“Deciding not to screen for Down Syndrome”

Conflict is unavoidable regarding emerging prenatal technologies. Fortunately, people on each side can press their case while recognizing the seriousness, legitimate concerns, and common humanity of their counterparts on the other side. Readers commenting on Amy Julia Becker’s recent New York Times essay show how this is done.

Everyone who knows me are aware that I am an emphatic liberal Democrat. On issue after issue–food stamps, abortion rights, universal health coverage, the taxation of wealthy University of Chicago professors–I am found on the predictably liberal side of the ledger. Notwithstanding my frank partisanship (maybe even because of it) it’s a joy to be involved in one issue that resists the usual ill-will, posturing, sniping, and sheer self-righteousness that disfigure most partisan debates.

Across every political, economic, religious, and social boundary, people of grace and goodwill work hard to care for individuals with intellectual disabilities. Liberal union activists fight for higher wages for direct care workers. Socially conservative football coaches host golf tournaments, the Knights of Columbus sells Tootsie Rolls, for organizations that assist individuals and families who need help.

Also across the political spectrum, individuals and families struggle with difficult ethical issues that admit no perfect or painless resolution. As prenatal screening and diagnostic technologies become more accurate, cheaper, and safer, millions of pregnant women possess wider options to screen for Down syndrome and other disabilities. As millions of women delay childbearing and thus bear increased statistical risk of key chromosomal abnormalities, such technologies assume added importance.

As never before, our nation has opened its heart, its schools, its summer camps, and its wallet to embrace individuals with physical and intellectual disabilities. As never before, expectant parents can use screening technologies that allow them to avoid having children who show genetic markers associated with key disabilities. These technologies seem to have outrun our medical system’s–and our society’s—capacity to intelligently deploy or to humanely manage them.

Such screening raise unavoidable, discomfiting issues. Americans of different political, religious, and moral viewpoints will want to use these technologies in vastly different ways. We will deeply disagree about how our government’s regulatory and financial resources should be used to accelerate or slow the proliferation of these same technologies.

There will be fights about women’s reproductive autonomy, the moral claims of fetal life, the moral worth of disabled citizens, and more. These issues are so important, so intimate to our humanity, that political conflict is unavoidable. Too much is at stake.

Although political differences are unavoidable, people on opposing sides can press their case while recognizing the seriousness, the legitimate concerns, and the common humanity of their counterparts on the other side.

To see how this is done, read Amy Julia Becker’s New York Times story, “Deciding not to screen for Down Syndrome.” More to the point, read the 137 readers’ entries within the comment thread.

I’ll have more to say about this article, and about the ethical, economic, and health-system implications of prenatal screening technologies. I depart from Becker, and from most of her diverse commentators, in several areas. For now, though, I’ll leave things there. Read it for yourself. I’ll simply note that the diverse perspectives, the mutual respect, and the candor expressed by interested readers surpasses most House and Senate floor debates.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

One thought on ““Deciding not to screen for Down Syndrome””

  1. My wife was 40 when our last was born. We had the screening. I would have probably aborted the fetus. I've never felt any particular attachment to the idea that they are very special. Sure, it's beautiful – the elegance of embryonic development. But in the scheme of things… Meh. We had a miscarriage once. I can't say it bothered me

    much. I suppose that's a possible benefit to the atheist/materialist worldview. You know, not having to be concerned. Of course, I find the suffering of animals to be quite troubling. So I guess I lose out there!

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