Creating the “Unfit”: Social Darwinism or Social Triage?

Abstract

Social Darwinism calls for “inequality, survival of the fittest” and not “liberty, survival of the unfittest. ” However, this theory fails to acknowledge that fitness can be a social construction. Social triage argues that bureaucratic decision makers find it inefficient to work with certain groups, and these decision makers sacrifice these groups’ needs in order that others (more beneficial to the organization) receive services. Social triage appears linked to social Darwinism. To favor society’s “most fit” members, it seems necessary to establish “unfit” members. Sacrificing the needs of certain populations seems possible only if fitness can be a social construction. Using a case study of efforts to reform private psychiatric hospitals, we argue that certain hospitals created a supply of “unfit” patients capable of paying the cost of private care, leading to social triage. Although it appeared that social Darwinism was outdated, the connection between these theories may suggest a resurgence in its use.