An Attempt to Ground the Expressivist Objection in Actual Practice Flounders

Abstract

Klein claims that current practice in the context of fetal selection and screening (FSS) falls well short of acceptable standards in very many instances. He refers to “FSS practices [that] are too often derivative of inaccurate and disparaging models of disability and disability experience . . . and sustained ignorance of disability issues [which is] evident in medical attitudes, practice, education, and research” (Klein 2011, 8). Moreover, the complaint is based upon a considerable degree of empirical evidence that is cited and discussed in the paper. For example, we learn that health care professionals (HCPs) are much more likely than lay people to favor termination of pregnancy when disabling traits are diagnosed in the fetus, and that these negative attitudes insidiously ‘pollute’ the decisions of people in the context of FSS, making them more likely to opt for termination of pregnancy. Worse, disturbing reports of women feeling pressured to opt for amniocentesis are also described. The paper also draws attention to more general problems in the responses of HCPs to the health problems of people with disabilities, which stem from stereotyping and prejudice. Obviously, one would not wish to defend such practices, and one can only endorse the claims in the paper for radical change in the education of health care professionals in relation to disability. Yet there is a tendency in the paper to overstate the negative aspects of care. For example, Klein states that “a large minority of [women] did feel pressured to consent to amniocentesis” (8)—so presumably the majority did not feel similarly pressured. We learn that “13% of physicians would emphasize the negative aspects of sickle cell anaemia, cystic fibrosis, and Down syndrome” (8), so presumably the rest would not. There are other similar examples in the paper in which Klein opts to interpret the data negatively as opposed to positively. The significance of this is that, given the statistics cited in the paper, it does not look promising to claim that there is a campaign, consciously or unconsciously orchestrated, against disabled people, nor does it look promising to claim that there is an institutionalized prejudice against disabled people in the health care professions. The statistics are definitely a cause for concern and as the author recommends, certain measures—perhaps