Washington (INA) Great advances have been made in prenatal diagnosis and these advances have been accompanied by social, legal and ethical issues which have to be carefully assessed.
More than 100 abnormalities and metabolic diseases today can be identified through the use of amniocentesis (a test which involves the withdrawal of a small amount of fluid from the uterus during the fourth month of pregnancy), ultra sound, and measuring alpha fetoprotein levels in the blood to detect neural tube defects.
Parents who gain genetic information indicating abnormalities from prenatal tests then are faced with the decision of whether to prepare themselves and their families for a child born with a handicap, or to terminate the pregnancy.
But, although selective abortion is legally possible, it is not morally acceptable to everyone nor is it economically feasible for all women.
If a couple chooses to have only one or two children, as the current trends suggests, most will do whatever is possible to assure that those children are born normal.
“Many people are having smaller families and, therefore, they want the families to be of as high a quality as possible,” says Virginia Corson, genetics counselor at the Prenatal Diagnostic Center at Johns Hopkins University. “People want the best possible start for their children.”
It is ironic that , while legislation is being enacted to enforce positive steps in training and hiring disabled people, and public facilities are being made more accessible to the handicapped, many of these persons would not be born today in an age where it is medically possible to identify undesired handicaps, and where parents then have the option to terminate the pregnancy.
“The medical model still persists which is to let us take care of these poor people, patients, as opposed to a more social model, seeing them as persons with capabilities,” says Jan Laland, information specialist at the American Coalition of Citizens with Disability, a group which strives to enhance the civil and human rights of disabled persons.
Since many genetic diseases are ethnically oriented, “We do not want to have eugenic programs that will exterminate races or that will oppress certain peoples,” says Neale. She is referring to disorders such as Tay Sachs (where 1 in 900 Jewish couples are at risk and of those, 1 in 4 pregnancies is affected, or 1 in 3,600 babies born to Jewish parents) or Sickle cell anemia (where 1 in 144 black couples are at risk, or 1 in every 600 black babies).
Traditionally, the attitude of society towards handicapped individuals has been negative, but that focus may shift to the parents of the handicapped. “It may be that once the availability of amniocentesis becomes more widely known, people will start to think that partners who don’t avail themselves of it are being irresponsible if they are particularly at risk,” says Tabitha Powledge.
A result of advances in prenatal diagnosis is the changing attitude of detecting the deformity prenatally, especially in a culture which is permissive of abortion if they discover a defect. I think that is going to decrease the respect for the handicapped. It is one more step in a mind set which says the best way to handle a problem is to get rid of it – to eliminate it by eliminating the person,” says Father Richard McCormick, Rose F. Kennedy professor of Christian Ethics at the Kennedy Institute of Ethics, Georgetown University, Washington, D.C.
“Instead of adapting the environment and the social organization of society to the needs of the handicapped, our tendency is to segregate them. We put them in institutions,” says Father McCormick, who views abortion as the same kind of intervention. “We get the problem out of sight by eliminating those fetuses that don’t’ meet our expectations. I think prenatal diagnosis, if we follow it by abortion, can be another step in just deepening his interventionist attitude.”
While in the future, it may be possible to treat abnormalities prenatally, at the present time, advances in genetic medicine provides us with me knowledge about our genetic constitutions, more about genetic defects, and prospective parents are given fuller knowledge on which to base reproductive decisions.
Those who are opposed to abortion look forward to the time when prenatal diagnosis and medical advances will offer the opportunity to treat the intauterine fetus. Others hope for improved medical technology, for the day we can diagnose a heart defect in utero, so that parents will have the option of wiping the slate clean, and starting a family with a “ perfect” child.