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especially internal bleeding, from the slightest injury. If allowed
to continue, this bleeding leads to permanent crippling and
eventually death. The bleeding is very painful and although
improved treatments have eliminated the need for constant
blood transfusions, haemophiliacs still have to spend a lot of
time in hospital. They are unable to play most sports and live
constantly on the edge of crisis. Nevertheless, haemophiliacs do
not appear to spend their time wondering whether to end it
all; most find life definitely worth living, despite the difficulties
they face.
Given these facts, suppose that a newborn baby is diagnosed
as a haemophiliac. The parents, daunted by the prospect of
bringing up a child with this condition, are not anxious for him
to live. Could euthanasia be defended here? Our first reaction
may well be a firm 'no', for the infant can be expected to have
a life that is worth living, even if not quite as good as that of a
normal baby. The 'prior existence' version of utilitarianism supports
this judgment. The infant exists. His life can be expected
to contain a positive balance of happiness over misery. To kill
him would deprive him of this positive balance of happiness.
Therefore it would be wrong.
On the 'total' version of utilitarianism, however, we cannot
reach a decision on the basis of this information alone. The total
view makes it necessary to ask whether the death of the haemophiliac
infant would lead to the creation of another being
who would not otherwise have existed. In other words, if the
haemophiliac child is killed, will his parents have another child
whom they would not have if the haemophiliac child lives? If
they would, is the second child likely to have a better life than
the one killed?
Often it will be possible to answer both these questions affirmatively.
A woman may plan to have two children. If one
dies while she is of child-bearing age, she may conceive another
185
Practical Ethics
in its place. Suppose a woman planning to have two children
has one normal child, and then gives birth to a haemophiliac
child. The burden of caring for that child may make it impossible
for her to cope with a third child; but if the disabled child were
to die, she would have another. It is also plausible to suppose
that the prospects of a happy life are better for a normal child
than for a haemophiliac.
When the death of a disabled infant will lead to the birth of
another infant with better prospects of a happy life, the total
amount of happiness will be greater if the disabled infant is
killed. The loss of happy life for the first infant is outweighed
by the gain of a happier life for the second. Therefore, if killing
the haemophiliac infant has no adverse effect on others, it
would, according to the total view, be right to kill him.
The total view treats infants as replaceable, in much the same
way as it treats non-self-conscious animals (as we saw in Chapter
5). Many will think that the replaceability argument cannot
be applied to human infants. The direct killing of even the most
hopelessly disabled infant is still officially regarded as murder;
how then could the killing of infants with far less serious problems,
like haemophilia, be accepted? Yet on further reflection,
the implications of the replaceability argument do not seem
quite so bizarre. For there are disabled members of our species
whom we now deal with exactly as the argument suggests we
should. These cases closely resemble the ones we have been
discussing. There is only one difference, and that is a difference
of timing - the timing of the discovery of the problem, and the
consequent killing of the disabled being.
Prenatal diagnosis is now a routine procedure for pregnant
women. There are various medical techniques for obtaining
information about the fetus during the early months of pregnancy.
At one stage in the development of these procedures, it
was possible to discover the sex of the fetus, but not whether
the fetus would suffer from haemophilia. Haemophilia is a sexlinked
genetic defect, from which only males suffer; females can
186
Taking Life: Humans
carry the gene and pass it on to their male offspring without
themselves being affected. So a woman who knew that she
carried the gene for haemophilia could, at that stage, avoid
giving birth to a haemophiliac child only by finding out the sex
of the fetus, and aborting all males fetuses. Statistically, only
half of these male children of women who carried the defective
gene would have suffered from haemophilia, but there was then
no way to find out to which half a particular fetus belonged.
Therefore twice as many fetuses were being killed as necessary,
in order to avoid the birth of children with haemophilia. This
practice was widespread in many countries, and yet did not
cause any great outcry. Now that we have techniques for
identifying haemophilia before birth, we can be more selective,
but the principle is the same: women are offered, and usually
accept, abortions in order to avoid giving birth to children with
haemophilia.
The same can be said about some other conditions that can
be detected before birth. Down's syndrome, formerly known as
mongolism, is one of these. Children with this condition have
intellectual disabilities and most will never be able to live independently,
but their lives, like those of small children, can be
joyful. The risk of having a Down's syndrome child increases
sharply with the age of the mother, and for this reason prenatal
diagnosis is routinely offered to pregnant women over 35.
Again, undergoing the procedure implies that if the test for
Down's syndrome is positive, the woman will consider aborting
the fetus and, if she still wishes to have another child, will start
another pregnancy, which has a good chance of being normal.