There is a new surge in ethical debates surrounding prenatal genetic diagnostics. Some scholars fear that prenatal genetic testing amounts to Eugenics – i.e. proactive selection for beautiful and healthy children and advocate for banning such practices. They rightly argue that everybody has to have the right for life and abortions of genetically defective fetuses with Down syndrome and other diseases reduces the “normal” diversity of human population.
To counteract these extreme views I would like to emphasize that these pro-life advocates have to realize that our society is now in quite a different state than it was 100 years ago when genetic technologies did not exist. Firstly, the probability of survival for children with genetic diseases to a reproductive age was negligible, but is not so today. Secondly, the welfare system did not exist and the economic burden of childcare was isolated to individual families meaning that if a family had a disabled child, they would not be able to afford another child and would be doomed to poverty. Luckily, the welfare system alleviated the suffering for families with disabled children, but at the same time it also removed the “evolutionary” constraint on the probability of further propagation of mutations in population.
The psychological, physical and economic burden on families with children with genetic disorders is absolutely staggering even with very good social system. When the parents are still strong and productive they are able to take care of their sick kids and nurture then to adulthood. But what happens when they are getting older and not capable of providing the same level of care? The parents are not able to delegate the welfare to social institutions because they know that their beloved children will suffer even more and will not receive the same love and care, and then the tragedies strike. The constant stress and unresolvable moral dilemma in many instances have lead people to murder, largely because euthanasia is a capital crime in the vast majority of countries, and suicide.
Advocating sterilization or limiting freedom of life choices for people with mental disabilities and other genetic disorders is inhumane. As a modern civil society we should ensure the well-being of every member, but we also have the obligation to ensure the economic viability of the society as a whole. Societies in many developed counties are facing the rapidly aging population, reduced reproductive capacity due to delayed marriages and late pregnancies leading to million dollar NICU babies, which added together are already decimating the healthcare budgets. Compounded by the extended recession healthcare systems will soon have to deal with the dilemma where to cut the funds – on our children or our elders?
What we can do to avoid such unpleasant future? First, we should promote healthy lifestyle not only through cultural changes but also tax incentives (for example institute taxes on fast food and “sin foods” with exceptionally high sugar or fat content). Secondly, we have to improve the efficiency of healthcare systems and implement the Personalized Medicine approach instead of the “shotgun” and “educated guess” prescription practices. And finally we have to promote reproductive health by educating couples on the benefits of genetic testing and prenatal diagnostics, providing healthcare coverage for testing that will not only ensure that the investments in fertility treatment indeed pays off and yields healthy progeny, thus reduces the economic burden of care on children with congenital disabilities.
Because premature birth is strongly correlated with maternal age I also believe that granting longer maternity leaves for younger mothers (for example a full year for women 25-36, nine months for 36-40 and only six months for women over 40) would create favourable economic stimulus for couples to start having kids early, thus reducing the reliance on fertility treatments and the rate of pre-term babies, thus reducing the long-term healthcare costs on premature babies.
Furthermore, parental genetic testing and pre-implantation testing can help to ensure healthy children, which is not only the key for happy family, but ultimately, is the vital factor for ensuring the economic prosperity of the nation.