Emanuel and his striving siblings have an adopted sister named Shoshana who suffers from cerebral palsy. The clear implication of Emanuel’s argument is that her life — like that of someone who endures a steep decline in old age — is not worth living. Is that what Emanuel really thinks? If so, he should say so explicitly. If not, he should explain why not, since every word of his essay appears to push in the opposite direction.

Though he would no doubt blanch at the suggestion, Ezekiel Emanuel has written an essay that in its implications clearly amounts to a defense of eugenics. Yet Emanuel’s position differs in one important respect from the version of eugenics that rose to prominence in the Western world in the early decades of the 20th century. Whereas eugenics was originally motivated by public-spirited ends — by the desire to purify the race for the sake of overall human flourishing — Emanuel’s version is provoked by a more personal concern: Extraordinarily creative, intelligent, ambitious, and successful individuals want to be seen and remembered as exemplars of “vitality,” and not as “burdens” slowly succumbing to the “agonies of decline.”

This is eugenics induced by narcissism.