Why Are There Fewer Abortions? Ctd

Marcotte isn’t convinced by Frum’s theory that the abortion rate has gone down thanks to the pro-life movement convincing more women to carry their pregnancies to term:

Yes, the abortion rate is down. But if that was due to women choosing childbirth over abortion, then we’d see a subsequent spike in the birth rate to go along with the abortion decline. But as Joerg Dreweke at the Guttmacher Institute pointed out in a 2014 analysis of the same abortion numbers Frum is looking at, “the decline in abortion between 2008 and 2011 coincided with a steep national drop in the birthrate”—13 percent and 9 percent, respectively. “By looking at abortion and birth numbers, this point becomes even more clear: Between 2008 and 2011, abortions declined by about 150,000, but births by roughly twice as much (down about 300,000),” he adds. Women aren’t “choosing life” more. On the contrary, they’re just getting pregnant less.

To be fair, Frum anticipated this objection and thought he had answered it: “At any given moment nearly 40 percent of women are using no birth-control method at all. Almost half of all American pregnancies are unintended.” An interesting point, but it doesn’t change the baseline fact that women just aren’t getting pregnant as often. So what’s going on? … The likeliest explanation is probably the most mundane one. It really is about the contraception.

Why Are There Fewer Abortions?

Birth Rate Single Women

This should be cause for major celebration on the pro-life side. Elizabeth Nolan Brown highlights a new CDC report finding that the abortion rate in the US fell steadily from 2002 to 2011, reaching its lowest level since Roe v. Wade was decided in 1973:

Overall, there were 13.9 abortions per 1,000 women in 2011, down 5 percent from 2010. There were 219 abortions performed per 1,000 births, down 4 percent from the previous year. Analysts say the decline has less to do with abortion restrictions passed in various states than with the recession and an overall decline in pregnancies and birthrates.

Pointing to the chart above, Frum advances a theory to explain this decline. The increasing acceptance of single parenthood, he argues, has encouraged more unmarried women who become pregnant to carry their pregnancies to term:

Women who already have one or two children outside marriage may continue to choose abortion as a way to avoid a third or fourth. As the Guttmacher Institute notes, 61 percent of women who have abortions are already mothers. But the urgency of having an abortion to terminate a first pregnancy has clearly faded, as single parenthood has become the norm for non-affluent Americans of all races.

This is the fascinating irony of the pro-life movement. The cause originated as a profoundly socially conservative movement. Yet as it grew, it became less sectarian. Women came to the fore as leaders. It found a new language of concern and compassion, rather than condemnation and control. Most radically and decisively, the movement made its peace with unwed parenthood as the inescapable real-world alternative to abortion.

Max Ehrenfreund agrees with Frum’s analysis, but isn’t sure the pro-lifers had that much to do with it:

That might be giving the conservative movement too much credit. Public attitudes about abortion have held steady in recent years, even as the rate of births to unmarried mothers has continued its steep climb. It looks as though unmarried women are making decisions about pregnancies more or less on their own. Whatever the explanation, Frum’s conclusion seems sensible: the best way to get people to create and stay in families is with policies that make raising a family genuinely easier.

Abortion, The Islamic Way

Indonesia, the world’s most populous Muslim-majority country, also has one of the world’s highest abortion rates: 37 per 1,000 women compared to 16.9 in the US. While investigating what’s behind the high prevalence of the practice in Southeast Asia, Tom Hundley discovers that what Islam has to say about it is not as clear-cut as you might expect:

Islamic jurisprudence does not encourage abortion, but unlike the Catholic Church, it does not absolutely forbid it. Scholars of the Hanafi school of Islamic law, the most widely followed of the four schools of Islamic jurisprudence in the Sunni world, generally accept that abortion is allowable within 120 days of conception. In Indonesia, where the Shafi’i school is predominant, the ulema (religious scholars) agree that abortion is allowed within forty days of conception—this reflecting the commonly held belief that Allah instills the fetus with a soul on the fortieth day.

Opinion varies widely on permissible grounds for abortion. Almost all religious scholars agree that abortion is allowed to save the life of the mother. A 2005 study in Indonesia found surprising tolerance among Muslim clerics for terminating a pregnancy in the event of contraceptive failure or when an unwanted pregnancy would result in severe economic or psychological stress.

A Pro-Life Election? Ctd

Olga Khazan discusses what the failure of “personhood” ballot initiatives in last week’s election – in contrast to Tennessee’s successful constitutional amendment paving the way for more restrictions on abortion – reveals about the split between the “incrementalist” and “absolutist” wings of the pro-life movement. While voters can’t stomach the radical changes the absolutists are demanding, that’s cold comfort to Kat Stoeffel, who argues that the incrementalists are in some ways a greater threat to abortion rights:

Rather than offering sweeping amendments for a hypothetical post-Roe future, [Target Regulation of Abortion Providers laws] revoke abortion access piecemeal, starting now. … Part of the insidiousness of TRAP laws is that they are so tedious they fly under the radar of all but the most dedicated pro-choice advocates. But another part of the problem is that TRAP laws don’t frighten the voter who is indifferent to abortion but also has the resources to navigate restrictions. She’s free to think, But I’d still be able to get one if I needed to and skip voting this year, as young people (who are traditionally pro-choice Democrats) disproportionately opted to do this year.

How does this play out? Based on the belief that he had an obligation to give a fetus a chance for life, a judge in Washington, D.C., ordered a critically ill 27-year-old woman who was 26 weeks pregnant to undergo a cesarean section, which he understood might kill her. Neither the woman nor her baby survived. In Iowa, a pregnant woman who fell down a flight of stairs was reported to the police after seeking help at a hospital. She was arrested for “attempted fetal homicide.” In Utah, a woman gave birth to twins; one was stillborn. Health care providers believed that the stillbirth was the result of the woman’s decision to delay having a cesarean. She was arrested on charges of fetal homicide. In Louisiana, a woman who went to the hospital for unexplained vaginal bleeding was locked up for over a year on charges of second-degree murder before medical records revealed she had suffered a miscarriage at 11 to 15 weeks of pregnancy.

Jessica Grose, meanwhile, pleads with her fellow left-feminists to stop describing the midterms as “bad for women”, as it’s a bit condescending to the millions of women who voted for Republicans like “combat veteran and hog castrator Joni Ernst in Iowa, black Mormon Mia Love in Utah, and youngest woman to ever be elected to Congress Elise Stefanik in New York”:

It’s not just candidates that women disagree on. It’s the issues themselves. Let’s take access to abortion, which is seen as a pivotal “women’s issue.” According to the Washington Post, polling over the years has shown that there’s actually not that much difference between men and women’s views on abortion. And women may be more supportive of restrictions on late-term abortions than men are. Particularly in this election, issues like the economy and security have outweighed social issues among all voters. Which is to say, though the right to choose is incredibly important to people like me and Ann Friedman, it’s not as important to a good portion of the female electorate.

A Pro-Life Election?


Rebecca Leber worries that the GOP’s victories on Tuesday, especially in statehouses across the country, spell danger for abortion rights:

Before Tuesday, Republicans controlled 60 of 99 legislative chambers. Thanks to the election, they will soon control at least 66. Majority status in two others remain undecided, according to the National Conference of State Legislatures. The only two Democratic “successes” of the night were holding onto majorities in the Iowa Senate and the Kentucky House. The GOP also picked up three gubernatorial seats. This has bad implications for women, particularly on abortion rights. State legislatures were responsible for 200 new abortion restrictions between 2011-2013.

At the federal level, Susan B. Anthony List president Marjorie Dannenfelser celebrates the fact that “the next Congress will usher in a record-breaking number of pro-life women”:

The Congress that convenes in January will have at least 21 pro-life women, breaking a high of 18 following the 2010 elections. In 2010, there were no pro-life women in the Senate. In the next Congress, Iowa Senator-elect Joni Ernst will become the third pro-life woman to serve, joining Kelly Ayotte (R., N.H.) and Deb Fischer (R., Neb.).

While prenatal “personhood” initiatives failed by wide margins in Colorado and North Dakota, Robin Marty worries that personhood activists are already working on a new strategy focusing on the local level:

While North Dakota and Colorado were busy pushing for yet another statewide voter referendum, groups like the Personhood Alliance, a “life at conception” pro-life group formed by Dan Becker, president of Georgia Right to Life, intend to launch a “ground-breaking campaign” for 2015 that will introduce “pro-life ballot initiatives at the county and municipal level.” … By moving to a city-by-city strategy, anti-abortion activists can target just the places where actual abortions are being performed. There, at the clinic doors, they hope they might find some moderate success, since their statewide plans to pass personhood have been nothing but one failure after another.

Emma Green has more on at Tennessee’s Amendment 1, which will allow the state to enact more restrictive abortion laws:

The amendment language is specifically framed in response to the state Supreme Court’s 2000 decision in Planned Parenthood [v. Sundquist]. In that ruling, the court overturned several state statutes, including requirements that abortion procedures must take place in hospitals; that women must get counseling from physicians before getting an abortion; that they must then wait two days until having the procedure; and that “a physician may bypass the requirements of [these statutes] only when ‘necessary to preserve the life of the pregnant woman,’ regardless of her health.” …

Now that the amendment has passed, the General Assembly may have more flexibility to legislate what women must do in order to terminate a pregnancy, including those “resulting from rape or incest.” State legislators still can’t create statutes that violate federal legal standards on abortion—it can’t be outlawed entirely, for example. But they will “almost certainly” have a greater ability to pass restrictions on how and where women get the procedure, said [Hedy Weinberg, executive director of the American Civil Liberties Union of Tennessee]—and they plan to, she added.

 notes that Tennessee was previously “something of an anomaly in the South, where it was the only state without significant abortion restrictions on the books”:

That meant a large number of women from surrounding states such as Arkansas, Alabama, Mississippi and Kentucky would travel to Tennessee to receive the procedures. About a quarter of the abortions in Tennessee are performed on women traveling from out of state, the Tennessean reported.

Anita Wadhwani talks with a supporter of the law who “believes Tennessee lawmakers will now have the ability to pass laws that deter out-of-state women from coming to Tennessee for the procedure”

“If we have an informed consent law and a waiting period, the incentive for women to leave their home state to come to Tennessee will be reduced,” said David Fowler, president of Family Action Council of Tennessee and a former state senator who originally proposed the constitutional amendment in 2001. “Tennessee in my opinion took the notion of abortion on demand to a new level, saying you can show up in the morning, have an abortion and leave that afternoon,” he said. “When the state has a waiting period law, I think you will see fewer who will find it expedient to travel to Tennessee.”

A Bad Night For Personhood

Fetal personhood ballot measures were defeated by solid margins yesterday in two states:

In Colorado, Amendment 67 — which sought to update the state’s criminal code to define fetuses as children — failed by a large 64 percent to 36 percent margin. It marks the third time that Colorado voters have rejected personhood. Meanwhile, in North Dakota, an effort to overhaul the state’s constitution to protect “the inalienable right to life of every human being at any stage of development” looked like it was poised to pass. Personhood proponents were hopeful that the conservative state would hand them their first major victory, galvanizing the push for similarly restrictive laws in other states. But Amendment 1 was defeated by similarly wide margins as the initiative in Colorado.

Noting that voters have turned down personhood in five separate ballot initiatives since 2008, Kliff reminds us that nobody is really sure what effects these laws would have:

Because no state has ever granted personhood rights to unborn fetuses, it’s really unclear how any specific amendment would work in practice. This was especially true with the North Dakota amendment, which didn’t give any particular rights to fetuses but instead required “the right to life of every human being at any stage” to be “recognized and protected.”

Supporters of both the Colorado and North Dakota initiatives argued that existing protections would still allow for legal abortion. Roe v. Wade, for example, protects legal, elective abortion during the first trimester of pregnancy. Choose Life North Dakota said that protection supersedes any state laws. But opponents argued that the amendment was written too broadly and that personhood laws would make abortion illegal. The director of North Dakota’s only in vitro fertilization clinic said that he would close his practice if Measure 1 passed. Embryos are sometimes discarded in treatment, and his lawyer warned that the practice could put workers at risk of legal action.

Even major pro-life advocates are wary of such laws:

Large pro-life groups like Americans United for Life and the National Right to Life Committee have not endorsed personhood ballot initiatives. Part of this is politics: some worried that the amendments (which opponents call draconian abortion bans) will fail so badly they’re not worth the effort, and that they will only prove an embarrassment. And there are also some policy disagreements about what it would actually mean to give personhood rights to fetuses and whether that could have unintended consequences, such as disallowing certain types of birth control. This was what Colorado’s new senator, Cory Gardner, a Republican, was getting at in March when he withdrew his support for Amendment 67.

Marcotte is particularly relieved that Coloradans shot theirs down:

Since the law would have made it a matter of homicide to cause a miscarriage, it could have been used to prosecute women who had miscarriages by accusing them of somehow failing to do more to care for their fertilized egg babies. “If you get a prosecutor who wants to make a statement about unborn life,” Aya Gruber, a law professor at the University of Colorado told Politico, “Absolutely, you could have prosecutions for miscarriages. This law allows it. It allows it!”

At the same time, 53 percent of Tennesseean voters approved an amendment to their state constitution that will make it easier for lawmakers to place restrictions on abortion. Amelia Thompson-Deveaux calls the amendment “the culmination of 14 years of work” by pro-life advocates:

They began organizing in 2000 when the Tennessee Supreme Court struck down several abortion restrictions on the grounds that they violated women’s right to privacy. That decision has until now kept Tennessee from passing anti-abortion laws like the ones that have closed abortion clinics in neighboring states. It’s been an expensive fight — in the last three weeks of October alone, the amendment’s opponents spent more than $3.4 million. Now the protections that have shielded the state’s seven abortion clinics will disappear.

You Can’t Hurry The Supremes

Dahlia Lithwick puzzles over the recent spate of high-impact SCOTUS decisions that came in the form of injunctions and cert denials. She looks to explain why “unsigned, unexplained reasoning is the new black”:

Between the state legislatures getting way out in front [o]f the court’s doctrine on voting rights and abortion, and the court’s decision to hang back and wait for conflicting decisions from different circuit courts in the marriage equality cases, what we seem to be witnessing is a Supreme Court that is dealing with events moving at lightening speeds. It may be attempting to impose what [former acting solicitor general Walter] Dellinger describes as “procedural dignity” upon the process. Even when the court issues late-night stays and unsigned orders, the court is clarifying that it gets the last word, even when the last word is haughty silence.

Thus, in the voting rights context, the court is merely ensuring that states do not put new systems in place immediately prior to the midterm elections. In the marriage equality context, the court is simply affording the states the opportunity to arrive at the correct conclusions on their own schedules.

And in the Texas abortion context, the court is reacting to a set of Texas regulations that appear to completely reinterpret (if not blatantly disregard) the rule announced by the court itself in its 1992 decision in Planned Parenthood v. Casey. As Greenhouse notes, the 5th U.S. Circuit Court of Appeals more or less ignored Casey when it ruled on the Texas abortion regulations: “In holding that the forced closing of every abortion clinic south and west of San Antonio, requiring women to travel hundreds of miles to exercise their constitutional right, was not an undue burden in purpose or effect, the Fifth Circuit ruled in blatant disregard of the Casey standard.” Really, was the court going to permit that to happen? When the court bats these issues away, it’s merely saying that nobody rushes the highest court in the land. Not even Texas.

A Long Drive To Get An Abortion In Texas, Ctd

The Fifth Circuit ruling from earlier this month that upheld Texas’s strict new abortion law – and would force most of the state’s abortion clinics to shut down – has been blocked by SCOTUS:

The justices addressed two parts of the Texas law that the United States Court of Appeals for the Fifth Circuit had provisionally let stand while it considered an appeal. One of them required all abortion clinics in the state to meet the standards for “ambulatory surgical centers,” including regulations concerning buildings, equipment and staffing. The other required doctors performing abortions to have admitting privileges at a nearby hospital. The Supreme Court, in an unsigned order apparently reflecting the views of six justices, blocked the surgical-center requirement entirely and the admitting-privileges requirement as it applied to clinics in McAllen, Tex., and El Paso.

Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. said they would have allowed the law to be enforced.

Amy Davidson compares the abortion ruling to another Fifth Circuit decision issued yesterday, which will allow Texas to enforce its voter ID law in the upcoming election:

These legal fights are about access, but they’re also about timing.

Texas bans abortions after twenty weeks. Women’s lives are not always set up in ways that allow them to simply drive hundreds of miles away, on any day they like, without making what can be complicated arrangements for work, school, or child care. For some, even gas money becomes a factor. (In that way, it would have worked as a regressive tax, too.) By the time everything is in place, a woman may have lost the chance to control her body and her future. And once you haven’t voted in an election, you’ve lost your chance—the vote won’t be re-run.

Robyn Pennacchia reviews why the admitting privileges requirement is spurious:

While this might sound reasonable if one doesn’t think too hard about it, the fact remains that you do not actually need your doctor to have “admitting privileges” in order to go to a hospital. If an emergency happens, you just go to the hospital emergency room, and they are required to care for you regardless of who your doctor is, whether or not you have even seen a doctor in the last 15 years, the reason you are there, and, indeed, whether or not you have insurance. In practice, a doctor having “admitting privileges” means pretty much nothing–but many hospitals, particularly in Texas, will not issue them to doctors performing abortions for fear of retribution from conservative donors and lobbyists.

Jonathan Adler expects more abortion-related news out of SCOTUS in the near future:

This case is likely to return to the Supreme Court later this term, and other abortion cases may reach the One First Street as well.  Most observers expect some or all of this law will be upheld by the Fifth Circuit, which would create a circuit split. (The U.S. Court of Appeals for the Seventh Circuit struck down similar requirements last December, and SCOTUS denied certiorari over the summer.) …

This is not the only abortion case that appears headed to the court.  As I noted here, the appellate courts are split on the constitutionality of state-level restrictions on the use of abortion-inducing medications.  Several states have enacted laws barring the off-label use of such drugs to induce abortions. As I understand it, such restrictions make it very difficult to use such drugs as abortifacients.  Such rules have been upheld in several circuits, but not in the Ninth, and a cert petition is now pending in that case. (Arizona filed last month and replies are due November 10.)

A Long Drive To Get An Abortion In Texas

Abortion Access

Lyle Denniston unpacks last week’s big abortion ruling:

The ruling, issued Thursday evening by the U.S. Court of Appeals for the Fifth Circuit, is expected to mean that only seven or eight clinics located in the largest cities in Texas will remain open.  Not long ago, Texas had more than forty clinics operating throughout the state.

This marked the second time that the Fifth Circuit had overturned most of a ruling by a federal trial judge in Austin blocking enforcement of provisions in a broad new abortion-regulation law that was passed by the state legislature in July of last year. Earlier this year, the Fifth Circuit had allowed the state to continue to enforce — and later upheld as constitutional — a requirement that took effect last October that any doctor performing an abortion in the state must have privileges to send patients to a hospital within thirty miles.  After that rule went into effect, the number of clinics still open dropped from more than forty to fewer than thirty.  In its Thursday ruling, the Fifth Circuit reaffirmed its view that this limitation is valid.

The second provision, not yet upheld as constitutional but now allowed to go into effect, requires all abortion clinics in the state to have facilities equal to an “ambulatory surgical center.”  It has been estimated that, if a clinic does not meet that standard, it could cost upwards of $1 million to upgrade.

Hayley Munguia illustrates the impact of this ruling with the above chart:

Certainly, an increased number of women will have to travel farther to legally obtain an abortion.

Before the new law was passed, no Texan lived more than 200 miles away from a clinic that performed abortions in the state. The closures mean that almost 800,000 women of reproductive age will live outside that range. With Texas law requiring a 24-hour waiting period after an in-person consultation, many women who make two trips to a Texas abortion provider will have to travel more than 800 miles total to legally obtain the procedure. And the clinics that are remaining open won’t have the capacity to help every woman who requests their services.

Sophie Novack talked to both supporters and opponents of the regulations:

“Abortion facilities should raise their standard of care to the level of ambulatory surgical centers to ensure that abortions are not performed in a manner that endangers the health and safety of women,” Joe Pojman, executive director of Texas Alliance for Life, said in a statement. “Texas women deserve no less.”

Abortion rights activists argue that it is a political move meant to shutter clinics and make abortions difficult to access. Health groups like the Texas Medical Association and the American Congress of Obstetricians and Gynecologists agree, saying the restrictions are not medically necessary.

“Thanks to good medical care, abortion is one of the safest procedures,” John C. Jennings, president of ACOG, said in a statement. “Under the guise of making abortion safer, these requirements actually make abortion less safe and will prevent women from getting the abortions they need. Even procedures with higher complication and mortality rates don’t have to meet these specious standards.”

Amy Davidson is among the opponents:

There is another factor, involving other numbers: poverty. The Fifth Circuit judges acknowledged that women without much money would be more affected by the law than others: they might not have a car, or a way to take a day off from work to drive six hours. But that didn’t, somehow, change the judges’ calculation.

Wesley J. Smith finds it ironic “that Planned Parenthood says only 3 percent of its business is abortion, yet closes its clinics en masse when the abortion going gets tough.” But he is unsure about what comes next:

Will the Fifth Circuit take it en banc? Don’t know. Will the case go to the Supreme Court if it survives the Fifth? I think so. Will it survive the Supremes? Don’t know.

Drum also wonders if the case will reach SCOTUS:

Conservatives, including those on the Fifth Circuit, are increasingly confident that Anthony Kennedy’s position on abortion has evolved enough that he’s finally on board with a substantial rewrite of current abortion law. And since the other four conservative justices have been on board for a long time, that’s all it takes. Kennedy might not quite be willing to flatly overturn Roe v. Wade, but it’s a pretty good guess that he’s willing to go pretty far down that road.

Waldman fears the consequences of such a ruling:

[I]f the Supreme Court were to uphold this decision, it would be a signal to every Republican-controlled legislature — one you can bet they’d heed — that there’s almost no restriction on abortion rights that is too extreme, too contemptuous of women and their rights, or too disingenuous to pass the Court’s muster. Right now, there are states where abortions are all but impossible to get; for instance, there’s only one clinic in all of North Dakota that performs them. But ten years from now, half the country could look like that.

Even states like Pennsylvania already have significant hurdles. Emily Bazelon recently reported on the arrest of a Pennsylvania mother, Jennifer Whalen, for trying to obtain an illegal abortion for her teenage daughter:

The closest clinic was about 75 miles away. Pennsylvania requires women seeking abortions to first receive counseling and wait 24 hours before returning for the procedure. The cost of a first-trimester abortion is typically between $300 and $600. Whalen works as a personal-care aide at an assisted-living center for the elderly. She didn’t have health insurance for her daughter. And she was worried about taking time away from work and her family to make two trips or to stay overnight. At the time, Whalen and her husband shared one car, which they both used to get to work. And she hadn’t told her husband about the pregnancy. “I knew he would be upset, and I was protecting the whole family,” she said. (Whalen’s husband, who waited outside in the car during our interview, declined to talk to me.)

Whalen called a local women’s center on her daughter’s behalf but was told no one there could help, she said. She and her daughter did more online searching, and a site popped up with misoprostol and mifepristone for sale for $45. Whalen hadn’t heard of the medication before. “I read all the information,” she said. “They said these pills would help give a miscarriage, and they were the same ones a doctor would give you.” She says she had no idea that buying them was illegal.

A New Eugenics? Ctd

Drum dismisses Dougherty’s argument:

These women were lying. The reason they had abortions is because raising a Down syndrome child is a tremendous amount of work and, for many people, not very rewarding. But that sounds shallow and selfish, so they resorted instead to an excuse that sounds a little more caring. Far from being afraid of eye-rolling neighbors who disapprove of carrying the baby to term because it might lead to higher tax rates, they’re explicitly trying to avoid the ostracism of neighbors who would think poorly of them for aborting a child just because it’s a lot of work to raise.

This has nothing to do with eugenic thought one way or the other.

One woman from the in-tray admits as much:

I don’t think it’s because of eugenics, stigma, or fear of being judged by the other mommies. It’s about fewer and fewer couples feeling like they could meet the challenges of a Down syndrome child in a way that’s fair to them.

So, I’m pregnant right now.

I hope I don’t have a Down baby, and I am sure I would consider abortion if it were screened. Why? Because I am a working future-mother and pretty-much sole breadwinner. It requires a lot of privilege and stability to feel comfortable raising a child with such serious disabilities. I doubt I have the extra time it would take to be an adequate parents to a Down child while also making enough money to support that child financially, and I certainly don’t have the extra money to get specialized care, which goes beyond both the medical and beyond what insurance will pay. It’s not about not wanting the “burden,” but knowing that in today’s society, I don’t have the resources to be the kind of parent a child with so many extra needs deserves to have. If I were a millionaire, it would be one thing. As someone who makes mid-five figures, it’s a very different decision.

Another reader:

The legacy of eugenics has always been troubling, and Gattica paints a picture of a slippery slope that we should guard against. But I rebel against the idea that we should resign ourselves to the fate of natural law and evolution. We can and do surpass unguided natural processes and medicine is no different.

It may sound harsh to say it, but Downs syndrome is not like having an odd hair color or even blindness. It is a condition that places substantial burdens on family members and society for the life of the person. It is a condition that usually makes the person unable to engage in society as we know it, let alone become a productive member in any normal use of that word.

I have a cousin with Downs syndrome and I respect him as a person. But I wouldn’t wish that condition on anyone. Surely there is some middle way between Gattica and mindless acceptance of the evolutionary roulette wheel.