Bioethical Concerns on Genetic-Based Abortions

Genetic-based abortions are a controversial debate, with ramifications such as impacting a woman’s right to self-autonomy, and whether a fetus, usually in the second or third trimester, has the right to live. Particularly seen in Iceland, recent articles declare Trisomy 21, also known as Down’s Syndrome, mostly eradicated with only 2-3 births being reported yearly. (1)

With scientific breakthroughs, genetic and blood testing can be done to check for any genetic deformities in the fetus which provided a basis for women to decide to either terminate or continue with the pregnancy. With 75-80% of women going through with termination (1), it has created a culture of scientific rationale and championing women’s rights to bodily autonomy within Iceland.

This can be seen as a result of Iceland’s progressive healthcare system, being one of the first countries to legalise abortion in 1935 in the circumstances of protecting a woman’s health, and has evolved since then through a strengthened resolve for women’s rights. However, the discourse surrounding this argues that this upholds the sentiment of ‘eugenics’, the practice of only breeding “ideal” people that fit a criterion.

Bioethical Ramifications: Point of Discussion

The debate surrounding this issue stems from women’s right to make decisions about their own body, and the right to live of fetuses that may carry the gene. Bioethicists argue that termination on the sole basis of the fetus carrying the gene for Down’s Syndrome could favour eugenic practices.

Associate Professor Claire McKinney from the College of William & Mary argues for women, in stating how qualitatively defining “women’s subordination to their reproductive systems makes such an approach… so problematic”. (2) She goes on to discuss how women are not constrained to their reproductive rights, and should not be given judgement for exercising their right to make their own medical decisions.

On the other side of the argument, Professor Tim Reynolds of Queen’s Hospital examines the views of ethics committees, which argue that terminating a pregnancy solely because the fetus carries the gene for Down syndrome raises ethical concerns and lacks moral justification (3). This demonstrates how promoting a culture of aborting fetuses with Down syndrome due to their gene alone could lead to eugenic practices.

The quality of life for people with Down’s Syndrome is often perceived differently by scholars. Scientific advancements have significantly improved the livelihoods of people with this condition, creating a more feasible future. For example, the Journal of Biomedical Sciences has published findings on “favourable conditions” that contribute to an improved quality of life (4). However, other studies conducted by the NHS’ Estia Centre outlines people with Down’s Syndrome are at higher risk of cognitive deficit diseases like Alzheimer’s and dementia, when compared to the average person (5), and require monitoring and constant health interventions.

The “what-ifs” – Is this science or is it ableism?

The what-ifs of terminating or continuing the pregnancy carry problems for both sides. On the one hand, women should not be forced to care for a child who may have Down’s Syndrome, lack self-autonomy, but at the same time, arguments for people with Down syndrome demonstrate how they can live fulfilling lives, with discrimination of such people being outdated and unfair.

Cultural barriers for people with Down’s Syndrome are frowned upon as science itself has helped them overcome their barriers, such as increasing their life expectancy from 13 to 60 in under 80 years according to the Department of Health and Social Care (6). On the other hand, their cognitive ability and IQ can be less than 20-30 points (7), showing how their independence is a barrier that will impact people around them.

Ultimately, this issue calls for continued discourse among ethicists. The controversy of governmental oversight of such procedures, and whether it promotes eugenics or supports women’s rights, will continue to spark debate for years to come. This article encourages readers to reflect on their own values and beliefs, fostering wider thinking and providing an opportunity to consider perspectives from marginalized groups, such as women and the disabled community.

Words by Shakeal Zaman

References:

Government of Iceland. Facts about Down’s syndrome and pre-natal screening in Iceland. [Online]. 2018. Available from: https://www.government.is/diplomatic-missions/embassy-article/2018/03/26/Facts-about-Downs-syndrome-and-pre-natal-screening-in-Iceland/#:~:text=Among%20the%20misconceptions%20which%20have,which%20cannot%20simply%20be%20ignored.
McKinney, C. Selective Abortion as Moral Failure? Revaluation of the Feminist Case for Reproductive Rights in a Disability Context. Disability Studies Quarterly. [Online]. 2016, 6.1. Available from: https://dsq-sds.org/index.php/dsq/article/view/3885/4213.
Reynolds, T M. Down’s syndrome screening is unethical: views of today’s research ethics committees. Journal of Clinical Pathology. [Online]. 2003, 56.4. pp.268–270. Available from: doi:10.1136/jcp.56.4.268.
Lee, A., Knafl, G., Knafl, K., and others. Quality of life in individuals with Down syndrome aged 4 to 21 years. Child: care, health and development. [Online]. 2020. Available from: doi:10.1111/cch.12815
NHS, Multiple morbidity across the lifespan in people with Down Syndrome. [Online]. 2023. Available from: https://slam.nhs.uk/estiacentre-blog/multiple-morbidity-across-the-lifespan-in-people-with-down-syndrome-3467.
GOV.UK. Government seeks views to improve lives of people with Down’s syndrome. [Online]. 2022. Available from: https://www.gov.uk/government/news/government-seeks-views-to-improve-lives-of-people-with-downs-syndrome.(7) Mégarbane, A., Noguier, F., Stora, S., and others. The intellectual disability of trisomy 21: differences in gene expression in a case series of patients with lower and higher IQ. European Journal of Human Genetics. [Online]. 2014, pp.1253–1259. Available from: doi:10.1038/ejhg.2013.24.