We have entered a new era of “choice.” It is “choice” offered as an aspect of medical care for pregnant women. Pregnant women are increasingly offered the option of prenatal screening of their fetus. Originally intended for women at high risk due to maternal age or family history, prenatal screening (PNS) is rapidly becoming part of routine prenatal care for every pregnant woman. The ostensible goal is to enhance pregnancy by giving the mother the security of information, knowledge that is intended to alleviate concerns about her baby’s health. Instead, this technology often creates more fears than it allays, and may actually induce women to terminate prematurely a successful pregnancy. This termination is, of course, by abortion, not premature delivery.
Genetic counseling is presumed to be nondirective and neutral as to the patient’s decision making. Yet, there are no standards for consent and testing, what information should be provided, and whether counseling about potential genetically-linked disabilities should be provided prior to testing. The counselor’s advice? “I would want to have as much data as possible to make an informed decision.” This supposedly neutral counseling biases a patient in one direction: information about pregnancy is good; comprehensive testing is better; and that a patient will want to receive (and act upon) the results of that information.
Even if the couple accepts the PNS with the intention to continue the pregnancy regardless of results, they may have a difficult time defending that decision. Undue influence may be exerted by the genetic counselor, physician, or family members who prefer that the pregnant woman interrupt her potentially “problematic” pregnancy.
It is often assumed that a woman will abort a fetus with a congenital defect. Failure to terminate after a positive diagnosis has been labeled a “nonroutine decision.”[1] More than once, I have been told that a married woman who refuses abortion after a positive test may be ushered into a separate room to make sure that her husband is not pressuring her to continue the pregnancy.
Meanwhile, the mother may have lost a valuable part of the natural course of most pregnancies. Opting for PNS can lead an expectant mother to delay bonding with her child until the results of all tests are complete. The traditional anticipation and joy over a new life is tinged with concern over whether this child will be “normal.” We have created a cultural phenomenon that Barbara Katz Rothman calls “the tentative pregnancy.”
There is a better way. As Christians, we know that all life is a gift. Unlike the proverbial Christmas sweater, the gift of a new life does not have a receipt for return or exchange. We may not understand why a child bears serious genetic defects. But some families have boldly decided to receive that gift with loving, open arms. These are the families like Teresa whose story is one of resistance to medical eugenics. Four months prior to his birth, Teresa learned their son had anencephaly. “While this has been the most painful experience I’ve ever had to endure, it’s probably been the most beautiful as well. Benedict spent his whole life in the arms of people who loved him; who could ask for a better life?”[2]
Choice, pregnancy, prenatal eugenics, and reproductive technologies share a family of ethical concerns. In this issue of Dignitas, we bring you Part I of a lecture I gave at Trinity International University in connection with a performance of the stage adaptation of Aldous Huxley’s Brave New World. Part I outlines the legal, cultural, and theological origins of morally untethered reproductive technologies.
The generally “high tech” concerns of reproductive ethics point to a larger constellation of “low tech” concerns regarding women’s bodies and women’s health. Maternal health is closely linked to the health of her children and her family. Women in majority world countries need prenatal care, a qualified birth attendant, medical care for possible postpartum hemorrhage, and drugs to prevent transmission of HIV/AIDS to their children. Women are at risk of discrimination not just in their reproductive capacities, but throughout their lifespan. Young girls are at risk beginning in the womb, in cultures where male children are prized. They often are at the end of the line in receiving basic health care. Older women, past child-bearing years, may be cast aside.
At CBHD, we are digging into thoughtful reflection on how a Christian understanding of human dignity engenders respect for the particular dignity of women, women’s bodies, and women’s health. As we network with bioethicists and others of good will around the world who share our commitments, we invite you to join our exploration.
[1] March of Dimes casebook, as cited in Elizabeth Kristol, “Picture Perfect: The Politics of Prenatal Testing,” First Things 32 (1993): 17.
[2] Teresa Streckfuss, “It’s about Love,” in Melissa Tankard Reist, Defiant Birth: Women Who Resist Medical Eugenics (North Melbourne: Spinifex, 2006), 100.
Paige Comstock Cunningham, "From the Director's Desk,” Dignitas 18, no. 1 (2011): 2, 5.
