This is a tough one, though I'm sure some regulars of this blog will have ready-made answers for the conundrum. A recent New York Times article by Amy Harmon has highlighted an ethically controversial side of prenatal genetic screening. One might think that prenatal screening for all sorts of genetic defects would be an unqualified good, except perhaps for the potential misuse of such information by health insurance companies.
But while insurance companies' access and use of test results can be legislated or kept in check using current privacy laws, it is far more difficult to tackle the thorny issue of what the parents are going to do with such information. The data are clear: parents opt for abortion in proportion to the severity of the handicap that their unborn child would have to bear in life. For example, a study of 53,000 women's choices found that prenatally screened conditions that were classified as having no impact on the quality of the adult's life lead to about 1% termination (presumably from distrust of the actual risks involved), but those conditions judged to have a serious impact led to a 50% abortion rate. Moreover, women were more likely to choose abortion if the disability was of a type that impacts cognitive functions, for example 80% termination in the case of Down syndrome.
This is what's making advocacy groups for disabled people rather nervous, with some groups -- like the Cystic Fibrosis Foundation -- going as far as not advocating prenatal screening. The objections raised to the screening procedure range from rather paranoid worries that one begins with the fetus and then proceeds to "take care" of the adults, to more reasonable positions that include the possibility of curtailed funding for research on treatments, to borderline issues concerned with the increasing isolation of handicapped people once a particular genetic disease is stamped. (Sorry to be politically incorrect here, but I really find it hard to use words like "differently able." These are people in need of both medical and psychological help, not simply variations on the normal human condition.)
The reality is that prenatal screening is going to spread as it becomes cheaper, and it would be disingenuous to think that parents are not going to make decisions based on the results they obtain. As usual, the question is one of fuzzy boundaries separating obviously positive aspects of the issue from the clearly detrimental ones. For example, the NYT article quotes Mark A. Rothstein, director of the Bioethics Institute at the University of Louisville School of Medicine, as asking "Where do you draw the line? On the one hand we have to view this as a positive in terms of preventing disability and illness. But at what point are we engaging in eugenics and not accepting the normal diversity within a population?"
Good question. Any complex, nuanced, and reasoned answers, everybody?
Rationally Speaking: an archived blog about science & philosophy, by Massimo Pigliucci
Friday, November 25, 2005
Abortion and genetic engineering
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Massimo,
ReplyDeleteWould the solution to a dilemma in bioethics have to pay homage first to nature, to "self" or some other less noble philosophical rationalization? Remember, and this once again, that the technology used to identify these conditions is not natural. And in the same course of action, neither would an abortion be.
So we show weakly developed logic to suggest that nature has anything WHATSOEVER to do with this type of solution. The Nazis used a similar (ill-logic) over the use of information and technology, btw.
The right answer should be, as per your review of Job, to accept the hardship and to let one's life be changed and the facades ripped off through the midst of it. Easy to do? No way! But why should anyone who counts themselves as a “thinker” rather prefer to live an unexamined life?!
cal
Cal, the technologies that you use to shop and prepare your food, or to sleep peacefully at night, are also "not natural." So why don't you accept the hardship and go out to hunt your dinner and sleep under the starry skies?
ReplyDeleteInnovation-wise, apples and oranges.
ReplyDeleteWould anyone have objected to the use of knowledge and technology by Nazis, if they merely preserved their food and created a safe warm place for themselves at night? NO - they willed to rid themselves of INDIVIDUALS THAT THEY DEEMED INCONVIENT or offensive by their very existence.
I think anyone who cares (anyone who chooses live the "examined" life) knows precisely why these two uses of nature vs anti-nature are conclusively different categories. Why don't you?
cal
Cal, the reason I brought that example up is to highlight the complete non sequitur of your objection. Nazis have as much to do with prenatal screenings as the latter have to do with hunting and gathering...
ReplyDelete"Nazis have as much to do with prenatal screenings as the latter have to do with hunting and gathering..."
ReplyDeleteThat's one point of view.
You may not find the comparisons to Nazis favorable, but that doesn't mean that the comparisons aren't fitting.
The reference you've used here in regard to hunting and gathering implies a time when people (or whatever kind of creature you want to pin this ill-logic on) were not accountable for their actions towards other creatures or humans. There, in fact, (provable by written history) has never been such a time. In the end technology doesn't change in the tiniest bit who we really are. So whether we have been thought in the past "primitive" by external standards, or "advanced" by those human contrivances, the internal self
is really still the same old, tired, selfish, fool.
cal
Did we run up against the Godwin Rule in the very first post? Ah well.
ReplyDeleteI'm for using ever bit of knowledge we can to assist in having healthy children. Diversity in genetic heritage is good but raising children with serious handicaps inflicts serious (and unnecessary) hardships on the child, the parents and society. I would not want a society that forced parents to abort if testing showed probability of handicaps but neither should those parents be allowed to place the burden of supporting that child on the general public. Besides, it's not like making another child is all that hard. In fact, the initial process is rather enjoyable. The more attempts, the better!
da: "I would not want a society that forced parents to abort if testing showed probability of handicaps but neither should those parents be allowed to place the burden of supporting that child on the general public."
ReplyDeleteLike the causes and effects post atomic bomb, the option should have never been invented.
If physicists can barely handle such a complicated and difficult emotional scenario, what makes you think that an individual, even at the rate of ONE little life at a time, could do better? We can't, we don't, and therefore the responsibility for said technology should have never rested with the general populace.
The real dilemma, of course, starts in the bedroom. If people saw their sexuality like the fallout from an atomic bomb, we would not be making excuses for those who wish to use technology to merely 'clean up' the something to the effect of residual radiation.
cal
the technology used to identify these conditions is not natural
ReplyDeleteNaturalistic fallacy, anyone? In which case, let's smoke pot and inject plenty of snake venom - both natural, no doubt. And let's leave the diseased and weak children to die or be eaten by predators, too - nothing more natural either.
Regarding eugeny and the like, let's please use earlier sources than the Germans - they might have been the most flashy in the business, but they sure weren't the first. What about denouncing America's eugenic movement of the early 20th century too, for a change? Or that of other Western European countries other than Germany, also?
Well, sorry for being off-topic. I'll try to post something more relevant later. Gotta run now - it's Friday! :-)
J
A more realistic view of this dilemma might be given by someone who has faced this choice or who has raised profoundly handicapped children. I know several couples with Downs kids and they have done admirable jobs with a very difficult task. But what of parents without the psychological function, the skills, and/or the means to carry out such a task.
ReplyDeleteIt's easy to make judgements from outside any given situation; a much different story if you are in the middle of it. I remain neutral in this matter because I have not had to walk in those moccasins, and at nearly 68 years old have no plans to do so.
"One interesting statistic would be to look into how many aborted fetuses would have been perfectly normal."
ReplyDeleteHere's another interesting thought. Imagine if there were a test for autism, a disability with a wide range of severity. Now the child might be born with severe language problems and retardation, or at the other extreme, the child might be of average or even above-average intelligence but socially awkward. Worse, both kinds of children could be born in the same family. So in such a situation, the decision to abort is far from clearcut.
I had relatives that almost faced a similar situation. They wanted 2 children. The first was born healthy, but early tests on the 2nd pregnancy indicated a possible severe problem. Fortunatly later test were normal and the child was born healthy. But they were facing a difficult decisions for a while - carry this pregnancy to term, or abort this pregnancy and try for another one. Some family members thought that they should accept whatever fate God gave them. But I kept thinking about the situation 17 years from now. In one case (don't abort), their youngest child would be severely mentally and physically handicaped, confined to a hospital, and would probably die before reaching 20. In the second case (abort and try again), their youngest child would likely be a normal vibrant high shool student - probably looking forward to attending college in a few years. I have a real difficult time accepting that the first case is morally better than the second case.
ReplyDeleteMorals are imaginary - they don't exist outside of the human mind. This makes it difficult to decide what is and isn't moral. We are left with morality decided by group decision.
ReplyDeleteThe assertion that there is some deep dilemma here smuggles in a huge unwarranted assumption - that abortion is morally blameworthy or otherwise ethically bad. If one believes that deciding not to carry a pregnancy to term is simply a practical decision rather than a moral decision, the dilemma is not nearly so profound. So what is wrong with abortion? I'd like to know if anyone has an answer free of emotional appeals, faith assertions, and empty rhetoric.
ReplyDelete(Cal, here is your cue to jump in with your even larger set of even less warranted assumptions about what is "natural" and why what is "natural" matters ethically. But be warned that, since you've proven unable to provide even a hint of argument in favor of any such assertions, most of us will continue to ignore you.)
I have to amend my prior comment about morals being imaginary: ALL categorizations are imaginary, not just the categorization of something being moral vs immoral. Every category one can think of is a human invention for practical purposes (such as the category of colors - we as a group decide what is and isn't "red" and simply use that decision without much debate; however, some categorizations are harder to reach consensus on, such as morality.) PS: this is old (ca. 2500 BC) news.
ReplyDeleteWow Cal... why don't we just head back to the dark ages
ReplyDelete"Like the causes and effects post atomic bomb, the option should have never been invented."
Cal, the technology is there for all purposes. While a dangerous avenue, the nuclear age has also offered as many or more positive opportunities for science as negative ones. Genetic testing and screening will become more and more previlant as it becomes easier and more reliable. This is the same technology that is allowing doctors and patients to screen people for risk factors for many deadly health problems that can be averted ( cancer, heart disease, ... )
I see nothing wrong with perental screening as it will help to allow parents to make an informed decision as well as prepare for any necessary medical care deemed appropriate. The sad but true fact is that many people can not afford the financial, emotional, or employment burden that a developmentally disabled or medically unsound child places on them. In the US a middle class family can easly be distroyed AND, thanks to Bush, be bankrupted due to the birth of a child with downs or other serious medical problems. Financial problems is the leading cause of marital strife and divorce. The health and welfare of my family comes before any one fetus. With the ability to have more or adopt I don't see any moral delima unless you believe that ANYTHING that increases abortion is wrong ( the same reasoning used to go out and kill abortion doctors ). If that is the case you should not blind the parents, but boost social programs so that these familes do not have to choose between abortion and bankrupsy. Or looking to clean up the environment so that fewer children are born with preventable abnormalities from chemical and biological waste.
Once you realize that abortion, in these cases, is not just some whim or fancy to have a perfect child you start to see that the problem is not in providing accurate screening, but in a economic and sociatal system where those that want to face these challanges risk everything they have worked for when making that choice.
"In a society that isn't threatened by underpopulation, there's room for some people to use the genetic information to end the "life" of the embryo, and others to ignore or avoid the information, or know yet not abort if they get bad information."
ReplyDeleteIt is regrettable that EVEN "bad information" has a tendency to become a relative term anymore. And I doubt few women, when reviewing the facts, do educate themselves on the areas that are potentially the most unpleasant to consider. If they had, it is unlikely that the following stats would exist at all. This, as I see it, has become a world more oriented around the male gender than it has ever been! i.e. is there a reason that men do not commit suicide over the loss of a UB child?
When I see this article I think of a parallel to voluntary 'widow burning', for some reason.
Study: Abortion increases suicide risk
13-year examination also finds higher rate of accidents, homicide
Posted: December 2, 2005
Women who have an abortion face a 248 percent greater risk of suicide, accidental death or homicide in the following year, according to a newly released 13-year Finnish study.
The survey also found the suicide rate among women who had an abortion was six times higher than for women who had given birth in the prior year and double that of women who had miscarriages.
The study was conducted by Finland’s National Research and Development Center for Welfare and Health and published in the European Journal of Public Health. The researchers studied data from the years 1987 to 2000 on all deaths among women of reproductive age, 15 to 49.
While the risk of death among women who had given birth in the prior year was lowest, death from suicide, accidents and homicide was highest among women who had an abortion in the previous year.
Women who had been pregnant had less than half the death rate of women who had not been pregnant. The risk of death for women who had suffered a miscarriage or ectopic pregnancy did not noticeably differ from women who had not been pregnant.
The findings confirm other studies carried out in the United States, as well as Finland, that showed an increase in the death risk of women who have abortions.
In 1997, a government-funded study in Finland found that women who had abortions were 3.5 times more likely to die the following year than women who had given birth.
Furthermore, researchers looking at death records linked to medical payments for birth and abortion for 173,000 California women discovered there was a 62 percent higher chance of death for aborting women than delivering women over the eight-year period that was examined.
The study also found that the increase in the risk of death was from suicides and accidents. It showed a 154 percent higher risk of death from suicide and 82 percent higher risk of death from accidental injuries.
The main author of the California study, David Reardon, said record-linkage studies like this one are key to getting an accurate picture of pregnancy associated mortality rates.
"In most cases, coroners simply have no way of knowing that the deceased recently had an abortion, which is why these new record-linkage studies are so important," Reardon said.
Government health officials in Finland found in a recent study that 94 percent of maternal deaths involving abortion could not be identified by merely looking at a death certificate. This discovery applies to the data published by the Centers for Disease Control in the U.S.
Also, previous studies draw links between women who get abortions and an increase in substance abuse, anxiety, sleep disorders, suicidal thoughts, psychiatric illness, relationship problems and risk-taking behavior, which could easily lead to death by suicide or accident.
Beyond that, authors of the new Finland study suggested there might be common risk factors between having induced abortion and dying from accidental injury. They called on medical professionals to be aware of these risks.
"Women seeking abortions should be informed that abortion is associated with significant physical and mental health risks, and it also deprives them of numerous physical and mental health benefits associated with childbirth." Reardon said.
He added, it's "especially important for health care providers to be aware of these risks and the risk factors which identify those women who are at highest risk."
"Providing women with the resources to help them resolve emotional issues relating to past abortions will not only increase their well-being but may possibly save their lives," he said.
http://www.wnd.com/news/article.asp?ARTICLE_ID=47705
cal
"But be warned that, since you've proven unable to provide even a hint of argument in favor of any such assertions, most of us will continue to ignore you.) "
ReplyDeletesounds good to me. I guess I'm just more of a believer that natures own regulated patterns of everyday functions, really are better and more orderly than "anti-nature”.
Just for future ref., the fear of being ignored (i.e. peer-pressure) passed entirely out of my consciousness, somewhere between ages of 9 and 29. That's what's cool about being over 35, btw. :)
cal
Cal,
ReplyDeleteWow, that's one of the worst conclusions I have ever seen from a study. They took raw data, did not control for living situations* and then "pro-life"-ers have gone and averaged out the results to make an outrageous claim. Garbage in, garbage out.
Let's start with the fact that the study made no attempt to find causation. This is the most damning fact that appears to have been overlooked by those who champion this study. For example they use the homicide statistic to claim "once again reinforces the conclusion that women who abort are more likely to engage in risk-taking behavior." without controlling for risky lifestyles before pregnancy, their is no ethical way to draw that conclusion from the study. It would be much more accurate to say that women who engage in "risky" behavior are more likely to get pregnant in the first place? ( that would be too simple )
"Increased tendencies toward anger and violence after abortion were also significantly associated with substance abuse and higher suicidal tendencies." - Hmmm... maybe it's the drug use and not the abortion that is causal ( why they are pregnant and getting an abortion as well ) not the other way around? But once again they never controlled for drug use in the study to see how that actually affects the outcome.
While the data used in the study should be fairly free of reporting bias that most other anti-abortion tripe suffers from, the conclusion reached by the "pro-life" community on this study are equally astounding and disturbing.
Corolation != Causation... I don't think I need to repeat it for most of the regular readers here, but for completness I do. Once you realize that corolation != causation you can see that these women are probably statistically more likey to die BECAUSE of the situations ( drug use, abusive partners ) that they are in NOT because they had an abortion; the same reason women might get pregnant by accident or by force as well; the same reason women want to keep abortion safe and legal. Once you control these studies for living situations I would bet that their is statistically no signifigant change in mortality rate ( in fact it's probably lower ).
Living in NYC you are more likely to be murdered, this does not mean that you are an immoral or risk taking person. You can also see that living anywhere and having a drug problem will endanger your life far more than a non-drug user living in the city at being murdered ( or committing succeed for that matter ). The study is bunk until they control for the behaviors they are projecting on those who abort.
"sounds good to me. I guess I'm just more of a believer that natures own regulated patterns of everyday functions, really are better and more orderly than "anti-nature”." - Then you should stop eating processed foods, driving in modern vehicles, using the computer, using drugs of any kind, turn off power to your house and go back to using wood stoves and growing your own food.
Cal, when attempting to change the minds of rational people you should bring better arguments to the table.
*They did mentioning controlling for maternal health at one point, but that was it.