Mae DesTroismaisons
Philosophical Problems in Medicine
May 6, 2013
Professor Arthur Kuflik
Two pro-choice women, Adrienne Asch and Bonnie Steinbock, share similar views on the subject of abortion as a whole, believing that the act itself is not morally wrong and that the rights of women outweigh those of embryos and fetuses. There is one subtopic on which their opinions dissent, however: the ethics of choosing to terminate a pregnancy for the sole reason that prenatal tests indicate that the future child will be disabled. Both agree that it is quite possible for individuals with disabilities to lead very fulfilling and rewarding lives, but if disability can be prevented, it should be. The main point of contention between Asch and Steinbock is how exactly disability is avoided; that is, by keepingdisability from occurring in people versus by keeping people with disabilities from occurring. Asch affirms that “the technology of prenatal testing followed by selective abortion is unique among means of preventing or ameliorating disability” because it perpetuates society’s devaluing of people with disabilities (610), while Steinbock contends, “From the fact a couple wants to avoid the birth of a child with a disability, it just does not follow that they value less the lives of existing people with disabilities, any more than taking folic acid to avoid spina bifida indicates a devaluing of the lives of people with spina bifida” (626).
Asch: Disability as a Form of Variation and the Social Construction of Disability
In her essay, “Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy,” Adrienne Asch reveals her concern not about prenatal testing itself, but rather unreflective uses of the technology (610). In response to the argument that testing followed by abortion due to disability cuts costs to the child, its family, and society, she notes that disability often occurs later in life too, and that the rate of disability becomes greater with age, so “unless society chooses a campaign of eliminating disabled people in addition to preventing the births of those who would be disabled, there is small cost-saving in money or in human resources to be achieved by even the vigorous determination to test every pregnant woman and abort every fetus found to exhibit disabling traits” (613). Money is not the main issue for Asch, though. Instead, she is deeply disturbed by the ways in which medical professionals, namely geneticists, OBGYNs, nurses, and midwives implicitly advocate for the abortion of disabled fetuses without properly educating parents about the conditions being tested for (609-616). In her eyes, disability is simply another form of variation like sex, race, and sexual orientation, and if the public healthcare system disapproves of selection efforts favoring males over females (or vice versa), then it should follow that they also frown upon selection against fetuses with disabilities. She states: “medicine and public health view disability as extremely different from and worse than these other forms of human variation” (610).
“The second way in which medicine, bioethics, and public health typically err,” she writes, “ is in viewing all problems that occur to people with disabilities as attributable to the condition itself, rather than to external factors” (611). Here, Asch begins to describe how most problems faced by disabled people are largely socially constructed, just as are the things that make life harder for women, gays, and minority ethnic groups. She stresses the idea that much social stigmatization surrounding disability is changeable, but the stigma is reinforced by the attitudes of healthcare workers: “Professionals fail to recognize that along with whatever impairment may be diagnosed come all the characteristics of any other future child” (613). She also queries as to how extra time and effort that parents put in to help cultivate an especially talented child differs from extra time and effort put in to meet the needs of a disabled child. The conclusion reached is that if in both cases parents seek to foster the child’s progress, then there is no real difference (615). Unless the condition causes “early degeneration, intractable pain, and early death,” she feels the abortion of a fetus due to a disabling trait is morally, but not legally impermissible (614). Thus, she maintains her pro-choice position: “The focus of my concern here is not on the decision made by the pregnant woman or by the woman and her partner. I focus on the view of life with disability that is communicated by society’s efforts to develop prenatal testing and urge it on every pregnant woman” (613).
Asch points out that doctors tend to provide very little description of disabling conditions to prospective parents, suggesting that the deliberative model is not adhered to in most cases of prenatal testing. For people to make informed decisions in this type of situation, “People who do not already have a child with a disability and who are contemplating prenatal testing must learn considerably more than the names of some typical impairments and the odds of their child’s having one” (616). She makes several suggestions that she feels would help health professionals better counsel potential parents-to-be who receive positive test results for disability:
Again, she asserts her pro-choice position by stating, “When our professionals can envision such communication and the reality of incorporation and appreciation of people with disabilities, prenatal technology can help people to make decisions without implying that only one decision is right” (emphasis added) (618). Currently, that implied “right decision” is to abort disabled fetuses. Legally speaking, all Asch wants is for people to be adequately informed about a disability before choosing to terminate because of it.
Steinbock’s Rebuttal
Bonnie Steinbock clearly wrote “Disability, Prenatal Testing, and Selective Abortion” at least partially in response to Asch’s claims that disability is a merely a form of variation and that most of the problems of disability are constructed socially. She first dismisses the variation argument swiftly by calling attention to the fact that unlike true forms of variation such as sex or race, there is no norm among all people with disabilities. Second, although she agrees that the stigmatization of and discrimination against disabled people is certainly a problem and that disabled people can indeed be happy and healthy, she thinks that the social construction of disability is exaggerated, asserting: “We do no one, not disabled individuals, not women, not families, a service by minimizing the physical, mental, and emotional burdens that may result from parenting children with disabilities” (625). In her view, selective termination of pregnancies due to positive prenatal test results for disability is not only legally justified, but morally permissible as well.
“It is reasonable for parents to wish to avoid having a child with a serious disability,” Steinbock writes, “because these conditions may involve undesirable events, such as pain, repeated hospitalizations and operations, paralysis, a shortened life span, limited educational and job opportunities, limited independence, and so forth” (625). Unlike Asch, she does not believe that in order to be a fit parent, one must be willing to care for a disabled child; she insists, “If abortion is permissible at all, it is permissible to avoid such outcomes, or the risk of such outcomes” (625). Steinbock recognizes the standpoint that prenatal testing is “a public statement that the lives of the disabled are worth less than those of the able-bodied” and understands that it is a serious claim that must be taken seriously; however, she does not consider it persuasive (626). Again, she disagrees with Asch by saying that a person or couple’s wish to avoid having a disabled child does not necessarily imply that that if that person or couple were to have a disabled child anyway, that it would then be unwanted, unloved, or uncared for (626). She uses the previously quoted folic acid analogy to support this. To conclude, she writes, “there is no reason why society cannot both attempt to prevent disability and to provide for the needs of those who are disabled” (627).
Although Asch and Steinbock are on opposite sides of the moral dispute concerning prenatal testing and selective termination of disabled fetuses, it is likely that Steinbock would accept Asch’s legal suggestions for improving the ways in which health professionals present information to their clients, for she writes, “prospective parents should be fully informed about the problems and challenges they are likely to face, and that the decision to terminate should not be based on fear or ignorance” (626). To promote accordance with the deliberative model of the physician-patient relationship, which is most widely preferred, Asch and Steinbock would probably agree that more in-depth inquiry, discussion, and consideration should take place before people choose to abort because of the risk of disability.
Bibliography
Steinbock, Bonnie, Alex John London, and John D. Arras. Ethical Issues in Modern Medicine: Contemporary Readings in Bioethics. 8th Ed. New York: McGraw Hill, 2013. Print.
Philosophical Problems in Medicine
May 6, 2013
Professor Arthur Kuflik
Two pro-choice women, Adrienne Asch and Bonnie Steinbock, share similar views on the subject of abortion as a whole, believing that the act itself is not morally wrong and that the rights of women outweigh those of embryos and fetuses. There is one subtopic on which their opinions dissent, however: the ethics of choosing to terminate a pregnancy for the sole reason that prenatal tests indicate that the future child will be disabled. Both agree that it is quite possible for individuals with disabilities to lead very fulfilling and rewarding lives, but if disability can be prevented, it should be. The main point of contention between Asch and Steinbock is how exactly disability is avoided; that is, by keepingdisability from occurring in people versus by keeping people with disabilities from occurring. Asch affirms that “the technology of prenatal testing followed by selective abortion is unique among means of preventing or ameliorating disability” because it perpetuates society’s devaluing of people with disabilities (610), while Steinbock contends, “From the fact a couple wants to avoid the birth of a child with a disability, it just does not follow that they value less the lives of existing people with disabilities, any more than taking folic acid to avoid spina bifida indicates a devaluing of the lives of people with spina bifida” (626).
Asch: Disability as a Form of Variation and the Social Construction of Disability
In her essay, “Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy,” Adrienne Asch reveals her concern not about prenatal testing itself, but rather unreflective uses of the technology (610). In response to the argument that testing followed by abortion due to disability cuts costs to the child, its family, and society, she notes that disability often occurs later in life too, and that the rate of disability becomes greater with age, so “unless society chooses a campaign of eliminating disabled people in addition to preventing the births of those who would be disabled, there is small cost-saving in money or in human resources to be achieved by even the vigorous determination to test every pregnant woman and abort every fetus found to exhibit disabling traits” (613). Money is not the main issue for Asch, though. Instead, she is deeply disturbed by the ways in which medical professionals, namely geneticists, OBGYNs, nurses, and midwives implicitly advocate for the abortion of disabled fetuses without properly educating parents about the conditions being tested for (609-616). In her eyes, disability is simply another form of variation like sex, race, and sexual orientation, and if the public healthcare system disapproves of selection efforts favoring males over females (or vice versa), then it should follow that they also frown upon selection against fetuses with disabilities. She states: “medicine and public health view disability as extremely different from and worse than these other forms of human variation” (610).
“The second way in which medicine, bioethics, and public health typically err,” she writes, “ is in viewing all problems that occur to people with disabilities as attributable to the condition itself, rather than to external factors” (611). Here, Asch begins to describe how most problems faced by disabled people are largely socially constructed, just as are the things that make life harder for women, gays, and minority ethnic groups. She stresses the idea that much social stigmatization surrounding disability is changeable, but the stigma is reinforced by the attitudes of healthcare workers: “Professionals fail to recognize that along with whatever impairment may be diagnosed come all the characteristics of any other future child” (613). She also queries as to how extra time and effort that parents put in to help cultivate an especially talented child differs from extra time and effort put in to meet the needs of a disabled child. The conclusion reached is that if in both cases parents seek to foster the child’s progress, then there is no real difference (615). Unless the condition causes “early degeneration, intractable pain, and early death,” she feels the abortion of a fetus due to a disabling trait is morally, but not legally impermissible (614). Thus, she maintains her pro-choice position: “The focus of my concern here is not on the decision made by the pregnant woman or by the woman and her partner. I focus on the view of life with disability that is communicated by society’s efforts to develop prenatal testing and urge it on every pregnant woman” (613).
Asch points out that doctors tend to provide very little description of disabling conditions to prospective parents, suggesting that the deliberative model is not adhered to in most cases of prenatal testing. For people to make informed decisions in this type of situation, “People who do not already have a child with a disability and who are contemplating prenatal testing must learn considerably more than the names of some typical impairments and the odds of their child’s having one” (616). She makes several suggestions that she feels would help health professionals better counsel potential parents-to-be who receive positive test results for disability:
- The woman or couple should receive detailed information regarding “the biological, cognitive, or psychological impairments associated with specific disabilities, and what those impairments imply for day-to-day functioning” (616).
- A discussion should be held that covers education laws, support services, and handicap accessibility of buildings and transportation (616).
- Literature by disabled people and their family members should be provided (616).
- Visits with individuals (adults and children both) living with the condition as well as their family members should be offered (617).
Again, she asserts her pro-choice position by stating, “When our professionals can envision such communication and the reality of incorporation and appreciation of people with disabilities, prenatal technology can help people to make decisions without implying that only one decision is right” (emphasis added) (618). Currently, that implied “right decision” is to abort disabled fetuses. Legally speaking, all Asch wants is for people to be adequately informed about a disability before choosing to terminate because of it.
Steinbock’s Rebuttal
Bonnie Steinbock clearly wrote “Disability, Prenatal Testing, and Selective Abortion” at least partially in response to Asch’s claims that disability is a merely a form of variation and that most of the problems of disability are constructed socially. She first dismisses the variation argument swiftly by calling attention to the fact that unlike true forms of variation such as sex or race, there is no norm among all people with disabilities. Second, although she agrees that the stigmatization of and discrimination against disabled people is certainly a problem and that disabled people can indeed be happy and healthy, she thinks that the social construction of disability is exaggerated, asserting: “We do no one, not disabled individuals, not women, not families, a service by minimizing the physical, mental, and emotional burdens that may result from parenting children with disabilities” (625). In her view, selective termination of pregnancies due to positive prenatal test results for disability is not only legally justified, but morally permissible as well.
“It is reasonable for parents to wish to avoid having a child with a serious disability,” Steinbock writes, “because these conditions may involve undesirable events, such as pain, repeated hospitalizations and operations, paralysis, a shortened life span, limited educational and job opportunities, limited independence, and so forth” (625). Unlike Asch, she does not believe that in order to be a fit parent, one must be willing to care for a disabled child; she insists, “If abortion is permissible at all, it is permissible to avoid such outcomes, or the risk of such outcomes” (625). Steinbock recognizes the standpoint that prenatal testing is “a public statement that the lives of the disabled are worth less than those of the able-bodied” and understands that it is a serious claim that must be taken seriously; however, she does not consider it persuasive (626). Again, she disagrees with Asch by saying that a person or couple’s wish to avoid having a disabled child does not necessarily imply that that if that person or couple were to have a disabled child anyway, that it would then be unwanted, unloved, or uncared for (626). She uses the previously quoted folic acid analogy to support this. To conclude, she writes, “there is no reason why society cannot both attempt to prevent disability and to provide for the needs of those who are disabled” (627).
Although Asch and Steinbock are on opposite sides of the moral dispute concerning prenatal testing and selective termination of disabled fetuses, it is likely that Steinbock would accept Asch’s legal suggestions for improving the ways in which health professionals present information to their clients, for she writes, “prospective parents should be fully informed about the problems and challenges they are likely to face, and that the decision to terminate should not be based on fear or ignorance” (626). To promote accordance with the deliberative model of the physician-patient relationship, which is most widely preferred, Asch and Steinbock would probably agree that more in-depth inquiry, discussion, and consideration should take place before people choose to abort because of the risk of disability.
Bibliography
Steinbock, Bonnie, Alex John London, and John D. Arras. Ethical Issues in Modern Medicine: Contemporary Readings in Bioethics. 8th Ed. New York: McGraw Hill, 2013. Print.