Why have so many more BAME doctors died from COVID in the UK (Razaq et al 2020)? Why are people with learning and mobility disabilities 6 times more likely to die from COVID in the UK? Why did the government write to all care homes encouraging elderly residents to sign a DNAR (“do not attempt to resuscitate”) letter to release NHS resources to fight against COVID? This was a clear violation of their human rights (Amnesty International 2020). It is as if the government’s herd immunity was trying to separate the strong from the weak on purpose.
Indeed, the best way of thinking about COVID and eugenics in its purest form is to imagine that the state would do absolutely nothing to prevent the spread of the virus: the state would rather argue that the virus would weed out the weak like a shark in the ocean. The concern that welfare support systems would stop natural selection from weeding out bad genes was a key concern for eugenicists at the beginning of the last century. Neo-Malthusians argued that nature demanded adaptation and that species either mutated or fell victim to selection. The lower social strata’s calamity was not only based on immoral or short-sighted behavior but was a sign of a degeneration of the human species that modern life had made possible. Eugenicists assumed that people were moving to cities, living in poverty, and that poor hygiene and diseases had a direct impact on the genetic quality of the human stock (Nordensvärd, 2013). Human society and modernity had destroyed ‘positive genetic material’ and ‘degenerated people reproduced themselves thanks to welfare politics’ (Etzemuller, 2011, p. 104).
Eugenicists argued that without the state people would reproduce themselves in larger numbers and pass on these “undesired” genes with catastrophic consequences for the nation’s human stock. Modern health and social policies provided not only the institutional conditions to translate ‘eugenic rhetoric’ into practice, but a welfare state balancing ‘preventing degeneracy’ against ‘limit public expenditure’ (Mottier, 2008, p. 263). Progressive eugenicists, like the Swedish Nobel prize winners Gunnar and Alva Myrdal, argued that the state needed to intervene through both positive and negative eugenics. The Myrdals referred to the lower strata of society having too many children and the upper and middle strata too few by referring less to racial waste, than a social waste of ‘human material’ (Nordensvärd, 2013) from an explosion of social costs from the children of losers of the modernisation process (Myrdal and Myrdal, 1935). The Myrdals argued that the main goal of prophylactic Social Policy (profylaktisk socialpolitik) was to create a better ‘human material’ (Myrdal and Myrdal, 1935) by healthy nutrition, education and moral upbringing.
Their negative eugenics would improve the quality of ‘human material’ (Myrdal and Myrdal, 1935) through the compulsory sterilization of individuals deemed unfit to reproduce. While such negative eugenics is now unacceptable in contemporary discourse, COVID has offered a new laisser-faire eugenics in which the virus spreads among the population, strengthens the overall human stock and weeds out its weaker elements. This is the re-introduction of natural selection through the virus. It does not need a welfare state to decide but just lets nature do its work. This laisser-faire COVID eugenic will not need social engineering but will rely rather on the state to do less and let nature have its course. We can call it herd immunity or we can call laisser-faire eugenics.
The virus has already torn into the weakest and most marginalized of society so we need to ask hard questions of governments. The UK revelations that one of the world’s wealthiest governments exposed vulnerable groups to protect the NHS from the virus incurred accusations of incompetence and callousness. But the practice is well established and thoroughly normalised in medical ethics. Increasing the numbers of more desirable members of a society and reducing those less desirable is a core tenet of eugenics (Galton, 1883). Eugenics provided the scientific basis for discriminating against groups based on their genetic make up against a notion of an idealised society. While associated in its most heinous form with Nazism, eugenics was a progressive force across Europe and the USA in the early C20th. Indeed it is still present in the valuation of intellectual property rights of the genome project (Kevles 2011) and as idealised notions of society have informed social and family policy (Nunn & Tepe Belfrage 2017).
Politically it is not acceptable to state that UK COVID policy was to weed out the weakest. The government did not choose death for citizens, but it did choose austerity to reduce PPE reserves, it did choose to not invest in care and allow the private sector to drive down salaries, and it has made political choices that contributed to fewer nurses. More importantly Governments have developed utilitarian, ambiguous and almost arbitrary guidelines for who should be left to die. In the UK, as in other countries, quality of life years (QALYs) have been used to quantify the cost and benefit of distributing scarce medical resources. QALYs have been at the heart of NICE (the UK’s “National Institute for Health and Care Excellence”) since the beginning of the 21st century.
Yet the quantification of the quality of life presents many problems. It highlights the individual life of the patient over their family and carers, disregarding the broader benefits to society a life can bring (ironically QALYs ignore loneliness). A focus on individual treatments underestimates a systemic need to invest in social care, which the pandemic has also made abundantly clear. QALYs ignore social discrimination so place additional burdens on those on the periphery of society to demonstrate their value as privileges of class, race, productivity, royalty are not costed in. Those with disabilities or underlying health conditions are valued less by QALYs – UK daily briefings are not signed and consultations have favoured universal medicalised fixes at the expense of equal health rights for vulnerable groups. Policies such as shielding can therefore ignore the health needs and vulnerabilities of some groups who need to travel for care or who live in sheltered accommodation. Most obviously younger and more “productive” lives are given priority over health protection measures so that the economy can be saved.
COVID has shown us that eugenic assumptions about the deserving sick remain engrained in health care decisions. We need to focus on why this is so and to show it for what it is.
Charles Dannreuther (C.Dannreuther@leeds.ac.uk) & Johan Nordensvärd (firstname.lastname@example.org)