Editorial Letter on Prenatal Testing

¶ … Editor,

In his letter printed June 8, 2014, Alistair Pullen discusses the fact that the advent of prenatal testing has helped transform pregnancy from a time of joy to a time of fear. He discusses his wife's pregnancy with his first daughter, in which prenatal testing revealed the existence of a disorder that was incompatible with life. As a result of the testing, Mr. Pullen and his wife chose to induce labor, resulting in their daughter being stillborn at 20 weeks of age. In their three subsequent pregnancies, prenatal testing helped reassure them that their children were healthy. While Mr. Pullen believes that prenatal testing helped transform the early periods of the pregnancies into high stress events, but that the high stress helps parents avoid something that is even more stressful; the birth of a child with a disorder that is incompatible with life.

I find myself both agreeing and disagreeing with Mr. Pullen's proposition that prenatal testing increases stress during pregnancy, but contributes to an overall reduction in pregnancy stress. Mr. Pullen and his wife chose to terminate a pregnancy after determining that the developing fetus had a condition that was ultimately incompatible with life. As a result, his conclusion that prenatal testing has the capacity of reducing stress in pregnancy is premised upon the foundation that it is acceptable or appropriate to choose termination in the event that prenatal testing uncovers a condition that is incompatible with life. At this point in time, this is a position held by roughly half of Americans, though evidence about termination rates when fetuses are actually diagnosed with serious disorders through prenatal testing suggests that these numbers may be much higher.

My concerns about prenatal testing are directly linked to these termination rates, because of the fact that parents are choosing to terminate children with disorders that are neither incompatible with life nor linked to low-quality of life, like Down syndrome. Advocates for people with Down syndrome suggest that society is losing something by terminating children with Down syndrome. At the same time, these same advocates suggest that society needs to make adjustments and changes to be more accommodating to those with Down syndrome. It brings to mind Greg Narbey's question, "How much accommodation or acceptance must majorities extend to minority groups, and when is accommodation or acceptance unreasonable?" (Narbey, 2009). The complex issue that arises from this scenario is: does the answer to this question change when the minority is a group that may be eliminated through prenatal testing?

I think that this question is more complex that a simple pro-life/pro-choice debate. Are there moral and ethical implications that accompany the choice to terminate pregnancies because of conditions discovered in the prenatal testing process? There is strong evidence that pro-choice policies result, not only in the births of fewer children with conditions that are incompatible with life, but also with conditions that are compatible with life, but may be considered inconvenient for caregivers. Will changing these conditions make it more difficult for minority groups, such as those with congenital disabilities, to receive accommodations, as their numbers shrink to smaller and smaller groups? Will improvements in prenatal testing result in the ability to determine disorders that are considered significant modern disorders, such as autism, and ADHD? If so, would it be considered moral or appropriate to terminate those pregnancies, or would it be considered discriminatory to do so? How would the conflict in the protection of minority groups conflict with the overall right to choose? All of these moral dilemmas must be considered when discussing prenatal testing and its implications.

Sincerely,

To the Editor:

There is no doubt that pregnancy has turned from a time of joy to a time of fear. When my wife was pregnant with our first daughter, Becket, we declined all tests until 20 weeks for all of the reasons this article mentions. During our 20-week ultrasound and blood work, we learned that Becket had a fatal condition called anencephaly and would not survive. Had we not undergone further testing and ultrasounds, the pregnancy would have continued, but our daughter would have died shortly after birth.