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Prenatal diagnosis, followed by abortion in selected cases, is
common practice in countries with liberal abortion laws and
advanced medical techniques. I think this is as it should be. As
the arguments of Chapter 6 indicate, I believe that abortion can
be justified. Note, however, that neither haemophilia nor
Down's syndrome is so crippling as to make life not worth living,
from the inner perspective of the person with the condition. To
187
Practical Ethics
abort a fetus with one of these disabilities, intending to have
another child who will not be disabled, is to treat fetuses as
interchangeable or replaceable. If the mother has previously
decided to have a certain number of children, say two, then
what she is doing, in effect, is rejecting one potential child in
favour of another. She could, in defence of her actions, say: the
loss of life of the aborted fetus is outweighed by the gain of a
better life for the normal child who will be conceived only if
the disabled one dies.
When death occurs before birth, replaceability does not conflict
with generally accepted moral convictions. That a fetus is
known to be disabled is widely accepted as a ground for abortion.
Yet in discussing abortion, we saw that birth does not
mark a morally significant dividing line. I cannot see how one
could defend the view that fetuses may be 'replaced' before
birth, but newborn infants may not be. Nor is there any other
point, such as viability, that does a better job of dividing the
fetus from the infant. Self-consciousness, which could provide
a basis for holding that it is wrong to kill one being and replace
it with another, is not to be found in either the fetus or the
newborn infant. Neither the fetus nor the newborn infant is an
individual capable of regarding itself as a distinct entity with a
life of its own to lead, and it is only for newborn infants, or for
still earlier stages of human life, that replaceability should be
considered to be an ethically acceptable option.
It may still be objected that to replace either a fetus or a
newborn infant is wrqng because it suggests to disabled people
living today that their lives are less worth living than the lives
of people who are not disabled. Yet it is surely flying in the face
of reality to deny that, on average, this is so. That is the only
way to make sense of actions that we all take for granted. Recall
thalidomide: this drug, when taken by pregnant women, caused
many children to be born without arms or legs. Once the cause
of the abnormal births was discovered, the drug was taken off
the market, and the company responsible had to pay compen-
188
Taking Life: Humans
sation. If we really believed that there is no reason to think of
the life of a disabled person as likely to be any worse than that
of a normal person, we would not have regarded this as a
tragedy. No compensation would have been sought, or awarded
by the courts. The children would merely have been 'different'.
We could even have left the drug on the market, so that women
who found it a useful sleeping pill during pregnancy could continue
to take it. If this sounds grotesque, that is only because
we are all in no doubt at all that it is better to be born with
limbs than without them. To believe this involves no disrespect
at all for those who are lacking limbs; it simply recognises the
reality of the difficulties they face.
In any case, the position taken here does not imply that it
would be better that no people born with severe disabilities
should survive; it implies only that the parents of such infants
should be able to make this decision. Nor does this imply lack
ofrespect or equal consideration for people with disabilities who
are now living their own lives in accordance with their own
wishes. As we saw at the end of Chapter 2, the principle of
equal consideration of interests rejects any discounting of the
interests of people on grounds of disability.
Even those who reject abortion and the idea that the fetus is
replaceable are likely to regard possible people as replaceable.
Recall the second woman in Partit's case of the two women,
described in Chapter 5. She was told by her doctor that if she
went ahead with her plan to become pregnant immediately,
her child would have a disability (it could have been haemophilia);
but if she waited three months her child would not have
the disability. If we think she would do wrong not to wait, it
can only be because we are comparing the two possible lives
and judging one to have better prospects than the other. Of
course, at this stage no life has begun; but the question is, when
does a life, in the morally significant sense, really begin? In
Chapters 4 and 5 we saw several reasons for saying that life
only begins in the morally significant sense when there is aware-
189
Pradical Ethics
ness of one's existence over time. The metaphor of life as a
journey also provides a reason for holding that in infancy, life's
voyage has scarcely begun.
Regarding newborn infants as replaceable, as we now regard
fetuses, would have considerable advantages over prenatal diagnosis
followed by abortion. Prenatal diagnosis still cannot
detect all major disabilities. Some disabilities, in fact. are not
present before birth; they may be the result of extremely premature
birth, or of something going wrong in the birth process
itself. At present parents can choose to keep or destroy their
disabled offspring only if the disability happens to be detected
during pregnancy. There is no logical basis for restricting parents'
choice to these particular disabilities. If disabled newborn
infants were not regarded as having a right to life until, say, a
week or a month after birth it would allow parents, in consultation
with their doctors, to choose on the basis of far greater
knowledge of the infant's condition than is possible before birth.