Advancements in pre-natal tests and screening procedures in the last half-century have enabled prospective parents to determine several important aspects of their fetus's condition in utero: from sex to chromosomal anomalies. One of the most routine tests offered to pregnant mothers looks for the presence of an extra chromosome on the 21st set of the karyotype e; the resulting condition is known as Trisomy-21 or Down's syndrome.
In the wake of a positive result from either amniocentesis or chorionic villus sampling, many women, for a combination of reasons, choose to terminate their pregnancies. Rates of fetal abortions with down's syndrome vary: in 2009 3 babies diagnosed with down's syndrome were born and in 2016 Denmark there were 4. These numbers have drawn mixed responses; among them the question of whether or not our society (and all societies) should strive to achieve similar rates by encouraging abortion of fetuses with a diagnosis of Down's syndrome. I will begin by arguing that it is unethical to actively encourage woman with a down's syndrome positive fetus to terminate the pregnancy on the basis that encouraging an abortion of a down's syndrome fetus works against all current accepted models of patient-centered care by preferring impure over weak paternalism. It should be noted that I consider pre-natal genetic screening and abortions to be both major benefactors in a woman's reproductive autonomy in such that they ensure that a woman with capacity has the information she needs to make informed decisions surrounding her pregnancy. Therefore, I will not consider women who freely terminate pregnancies involving fetuses with down syndrome diagnoses to be acting unethically; only the bodies which encourage it.
Interlocutors generally take the stance that because we have developed (and continue to develop) advanced pre-natal screening and procedures, then simultaneously we have also brought upon ourselves as a society and to our species the moral responsibility for producing the healthiest, fittest population possible. They consider the concept of autonomy as not only possessing the freedom of choice, without government infringement, but, in a richer sense, choice in accordance with one's own values. Ergo, if one's values include equality, health and intellect, then the encouragement of abortion does not infringe upon the principle of autonomy nor constitute coercion or undue inducement and is then ethical.
However, I would argue that the compatibility of values is not grounds enough for actively encouraging abortion not only because of the high degree of subjectivity involved but that this encouragement, even in the name of a proposed "greater good", because the idea is impurely paternalistic by design it has the potential to destabilize the entire foundation upon which our healthcare system in founded upon
Moreover, I do give to the opposition that pre-natal is already concerned with ensuring the birth of well-born children. But in the case of a down's syndrome diagnoses encouraging the termination of the pregnancy in support of a great social good expands the modus operandi of pre-natal diagnoses beyond only being concerned with ensuring the birth of viable neonates to seeking to improving the most beneficial qualities of populations. Through this expansion pre-natal diagnoses would become linked with the ideologies of eugenic practices. I argue that because eugenics is intrinsically wrong within its conception and practice through coercion and abrogation of reproductive freedom, state control, discrimination and racism, denigration and stigmatization of the disabled, and deprivation of life that the current concerns of pre-natal diagnoses should not be expanded to include the population at large.
Moreover, I argue that these same goals of producing the fittest, healthiest population which eugenicists claim to concern themselves with are attainable without the necessity in particular to encourage woman to terminate their down's syndrome pregnancies. More specifically, that there is no inherent need for external pressure as the process of prenatal diagnosis has an internal momentum that already drives toward abortion. I argue that within the current health care system there are overt and covert forces that exert coercive pressures toward the utilization of prenatal diagnosis and termination of pregnancy should an abnormal fetus—however that is defined—be detected. Consider how pre-natal diagnoses operate in the current context: they are widely accessible and considered routine, this is by very nature coercive as it implies that the test and procedures should be used. Not only does the very existence of these tests imply that is should be used, but that the condition which is screening is an unfavorable one that should be avoided. I state that because the pre-natal screening and procedures are usually undertaken with the implicit expectation that termination of the pregnancy will be the subsequent outcome should an anomaly [in this case down's syndrome] be uncovered that pressures of active encouragement are separate and distinct from the pressures of the process. Given this argument, actively encouraging the abortions of fetuses with down's syndrome is not only unethical, but would also appear to be quite unnecessary in the pursuit of ensuring the fitness of the population at large.
Even if the primary concern is not the genetic fitness of a population. Interlocutors may consider if one or two capable and competent individuals have decided to have a child, and selection is possible, then they have a significant moral obligation to select the child, of the any possible children they could have, whose life can be expected, in the available circumstances and context, can be expected to enjoy the most well-being based upon parameters of their genetic endowment. It follows then, that encouraging the abortion of a down's syndrome positive fetus is not unethical as it attempts to protect the parent(s) from moral defect.
This begs the question of whose best interests are being looked out for and protected by this moral obligation. Surely, there are only four potential answers; those of the prospective parents, those of the unborn, those of the state, or a combination of all three. Regardless of whether one states the best interests of this moral obligation lie with one, some, or all of these options each consideration requires the formulation of reasonable opinions on difficult questions about the nature of well-being and the constituents of the good life, and about the weight we should give to the prospects of future children when these compete with other moral considerations. In this case of down's syndrome, it would be argued that the expected quality of life is diminished resulting from an inborn deviation from a species norm or some other standard of normal which is intrinsically bad and therefore always merits correction. However, a species standard, if you will, is arbitrary and ambiguous. Do we not all suffer from deviations from a species norm inherent to our nurture or nature which reduce our well- being and make it more difficult to realize a good life?
Maybe, I should consider their reasons behind believing that no child with down's syndrome could enjoy well-being and in turn, a good life. There are obvious physiological deficits associated with the condition: eye and heart problems, underactive thyroid, developmental and learning delays, and an increased rise of leukemia is a non-exhaustive list. However, there are treatments and therapies for all these health issues and none of them are exclusive to down's syndrome as they exist in individuals without the chromosomal anomaly.
Perhaps the opposition could consider the perceived inability of a down's syndrome individual to attain a satisfactory level of well-being as a negative consequence of disability due to social prejudice.
This ties back into the question I asked about whose best interests are protected through selection as a moral obligation, there are parents who undoubtedly love and cherish their children with down's syndrome, and individuals with down syndrome who, by their own accord, lead happy and fulfilling lives. I argue that those whose best interests are protected are those by and large outside of the parent-child dyad.
Ultimately, I am inclined to state that I do intuitively agree with the ideologies of both counter-arguments. Individuals and society at large do many uncontroversial things to ensure that their child will have the best chance at the best life and be a positive contribution to a population. Evident in such social norms as selecting a mate based on evolutionary attributes and paying consideration to personal, financial and health situations at the time before, during, and after conception.
The goals of the opposition are not controversial in this case, but their proposed application of encouraging down's syndrome abortions is. In this paper I made the case for its unethicality by highlighting how it employs a type of paternalism that would expand the current purpose of pre-natal diagnoses beyond ensuring the birth of healthy babies to the eugenic conceptions of a genetically ideal population that is not necessarily in the best interests of the parent-child dyad.
Lastly, I argued that there are difficult questions that should be raised concerning the nature of well-being and the constituents of the good life for disabled individuals in particular those with down's syndrome before one can justify that absolute termination should be employed or considered a moral obligation.