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Should States Decide Which Lives are Worth More than Others? A response to Jaime King’s Article In Nature Magazine

In the November 2012 issue of Nature professor Jaime S. King has an article titled “Politics and fetal diagnostics collide.”  The summary:  “Without better regulation, non-invasive prenatal genetic tests will be targeted by US anti-abortion lobbyists.”

For the record, I have notified Professor King of this post.  UPDATE:  She has replied and says she will write a response.  I have also found an online copy of the article that won’t cost you $32 to download.

Clearly, King and I will be world’s apart on the issue of abortion.  It follows that there is much that I find in her article objectionable and could not possibly respond to every item.   It is unclear, however, what precisely she means by ‘better regulation’ that would not be targeted by ‘anti-abortion lobbyists.’  I suppose on this she means people like me.  If genetic testing was not merely a preliminary stage of the abortion process as it seems to so often be, then it would not be a target.  That doesn’t seem to be in view in her article, but I don’t see otherwise how ‘better regulation’ would have the effect she is hoping for, since she frames the whole issue as having to do with ‘women’s reproductive autonomy.’

She makes this comment:  “As the use of NIPT becomes more widespread, pro-life advocates will almost certainly see the technology as a reason to further constrain women’s abortion rights.”

This is a tired argument that is all the worse for being simplistic.  Let us take just a couple of examples, here.  The editor of the Journal of Medical Ethics, Julian Savulescu has gone even further than King’s article, which highlighted selective abortions on the basis of gender and disability.  He believes we should select based on things such as “potential alcoholism, psychopathy and dispositions to violence” and “If it were possible to genetically select good impulse control, we should do so.”  Indeed:

…you could argue that people have a moral obligation to select ethically better children. They are, after all, less likely to harm themselves and others. That doesn’t necessarily imply that people should be coerced into making a choice, but we should encourage them.

I ask you:  how exactly does ‘encouraging’ people to screen out children who are girls (most gender selective abortions are of girls;  oh the irony), have disabilities, potential alcoholism, psychopathy, and dispositions of violence comport with a ‘woman’s reproductive autonomy’?  The devil is in the details.  While Savulescu is hanging his hat on the allegedly uncoerced, encouraged ‘voluntary’ approach, ‘bioethicist’ Jacob Appel shows a little more consistency, arguing that in fact the state should require that certain traits be screened out, and moreover, that the question of whether or not children born with a disability should be euthanized should be decided by the state and doctors, not parents, because parents can’t be expected to be objective in regards to the “suffering for children.”

I ask again, where is the autonomy?

Perhaps two more examples will do;  John Holdren, the current ‘science czar’ in the Obama administration once joined with Paul Ehrlich  in saying,

Indeed, it has been concluded that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution if the population crisis became sufficiently severe to endanger the society.

This was shortly after Planned Parenthood itself, that bastion of “women’s autonomy” sat down to work out some ideas for handling the ‘population crisis’ listed “compulsory abortion” as one of several other ideas that I doubt Professor King would consider consistent with a “woman’s autonomy.”

We will do well to remember that it was the staunch eugenicist SC Reed, one of the earliest promoters of genetic counseling (and a board member of Planned Parenthood in the 40s and 50s), who said in an essay called “The Local Eugenics Society” “Our present day use of the term ‘human genetics’ instead of ‘eugenics’ may be financially and politically expedient but there is no great philosophical distinction between them.”  Reed would eventually lead the way in Minnesota for newborn screening and other genetic counseling programs… which, I wonder, does Professor King realize that early eugenicsts believed were actually eugenics?  (See also Frederick Osborn and past president of the American Society of Human Genetics, Lee R. Dice.  Incidentally, both Reed and Dice were presidents of this organization, a current advocate for genetic counseling… which, you may believe if you like has nothing to do with eugenic coercion.)

To put this point more plainly, eugenicists past and present, as well as abortion advocates past and present, have not been afraid to dispense with a ‘woman’s autonomy’ or override a woman’s ‘reproductive rights.’  It is not hard to see why;  if you really believe that we ought to screen out genetic flaws and ease human suffering, then whatever Savulescu (for example) might say, Appel and the rest are right in saying that this issue cannot be left to individuals.  The dispassionate state must intervene;  and think of the money that will be saved by not bringing a disabled child into the world.  (Don’t laugh–this was the exact argument used by Reed and his fellow eugenicists for why the state of Minnesota should be engaged in genetic counseling and newborn screening.)

If Professor King were really worried about a woman’s ‘autonomy’ and ‘reproductive rights’, she would do well to broaden the scope of her concerns beyond ‘anti-abortion lobbyists’ and include those who support abortion but for entirely different reasons.  I am reminded of an article by Diane Francis in 2009 where she argued that “A planetary law, such as China’s one-child policy, is the only way to reverse the disastrous global birthrate currently.”  And if that doesn’t fly in the face of ‘autonomy’ and ‘reproductive rights’ I don’t know what does;  compulsory abortion and sterilization “is the only way” to implement such a policy, as China has demonstrated.

I don’t know whether or not Professor King shares such views.  For all I know, she does.  I hope, obviously, she doesn’t.  But it is really besides the point:  the idea that that it is the pro-lifers who have it out for a woman’s reproductive rights is absurd.  Pro-lifers are not animated by that at all, except insofar as they chafe at the idea of government bureaucrats penalizing childbearing.  For a pro-lifer, the idea of ‘reproductive rights’ is something that they support… they just don’t believe that the sum total of the concept is represented in the right to kill the human growing in a woman’s womb.  In the meantime, the real dangers of autonomy and ‘reproductive rights’ are gathering from the left, not the right.

But the section that really had me grinding my teeth was this one:

Ideally, no fetus would ever be aborted because of its sex or skin colour. [...] But forcing women to have children they do not want will not end prejudice.  Instead, it will create a slew of problems.  Greater restrictions on abortion may result in more suffering for children.  Bills restricting terminations sought for particular reasons will drive a wedge between patients and providers.  They will encourage women to withhold information or lie, and they will punish providers serving clients who tell them the truth.  Moreover, by dictating which fetuses can legally be aborted, states are entering the dangerous territory of valuing some lives more than others.

Let’s take this one piece by piece.

Ideally, no fetus would ever be aborted because of its sex or skin colour.

Ah, the fetus.  Not a baby.  We must make this point clear, because of course if we’re only talking about a fetus, then we must ask Professor King why it should not be ‘ideal’ to eliminated it based on its sex or skin color, or any other reason.  It is just a fetus, after all.  But by issuing the caveat that it is not ‘ideal’ my opinion is that Professor King is tacitly admitting that it isn’t ‘just a fetus.’

The lie we tell ourselves is that a fetus is an inoffensive, neutral, scientific term merely reflecting one stage of human development, but of course in real life we all know that the only difference between a fetus and a baby is that the former may not be wanted while that latter is.  By the waving of a magical rhetorical wand, that ‘thing’ in the womb magically becomes something else, merely by virtue of some other person’s perception of it.  Not very neutral and scientific if you ask me.

But forcing women to have children they do not want will not end prejudice.  Instead, it will create a slew of problems.

One of the observations I have made about what I call the ‘culture of death’ is that it is distinguishable in part by the fact that it views death as a solution of problems.   I note, for example, that having children one does want creates a slew of problems;  how to feed them, where to house them, where to school them, how to pay for their health care as they age, and finally where to bury them.  This is in fact the whole point of those believe that ‘family planning’ is a solution to ‘over-population.’   All of life entails a ‘slew of problems.’  Choosing not to steal a million dollars from the bank creates a ‘slew of problems.’  Of course, stealing from the bank also creates a ‘slew of problems.’  Obviously, the morality and rightness of a particular deed is not bound up very tightly with whether or not it will ’cause problems.’    Some would even go so far as to say the one has nothing to do with the other.

Will forcing women to have children they don’t want create a slew of problems?  Probably, but that is no reason to shy away from doing the right thing.  There are many alternatives to simply making the new human being DEAD.  There are hundreds of thousands of people ready to adopt those children, for example.  I am prepared to adopt your unwanted child… there.  Your ‘problem’ is over.  My email is director@athanatosministries.org.  I’m pretty sure we can find a way to address the problems of unwanted people in this world in much the same way we address the problems that arise from the presence of wanted people in this world–that is, besides killing them.

Greater restrictions on abortion may result in more suffering for children.

Is the key word in this sentence, ‘may’?  Even so, let us concede this for a moment.  Conceding it, what difference does it make?  The aforementioned Jacob Appel supports the Groningen Protocol with one minor tweak:  letting the doctors decide whether or not the already born child will suffer.  Appel nobly has the “neonate’s” interest in mind, but Francisco Minerva and Alberto Giubilini have gone further in an article published in Savulescu’s journal.  The article is titled “After Birth Abortion:  why should the baby live?”

They explicitly address this issue but from another angle I’d like to call attention to:  not being aborted may not result in “more suffering for children.”  Before I get accused of being the Master of the Obvious, let me observe that Minverva and Giubilini say that even if they do not suffer, even if they have already been born, they can still be killed.  (At that point, I suppose, the ‘baby’ becomes a ‘neonate’, so no harm done.)

Although it is reasonable to predict that living with a very severe condition is against the best interest of the newborn, it is hard to find definitive arguments to the effect that life with certain pathologies is not worth living, even when those pathologies would constitute acceptable reasons for abortion.  It might even be maintained that ‘even allowing for the more optimistic assessments of the potential of Down’s syndrome children, this potential cannot be said to be equal to that of a normal child’.  But, in fact, people with Down’s syndrome, as well as people affected by many other severe disabilities, are often reported to be happy.

Nonetheless, to bring up such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.  On these grounds, the fact that a fetus has a potential to become a person who will have an (at least) acceptable life is no reason for prohibiting abortion.  Therefore, we argue that, when circumstances occur after birth such that they would have justified abortion, what we call after-birth abortion should be permissible.  [bold mine, italics theirs]

So there you have it;  just as it did not matter what gender or skin color the ‘fetus’ has as to whether or not it can be aborted, neither do we find it matters if they ‘may suffer’ or not.  The putative suffering is irrelevant in the cause of autonomy… but is it really autonomy?  i observe that these two scholars are not content to restrict their concern to the suffering or non-suffering of the child, nor limit it to the burden on the family, but also “society as a whole, when the state economically provides for their care.”

Now, what happens if the family does not think the child is an ‘unbearable burden’ but society does?  I mean, if the state is economically providing for the care of the child–and we aren’t talking about an unborn child here, we’re talking about one already born, now–shouldn’t it have some say in whether or not it should continue to live, regardless of whether or not the child is happy?

It is not hard to see how such arguments necessarily progress in proportion to the courage of the scholar to extend them to their logical conclusion.    Giubilini and Minerva were very courageous, Appel respectably courageous, and Savulescu moderately–depending on what he meant by ‘encouraged.’  In the meantime, Obama’s chief science advisor, John Holdren, is ready with an interpretation of the Constitution to that will justify compulsory abortion.  And if compulsory abortion can be so justified, certainly compulsory after-birth abortion can be justified, no?

I note in passing Giubilini and Minerva’s usage of the phrase “life [...] not worth living.”

You know, I think I know where they got this idea/phrase from:  Karl Binding and Alfred Hoche.  They actually wrote a book about it, basically citing all of the above arguments, up to and including the possibility that someone may suffer, the right of parents/spouses/children-of-decrepit-old-people to end such a life, noting in particular the special interest of “society as a whole, when the state economically provides for their care.”  It was called “Allowing the Destruction of Life Unworthy of Life” and it provided the guiding principles and ethical cover for what was to become the German T4 program, which saw the deaths of hundreds of thousands of disabled children, adults, etc, for their own good, and the good of the state.***

In point of fact, as someone who is the parent of a child with a disability who once sat across from a genetic counselor, let me assure you that such lives very much are worth living, and our daughter is absolutely “equal to that of a normal child,” and not merely because we wanted her, or ‘chose’ not to abort her.  Indeed, I find the whole notion despicable and beneath contempt.  She is not leading a life of suffering, but as it happens, even if she were, she would still have a life worth living, and suffering can be managed–all the more so as technology continues to advance.

I don’t usually reference my daughter on this blog, but since Professor King will not otherwise know about this personal dimension, I felt like I ought to say something about it.  Here is a video of my precious daughter who may or may not be among those who suffer–you decide… if it actually matters in this debate at all… and I’m inclined to think it doesn’t at all.

That is my ‘family’s unbearable burden’:  Joy unleashed on any and all my daughter meets.  This is a girl that arguably fits the criteria for a ‘child that may suffer’ more than most, but I defy any insinuation that aborting her was the ‘solution.’  I reject Professor King’s implication that she is the one with the compassionate view, as though the rest of us are indifferent to potential and actual suffering.

Giubilini and Minerva are quite right:  many children with disabilities are happy, do bring their families great joy,and  do not lead a ‘life unworthy of life.’  Mine is one of them.  Professor King may be right:  not aborting such a child “may result in more suffering for children” but it may not.  Having any child at all may result in more suffering.   At any moment, my own life might descend into suffering–eg, if I get hit by a car and find myself paralyzed.  In anticipation of this possibility, should I commit suicide?  Absurd.  The notion that there may be suffering is any kind of consideration is completely irrelevant to the issue.  Don’t take my word for it;  the experts who wrote the “After-Birth Abortion” article, who see it just so.

(True story: Peter Singer recently argued on the issue of whether or not we ‘may’ suffer by pointing out that indeed we know for a fact that we all will suffer, and so will all future children:  for this reason the whole human race should be sterilized, sparing them all lives of suffering!  This whole line of argument has no non-arbitrary cutoff point.  It only boils down to what degree someone is willing to extend the principles and act on them.)

Bills restricting [...]  tell them the truth.

I would like to address this one but as this is getting quite long, will have to let it go for now.

Moreover, by dictating which fetuses can legally be aborted, states are entering the dangerous territory of valuing some lives more than others.

I was left scratching my head on this one.  Do I understand correctly that Professor King is suggesting that, in order to value some lives more than others, we value all of them, equally, as having no value?

This is better than valuing some more than others?  It is better to regard all fetuses as having no value than ‘entering the dangerous territory of valuing some lives more than others’?  Putting no value on lives at all is far more dangerous territory.

The whole justification for abortion on demand is premised upon the notion that the ‘fetus’ only has value insofar as a woman (un-encouraged and completely autonomously) wants the child, so it necessarily follows that it does not have intrinsic value.  If it did have intrinsic value, we would not allow women to kill the ‘fetus’ except possibly in view of the most dire of circumstances.  So the whole system requires us to assume that the fetus is a cypher as far as ‘value’ goes, taking ‘content’ only if a woman decides to provide it.

But the real irony is that the whole premise of her article is to advocate for more genetic testing and counseling with women having the ‘right’ to abort the ‘fetus’ that tests reveal as ‘inferior’ or merely undesirable.  The whole article thus represents a headlong rush into “the dangerous territory of valuing some lives more than others.”

Hence my confusion about who ‘better regulation’ of genetic testing was necessary or the pro-lifers would become agitated.   Is it Professor King’s point that the only people permitted to enter this “dangerous territory” are the (can I call them) mothers?  Ie, women acting autonomously can decide which lives have more value than others, but the states ought not?

If that is what she means, then I find myself in both agreement and disagreement:  I agree that it is dangerous indeed to begin trying to sort out which lives have more value than others, but only because I firmly maintain that all lives equally have value, not that lives equally have no value unless the woman or the state decides it does.  The state should be protecting all life, and especially the lives that are completely defenseless and unable to protect themselves.  Autonomy only goes so far:  I have the right to make decisions for my own body, but if I reach out with my body to slay another body, society has the right to register an opinion about that, and perhaps act on that opinion.

But from the foregoing, you can see that I doubt very much that a woman’s autonomy and ‘reproductive freedom’ is really the guiding principle behind this whole debate, and likewise dispute the idea that abortion is the primary area of concern.  Scholars have and will continue to make the same arguments, pushing them further and further along their logical progression.  I was concerned, therefore, when Professor King said this:

“The FDA must step up its involvement to ensure that NIPT is integrated into prenatal care carefully–and, especially, to prevent it from being offered directly to consumers, as are other genetic tests.”

I read this to be saying that this test, along with all the other tests, should be administered within the doctor-patient relationship, with guidance… or is it ‘encouragement’… from genetic counselors.  King perhaps thinks that this will preserve a woman’s autonomy and ‘reproductive rights.’  I think the opposite: Julian Savulescu, SC Reed, Lee Dice, and Frederick Osborn and other eugenicists are counting on the women believing their action is completely voluntary.  I for one believe that if a genetic counselor sits in front of you and spells out all the horrible outcomes and the life of suffering a child may experience, and oh, by the way, the burden may be unbearable for the family, (and under one’s breath, for the state, too), this is tantamount to coercion.

But what value am I and my opinion?  I am merely a bipedal primate (former fetus, former neonate, etc).

I walked away from Professor King’s article believing that I was more concerned about a woman’s autonomy and reproductive rights than she was, and I’m the pro-life ‘lobbyist.’

*** Of course I acknowledge that just because Giubilin and Minerva’s arguments are identical to Binding and Hoche’s, they do not envision that the ideas justify throwing millions of people into ovens.  Neither did Binding and Hoche.

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