David Wasserman

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation...

It is gratifying that thoughtful philosophers and bioethicists like Mahowald and Nelson are continuing to address the objections to prenatal testing that have been made by disability scholars and advocates. But it is frustrating to see those objections presented in ways that reflect the doubts of those who reject them more than the intentions of those who make them, in ways that make those objections appear censorious toward pregnant women and prospective parents or naïve about nonverbal expression. We recognize that disability critics share the responsibility for these misunderstandings, that their objections to prenatal disability testing have not always been made as clearly or consistently as they might have been. We therefore welcome this opportunity for clarification and rebuttal. Briefly, we will argue against Mahowald that it is not apparent how prospective parents could have a duty to potential offspring requiring them to prevent the birth of any child expected to have a life worth living. And we will remind Nelson that our primary concern is with the perpetuation of stigma; that even if any reason for abortion can be framed in terms of a trait of the fetus to be aborted, only certain reasons for abortion are based on the rejection of future children because of stigmatized traits

It might seem that racial profiling by doctors raised few of the same concerns as racial profiling by police, immigration, or airport security. This paper argues that the similarities are greater than first appear. The inappropriate use of racial generalizations by doctors may be as harmful and insulting as their use by law enforcement officials. Indeed, the former may be more problematic in compromising an ideal of individualized treatment that is more applicable to doctors than to police. Yet doctors, unlike police, should not attempt to ignore race altogether. Race and ethnicity are associated with the geography of disease, with social and cultural factors relevant to disease, and, to some extent, with genetic predispositions to disease. Moreover, greater attention to the distinctive health conditions of certain racial and ethnic groups is necessary to make up for past neglect. But it will be a tricky business to steer a middle course between a naïve, reckless, or dogmatic color blindness and a stereotype-driven overreliance on race and ethnicity. In trying to steer such a course, the doctor can only hope for the day when a combination of more individualized genomic medicine and greater social equality will make it possible for her to pay less attention to race and ethnicity without detriment to her patients' health

Adrienne Asch inspired, challenged, and provoked a generation of bioethicists and philosophers who were discovering the subject of disability. For Adrienne, disability was a complex phenomenon that raised universal issues of embodiment, justice, well‐being, and identity. She insisted that bioethicists and philosophers who invoked disability in discussions about these issues first learn something about it, for which her own work provided critical insights. She argued eloquently that those who relied on unsupported assumptions about disability, even in the most arcane debates, reinforced harmful stereotypes and impoverished their own thinking. At the same time, she urged that the claims of disability scholars concerning discrimination, fairness, and kindred issues be made with philosophical clarity. She was fearless with the smug and insular in both fields, but generous with those, like me, who were merely naive.

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation by prospective parents before deciding whether or how to use NIPW.

It is gratifying that thoughtful philosophers and bioethicists like Mahowald and Nelson are continuing to address the objections to prenatal testing that have been made by disability scholars and advocates. But it is frustrating to see those objections presented in ways that reflect the doubts of those who reject them more than the intentions of those who make them, in ways that make those objections appear censorious toward pregnant women and prospective parents or naïve about nonverbal expression. We recognize that disability critics share the responsibility for these misunderstandings, that their objections to prenatal disability testing have not always been made as clearly or consistently as they might have been. We therefore welcome this opportunity for clarification and rebuttal. Briefly, we will argue against Mahowald that it is not apparent how prospective parents could have a duty to potential offspring requiring them to prevent the birth of any child expected to have a life worth living. And we will remind Nelson that our primary concern is with the perpetuation of stigma; that even if any reason for abortion can be framed in terms of a trait of the fetus to be aborted, only certain reasons for abortion are based on the rejection of future children because of stigmatized traits.

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success.