In this class we will move from discussing the ethics of abortion to discussing the ethics of selective reproduction.

Transcription

1 UNIT 3: ABORTION, SELECTIVE REPRODUCTION, AND BIOMEDICAL ENHANCEMENT HANDOUT 4: SELECTIVE ABORTION 1: SELECTIVE REPRODUCTION In this class we will move from discussing the ethics of abortion to discussing the ethics of selective reproduction. Selective Reproduction The deliberate attempt to create one possible future child as opposed to a different possible future child. 1 There are a variety of different methods of selective reproduction that require varying levels of technology. (i) Using prenatal screening techniques (such as amniocentesis) to detect undesirable traits (down syndrome is often such a trait) and then aborting the pregnancy in order to conceive again. (ii) Using In vitro fertilization (IVF) to implant sperm and/or eggs from a specific donor, who you expect to have certain characteristics, so that the child will have those characteristics as well. (iii) Genetic enhancement techniques that would involve deliberately inserting genes into embryos in order to design children with certain traits. Today we will look at the ethics of method (i) which involves selective abortion. 2: SEX-SELECTIVE ABORTION Some who, in general, are pro-choice on the question of abortion oppose abortion in certain cases. Specifically, many oppose abortion when it is targeted specifically at some group. Today we will look at two types of selective abortion: sex-selective and disability-selective abortion. 1. Based on the news article from today s reading, what reasons can you think that could make sex-selective abortions problematic? 3: DISABILITY-SELECTIVE ABORTION Another more common variety of selective abortion is directed at disability. For instance, studies have shown that somewhere between 67-85% of parents elect to have an abortion upon receiving a diagnosis of Down syndrome. 2 Many in the disability rights movement, among them Adrienne Asch, have argued that this variety of abortion is morally objectionable. 1 Stephen Wilkinson, Choosing Tomorrow s Children, 2. 2 J. Natoli, et al. Prenatal diagnosis of Down syndrome: a systematic review of termination rates ( ). Prenatal Diagnosis 2012; 32(2):

2 3.1 THE EXPRESSIVIST ARGUMENT AGAINST DISABILITY-SELECTIVE ABORTION One of the main objections against the practice of disability-selective abortion is commonly termed the expressivist argument. We can outline Asch s version of this argument as the following. The Expressivist Argument P1 Selective abortion for disability expresses a negative, and discriminatory, attitude about those with disabilities. P2 It is morally wrong to engage in practices which express negative, and discriminatory, attitudes. C We should not engage in selective abortion for disability. The idea behind this argument is not that selective abortion harms the fetus being aborted, but that it expresses a negative attitude about those who currently have disabilities. Based on P2, we can say that selective abortion is a kind of hate speech. When a KKK member burns a cross in someone s front yard, one reason this is morally wrong is that it involves trespassing and likely damages property. More fundamentally, however, doing so is wrong because it constitutes a deep offense to some ethnic, racial, cultural, or religious group. The speech itself constitutes a sort of harm. Many in the disability rights movement liken selective abortion to hate speech in this way. 3.2 JENNIFER TOWELL S REACTION TO MATERNIT21PLUS An example of this type of concern can be seen in the reaction that followed from the a segment on the January 28, 2013 edition of the Today Show (see the full segment here). This segment featured a couple who had used a new, less invasive, method of prenatal testing called MaterniT21 Plus, cleverly (or perhaps offensively depending upon your point of view) named for its ability to tell you if your child has Down Syndrome. In one portion of the interview (at the 2:45 mark) Matt Lauer states Lets get right to the good news before having the couple reveal that their child does not have Down Syndrome. While many would see the parents relief and happiness about this news as justified, others were offended by for the issue was presented. In a blog post that went viral days after the show aired, Jennifer Towell, mother a child with Down Syndrome, expressed such a stance. The good news of this particular segment--- which had claimed that the testing would allow the parents to prepare and line up specialists-- the good news was that their baby did not have Down syndrome. The good news that The Today Show celebrated on January 28, 2013 was that this couple's baby-to-be will not be like our precious son, Joey. Furthermore, she was clear that her concern was that society would begin to perceive her son, and others like him, in a negative light. For that, I'm more dedicated to trying to help advocate and educate the world that having a child with Down syndrome is not some kind of dark cloud. 2

3 She exhorts her readers to think carefully before casting Down syndrome in a negative light. For now, I wonder, is it too much to ask others to not celebrate on national television that their child does not have Down syndrome? 1. What was your initial reaction to Towell s blog post? Do you think she had good reason to be offended in this case? 3.3 ACTION AND EXPRESSION The most controversial premise in Asch s argument is P1. Evaluating this premise requires explaining exactly what attitude is expressed by disability-selective abortion. This first requires understanding what it means for a practice to express something. This is not as easy as it might first appear. In the case of words it is generally, although not always, easy to determine what they express. For instance, the word chair expresses the idea of something that is meant to be sat on. It is relatively easy to determine what this word means because it is part of an established system of language where words have known meanings. Actions, or practices, also express meanings. As we saw previously, Judith Jarvis Thomson thought that parents who elect not to have an abortion and take the child home with them have expressed, at least implicitly, that they will care for it. However, it is not as easy to determine what an action or practice expresses. One way to think about what it means for an action to express something is the following. Some action, A, only expresses some belief, B, if the person performing A must believe B for the performance of A to make sense. 3 For instance, it is likely that the act of going to the grocery store expresses the belief that groceries are needed because it is unlikely that one would go to the grocery store for another reason. 3.4 SELECTIVE ABORTION AND FIRST IMPRESSION What, then, is expressed by the choice to have an abortion after prenatal testing shows that the child will have Down syndrome? Asch provides the following example to help explain this point. You are a professor in a philosophy department at a large urban university. In your class of fifty students, you notice that five students have pierced tongues and lips and that a few others have dyed their hair in unnatural colors. You have difficulty even looking at these students because of their style, and you ignore their raised hands when they want to participate in class discussion. Midway through the semester, a man with dyed hair comes to your office to raise questions about the work in the course, and you realize that he actually has some interesting observations to make 3 Allen Buchanan et al., From Chance to Choice,

4 about the class and find yourself chagrined at your avoidance of his raised hand, of which you were only half aware until he appears at your door (Asch, 235). What the act of ignoring this person s questions in class expresses the following belief: people with dyed hair do not have anything valuable to contribute to class. Something similar occurs, according to Asch, with disability-selective abortion. The belief expressed is that it would be better if people with disabilities were not born, just as it would be better if people with dyed hair did not participate in class. In each case, Asch argues that what is problematic is that these conclusions were made from a first-impression. Disability is so objectionable that finding out that fact alone is enough to justify having a different child. Recall that in order for a practice to express a negative attitude, that the practice in question must be necessarily tied to the attitude in question. Asch notes on pg. 236 that some have tried to point out that there are other less objectionable reasons for disability-selective abortion. (i) The prospective mother and father may feel they don t have the emotional or financial resources to raise a child with special needs. (ii) They may already have another child with a disability and feel they cannot care for another. (iii) The parents may have the disability in question and not want to pass on a harmful condition to their child. Asch responds in the following way. All these claims do not refute the view that this one characteristic of the embryo or fetus is the basis for the decision not to continue the pregnancy or implant the embryo [ ] In most cases of preimplantation genetic diagnosis or prenatal diagnosis, the woman or couple desires to be pregnant at this time; the termination of the process only occurs because of something learned about this child (Asch, 236). 4: OBJECTIONS TO ASCH S ARGUMENT Asch considers three main objections to her argument. 4.1 THE ANY/PARTICULAR DISTINCTION At the basis of Asch s argument is the idea that there is a difference between having an abortion that would have been done with any fetus, and having an abortion because of this particular fetus. A women who gets pregnant and decides to have an abortion because she knows she is not in a position to care for the child would have had an abortion regardless of what the fetus is like. On the other hand, a woman who only decided to have an abortion after finding out that the fetus she carries has a disabling trait is having an abortion because of something about this particular fetus. 4

5 Some have argued that, if this argument is sound, then it would actually show that all abortions are wrong. James Lindemann Nelson argues that this any/particular distinction as applied to the case of disability could be used to call any abortion into question. He claims that the fetus who would be the fourth-born child is also a particular fetus, and that any decision to abort is always a decision particular fetus at a particular time (Asch, 236). Does the decision to have an abortion because a couple already has three children express a negative attitude about children who are fourth born? 1. How does Asch respond to this argument? 2. What does she say about abortions that are performed based upon the paternity of the child? 3. Explain the role that the social stigma that accompanies disability plays in these responses. 4.2 THE SELECTION/PREVENTION DISTINCTION Others have argued that if abortion to prevent disability is objectionable, then so should prenatal care that is designed to prevent disability (such as taking folic acid to prevent spina bifida). They argue that if Asch thinks that abortion is especially problematic it must be because she actually has some moral concerns about abortion in general. Asch responds in the following way. Ending an otherwise desired pregnancy after learning of a diagnosis of spina bifida or cystic fibrosis says that this one fact trumps everything else one could discover about the child-to-be, and says that the woman (or couple) cannot accept into her intimate life a child with this characteristic when she planned to accept a child. A health report card becomes precursor to membership in the family, making the family rather like the club that Leo Kittay describes in the discussion with his mother captured in her chapter in this volume (Asch, 239). 1. Explain the point Asch makes in this passage and how it shows that there is an important moral difference between what is expressed by prenatal care and what is expressed by selective abortion. 5

6 4.3 IDENTITY AND DISABILITY A common reply to this argument is that selective abortion only expresses a negative attitude about the condition of disability itself and not those who have disabilities. In other words, selective abortion expresses attitude (i) from below but not attitude (ii). (i) Down syndrome is an undesirable condition and it would be better if it did not exist. (ii) Jill, a person with Down syndrome, is undesirable and it would be better if she did not exist. Some have argued that Asch s argument is only convincing if disability is such a central part of one s identity that it is impossible to negatively evaluate a disabling trait without also negatively evaluating people with disabilities. Asch responds that she does not believe that disability is central for everyone who shares her view of prenatal testing (Asch, 241). She believes it is in principle possible to separate the disability from the disabled person. However, she also points out that present oppressive social conditions make disability more central to identity. Disability becomes central, or salient, when circumstances in the world around us compel us to make it salient or central. Put another way: those people within the disability rights movement who challenge prenatal testing do so in much the same spirit as the challenge prenatal testing do so much in the same spirit as they challenge other practices that have historically kept people with disabilities from being accepted as customers, students, coworkers, friends, and loved ones. They do so because they needn t celebrate nor even like certain facets of their impairments, yet they recognize that their lives impairments and all are respectable, acceptable ways to live (Asch, 243). Because presently and historically disabled people have encountered social stigma and discrimination, the property of disability is more central to one s identity than might be otherwise. To use the example from the text, Asch notes that she also lacks musical talent. However, this trait (being nonmusical ) does not become a central part of her identity because there is not a social stigma attached to this trait. I needn t worry that people like me (without good intonation) will be told that the world would be better off if there weren t more people like us, when I am doing the best I can with the equipment I have in the world as it is [ ] I do not need to have an emotional investment in the fate of nonmusical people because it is not yet a characteristic that carries social stigma and occasions discrimination; prenatal testing does not yet announce to prospective parents that they might wish to learn of the musicality of their next child and prevent the birth of anyone with impaired intonation (Asch, 243). 6

7 5: UNDERSTANDING DISABILITY: THE SOCIAL AND MEDICAL MODEL Toward the end of today s reading Asch also suggests that disability-selective abortion reinforces a misguided understanding of what disability is. There are two main models for understanding the cause of disability: the medical model of disability and the social model of disability. Medical Model of Disability The view that the functional limitations which constitute disability arise purely from a physical conditional that is intrinsic to the individual with the trait in question. Social Model of Disability The view that the functional limitations which constitute disability arise purely from a social and political context which negatively values or fails to accommodate the individual with the trait in question. 1. Consider someone who is paralyzed from the waist down. How would the medical model and social model explain what it is that makes this trait disabling? 2. What would the medical and social model think should be done to get rid of this disability? The social model portrays disability as similar to other characteristics which have been subject to oppression and discrimination (race, gender, ethnicity, religious affiliation, etc.). The idea is that much of what makes disability disabling is a social context that is inhospitable to difference. It is important to note that these two models are not mutually exclusive. The most accurate model of disability should accept that both medical and social factors play a role (a point which Asch does not deny). She does, however, think that selective abortion enforces the idea that disability is purely medical. In other words, it enforces the idea that it would be better to spend resources on technologies which give us the ability to detect and eradicate disability than it would be to use resources to make society more accommodating. 6: REVIEW QUESTIONS 1. What is selective reproduction? What are some methods of selective reproduction? 2. What is the Expressivist Argument? Explain how this argument equates disability-selective abortion with hate speech and how the idea behind this argument was present in Jeniffer Towell s blogged response to the Today Show. 3. Under what conditions can we say that a practice or action expresses some belief? 4. Explain what Asch believes is expressed by disability-selective abortion. Why does she think it is a clear case of first impression? 5. Explain how Asch s argument relies upon what she terms the any/particular distinction. How have some argued that her use of this distinction threatens to make all abortions wrong? How does Asch respond to this argument? 7

8 6. Explain how some have criticized the Expressivist Argument by arguing that, if sound, it would also make prenatal care wrong. How does Asch respond to this criticism? 7. Explain the idea, put forward by some who reject the Expressivist Argument, that selective abortion only expresses a negative attitude about disability, not people who have disabilities. Explain Asch s response by describing how she thinks that disability becomes a central part of one s identity. 8. Explain the difference between the social and medical models of disability. Why does Asch believe that selective abortion reinforces the view that disability is purely medical? 8