Genetic services, economics, and eugenics

What are the aims of genetic services? Do any of these aims deserve to be l abeled "eugenics"? Answers to these strenuously debated questions depend no t just on the facts about genetic testing and screening but also on what is understood by "eugenics," a term with multiple and contested meanings. Thi s paper explores the impact of efforts to label genetic services "eugenics" and argues that attempts to protect against the charge have seriously dist orted discussion about their purpose(s). Following Ruth Chadwick, I argue t hat the existence of genetic services presupposes that genetic disease is u ndesirable and that means should be offered to reduce it. I further argue t hat the economic cost of such disease is one reason why governments and hea lth care providers deem such services worthwhile. The important question is not whether such cost considerations constitute "eugenics," but whether th ey foster practices that are undesirable and, if so, what to do about them. The wielding of the term "eugenics" as a weapon in a war over the expansio n of genetic services, conjoined with efforts to dissociate such services f rom the abortion controversy, has produced a rhetoric about the aims of the se services that is increasingly divorced from reality. Candor about these aims is a sine qua non of any useful debate over the legitimacy of the meth ods used to advance them.