Introduction
In our case of Mrs. Brown, she is inclined to get an abortion despite her physician’s assurances and official diagnosis of possible mild defect in her fetus. Would her physician agree that she should abort? If I am that physician, I would recommend that she keep her child.
My recommendation for Mrs. Brown to carry the child to birth rests on an appreciation that, based on the facts of the fetus’ medical condition, an abortion is unnecessary because the fear associated with the mild birth defect is unfounded.
First, I will describe the current arguments of those who believe that any defect, mild or severe, must be aborted. Next, I will show you how the argument itself is defective (and in itself to be aborted, as their position dictates them). Then, I will also anticipate the potential refutation of the abortion proponents to my arguments.
Arguments for abortion
Despite assurances, the risk for fetal defects due to chromosomal aberration remains, physically (tallness, low fertility, infertility, and breast enlargement), mentally (potential manic-depressive problems), and behaviorally (tendency towards behavioral disorders). Purdy (1995) argued that every child should be provided with at least a minimally satisfying life, and genetic defect and its physical, mental and behavioral consequences cannot provide that level of satisfying life. Otherwise, the child will be socially outcast among the “defectives,” she will feel unloved, feels resentment for the short end that her birth had given her. The mother also will blame herself for giving birth to her, watching her suffer from such burdensome conditions. Her descendants too will be burdened with her genetic defects and the resultant woes. Purdy (1995) also insisted that, until there are assurances and certainties that the risks are not going to happen, it is the moral duty of the mother to not bring defective babies into the world, and burden the society for their care.
Lippman (1991) noted that people do not believe society has an obligation to adjust their lives to the comfort of disabled people. The society has the right for public health, which can only be achieved through a reduction if not elimination to the birth frequency of children with genetic defects (public health model).
Moreover, the mother has the right to health, and that means physical, emotional, psychological, and familial well-being. It is unfair for the mother to suffer the burden of taking care of a defective child that will have no future contribution to society or the family, other than being a constant burden for the rest of her life. The mother has the right to choose fetuses she wants to discontinue and those to continue (assembly line model). Above all, women has the right to be respected for their autonomy in choose, which child they want to bear (reproductive control model). Choosing to bear and give birth to fetuses with no congenital defect also enhances the mother’s pregnancy experience (reassurance model).
And that is exactly the reason Mrs. Brown sought prenatal testing, to have a good pregnancy experience and eventual mother experience.
Confirmation
Despite the perceived risks, such risks remain a statistical possibility, a number’s game, and the argument that statistics is certain is defective. Nature is never governed by statistics. There is no certain way of knowing that such risks will even exist after birth. Even if it does, tallness, low fertility and infertility, these are choices that must be left to the child, and not for the mother to make. What if the child learns to even appreciate his or her tallness, and would even thank nature having the chance to not have a child of him or her? The uncertainty that statistical mathematics cannot remove should never be the basis to decide whether a child have life. Numbers cannot understand nor explain why people with diseases all their lives continue to live satisfactory lives (Huntington). And, there is no significant difference between having congenital defects and suffering recurring diseases. In fact, they even lived fruitful lives. Think what could have been the outcome of World War II without a Roosevelt. How about significant contributions of Stephen Hawking? And did not President Abraham Lincoln battle against severe depression all his life? The ‘mild’ defects noted in the fetus of Mrs. Brown may just be exhibiting only a similar Lincolnian struggle at worst. That would bring her in company of the great people this American nation had produced throughout history. Contrary to what Purdy asserted, it is not a moral responsibility for a mother to abort a child with mild congenital defect (even given that such condition even results into these associated symptoms). Instead, it is moral corruption to restrict the widely vast potentials of the unborn child to become a very useful member of society, whether or not she has more or less than 46 chromosomes.
The statistics that Lippman cited is not clear much “many” really was. However, if statistics is to be relied upon, the “many” who felt no obligation to disabled individuals are mere flipsides of the other “many,” even more “many,” people who are willing and are able to take obligation with people impaired with congenital defects. This means that statistics receives meaning based on the perspective its interpreter takes. The right to public health is an illusion based on the fact that never in history has that right been met by any society at any time. At least one person fell sick in each country in each second around the world; so the public can never claim that right. What we can see in the public is its active participation in taking care of those who are sick; and, by extension, such public exerts its right to take care of defective people as well as sick people instead. The proper right that the public wants to have is to be given the opportunity to care for others, those diseased and those congenitally defective, and even those among the worst of us like criminals in prisons.
It is true that the mother had the civil right to choose whether to keep her child or abort it. However, it is her physician’s duty as a professional consultant to guide her with choices that she may not have considered before, choices that she may have to live with regret throughout her life. Would a life of regret born of killing her “defective” child be an exercise of a “healthy” life? It is the physician’s professional duty to care for her mental as well as physical well-being in the present and in the near future if such can be done through proper and effective guidance of her choices in such a crucial matter as life.
Subsequently, the mother’s right to health and well-being is best serve through wise decision making based on facts and certainty. If certainty cannot be obtained, the better option towards health and well-being comes from making a decision that will not result to deep regrets and emotional burden in the future. And, if mothers of children with serious defects can manage to life and well-meaning life, what more the mothers of children with ‘mild’ congenital defects can potentially enjoy from life? Having her child born would be one of those joyful experiences in her life. All these choices designed for a perfect number of chromosomes will always belong to the mother. The question is, does perfection really mean so much in the ordinariness of life? Each person, including the mother, is dealing with their own imperfections, and that of those others around them, each moment of their lives. And, with all those experiences of living with imperfections, dealing with an incomplete chromosomal count will be such a burden in the end. Huntington is correct to ask: Is really that bad? What is certain in anyone’s life is, even life is not really that bad, after all.
And, what about the good experience brought about by prenatal testing from knowing that her child has no birth defects? For all indications in history, it is never that bad even before the existence of prenatal testing. For all indications, prenatal testing is a marketing manipulation on the mind of women in the name of profit (Lippman, 1991). It encourages women to fear imperfection, beginning with their fetuses’ genetic composition. And, how far in perfection genetic studies have come so far? So it still fell short from that perfection. Still, corporate marketers wants women to believe, or at least presume, that the science behind prenatal testing has been perfected in all its biomedical, social, psychological, and behavioral implications. Lippman (1991) noted the suspicious focus in expanding the prenatal diagnostic services and their focus on disability, not on society’s discriminatory practices, which was assumed to be incorrigible. The experience with prenatal testing was of circumventing the “insisted problem” of birth defects, not in solving it. Proponents of selective abortion marketed claims that it will “improve” infant mortality and morbidity statistics by killing an unborn child? That tells us what became more important in their mind right now: statistics, instead of life.
Conclusion
In this age of statistical “facts,” much of the arguments in favor of selective abortion, including the abortion of fetuses with mild congenital defects, rest on a probability of risks interpreted with pessimistic points of reference. Probable, if not mere possible, risks of physical, mental and behavioral symptoms and of social estrangement and motherly “health” are given weight, albeit unnecessarily, on issues that determine whether a life should exist or not, or should be allowed to live or be killed before birth. Such development reflects a scientific blindness that failed to see human beings as entities of complex realities that even mathematical estimations cannot capture. Concepts as caring for the sick and the defective, love for others, and longsuffering choices to serve others who are less fortunate will never be captured in statistics; much more by interpreters of statistics who no longer believe in these.
The issue surrounding congenital defects and abortion is not essentially an issue of a missing chromosome. Instead, it is an issue of one human being, or a small group of them, trying to expect perfection in humans, in fact even insists on defining such perfection, based on the ‘correct’ number of chromosomes inside a person’s cellular nucleus. It is a sociopolitical effort of a few to impose their personal standards on the many. And, which human being can say he is perfect in the first place? No one can because all of mankind makes mistakes, even very serious mistakes like taking the lives of other people. In the same manner, all of mankind too has potential to be good contributors to society even with incomplete or excess genetic materials. If a human being becomes a burden of society (e.g. criminals, corrupts, tyrants) despite their complete chromosomal count, what’s the difference between them and those who have 45 or 47 chromosomes? Should those with less perfect chromosomal counts cannot leave home to wreak havoc upon society, one more of them will be a service to society if by their existence one less criminal will be out of circulation for life. If we look at people with optimism, even people with defects have enormous potentials.
References
Lippman, A. (1991). Prenatal genetic testing and screening: Constructing needs and
reinforcing inequities. American Journal of Law & Medicine, 17(1 & 2): 15-50. Retrieved from: http://web.ntpu.edu.tw/~markliu/prenatal_genetic_testing.pdf
North, M. (2002). The Hippocratic oath. National Institutes of Medicine. Retrieved from:
http://www.nlm.nih.gov/hmd/greek/greek_oath.html
Purdy, L. (1995). Genetics and reproductive risk: Can having children be immoral?
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