The New Screening Technologies Make Being "Pro-Choice" Far Harder


The New Screening Technologies Makes Being "Pro-Choice" Far Harder.
According to the Nuffield Council on Bioethics in England, between 1989 and 2012, 89% and 95% of UK couples given a diagnosis of Down’s syndrome after a pre-natal screening test, chose to abort the fetus. (In the US, the termination rate is lower but how much lower is subject to debate). This may seem problematic to some of us, even if we are pro-choice, given the rich lives many persons with Down’s enjoy. It is a preview of what is to come as screening for genetic differences of many different kinds becomes increasingly sophisticated, comprehensive and aggressive.

One of these, Noninvasive Pre- Natal testing (NIPT), in use since 2011, can safely test a fetus for Downs and a few other genetic conditions like cystic fibrosis and achondroplasia. In the future, when the whole genome of a fetus is regularly sequenced, the screening may identify all kinds of other variations and anomalies.

With good counseling, the screening can help expectant mothers decide whether they should seriously consider terminating a pregnancy due to the seriousness of the fetal abnormality. Used without proper safeguards, it could lead to abortions of babies that many of us, I believe, might find troubling and perhaps unethical. A new era of eugenics is upon us and with it a need to carefully review current guidelines for abortion. The bioethical questions are daunting and far reaching for every citizen, policy makers and politicians.

In 2016, Indiana governor Mike Pence signed into law HB 1337 which “Prohibits a person from performing an abortion if the person knows that the pregnant woman is seeking the abortion solely because of: (1) the race, color, national origin, ancestry, or sex of the fetus; or (2) a diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability. Provides for disciplinary sanctions and civil liability for wrongful death if a person knowingly or intentionally performs a sex selective abortion or an abortion conducted because of a diagnosis or potential diagnosis of Down syndrome or any other disability.”

Predictably, “pro-choice” liberals and “pro-life” conservatives reacted to this Indiana law and others like it very differently:

Columbia law professor Carol Sanger is certainly right that such sex selective abortions are rare in US and that the motivations of conservatives in the eight states that enacted such statutes was surely to “whittle away abortion rights on ethical sounding grounds. .,” Sanger, in the same Slate interview, reminds the reader that in Roe v. Wade and Planned Parenthood v. Casey, women are never obliged to explain their reason (reasons) for wishing to terminate a pregnancy.

Conservatives like Anna Higgins of the Charlotte Lozier Institute reacted very differently. “Allowing these facts to inform our public policy and taking the steps necessary to eliminate sex-selective abortion will put the United States squarely on the frontlines in fighting the actual “war on women.” Such a stance will create a platform from which the U.S. can affirm the unique value of each individual, and can publicly condemn unjust discrimination against either sex.”

As an international development professional I am well aware of the use of ultra sound for fetal sex determination that has resulted in the abortions of tens of millions of female fetuses (so called gendercide) especially in China and in India over the last three decade or so. It struck me then and now as an egregious human rights violation or less politely, murder. (Fortunately sex selective abortions in these countries are, for the moment, declining and sex ratios are coming back into balance.)

Many in the disability rights movement would certainly find much to like in the Indiana law, even they are troubled by the politicization of the issue. Personal testimony of persons with disabilities about the use pre-natal screenings to uncover fetal anomalies is both lucid and heartrending: “Marsha. Saxon (1998) expresses well the sense of offense experienced by many disability rights critics when she says, “ The message at the heart of widespread selective abortion on the basis of prenatal diagnosis is the greatest insult: some of us are “too flawed” in our very DNA to exist; we are unworthy of being born…. fighting for this issue, our right and worthiness to be born, is the fundamental challenge to disability oppression; it underpins our most basic claim to justice and equality — we are indeed worthy to be born….” p. 308 of article, “Disability, Bioethics and Human Rights,” by Adrienne Asch (in Handbook of Disability Studies edited by Gary Albrecht; Sage Publications, Inc. 2001)

I understand that pro-choice activists are fighting to protect encroachments on “reproductive freedom,” and do battle with any law that might infringe on this “right.” But while I would be the first to acknowledge that there is a political agenda behind such legislation, this does not make asking questions about the morality of such abortions of female fetuses and the disabled, etc. less valid and urgent.

So I will risk beheading by my liberal tribe and declare that I can no longer subscribe to the absolute right to abortion with no “why” questions asked. The screening technologies of the womb, which did not exist at the time of Roe v Wade, have radically changed the terms debate. Will parents one day terminate pregnancies because a scan reveals a minor “disability” like shortness of stature for a couple that demands a basketball center for an offspring? Or blue eyes not brown eyes — let alone deafness or blindness? (And the technology may soon exist to alter the very genome in unfathomable ways).

What abortions (or altering of the genome) cross some moral line that we as a society just won’t tolerate? And what kind of scans for certain fetal characteristics should be permitted and what not? I don’t believe that leaving the decision solely up to the mother-the pro-choice position — is defensible now. (And many of the government regulations in place in some countries today to limit screenings of certain genetic variations will be rendered obsolete or incomplete tomorrow.)

Is Mike Pence wrong when he said in reference to the Indiana law that “I believe that a society can be judged by how it deals with its most vulnerable — the aged, the infirm, the disabled and the unborn?” As a liberal, I think not.

We are entering an era of a new eugenics and how we respond will define our character and values. As the brilliant cancer doctor and author Siddhartha Mukherjee recently explained in an interview: “The dangers are that there will be unintended consequences. All of a sudden we may find ourselves making decisions about which human genes are more preferable than others. In doing so, we risk making wrong decisions about what variations are and are not allowed to exist.”

“Transpartisans” can help conservatives and liberals debate the Indiana law in a way that moves it somewhat out of the realm of politics — as hard as that is. We could start with “easy parts of the legislation” that begs for consensus: Taking the life of a baby girl in the womb simply because she is a girl (gendercide) is wrong ( at one week, ten weeks or twenty five weeks) and needs to be unequivocally condemned.

Arranging a series of consultations with persons with disabilities to help formulate a common sense position on appropriate fetal screening protocols seems eminently doable as well.

It behooves all of us to build bridges between Pro Choicers and Pro Lifers. The scary new eugenics we face as a society demand revisiting old positions and coming up with new thinking about when it is right and when it is wrong to terminate a pregnancy. Both sides should leave rancorous questions of “viability” and “when life begins” to the side and find ways to face this growing challenge posed by the ever more sophisticated scanning technology together.

Josh Goldstein