Morality: Incest Laws

[Simon_Jester]

At the end of his recent posts, Alyrium stated that he isn't pushing for abortion of Tay-Sachs carriers, even though he still seems to consider it an "on the table" option. Much of what I wrote should change in light of that, but I would like to preserve my original points that I made without considering that, because I think some of them are relevant.

Up here at the top, I will reply to that... not a concession, I don't call it that, since nothing was or needed to be conceded. But I will reply to that clarification of intent. And then the rest:

It may be. I will need to do some happy math and compile a list of diseases with their carrier frequencies. I am happy to only selectively abort infected fetuses and leave the decision to carriers to parents. All you need to do is reduce the fitness of carriers to eventually remove it, you dont need to eliminate in one generation.

FINALLY!

However, I still find myself made very dubious about the entire proposal by this exchange. Because if you had been given the authority to do this, I find myself wondering whether you would have reached that compromise position, or whether you would have taken the "let us eliminate the scourge as fast as possible" tack. On how clear and well-placed your judgement calls about which diseases are a scourge it is worth aborting millions of pregnancies to avert are. And so on.

One of the big reasons consent is a huge issue is because of exactly this: even given an expert acting in good faith on medical issues, they cannot know all the issues affecting the patient, especially those involving the patient's own quality of life. Experts sitting at desks are prone to be much more casual with the lives and fertility of others than those same others would ever tolerate.

Sometimes that's because of their better position to be objective, perhaps. But I think more often it's simply because of psychological distance, and that is not the same thing as objectivity. Distance makes it much easier to proclaim on the fate of someone else, someone who is merely an abstract case of an abstract disease. Even with the best will in the world, that status lends itself to callous disregard for others. Not hostile or malevolent, just callous: thick-skinned, prone to dismiss suffering that ought to be dismissed.

For certain operations, I do not trust a human being at a desk to make broad, sweeping, highly general decisions about whether it is "worth" depriving others of lives or fertility.

---

You missed the point, then. If you did it for Tay-Sachs that wouldn't happen. Do it for each of several dozen possible lethal genetic diseases, on the other hand, and you have more of a problem.

I calculated it for CF which is many times more prevalent and also treatable.

So?

The problem here is fertility reduction due to systematic abortion of fetuses which carry genes for one or more of these lethal-recessive diseases. How many people are on that list? It's quite possible, for all I know, that if you add up every disease on your list, you're talking about a majority of people born in the world. In which case aborting that many fetuses would cause a population crash, as the birth rate plummeted.

That still doesn't address the consent issue. Which is supposed to be important here, remember? Isn't recognizing the idea of patient consent supposed to be one of the main differences between the bad old days of eugenics and the bright new future? You were citing it as such earlier today.

It is. Which is why every effort should be made to prevent force and find work-arounds when necessary. The problem is you have to balance the "rights" of patients against those who they would bring into the world to not suffer. What about people who oppose abortion completely? Who think it is Gods Will (tm) that their child suffer?

Even if your goal is only to remove the disease condition and not the gene from the population through mandatory screening for having both copies of the gene that causes Tay Sachs, or a single copy of ALD (male fetuses only of course), how the hell do you deal with a patient who will willfully and with self-rightous indignation put a child through that hell?

The notion of informed consent is less about the consent and more about recognizing that a person is just that. A person, not property of the state, or an experimental subject to be used and abused in the name of progress. A child however, not a fetus, but a child, has "rights" as well. It is not a right to exist (if we accepted that we open the door for banning contraception and making engaging in every available mating opportunity mandatory), but once born they do have a right not to spend their short lives in agony and fear. Just as a patient has a right not to be used, so does a child.

How does this address the consent issue? Again, this is a colossal problem if you propose to abort all fetuses carrying the lethal recessive for a disease whether or not they express the disease itself. Because in that case the number of potential suffering children you are averting becomes much smaller.

It's one thing to say "this specific fetus carries genes that will kill it horribly in childhood, we are aborting it." But you have to stretch the argument much farther, and stretch it thinner, if you say "this specific fetus carries genes that might cause its offspring to die horribly in childhood, with 1% probability, therefore we are aborting it."

The first case, I can understand how you justify by weighing the enormous utilitarian-negative of an agonizing death against the utilitarian negative of violating patient consent. I have deep misgivings, but I can at least comprehend the fucking argument.

But it is ludicrous and grotesque for you to go on as if the same argument works equally well for carriers as it does for those who express the disease. If you're willing to abort fetuses because of a 1% chance their children will die in agony, there can not and will never be a case where you're willing to not abort fetuses. If a 1% probability of a major utilitarian negative is enough to justify not permitting someone to have a child, then there will always be such a negative: the probability of bad things happening in a child's life is always going to be nonzero, simply by blind chance and factors that have nothing to do with genetics.

It approaches mathematical certainty that a randomly chosen person will have offspring that wind up suffering horribly with 1% or greater probability, whether they carry a genetic disease or not. Why is the added increment of probability due to a genetic disease (a consequence with probability on the order of 1 to 0.1% that MIGHT occur IF this person has children AND ONLY IF they have children with another carrier of the lethal recessive) suddenly enough to justify forced abortions?

Once again, I can see how this argument works for fetuses that actually have the disease. Do not use them as examples. I want to understand why (or, for that matter, whether) you advocate the same approach to carriers as you do for fetuses carrying the double recessive that will cause lethal disease.

You are letting the fact that you have found a solution to a problem blind you to the fact that the cost of the solution is grossly disproportionate to the cost of the problem.

Thing is, you declare it to be a utilitarian negative if a baby is born with a lethal genetic disorder. That I can understand... but it undermines the argument you just made: the existence of a person with a lethal genetic disorder cannot be a utilitarian negative, and cannot be a reason for action of any kind, if that person does not yet exist.

It does not work that way. There are an infinite number of possible healthy persons. The birth or non-birth of any one of them is inconsequential, if the birth had value in itself we would be obligated never to turn down heterosexual unprotected intercourse because if we did turn it down we would be denying a childs right to exist.

There are three obvious holes in this argument to my eye.

The really critical hole is that you're assuming that the positive value of permitting a child to be born must be vastly positive, positive enough to trump any and all other concerns. This is not true. It might, instead, be merely positive enough to trump some concerns, but not others. Say, it might be too small to justify the known fact that the child will die horribly, while still being significant compared to the 1% chance that the child's child would die horribly.

Second, you fail to distinguish between a conception and a successful pregnancy. A utilitarian system that placed high value on all conceptions would indeed have perverse results. That would be silly. But, a conception having occured, if we're gong to start talking about the future state of the child who might exist as a consequence, things change. Now we're no longer talking about one of the infinite number of people who could conceivably exist. We are talking about one of a finite number of people who have some existent precursor form that does exist. We can place a (small) nonzero value on those finite number of precursor-forms, without placing a (large) nonzero value on the act of conception that would make conception mandatory.

Third and finally, there is (still) the question of how this ties into the rights of the mother. You do not get to monkey around with people willy-nilly, regardless of whether you place value on the effects of your actions. In particular you don't get to act this way towards the fetuses carried by pregnant mothers, even if you place zero value on fetuses because the mothers themselves do. They have invested considerable time and effort into bearing those fetuses, and fully intend to invest more both before and after birth. They will, quite often, strongly prefer to bear a child, to the point where they would make vast sacrifices to retain that opportunity.

You might be able to override that preference in cases where you can prove the child will die horribly. You do not get to override it casually or at will, as in cases where there is only a 0.1 to 1% chance of anything going wrong as a consequence.

I would have far more respect for your position if you seemed willing to admit that.

Now, if you want to wait a few more generations, you can prevent screening of the parents (or make their at-birth screening private) and bring mating with respect to the gene random. You stop hiding the gene in the carriers and expose it to selection. In a few generations of selective abortion of double recessive fetuses the gene is gone. it just takes longer, and the prenatal screening is cheap as hell.

How is this state of affairs different from what we had in premodern times, when there was no way to screen the parents at all?

That's why I call into question whether you've sat down and done the math properly. Because you're proposing to violate the extremely strong preferences of a huge number of people, to put them in a position where they will feel they have been harmed even if you do not grasp how or why... to avert potential suffering that is petty in comparison.

As I said, I have not said they cant have kids at all, and I have already conceded that a cultural shift would need to occur to make sure that undue suffering does not occur. Again, chances are most people (as opposed to psycho fundies who dont care about kids once they are born) would abort if they knew their fetus had any of these conditions.

The cultural shift in question would have to completely remove the preference of pregnant women to have children. At which point we would probably

Pregnancy is, to put it mildly, inconvenient and dangerous. It is an inconvenience many women have been willing to put up with, even when it was far more dangerous, becuase they wanted to have children and paid the price accordingly. I submit that this is probably an instinctive preference, because if pregnant females of an intelligent species had no desire to have children at all, that species would vanish within a very short time.

As long as that preference exists, and as long as you propose to abort carriers, not just infants who express the disease, you will be violating an enormous number of women's preferences as patients in order to avert a small potential harm that might come about tas the consequence of the pregnancies.

And that will still be wrong.

For, realistically, many diseases, because Tay-Sachs isn't the only one involved here?

Screening for many diseases is very very cheap.

You missed the point again. Here, I was not discussing the cost of screening. I was discussing the potential effect on society of aborting every fetus carrying a copy of any lethal recessive. There is more than one lethal recessive condition out there. How many fetuses would be left if you aborted all the carriers, not just the ones for Tay-Sachs?

That is going much too far, and you ought to realize it.

There are many ways of doing it, aborting carriers is just the fastest way of doing it. Done in one generation and you never have to worry about ANY of them again.

And until I can see you acknowledging the major, prohibitive ethical problems with doing that, I will not for a moment imagine that anyone can be trusted to do a forced-abortion-enforced eugenics program. Because I don't trust you, given the level of ethical insight you've shown in this conversation. And if I can't trust you I'm damn sure not going to trust a random person, even a random population geneticist.

That depends on the community. Your calculations of the number of Tay Sachs babies per century are based on random mating. Unless people are fish, mating is almost never random. In isolated communities like orthodox jews, the recessive carriers will eventually proliferate in their small population with the assortative mating scheme they have going, making it very difficult to find non-carriers to marry the carriers, after a latency period, Tay Sachs will skyrocket if the mating scheme fails (due to, you know... people falling in love). I will need to find my pop gen book to look up the equations to calculate how quickly the number of carriers having to have arranged marriages will become intractable. That is the problem with inbreeding depression.

What's the equation? I'd like to be able to do the math for the general population.

Specific breeding communities like the Ashkenazim may need different responses from the medical community. They already get one- the issue of Tay-Sachs is treated very differently among Ashkenazim than it is among the general population, because the disease is two order of magnitude more likely to crop up there: more like 0.1%, and less like 0.001%.

Remember, population wide with random mating Tay Sachs is very rare. Among certain subpopulations it is not. Among that subpopulation you probably will not need to force anyone to abort. These subpopulations account for the vast majority of Tay Sachs cases. As a result the harm you cause by making such a thing mandatory is very very small. With other conditions such as ALD that are sex-linked, you dont have the probability game to worry about. 50% of a carriers children will die a horrible death in childhood or suffer severe disability as adults. The other 50% are normal. Almost no one will want that child born, nor will they want it as a scourge looming over their grandchildren. Same with Tay Sachs. Each of these diseases can be near eliminated from the population relative to what they are already (which is already low) without ever having to use force.

What about Tay Sachs in the general population, and other cases where the frequency of carriers is roughly 1%?

[Simon_Jester]

Parents can give consent, can't they?

I do not feel like explaining this ethical minefield to LionElMoron - someone else can take this one.

Uhh... how is it an ethical minefield? Parents are always required to give consent for medical procedures their children undergo; how is this any different?

An answer, in hopes that it will prove informative:

Parents do not own their children. Their power to consent to procedures applied to children is limited, not least because of the risk that they will submit their children to monstrous procedures committed by quacks. An obvious example would be parents trying to "save" their gay son by getting someone to stick electrodes into his brain and try to condition him into being attracted to women, the way you describe earlier. There are quite a few parents who discover that their 16 year old child is a homosexual and would force them into something like that if they could... even if there was a significant risk of the child dying.

There are more who could be pressured into it by "doctors" who have strange obsessions or fixed ideas that convince them to perform harmful treatments under the delusion that it is right to do so: look up the history of lobotomy for an example of how that can happen. Basically, it was promoted as a "treatment" for certain "intractable" patients (many of whom were guilty of nothing more than being unruly teenagers) by a limited number of unethical surgeons*. Which resulted in quite a few thousands of people getting important bits of their brain chopped out to make them more tractable, easier to handle and control.

So no, it is not enough for the parents of a young child to consent to some high-risk experimental surgery, though given the 100% lethality of young-onset Tay Sachs, it is possible that a review panel might be convinced to allow such surgery if there were a viable technological means of getting the needed chemicals into the brain. Which, at the moment, there isn't. I'm not a neurobiologist, so I can't say exactly how likely it is that such a thing will ever exist.

*I almost hesitate to use the term because of the slur it implies on the profession.

[Alyrium Denryle]

I will get to most of the other stuff sometime tomorrow, but this is worth dealing with now

However, I still find myself made very dubious about the entire proposal by this exchange. Because if you had been given the authority to do this, I find myself wondering whether you would have reached that compromise position, or whether you would have taken the "let us eliminate the scourge as fast as possible" tack. On how clear and well-placed your judgement calls about which diseases are a scourge it is worth aborting millions of pregnancies to avert are. And so on.

That is why you never allow one person to make these decisions. I am really good with population genetics, but am not an expert on genetic diseases. I am also a tad ghoulish at times, and do not empathize with people very well. When everyone else is playing social chess, I play social checkers unless I try really hard and try to think like a computer. I would not trust myself with these decisions, which is why to the extent that anything I suggest here gets implimented, it should only ever be done by a panel with a group of ethicists, the majority vote having veto power over anything the scientists propose. I look at this as if I were managing an inbred population of endangered antelope, and other biologists tend to do the same. The benefit with me though is that I am always persuaded by an argument stronger than my own, and admit to fault.

Distance makes it much easier to proclaim on the fate of someone else, someone who is merely an abstract case of an abstract disease. Even with the best will in the world, that status lends itself to callous disregard for others. Not hostile or malevolent, just callous: thick-skinned, prone to dismiss suffering that ought to be dismissed.

This is definitely true. Which is a reason (in concession to Broomstick) that such a panel would need to include members who are either afflicted by, or are the relatives/caregivers of one who is afflicted by some of the conditions under consideration.

The problem here is fertility reduction due to systematic abortion of fetuses which carry genes for one or more of these lethal-recessive diseases. How many people are on that list? It's quite possible, for all I know, that if you add up every disease on your list, you're talking about a majority of people born in the world. In which case aborting that many fetuses would cause a population crash, as the birth rate plummeted.

[mode=heartless]
Well, you know my position on population control... that would be killing two birds with one stone [/mode]

You set me up for that.

It's one thing to say "this specific fetus carries genes that will kill it horribly in childhood, we are aborting it." But you have to stretch the argument much farther, and stretch it thinner, if you say "this specific fetus carries genes that might cause its offspring to die horribly in childhood, with 1% probability, therefore we are aborting it."

Which is true. That is the reason I withdrew from that position. If however the option is given to parents in that situation, a significant number will probably elect to abort. Particularly if they are members of a group hard-hit by the disease in question.

Second, you fail to distinguish between a conception and a successful pregnancy. A utilitarian system that placed high value on all conceptions would indeed have perverse results. That would be silly. But, a conception having occured, if we're gong to start talking about the future state of the child who might exist as a consequence, things change. Now we're no longer talking about one of the infinite number of people who could conceivably exist. We are talking about one of a finite number of people who have some existent precursor form that does exist. We can place a (small) nonzero value on those finite number of precursor-forms, without placing a (large) nonzero value on the act of conception that would make conception mandatory.

I will need to think through this one, and get back to you once it has been pondered fully. I will state however that I make a distinction between a child that WILL be born, and a potential child who's death has been pre-determined.

If I am a women who is pregnant and has already made the decision to abort (for the sake of argument, lets say I am 8 weeks in, there is no chance of miscarriage, and my decision will not be revoked) it does not matter what I do. I can drink, smoke, snort meth, go stair-diving. None of those things will impact the child that will never exist. Those are of course the direct considerations. The moral obligations held (or not held) toward the soon to be aborted fetus, and the child it may have become. The child will never be born, and nothing suffers as a result (except for me if I snort meth and go stair-diving)

If however it is pre-determined that the child will be born (say I am 8 weeks in, no chance of miscarriage, and am a raving fundie who thinks that the fate of all pregnancies should be strictly in the hands of god, and this decision is irrevocable) then I have moral responsibilities toward the child, as the consequences of my actions will have an impact on a being that exists.

Third and finally, there is (still) the question of how this ties into the rights of the mother. You do not get to monkey around with people willy-nilly, regardless of whether you place value on the effects of your actions. In particular you don't get to act this way towards the fetuses carried by pregnant mothers, even if you place zero value on fetuses because the mothers themselves do.

I have already acknowledged this as a serious problem. To weigh it, I would need to look up the diseases that would be on my list, figure out how many people would be impacted, how many abortions would need performing, figure out what the likely rate of consent is etc etc etc. Then I could weigh that. It is also why I have stated a cultural shift would need to occur such that these actions are seen by individuals as necessary and not in violation of individual rights...or the woman's body for that matter.

Forcing someone onto a table and operating on them against their will is basically medical rape. Something I cannot permit, which is why chemically induced abortion is preferred for example. Advances in diagnostic testing would need to be made, and gov subsidized etc. That of course deals with the direct harm to mom.

The indirect value of the fetus placed on it by mom is another matter. Which is another reason I backed off that position. Simply making the option available to her should be sufficient to reduce carrier fitness.

I would have far more respect for your position if you seemed willing to admit that.

You will note in the last few posts I have made, that I am.

You missed the point again. Here, I was not discussing the cost of screening. I was discussing the potential effect on society of aborting every fetus carrying a copy of any lethal recessive. There is more than one lethal recessive condition out there. How many fetuses would be left if you aborted all the carriers, not just the ones for Tay-Sachs?

Again, I would need to compile a list. Honestly, everyone has a recessive lethal. Everyone. In fact, everyone has a metric shit ton. However no one is ever born homozygous for most of them, because those that are conceived with them get miscarried.

And until I can see you acknowledging the major, prohibitive ethical problems with doing that, I will not for a moment imagine that anyone can be trusted to do a forced-abortion-enforced eugenics program. Because I don't trust you, given the level of ethical insight you've shown in this conversation. And if I can't trust you I'm damn sure not going to trust a random person, even a random population geneticist.

Part of this, honestly, is me trying to defend a position I know is ghoulish. I have acknowledged most of what you have brought up multiple times (except for instances where I missed the point, it happens). Lets see:

It may be. I will need to do some happy math and compile a list of diseases with their carrier frequencies. I am happy to only selectively abort infected fetuses and leave the decision to carriers to parents. All you need to do is reduce the fitness of carriers to eventually remove it, you dont need to eliminate in one generation.

I did and I didnt. I offered it (mostly) as a hypothetical if you wanted to be REALLY efficient. Again, all you need to do is stop the carriers from completely hiding the recessive trait, expose it to selection, and the recessive goes away, it will just take longer.

[Alyrium Denryle]

Think about what you know of me. How passionately I go over the ethical obligations owed to others. Do you really think that outside an exercise, playing devils advocate,. or just being bored, I would propose such things?

Lets go over the original context under which I made my initial argument.

Initially i mentioned the abortion of carriers specifically as a means of being efficient. I made no claims about its morality.

What I meant by this:

I fail to see the problem with the abortion numbers. A fetus has Zero value. The only problem I am seeing is the significant negative utility involved with forcing them (yeah...forcibly aborting someone's second trimester fetus is bad... which is what a medical abortion rather than surgical is for, which is why I LOVE first trimester genetic diagnostics, preferably in the first 8 weeks) . Obviously a cultural shift would be required, one which is morally obligatory, but is probably not going to happen.

The number of abortions in this case would be sufficiently low that the abortions on their own are not a problem. I admitted the significant negative utility in forcing them on the parents, and that getting rid of that would be unlikely (although could be mitigated with better detection and abortion technique), at best, even if we would prefer it given the absolute numbers involved, and given that the singular fetus by itself, given that it will never be born, has no value. If you remove the instrumental value (namely the value mom places on it) the moral case for the abortions being wrong disappears. You are correct though, the preference for having children is sufficiently strong that it is at best unlikely to ever occur.

Do you understand now?

[Simon_Jester]

IThat is why you never allow one person to make these decisions. I am really good with population genetics, but am not an expert on genetic diseases. I am also a tad ghoulish at times, and do not empathize with people very well. When everyone else is playing social chess, I play social checkers unless I try really hard and try to think like a computer. I would not trust myself with these decisions, which is why to the extent that anything I suggest here gets implimented, it should only ever be done by a panel with a group of ethicists, the majority vote having veto power over anything the scientists propose. I look at this as if I were managing an inbred population of endangered antelope, and other biologists tend to do the same. The benefit with me though is that I am always persuaded by an argument stronger than my own, and admit to fault.

I'm sorry; you're right. By the end of that I was starting to get a little exasperated and unnerved at the same time, which is a bad combination.

That said, the problem is that I really could imagine something like this happening in the sort of society where it was already generally accepted that the state had the right/duty to step in and force an abortion on women whose fetus was going to express the disease. Especially if it were done for a short list of five to ten diseases- in which case, as you say, the total abortion rate would not change significantly.

Abortion of carriers is taking the whole scheme too far, by such a margin that if I'm not confident of the system's reliable fail-safing long before it reaches that level, I'm reluctant to go along with the system being empowered to coerce abortions at all.

This is definitely true. Which is a reason (in concession to Broomstick) that such a panel would need to include members who are either afflicted by, or are the relatives/caregivers of one who is afflicted by some of the conditions under consideration.

I submit that as a minimum condition you would need to give veto power to two separate groups on the review board: the bioethicists, and the afflicted. It should not be possible to vote to systematically abort all cystic fibrosis cases, for example, over the objections of all or even a majority of the cystic fibrosis cases present. Their perspective on the matter is one that cannot be duplicated by any other person, and is extremely relevant to the quality of life issue.

You would also want to use large numbers for each group, to avoid idiosyncracy on the part of the membership.

The problem here is fertility reduction due to systematic abortion of fetuses which carry genes for one or more of these lethal-recessive diseases. How many people are on that list? It's quite possible, for all I know, that if you add up every disease on your list, you're talking about a majority of people born in the world. In which case aborting that many fetuses would cause a population crash, as the birth rate plummeted.

[mode=heartless]
Well, you know my position on population control... that would be killing two birds with one stone [/mode]

You set me up for that.[/quote]Yes, actually. My concern is that the abortion rate would go high enough that the resulting population crash would be too high even by the standards of draconian population control. Draconian population control has to retain some level of birth rate to keep the system from collapsing when the current generation of breeders retires from the workforce and the remaining workforce predictably winds up sinking most of its resources into caring for its parents and grandparents.

Aborting all carriers of lethal recessives might well make things worse than that. If you were only doing it for one disease, it wouldn't guarantee such a problem, but you're not going to be: you could never justify doing this with Tay-Sachs but not for ALS, for instance.

It's one thing to say "this specific fetus carries genes that will kill it horribly in childhood, we are aborting it." But you have to stretch the argument much farther, and stretch it thinner, if you say "this specific fetus carries genes that might cause its offspring to die horribly in childhood, with 1% probability, therefore we are aborting it."

Which is true. That is the reason I withdrew from that position. If however the option is given to parents in that situation, a significant number will probably elect to abort. Particularly if they are members of a group hard-hit by the disease in question.

Consent changes everything, naturally.

The way you address a genetic condition that occurs with high frequency (say, 10% carrier frequency) is going to be entirely different from the way you address one that occurs with low frequency. At carrier frequencies of a few tenths of a percent, the condition is only going to arise in on the order of one in a hundred thousand births, at which point it becomes indistinguishable from background problems that lead to infant mortality. There is no longer any practical need to "treat" the problem with abortions.

In other words, trying to treat such a large population as you would an endangered species of gazelle is wrong, because the species is not endangered; there is a breeding population in the millions and the condition is rare enough that random mating can never eliminate it from the population.

Second, you fail to distinguish between a conception and a successful pregnancy. A utilitarian system that placed high value on all conceptions would indeed have perverse results. That would be silly. But, a conception having occured, if we're gong to start talking about the future state of the child who might exist as a consequence, things change. Now we're no longer talking about one of the infinite number of people who could conceivably exist. We are talking about one of a finite number of people who have some existent precursor form that does exist. We can place a (small) nonzero value on those finite number of precursor-forms, without placing a (large) nonzero value on the act of conception that would make conception mandatory.

I will need to think through this one, and get back to you once it has been pondered fully. I will state however that I make a distinction between a child that WILL be born, and a potential child who's death has been pre-determined.

True, but there is also the category of a specific child who WILL be born barring a decision not to permit that to happen. This is the category carriers of lethal recessives would fall into in your proposed system (assuming it has not decided about whether to abort carriers yet). Their death is not predetermined by outside forces; indeed, they are no more likely to die than anyone else.

The indirect value of the fetus placed on it by mom is another matter. Which is another reason I backed off that position. Simply making the option available to her should be sufficient to reduce carrier fitness.

OK.

I would have far more respect for your position if you seemed willing to admit that.

You will note in the last few posts I have made, that I am.

This is true. Guess what that did to my respect for your position.

I still have misgivings because it reminded me of the potential for abuse. But I do feel rather less shaky than I would otherwise.

Again, I would need to compile a list. Honestly, everyone has a recessive lethal. Everyone. In fact, everyone has a metric shit ton. However no one is ever born homozygous for most of them, because those that are conceived with them get miscarried.

Exactly what I was getting at. That said, getting rid of even the ones that the fetus can survive to birth when homozygous for the lethal recessive is going to mean a lot of abortions if you index over all such conditions. It only looks small because we're considering one disease in isolation.

Part of this, honestly, is me trying to defend a position I know is ghoulish. I have acknowledged most of what you have brought up multiple times (except for instances where I missed the point, it happens). Lets see:

True. I wasn't... entirely sure if you were joking.

For future reference, it does help if you say something like "I recognize that there are major ethical issues with this." Otherwise, you're liable to get creamed on the ethics front, especially when promoting a policy that does (not without reason) remind people of the Nazis whose leadership were poster children for large-scale forced abortions*.

*Any ambiguity in that statement is totally intentional.

The number of abortions in this case would be sufficiently low that the abortions on their own are not a problem. I admitted the significant negative utility in forcing them on the parents, and that getting rid of that would be unlikely (although could be mitigated with better detection and abortion technique), at best, even if we would prefer it given the absolute numbers involved, and given that the singular fetus by itself, given that it will never be born, has no value. If you remove the instrumental value (namely the value mom places on it) the moral case for the abortions being wrong disappears. You are correct though, the preference for having children is sufficiently strong that it is at best unlikely to ever occur.

Do you understand now?

Honestly, I'd guessed that this was likely to be your position and response, but I wanted to make sure I'd nailed down the ethical issue with sufficient firmness. Among other things, it badly weakens the overall position of "we would be wise to abort fetuses that are homozygous with lethal recessives" when you take the jump to aborting carriers, which means canceling* many millions of potential healthy children.

*With the most permissive view in the world towards abortion this is the nicest word I can pick.

[Broomstick]

People unquestionably have a drive to reproduce. They also have a drive to produce healthy children. The latter isn't quite as strong as the former (offspring do not need to be perfect to be Darwinian winners, after all), but it is still present.

Evidence for this goes back to the ancient world, where from the dawn of writing we find texts advising women how to eat, drink, and conduct themselves to produce healthy children and keep them healthy. Many cultures have practiced infanticide, sometimes quite explicitly to concentrate resources on those most likely to survive and prosper.

With the advent of modern medical science, parents have access to more information than ever before. Society fortifies foods to protect against some defects. Women are immunized to prevent diseases that can deform the unborn (such as German measles). Even drug addicts have been known to either reduce or stop usage during pregnancy to protect the baby - almost always to relapse right after the birth. Women no longer have to wait months to be sure they're pregnant. They can find out long before a birth if there are certain problems.

As a result, even though there are more people with arguably bad genes surviving these days the rate of severe birth defects has significantly dropped over the past century (so has the rate for less severe ones, but not as much as parents are less inclined to abort over small problems).

With TS we see that one of the most affected communities, Ashkenazim (the others being French-Canadians, Cajuns, and the Irish) voluntarily taking steps, individual by individual, to avoid TS births. This has been so successful that such births are now less common among them than in the general population! Likewise, fewer babies with Down's Syndrome are being born, despite the average age of pregnant women going up. These are examples that people who are informed and free to make choices will, on their own, make eugenic choices without the need for coercion.

With IVF this process it taken further - the best eggs and sperm are chosen, and the embryos can be screened for any issues prior to implantation. Since there are usually several embryos produced choosing the one or two with the fewest problematic genes only makes sense. The biggest obstacle is that the technology is expensive and available only to the wealthy or those people where society deems the risk sufficient that is makes more sense to pay for IVF+screening than to pay the lifetime cost of care for the severely disabled.

However, no system will ever be perfect. As long as conception occurs naturally (and most will be such) not every child will be screened before birth. Spontaneous mutations will continue to occur (some genetic diseases come only from such, as those born with such genes never reproduce). And people will differ on what they will or won't find acceptable. On the level of individuals that's one thing, and in line with the imperfect but working system we evolved under. Extreme views will be rare, and parents have an incentive to produce children and will tend to err in favor of the child rather than against. Over the entire population things will tend to even out, and the rate of children born with severe defects will decrease, even if it won't disappear. Having a society, or a small committee, make such decisions is not a good idea. Historically, it has led to abuses and needless suffering.

So really, the best option for optimum (though not perfect) results is education of individuals and access to reproductive medicine.