Because we are so smart, there are many ways in which impairment and premature death are effectively prevented all the time. There are also ways in which the impact of impairment has been reduced, through medicine, technology and social change. Most of this is absolutely brilliant.
However, all of it has its limits. Maybe there will be some technology in the future which allows everyone to have fully working bodies and brains throughout a lifetime, but none of us are going to live to see it. For the foreseeable future, impairment is part of what makes us human.
I do think that a lot of harm is caused to us all by pretending otherwise. And one area in which causes a great deal of harm, as I started writing about on Monday, is around choices about bringing children into the world.
The point I started making then was that nobody can choose whether or not to have a disabled child. The only genuine choice a person has is whether or not to have a child.
I hope I would never judge any individual who chose to terminate a pregnancy on the grounds of disability; each decision must be very complicated, personal and painful. I sympathise with that, simply because the way people must feel about it, regardless of whether it is the same as the way I might feel. And I can think of a number of reasons why people would choose to do this:
- The child is likely to die later in the pregnancy or very shortly after birth and it is felt that it would be better to take control of an inevitable ordeal.
- The child is likely to have a very poor quality of life to the extent that it is felt that no life would be better than that kind of life.
- The additional stress, effort and difficulty associated with caring for a disabled child makes the parents' plans for their future life unviable and what was a wanted pregnancy is now an unwanted one.
Take Down's Syndrome. The most marked aspect of Down's Syndrome is a learning impairment, which can vary greatly, but the average IQ for someone with Down's is about half of average - my IQ is measured at about one and a half times average, to have a gauge of how undramatic this difference might be. People with Down's Syndrome tend to be more vulnerable to various medical conditions and their life expectancy is reduced to middle-age, although some people with Down's have very serious heart problems and can die very early on indeed.
No life better than that kind of life? Well, you'd have to speak to someone with Down's Syndrome. I have known people with learning impairments who are largely contented and others who, for all sorts of reasons, aren't very happy at all. Like the rest of us, it depends on all sorts of things but chiefly the quality of the relationships a person enjoys with other people.
Around 90% of pregnancies where Down's Syndrome is diagnosed end in termination.
I recently came across the following paragraph whilst researching an unrelated matter on the Health Technology Assessment website (the research wing of the UK Department of Health), about antenatal screening for Downs Syndrome;
In general, serum screening is more cost-effective than screening based on maternal age alone at detection rates of about 50% or greater. As the number of screening markers increases, the cost per pregnancy screened increases but, if an extra marker is sufficiently discriminatory, the cost per Down's syndrome birth avoided may decline. For example, the estimated cost per pregnancy screened and the cost per Down's syndrome birth avoided is: £8.90 and £25,600 for the double test; £9.60 and £22,700 for the triple test, and £11.60 and £23,100 for the quadruple test.Prospective parents in the UK are very unlikely to have a life or death decision on how many Reichmarks it might cost the NHS to have that child. However, this does raise questions about the influences bearing down upon these complicated, personal and painful decisions. Especially given the pretty appalling detection rate of the non-invasive tests available just now (amniocentesis is far more reliable, but far more dangerous to the foetus).
And I find myself