Past: Imperfect; Future: Tense.

How should the field of bioethics grapple with a history that includes ethicists who supported eugenics, scientific racism, and even Nazi medicine and also ethicists who created the salutary policy and practice responses to those heinous aspects of medical history? Learning humility from studying historical errors is one path to improvement; finding courage from studying historical strengths is another, but these can be in tension. This commentary lays out these paths and seeks to apply them both to a contemporary challenge facing the field: why hasn't bioethics been more at the forefront of efforts to address inequities in health and health care?

Addressing the paradox: Health expansion threatening sustainable healthcare.

We need to address the paradox that health expansion threatens sustainable healthcare as anti-aging drugs are on the trail from trial to the market and come together with health enhancement measures changing demography and the health of populations. This poses global, social, and professional problems, and challenges clinical medicine as well as health policy. To handle the emerging challenges, we need to address four crucial issues: (1) injustice (access), (2) sustainability, (3) basic human rights, and (4) eugenics. To do so we need to differentiate between health improvements and health enhancements and reinforce medicine's strongest moral appeal: to reduce suffering.

Nursing and eugenics in the early 20th century United States.

BACKGROUND: Research has documented how ideas about race, class, ethnicity, ableism, and structural hierarchies determine health outcomes and disparities today. The historical role of nursing practice and education needs further exploration. PURPOSE: This study aims to better understand how some nurses thought about and interacted with eugenics in the early 20th century. METHODS: Historical analysis of primary and secondary sources. DISCUSSION: In the early 20th century, reformers of the day, including some nurses, demonstrated much ambiguity of thinking as they pushed for eugenic improvement of the "human race" while also enhancing environmental changes, such as good nutrition and clean, safe housing. CONCLUSION: Nursing's past relationship with eugenics sheds light on the history and construction of the system leading to health disparities among marginalized groups. Nurses must acknowledge the historical roots and context of their education and practice as we engage in critical conversations about social inequities.

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Risky migrations: Race, Latin eugenics, and Cold War development in the International Labor Organization's Puno-Tambopata project in Peru, 1930-60.

Histories of economic development during the Cold War do not typically consider connections to race science and eugenics. By contrast, this article historicizes the debates sparked by the International Labor Organization's Puno-Tambopata project in Peru and demonstrates how Cold War development practice shared common epistemological terrain with racial and eugenic thought from the Andes. The International Labor Organization project's goal of resettling indigenous groups from the Peruvian highlands to lower-lying tropical climates sparked heated debates about the biological specificity of Andean highlanders' physiques and ability to survive in the tropics. Such concerns betrayed the antitypological consensus expressed in the United Nations Educational, Scientific and Cultural Organization (UNESCO) Race Statements and defended by one of the main proponents of the resettlement project, the Swiss-American anthropologist Alfred Métraux. The concern with Andean racial types was central to the research agenda of the acclaimed Peruvian physiologist Carlos Monge, who endorsed modernization projects that did not entail moving highlanders outside of their traditional climate. The debates sparked by the Puno-Tambopata project demonstrate how Cold War development discourse grappled with racial and eugenic thought from Latin America and the Global South and thereby produced projects of indigenous "improvement."

Uterus collectors: The case for reproductive justice for African American, Native American, and Hispanic American female victims of eugenics programs in the United States.

In this article, I offer historical, jurisprudential, and moral analyses of racial eugenics campaigns against African American, Native American, and Hispanic American women. I argue that African American, Native American, and Hispanic American women were sterilized at a time in US history when doctors working for/with the Department of Health, Education, and Welfare, the Indian Health Service, and Medicaid engaged in forced and coerced sterilizations with impunity. As a result, Black and Brown women did not have equal protection of the laws nor unimpeded access to the courts. Therefore, they had few options for protecting themselves from harm or redressing their grievances against the state. For these reasons, I conclude that African American, Native American, and Hispanic American women who were sterilized without their knowledge or consent by doctors working for public health agencies ought to be awarded reparations by the United States Congress. Additionally, I conclude that federal prosecutors and the American Medical Association ought to bring criminal charges and professional sanctions against the doctors and healthcare workers involved. Finally, I conclude that medical professionals ought to engage in a nationwide effort to reconcile people in Black and Brown communities with the healthcare community in the United States.

R.A. Fisher, eugenics, and the campaign for family allowances in interwar Britain.

Ronald Aylmer Fisher (1890-1962) is today remembered as a giant of twentieth-century statistics, genetics and evolutionary theory. Alongside his influential scientific contributions, he was also, throughout the interwar years, a prominent figure within Britain's eugenics movement. This essay provides a close examination of his eugenical ideas and activities, focusing particularly upon his energetic advocacy of family allowances, which he hoped would boost eugenic births within the more 'desirable' middle and upper classes. Fisher's proposals, which were grounded in his distinctive explanation for the decay of civilizations throughout human history, enjoyed support from some influential figures in Britain's Eugenics Society and beyond. The ultimate failure of his campaign, though, highlights tensions both between the eugenics and family allowances movements, and within the eugenics movement itself. I show how these social and political movements represented a crucial but heretofore overlooked context for the reception of Fisher's evolutionary masterwork of 1930, The Genetical Theory of Natural Selection, with its notorious closing chapters on the causes and cures of national and racial decline.

The role of genetic essentialism and genetics knowledge in support for eugenics and genetically modified foods.

People are regularly exposed to discussions about the role of genes in their lives, despite often having limited understanding about how they operate. The tendency to oversimplify genetic causes, and ascribe them with undue influence is termed genetic essentialism. Two studies revealed that genetic essentialism is associated with support for eugenic policies and social attitudes based in social inequality, and less acceptance of genetically modified foods. These views about eugenics and genetically-modified foods were especially evident among people who had less knowledge about genes, potentially highlighting the value of education in genetics.

The Health Care System Debate and the Health Care Policy of a Unified Nation Immediately after the Liberation.

Immediately after the liberation, the health care system debate was studied focusing on the orientation of the American and Soviet medical systems, roughly divided into Lee Yong-seol and Choi Eung-seok. However, the existence of people who are not explained in the American and Soviet health care systems' orientation led to the need to reconsider the existing premise. Therefore, this study identifies the characters that were not explained in the perspective of existing studies, and reevaluates the arguments of Lee Yong-seol and Choi Eung-seok. This paper raises the following questions: First, what is the background of the policy orientation that Lee Yong-seol and Choi Eung-seok had? Second, if there are people who made different arguments from Lee Yong-seol and Choi Eung-seok, what direction did they set and argue? third, how the orientations of Lee Yong-seol and Choi Eung-seok and etc. converge into the answer to the Joint Soviet-American Commission? In response to theses questions, this study confirms the following: first, Lee Yong-seol's and Choi Eung-seok's health care policies were established based on realism and empiricism. As a policyholder, Lee Yong-seol emphasized withholding medical state administration and raising the level of medical education and medical systems according to the condition at that time, although the American system was mobilized by Lee as the basis for his judgment and administrative assets. On the other hand, Choi Eung-seok aimed for a Soviet-style systems in health care but this was realistically put on hold. Choi insisted on the establishment of the Medical Service Associations and rural cooperative hospitals that appeared in Japan's medical socialization movement. In summary, immediately after the liberation, Lee Yong-seol's and Choi Eung-seok's policy arguments were based on policies that could be implemented in Korea, and the American system and Soviet system served as criteria for the policy resources. Second, Jeong Gu-chung and Kim Yeon-ju show that the topography of the health care debate immediately after the liberation was not represented only by Lee Yong-seol and Choi Eung-seok. Both Jeong and Kim were consequently led to medical socialization, which was the implementation of a health care system that encompasses social reform, but the context was different. Jeong drew the hierarchy of the health care system, which peaked in the United States, from the perspective of social evolution based on his eugenics, but the representation suitable for Korea was the Soviet model absorbed into his understanding. On the contrary, Kim argued that representations suitable for Korea should be found in Korea. As national medical care, Kim's idea aimed at a medical state administration that provides equal opportunities for all Koreans. Third, the aspect of convergence to the Joint Soviet-American Commission reply proposal was complicated. Among the policies of Lee Yong-seol, the promotion of missionary medical institutions and the gradual planning of medical institutions converged into the three organizations' proposal, and Choi Eung-seok's policy was almost the same as that of the Democracy National Front and the South Korean Labor Party. However, the medical system of Japan, the colonial home country, appears to have been based on Lee Gap-soo, chairman of the Korean Medical Association in the colonial period, and the plan was in line with the use of the union system of the left-wing organizations' proposal in the south. It was in accordance with a common task to expand health care from colonial conditions to different status.

Reproductive injustice, trans rights, and eugenics.

This article explores how the recognition of the gender identity of trans people can have negative consequences on their reproductive health and rights. First, it argues that, while both the right to gender identity and the right to sexual and reproductive health are part of the indivisible core of human rights, in practice trans people are forced to choose between them. Understanding this scenario requires focusing on the eugenic dimensions of trans policies, even in states where the recognition of a gender identity other than that assigned at birth is not tied to surgical or hormonal compromises. The concept of "passive eugenics", coined over twenty years ago by James Bowman, offers a valuable key in this respect. Second, the paper highlights some factors that hinder a successful approach to the reproductive health and rights of trans people. These factors include: the normative imageries about the reproductive capacities and desires of trans people, representations about pregnancy and "womanhood", and the form taken by identity politics in contemporary feminist movements. The attention given as a priority (if not exclusively) to initiatives for the legalisation of voluntary abortion, understood as a right pertaining to (cis) women, offers a significant example of these difficulties. Finally, the paper advocates the adoption of a reproductive justice approach to work on sexual and reproductive health and rights, arguing that it has, among other virtues, that of challenging the binary matrix that characterises Western thought.

Focusing on Human Rights: a framework for CRISPR germline genome editing ethics and regulation.

The late 2018 announcement of the claimed births of CRISPR-edited babies has stimulated widespread condemnation and calls by some leading scientists for a moratorium on any further germline genome editing (GGE) for reproductive purposes. Concurrently, national and international bodies are calling for the development of robust guidelines and regulations that will identify permissible conditions under which such GGE efforts might eventually proceed. Crucially, these conditions go beyond rigorous safety standards to address some of the social and ethical concerns that arise with germline interventions. As these bodies convene to navigate this unique terrain, we suggest an important standard for generating ethically robust guidelines. Our approach builds from concerns about social exclusion and social justice with a focus on fundamental human rights. We believe that a deontological or rights-based approach, rather than a utilitarian approach, is needed to ensure that this socially disruptive technology minimizes further marginalization of people with disabilities and does not create a new form of social injustice. In pursuit of a deontological framework, we propose the implementation of an objective assessment tool: the Human Rights Impact Assessment (HRIA). Use of the HRIA establishes necessary constraints on applications of GGE in order to safeguard the most vulnerable members of society.

[Neurologists and neuroscientists during the "Third Reich": attempt at an assessment]. / Neurologen und Neurowissenschaftler in der NS­Zeit: Versuch einer Bewertung.

On behalf of the German Neurological Society (DGN) former presidents, honorary presidents and honorary members were checked for possible formal or ideological affiliations with National Socialism (NS) 75 years after the NS dictatorship. When the DGN was reformed in 1950, 6 of the 7 "founding fathers" were former members of the National Socialist German Workers' Party (NSDAP), which is in strong contrast with the traditional narrative of a "new beginning". The first four (Pette, Schaltenbrand, Vogel and Döring) and in total 10 out of 13 incumbent presidents until 1976 (Zülch, Bay, Hirschmann, Jung, Bauer, Behrend) as well as honorary president Bodechtel had belonged to the NSDAP, Storm Troopers (SA), or "Schutzsstaffel" (SS). Approximately two thirds of the German and Austrian honorary members appointed until 1985 had been associated with the NS system or the NS ideology (e.g. Becker, Birkmayer, Jacob, Reichardt, Seitelberger, Tönnis and von Weizsäcker). The individual attitude of neuroscientists towards eugenics ranged from approval to refusal and a few had been involved with (Appellate) Hereditary Health Courts. None of the physicians considered here were directly involved in killing patients but several of them knew of the "concomitant research" in the context of "euthanasia". Others used research resources generated during the "euthanasia"-programme and after 1945. The only professor of neurology who conducted ethically inacceptable human experiments was Georg Schaltenbrand. Almost all neurologists could pursue their career after the war, sometimes after having undergone lengthy denazification trials but very few of them were willing to face up to their past. Categorizations, such as "collaborators", "beneficiaries" and "physicians with ambivalent roles" should be replaced by a more differentiated assessment. When dealing with the past of German neurology it would be advisable to resort to a categorization of remembrance instead of naming awards after incriminated persons.

Two Threats to Precision Medicine Equity.

In January 2015, President Barack Obama unveiled the "Precision Medicine Initiative," a nationwide research effort to help bring an effective, preventive, and therapeutic approach to medicine. The purpose of the initiative is to bring a precise understanding of the genetic and environmental determinants of disease into clinical settings across the United States.1 The announcement was coupled with $216 million provided in the President's proposed budget for a million-person national research cohort including public and private partnerships with academic medical centers, researchers, foundations, privacy experts, medical ethicists, and medical product innovators. The Initiative promises to expand the use of precision medicine in cancer research and modernize regulatory approval processes for genome sequencing technologies. In response, Congress passed the 21st Century Cures Act in December 2016, authorizing a total of $1.5 billion over 10 years for the program.2 Although the Precision Medicine Initiative heralds great promise for the future of disease treatment and eradication, its implementation and development must be carefully guided to ensure that the millions of federal dollars expended will be spent equitably. This commentary discusses two key threats to the Precision Medicine Initiative's ability to proceed in a manner consistent with the United States Constitutional requirement that the federal government shall not "deny to any person . . . the equal protection of the laws."3 In short, this commentary sounds two cautionary notes, in order to advance precision medicine equity. First, achieving precision medicine equity will require scientists and clinicians to fulfill their intellectual, moral, and indeed legal duty to work against abusive uses of precision medicine science to advance distorted views of racial group variation. Precision medicine scientists must decisively denounce and distinguish this Initiative from the pseudo-science of eugenics - the immoral and deadly pseudo-science that gave racist and nationalist ideologies what Troy Duster called a "halo of legitimacy" during the first half of the 20th century.4 Second, to combat the social threat to precision medicine, scientists must incorporate a comprehensive, ecological understanding of the fundamental social and environmental determinants of health outcomes in all research. Only then will the Precision Medicine Initiative live up to its potential to improve and indeed transform health care delivery for all patients, regardless of race, color, or national origin.

Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 2: Europe.

This article deals with the nine European nations which legalised non-consensual sterilisation during the interwar years, thus completing the review, the first part of which was published in an earlier issue of this Journal. Like we did for North America, Japan and Mexico, countries concerned are addressed in chronological order, as practices in one of these influenced policies in others, involved later. For each, we assess the continuum of events up to the present time. The Swiss canton of Vaud was the first political entity in Europe to introduce a law on compulsory sterilisation of people with intellectual disability, in 1928. Vaud's sterilisation Act aimed at safeguarding against the abusive performance of these procedures. The purpose of the laws enforced later in eight other European countries (all five Nordic countries; Germany and, after its annexation by the latter, Austria; Estonia) was, on the contrary, to effect the sterilisation of large numbers of people considered a burden to society. Between 1933 and 1939, from 360,000 [corrected] to 400,000 residents (two-thirds of whom were women) were compulsorily sterilised in Nazi Germany. In Sweden, some 32,000 sterilisations carried out between 1935 and 1975 were involuntary. It might have been expected that after the Second World War ended and Nazi legislation was suspended in Germany and Austria, including that regulating coerced sterilisation, these inhuman practices would have been discontinued in all nations concerned; but this happened only decades later. More time still went by before the authorities in certain countries officially acknowledged the human rights violations committed, issued apologies and developed reparation schemes for the victims' benefit.