Book review: Winners and losers in the great human race

Imperfect Conceptions: Medical Knowledge, Birth Defects and Eugenics in China by Frank Dikotter Hurst pounds 25

One of the aims of China's 1995 "Maternal and Infant Health Law", that made prenatal testing compulsory, was to improve the quality of the population by restricting births deemed to be imperfect. Originally entitled the "Eugenics Law", it asserts, according to Frank Dikotter, "that those 'deemed unsuitable for reproduction' should be urged to undergo sterilisation or abortion, or to remain celibate".

As a science eugenics (from the Greek meaning "well born") involves the study and elimination of genetic disease with the aim of improving the human race. The objectives of eugenics, however, have often been distorted to serve nationalist arguments of the "pure race" kind.

In Imperfect Conceptions Frank Dikotter (reader in the history of medicine and director of the Contemporary China Institute, University of London) offers a first-rate account of the role that eugenics has played and is playing in China. The book is the first in- depth study on the subject, and in concise and lucid style offers a clear outline of the issues at stake. What is revealed in the process is not only the present situation in China but also the underlying differences between Eastern and Western approaches to medicine and, ultimately, the social attitudes and pressures that shape Chinese society.

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The major difference between orthodox Western medical practice and the Chinese approach to medicine is the degree to which a holistic outlook is implemented. Whereas in the West medicine tends to treat a patient as an individual with an isolated malfunction of a particular system or organ, in China the individual is seen as being closely related to the environment. The lack of a clear distinction between the cultural and biological spheres in a holistic approach has far-ranging implications, not least the belief that during pregnancy maternal impressions can affect the physical and moral development of the unborn child.

Following an overview of medical and social attitudes to human conception in late imperial China, Dikotter traces the spread of eugenic discourse in Republican China (1912-49), its denunciation in the early years of the People's Republic of China, and its reinstatement since the death of Mao in 1976.

The West's repudiation of eugenics stems largely from the 1920s. The race and class prejudice it can engender (the most extreme example being the Nazi attempt to eradicate whole gene pools) was recognised as an infringement by the state, through the guise of science, on the lives of individuals. Whether by the sterilisation automatically prescribed to those judged as mentally ill, unstable or retarded (a practice only recently abandoned in most Western countries) or the deliberate starving to death of children with real or presumed disabilities in certain Chinese orphanages (as shown in the 1996 Channel 4 documentary Dying Rooms), the most controversial, not to say frightening, effect of the implementation of eugenic principles is on institutionalised individuals who are wards of the state.

Frank Dikotter's book challenges us to scrutinise the ethical and political implications of all medical or science-based legislations. It gives a message of support to those isolated voices in China who are struggling to shift the monolithic one-party state from supporting eugenic practices on the basis of what is often antiquated medical knowledge. As Dikotter points out, "scientific knowledge cannot be relied on to solve social problems, especially outside a democratic political system."