In the arena of prenatal care, there is one topic that perhaps is not discussed enough. Prenatal screening has major ethical ramifications, typically ignored by many individuals in medicine. Any tests performed, whether it is ultrasound or genetic, are not immoral in and of themselves, but rather the moral issue arises in what we do with the information obtained. Given the information, there are three possible uses for it:
1) The parents use that information to prepare themselves for a child with a specific condition. This may include spiritual and emotional preparation, as well as lining up the proper care once the child is born.
2) The doctors may be able to use the information to treat the child in utero. With advances in microsurgery, there are cases of spina bifida being treated at an early age to increase the child's survival and quality of life.
3) The last option is the final option. Abortion. The information obtained can be used to make a decision as to whether to kill the child or not.
It is this last option that is the most common and most horrific. Take for instance Down's Syndrome. A recent BMJ article states "Around 92% of women who received an antenatal diagnosis of Down’s syndrome decided to terminate the pregnancy, and this proportion was constant throughout the period covered by the register." For many of us, this may be something we were already aware of. Yet, it is still horrific. Down's Syndrome is not a death sentence, rather there are many individuals who are able to live happy and productive lives. If any of you have had the blessing to know or work with an individual with Down's, you know that they are some of the most innocent and friendly individuals you may encounter. So the question is, why are 9 out of 10 fetuses diagnosed with Down's terminated? The answer: Eugenics.
Our society despises imperfection, at least, what they perceive to be imperfection. This is especially true in regards to children. Every family wants the 'perfect' child, and so any indication of disease, whether present or potential, raises the specter of termination. For many diseases, termination of a pregnancy is considered acceptable medical practice, and in many instances, is encouraged by physicians. What does this say about those individuals in society who live with these diseases or disabilities? What are we telling them when we are willing to kill off other people like them in the womb? In my own opinion, this would seem to show a devaluing of their dignity and integrity. We are telling them they are something less and don't deserve to live and the fact that they are alive is a mistake.
When we are willing to kill off the 'imperfect' child, we are practicing eugenics, plain and simple.
What are your thoughts?
Tuesday, March 09, 2010
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I'm a 1st year medical student at UCI SOM and have been deeply struggling with this in our Genetics course. I have a problem with what the purpose of genetic counseling has come to mean: whether or not a child should be born or aborted. Whenever this topic arises (at almost every discussion), I don't even know how to respond.
ReplyDeletePrenatal screening for autism makes even less senses. Wikipedia identifies some 25 markers for autism. Contrary to Autism Speaks' "Jerry Lewis" style fundraising propaganda, autism is basically a personality type (i.e., difficulty in reading facial body language). A desire for prenatal screening is the direct result of Autism Speaks' fundraising scare tactics and stigmatization -- it runs contrary to valuing each child as a unique individual.
ReplyDeleteIn the case of autistics, make that a unique individual with valuable contributions to society.
Prenatal screening for autism only identifies the parents' own personality traits. (Autism is 90-98% hereditary and anything detected through prenatal screening would identify 100% herediary traits.) In other words, as a result of stigmatization, parents are made to fear their own personalities manifesting in their offspring!