The Greatest Good

...When Galton died, in 1911, intelligence tests were starting to become a feature of American life...

...The relatively simple treatments available were provided in homes and neighborhood offices, or in hospitals run by the patient's religious denomination—to which the doctor himself usually belonged...

...Native-born Americans understood the English used in the tests better than immigrants did and had also received a better education...

...Whatever Jefferson meant by those strange words, they seem to point in a distinctly nonsociobiological direction...

...Henry Beecher published a famous article asserting that experiments by a number of prominent postwar researchers had not helped their subjects, and that some had been insufficiently apprised of risks...

...Disharmony between the interests of researchers and subjects, and doctors and patients, is no longer denied...

...The lessons that the medical researchers learned in their first extensive use of human subjects," reflects the author, "was that ends certainly did justif y means...

...Rothman's truly fascinating story is this three-fold transformation: of medical technology, the social environment of doctors, and the legal conditions under which they practice their art...

...Beecher's 1966 essay had such a great impact, though, that hardly anyone will still defend utilitarianism...

...Although bioethics claimed autonomy for the individual, at the same time it empowered a new class of medical decision makers—the courts, the clergy and philosophers...

...On the one hand, such efforts gave medicine something it had never had: a large number of effective treatments...

...A good question...

...But as Rothman demonstrates in several very painful chapters, many doctors appeared to ignore this injunction...

...At the start of the present century, it prevailed in the study of human behavior...

...Systematic research has generated many effective but complicated therapies...

...If nontherapeutic experimentation was needed, investigators themselves frequently took the role of the guinea pig...

...The progress was real, however, and Washington increased its funding of medical research from $700,000 in 1945 to $1.5 billion in 1970...

...Rather, Degler speculates plausibly, cultural explanations of human behavior were "perceived as being unable to lead to fresh outlooks or theories, or to answer novel questions...

...All recipients had interests different from those of all potential donors...

...After 1941, many of them abandoned such scruples...

...Boas didn't claim to have decisive evidence of an underlying racial equality...

...Organ transplants seemed to involve conflicts of interest among would-be recipients of scarce body parts...

...The estrangement bred suspicions that made it impossible for doctors to maintain their traditional freedom from outside regulation once it came under attack in the 1960s and '70s...

...Perhaps so, but such a conception of rights is appropriate to an aristocratic society, not a democratic one...

...Neither did most procedures require elaborate or protracted training...

...In any case, as Degler comments, it was overthrown not by "highly persuasive empirical evidence, unknown before, but rather by a willingness to substitute a new assumption powered by an ideological commitment...

...Nature cannot be meaningfully separated from nurture, and if the aim is simply to give the former its due, attempts to show that all behavior is fundamentally biological are pointless as well as mistaken...

...Before the late 19th century, its arsenals were filled with purist quackery...

...Degler, who approves all this, concedes that "New knowledge...

...Should we eventually come to see order and rank as our true needs, we will surely gravitate toward a more authoritarian kind of politics...

...In the past, doctors had defended their right to prescribe treatments at their own discretion by maintaining that they had no concerns other than those of the patient, and this assumption had been extended to cover medical researchers...

...was not in itself the primary impetus behind the new openness toward biology," any more than new scientific knowledge had been responsible for discrediting racism (or, forthat matter, the emergence of bioethics...

...Reproductive success shapes a large part of human behavior...

...The cases, Beecher insisted, were not atypical...

...What little of it had occurred before World War II could usually be defended as therapeutic—it helped the subject as well as humanity...

...And I myself am not reassured by Degler's contention that sociobiology seeks to find what is common to all human beings, not what distinguishes one group from another...

...Two anthropologists he cites undermine Barkow's logic, at least for me...

...Granted, not all sociobiologists are political conservatives, as Degler continually assures us, yet there is something unmistakably conservative about the idea that social ranking, authority—I'm sure you can add to the list—are permanently rooted in the deep dark heart of man...

...While the question is still open, he maintained, we must reject hereditarianism for moral reasons...

...Nothing in sociobiology makes this limitation inevitable...

...in the 1970s, for instance, studies showed that physicians at prominent maternity climes routinely decided, on their own, to starve defective infants to death...

...Let us consider one of the studies that Degler, at times a bit laboriously, describes...

...Less discussed and discussable are the interests of the patient and the patient's family...

...government decided, for the first time, to finance medical research...

...Other social scientists influenced by sociobiology characterize the principle of authority in a very similar way...

...Indeed, no w that even ordinary doctors were a caste apart, many of their patients suspected that they could not be trusted either...

...Over the past 50 years, argues David J. Rothman, they have become Strangers at the Bedside (Basic Books, 303 pp., $24.95...

...Training has thus become more time consuming and more technical, and the new methods are applied largely in hospitals by specialists who (whether Americans or foreigners) tend to speak only medical English...

...William Durham observes even more fundamentally that the mere fact of our sharing certain kinds of behavior with animals does not mean we could have gotten them only from animals...

...Utilitarianism has dominated different fields of endeavor at different times...

...James Silverberg points out that the universality of an aspect of human behavior does not in itself make it of biological origin...

...I regret that the author has arbitrarily excluded from his account medicine's loss of financial independence to the U.S...

...We have here an ideological perspective, not a scientific theory...

...Rothman calls this willingness to engage in ethically dubious conduct in order to produce results "medical utilitarianism...

...Over the next decade," notes Degler, they gave "proponents of eugenics a new and presumably objective basis for determining who was a desirable member of society...

...Scarcely less self-interested were the scholars who rejected this mentality...

...in a prison, inmates evidently volunteered for infection but were not apprised of dangers that may have killed one of them...

...The most important of them, the anthropologist Franz Boas, was (quite typically) a Jewish immigrant from Germany and a liberal...

...But another large part of our behavioral repertoire has little impact on the reproduction rate—one reason why, notwithstanding human nature, institutions differ so widely across cultures...

...But one of them is at least better suited to our culture and institutions...

...In 1975 anthropologist Jerome Barkow published a sociobiological interpretation of prestige and social hierarchies...

...Since the "hereditarians" had ignored these environmental considerations, it could not be said that only genetics was capable of explaining variation among groups...

...In 1966 Dr...

...As he himself admits, the dynamic that stripped individual physicians of their exclusive right to make treatment decisions is not "altogether separable from the one that brought Federal, state and corporation administrators to the bedside...

...And what was to prevent an ambitious surgeon from declaring one person dead to install his heart in someone else...

...By the mid-' 70s these "outsiders...

...It is our own official theory, in the Declaration of Independence, "that all Men are created equal," with an inalienable right to liberty...

...government and third parties...

...Moreover, areputation as an investigator became important to promotion not only for professional researchers but also for doctors in general...

...As many sawit, whole races could be undesirable...

...The sectarian ties of hospitals are weak, and house calls have almost vanished, along with the physician's knowledge of the patient's personal life...

...Carl N. Degler's In Search of Human Nature: The Decline and Revival of Darwinism in American Social Thought (Oxford, 400 pp., $24.95) tells a story that begins with the utilitarian social scientists who adopted Darwinian principles...

...The critical pronouncements no longer originated in medical texts but in judicial decisions, bioethical treatises, and legislative resolutions...

...The very triumphs of medicine expanded the problem even further...

...Doctors traditionally attempted to resolve the dilemmas of medical practice by applying what Rothman terms "bedside ethics": the idea that since each patient and situation is unique, the doctor's only rule is, "First, do no harm...

...Therefore, he reasons, "our ancestors were socially ranked," and "cultural systems of social rank are based on, not opposed to, our primate heritage...

...By the 1960s, claims Rothman, doctors "had moved so far apart" from everyone else that most lay people could not remember the last time they "spoke to a physician and had their clothes on...

...that in wartime the effort to conquer disease entitled them to choose the martyrs...

...Doctors, in short, were an everyday part of the communities that made it possible for them to earn their daily bread...

...His objectionable cousin Francis Galton, the founder of eugenics, who was more Darwinian than Darwin, wished to promote the greatest good of the greatest number by restricting the reproduction rights of the biologically unfit...

...That, of course, has never been the sole aim...

...One sociologist, according to Degler, wonders: "Has the anthropologists' view of the equality of all races gone too far...

...Within academia, the triumph of this new assumption made anthropology, sociology and psychology independent of the biological disciplines...

...Professors of northwest European descent held that the data confirmed the biological superiority of northwest Europeans...

...Modern medicine, as we are constantly reading in the newspapers, has the power to keep patients alive as vegetables, and to save babies with once fatal birth defects...

...Despite his sympathy for this style of argument, Degler doesn't ignore the objections to it...

...What has cometo be known as "bioethics" applied natural rights principles to medicine...

...Human beings are, to be sure, animals, deriving many traits from animal ancestors...

...In the United States this doctrine, which implies that the end justifies the means, has always seemed less congenial than its opposite: the philosophy of natural rights...

...Reproductive success" had the great advantage of being a mechanism capable of driving biological evolution, something natural selection hadn't explicitly provided...

...What is more, traits that are purely cultural in origin can significantly affect reproductive success and thereby our biological makeup...

...The "movement's strong commitment to individual rights," says Rothman, "was at the core of its success...

...On the tests, native-born Americans—chiefly of English, Scottish, Irish, German, and French origins—outscored immigrants from Italy, Poland and Russia...

...The story begins in 1941, when the U.S...

...Thus the weak members of civilized societies propagate their kind...

...There will never be theoretically satisfactory evidence until all forms of discrimination end...

...In fact, much medical practice in the United States simply was utilitarian, at least until then...

...We cannot accept it without betraying our ideals and our history...

...On the other, it was these very treatments, and the specialization they promoted, that turned doctors into strangers...

...Other wartime research projects engaged in similar abuses, and no objections were raised...

...Every human culture, he notes, uses fire—and Degler admits that "no sociobiologist has been foolish enough to claim it as biologically based...

...Actually, few defended it in its heyday...

...Specialists in animal behavior (ethology) applied the new ideas to their own discipline and so created sociobiology, which proceeded to attract a new generation of social scientists back to Darwin's belief that human behavior resembles that of other animals and has been inherited directly from animal ancestors...

...In addition, the "commitment to patient autonomy presumed that the most critical problem in American medicine was the nature of this doctorpatient relationship," Rothman rightly complains, "and that, by implication, such issues as access to health care or the balance between disease prevention and treatment were of lesser import...

...Beecher made it quite impossible to believe...

...In reality, sociobiology merely establishes that nothing in the physical constitutions of humans and other primates prevents their developing status hierarchies...

...The same might be said about other conceptions of human nature...

...In 1968, when a committee chaired by Beecher proposed a definition of mortality—brain death—that was intended to promote transplants, some doctors thought he had "violated the very maxims he had set forth" in 1966 against medical utilitarianism...

...Yet the debate over organ transplants and aggressive therapy shows that it is not invariably clear who should enjoy those "individual rights"—one patient or another, patients in general or their families, the mother or the fetus—and bioethics provides little guidance...

...We build asylums for the imbecile, the maimed, and the sick," fretted Darwin himself...

...No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man...

...it was the history, or culture, of each population that explained its pecularities...

...Their presence in all human societies, said Barkow, suggests that they have been inherited directly from lower primates, who exhibit analogous forms of behavior...

...Physicians received an education much more like that of other professional people than their successors do today, and the ability to shmooze with the paying customers was the soul of medical technique...

...framed the normative principles that were to guide the doctor-patient relationship...

...A Russian-born sociologist proved, more ingeniously, that Russians were superior...

...In the 1930s biological Darwinism was rejuvenated by scientists who translated the concept of natural selection (" survival of the fittest") into the language of population genetics (individuals with adaptive traits reproduce more prolifically than those without them...

...How can we identify such individuals...

...Darwin found reasons to accept the phenomenon...

...Do families that reject aggressive therapy wish to spare their relatives a life not worth living, or to spare themselves the burden of caring for a hopeless invalid...

...Rights, some argue, pertain to individuals, and superior individuals will enjoy them whatever group they belongto...

...This too had lamentable consequences, for in the laboratories medical utilitarianism had lingered on from the War...

...Boas argued that although the differences uncovered by intelligence testing were real, they were not innate...

...A University of Chicago professor, for example, hoping to find a cure for malaria, an uncommon disease in these parts, infected patients in a mental hospital without their knowledge...