The Legacy of American Eugenics: From Buck v. Bell to Modern Echoes

Trace the history of eugenics in America from the Supreme Court's Buck v. Bell decision to contemporary concerns. Understand how eugenic logic persists in policy and why this history matters for bioethics.

The Legacy of American Eugenics: From Buck v. Bell to Modern Echoes

We often think of eugenics as something that happened in Nazi Germany. We forget that the Nazis learned it from the United States. In the early twentieth century, America was the world leader in the "science" of improving the human race by controlling breeding. This was not a fringe movement—it was supported by presidents, philanthropists, leading universities, and the Supreme Court.

Understanding this history is essential for anyone working in bioethics, public health, or healthcare policy. Eugenic logic did not disappear after World War II; it went underground, resurfacing in different forms across different populations. Recognizing these patterns is the first step toward preventing their recurrence.

Defining Eugenics

The term "eugenics" comes from the Greek for "good birth." It was coined by Francis Galton, Charles Darwin's cousin, who theorized that just as we breed horses for speed, we could breed humans for intelligence and moral character.

Eugenics divided into two branches:

Positive Eugenics encouraged the "fit"—usually white, wealthy, and educated—to have large families. This manifested in "Better Baby" contests at state fairs and propaganda celebrating prolific "quality" families.

Negative Eugenics sought to prevent the "unfit"—poor, disabled, criminal, and minority populations—from breeding. American policy focused heavily on negative eugenics through segregation and sterilization.

The Virginia Sterilization Act and Carrie Buck

In 1924, Virginia passed a Sterilization Act allowing the state to sterilize residents of state institutions deemed "feeble-minded" or genetically defective. Officials wanted a test case to ensure the law's constitutionality.

They chose Carrie Buck. Carrie was seventeen, a resident of the Virginia State Colony for Epileptics and Feeble-Minded. She was the daughter of a woman labeled feeble-minded, and she had given birth to an illegitimate child—actually the result of rape, though courts ignored this fact.

The state argued that her "defect" was hereditary and that three generations of "imbeciles" were a burden on society. The case climbed to the Supreme Court.

Buck v. Bell: The Infamous Ruling

In 1927, the Supreme Court upheld Virginia's law in an 8-1 decision. Justice Oliver Wendell Holmes Jr., often celebrated as a progressive legal thinker, wrote the majority opinion containing one of the most infamous lines in American legal history:

"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."

This ruling has never been explicitly overturned. It opened the floodgates. Over 60,000 Americans were forcibly sterilized during the twentieth century under laws modeled on Virginia's statute.

The Shifting Target

Initially, eugenics targeted the white poor—people like Carrie Buck who were deemed mentally deficient or morally suspect. But after World War II, when Nazi atrocities revealed where eugenic logic could lead, explicit eugenic language fell out of favor.

The practice did not stop; it shifted targets. The focus moved increasingly to racial minorities.

North Carolina ran a massive program targeting Black women, often using social workers to coerce participation: accept sterilization or lose welfare benefits. In the South, the practice of performing hysterectomies on Black women without their knowledge during unrelated surgeries became known as the "Mississippi Appendectomy."

In the 1970s, the Indian Health Service sterilized vast numbers of Native American women—some estimates suggest twenty-five percent of women of childbearing age—often without proper consent or with consent obtained under pressure.

Eugenics and Immigration

Eugenic thinking also shaped immigration policy. Harry Laughlin, a leading eugenicist, testified to Congress that immigrants from Southern and Eastern Europe—Italians, Jews, Greeks—were genetically inferior and would pollute the American gene pool.

This testimony directly influenced the Immigration Act of 1924, which drastically restricted immigration from those regions. The explicit goal was to maintain the "Nordic" character of the nation and prevent "race suicide"—the fear that superior stock would be outbred by inferior populations.

Modern Echoes

If you think eugenics ended decades ago, the evidence suggests otherwise.

Between 2006 and 2010, doctors in California prisons performed illegal tubal ligations on nearly 150 female inmates. When investigated, one doctor defended the practice as cost-effective—it saved the state money in future welfare costs for unwanted children. This is the same utilitarian logic that Holmes articulated in 1927: fiscal responsibility justifies violating bodily integrity.

Private organizations have also continued eugenic practices under different framing. Some offer cash payments to people with addiction if they agree to sterilization or long-term contraception. The ethical debate—coercion versus incentive, harm reduction versus exploitation—reveals how eugenic logic persists when applied to populations deemed unworthy of reproduction.

More recently, allegations emerged of unnecessary hysterectomies performed on immigrant detainees at detention facilities. Vulnerable, confined populations—whether in 1927 Virginia or contemporary detention centers—remain at risk of having their reproduction controlled by those with power over them.

Liberal Eugenics and Genetic Selection

The future presents new challenges. What philosophers call "liberal eugenics" involves not state coercion but parental choice. With technologies like CRISPR and pre-implantation genetic diagnosis, parents can screen embryos for genetic conditions.

In some countries, nearly all pregnancies diagnosed with certain genetic conditions are terminated. Is this eugenics? Or is it reproductive autonomy? Philosophers distinguish between state-driven eugenics (coercive) and consumer-driven eugenics (voluntary), but the outcomes raise similar questions: What kinds of lives does society deem worth living?

The distinction between preventing suffering and selecting for "desirable" traits blurs in practice. The technologies that allow screening for serious diseases could eventually allow screening for traits like height or intelligence. Where we draw lines—and who draws them—will define the ethics of genetic medicine.

Why This History Matters

Eugenics is not merely a historical curiosity. It is a logic that persists whenever we:

The utilitarian calculations that made sterilization seem rational in 1927—reducing welfare costs, improving the gene pool, preventing crime—remain tempting whenever resources are scarce and vulnerable populations are politically powerless.

The antidote is a stubborn commitment to human dignity that defies economic calculation. It requires recognizing that every person's reproductive autonomy deserves protection, regardless of their circumstances or perceived "fitness."

Conclusion

The history of American eugenics demonstrates how respectable science, progressive politics, and humanitarian concern can combine to produce profound injustice. The people who sterilized Carrie Buck believed they were doing good. The doctors who performed Mississippi appendectomies believed they were helping families. Good intentions provide no guarantee against harmful outcomes.

For anyone working in health policy, this history serves as both warning and guide. It warns against allowing utilitarian logic to override individual rights. It warns against policies that affect confined populations without robust oversight. And it guides us toward frameworks—like Reproductive Justice—that center the autonomy of those most vulnerable to institutional control.

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