Prenatal tests, genetics, and abortion.

Science, technology, and life.
Oct. 29 2008 7:46 AM

Pre-Birth Defects

Prenatal tests, genetics, and abortion.

Human embryo. Click image to expand.
Human embryo

Is it dangerous to know too much about your unborn baby's genetic flaws?

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

This weekend, front-page stories in the Wall Street Journal and Washington Post raised that question. The articles addressed new prenatal tests that can screen fetuses for 150 to 200 genetic abnormalities. Critics worry that as the tests spread, they'll lead to more abortions.

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It's pretty rich to see pro-lifers wring their hands about this information while, at the same time, they campaign for ultrasound laws. As Emily Bazelon has pointed out, you can't be for information when it discourages abortions but against information when it leads to abortions—not if your real purpose is, as pro-lifers insist, simply to inform women. And my libertarian hackles go up when paternalists fret that genetic tests might cause undue "anxiety" in "emotionally vulnerable" couples. If you're going to let people raise their own kids, you'd better trust them to think for themselves.

So, I'm not for restricting these tests. On the other hand, purveyors of the tests are way too sanguine about information being value-neutral. Pro-lifers have a legitimate worry, and the rest of us should think about it: In ways that are not entirely rational, genetic tests can shift a couple's presumption from continuing a pregnancy to aborting it.

If you're cool with being pregnant and you don't think anything's wrong with the baby, your default plan is to keep going. But now you get a test result that exposes a genetic glitch. If you have time to end this pregnancy and try again, what are you going to do?

How serious is the glitch? We don't know. As the Post and Journal explain, the new tests detect genetic "variations," "alterations," "abnormalities," "deletions," and "additions." In many cases, they can't predict whether these glitches will cause disease. They can only tell you that the glitches are "associated" with diseases that are "usually" severe. As one proponent puts it, the tests "identify smaller pieces of DNA that are either added or subtracted, and many of these can cause disease." Can cause disease. The Journal story focuses on a fetus diagnosed with autosomal recessive polycystic kidney disease. That fetus is now a 20-month-old boy. He's pretty messed up, but his doctor says he doesn't have ARPKD after all. What does he have? "Unclear."

This is the world we're entering in prenatal testing. It's a world where you'll know more and more about which diseases your baby might get. Instead of thinking the baby is normal, you'll know it's abnormal. And from talking to your doctor and looking up the associated diseases on the Internet, you'll get a very clear picture of how awful the child's life might be if it gets the disease. With that picture in the front of your mind and the "abnormality" label in the back of your mind, your conceptual frame—and your default plan—can change. Genetically, something is definitely wrong with your baby. What are the chances it won't get the disease? Can you live with yourself if you fail to prevent this, knowing what you now know?

We already have evidence that prenatal testing, even with uncertainty, can dramatically increase the abortion rate. Ninety percent of women turn to abortion when they find out the baby has a Down syndrome chromosome, even though the effects of that glitch vary considerably. And what's the biggest driver of these abortions? Cheaper, earlier tests that are now being proposed or recommended to all pregnant women.

I've said it before, and I'll say it again: Freedom and responsibility go hand in hand. Information about your pregnancy is good, and the decision about what to do with it is yours. But you have to choose wisely. And to do that, you have to understand how selective, unclear information can alter your frame of mind.