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Prenatal Diagnosis: What Do I Say?

“Connecting the pro-life movement and special needs community one story at a time.”

That’s the mantra here at Especially Pro-Life. To live up to that, I wanted to talk about the area where the pro-life and disability rights movements most closely meet: prenatal diagnosis.

I sat down (over Zoom) with Josh Brahm, president of the Equal Rights Institute, to ask how to approach prenatal diagnosis in different settings and with particular kinds of diagnoses, specifically chronic, but non-fatal conditions like Down syndrome as well as diagnoses like trisomy 18 that are often lethal within an infant’s first year after birth (though 12 percent live past the first year!). I modify the presentation and some of the content of Josh and his team’s thoughts (partially articulated in the Sidewalk Counseling Masterclass) in this post, but credit for the foundations and the great majority of the responses’ details goes to them.

As a pro-life apologist (unless you’re exclusively a sidewalk counselor and avoid the abortion issue in all other settings like the plague), you’re more likely to engage with someone who is seemingly disinterested (as in he or she is not or is not close to someone currently in a prenatal diagnosis situation), but is citing prenatal diagnosis as a legitimate reason for legalized elective abortion.

Answering this concern often depends on if the pro-choice person has been offering a series of reasons that justify abortion that may include rape or incest, poverty, and/or prenatal diagnosis. If this is the case, you may want to focus on finding the root of their support of legal elective abortion (without being dismissive of their points). This may be a utilitarian worldview or a perspective that does not recognize the science stating that a unique human life is present starting at conception.

If you can reasonably decide that the pro-choice person’s reference to prenatal diagnosis is of particular and focused concern because of prenatal diagnosis itself, you’re going to want to reach that person where he or she is. I use the word “ableism” to do this. The language of ableism and disability ethics is recognizable to many pro-choice people and can help demonstrate how the violence of abortion actually violates a shared viewpoint which affirms that those with special needs are inherently dignified and worthy of protection.

Try saying something like this (of course, assuming that you mean it): “When able-bodied people like medical doctors decide that a disabled person does not have the right to life or lacks a life worth living and, thus, pushes abortion as the only reasonable choice for a woman (which happens often), they are engaging in blatant, discriminatory ableism. We should, of course, love, help, and value disabled people as much as we can. If they have a condition where pain is a big factor, then non-violent, life-affirming palliative care should be offered, without a doubt. But I don’t think we should kill them. I don’t think disabled toddlers should be allowed to be killed just because able-bodied people deem their lives disposable.”

Note how I trot out the toddler at the end. Both pro-life and pro-choice people oppose killing special needs individuals after birth. This demonstrates that the main issue is something other than how a disability may or may not change a person’s inherent moral value. Once you can see that this is the heart of the matter, you can address the biological realities and philosophical disagreements about the unborn and/or his relationship to the mother.

Pro-choice people, and even some self-identified pro-life individuals, may also bring up “really hard cases” where they will say something like this: “If we are (pretty) sure that the baby is going to die in the womb or soon after (from trisomy 18, trisomy 13, etc.), it’s a kind of ‘mercy killing’ to have this abortion, especially if the child may be facing a lot of suffering, the parents are in emotional distress, etc.” In this “hard case,” abortion is being used as the means to euthanasia.

In response to this, just like in other contexts surrounding the abortion issue, you want to find common ground and show empathy. You should acknowledge that this is a heartbreaking situation and your thoughts and prayers go out to mothers and fathers that are currently living in it. You should also express that it’s normal and just for parents to hope for a child that will not have major physical and/or development issues. Though parents are called to love and embrace caring for a child with special needs, it’s not unjust for them to affirm their desires for a condition-free child prior to learning more about their baby. Next, you should address the concern directly by conveying your notion that a person with a condition that is likely to prove fatal before or within months after birth should be given the best possible palliative care, having all their moments on earth filled with “great love” until nature takes its course.

Real-life stories showcasing this “great love” are out there and prove themselves to be the most moral and emotionally-settling way of approaching this situation, as seen in the mini-documentary Choosing Thomas. Thomas, who has trisomy 13, was taken home by his parents 53 hours after his birth and spent the next few days before his death being held, spoken to, kissed, and shown “great love” by his parents who “didn’t terminate because he’s [their] son.” After you articulate this, many pro-choice people will agree and, then, may move on to issues related to the moral status of the unborn child and/or bodily autonomy.

If you’re one of thousands of pro-life sidewalk counselors, however, you may have encountered an abortion-minded woman and/or her partner who reference prenatal diagnosis as their reason for coming to the abortion clinic. Most abortions in the U.S. are sought for social or economic reasons, making this a rare situation. But if you are a sidewalk counselor, especially at a clinic that performs late-term abortions, it’s important that you are familiar with the message that best empowers mothers and fathers to choose life under these uncommon circumstances.

Very often, the mother and/or father wanted to have a healthy baby before their child’s diagnosis was confirmed, typically through amniocentesis or chorionic villis sampling (CVS). They are probably devastated and grieving the prospect of aborting a formerly desired baby. By understanding this and, therefore, knowing that abortion is not wanted as an end by the parents, but instead as a means to a) prevent the potential pain or social isolation of the child with a disability, b) avoid the medical costs associated with many conditions, or c) spare themselves of the supposedly increased emotional grief of having their child potentially die naturally soon after birth, etc., you are equipped to reach this father and/or mother where they are.

In a prenatal diagnosis situation where the child is not expected to live for longer than a year after birth or a chronic, but non-lethal condition has been detected, you want to meet their needs through a language of empathy, encouragement and hope. This can help them be more likely to respond positively in this high-stakes situation. You do this by (after learning that this is in fact their predicament) saying something like: “I’m very sorry, that must have been an extremely difficult day when you found out. The worst day in this pregnancy was when you found out that your child had this diagnosis. Can I ask what the child’s name is?” After they tell you this (which serves to re-humanize the baby), make sure that they did want to have this child and determine what the prenatal diagnosis actually is.

Your concern for their situation and desire to listen with compassionate interest will likely be welcomed by the parent(s) and will allow you to relay the realities of the current predicament honestly by saying something like: “You know, when you found out about William and what William has, that was the most difficult day of this entire process. I think there could be a worse day, and that’s if you go through with this abortion, but let’s talk more about how that day when you found out was really hard.” Allowing the parent(s) to say out loud that that was truly a difficult day and explain why gives them an opportunity to make their suffering known and acknowledged rather than kept festering and unheard. After that, and with a smile, point out that nothing has changed with William. Getting that diagnosis did not alter who William is. At this moment, he’s safe, relaxed, and not suffering in the womb. With the hostile attitude that many medical professionals have towards babies with a prenatal diagnosis, that fact is often not presented to or reflected on by the distressed parent(s). Dispelling unfounded fears about the situation for the parent(s), especially in non-fatal cases like Down syndrome, is important in helping them choose a mindset that recognizes the child already present and embraces the joys and responsibilities that being his parent(s) does and will continue to entail.

Then, you want to tell the parent(s) about the love and hope that is waiting for them at their local pregnancy resource center or, in the case of a potentially lethal condition before or soon after birth, organizations like Be Not Afraid that provide abundant support to parents, including assistance with a birth and newborn care plan, funeral and memory-making planning, connections with parents who have gone through similar events, among other resources. Next, you should acknowledge that it’s natural to want to protect and want the best for William, and that, if they decide to have an abortion instead of having William, it will weigh on them in an incredibly negative way and for the rest of their lives, while carrying to term would leave them with a much better psychological outcome and would be the best action to take for everyone involved.

Finally, make sure to say something like this: “This will be tough no matter what. Though you may have been told that abortion is the easy solution, there’s not an easy answer since you know that William is here today with you, and that abortion terminates him. I want you to have the knowledge for the rest of your life that you did all that could to nurture and support William and then have no regrets.”

Remember, an OB-GYN or another physician who’s been helping the parent(s) has probably used euphemistic language after the prenatal diagnosis, so calling abortion ‘murder’ or ‘killing’ at the clinic may lead the mother or father to think you’re exaggerating and, therefore, conclude you are not trustworthy. You also want to avoid talking about ‘eugenics’ in a Down syndrome or similar prenatal diagnosis situation, because that tragic history with a legacy that continues today is not popularly known and may, again, make you seem deceitful or conspiratorial.

Our words, demeanor, and empathy for the person in front of us—whether he is bringing up prenatal diagnosis during a tabling session because it’s another reason on a laundry list to justify elective abortion; or whether she is heartbroken at the abortion clinic since the baby she always wanted was just diagnosed with anencephaly last week— is especially important in cases of prenatal diagnosis. By engaging with others who have misguided perceptions about people with disabilities and parents going through a difficult situation, we change the hearts and minds that may soon or one day care for the hearts and minds of the beloved members of our human family with special needs.

See the original version at the Equal Rights Institute Blog:

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