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Down's Syndrome, Society, and Abortion

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  • Why are you attempting to define something that is so completely subjective and has an almost endless list of other circumstances and factors that would contribute to the decision. This just feels like an attempt to bait the forum into an abortion argument.
    And Kate wins.
  • But let's say that after you have the kid you try to give it up for adoption or something. Basically, society is now burdened with this person, and it could have been avoided.
    Adoption is voluntary. It would only place a burden on those who willingly accept it.
    The chances of a child with a major physical or mental defect are incredibly slim.
  • It should also be told to the parents, the chance that their child will have a genetic disorder, if they like it or not. It is irresponsible to have a child without knowing what you are getting into. It is wrong to have a child without planning, a stable income and a stable environment to have the child in. If it looks like your like/marriage/town/job is about to go to shits then think again about child rearing.

    This just shows how we have failed to grasp how genetics can help us. *note* This usually were someone cries "Eugenics". But did the communists not have a welfare scheme. So does most of the west. So the Nazi's practised rudimentary genetic screening, they also build roads and houses. Is that Nazi now.....? Using genetic testing to lower the rate of dangerous genetic abnormalities is not *nazi* but responsible.....
  • Unadopted children are wards of the state, and must be cared for as such with taxpayer dollars.
    Gotcha.
    The chances of a child with a major physical or mental defect are incredibly slim.
    Are you saying the chances of having a kid with major defects or adopting a kid with major defects are low?
  • edited October 2009
    Adoption is voluntary. It would only place a burden on those who willingly accept it.
    Unadopted children are wards of the state, and must be cared for as such with taxpayer dollars.
    Invasive tests also cost taxpayer dollars. Regardless of the moral questions, and regardless of the chance of miscarriage, this is an important concern. Assuming public health insurance, I would say that the state should only pay for the test when there is a sufficiently high risk of Down's syndrome, otherwise the test will not be covered by insurance.
    Post edited by lackofcheese on
  • Invasive tests also cost taxpayer dollars.
    Far fewer, and in most cases are payed for by private insurance.
    Assuming public health insurance, I would say that the state should only pay for the test when there is a sufficiently high risk of Down's syndrome, otherwise the test will not be covered by insurance.
    I thought this much was obvious and thus unstated.
  • This just shows how we have failed to grasp how genetics can help us. *note* This usually were someone cries "Eugenics". But did the communists not have a welfare scheme. So does most of the west. So the Nazi's practised rudimentary genetic screening, they also build roads and houses. Is that Nazi now.....? Using genetic testing to lower the rate of dangerous genetic abnormalities is not *nazi* but responsible.....
    Nice attempt at reverse Godwin, but still Godwin.
  • Assuming public health insurance, I would say that the state should only pay for the test when there is a sufficiently high risk of Down's syndrome, otherwise the test will not be covered by insurance.
    I thought this much was obvious and thus unstated.
    Under those circumstances the moral issues I brought up before mostly disappear as well, since I would assume no-one would pay the cost without a good reason.

    How do we define the threshold risk? I guess (societal cost of test) / (societal cost of Down's Syndrome) is reasonable, but what does it equate to, approximately?
  • edited October 2009
    The chances of a child with a major physical or mental defect are incredibly slim.
    Are you saying the chances ofhavinga kid with major defects oradoptinga kid with major defects are low?
    Sorry, working while forum surfing = Kate Fail.
    I meant that the chance of a child with a major physical and/or mental defect being adopted is slim.
    If you want to put it into terms of dollars and cents: Let's say a pregnant woman that was uninsured and received medical care at the tax payers' expense was given the test and discovered that her child likely had DS. If she then decided to abort the child, she would be saving the tax payers from the expense of a child that would require more expensive medical care than the norm. She would also be saving the tax payer from this potential child's greater educational costs and possibly housing and further living costs when he/she is an adult in a state funded home for those with special needs. In the face of those costs, the cost of testing seems rather minimal.
    How do we define the threshold risk? I guess (societal cost of test) / (societal cost of Down's Syndrome) is reasonable, but what does it equate to, approximately?
    Yeah, I keep those figures readily at hand... ^_~
    Post edited by Kate Monster on
  • edited October 2009
    NYS New Born Screening program test all babies born in the for "treatable" genetic disorders. They don't test while in the womb (too risky/insurance issues I'm sure) nor do they test for know but "untreatable" genetic issues. I don't agree with this. We should test for all know diseases. More to say on this later...

    EDIT: Newborn Screening Website. I understand that NYS doesn't want to put doctors in the situation where they have to tell parents their new born has an untreatable condition and their is nothing they can do about it. I do think that good parents armed with this information will look for a cure, put money into research and rally others into action. Negative parents will give up and accept then inevitable or hand them over to be wards of the state.
    Post edited by Wyatt on
  • edited October 2009
    NYS New Born Screening program test all babies born in the for "treatable" genetic disorders. They don't test while in the womb (too risky/insurance issues I'm sure) nor do they test for know but "untreatable" genetic issues. I don't agree with this. We should test for all know diseases. More to say on this later...
    Agreed.
    If for no other reason than to provide parents with fully informed choices. I may be able to adequately provide a decent life for a child with relatively normal health. I may not be able to provide for a child with a chronic disease without financial assistance (particularly if that child requires 24 hour care that would require me or my spouse to stop working to provide said care).
    Post edited by Kate Monster on
  • Let's say a pregnant woman that was uninsured and received medical care at the tax payers' expense was given the test and discovered that her child likely had DS. If she then decided to abort the child, she would be saving the tax payers from the expense of a child that would require more expensive medical care than the norm. She would also be saving the tax payer from this potential child's greater educational costs and possibly housing and further living costs when he/she is an adult in a state funded home for those with special needs. In the face of those costs, the cost of testing seems rather minimal
    Minimal, but comparing the cost of testing to the living costs isn't telling the full story. Here's what you need to compare:
    Probability(Down's syndrome birth occurs given test) * cost(Down's syndrome life) + cost(test)
    vs
    Probability(Down's syndrome birth occurs given no test) * cost(Down's syndrome life)
    This is, approximately, the expectation (an important term) for the cost of each scenario.

    Statistics like this is the reason insurance companies can make money - a fire might be extremely expensive, but it's also extremely unlikely.

    I agree with mandatory screening, since it is most probably sufficiently cheap and gives a lot of useful information, but after this step patients need to be fully informed of
    1) The actual chance (i.e. using Bayesian methods and taking into account as much information as is reasonably possible) of any given disorder, and its consequences
    2) The options available, particularly for invasive testing.

    It's obvious, but it's important, and insufficient information is a big reason people make stupid medical decisions.
  • I agree with mandatory screening, since it is most probably sufficiently cheap and gives a lot of useful information, but after this step patients need to be fully informed of
    1) The actual chance (i.e. using Bayesian methods and taking into account as much information as is reasonably possible) of any given disorder, and its consequences
    2) The options available, particularly for invasive testing.

    It's obvious, but it's important, and insufficient information is a big reason people make stupid medical decisions.
    Most doctors provide information about the tests they give including stats and options. I think your point is a given. The bigger problem is that not all patients are capable and/or willing to understand their options nor the ramifications of each option.
  • It's obvious, but it's important, and insufficient information is a big reason people make stupid medical decisions.
    People make stupid decisions even when given the correct information because they have no understanding of probability or statistics. Even if you tell someone the exact specific odds of something like this, that in no way is going to help them make a better decision. These are the same people who buy lottery tickets.
  • I would equate being "fully informed" to actually knowing what it all means, particularly the statistics.
  • I would equate being "fully informed" to actually knowing what it all means, particularly the statistics.
    Good Luck with that.
  • It's obvious, but it's important, and insufficient information is a big reason people make stupid medical decisions.
    People make stupid decisions even when given the correct information because they have no understanding of probability or statistics. Even if you tell someone the exact specific odds of something like this, that in no way is going to help them make a better decision. These are the same people who buy lottery tickets.
    On a side note: I buy a lottery ticket with my office as an elective contribution to NYS education and to partake in a shared social activity. I have so little in common with my co-workers that taking part in something like this provides a social lubrication that makes my workday much more pleasant. $2.00 a week for NYS education and a better work environment is well worth it.
  • edited October 2009
    I would equate being "fully informed" to actually knowing what it all means, particularly the statistics.
    Good Luck with that.
    Well, the terminology is just a debate of semantics. The point is that I agree with Scott and Kate - people need to understand the information they're given; we should try to make them understand, if we can.
    Post edited by lackofcheese on
  • edited October 2009
    Well, the terminology is just a debate of semantics. The point is that I agree with Scott and Kate - people need to understand the information they're given; we should try to make them understand, if we can.
    Well, I think we should provide them with the information. If they are unwilling to utilize said information then there is almost no way to enforce it. If they are incapable of understanding it, then why the hell don't they have a guardian to make these decisions on their behalf?
    Post edited by Kate Monster on
  • This just shows how we have failed to grasp how genetics can help us. *note* This usually were someone cries "Eugenics". But did the communists not have a welfare scheme. So does most of the west. So the Nazi's practised rudimentary genetic screening, they also build roads and houses. Is that Nazi now.....? Using genetic testing to lower the rate of dangerous genetic abnormalities is not *nazi* but responsible.....
    Nice attempt at reverse Godwin, but still Godwin.
    Goddamn it!
  • Goddamn it!
    Were you going for a Godwin, or were you actually wanting to have a discussion about Eugenics. I recently read a fascinating book about programs in Central and South America. I think Nazi's ruined Eugenics debates in the same way they ruined swastikas, charlie chaplin's moustache, and anti-semitism.
  • I think he was attempting to pre-emptively play an anti-Godwin defense maneuver, not realising that his anti-Godwin defense was in itself a Godwin.
  • Well, the terminology is just a debate of semantics. The point is that I agree with Scott and Kate - people need to understand the information they're given; we should try to make them understand, if we can.
    This is a problem I run into quite often in the public health arena. In order to actually understand all the consequences of, say, a screening test for Down's and the subsequent confirmatory invasive testing, you need a lot of specialized knowledge. A whole lot, as a matter of fact. This is why we have specialists and experts; no one person can actually know enough about everything in order to make all the decisions they need to make. Instead, people need to be taught how to analyze facts and such in order to make intelligent decisions. More critical thinking and less information, in other words.
    I agree that legally, the option of invasive testing should always be available, in the same way that the option of abortion should always be available, but there needs to be some morally sound basis for deciding when and when or when not to do an invasive test. Let's define it more clearly.
    How about this? Whenever a positive result is obtained on the screening test, you're entitled to the invasive test for confirmation purposes; that should be standard practice anyhow (unless you want to abort based on the screening test). If the test is negative, you have to pay for the invasive test if you want it. As a diagnostic microbiologists, I know that screening tests are over-conservative and err more on the false positive side. The false negative rate in such tests is generally so low that's it's virtually non-existent. So, a positive result usually needs confirmation to be as sure as possible, but a negative result is as reliable as can be reasonably expected.
  • edited October 2009
    Instead, people need to be taught how to analyze facts and such in order to make intelligent decisions. More critical thinking and less information, in other words.
    Very much so, but what do we do with those who cannot be taught, or refuse to be taught?

    Only sponsoring invasive tests for positive screening results is reasonable, but a probabilistic threshold makes more sense. This might mean that, say, you only get the test for free if you're above a certain age and/or you have a positive screening result.
    Post edited by lackofcheese on
  • edited October 2009
    Instead, people need to be taught how to analyze facts and such in order to make intelligent decisions. More critical thinking and less information, in other words.
    Very much so, but what do we do with those who cannot be taught, or refuse to be taught?
    That's a decent rule of thumb, but a probabilistic threshold makes more sense. This might mean that, say, you only get the test for free if you're above a certain age and/or you have a positive screening result.
    What do you mean "what do we do"? If someone is mentally handicapped and cannot attain the most basic reasoning skills (and I mean actually basic, not what Scrym might consider basic), then they should be under the supervision of a guardian that can make decisions on their behalf. If they choose not to make an informed decision, then that is their choice. Freedom is a double edged sword.
    Post edited by Kate Monster on
  • You're right, the best answer is "nothing at all", but I'm interested in seeing alternative responses if there are any.

    However, introducing some kind of standardized test for basic reasoning skills might be a good idea.
  • You're right, the best answer is "nothing at all", but I'm interested in seeing alternative responses if there are any.

    However, introducing some kind of standardized test for basic reasoning skills might be a good idea.
    Creating one standardized test for basic reasoning would not only be problematic, but impossible to implement and highly biased.
  • edited October 2009
    but a probabilistic threshold makes more sense.
    No it doesn't. The test itself has a given false-positive rate irrespective of the age of the mother. It has to do with the chemistry of the test. Yes, there is a low chance of a young mother actually having a Down's child, but the false-positive rate is still only 5%. It makes just as must sense to do additional testing no matter the age range.
    Post edited by TheWhaleShark on
  • edited October 2009
    I don't mean "standardized test" in the usual sense - it wouldn't even have to be entirely on paper. However, some kind of test would be very handy since it would pick out at least some people incapable of making decisions. The idea of "lack of basic skills" being a sufficient condition to require a guardian implicitly means that there is a "standard" to the test. Anyone who fails would be put under review before they were forced to have a guardian, however.

    I disagree that the test would be inherently biased. Very difficult to implement - yes, but not impossible. It would probably require individual instructors, more like a driving test.
    Post edited by lackofcheese on
  • edited October 2009
    but a probabilistic threshold makes more sense.
    No it doesn't. The test itself has a given false-positive rate irrespective of the age of the mother. It has to do with the chemistry of the test. Yes, there is a low chance of a young mother actually having a Down's child, but the false-positive rate is still only 5%. It makes just as must sense to do additional testing no matter the age range.
    The false-positive rate tells you how likely it is for a person without the disease to be diagnosed as having the disease. This probability is not the one we're concerned with - we want to know how likely a person screened as having the disease is to have the disease, given the other information we know about the person. The first one is independent of the person, and always has a value of 5%. On the other hand, the second is heavily dependent on the person - for example, it is 0% for someone who is known not to have the disease, and 100% for someone who is known to have the disease.

    Bayesian probability. Read up on it.
    Also, watch this TED video:
    Post edited by lackofcheese on
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