Taboos: Abortion for abnormality is not a Nazi business
Aborting abnormal fetuses has nothing in common with Nazi-style eugenics, argues Ann Furedi
One reason why fertility treatment so often ends in failure is that about half of all embryos used in in vitro fertilisation (IVF) treatment have a chromosomal abnor- mality. An embryo with a chromosomal defect is less likely to implant in the womb and, if it does, is more likely to miscarry. So the research staff who have developed a highly sensitive DNA test to detect embryos with chromosomal abnormalities might justifiably have expected their work to be applauded. Instead it was condemned as 'appalling'. Josephine Quintavalle of the pressure group Comment on Reproductive Ethics labelled it 'pure eugenics', and several media commentators followed suit.
The new test will allow doctors to screen the embryos created during infertility treatment, to select only healthy ones for use, and to discard the abnormal specimens. Ian Findlay, the molecular biologist who developed the technique, claims that, 'By looking at 10 chromosomes, we can test for almost every genetic disorder and confirm diagnosis on the day of testing'. He believes that in future the test could be adapted to allow embryos to be screened through a blood sample taken from the pregnant woman, rather than the actual embryo. Any pregnant woman could then learn if her pregnancy was affected by Down's syndrome or another chromosomal abnormality in the earliest days of pregnancy.
There is no suggestion that any woman would be forced or even encouraged to submit to such tests. But despite Findlay's insistence that 'all we are doing is giving patients a choice', the 'eugenics' label has been publicly hung around his neck. Indeed, anybody who believes that it is legitimate for women to take measures to avoid bearing a child with a genetic abnormality now risks being branded a Nazi-style eugenicist.
The attempt to equate antenatal tests, embryo screening and abortion on grounds of fetal abnormality with the Nazi doctrine of 'racial purity' has become a central theme of anti-choice literature. Sunday Telegraph editor Dominic Lawson is only one prominent commentator to have argued that abortion on grounds of fetal handicap is 'nothing less than the state-sponsored annihilation of viable, sentient fetuses' on a par with Hitler's actions in Nazi Germany. Marie-Claire Darke's contribution to a collection of essays claiming to represent feminist dissent on abortion (Angela Kennedy (ed), Swimming Against the Tide, 1997) is typical in equating abortion on grounds of abnormality to the Holocaust. Darke concludes that, 'Modern technological advances used in the detection of abnormality are the full flowering of a fascist ideology against our bodies'.
It now seems that unease about 'eugenic abortions' carried out on the grounds of disability is no longer restricted to those, like Darke, who actually oppose all abortions on principle. Increasingly, those who do support a woman's general right to end an unwanted pregnancy will hesitate when asked if a woman should be able to terminate a pregnancy simply because she does not want a disabled child. In November, Observer gossip columnist Nick Cohen reported that there was concern about this issue even within the ranks of the pro-choice movement itself. He hinted at an ideological schism between hardline 'eugenicists' (including me) who support antenatal screening and women's right to end pregnancies affected by abnormality, and those more in-tune with the times who are apparently worried about being tainted with the eugenic label.
Some disability rights campaigners argue that the legality of abortion for abnormality encourages discrimination against people with disabilities. Professor Tom Shakespeare, himself an achondraplasic dwarf, argues that aborting fetuses because they are affected by his condition is a comment on the value of his life. Other disability rights activists say they feel stigmatised and degraded that women can end pregnancies simply because the child would be like them. And, they ask, if society can condone the elimination of fetuses affected by Down's syndrome, how long will it be before it accepts the elimination of babies with Down's syndrome?
Such arguments spectacularly miss the point. In Britain today, embryo screening, antenatal testing and the provision of abortion on grounds of fetal abnormality have nothing in common with the eugenic tradition.
These new technologies are a means to extend women's choice in pregnancy. They allow a woman to make an informed decision about the future of her pregnancy - and about her own future. Of course, women's decisions may be shaped by the information and the counselling they receive, by their perceptions of what life with a disabled child will be like. But ultimately the choice is theirs.
It is difficult to understand how this can be associated with eugenics, a tradition that assumes society can and should be improved by the manipulation of genetic inheritance. It is even more difficult to understand how it can be associated with the practices of the Nazi regime - forced abortion, sterilisation and euthanasia. There is simply no comparison between a state that offers a woman (who wants it) a chance to gain information about her fetus, and a state that coercively sterilises women it deems unfit mothers and slaughters people it feels unworthy of life.
However, it is undeniable that the process of antenatal screening and abortion on grounds of fetal handicap goes against the grain of liberal opinion today. It is clearly judgemental and value-laden, two qualities that are strictly taboo among the politically correct. In opting to end a pregnancy on grounds of abnormality a woman is saying that, while she may be prepared to raise an able child, she is not prepared to raise a disabled one. In choosing to abort a fetus because it is abnormal a woman demonstrates that although she wanted a child, she does not want any child. To some, that seems unacceptable. To me, it is fair enough.
Most women, when they decide to have a child, have an image of what that child will be like, and fantasise about what motherhood will be like for them. When a woman discovers her child will be affected by a serious disability that image is shattered. Some women faced with this situation readjust their dreams to accommodate the knowledge they now have of their child-to-be. But for others the knowledge of abnormality can turn a wanted pregnancy into an unwanted one. The woman may feel unable - or simply unwilling - to cope with a child that will have needs she had not previously considered.
It may be true that women might be more willing to accept an abnormal pregnancy if they had a more balanced view of what life with a disabled child will be like. It may be the case that more women would be prepared to continue abnormal pregnancies if more resources were available to help them cope with the practical problems they anticipate. It may also be true that if disabled people were subject to less prejudice, the prospect of raising a child with special needs might be more acceptable. But women have to make their decisions in the context of society as it exists.
No matter how much help were given to assist the mothers of disabled children, there will still be women who choose abortion simply because they do not wish to bear an abnormal child. Those who support women's choice on abortion must surely uphold these women's right to make that choice, and support the development of tests that enable women to make such choices.
Technologies to help detect and end abnormal pregnancies do not cause or legitimise discrimination against people with disabilities. A woman who chooses to end a pregnancy because the fetus is affected by Down's syndrome or achondroplasia does so to resolve a problem for her as an individual - not to make a statement about the status of disabled people in society.
A woman who follows the official advice and takes folic acid supplements to minimise her chance of conceiving a pregnancy with a neural tube does so because she values the good health of her potential child: she would rather it did not have spina bifida. Does it follow that she has a discriminatory attitude to people affected by spina bifida? Or is she simply trying to maximise her future child's chances? How should she be judged?
If the decision to abort an abnormal fetus expresses a negative view of a particular condition, that should not be surprising. Most of us value health more than ill-health, ability over disability. But that does not mean that we accord less human value to sick or disabled people than to well or able-bodied people. One of the eternal struggles of humanity has been to restore health in the face of disease, and to allow individuals to live their lives free from suffering and in such a way as to maximise their opportunities. Antenatal and embryo screening, and the provision of abortion on the grounds of abnormality, should be located in this humane tradition - a world away from the assumptions of eugenics.
Reproduced from LM issue 117, February 1999