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The Ethics of Prenatal Screening

Yesterday on Facebook, I mentioned in my status that I was wrestling with the ethics of prenatal screening.  That resulted in 25 or so comments from people, and those comments were very enlightening and helpful.  So much so, that I wanted to move the conversation to this blog and get some more input (and hopefully the commenters from yesterday will come back!).

It started when I read Gilbert Meilaender’s Bioethics: A Primer For Christians. He advises against Amniocentesis with these words:

Amniocentesis can on occasion be put to good use.  (It was, in fact, first developed to detect Rh blood group incompatibilities between a pregnant woman and the child she was carrying.)  But we deceive ourselves if we suppose that, as a routine feature of medical practice, it can simply assist a couple to prepare themselves for their child’s birth.  It does exactly the opposite.  It sets our foot on a path that is difficult to exit.  We may tell ourselves that we only want to know the health of the fetus, that abortion is not a possible end in view, but, for the most part, I think, we thereby deceive ourselves.  The technology carries its own momentum, which, if not irresistible, is nevertheless very powerful.  It prepares us not for the kind of commitment that parenthood requires, an unconditional commitment, but for a kind of responsibility that finite beings ought to reject.  The time of pregnancy will be better spent learning to love the child we have been given before we begin to evaluate and assess that child’s capacities.  Christians could do the world a considerable favor and could bear substantial witness to the meaning of God’s own love for the world if they would simply say no to routinized prenatal screening – thereby saying to their children and, by implication, to others: “It’s good that you exist.”

To me that is a beautiful paragraph culminating in what it means to believe that life exists.  The value of a child is not in his intelligence, or his abilities, but simply in the fact that the child is created by God, and created in God’s image.

Meilaender believes that when we do routine prenatal screening, we are opening the door toward abortion.  Moreover, it seems to me that we might be saying to our children that we only value them if they meet our present standards.

I am no expert in bioethics, and certainly no expert in prenatal screening (one of the commenters yesterday was quiet enlightening regarding screeining).  So I am opening the floor to what I hope will be a civil conversation:  Do you support routine prenatal screening, or do you agree with Meilaender?  What might be some of the benefits of routine screening?  I am certainly open, and hoping that the readers will contine to enlighten me as the did yesterday.

  1. Ken England
    January 29, 2009 at 12:36 pm

    Meilaender states it the way I would pursue it

  2. January 29, 2009 at 1:35 pm

    I totally disagree with Meilaender. His idea that somehow the mere fact of having a test devalues the life of that baby is ridiculous. I don’t even understand the argument. I had my son’s vision tested, Meilaender would seem to imply that I think he is now less valuable because he wears glasses.

    As for the “push” toward abortion, the same couple that would now suddenly consider abortion because of a special needs child are probably the same couple that would consider abandonment after the baby is born.

    Testing can save lives and testing can help parents prepare both for the long term and the short term. NIC nurses will tell you that there are things that can and need to be done immediately for special needs babies that will help them have a better future.

    I can’t really imagine why you wouldn’t have the test.

  3. jlemke
    January 29, 2009 at 1:43 pm

    I think Meilaender is saying the opposite. Children have value not because of their health, but because they exist. His fear (justifiable, I think) is that testing starts us down the road toward devaluing the child. Keep in mind the very last sentence of his paragraph – “It’s good that you exist.”

    Also remember, he’s talking about routine, prenatal screening. Not any old sort of medical test.

    So the question is, are we devaluing our children by testing them for something we can’t fix – or worse, when the only fix is termination of the pregnancy?

  4. January 29, 2009 at 2:10 pm

    Meilaender’s argument seems to lend credence to the view that there is some kind of delineation between pregnancy and birth. Life begins at conception right, so why should we throw away an opportunity to care for our child. It’s ok to test for things after birth, but not prior?

    Doesn’t doing everything in your power to provide the best for your child prove that “it’s good you exist.”?

  5. Brian D.
    January 29, 2009 at 2:14 pm

    I am not sure if this is off topic or not, but ould the same arugement be made over an ultra sound that tells us the gender of a baby? If a couple really wanted a boy and are having a girl, could the same not be said that termination becomes an option? I am not sure I agree with the devalue of a child.
    If I can prepare with support groups, or gather as much information as possible towards a possible condition, I feel I would be better prepared for the birth over if I went in blind.

  6. jlemke
    January 29, 2009 at 4:36 pm

    Brian, I have not evidence that people terminate pregnancies based on ultra-sound. However, if that were true, I think it would be wise to consider whether or not we do them – after all, humanity lived without ultra-sounds for 5000 or so years.

    Jeff, suggesting that Meilaender believes that life begins at birth does not take his argument seriously. In fact, he clearly believes life begins at conception. That is why he is so interested in protecting the life of the child. His argument is that prenatal testing endangers children. It’s an argument worth considering. As I already noted, there is much evidence that prenatal testing for Downs results in abortions.

    It seems to me that if we are doing prenatal testing for things that cannot be cured or helped until birth, we are only offering one real solution – terminate the pregnancy. This is precisely what Meilaender wants to avoid.

    I am not suggesting that we should not test for things that can be treated or helped prior to birth. I am suggesting that routing testing may not be the best thing to do.

  7. January 29, 2009 at 4:50 pm

    I don’t know that the tests themselves are the deciding factor to someone choosing an abortion – I think it is more the heart condition of the parents. If someone feels that a life holds less worth or is “disposable” because of a genetic condition like down syndrome the test did not give them that opinion- they held it before the test occurred. Those who have tests to find out if there is something “wrong” with their baby because they only want a “perfect” baby or those who have the tests because they want to prepare themselves to be the best parents they can be to a child with special needs – the test results are not changing their views on abortion. They had those views regardless of the test results.

  8. jlemke
    January 29, 2009 at 5:04 pm

    Very true, Jenny. Here’s my question back to you:

    If we as Christians do prenatal tests only to find out about the health of our child, are we making the same mistake but on a smaller scale? In other words, we may not choose abortion, but could we be implying that the health of the child matters greatly? And if it does, are we saying something about how the health of the child and his worth are connected? How do we avoid this problem?

    The problem for me is that I am of two minds about this issue. I agree that I want a healthy baby – maybe that’s not God’s plan, but it’s what I want. What I don’t want to do is link health to value.

  9. Brian D
    January 29, 2009 at 5:20 pm

    Great points. Would you take the stance then that we should have faith and trust in God. That any sort of prenatal testing is then us trying to get what we want and maybe not so much what God has planned for us?

  10. jlemke
    January 29, 2009 at 5:30 pm

    Yes, Brian, but it’s too easy to say and not so easy to do. I want a healthy baby as much (or more) than the next person.

  11. January 29, 2009 at 5:39 pm

    John, you missed my point. It wasn’t about what Meileander believes (I’m sure he has a wholly Biblical view of life beginning at conception or you wouldn’t be quoting him), but that there appears to be some distinction between an unborn child and a child already born as you responded earlier that he was not referring to any medical test only prenatal.

    I’m guessing he would NOT be against testing my kids for blood-disorders or cancer screenings? If not, then why a special caution for the unborn? If we truly value the child why wouldn’t we do whatever we can to care for them. If it’s simply because some MIGHT consider abortion and the some MIGHT follow through it’s not enough for me to view the tests as wrong.

  12. jlemke
    January 29, 2009 at 5:54 pm

    OK, Jeff. Your right, he’s not against testing for those things. But those things are treatable. He’s against routine testing for untreatable diseases, like Downs.

    His special treatment for the unborn arises out of concern that we not end lives due to the screening.

    Here’s my question back to you: Does prenatal screening for untreatable diseases (emphasis on untreatable) show more or less care for the child? Again, the Downs example is helpful. Downs is not treatable, and clearly results in increased abortions. Thus, the results of the test – regardless of our good intentions – shows a lack of care for children.

  13. jlemke
    January 29, 2009 at 5:55 pm

    For the record, you’re right – I misunderstood your earlier post!!

  14. January 29, 2009 at 6:10 pm

    Great post and great thread. I greatly appreciate Meileander’s value of life, but I think is incorrect in how it applies it to prenatal screening.

    Employing the classic, unprovable, often outright wrong slippery slope argument, he tries to make the point that prenatal screening is a powerful force that overrides unconditional love. John, you do the same by saying that by wanting to consider the health of our unborn children we aren’t loving them for who they are (or that test results show a lack of care). The result of the test has absolutely nothing to do with our care for the child. It can show the opposite…wanting to care for our children to the best of our ability.

    I acknowledge that some of the population do this, and sometimes it leads to an abortion. But this is not an indictment against the test, it is an indictment against those parents and our culture of selfishness.

    I agree with Jeff that we do these things all the time for our out-of-utero children because we love them unconditionally, so why not for our in-utero children? Even if we can’t cure something, isn’t it loving and caring to manage it? Many of us adults have conditions that we can’t cure but we manage (with glasses, medication, etc), and we regularly test ourselves to make sure we are managing well. We consider hospice – which is not curative but managing, extremely caring. Why not for the unborn? Isn’t this an act of love?

  15. jlemke
    January 29, 2009 at 6:18 pm

    Brian: First, it’s not a slippery slope argument – it’s what happens. Second, prenatal testing for some diseases does nothing for the managing of the disease, at least not in a way that’s clear to me. I may be wrong in that, though. I was hoping someone with medical knowledge might join in.

    The point is this – prenatal testing does little that is helpful, but much that is damaging.

  16. January 29, 2009 at 6:19 pm

    Based on what I have been told by Nurses in Neo-Natal Units, there are things that can be done immediately at birth to care for special needs children. Things that if there is pre-knowledge can be planned for and at the ready the instant the child is born. And these things, while not changing the special needs they have, can contribute to a “healthier” baby and have positive long-lasting consequences.

    He uses the word “momentum” to describe how the tests set us on a certain course. Newton’s laws of motion popped into my head as I read that statement. Momentum or motion can be stopped when a greater force is applied to it. The point of some of the other comments seem to be that the people choosing abortion do not have or would not seem to have that greater force, faith in Jesus Christ.

  17. Janelle
    January 29, 2009 at 6:20 pm

    As a mother with a child that has a severe condition that was detected 48 hours after birth, I have to disagree with Meilaender. Being told that my child may be blind and may have kidney cancer was the most difficult thing I’ve ever gone through. And while that would have been difficult to hear at any time, I could have handled it better during pregnancy (when I was generally well-rested, feeling good, and relatively emotionally stable) than 48 hours after birth when my hormones were all screwed up, and I was completely sleep-deprived. If I had known about the condition before birth, I could have done extensive research ahead of time and hit the ground running to provide her the best care possible, instead of researching it during a 2AM feeding and taking the first few months of her life just figuring out some of the things we need to do to care for her.

    Did the eye condition change my love for my child? Of course not!! I loved her long before I ever saw her, and that certainly didn’t lessen with the diagnosis. Does she have less value because of it? A thousand times, no! To say that prenatal testing indicates that we value the child less if not “healthy” is a severe oversimplification, I think.

    I agree that we need to have faith and trust in God, but I fail to see how prenatal testing by a Christian precludes that. Since Elli has been born, I have learned as much as I could about her condition and taken all the steps that are available to us to give her the best care possible, yet everybody seems to think that’s simply being a good parent. How is it being a good parent now, but it’s “not trusting in God” if I started that process a few months earlier? That doesn’t seem to follow logically. If that’s not trusting in God, then should I stop having the ultrasounds that she receives every 3 months to check for kidney tumors? Is that not trusting in God? If we follow that particular argument out to its logical conclusion, then we should never do any sort of screenings (PSA tests, ultrasounds, etc.), because we should just trust God to work it out.

    I have to admit, though, that calling amniocentesis “routine” is pretty questionable. Those are far from “routine” and are only done if other tests indicate trouble. And in every case, you are not even remotely required to get the screening.

    That being said, if it is true that Downs babies are aborted at a higher rate, that is a true tragedy that should cause all of us to grieve. However, the fact that some use a tool in an evil way does not mean that the tool itself is evil. As Jenny and Jeff said, this is a heart issue, which can’t be fixed simply by outlawing a tool.

  18. jlemke
    January 29, 2009 at 6:28 pm

    Interesting take, Janelle. Keep in mind, no one here has talked about “outlawing” anything. But your argument is the one my wife gives – that knowing in advance is helpful.

    One other thing that continues to be misunderstood in this thread: No one is suggesting that we not test for things that are treatable – only for those that are not. There’s a huge difference.

  19. Jessie D
    January 29, 2009 at 8:02 pm

    Unfortunately the same tests that we use to screen for un-treatable diseases/disorders are the same ones we use for treatable diseases/disorders. The same ultrasounds that we use to measure our in-utero babies to check their size, see if their heart is working and so forth is also used to measure a skin fold thats used to ID “Downs”, blood tests that could tell us if our baby has a neurotube defect (possibly treatable and may require a special delivery) could also lead us to genetic issues our baby may have.

    so maybe its not the tests we need to be concerned about, or even the results, but the way practitioners approach a mother/father with these results and lead them to their “options”.

  20. January 29, 2009 at 8:14 pm

    “First, it’s not a slippery slope argument – it’s what happens.” Any proof for this assertion? Most importantly, any biblical principles to support it?

    I agree that it does happen sometimes, but the arguments that Meileander and you have been putting forth is that it NECESSARILY happens. That is completely false, as evidenced by the number of Christians who go through prenatal testing without pursuing abortion or devaluing the child at all.

    I’ve heard this before:

    Drinking leads to drunkenness
    Dancing leads to sex
    Rock music leads to devil worship
    Testing leads to devaluing children

    All of them have been true for some people, but none of them are necessarily true for all people.

  21. January 29, 2009 at 8:25 pm

    John in answer to your question the health of our children does matter greatly – otherwise why prenatal checks in the first place. I don’t think that immediately lends itself to poor health equals less worth as a human. It’s because we care about our children that we want them to have the best care possible. And even “un-treatable” conditions need special treatment / therapy and parents can prepare themselves and siblings for that. Truth be told I opted out of prenatal testing (other than ultrasound) because the results wouldn’t have changed my mind about continuing with the pregnancy. On the other hand would I want to know if I was going to have a special needs child – honestly – yes. Support groups, knowing what expect – related health issues (downs children often suffer from heart defects as well) and just like Janelle said “hit the ground running” once the baby is born.
    The other unfortunate issue is that these tests are not 100% accurate. I know of a couple who were told their daughter would have downs (found via ultrasound) and she was born perfectly healthy. If they would have chosen to abort based on these test they would have aborted a “perfect baby”. Like I said before the parents who opt to abort a baby based on tests have an opinion of the value of life and human worth that was not put in place by the test itself.

  22. Jeff
    January 29, 2009 at 9:34 pm

    How can you say “prenatal testing does little that is helpful, but much that is damaging.”? How do you quantify a statement like that?

    According to experts Downs babies run the risk of a bowl obstruction at 28 weeks, is that not worth monitoring for? Monitoring that wouldn’t occur without testing.

  23. jlemke
    January 29, 2009 at 10:02 pm

    Brian: See http://www.nytimes.com/2007/05/09/us/09down.html. “90% of pregnant women who are given a Down syndrome diagnosis have chosen to have an abortion.”

    Jessie D: That’s the sort of helpful insight I’m after. If prenatal testing is worthwhile for more than just terminating pregnancies, I’m all for it.

    Jeff: I’m not trying to quantify that statement. It’s my (tentative) assertion, which has been running all through this thread. My intention is not to push back just for the sake of pushing back, but to better understand what we should be doing as Christians in the world.

  24. January 29, 2009 at 10:53 pm

    That is truly an alarming statistic, but I still disagree.

    One of the main concerns I have with Meilaender and your comments is that you both claim that simply having the test leads to a devaluing of the child. Your stats don’t support that claim.

    Let’s say 1,000 women have the test. Probability shows that 1-2 of these women will have a downs baby (current probability is 1/800 to 1/1000). The stats show that 90% of this 1/1000 will have an abortion. This is absolutely tragic (but again, an indictment on the people/culture, not the test). But what you are claiming is that the other 999 have devalued their children and/or failed to love them unconditionally. Neither one of us can statistically prove our point on the 999, but do you really believe that those 999 have devalued their children? That’s a tough one, especially since some of them are most certainly in our church and maybe on this thread.

    I greatly appreciate this post and the push back as it does help us think as Christians.

  25. jlemke
    January 29, 2009 at 11:37 pm

    I don’t believe all 999 have devalued their children. However, what are we saying as a culture?

    Look at it in a different way. 90% have abortions after a positive test for Downs. What percentage of people in North America say they are born again? 30%? So, either Christians are not getting the test (a possibility, based on anecdotal evidence from this thread) or professed Christians are aborting when they find out. That would imply that a high percentage of Christians are testing and WOULD abort if they had a positive test. So, I think my argument cannot be dismissed so lightly – and, contrary to your statement, the stat may support my claim. The test itself may be devaluing children. I stress the “may be” part of it, because I’m open. but I’ve been surprised that not one on this thread has really taken his argument more seriously (except for Ken).

    The problem is not the 1 out of 1000 abortions (although I think it’s a bad problem in its own right), but a culture of testing that leads to abortions. I know you don’t like slippery slope arguments, but let’s look at some others:

    heroin use leads to heroin addiction
    meth use leads to meth addiction
    lack of a father figure leads to dysfunctional children
    prenatal screening leads to devaluing children

    All slippery slope arguments cannot be dismissed out of hand – they need to be individually evaluated. The questions I have had still remains, even after all the push back I’ve gotten: If the test leads to high rate of pregnancy terminations, does the test itself devalue life? Or at least show a devaluing of life? Should Christians participate in such testing?

    I’m certainly not dogmatic. If someone decided to test (or has decided to), I would not lose sleep and by the time I’m done with this thread I may even be convinced. But in a Christian culture that is so quick to proclaim how “pro-life” we are, I think we need to more closely examine ourselves.

  26. January 30, 2009 at 12:21 am

    Meilander seems to say that by refusing the test we are testifying to the value of life. Wouldn’t we be saying the same thing and more (since 90% of confirmed Downs diagnosis end up aborting) by choosing to have the baby regardless of it’s special needs? Doesn’t that add value to the life of that child?

    One other thing, it is my understanding that amniocentesis is not routine test, it usually is done once other triggers have been met. So the slippery slope argument might be whether to have ANY pre-natal testing including ultra-sounds?

  27. jlemke
    January 30, 2009 at 9:51 am

    Jeff, I see your point, I think, but let’s try another angle. When we “choose” a special needs child, could we be saying that the child has less worth but we chose the life anyway? And wouldn’t that say the opposite of what we intend? Could it be better to simply not care (again, as above, I confess that this is beyond me) and value the child without knowing in advance? I’m asking.

    At the end of all this, we should be able to say that each child has value regardless of capability. They are image bearers, period.

    BTW, thanks to everyone for their input on this. It’s been quite helpful.

  28. January 30, 2009 at 9:54 am

    Wow, I wake up and we’re still going!!

    You are correct, John, it is a cultural issue. Similar to the divorce rate amongst Christians, pre-marital sex rate amongst Christians, etc, etc. We have a cultural problem and a discipleship problem. I think that is what I and others have been saying is the key. It’s not the test. It’s the fact that people conditionally love their children BEFORE the test, not that the test causes them to conditionally love their children. So the solution is ultimately found in changing hearts which is completely distinct from the test. The test is merely a tool and morally neutral.

    By the way, your counter-arguments are a little more proven cause and effect than this current post. Yes, heroine leads to heroine addiction. There are a lot of factors as to why this is a cause and effect. There is such a thing as cause and effect, but testing leading to devaluing leading to the potential for abortion leading to abortion is not cause and effect. The potential for abortion existed prior to the test in people’s minds.

  29. January 30, 2009 at 12:54 pm

    John, I may be coming around to Meileander’s point of view. We were offered the opportunity to have the tests with each of our kids. There were NO other indicators of problems so we inquired why we would have the tests. The response was so we could find out if the baby had Downs and then decide what to do. The implication was so we could consider abortion. We already new what we would do, so we refused the test.

    Now, if there had been other indicators found in the blood tests or ultrasounds that they were trying to confirm, we would have had the tests without a moments hesitation.

  30. jlemke
    January 30, 2009 at 3:48 pm

    Thanks, Jeff. I was starting to feel awfully lonely!! Anyway, it’s all been very helpful for me as I’ve been challenged in how I think about it.

  31. Brian D
    January 31, 2009 at 10:16 am

    What is interesting about that comment Jeff is that you were offered the opportunity so you could consider the choice of abortion. That kind of sounds like the people giving the test may even be trying to help persuade you in your choice. In which case yes, I would have to come around and even say if presented as an option towards termination, I would have to refuse the test.

  1. July 18, 2015 at 9:35 am

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