“Any/Particular” critique of disability selective abortion: remembering Adrienne Asch

Over the weekend, an important voice in the discussion of the ethics of prenatal testing for disability fell silent. Adrienne Asch made critical contributions from a seemingly conflicted position: vigorously pro-choice but condemning of selective abortion for disability.

The New York Times’ obituary provides a good overview of Asch’s life:

• Born prematurely, she became blind from retinopathy.
• She was a professor of bioethics at Yeshiva University.
• Asch served on the board of the National Association for the Repeal of Abortion Laws, now known as Naral Pro-Choice America.
• She was a vocal critic of prenatal testing for selective abortion:

My moral opposition to prenatal testing and selective abortion flows from the conviction that life with disability is worthwhile and the belief that a just society must appreciate and nurture the lives of all people, whatever the endowments they receive in the natural lottery.

I first became familiar with Professor Asch’s work when I read Prenatal Testing and Disability Rights, a volume she co-edited with Erik Parens. I have recommended this book many times to anyone interested in learning about the history of prenatal testing, the experience of disability in families, the stigmatizing effect of prenatal testing on the condition tested-for, and measures to improve the ethical administration of prenatal testing–all subjects covered in the four sections of the book.

Asch’s stand-alone chapter is titled, “Why I haven’t changed my mind about prenatal diagnosis: reflections and refinements.” Asch’s main critique of disability selective abortion is that it is disability selective abortion–it’s not just “any” abortion, but done because the particular pregnancy has a disability. This position is summarized as the “any/particular” critique.

Asch wrote:

Prenatal testing is a clear case of first impression, and as with any such impression, it is an incomplete impression; when followed by selective abortion … that first impression includes a decision never to learn about the rest of who that embryo or fetus could become after its birth.

***

Although Nelson contends that the any/particular distinction collapses because all abortions are abortions about particular fetuses at particular times in women’s (or couples’) lives, the reports of researchers who have studied women’s experiences of these abortions following prenatal detection of disability indicate that the women view them as very different from previous abortions or from abortions for other reasons.

Asch was widely published in scholarly journals and a very active speaker–her commitment to speaking out on these issues was demonstrated most recently by her participation remotely despite her ailing health in a pre-conference session at the National Society for Genetic Counselors’ annual meeting.

As part of a symposium convened and published by the Florida State University Law School, Asch contributed the article, “Disability equality and prenatal testing: contradictory or compatible?” In it, Asch wrote:

[P]renatal genetic testing followed by selective abortion is morally problematic, and [] it is driven by misinformation.

***

If counselors, midwives, and obstetricians are truly committed to patient decision-making and to informed reproductive choice, they should be providing enough information about life with a disabling condition so that prospective parents can imagine the ways in which life can be worthwhile as well as those in which it can be difficult.

***

[W]e must persuade professionals to change what they tell prospective parents about life with disability; convince those parents to learn about how children and adults in today’s world survive and thrive; and then endorse the choices people make about their reproductive and family lives.

Asch’s voice was needed and will be missed. RIP.