Many commentators are concerned that physicians have an agenda when they discuss results of prenatal testing with their patients. Often, physicians have preconceived values regarding what should be an exclusively patient-centered arena. For example, many physicians are predisposed to recommend abortion when prenatal testing reveals the presence of genetic or structural anomalies that would result in disability.
Such predispositions and preconceptions may be distinguished from an objective approach in which the physician provides in-depth background on the specific potential disability and presents possible outcomes for the family, whether they choose to abort or to continue the pregnancy. Using such an open-ended approach would “promote genuine reproductive choice and help families and society to flourish”.1
Of course, I agree that a just society must appreciate and nurture the lives of all people. And of course, many disabled persons live lives of great personal satisfaction and value. I do not agree, however, that prenatal testing is in itself morally troubling.
Certainly, physicians should present both sides of the question. Prospective parents need information, rather than a bulleted summary burdened with the specialist’s prejudices. I conjecture some prospective parents might choose to continue with such a pregnancy if they were provided with a more complete analysis and report.
And certainly, society’s attitudes need quite an adjustment. If we are moral persons, Kantian ethics requires us to respect all individuals. Our children are not means to our personal fulfillment, nor are they trophies to be displayed in their precocity and perfection. Children are ends in themselves, and if a child is disabled she is deserving of as much respect as any other.
But respect for persons does not require a potential mother to knowingly bring a seriously disabled child into the world. For example, severe spinal bifida would entail a lifetime of supervision and medical care. Even mild spina bifida can be burdensome and cause serious problems later in life. Prenatal testing makes it possible to avoid giving birth to a child so burdened.
The key issue is the availability of an authentic choice. Prenatal counseling should be as rigorous as any well-designed informed consent process. Physicians in this field should have advanced training and expertise, beyond the standard obstetrics curriculum.
There is also the potential for financial abuse of the system, as with any advanced technology. Until prenatal testing becomes commoditized, that is, financially available to all, the procedure should not be “standardized”. Not every 28-year-old needs prenatal testing. Obstetricians should not offer the procedure as a necessary part of being pregnant.
