Preventing the existence of people with disabilities

Quality of Life and Human Difference: Genetic Testing, Health Care, and Disability

Volumn , Issue , 2005, Pages 142-171

  McMahan, Jeff ^a  

^a RUTGERS UNIVERSITY   (United States)

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EID: 84927116763     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1017/CBO9780511614590.007     Document Type: Chapter

References (17)

1. For a description of a disabling condition-dystrophic epidermolysis bullosa-with effects that cause life to be worth not living and that are present at birth, see Jonathan Glover, “Future People, Disability, and Screening,” in Peter Laslett and James S. Fishkin (eds.), Justice between Age Groups and Generations (New Haven, CT: Yale University Press, 1992), pp. 129-30.
2. For a clinical description of the condition, with photographs that give some indication of its grisly nature, see Robin M. Winter et al., The Malformed Fetus and Stillbirth: A Diagnostic Approach (Chichester: Wiley, 1988), pp. 205-6.
3. Derek Parfit, Reasons and Persons (Oxford: OxfordUniversity Press, 1984), Chapter 16.
4. “Wrongful Life: Paradoxes in the Morality of Causing People to Exist,” in Jules Coleman and Christopher Morris (eds.), Rational Commitment and Social Justice: Essays for Gregory Kavka (Cambridge: Cambridge University Press, 1998), pp. 208-47
5. the relevant discussion is on pp. 223-5. A revised and abridged version of this paper appears in John Harris (ed.), Bioethics (Oxford: Oxford University Press, 2001), pp. 445-75.
6. Parfit, Reasons and Persons, p. 360. I discuss this principle at length in “Wrongful Life,” section IV of the original version.
7. Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life (New York: Oxford University Press, 2002), Chapter 1, section 5, and Chapter 4, section 1.
8. McMahan, “Wrongful Life,” pp. 234-9 of the original version, and McMahan, The Ethics of Killing, Chapter 4, section 8.2. People do sometimes claim that a good parent should be just as happy to have a disabled child as to have a normal child. I suspect that people think that this claim is somehow implied by the plausible view that it is right and admirable to want to be, and to try to be, the kind of person who would love his or her child equally whether it was disabled or not. But in fact, it does not follow from this plausible view that it is also admirable to be indifferent about whether one has a normal or a disabled child. It is also admirable to want to be the kind of person who would love his or her child equally even if the child were to become a criminal, but it does not follow from this that it is admirable to be indifferent about whether one’s child will grow up to be a criminal. (This is not, of course, to suggest that disability is analogous to criminality. The point is only that, if there is no implication in the case of criminality, there should be none in the case of disability either.)
9. An important question for those who hold this view is whether it commits them also to opposing social efforts to discourage people from causing themselves to have a disabled child rather than a normal child. There are two possibilities: (1) causing a child to be disabled when he or she would otherwise have been normal (for example, through the ingestion of drugs late in pregnancy) and (2) causing the existence of a disabled child rather than a different child who would have been normal (for example, through the ingestion of drugs prior to conception). I am indebted to discussions with Robin Jeshion for encouraging me to address the question of the relation between our views about screening for disability and our views about causing disability-for example, through prenatal injury. I discuss this and related questions in another paper provisionally called “On the Morality of Preventing, Allowing, and Causing the Existence of People with Disabilities.”
10. Parfit, Reasons and Persons, pp. 420-2
11. Jeff McMahan, “Problems of Population Theory,” Ethics 92 (1981): section VI.
12. “Genes, Embryos, and Ethics,” New York Times, March 3, 2002. I owe this objection to Tad Brennan, though I have added to his example the stipulation that the couple would like to have a second child if it would not be disabled, so that their ranking of the outcomes is: normal child, no child, disabled child. This addition strengthens the objection because it rules out as explanations of the parents’ preference those considerations that often lead people who are glad to have had one normal child not to want a second.
13. Here I follow Robert M. Adams in his seminal and important paper, “Existence, Self-Interest, and the Problem of Evil,” Nous 13 (1979): 53-65.
14. Parfit, Reasons and Persons, p. 360.
15. Ruth Chang, “The Possibility of Parity,” Ethics 112 (2002): 659-88.
16. W. B. Yeats, “The Choice,” in M. L. Rosenthal (ed.), Selected Poems and Two Plays of William Butler Yeats (New York: Collier, 1966), p. 131. 17. I owe this objection to Shelly Kagan. It might be objected that, if life with a normal child is better than life with a disabled child, and life with a disabled child is not worse than life without a child, it follows that life with a normal child is better than life with no child. And that seems a false generalization. In general, being a parent does not seem even presumptively to offer a better life than remaining childless. There are, however, various reasons why the conclusion does not follow. I will note only one. The three comparative evaluations I have cited seem to be made from a point of view that abstracts from personal values. Understood in this way, the second claim-that life with a disabled child is not worse than life without a child-does not imply either that life with a disabled child is better or that such a life is exactly equally as good as life without a child. It must be understood, instead, as asserting that life with a disabled child is on a par with, or perhaps incommensurate with, life without a child. But if A is better than B, and B is on a par or incommensurate with C, it cannot be inferred that A is better than C.
17. Iamgreatly indebted for comments on an earlier draft to Tad Brennan, David Wasserman, Robert Wachbroit, and audiences at Yale University, Ohio State University, and the University of Pennsylvania School of Law.