“Three Generations of Imbeciles Are Enough”

So wrote Justice Oliver Wendell Holmes, Jr. in Buck v. Bell, a 1927 Supreme court case upholding a Virginia law that authorized the state to surgically sterilize certain “mental defectives” without their consent. The fascinating and disturbing history of the case is covered in a recent USA Today article.

Carrie Buck was a patient in the Virginia State Colony for Epileptics and Feeble-minded. Upon a finding that she was “the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health, and that her welfare and that of society will be promoted by her sterilization,” the Court upheld her involuntary tubal ligation. The Court infamously justified its decision as follows:

We have seen more than once that the public welfare may call upon the best citizens for their lives. 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. . . . Three generations of imbeciles are enough.

State laws permitting sterilization of individuals deemed unfit to reproduce — most commonly institutionalized persons with mental illness, or even conditions such as epilepsy — were common in the first half of the twentieth century. Buck herself did not learn of her sterilization until decades later — she was told at the time that the operation was an appendectomy. According to the USA Today article, more than 65,000 people were sterilized under such laws, which were enacted in more than 30 states.

658238_u_s__supreme_court_hallwayToday, thanks to the Human Genome Project and its progeny, scientists understand the genetic transmission of mental illness to a degree nearly inconceivable at the time of Buck v. Bell. While the science underlying such efforts may seem as dated today as the pre-Copernican notion that the sun revolves around the earth, the Virginia law upheld in Buck v. Bell was not repealed until 1974.

Some three generations after Justice Holmes penned his infamous statement, Buck v. Bell remain an issue in contemporary debates surrounding law and genetics.

Indeed, Paul Lombardo, a scholar of the case and the focus of the USA Today article, says that he is currently working on a book titled 100 Years of Eugenics: From the Indiana Experiment to the Human Genome Project. The case illustrates two important tensions in the relationship between law and genomics: the capacity of legislators to base social policy on incomplete scientific understandings, and the role of courts in checking or advancing these efforts. The legacy of Buck v. Bell — beyond the thousands of nonconsensual medical procedures it sanctioned—will be in shaping future debate over individual rights where science intersects with the law.

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Filed under: Genomics & Society, Informed Consent
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