Euthanasia Of Newborns With Impairments

Because newborn infants cannot make informed decisions about whether to end their lives, those who grant that some euthanasia is legitimate usually argue that such decisions should be made for newborns on the basis of whether a child's life will be of value to the child. The witholding of life-prolonging treatment is treated in the same way because there is no possibility in this case of informed refusal of treatment by the patient. According to the minority group model, infants born with incurable impairments may be wrongly killed because caregivers and parents assume that their lives would be entirely unrewarding even though many people with similar disabilities lead satisfying lives.

PUBLIC POLICY. Even if euthanasia or PAS for some disabled individuals were morally justified and not a result of depression or exclusion from independent living, some authors predict that if those options were made legal and routinely available, many morally unacceptable acts would result. They cite the difficulties of judging the mental competence of suffering patients who request death. In busy or understaffed hospitals people could be put to death who did not really want to die or were not really able to make a decision about it. Those authors mention the further danger that death may be sought not for the benefit of the person who dies but for the benefit of family members overwhelmed by the responsibility of caring for or paying for the care of an incurable individual or for the benefit of insurance companies and publicly funded healthcare programs.

This position creates a conundrum: Is it acceptable to adopt a policy that denies euthanasia and PAS to some people who are morally entitled to it, resulting in their prolonged suffering, to prevent the wrongful killing of others from carelessness, poor administration, or evasion of the law? Some argue that disabled people would be particularly vulnerable to being put to death wrongly under a policy of legal euthanasia or PAS because of the tendency of nondisabled people to expect a life with disabilities to be much worse for a disabled person than it actually is, the corresponding tendency of healthcare professionals and others to overlook the needs for treatment and other services, and the costs of providing for the disabled person's needs. Any such policy must include rigorous safeguards to prevent abuses and errors, but no safeguards are foolproof.

ABNORMAL FETUSES, PRENATAL SCREENING, AND ABORTION. Testing during pregnancy for a variety of genetic and other congenital abnormalities is available in many places. Familiar examples are the test for Down's syndrome performed by means of amniocentesis or chorionic villus sampling and the blood test for the alpha-fetoprotein level to gauge the likelihood of neural tube defects. Most prospective parents seek prenatal tests with the intention of aborting the fetus or embryo if it is found to have an abnormality. The tests that exist or will exist in the near future are for types of impairments that can be fairly severe, although some exhibit a great range of severity, and tests cannot show how severely or mildly affected a child would be.

Those who regard abortion as wrong in every case or defensible only in very limited cases (e.g., to save the life of a pregnant woman) must regard abortions of impaired fetuses as immoral. Antiabortion arguments usually are based on the thesis that an unborn human being, no matter how primitive its stage of development, has a right not to be killed (and indeed to be kept alive) because it is human. If a human fetus has a right to life from conception onward by virtue of its human genome and if abortion is therefore wrong, abortion is just as wrong when a fetus is affected by spina bifida or another abnormality as it is when a fetus is normal. According to this view these fetuses are surely human, just as are adult disabled people. The most common antiabortion position holds that human fetuses are already full-fledged persons with moral rights. Thus, impaired fetuses are also persons with moral rights.

Those who argue that abortion is wrong because of a being's potential to become a person rather than as a result of its actual personhood may have some flexibility to justify exceptions for fetal abnormality. However, many abnormal fetuses have the potential to fulfill the fundamental criteria of personhood and thus could not rightly be aborted even according to the potentiality theory.

Therefore, an antiabortion position opposes nearly all abortions of impaired fetuses. Some general opponents of abortion try to defend an exception for fetal abnormalities, but it is difficult to make that position logically consistent.

Those who regard abortion as often permissible (those with a "prochoice" position) may hold a range of different views that are based on various ethical principles and countenance abortions at different stages of fetal development or for different purposes. Some regard only early abortion as acceptable, for example, before sentience; others think abortion is acceptable later in pregnancy. Some regard abortion for frivolous reasons as unacceptable, whereas others regard it as legitimate for almost any reason as long as other criteria are fulfilled. However, most defenses of abortion attribute to an embryo or early fetus a moral status below that of persons and for that reason see nothing wrong with an early abortion chosen because the prospective parents would find it burdensome to raise a child in their circumstances. The presence of an impairment in an embryo or young fetus would count as such circumstances for many couples or pregnant women. Therefore, on the whole, according to the prochoice position, early abortion of an abnormal fetus is morally acceptable.

Furthermore, if a prochoice stance is assumed, there are positive reasons for aborting an impaired embryo or fetus. If the child were born, it might experience significant suffering, and raising a disabled child can be a great strain on parents and siblings. Indeed, a good prospective parent tries to produce a normal child rather than a disabled child and to give it advantages whenever possible. Bonnie Steinbock (2000) argues that given the prochoice assumption, selective abortion is a method of disability prevention that is comparable to a pregnant woman's taking folic acid to prevent neural tube defects. It also may be argued that the birth of disabled children is best avoided on the grounds that it drains resources from the healthcare system because those children may require multiple surgeries and other costly interventions.

THE DISABILITY RIGHTS CRITIQUE OF SELECTIVE ABORTION. Some authors who adopt a generally prochoice stance, however, argue specifically that abortion in response to fetal impairments is wrong. This has been called the disability rights critique of selective abortion. It consists of several distinct arguments, two of which are given below.

The expressive argument. The expressive argument is used both to show that the choice to abort an impaired fetus is wrong and at times that the government should not sponsor prenatal screening services. In this view aborting a fetus solely because it would develop into a disabled child expresses rejection of the disabled and perhaps exhibits the attitude that such children are undesirable or should not be born or the belief that the lives of all disabled people are miserable and lack value.

To express such an attitude is morally wrong for several reasons. For one thing the attitude is both erroneous and unfair. Many disabled people have good lives, and respect for the equal human worth of all individuals is one of the bases of morality. Also, aborting impaired fetuses, it is claimed, perpetuates bias against the disabled, just as selective abortion of female fetuses in certain societies perpetuates bias against women. Also, communicating a message of contempt to disabled people demoralizes them. Public funding of prenatal screening programs that people will use for abortion decisions does particular emotional harm because it shows public contempt and announces that society cares more about eliminating disabled people from the population than about helping those who are already born.

The main counterargument to the expressive position is that people who choose to abort impaired fetuses do not have the feelings or beliefs they are accused of expressing. Instead, their decision may be motivated by perfectly legitimate attitudes. Parents undergo special hardships in raising a disabled child that may include providing arduous or costly care well into the child's adult years. The desire to avoid those hardships is not tantamount to distaste or contempt for disabled people and does not stem from a belief that those people are all wretched. In light of the prochoice assumption, in aborting an early-term fetus with an impairment prospective parents choose not to produce a child who probably will suffer more and have more limited opportunities than a normal child does. The attempt to avoid those outcomes is part of the legitimate effort to do well for their families.

It should be noted that regardless of the actual attitudes of the agent, an action can convey an unintended but hurtful symbolic message, particularly if it is done in a context of widespread discrimination. However, this must be balanced against the central interests of adults in exercising reproductive freedom and making choices that determine the nature of their family life.

The cultural differences/social construction arguments. The arguments in this category focus on society's contribution to the phenomenon of disability. According to the minority group model, mainstream society causes much of the disadvantage inherent in disability by excluding disabled people from its central activities. Disability is socially constructed in this view. The way to eliminate the disadvantages of the disabled, then, is not to eliminate impaired people from the population through prenatal screening and abortion but to restructure society so that the impaired are included in it.

In addition, it is claimed that certain groups of disabled people form a distinct culture that should be respected. Defect-based abortion threatens to destroy that culture. This sometimes is claimed with respect to the Deaf (deaf people who identify with Deaf Culture, with a language such as American Sign as its central component). If too few congenitally deaf children are born, they will not be able to perpetuate their community.

Counterarguments to these claims turn on the shared assumption that appropriately early abortion is generally legitimate because the fetus is not yet a person with rights. Selective abortion does not kill off members of a society or participants in a culture; it simply makes it the case that there will be fewer people eligible to join the culture in the next generation. That harm to the culture must be weighed against the disadvantages impaired children would suffer if they were born. Even if society were made more inclusive, significant disadvantages would remain.

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