Genetics and abortion

The genetics and abortion issue is an extension of the abortion debate and the disability rights movement. Since the advent of forms of prenatal diagnosis, such as amniocentesis and ultrasound, it has become possible to detect the presence of congenital disorders in the fetus before birth. Specifically, disability-selective abortion is the abortion of fetuses that are found to have non-fatal mental or physical defects detected through prenatal testing.^[1] Many prenatal tests are now considered routine, such as testing for Down syndrome. Women who are discovered to be carrying fetuses with disabilities are often faced with the decision of whether to abort or to prepare to parent a child with disabilities.^[1]

Legality of selective abortion

In many countries abortion is available upon request up to a certain point in the pregnancy, not taking into account why the mother wants the abortion, but in a small number of countries all abortions are prohibited, including for those pregnancies that risk the mother's life, including Vatican City, El Savador, Chile and Malta. Countries may also restrict abortion even if the child has a genetic defect. Countries that allow abortion if the mother is at risk but do not allow abortion if the child has a genetic defect include Iran, Ireland, Mexico, and the Dominican Republic.

Not all genetic markers which can be checked are for disease, leaving open the possibility that parents may choose an abortion based on personal preference rather than avoidance of disease. In some jurisdictions, sex-selective abortion is specifically prohibited. Many pro-life activists are concerned that genetic testing will give women excuses to get abortions. It is believed that eventually genetic testing will be able to provide a wealth of knowledge on the future health of the child.^[2]

Genetic testing for Down syndrome

Today screening for Down syndrome is offered as a routine part of parental care. The American Congress of Obstetricians and Gynecologists recommends offering various screening tests for Down syndrome to all pregnant women, regardless of age. Genetic testing however, is not completely accurate but it can help to determine if further tested should be administered or if there should be concern. Testing for Down Syndrome can be conducted at different times of the pregnancy. Most women chose the first trimester choice which is done in two parts at the 11th and 13th week of pregnancy. These tests include an ultrasound to measure a certain area on the back of the baby's neck. If there is a problem with the baby than there will be an excess of fluid in this area. The second part of the test is a blood test which looks for abnormal levels of PAPP-A and HCG which may indicate a problem with the baby. Of all women who test for Down Syndrome only 5 percent are identified as being at risk. Of those 5 percent far fewer are actually carrying children with Down Syndrome. Screening tests are actually better for testing what women are at risk compared to how many women are actually carrying children with Down Syndrome.^[3]

Statistics today conclude that 90 percent of fetuses that are diagnosed with Down syndrome via fetal genetic testing are aborted. However, only 2-3 percent of women agree to completing genetic testing, CVS or amniocentesis, the current tests for chromosomal abnormalities. When taking this into account, it is believed that approximately 50 percent of fetuses with Down Syndrome are aborted.^[4]

Proponents of Disability-Selective Abortion

Support for disability-selective abortions stems from arguments that those born with disabilities have a quality of life that is reduced to the extent that non-existence is preferable, and terminating the pregnancy is actually for the sake of the future child.^[5] Some argue that abortion of fetuses with disabilities is moral in that it prevents the child and/or parents from suffering, and that the decision to abort is not made lightly. One such example comes from the utilitarian perspective of Peter Singer who argues that abortion of healthy fetuses is not justified, but that disability-selective abortions are justified if the total amount of happiness will be greater by doing so.^[6] His justification for such line of thinking comes not only from the quality of life for the child, but also the suffering of the parents and lack of willing adoptive parents for children with disabilities.^[6]

Opposition to Disability-Selective Abortion

Several different arguments lie at the heart of opposition for disability-selective abortions. Those against disability-selective abortions often quote the right to life of all fetuses. Further arguments include that such abortions are based on misinformation or stereotypes about the lives of people with disabilities.^[5] Others consider abortion of fetuses with disabilities a form of discrimination, arguing that abortion after a positive diagnosis sends the message that a life with disability is not worth living.^[7] Disability and feminist activists warn against the eugenic possibilities of disability-selective abortions for the disabled community. Reproductive rights activists not only fight for women’s right to abortion, but also for their right to choose not to use prenatal testing. A notable pro-choice supporter who condemned disability-selective abortion was Adrienne Asch, who believed that perceived problems associated with disability were not attributable to the disability itself but an absence of social support and acceptance.^[8]

• The European Blind Union has stated its opposition to compulsory abortion for genetic indications in its manifesto: "the right to life shall include the prohibition of compulsory abortion at the instance of the State, based on the pre-natal diagnosis of disability".^[9]
• According to an article in Disability Studies Quarterly, the disability rights movement in Germany has disapproved of abortion in cases in which the fetus is found to have a congenital defect. This issue for the German disability-rights movement has continuity going back to the early eugenics movement, through to the Nazi era, when Nazi eugenic practices became a concern, and on into the present.^[10]
• A report given to the NSW Anti-Discrimination Board and NSW Law Reform Commission by the AIS Support Group of Australia (AISSGA) reviewed the Australian incidence of abortion in cases when the fetus was diagnosed with an intersex condition. Between 1983 to 1998, the Victorian Department of Human Services reported that 98 out of 213 fetuses detected to have Turner syndrome had been aborted, 28 out of 77 found to have Klinefelter syndrome, and 39 out of 189 fetuses with sex chromosome anomalies had been aborted. The AISSGA proposed that parents expecting children with sex chromosome anomalies be advised by a genetic counselor, and be given contact with support groups for people with these conditions, so as to gain a better understanding of the actual effects of the conditions.^[11]

See also

• Eugenics
• Fetal rights
• Genetic counselling

References

1. Lawson, K. (2006). Expectations of the parenting experience and willingness to consider selective termination for Down Syndrome. Journal Of Reproductive and Infant Psychology, 24(1), 43-59.
2. http://www.telegraph.co.uk/health/healthnews/9315265/Unborn-babies-could-be-tested-for-3500-genetic-faults.html
3. http://www.mayoclinic.com/health/down-syndrome/DS00182/DSECTION=tests-and-diagnosis
4. http://www.patheos.com/blogs/thinplaces/2012/06/down-syndrome-prenatal-testing-and-abortion-its-complicated/
5. Vehmas, S. (2002). Is it wrong to deliberately conceive or give birth to a child with mental retardation?. Journal Of Medicine & Philosophy, 27(1), 47-63.
6. STANGL, R. (2010). Selective Terminations and Respect for the Disabled. Journal Of Medicine & Philosophy, 35(1), 32-45. doi:10.1093/jmp/jhp058
7. Batzli, K. (2010). The Expressivity of Prenatal Testing and Selective Abortion for Disability. Penn Bioethics Journal, 6(1), 21-24
8. ASCH, A. (1999). Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy. American Journal Of Public Health, 89(11), 1649-1657
9. European Blind Union. (February 26, 2004). European Disability Forum Consultation on International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities. Retrieved March 13, 2007.
10. Köbsell, Swantje. (2006). Towards Self-Determination and Equalization: A Short History of the German Disability Rights Movement. Disability Studies Quarterly, 26 (2). Retrieved March 13, 2007.
11. Briffa, Anthony. (2003). Submission to the NSW Anti-Discrimination Board and NSW Law Reform Commission Regarding Discrimination against People affected by Intersex Conditions. Retrieved March 13, 2007.