is necessary to examine whether the reproductive autonomy model remains useful in upholding the autonomy of pregnant women or whether it allows public health considerations and even eugenic aims to be smuggled in under the smokescreen of autonomy. In this article I argue that if we are serious about upholding women's autonomy in the context of prenatal testing, what is needed is a model based on a more robust conception of reproductive autonomy, such as the one defended by Josephine Johnston and Rachel Zacharias as 'reproductive autonomy worth having'. While Johnston and Zacharias put forward a basic outline of this conception, I apply it to the specific case of prenatal testing and show how it responds to objections levelled against the reproductive autonomy model. I argue that adopting this kind of conception is necessary to avoid fundamental challenges to women's autonomy when it comes to prenatal screening and testing.

CRISPR'd babies: human germline genome editing in the 'He Jiankui affair'

The world was shocked in Nov. 25, 2018 by the revelation that He Jiankui had used clustered regularly interspaced short palindromic repeats ('CRISPR') to edit embryos-two of which had, sometime in October, become living babies. This article is an effort to provide some deep context for the He Jiankui affair and to begin analyzing it. It focuses on He's experiment, without delving into the broader ethical issues around 'human germline genome editing' in the abstract. It begins by carefully defining 'human germline genome editing'. It then describes the little we know about the experiment before providing background on CRISPR, the pre-He ethical and legal status of human germline genome editing, and on He himself. The fourth, and longest, section provides a detailed narrative of the revelation of the He experiment and its fallout. The fifth section critiques the experiment, which I believe merits unequivocal condemnation on several grounds. The last section suggests some important immediate reactions, by 'Science' and by China.

The professionalization of psychologists as court personnel: Consequences of the first institutional commitment law for the "feebleminded"

The first law providing for the permanent, involuntary institutionalization of "feeble-minded" individuals was passed in Illinois in 1915. This bill represented the first eugenic commitment law in the United States. Focusing on the consequences of this 1915 commitment law within the context of intelligence testing, eugenics, and the progressive movement, this paper will argue that the then newly devised Binet-Simon intelligence test facilitated the definition and classification of feeble-mindedness that validated feeble-mindedness theory, enabled the state to legitimize the eugenic diagnosis and institutionalization of feeble-minded individuals, and especially empowered psychologists to carve out a niche for themselves in the courtroom as "experts" when testifying as to the feeble-mindedness of individuals.

The Wisdom of Germline Editing: An Ethical Analysis of the Use of CRISPR-Cas9 to Edit Human Embryos

With recent reports that a Chinese scientist used CRISPR-Cas9 to heritably edit the genomes of human embryos (i.e., germline editing) brought to term, discussions regarding the ethics of the technology are urgently needed. Although certain applications of germline editing have been endorsed by both the National Academy of Sciences (US) and the Nuffield Council (UK), this paper explores the ethical concerns related even to such therapeutic uses of the technology. Additionally, this paper questions whether the technology could ever feasibly be contained to the therapeutic realm. Consequently, this paper necessarily considers the ethical concerns related to enhancement uses of the technology even if only therapeutic applications are initially considered. In light of the concomitant risks, this paper assesses the technology's countervailing benefits to conclude they do not prevail given that similar outcomes can largely be achieved with existing technologies. Consequently, this paper recommends an international ban on germline editing.

Fraught claims at the intersection of biology and sociality: Managing controversy in the neuroscience of poverty and adversity

In this article, I examine how a subfield of researchers studying the impact of poverty and adversity on the developing brain, cognitive abilities and mental health respond to criticism that their research is racist and eugenicist, and implies that affected children are broken on a biological level. My interviewees use a number of strategies to respond to these resurfacing criticisms. They maintain that the controversy rests upon a fundamental misunderstanding of their work. In addition, they use what I term 'plasticity talk', a form of anti-determinist discourse, to put forth what they believe is a hopeful conception of body and brain as fundamentally malleable. They draw attention to their explicit intentions to use scientific inquiry to mitigate inequality and further social justice - in fact, they believe their studies are powerful evidence that add to the literature on the social determinants of health. Though they may be interested in improving lives, they argue that their aims and means have little in common with programs trying to 'improve' the genetic stock of the population. I argue that theirs is a fraught research terrain, where any claims-making is potentially treacherous. Just as their studies of development refuse dualistic models, so too do their responses defy dichotomous categorization.

A colonial legacy of HIV/AIDS, NTD, and STI super-syndemics: Eugenicist foreign aid and intertwined health burdens in Nigeria

Syndemics theory has been applied to the structurally shaped, biologically facilitated co-occurrence of HIV/AIDS with Neglected Tropical Diseases (NTDs) and with sexually transmitted infections (STIs). The biological and social pathways of interaction between all three ailments have not yet been analysed together. The effects of these diseases are often exacerbated by structural factors including access to care and socioeconomic status. We explore the interrelated biological pathways and structural factors that have further heightened the risk for HIV/AIDS, NTDs, and STIs. Furthermore, we argue women in rural areas are at an increased risk for all three diseases due to biological and social factors including increased distance to quality care and lower reproductive autonomy. This paper integrates the established syndemics of HIV/NTDs and HIV/STIs within the historical and modern contexts of colonisation and neo-colonisation in Nigeria. We explore the effects of colonisation on women's health by evaluating the influence of foreign aid policies, structural programmes, and shifting gender norms. Applying a syndemic approach, juxtaposed by historical contextualisation, offers important implications for the prevention and treatment of HIV/AIDS, STIs, and NTDs. Our analysis suggests a perspective through which to view health of regions with a history of colonisation.

Eugenics and racial anthropology in the Ukrainian radical nationalist tradition

ArgumentEugenics and race played significant roles in Ukrainian interwar nationalism, yet remain largely unstudied. The Ukrainian nationalists' understanding of the racial makeup of their imagined community was contradictory as they struggled to reconcile their desire for racial "purity" with the realities of significant variations between the populations inhabiting the enormous territories which they sought to include in their intended state project. The "turn to the right" over the 1930s placed an increased onus on race, and eugenics came to occupy an increasingly prominent place in Ukrainian radical nationalism from around 1936. In 1941, the leading Ukrainian far-right organization, the OUN had developed a project for eugenic engineering, for their aborted state, declared in L'viv on June 30, 1941. Racial conceptualizations of the Ukrainian community figured prominently well into the Cold War era, gaining a new actuality and meaning in an émigré community dispersed across several countries.