Bonnie Steinbock Down's Syndrome
ETHICALLY DEFENSIBLE OR NOT
Bonnie Steinbock and Down's Syndrome
Prenatal genetic testing is a medical procedure, which detects genetic abnormalities early, to enable the mother or parents to make appropriate decisions about the condition (Khasin, 2013). Unlike prenatal genetic screening, which requires only a blood test, prenatal genetic testing obtains a direct sample of the amniotic fluid through a needle. The result is, therefore, more reliable. Prenatal genetic testing has been commonly used in detecting genetic abnormalities, such as Down Syndrome, Trisomy 18 and Trisomy 13. Trisomies are extra chromosomes, which are not compatible with life. This means that children with these chromosomes die shortly after birth (Zieve et al., 2013). The main ethical issue against the procedure is that a finding of Down's Syndrome or another genetic abnormality leads women to seek abortion. Since there is no cure for these diseases, the discovery can only depress mothers and/or motivate them to seek abortion (Khasin). And abortion is the destruction of life and, thus, ethically impermissible.
This is a critique of the said ethical issue. It will attempt to prove that Bonnie Steinbock correctly argues that the practice of screening for moderate disabilities, like Down's Syndrome, followed by selective abortion, is ethically defensible.
Description of the Paper
The first part will consist of the five philosophical issues raised against this practice, Bonnie Steinbock's arguments in its favor, the objection of the ethics committees, my reply to the objection, and my conclusion to all the foregoing.
Interpretation of the Text
Opponents advance five grounds or issues against the practice (Arras et al., 2007). These are that disabilities are neutral forms of variation; disabilities are more socially constructed than are medical problems; attempts at reducing the incidence are more generally morally acceptable; the moral acceptability of prenatal testing, followed by selective abortion; and the moral importance of the distinction between the practice and therapeutic intervention in preventing the occurrence of disability (Arras et al.).
Disabilities are not neutral forms of variation -- Opponents suggest that living with a disability is only a variation from the normal. Disabled persons are only different because they use one part of their body differently or they do not have that part. Others cannot speak well or see or hear or move. Opponents perceive these persons as only differently abled and their disability need not be prevented. But a disability is not just a form of variation. The problem is the absence of a norm. A person who from birth cannot speak is a deviation from that norm because he or she lacks that facility to speak. A person or child who lacks the natural or "normal" faculty that every "normal" person has cannot just be considered a form of variation. The fact is that disability is clearly seen as inherently bad and undesirable. It is a disadvantage to anyone who has it. It is something everyone hopes to avoid and is not merely neutral forms of variation (Arras et al.).
Disabilities are only largely socially constructed -- Opponents insist that disabilities may be disadvantageous only in ways by which society responds to them (Arras et al., 2007). These ways can be modified. Society does not respond to the disability itself. Disabilities may be compensated in some ways but not all disability entirely lies in the environment or social adaptation, as opponents of prevention measures assert. It is not completely or even mostly socially constructed. Society may be able to offer a lot of opportunities to the disabled but the fact remains that not all disabilities can be overcome. It cannot be denied or dismissed that a mental retardate cannot attend college even if he or she sees life as something worth living. Neither can he or she get a job or raise children. Social prejudice cannot correct these...
These are realities. This is acknowledged by Adrienne Asch (1999) herself (Arras et al.).
Preventive Measures Must be Assessed -- The consensus is that the prevention of disability is a good thing (Arras et al., 2007). It is in the means that disagreement arises. Opponents are careful to distinguish actions that prevent disability from actions that prevent persons likely to become disabled from coming to existence or getting born. The latter actions include prenatal genetic testing and selective abortion. The use of iodized salt to prevent mental retardation or adding folic acid to flour to reduce the incidence of neural tube disorders are non-malignant means if they do not compromise
public health or entail high cost. Stopping smoking and
alcohol is another non-problematic preventive measure (Arras et al.).
Prenatal Genetic Testing and Selective Abortion are Morally Objectionable. -- a pregnant woman preserves her right to decide to continue her
pregnancy or not (Arras et al., 2007). There is always a chance that she might change her mind if and when circumstances change. If she separates from her husband or mate, she may not want to continue the pregnancy if she does not want to become a single mother. At the same time, she may decide to terminate a defective pregnancy because she wants a healthy and normal child. Then she and her husband or mate can try for another child again if they opt to submit to prenatal genetic testing and selective abortion. By all means, they should get fully informed about the
consequences and challenges of the choice they make. They should not decide out of fear or a lack of knowledge. They and everyone knows that parenthood is a difficult task even if the child has no disabilities. A couple who prefers not to take the burden of raising a child with special need, such as a disability, should be allowed to make that choice. They should not be made to feel guilty about the choice (Arras et al.).
The Moral and Symbolic Importance of Prenatal Testing -- Opponents argue that this practice tells people with disabilities that they are not wanted, that their lives are less worthy than those who are normal (Arras et al., 2007). They feel that prenatal testing creates or strengthens the public view that the disabled should not exist. This enhances intolerance and
discrimination towards them. However, a couple who chooses to avoid the birth of a disabled child does not necessarily mean they value the lives of disabled people less. That choice or wish does not necessarily mean that not being able to prevent the birth of a disabled child will not be wanted or loved less. Society can always try to both prevent disability and provide for the needs of the disabled if the birth is not prevented. The rise in the popularity of prenatal screening was accompanied by an increase in improved attitudes towards the disabled, as shown by the passage of the Americans with Disabilities Act (Arras et al.).
Objection
Current data on
disabled children and their families indicate that these disabilities do not interfere with a satisfying life (Asch, 1999). Many issues associated with disabilities emanate only from social arrangements that public authorities can change. Prenatal testing can diminish women's choices rather than expand them. This objection challenges the
endorsement of pregnancy genetic testing and the belief that women should terminate their pregnancies if a disability in the
fetus is found (Asch).
Reply to Objection
It is hardly tenable that disabilities will not always interfere with a satisfying life. With dedicated care for the disabled child, family members may be able to have many satisfying moments with him. But all them, the disabled child especially, will always prefer that the disability is not there. While society can magnanimously cope with disability, not all disabilities can be completely or adequately overcome. The fact is that disability will always be seen or felt as something inimical, advantageous or inherently bad. Thus, it is better prevented. Pregnancy genetic testing allows a woman to either terminate pregnancy or continue with it, rather…
