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New Zealand needs a genuinely pro-choice approach to prenatal screening

25 March 2013
By Dr Colin Gavaghan
Director of the New Zealand Law Foundation Centre for Law and Policy in Emerging Technologies and Associate Professor at the University of Otago's Faculty of Law
Appeared in BioNews 698

Being a bioethicist in the Antipodes is becoming a dangerous business these days. Just over a year ago, the publication by two Australian academics of a paper exploring the acceptability of 'post-birth abortion' led to media furore, hate mail and even death threats to the authors. Now, New Zealand has had its own mini-firestorm generated by an academic paper on a controversial topic.

A recent edition of the New Zealand Medical Journal contained an article by Otago University's Robert Cole and Gareth Jones, entitled 'Testing times: do new prenatal tests signal the end of Down syndrome?' The article dealt with non-invasive prenatal diagnosis (NIPD), a new way of testing fetuses for Down's syndrome, 'which enables diagnosis earlier in pregnancy with less risk of complications'.

Cole and Jones defended a broadly pro-choice approach to prenatal screening and abortion of Down's syndrome fetuses, stressing that their position did not devalue the lives of people with Down's syndrome, and striving to distinguish their position from eugenics.

Such efforts were unpersuasive to the campaign group SavingDowns. The group, which opposes screening for the purposes of allowing termination of affected pregnancies, responded not only by criticising the paper's content but by calling for the resignation of Jones and reporting the article to the Human Rights Commission.

Whereas the paper by the Australian academics, Minerva and Giubilini, was at least genuinely provocative (while undeserving of some of the appalling response it garnered), the Cole and Jones paper may seem an unlikely target for such vitriol. The position it adopted was essentially in support of the legal status quo and in keeping with a fairly mainstream body of bioethical opinion.

The contribution of people with first-hand experience of these issues is indispensable in the context of discussing policy and practice around matters like this. Unfortunately, SavingDowns' apparent policy of trying to wreck the career of anyone who says what they consider the wrong thing is hardly likely to facilitate much productive dialogue with academia or healthcare professionals.

It would also be unfortunate though, if the issue of 'academic freedom' completely overshadowed the substantive questions arising from this dispute. SavingDowns' scattergun approach to attacking the article has resulted in a lot of shots going wide of the target, but a few of their concerns merit closer attention.

The position set out in the Cole and Jones article is that prenatal screening and abortion are only options. The position of the state and the profession is not pro-screening or pro-abortion, and certainly not eugenic. Rather, the value being upheld throughout is one of choice.

But the truth may not be so simple. New Zealand law doesn't allow for abortion on demand. Specifically, abortion wouldn't be permitted for just any reason that the pregnant woman deemed sufficient. If our position were genuinely 'pro-choice', wouldn't we allow those choices too? To say otherwise, to make an exception for 'seriously handicapped' fetuses, seems to commit us, as a society, to saying something in particular about handicap.

SavingDowns trace this back to the Royal Commission Report of 1977 that drew a marked distinction between abortion 'for reasons of social convenience', which it viewed as 'morally wrong' and abortion of a 'fetus [...] likely to be born with a severe physical or mental handicap', which is 'not immoral'. It is not only groups like SavingDowns that regard this position as dubious or discriminatory.

Of course, this 'discriminatory' position could be resolved in one of two ways. The restrictive course would be to treat 'handicapped' pregnancies the same way as we currently treat 'normal' pregnancies, allowing abortion only where the continuation of pregnancy presents a serious risk to the mother, etc. The permissive course would be to treat all pregnancies as we currently do those affected by 'serious handicap', allowing abortion on demand up to 20 weeks gestation.

This latter course is the one I have advocated in relation to preimplantation screening (see BioNews 398). A genuinely pro-choice approach to abortion would not treat 'disabled pregnancies' differently from other kinds. Rather, it would respect and support whatever choices women make in these situations. Whether this would satisfy SavingDowns is unclear – their position on abortion per se is a matter of some conjecture – but it would, I think, allow the law to send a message that is resoundingly pro-choice, untainted by any hint of a eugenic agenda.

16 November 2015 - by Dr Jane Currie 
Tomcat is a play set in a future where state-controlled prenatal screening has eradicated all genetic conditions. Nearly all, that is...
29 September 2008 - by Ailsa Stevens 
A decade ago, it was found that the blood of pregnant women contains DNA from the fetus. The discovery of this 'free fetal DNA' (ffDNA) has led to the development of non-invasive prenatal diagnosis, where genetic characteristics of the fetus can be analysed a mere few weeks into pregnancy by...
16 June 2008 - by Dr Zuzana Deans and Dr Ainsley Newson 
Dr Phillipa Brice's accompanying commentary highlights how non-invasive testing of free fetal DNA (ffDNA) in pregnancy could transform women's experiences of antenatal screening and prenatal diagnosis. NIPD is already available for foetal sex, rhesus D blood type and some Mendelian conditions such as achondroplasia, with tests for aneuploidy detection and...
26 November 2007 - by Dr Helen Watt 
Prenatal tests, and selection of children, are deeply entrenched in our liberal culture: it is hard to subject them to a radical critique without attracting heavy disapproval. While it is socially acceptable to refer to prejudice against disabled people - and even to link this with pressures to screen - to challenge...
23 October 2007 - by Jane Fisher 
As we approach the 40th anniversary of the 1967 UK abortion law, later abortions have come under particular scrutiny as calls are made for a reduction in time limits. Many of the (relatively few) terminations that occur after 20 weeks are after a diagnosis of fetal abnormality. The UK charity...
10 July 2007 - by Dr Jess Buxton 
When the technology for testing IVF embryos for genetic mutations that cause disease was first developed over 15 years ago, its potential uses seemed pretty clear cut. Preimplantation genetic diagnosis (PGD) provided a way in which couples at high risk of having a child affected by a genetic disorder could...
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