Dowling College ASC 128 Presentation Write Up
Genetic Disorders and Abortion
By,
Natalie Brodie
Presented on January 18, 2001
The question I focused on in the presentation was, “Should abortion be an option if a woman finds out that her child will have a genetic disorder?” Obviously, abortion is an option by law, but I focused on abortion as an ethical option. Before I tried to answer this question, I had to discuss some important information with the class. First, I had to define genetic disorders. I discussed four categories of genetic disorders and then gave the class some examples of genetic disorders. I discussed two types of tests that are available to diagnose a fetus with a genetic disorder. Then I gave the class a brief history of abortion. Finally, I discussed the arguments for and against abortion of a fetus with a genetic disorder.
Genetic disorders are caused by mutations or defects in a gene or a set of genes. Mutations are changes in the DNA sequence of a gene. These mutations can happen at any time, from when we are a single cell to when we are ninety or even older. Some people say that there are disorder genes. However, it is not agene or genes that cause the illness. It is a mutation that causes the normal genes to operate improperly. So, it is better to say that there are mutated genes that cause genetic disorders.
There are four categories of genetic disorders. The first category is chromosome abnormalities. These are disorders caused by entire chromosomes or large segments of them being missing, duplicated or otherwise altered. An example of this type of disorder is Down Syndrome. The second category is single-gene disorders. These result when a mutation causes the product of a single gene to be altered or missing. An example is sickle-cell anemia. The third category is multifactorial disorders. These result from mutations in multiple genes and are often coupled with environmental causes. An example is diabetes. The fourth categoryis mitochondrial disorders. These are rare disorders caused by mutations in non-chromosomal DNA that is located within subcellular organelles, the mitochondria.
Some examples of genetic disorders are as follows: Alzheimer’s disease, amyotrophic lateralsclerosis (Lou Gehrig’s disease), arthritis, asthma, cystic fibrosis, hemophilia, multiple sclerosis, muscular dystrophy, spina bifida, and Tay-Sachs disease. There are around two hundred genetic disorders that can be diagnosed before birth.
The two types of tests that are available for the diagnosis of genetic disorders in fetuses are amniocentesis and chorioic villus sampling (CVS). Amniocentesis, which is considered the gold standard of invasive genetic prenatal diagnosis, has been offered for genetic testing since the mid-1970s. Midtrimester amniocentesis is utilized for the molecular and biochemical diagnosis of fetal disorders where analysis ofamniocytes or amniotic fluid is informative. Despite the power of mid-trimester amniocentesis as a diagnostic tool, a major disadvantage is the timing that it is done. It is generally done between the fifteenth and eighteenth weeks of pregnancy. This time period came about because of the need to perform the procedure late enough to obtain a consistent and successful result, but as early as possible to permit a termination if that option were desired. It takes ten to fourteen days for reliable karyotyping on amniotic fluid cells and up to three weeks in total turnaround time. Karyotyping is the procedure used to look at the general appearance of a set of chromosomes. Therefore, a pregnancy termination can be done at eighteen to nineteen weeks after an amniocentesis was done at sixteen weeks.
CVS permits evaluation of fetal karyotpe through first-trimester aspiration of a portion of the developing placenta using a trancervical or transabdominal approach. CVS is usually done at ten to thirteen weeks. The turnaround time for karyotyping is shorter than it is for amniocentesis. It is seven to fourteen days, verses twenty-one with amniocentesis. This allows the option of earlier termination in the event of fetal abnormality. The principle drawback is that the placenta may have a population of cells with abnormal chromosome compliments even though the fetal karyotype is normal. This is primarily due to mosaicism, which is the condition when tissues of different genetic makeup occur in the same organism.
As with all invasive prenatal procedures, both amniocentesis and CVS occasionally lead to fetal loss. So, there are some risks a woman must take. She must decide between the risk of losing the baby or having a child with a genetic disorder.
The following is a brief history of abortion that I discussed in my presentation. In the U.S., abortion laws began to appear in the 1820s, which forbad abortion after the fourth month of pregnancy. Through the efforts primarily of physicians, the American Medical Association, and legislators, most abortions had been outlawed by 1900 in the U.S. By 1965, all fifty states banned abortion, with some exceptions that varied by state. These were, to save the life of the mother, in cases of rape or incest, or if the fetus was deformed. In 1973, the Supreme Court declared most existing state abortion laws unconstitutional in the case of Roe versus Wade. From this, “pro-life” and “pro-choice” movements evolved. The first one tries to outlaw abortion and the second one tries to eliminate most legislative restrictions on abortion.
Finally, here are some of the arguments that I presented for
the abortion of a fetus with a genetic disorder.
1. “Abortion has had an important and positive public
health effect.” – Joycelyn Elders
2. Abortion saves a child misery and
pain that the genetic disorder will put them through.
3. We are permitted to do what we canto
fight diseases and their crippling effects, so why can’t we prevent suffering before birth?
4. Abortion helps to save parents the
agony of losing a child that will die from a disorder anyway.
5. Abortion prevents parents from being financially unstable - some
genetic disorders require constant hospitalization, doctor visits, and/or
medication.
6. Abortion is not a murder because
fetuses are not people.
7. A women should have the right to
choose what to do with her body.
8. Religious stand – A physical life
may end with abortion, but an immortal soul will live unharmed.
A possible case that I presented to the class, which supports the argument for abortion, is one of my sister’s boyfriend’s sisters. She has cleft palate along with many other problems. Cleft palate is when there is a cleft or opening in the middle ofthe palate or roof of the mouth, which is caused by the failure of the two parts of the palate to join in prenatal development. She wasn’t supposed to live past a few months, but she is now twenty-two years old. She cannot talk, doesn’t really understand anything, is fed through tubes, wears diapers, is bedridden, and needs around the clock care. What kind of life does she have? Is it a life that one would want to live? So, this is a case that I posed to the class as a possible support for abortion.
Here are some of the arguments against an abortion of a fetus with a genetic disorder.
1. Abortion is bringing
back Eugenics – the idea of improving the human species through the control of
hereditary factors in mating.
2. Abortion is discriminating against disabled people – disability
rights advocates argue that selective abortion expresses discriminatory
attitudes towards people with disabilities.
3. People with genetic disorders can have
lives that are just as valuable as people without disorders.
4. Some say that a fetus is a person
and so an abortion is murder.
5. It is possible that a cure for a
genetic disorder will be discovered.
6. There are a small percentage of
tests where diagnosis is incorrect.
7. Religious stand – Abortion goes
against God’s plan.
In conclusion, I discussed the fact that whether or not an abortion should be an option if a woman finds out her child will have a genetic disorder, is a very controversial issue.
Overall, I think the presentation went very well. From the evaluations I received from the class, I think the class thought it did too. Many people commented that the outline I had in the beginning was helpful because it prepared them for what I was going to discuss. The class thought it was well organized.
Basically, everyone thought the content of the presentation was good. The class also seemed to have liked some of the questions I asked them. Many commented on how this was a tough topic to cover, but I did it well. The class also thought the handout I gave them was good. They saw it as a real “eye opener”.
For next time, I will try not to read too much from the notes. No one commented that I read excessively, but maybe just a little too much. For me, it is just a habit when Iam nervous. It is something I realize though and I will continue to work on this in future presentations. This was a very interesting topic to research. I think the presentation wen tas well as it did because of this.
Book
Grace, Eric S. Biotechnology Unzipped. Washington D.C: Joseph Henry Press, 1997.
Asch, Adrienne. “Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy”. The American Journal of Public Health.Vol.89, Nov., 1999, 1649-1657.
Colson, Charles and Nancy Pearcey. “Why Max Deserves a Life”. Christianity Today. Vol.41, June 16, 1997, 80.
Gillam, Lynn. “Prenatal Diagnosis and Discrimination Against the Disabled”. Journal of Medical Ethics. Vol.25, April, 1999, 163-171.
Newell, Christopher. “The Social Nature of Disability, Disease, and Genetics”. Journal of Medical Ethics. Vol.25, April, 1999,172-175.
Stranc, Leonie C. “Chorionic Villus Sampling and Amniocentesis for Prenatal Diagnosis”. The Lancet. Vol.349, March 8,1997, 711-714.
www.bcodp.org.uk/general/genetics.html- “The New Genetics and Disabled People”.
www.nrlc.org/abortion/pba
-Partial-Birth Abortion