| Abstract |
This paper examines the ethical endorsement of selective abortion of a disabled fetus by seeking to confirm if this reproductive choice derives from autonomous will. Considering that selective abortion of a disabled fetus follows the offer of medical services in the context of prenatal care, we have to evaluate the role of these services when reproductive choices are to be taken. The fact that the offer of prenatal testing and genetic counseling is legitimate ethically and medically, since it presupposes the protection of the autonomy and health of the people that undergo the test, refers to the importance of the two fundamental ethical principles of autonomy and beneficence (utility). So, a safe criterion of evaluation for the two services can be the confirmation of the fundamental principles and their derivative rules.
The prenatal testing in order to respect the autonomy of the pregnant has to assure the voluntary disposal of the woman, which is validated by the informed consent in the context of counseling before the testing. So, problem arises in case the consent is given under pressure and inadequate information. The prospect of acquiring genetic information seems to undermine the self-determination and the sense of control in woman’s life, when the majority of the doctors impose by not an obvious way the prenatal testing in the context of its establishment as a routine process and pressure the pregnant to undergo the testing by insisting that it is a responsible thing to do, while the underlying message that is communicated to the pregnant consists in selective abortion of a disabled fetus being a responsible thing to do. It is possible for the woman to find it difficult to reject a test that her doctor has to offer, especially when the apparent justification for the test is the assurance of the pregnant about the health of her fetus and the acceptance of the test seems to be the only choice sanctioned by the doctors and the society. The establishment of the testing as a routine process, considering that it raises the issue of selective abortion in case of positive diagnosis, intensifies the already existing problem about the pressure that woman feels in order to undergo the testing, in case this pressure results from the pursuit of the testing to control the reproductive capability of the woman, as responsible for the production of quality products, with the control of the woman having contiguity with the control of disabled fetuses and selective abortion seen as a mechanism of quality control, given that the testing precedes.
At the same time, the woman’s right to decide whether to undergo the testing seems to be undermined and restricted not only from the medicalization of pregnancy and the pressure, but also from the few informations that are given, in order for the informed consent to be validated. The problem in this case about inadequate information doesn’t consist only in the difficulty of woman being adequately informed but also in the intentional omission of the information, so that the pregnant can’t refuse her consent to the testing. But the empirical data about the negative impact of the diagnostic genetic information to all people involved in the testing make a strong argument against the compulsory prenatal testing, with the legitimate interest of woman in knowledge consisting in autonomous choice and her preparation to use the knowledge having realized its importance.
At the same time, considering that the offer of prenatal testing from the medical community aims to protect the health of the fetus and its parents, as much as this is feasible, and to promote the parent’s right to reproductive choice, the second problem arises in case of positive diagnosis with the examination not corresponding to its conventional picture and consequently restricting the spectrum of “choice” for parents between a “defective” being and the non-existence of the fetus, proposing abortion, which is a negative action, as a cure for a “defective” being. The qualification of the prenatal testing as medical seems to give the impression that everything it detects is necessarily harmful and detrimental for health, considering the nature of the medical profession and the priority given to the detection of disabilities against other insignificant for health characteristics, so that the establishment of prenatal testing as an integral and ordinary part of prenatal care raises the danger selective abortion that follows the testing being presented as a medical necessity. The establishment of selective abortion as a medical necessity seems to be achieved better, when the prenatal testing transforms the experience of pregnancy, which is for most of the women a natural and healthy function, to a risky process, which demands continuous medical surveillance. The equation of disability with disease renders inevitable the relation of prenatal testing with selective abortion, with prenatal testing not only detecting disabilities but also aiming to prevent and cure them, and considering the lack of alternative medical treatments for the diagnosable disabilities selective abortion seems not only to prevent but also to “cure” the disability. Inevitably, this kind of interlinked relation of prenatal testing with abortion raises an anxiety about the offer of non directive counseling to parents that are confronted with a positive diagnosis.
Although the success of genetic counseling is ensured as long as the woman has received all the possible information, has understood them and subsequently can make an autonomous choice, is ascertained that the professional commitment to non- directive counseling is being violated and that some counselors don’t practice their profession in a way that legitimates the woman’s decision to give birth to a child that has been diagnosed with a disability. Particularly, the intentional omission and the selective offer of information combined with the communication of disability in a negative way and the information mostly about the negative impact of disability in the quality of life of the future child and its parents can “force” the woman to give her consent about abortion, since the information have predisposed her negatively about giving birth to a disabled child. The problem with this pattern of counseling, which doesn’t respect the autonomy of future parents, is intensified when the reasons given for the abortion aren’t only medical but also social and economical.
The majority of doctors maintains through the prism of the utilitarian approach that selective abortion is an ethical action in case of disability, since the consequences of this action promote the welfare of all people involved (the disabled fetus, the future parents and the society), who are affected from this action, but there are doubts about the utility that derives from the abortion of a disabled fetus, so that the ethical legitimation of the particular action is under dispute. Particularly, is sustained that the disabled fetus has an interest in not being alive, because disability will damage seriously the quality of its life, therefore abortion can promote the welfare of the fetus. Although altrouism seems to be a satisfactory reason for selective abortion in case of disability, there are two important difficulties for its acceptance with the first difficulty concerning the limited number of medical conditions for which this justification stands, where indeed the alternative of abortion is the birth of a child whose quality and value of life is negative, and with the second difficulty concerning the ascertainment that the welfare of a disabled person can be promoted by assistance from the family, the citizens and the society.
Meanwhile, the welfare of the future parents and of the society although it is promoted from selective abortion it is likely the promotion of their welfare to have at long term negative consequences, so that the produced utility for the parents and the society can’t compensate the damage that results from the selective abortion. Particularly, is sustained that delegates of social policy have interest in improving the health and reducing the cost at the domain of health, where abortion for disabilities of the fetus seems to achieve both aims. But selective abortion for the promotion of society’s welfare in terms of health and costs is altering the pattern of disease, is influencing the nature of the medical profession, prompts questions about the connection that exists or should exist between health and the range of opportunities that is offered to people and is changing the attitude of society towards disease – disability and social responsibility for the disabled people, since the society avoids to create a more accessible environment for the disabled. Indeed, the avoidance of creating a more accessible environment combined with the inadequacy of social solidarity programs doesn’t affect only people with diagnosable disabilities from the prenatal testing, but also affects the majority of people who have disabilities that either can’t be diagnosed from the prenatal testing yet, or they don’t occur due to genetic factors, so that these people too become recipients of social negligence, probably also included at the list of the undesirable citizens. Moreover, the importance that is given to the avoidance of economic burdens and to the prevention of disability on behalf of society and doctors allows the disability to become the only important characteristic failing to acknowledge that along with any diagnosable damage to the fetus come other characteristics too, which complete the entity, with danger the value of the entity being reduced at its biological characteristics. However, a fair society has to appreciate the life of all people regardless their physical endowments, without implying that groups of people should not exist, because society isn’t properly prepared for them.
At the same time, is sustained that future parents have interest in avoiding the psychological and economic burden, which brings about the care of a disabled child, where abortion of a disabled fetus seems to dispense future parents from this kind of burden. But selective abortion for the promotion of future parent’s welfare in terms of economic resources, time and psychological strength encourages the social discrimination against disabled people to the extent that many of the problems, which parents with disabled children confront, result from social discrimination and not from the damage itself and the welfare of the future parents consists in avoiding the social discrimination, that families of disabled people already bear. The problem about the negative impact that a personal decision may have for all the people in the society, refers to the already existing problem about the offense of the autonomous reproductive choice. As many as women “choose” to proceed to the selective abortion, they often feel that their decision isn’t entirely voluntary, as they are corresponding to a social context, in which the inadequacy of social solidarity programs for the disabled people, the stereotypes and the social inequalities discourage the birth if a disabled child. So, it is impossible for the selective abortion to be sustained by the woman’s right to decide, when she is living in a society with values and her decision is constrained from oppressive values and attitudes. The objections that have been mentioned so far about selective abortion are reinforced from censors of abortion, who, sustaining that the fetus has moral status, imply that when a woman voluntarily and responsibly pursues motherhood, then she owes to show the analogous responsibility, when she decides to have an abortion. The reasons for her decision have to be important and serious, as important is the fact that abortion deprives the fetus of a remarkable future and of the possibility to live a remarkable life. So, acknowledging that the individual choice, either autonomous or constrained, can influence people, they deem that only in case the woman’s interest in life is in danger from the pregnancy the abortion can be justified ethically, since the protection of this interest doesn’t offend human dignity and is in accordance with a responsible social behavior. Interests less important than that in life can’t preponderate over the fetus’ interest in life and for this reason they are disapproved.
The findings of this paper suggest that selective abortion of a disabled fetus is a form of eugenics, since it meets in a way the aims of eugenics. Considering that “good” and “bad” eugenics exist, selective abortion is a form of “bad” eugenics, when the specific reproductive decision is not taken autonomous from the pregnant woman and the reason for her decision is the mere fact of disability. This “new eugenics” reality deserves further study and the role of medical services as also the role of society to the reproductive decision making process need to be reassessed.
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