What does Ashton Kutcher’s Teen Choice Remarks have to do with Down syndrome prenatal testing?

Ashton Kutcher’s remarks upon winning the “Ultimate Choice” award are receiving a lot of coverage, and not just because he revealed that his real name, his first name, is Chris. But what do they have to do with prenatal testing and Down syndrome?

For many, probably nothing. Certainly for Kutcher, I’m sure he did not mean for them to apply to prenatal testing for Down syndrome. And, for some, the messenger may get in the way of the message–this is the actor who most know for his relationship with actress Demi Moore and the MTV prank show, Punk’d. But that should not get in the way of the message.

Kutcher had three points for the audience of screaming teens:

1. Opportunity looks a lot like hard work.
2. The sexiest thing is being really smart and really thoughtful.
3. Build a life, don’t simply live one.

How do these words of wisdom apply to prenatal testing and Down syndrome?

1. Opportunity looks a lot like hard work.

Recently, a person very close to me and I were talking about the subject of this blog. This person is in the medical field and shared this pessimistic view: “prenatal testing presents the patient with a hard choice, and more and more, fewer people are willing to choose to do hard work.” This person’s point was that prenatal testing is converging at a time that, in this person’s estimation, is one where people are often taking the easy way out. Whether you agree or disagree with this view, clearly Kutcher thought an audience of teens needed to be reminded that opportunity is the result of hard work. And, when faced with a prenatal test result, as hard as that news may be, some do look at it as an opportunity–though often in hindsight. This is reflected in the regularly stated phrase that while most parents would not have chosen to have had their child be born with Down syndrome, now that they are parenting that child, they would not change it. So, opportunity does look like hard work.

2. Sexy = being smart and thoughtful.

This second point would be one to easily gloss over or ignore because of the very likely comments or thoughts by some readers that Kutcher’s Rule #2 would counsel against continuing a pregnancy after a prenatal diagnosis. I mean, your child with Down syndrome, a condition associated with mild to moderate intellectual disability, will not be really smart and therefore not sexy. But that ignores the second part of Kutcher’s Rule #2: being really thoughtful. I doubt most parents have as their highest goal that their children be sexy–I certainly hope not, at least. But, parents do want their children to be thoughtful of others. And on this factor, the research backs up that having a child with Down syndrome not only means raising a child that more often than not will be more empathetic, but that parents and siblings, too, become more thoughtful and compassionate for having grown up with a loved one with Down syndrome.

3. Build a life, don’t live a preordained one.

It is Kutcher’s last point that really prompted this post, because this does directly apply to prenatal testing for Down syndrome. Kutcher cites Steve Jobs for this last point, given Kutcher’s portrayal of Jobs in the upcoming biopic. Kutcher refers to Jobs saying that when you are born into this life, there are those who want to put you in a box of their design, i.e .that this is just how life is and now you are supposed to live it. But Jobs, and Kutcher, say that should be ignored. Instead, you should build a life of your own. Prenatal testing by its nature puts raising a child with Down syndrome into the box of something that can be avoided. But if you talk to families of children with Down syndrome, as Andrew Solomon did for his book Far from the Tree, and as professional guidelines recommend patients do when receiving a prenatal diagnosis, these are families who found that life was not the box they were told it would be. Moreover, people with Down syndrome can look forward to the best opportunity for a good life than ever before because of parents, practitioners, policymakers, and philanthropists who looked at what was the preordained life–institutionalization, segregation in schools, segregation from the community, menial job prospects–and bucked those trends to build a life of raising their children at home, mainstreaming and including their children in school, and having their children involved in their communities as adults.

So, Kutcher’s three points bear on the concerns involved in prenatal testing. And, this is not to suggest they force a decision one way or another. But, rather, they reflect the wisdom of making a choice that is true to your own self and values, not those imposed on you by your family, medical provider, or society.