Archives for category: Reproductive technology

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Nils Holtug argues for the Value of Existence View which makes ‘the comparative claim that existence can be better (or worse) for a person than non-existence’ (p.370). Derek Parfit and John Broome argue against this view by stating that it is incoherent. Parfit argues that causing someone to exist cannot be better for a person because the alternative would not have been worse. Broome argues that it can never be true that it is better for a person to exist than to not exist because if she had not existed there would not have been a ‘her’ to have been worse off.

The argument set out by Parfit and Broome is called the Metaphysical Argument and it relies upon two premises. The first premise makes the judgement that it is better (or worse) to exist than never to exist and entails that it is worse (or better) to not exist than to exist. The second premise is that it cannot be worse (or better) to not exist. The first claim, Holtug states, is based upon the logic of ‘betterness’ relation, and the second premise is based upon the metaphysical principle called The No Properties of the Non-Existent Principle. This means that an individual cannot have any properties if it does not exist.

This principle can be disputed. Broome’s argument relies upon the point that if a person does not exist then it is impossible for any properties to be attached to her. Holtug contends that the logic of betterness relation that the argument relies upon assumes that in order for existence to be worse than non-existence, non-existence must be better than existence. To explore the logical properties of the betterness relation, Holtug considers the following definition:

1)      y is worse for S than x, if and only of x is better for S than y.

If (1) states that existence if better (or worse) for a person than non-existence, non existence is better (or worse) for her. The latter part seems to violate the No Properties of the Non-Existent Principle. It seems to ascribe to her the property of being worse (or better) off in a possible world in which she does not exist. According to this principle we cannot claim that existence is better for her than non-existence because this implies that non-existence is worse for her than existence. So Holtug reassesses the argument with the proposition:

P: Non-existence is worse for Jeremy than existence.

Can the truth of P be established without ascribing to Jeremy positive properties in a possible world in which he does not exist? Holtug claims that P can be established by appeal to a preference that Jeremy has in an actual world in which he exists. Existence may be preferable for Jeremy because he prefers existence to non-existence. Jeremy’s life includes a surplus of positive value, whereas his non-existence had no value. Holtug insists that this is compatible with The No Properties of the Non-Existent Principle; it is better to have a surplus of values than no value. The Metaphysical Argument is not preserved because the Value of Existence View does not rely upon someone existing for the possibility of them benefiting from existence.

  • Holtug, Nils. “On the value of coming into existence” Journal of Ethics , 5:4 , 2001 , 361-384
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Christine Overall argues that a reasonable view of abortion needs to entail both concern for the autonomy of a woman and the well-being of the embryo/fetus. The main objection to abortion has been until now that it results in the death of the embryo/fetus. However, with new reproductive technologies abortion can now consist of two quite distinct aspects. One is the premature emptying of the uterus and the other is causing the death of the embryo/fetus. These two aspects pertain to the rights argument of the abortion issue: the right of the pregnant mother to the control of her own body and the alleged rights of the embryo/fetus.

Overall contends that recent developments in reproductive technologies means that these causally linked events will no longer necessarily have to result in the death of the embryo/fetus. This has been brought about through in vitro fertilisation, where the embryo at an early stage of its development need not be dependent on the occupancy of a uterus. Also, the age of viability of a fetus has decreased so that, with the help of sophisticated support systems, a fetus may be able to survive outside of the uterus. In Overall’s view these new possibilities has opened up the ability to discuss the rights of both the mother and the embryo/fetus.

The conservative position on abortion claims that the embryo/fetus has the right to life. However, Overall states that this is not necessarily true and a better argument is that the pregnant woman or anyone else, such as a physician, has the right to kill an embryo/fetus. Overall quotes Mary Anne Warren who remarks that if abortion could be performed without endangering the embryo/fetus then the woman would never have the right to destroy it. Not having the right to life does not necessarily imply that one being can kill another. This seems to go against the liberal approach to abortion but the distinction is between the ability to expel the embryo/fetus from the uterus without harming it and causing the death of the embryo/fetus.

However, from the liberal view the embryo/fetus has no right to the occupancy of another’s body. A woman’s goal in obtaining an abortion is not necessarily to kill the embryo/fetus but just may be a desire not to be pregnant for whatever reason and abortion can be seen primarily as an emptying of the uterus. If there was a way to preserve the embryo/fetus’s life and respect the woman’s desire to not continue with a pregnancy, then Overall thinks that the evacuation of a uterus that causes no harm to the embryo/fetus or the mother would be the best possible result that could resolve the longstanding issues of abortion.

The implication for this, in Overall’s view, is the transfer of the moral quandaries involved with abortion to other moral dilemmas. These could be dilemmas such as the consideration of whether there will be a moral obligation to preserve all evacuated foetuses. Also, if embryos could be adopted through evacuation and implantation in a willing mother should all embryos become candidates for adoption?

  • Overall, Christine. “Abortion” in Ethics and Human Reproduction: A Feminist Analysis , Overall, Christine , 1987 , 68-87

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Prenatal testing is a form of reproductive technology used to determine the physiological condition of a foetus, particularly with regard to any genetic disability. Physicians claim that such technology allows the parents to make a decision as to whether to continue a pregnancy of not based upon their assessment of the potential value of the child’s life and/or the parents capacity to cope with the outcome. Such a claim is criticised by disability activists as encouraging the abortion of foetuses with disabilities through societal ignorance and implicitly discriminating against existing people with disabilities.  To establish whether it follows that discrimination against disabled people occurs because of prenatal diagnosis this essay will evaluate the arguments of two disability activists, Marsha Saxton and Christopher Newell.

Marsha Saxton, who is disabled with spina bifida, claims that the widespread assumption that the increased use of reproductive technologies, in particular prenatal screening, will reduce the incidence of disability and increase quality of life should be challenged. Saxton asserts that this assumption is based upon such premises that having disabled children is wholly undesirable, and that the quality of life for the disabled is less than that of others. Her argument is based upon current societal attitudes which she states are stereotyped and lacking in knowledge of the disabled[1].

The stereotyping of the disabled, for Saxton, comes from the media. It is a causal argument where society, being oriented toward ideals of beauty, athletic prowess, self-reliance and productivity, causes the concept of disability to trigger fear in society with disabled people reminding able people of their vulnerability. This in turn causes disabled people to be excluded from mainstream society through lack of employment opportunities, second class education, and environmental barriers. Because many disabled people are excluded from the community they become isolated, thus limiting society’s exposure to their life experience. Through limited exposure to disabled people, the fear of parents pregnant with a disabled child is that it will suffer and be a burden. This causes many parents to choose to terminate the life of a foetus with a disability[2]. Is the fear of disability necessarily the cause for parents to terminate a pregnancy after prenatal diagnosis?

Genetic counselling that the parents receive after a positive prenatal diagnosis is supposed to be based upon informed choice, reproductive freedom and non-directiveness. However, informed choice needs to be based on the systematic processing of accurate information. Genetic counsellors have little time to present information to the parents to make such a major life decision. Therefore, they usually present information on the ‘burden’ of the condition, such as its risks and severity and these are all negative terms with little or no emphasis on the positive aspects of having a disabled child[3]. For example, a study of women who were mothers of children with Down’s syndrome or other disabilities asserted their commitment to their child and states how they enriched their lives[4]. This conclusion is substantiated by statistics from Victoria in 1999, a year in which 5550 prenatal tests occurred. 4.4% of these tests had abnormalities and, although abortion rates following positive tests vary, the 1998 Annual Report of the Consultative Council on Obstetric and Paediatric Mortality reported 80% of foetuses with Down’s syndrome were aborted[5]. This data correlates with a British study that is cited in the British Medical Journal, where 81% of foetuses with Down’s syndrome were aborted[6]. Therefore, it can be asserted that a fear of the burden of a particular condition of disability causes the majority of people to abort foetuses with that condition.

Christopher Newell, also a person with disability[7], argues that the use of reproductive technology ‘will perpetuate the oppression and control of people with disability, especially if the knowledge of people with disability is not utilised in bioethical debates’[8]. Newell’s argument is based upon a social constructionist view of disability, but it is also informed by his deeply held religious convictions on abortion and euthanasia[9]. Newell asserts that it is the dominant biomedical view of disability that influences the claim that developments in genetic technology are inherently good because of its capacity to eliminate suffering. Newell challenges this view because it is not informed by those who live with disabilities.

The dominant bioethical view of disability, Newell contends, fails to define ‘disability’ or ‘abnormality’ but objectifies it and treats it as the ‘other’, ignoring its social dimension. He goes on to state that although postmodernism recognizes the social nature of disability and genetics, bioethics has yet to do so. Rather than seeing people with disability as leading inherently low-quality lives and being an economic burden on society, Newell asserts that there should be an economic situation which enables and facilitates people with disability to contribute to society. For Newell, the medical model of disability fails to recognise the contributions that people with disability make to society and negates the existence of many disabled people who are happy and satisfied with their lives. To fortify his argument Newell gives the anecdotal examples of his friend who has Down’s syndrome being happier than many of his academic colleagues, and the disability activist Alison Davies who states: “Despite my disability and the gloomy prediction made by doctors at my birth, I am now leading a very full, happy and satisfying life by any standards. I am most definitely glad to be alive”[10]. Is Newell’s conditional argument that reproductive technology is oppressive and controlling because it is uninformed of the perspectives of people with disability correct?

In Australia, regulation of reproductive technologies is guided by the National Health and Medical Research Council. It recognises the views of disability activists that the practice of selection against disability is discriminatory against those that may have that condition. The outline of guidelines for ethical practice within the area of Prenatal Genetic Diagnosis states:

–          What counts as a serious genetic condition is controversial;

–          there are different perceptions of disability; [and]

–          the practice of selecting against some forms of abnormality may threaten the status of people have that form of abnormality[11].

This seems to negate Newell’s argument that the medical model is uninformed by people with disability. However, these guidelines then go on to state that PGD should not be used for:

–          Prevention of conditions that do not seriously harm the person to be born;

–          selection of the sex of an embryo except to reduce the risk of transmission of a serious genetic condition; or

–          selection in favour of a genetic defect or disability in the person to be born[12].

The restriction on selection in favour of a disability implies that one of the main purposes of genetic testing is to prevent such people being born. NHMRC Guidelines also state that the use of genetic technologies is to include ‘interest in reducing the economic and social costs of caring for the incurable’ and ‘hope for progress in the overall health and fitness of the community’[13]. Therefore, the conclusion can be drawn that, although the medical view may recognise the views of people with disability, it is determined to ignore such views in preference for a utilitarian purpose of the common good.

Are these reproductive technologies discriminatory? Prenatal genetic testing aims to detect major foetal abnormalities and provide prospective parents with alternatives. As Newell contends, the bioethicist Lynn Gillam’s argument that prenatal diagnosis does not inherently discriminate against people with disability fails to take into account that such technology does not apply to all sorts of purposes, such as conditions of skin colour, sex, or any other attribute. Its only purpose is to screen for disability. For Newell, it fails to take into account that, rather than the disabled being seen as leading low-quality lives and being an economic burden, there should be an economic situation which enables and facilitates people with disability to contribute to society. However, this premise is irrelevant to reproductive technology but is in the realm of public policy. The purpose of reproductive technology is to deal with the situation that is the current reality, where people with disabilities still suffer neglect through lack of services, leaving parents and carers to struggle[14]. Both Saxton and Newell concede that a decision to terminate a pregnancy with a disabled foetus may be made on the grounds of the availability of resources and this may be more of a factor than any discriminatory perspective.

Direct discrimination has two features: that it is explicit and intentionally aims to disadvantage a group[15]. Although decisions to selectively abort a child on the grounds that it is disabled may seem discriminatory, because of the lack of societal resources it is understandable that prospective parents may make this choice. Parents may also make a choice to abort a nondisabled child because of lack of resources, and a disabled child needs far more. The decision may be explicit and it may be intentional but it may not be aimed at disadvantaging those who are disabled.

Although people with disabilities may suffer direct discrimination through fear and hostility within the community or oppression through lack of facilities to help them live and work, it should not be found that prenatal testing causes direct discrimination. However, it may cause indirect discrimination through the encouragement of a perception within the community that people with disabilities are a burden. Therefore, Saxton is right to challenge the assumption of a better future population because of prenatal screening but Newell’s conclusion that it is reproductive technology that results in the oppression and control of the disabled is uncertain.

BIBLIOGRAPHY

  1. Altman, Andrew, “Discrimination”, The Stanford Encyclopedia of Philosophy (Spring 2011 Edition), Edward N. Zalta (ed.), Retrieved from: http://plato.stanford.edu/archives/spr2011/entries/discrimination/  on 05/02/2012
  2. Gillam, L., “Prenatal diagnosis and discrimination against the disabled” Journal of Medical Ethics , 25: , 1999 , 163-171
  3. Hume, J., ‘Disability, Feminism and Eugenics: Who has the right to decide who should or should not inhabit the world?’(Paper presented at the Women’s Electoral Lobby National Conference, University of Technology, Sydney , 26 January 1996)
  4. National Disability Insurance Scheme Campaign 2012- “Every Australian Counts”, Retrieved from: http://www.everyaustraliancounts.com.au/ on 31.01.2012
  5. National Health and Medical Research Council, “Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research”, June 2007, Revised Edition, Australian Government (2007), Retrieved from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e78.pdf on the 03.02.2012
  6. Newell, C., “Flourishing Rhetorically: Disability, Diversity and Equal Opportunity Disappointment”, Retrieved from: http://www.adcet.edu.au/StoredFile.aspx?id=1236&fn=Newell.pdf on 01/02/2012
  7. Newell, C., 1999, “The Social Nature of Disability, Disease and Genetics: A Response to Gillam, Persson, Holtug, Draper and Chadwick” in Journal of Medical Ethics Vol. 25 No. 2 (April 1999), 172-175
  8. Ng, Y. F., 2010, “Prenatal Testing, East and West: Regulating disabled foetuses in China and Australia”, in the ‘Alternative Law Journal’ Vol. 35-2 Monash University, 77-82
  9. Research Department of the Catholic Bishops Conference, “Inquiry into the Scientific, Ethical and Regulatory ConsiderationsRelevant to Cloning of Human Beings”,  in Inquiry into Cloning: xiv.iii. from the Submission to House of Representatives Standing Committee on Legal & Constitutional Affairs (2000)
  10. Saxton, M. “Prenatal screening and discriminatory attitudes about disability” in Embryos, Ethics, and Women’s Rights: Exploring the New Reproductive Technologies, Baruch, Elaine Hoffman; D’Adamo Jr., Amadeo F.; Seager, Joni , 1988, 217-224
  11. Webley C. & Halliday J., ‘Report on Prenatal Diagnostic Testing in Victoria 1999 (1999) Perinatal Data Collection Unit

 


[1] Saxton, 1988

[2] Saxton, 1988

[3] Ng, 2010: 81

[4] Hume, 1996: 2

[5] Webley and Halliday, 1999

[6] Gillam, 1999: 163

[7] Newell, “Flourishing Rhetorically”

[8] Newell, 1999: 174

[9] Research Department of the Catholic Bishops Conference (2000)

[10] Newell: 173

[11] NHMRC, 2007

[12] NHMRC, 2007

[13] ibid.

[14] NDIS, 2012

[15] Altmann, 2011