A Dialogue on Mandatory Abortion

Preface
This potentially ongoing exchange grew out of an earlier post in which I offhandedly defended the horrible-sounding practice of mandatory abortion (in the case of even more horrible, and incurable, diseases and conditions, that is).

Dialogue
Anonymous
I had a question or two about your stance on mandatory abortions. If all babies with a certain disease (for example, Tay-Sachs) are aborted, doesn't that completely destroy the incentive and ability to find a cure for that disease? Forget drug trials for that disease. Also, let's say that there's a 2% chance that the disease will not kill the person whom it afflicts, and a 98% chance that it will result in a terrible horrible death. Is that a high enough probability to require abortion? If so, isn't that probability still lower than what the judicial system should require for imposing non-lethal punishment upon a criminal defendant?

Me
It seems clear that aborting everyone with a given incurable disease would almost certainly prevent a cure. But I don't think it's worth it in certain cases. Many people would suffer and die in the costly search for a cure. On the other hand, many families would have to get abortions. Certainly the latter is a painful process - but not necessarily more painful overall than the search for a cure. I think it depends a lot on the specifics.

I'm not sure about the point of your criminal punishment analogy. In my view, a mandatory abortion requirement would depend on the expected value of a life with a given disease or condition. It would only apply in extreme cases and at the discretion of state-appointed experts who reviewed the findings of the primary ob/gyn doctors (who would be obligated to report certain diseases and conditions that met a some high standard). I'm not sure what, if any, exceptions would apply. I'm inclined to think that ideally there would be none - what could justify creating a life with something along the lines of infantile Tay-Sachs? I'm also realizing that it would be quite difficult to craft a mandatory abortion requirement, aside from the obvious objections of certain groups of people. Anyway, my response to your punishment analogy is that the relative harms of false positives and false negatives are different in the punishment and mandatory abortion contexts. I think it's worse to convict an innocent person than to mandate the abortion of a fetus that wouldn't have led a sufficiently bad life. And I think it's often more harmful to allow the birth of a baby with a sufficiently bad disease or condition than it is to let a guilty person go free. Note also that the mandatory abortion provision would only apply when a test indicates that the fetus has a disease or condition; perhaps the provision should only rely on tests that are virtually flawless. Then the only question is the expected value of life with the disease or condition. Now that I think about it, the implication of my position - which I'm fine with - is mandatory euthanasia for the incompetent in some cases (e.g., infanticide as an alternative to mandatory abortion when no sufficiently reliable prenatal test is available). To me the real problems are practical; this would be some statute to draft.

Anonymous
You're right that people would die painful deaths while humanity searches for a cure. But once a cure is found, then most -- if not all -- of the people with that disease henceforth will be able to lead full and, I assume, relatively painless lives. That condition will last forever, meaning that potentially countless lives will be saved by the cure. I agree that you have to consider the expected value of a life, and that a horrifically painful life will have quite a negative expected value. But if you really want to aggregate expected values here, don't you think that the value added by a cure, multiplied repeatedly for as long as mankind exists and uses that cure, would be quite large, and would probably result in a net positive value? I suppose you can make the argument that you're then subjecting the disease-afflicted children, who are born before a cure is found, to immeasurable suffering for the sake of speculative children in the future. And perhaps you can't add expected values of different people together. I haven't taken the time to think about my intuitions on this, but to me, something feels wrong about simply acquiescing to a disease instead of trying to find a way to cure it. Of course, this assumes that a cure can be discovered at all, let alone in the reasonably near future. In that respect, you're correct that it depends a lot on the specifics.

I'm going to leave alone your response to my criminal punishment analogy. Not only was your response effective, but also all this talk about Tay-Sachs and mandatory abortion....

Me
I take issue with the way in which you're valuing the cure. You implicitly assume that the alternative to the cure is countless afflicted people over time. But mandatory abortion/infanticide would prevent these people from coming into being. Thus the relevant cost (broadly speaking) is the cost of the mandatory procedure, which is certainly significant but pales in comparison to innumerable cases of suffering and death. It may be better to abort a diseased fetus even if a cure is readily available, because the cost of not having a child or of conceiving another child may be lower than the cost of treating the child (especially if treatment is risky or limited). In short, a cure doesn't necessarily have net positive value in the case of diseases that make lives not worth living and can be detected before or at birth.

I can see why one would view abortion as a form of acquiescence, but that's a matter of perspective, not a normative point. Besides, there's no inherent value to "fighting." It may feel better (more noble or whatnot), but does it do the most good?

I also want to note the undesirable implications of treating the values of lives as incommensurable. This may be attractive, but the alternative to measurement, however flawed, is no rational basis for decision-making. Consider environmental goods, such as the existence of bonobos, for example. Some may consider them "priceless," but this is belied by these people's willingness to trade them off for other goods. The real issue is valuation. (Should it be based on willingness to pay? Willingness to accept? Something else? How, if at all, can differential levels of wealth be accounted for?)