Downs Syndrome Has Been Eliminated in Iceland. But was it Ethical?

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Recently I found myself caught up in a discussion about the disappearance of Downs Syndrome in Iceland. It's one of those Facebook threads you make a single comment on, expecting it to end there, only for your notifications to blow up a moment later and embroil you in argument until 4am.

The gist is that a test, amniocentesis, exists which can determine whether a developing fetus has downs syndrome. Nearly 100% of pregnant women in Iceland pay to have the test performed, and nearly 100% of those with a positive result choose to abort the fetus.

Crucially, this means it was entirely voluntary. The predictable accusations of eugenics miss their mark, because what made eugenics so terrible was not the goal of improving humanity (how could that be terrible in itself?) but the fact that it was implemented by government force.

It's also still a woman's right to choose what to do with her own body. If she does not have the freedom to control her own bodily processes, she does not have ownership of herself. From a legal standpoint that ends the debate. Women are free to terminate their own pregnancies at will. What's not yet settled is the moral debate.

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Does the fact that these abortions were informed by a medical test for Downs syndrome alter the moral calculus at all? Is it fine if there is no test, but becomes wrong if there is? Arguments that the initial test isn't always accurate lie by omission: The second stage of the test is 100% accurate or vanishingly close.

Even if it weren't, that would be an argument for improving the test, not disallowing it. It may help at this point to explore the worldview of the people who vehemently oppose abortion for any reason at all, often including rape.

Whereas the view of neurologists, biologists and so on is that we are born with nothing more than instinct, and become who we are as adults by accumulating life experiences, supernaturalists like Christians, Muslims, Mormons, Jews, Jehova's Witnesses and so on believe in the "pre-born".

That is to say, they believe you have always been who you are now, even before you were born. That you have no memory of waiting around in Heaven but that's where you were prior to your own birth, and where you return to when you die.

This perspective isn't universal to all denominations but some version of this idea is the most common basis for opposition to abortion, and why such people equate it to the murder of a fully developed person.

However, there's another way to look at it. Each of us is the result of genetic recombination. Some of our father's DNA and some of our mother's, combined in a particular way. Combined in different ways, it would result in people similar to you in many ways but not identical, like siblings.

There are uncountable possible combinations of those two genomes. A finite, but very large number. All of those combinations could have been the 'you' that was actually born. Would it have been a tragedy if possible combination #45,021,345,973 was born instead of possible combination # 22,810,592,780 (you)?

Would that mean you were murdered? No, because you would never have existed. the specific combination of your father and mother's genomes which makes you physiologically who you are (nature(, and the series of life experiences which molded your personality (nurture) would have never happened. A person was not murdered, rather a potential person was prevented.

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The number of potential people who could be born is, again, uncountably high. Is every potential person that is not conceived and brought to term therefore murdered? Humans are incredibly fertile compared to other mammals, able to mate in any season and have as many as eight offspring in a single pregnancy. (Though 15 fetuses in one womb was reported, they were not carried to term as there simply wasn't room.)

Every woman who isn't barren therefore has the potential to bring a large number of potential people into the world. The Duggars are a good example of what this looks like in practice. If a woman is physically able to birth twenty new human beings, but chooses to birth only one, has she murdered the other nineteen?

Women are born with two million eggs, some of which are flushed out of the body each month if none were fertilized. Women's bodies sometimes miscarry, in effect a natural abortion. Who is to blame there? The woman? God? Does God sometimes perform abortions? Are violent storms the work of God, but not miscarriages?

So, it should be clear that it is nonsense that women are morally obligated to turn every potential human their body could create into an actual human. It isn't necessary or a good idea for every possible person to be born, for some pretty obvious common sense reasons.

The question then becomes, on what basis does the mother decide whether the potential person growing in her womb should be born? Legally, that's her business and nobody elses.

For the sake of the larger moral thought experiment however, let's say that there's one universe where a given mother chooses to carry to term a fetus which tested positive for Downs syndrome.

In another universe, she terminated that pregnancy and had a child without Downs syndrome. Now, let's suppose at the age of ten, both children meet. Would the child without Downs syndrome regard the child afflicted with it as an improvement? Would they scold their mother for not having that child instead?

It is not only the life of the fetus which factors into this equation, but also the lives of the healthy children who might've been born instead. What answer should we give them as to why we chose not to bring them into the world? Did we believe it would be better for them to be disabled?

If you have the choice between having a disabled child or a healthy one, why would you not choose the healthy one? Cruelty? Desire to see your child struggle through life because you didn't do one simple thing to ensure he/she would have the best chance at success you could give him/her?

Is there some reason we need more mentally disabled people? In a country with universal healthcare, is it wise to deliberately create people who will likely never be able to pay into it? Homelessness in Iceland is a death sentence for obvious reasons. Can they afford to over-burden their social safety net with lifelong dependents?

On a global scale, with 7.5 billion humans and climbing, can we afford to leave it to chance whether each new human brought into the world will be able to support itself?

Can we afford to choose a child with very low intelligence over a potential genius, when each genius brought into the world has the potential to invent new technologies which enable us to support the basic needs of more and more human lives?

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We need all the geniuses we can get these days, and can ill afford to instead move in the opposite direction. This unsettles some, understandably, given the historical crimes of eugenics. But again, the entire problem with eugenics was that it was compulsory. Government control over human reproduction begets atrocities.

That problem disappears when the decision is made by each individual mother, the only one who ought to be able to make such a decision in the first place. Is there anyone reading this who isn't highly selective about who they want to have children with? Isn't that a form of simple eugenics practiced by everybody?

Provided the right to choose remains in the hands of women, some level of corrective, intelligent influence on human evolution can be practiced in a manner consistent with voluntarism. We can reap most of the benefits without any of the dangers or drawbacks, ensuring that the next generation is gifted the best chance at success we can possibly give them.

Anything less would be to favor disability over health, and to knowingly saddle children with severe health problems and barriers to success in life that were never necessary to burden them with. We have a choice, and choices unavoidably carry moral weight.

There is a moral cost to terminating a pregnancy which I hope no reasonable person denies. But there is a steeper moral cost by far to deliberately creating a severely disabled child instead of a healthy one.