A recent CBS News article covered the consistently low rate of Down Syndrome births in Iceland, reporting that nearly 100 percent of women who receive a positive result for Down Syndrome from their prenatal tests “choose” (and I use that term loosely) to abort their unborn child.
Many have corrected the notion that Iceland is “eradicating” the chromosomal abnormality of DS, as the original CBS article put it, when it is instead facilitating the extermination of unborn babies who possess it. If we are to lower the abortion rate of Down Syndrome babies in the U.S. (currently estimated at about 67 percent) and across the globe, we must look earnestly at how exactly a 100 percent termination rate is being achieved in Iceland.
Why Mothers Abort Down Syndrome Babies
None of these terminations are coerced. There is no Nazi-like mandate in Iceland to exterminate the “undesirables,” or a denial of healthcare to women who choose life for their allegedly disabled children. Rather, the use of prenatal screening tests (the Combination Test, not to be confused with the newer non-invasive prenatal testing, or NIPT) is ubiquitous and inexpensive and has been available in the country since 2000.
According to CBS News, “While the tests are optional, the government states that all expectant mothers must be informed about the availability of screening tests, which reveal the likelihood of a child being born with Down syndrome.” CBS reports that testing is about 85 percent accurate and about 85 percent of pregnant women in Iceland opt to have the testing done.
While geneticist Kari Stefansson told CBS the genetic counseling accompanying the test is “heavy handed” in their socialized healthcare system, no one is forced to take the test. Yet Iceland usually has only two Down Syndrome births out of roughly 4,000 Icelandic babies born each year. The instance of the trisomy 21 is about one in 800 babies born in the U.S., which means that Iceland has a 60 percent lower DS birth rate than ours.
The impact of Iceland’s prenatal screening doesn’t sound all that dramatic, but it’s likely this is underestimating the impact of prenatal testing, because that’s just the rate of trisomy 21 in babies born. It doesn’t include the preborn. If the majority of Down Syndrome babies are destroyed before birth, the real rate of occurrence of DS is actually much higher, and Iceland is actually doing a thorough job of preventing the birth of babies with Down Syndrome.
If the U.S. birth rate for Down Syndrome is only 33 percent, then the real rate of DS here is 3 in 800 (.00375 percent). Comparatively, Iceland’s rate is only one in 2,000 births (.0005 percent), 7.5 times lower than ours, and their births are almost solely attributed to the 15 percent that opt not to take the test.
That is no small achievement. Denmark, which has similar non-coercive prenatal screening laws, has a near 98 percent Down Syndrome abortion rate, while the UK rate is about 90 percent.
David Harsanyi rightly pointed out that abortion for reasons of disability is eugenics. This is undeniable: eugenics is about eliminating undesirable characteristics from a population more so than actively promoting “good breeding.” The programs of the Nazis included state-mandated sterilization of the disabled and mentally ill (a loose definition that included “the feeble-minded” and even alcoholics), soon followed by state-mandated extermination of those same types of individuals.
Yes, an ideal “master race” that went beyond simply the able-bodied was a goal, and yes, exterminating an entire ethnic group (the Jews) became a goal. But the core of eugenics was always a liberal dispensation of death to the undesirables.
The Nazis are the model for eugenics carried to its most evil extreme. But were the goals of the Nazis evil, or just the 100,000-plus murders of the disabled the state committed in the name of a healthy and ethnically ideal population (bearing in mind especially that they started their eugenic exterminations with the most vulnerable, with children under three years old)? Is it any less evil for an individual to decide of her own volition to exterminate another “undesirable” human life than for the state to do the same? Is it any less evil for a government to promote the eradication of the “unfit” because they are expensive to care for in their socialized healthcare systems, than for a mother to decide she just doesn’t want the burden of a special needs child?
The Rise of ‘Nudgenics’
The group of mothers interviewed by CBS News said for the most part that they didn’t feel pressured to take the test, though one mother admitted that when she was told that most other women get the test, that influenced her decision “a little bit.” As Hulda Hjartardottir, head of the Prenatal Diagnosis Unit at the hospital where the vast majority of Icelandic babies are born, noted, “We try to do as neutral counseling as possible, but some people would say that just offering the test is pointing you towards a certain direction.” In other words, women are being nudged toward the test, but the counseling that comes after a positive result, if we are to believe Stefansson, applies more pressure. A 100 percent termination rate upon positive results certainly indicates that is the case.
Yes, it’s technically a choice to take the test. Even if the test were to be mandated, the choice to continue your pregnancy is entirely up to you. As a letter to the UN expressing concern over prenatal screening for Down Syndrome and other genetic markers of disability framed the problem, “History repeats itself. The extermination of ‘unwanted’ persons from society happens sooner and is slickly marketed as ‘individual choice’. The effect on society is the same.”
That same letter to the UN expressed concern about the rapid adoption of NIPT (non-invasive prenatal testing) across Europe and the U.S., which screens for the most common chromosomal anomalies, including Down Syndrome. A paper in the International Journal of Women’s Health echoed that concern:
“There are concerns that NIPT could become “routinized”, or merged into the barrage of blood draws that accompany pregnancy visits. If patients are not given a clear choice about whether or not to undergo NIPT, they may not have an opportunity to think through whether they truly want the test results or how they would react to them…While NIPT as a primary screen could reduce health care costs, it would also allow only one point of contact between a pregnant woman and her physician in which to discuss the implications of undergoing prenatal testing. There is already evidence that both physicians and patients feel there is less need to obtain written consent for NIPT than for invasive testing.”
The developed world is experiencing “nudgenics”: eugenics via nudge (and beyond that, overt pressure from doctors and other individuals). But victims are victims regardless of whether the act was a product of coercion, persuasion, or merely “choice architecture,” as Cass Sunstein and Richard Thaler call it in “Nudge.”
‘Life Unworthy of Life’
The problem with testing for Down Syndrome isn’t the fact that you know your child has Trisomy 21 before birth. Testing is amoral. The problem with testing has always been in the presentation and exploitation by governments and individuals alike to eliminate those deemed “unfit for life” before the point at which it becomes legal murder for one to do so. In Iceland, abortion is legal up to 16 weeks, except in the case of an abnormal fetus. You can repeat that testing is totally optional and abortion is totally optional all you want.
The fact is that the Icelandic government and many others have codified the idea that Down Syndrome life is less valuable than non-Down Syndrome life. Such states have accepted the idea that some life is “life unworthy of life” or “Lebensunwertes Leben.” Instead of using their coercive power in pursuit of this perverse idea, they ensure that healthcare professionals nudge, persuade, even pressure parents toward that end. Doctors can paint the most dire picture of the life of their disabled child without offering resources or any evidence that their child might live a full and fulfilling life, and their expertise carries weight.
Culture, too, has already primed their minds to make the worst choice. “The desire to be perfect and healthy is anchored in people’s minds through public discourse. Because of that, many expectant parents have a conflicted conscience,” as doctor and historian Christiane Rothmaler told Deutsche Welle in a discussion of Nazi eugenics. If you are waiting for state coercion to trigger your concern about eugenics, you ignore the tragedy unfolding right now as institutions encourage individuals to eradicate the “unfit.”
The libertarians and the far left are largely in agreement that consent and volition are the highest values when it comes to personal decisions around sex and reproduction. Olafsdottir tells women who are wrestling with the decision or feelings of guilt, “This is your life—you have the right to choose how your life will look like.” As long as the state isn’t forcing anybody to do anything, there’s really nothing wrong with a 100 percent termination rate for Down Syndrome babies. “That’s not eugenics or genocide,” they argue. “There’s no targeting of a specific group for destruction. It’s all just individuals who happen to be making the same choice.”
You Can’t Argue For ‘Choice’ And Life in the Same Breath
You could argue that this isn’t genocide in the strict sense of the word. But you can’t argue it’s not eugenics. If you think it’s okay for tiny, innocent preborn babies to be killed in the name of lebensunwerten lebens, if you call it a “mercy death,” then be honest: you support eugenics.
But if your highest ideal in the area of sex and reproduction is volition and consent, then you must concede that abortion violates this principle. The baby doesn’t get to choose whether he wants to die or not, does he? You can’t have it both ways. If you value “healthy life” over “life,” what’s wrong with the government enforcing your ideal anyway? But if you value voluntary choice, then you have to abandon the idea that the “unfit” can be killed by either an individual or the state.
Olafsdottir told CBS News correspondent Elaine Quijano that seeing abortion of Down children as murder is “so black and white.” She insisted that, “Life isn’t black and white. Life is grey.”
But there is no grey area, there’s only equivocation and cognitive dissonance. The left’s position on this is inherently contradictory. You can’t call the eradication of Down Syndrome babies a tragedy and still support the right to eradicate them. You can’t value consent and support that right, and you can’t maintain an artificial distinction between the individual and the state when it comes to lethal application of eugenics.
The only consistent position is that life is intrinsically valuable. There is no middle ground.