Everworse: What’s Wrong with Selecting for Disability?

by Mark Greene and Steven Augello


New Technologies, New Choices

If the astrologers are to be believed, parents have long had the ability to influence the fortunes and characteristics of their future children; all they need do is time conception in the hope that birth will occur with the sun in a suitably propitious constellation. But the astrologers are not to be believed. Instead, prospective parents are turning to new reproductive technologies, including pre-implantation genetic screening and embryo selection, as a means to exert some influence over the characteristics of future offspring. Although the significance of genetics is often exaggerated—our genes are not our destiny—genetic selection has a far better claim to efficacy than astrological selection.

We distinguish three applications of genetic selection: selection on non-disease characteristics; selection against disease or disability; and selection for disease or disability. Selection on non-disease characteristics (whether aimed at enhancement, such as selection for high IQ, or simply at satisfying parental preferences for a baby of a particular sex or with a particular eye color) is the most controversial application of genetic selection, evoking fears of eugenics, designer babies, and toxic parental expectations. Although selection against genetic disease or disability has its critics, it is already widely accepted in actual medical practice. But it is the third application, selection for disability, that comes closest to being uncontroversial, striking many people as just obviously wrong.