As we have discussed here before, preventive screening has, in some cases, become controversial. Example: PSA blood tests for signs of prostate cancer. Some believe that false positives can lead to unnecessary further testing or treatment–adding to the strain on health care resources and putting some men through unnecessary and painful procedures. On the other hand, such tests do catch cancer and sometimes save lives.
Along this same line, the Wall Street Journal has an interesting article about the increasing use of blood tests shortly after birth to detect genetic diseases. From the story:
Newborn testing identifies at least 3,400 babies with a disorder each year, according to the Centers for Disease Control and Prevention. The programs generally have focused on well-understood medical conditions in which early intervention can make a difference in a baby’s life…
Proponents of broader screening programs say early intervention in a disease can improve a child’s life and might speed the development of treatments for rare diseases, where symptoms often don’t appear until severe damage has occurred. Often there are few specialists knowledgable about rare disorders, and newborn screening can save families years of anguish searching for a diagnosis. Some parents also say the information is important to know for family-planning purposes.
But critics say the additional tests may raise flags that lead to unnecessary further testing, or treatment, for babies who will not get sick. The tests can add big additional costs to the health-care system, they say. And some people are concerned about privacy, since stored blood-spot samples can be used by researchers. Some states give parents the ability to decide whether they want a child’s specimens used for research purposes.
I don’t believe money should be the primary concern in this matter. Protecting people is. But I want to take this discussion to a more macro level.
In a Hippocratic medical milieu that accepted human exceptionalism and the unconditional equal intrinsic value of all patients, preventive screening would seem an ideal approach to catching conditions early to plan for proper care. But, as I project out along the current cultural trajectory, I worry that some babies who test positive for very seriously disabling or terminal conditions could one day be consigned to a lesser societal value and reduced treatment options by the encroaching “culture of death” utilitarianism we see permeating bioethics and the broader values of society.
This isn’t paranoia: We already see the infanticides of seriously disabled babies practiced openly in the Netherlands under the Gronningen Protocol–supported by respectful coverage in the New England Journal of Medicine and supportive stories in newspapers like the New York Times. Studies show the same killing paradigm now occurring in Flanders, Belgium. In the USA, Down babies have been denied life-saving surgery to repair a serious but fixable digestive condition, which would lead to child abuse charges were a “normal” child allowed to go untreated. Some leading bioethicists, such as Peter Singer, call for the discarding of a sanctity/equality of life ethic in favor of one founded on the so-called “quality of life.” Thus, I worry that the results of screening tests could one day eventually impact our perception of the baby and deleteriously impact his or her future course of care.
The ultimate answer to my concerns isn’t to squelch screening. That would be unwise. Rather, it is to embrace human equality of all people regardless of health or disability.
July 26th, 2011 | 3:15 pm
Wesley:
You’re on record as being opposed to prenatal testing because you’re concerned it encourages abortion of fetuses with serious abnormalities; and, you’re concerned that post-natal testing will cause those with identified disabilities to be treated as second-class citizens. At the same time you say you “don’t want money to be the primary concern in this matter,” — which I find puzzling in light of your expressed opinions about health care reform.
Granted most people want to treat others with fairness and compassion, but that doesn’t always play well in an environment in which there’s scarcity of resources. It would be great to have an idealized society in which there’s enough to go around for everybody, and in which everybody has equal access to it, but that’s decidedly not the case, and at some point it usually becomes necessary to decide who gets what. Simply stated, there are times when practicality trumps “the democracy of the barber shop.”
Getting the best for the most people, within sound fiscal limits, should be our objective. If we can save both lives and money by identifying and treating health problems as early as possible, then that’s the way we should go. There’ll be plenty of time to love our neighbors *after* we’ve helped them to survive.
HW
Wesley J. Smith Reply:
July 26th, 2011 at 3:30 pm
Your assertion about my position on pre natal testing is overbroasd and unnuanced.
HistoryWriter Reply:
July 26th, 2011 at 7:31 pm
@Wesley J. Smith,
Forgive me if it appears that way, however I think that’s what you said the last time this issue was discussed. As I recall you were concerned that abortions of Down syndrome pre-borns would occur as a result of newer, more accurate diagnostic tests that are able to detect the problem in much earlier stages of pregnancy than heretofore. In fairness, how would you suggest I narrow it down and/or “nuance” it?
I think, too, that we touched on this in a discussion of “transhumanism,” in which I posited that if it’s ethically acceptable to detect and correct birth defects in utero it should be equally acceptable to eliminate the same defects genetically, before the fact. You didn’t reply to that , and I’m still wondering where you stand.
HW
Wesley J. Smith Reply:
July 26th, 2011 at 7:58 pm
I do not opposed genetic testing per se. I oppose eugenic cleansing. I think it would be acceptable to treat a genetic anomaly at any stage of life.
HistoryWriter Reply:
July 27th, 2011 at 6:24 am
@Wesley J. Smith,
Assuming the technology were to exist, would you believe it appropriate to treat a genetic anomaly BEFORE the fact, by manipulation of parental DNA, to prevent it from ever occurring? In other words, if it were possible to eliminate Down syndrome altogether by means of DNA manipulation, would you find that ethically acceptable?
HW
Wesley J. Smith Reply:
July 27th, 2011 at 9:11 am
Yes, depending on method. Example: If you could screen egg and sperm. I do not support genetic screening of embryos, in which the unwanted are discarded.
HistoryWriter Reply:
July 27th, 2011 at 12:41 pm
@Wesley J. Smith,
Fair enough.
HW
July 27th, 2011 | 9:55 am
Anybody remember “Gattica?” Wesley’s argument reminds me of that.
I know myself and other pro-lifers are opposed to the misuse of screening for the purpose of aborting or euthanizing babies, but I’m going to have to say I support efforts to increase and improve post-natal screening, with the requirement that all screened blood is full property of the parents and only the parents receive the initial findings of the screening.
There are so many things that can happen to a baby that makes life hard for them. Anything that gives us an advantage over genetic diseases and helps them live their lives with as much fullness and happiness as possible is a blessing.
July 27th, 2011 | 2:56 pm
Today we would abort Einstein, Beethoven, Mozart, Lewis Carrol, and probably Jane Austen.
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