Introduction

In 2006 a movie entitled “The Good Shepherd” came out in theaters. The movie is a theatrical representation of the origin of the United States’ CIA. At one point in the movie, Joe Pesci’s Italian-American mafia character, in conversation with Matt Damon’s Anglo-American CIA agent character, wonders, “We Italians, we’ve got our families and the church. The Irish, they’ve got their homeland. The Jews, they have their traditions. What do you guys have?” To which Matt Damon responds, “The United States of America. The rest of you are just visitors.”¹

What this remarkable comment offered the viewer was the deeply troubling notion that very real boundaries exist in this country by which human bodies are evaluated as “one of us” or “just visitor.” In this paper I will examine the evaluative mechanism known as “prenatal testing.” I will argue that prenatal testing is deeply connected with a certain mapping of human bodies, by which social deviancy is located in genetic structures themselves, with the aim of eliminating “social undesireables.” My argument therefore unequivocally contends that the way in which prenatal screening is currently practiced is inherently embedded in a sophisticated eugenic endeavor.

This endeavor is obscured by arguments over autonomy and rights, and a poor historical memory. Therefore, I will begin my paper with a brief account of some eugenicist movements in the late 19^th and 20^th century United States and England, followed by a brief description of the procedures and stated purposes of prenatal testing. I will then proceed to analyze the issue in light of universal ethics, especially as it intersects with reproductive technologies. Then I will turn to more subversive accounts for help in raising some of the critical questions, and finish by examining how an ecclesial response frames and answers these questions. Finally, I will offer my own attempt to draw together the insights of this paper in a few constructive theological suggestions.

Reproduction and Eugenics: A Selective History

Many of the issues surrounding prenatal testing are connected with questions concerning reproduction more broadly. Pfeffer explores the political history behind reproductive technologies to better understand how infertility has been constructed as a problem in the 19^th and 20^th century. Near the beginning of the 20^th century in England, public officials were very concerned about the decrease in childbirths. Pfeffer points out that there was considerable concern that the lack of children would decrease the strength of England’s imperial aims, and that England would become a “colony.”² Mussolini and Hitler exploited this concern, and made it seem even more plausible that England, like the ancient Roman Empire, had entered a time of irreversible decline (degeneration).

While Pfeffer does not draw this out explicitly, her account makes clear that reproductive technologies, and the sophisticated controlling of childbirth through prenatal screening, are historically tied to a cultural imperialist imagination. In England around 1907, the British Eugenics Society was especially concerned with helping social elites reproduce, and preventing social deviants from reproducing through various sterilizing procedures. The concern for the lack of childbirths was not just one of a decline in population, but of a particular component of the population: the masculine, strong, and beautiful.³

In the 1920s the United States began to put considerable energy into issues surrounding population control. Americans began to feel threatened by the burgeoning population in Asia. Demographic techniques for mapping various populations garnered financial backing in the late 30s, and in 1945 the decline in fertility in Europe and America “became the subject of research aimed at discovering why, in late nineteenth century, women had begun to have fewer children, in order to reproduce it strategically in other countries.”⁴ In this light, an eerie probability arises: the bombing of Hiroshima and Nagasaki was in part population control. Americans actually feared the growth of the Japanese empire. And once completed, America utilized the bombing as a way to begin studying the human genome, to determine the effects of radiation on genetic structures. Those discoveries are the basis of prenatal testing, which allows us to screen for and eliminate children discovered in utero to have genetic “defects.”⁵

In the post-WWII baby boom, anxieties over population control shifted to the impoverished but populated areas in Asia where it was feared that communism would explode.⁶ The nuclear family, the ideal family, and “family building” became important points of rhetoric in which the United States attempted to strengthen itself against the threat of communism. In this way the nuclear family is tied to American imperial, masculine, aims to shape the family correlatively with the goals of the state.⁷

Within this context the idea of family planning emerged as crucial to national health. As Pfeffer writes, “according to family building, couples must ‘space’ their children’s conception in an orderly fashion which ensures that they are born in a sequence that is manageable practically and threatens the least disruption of their sexual relationship.”⁸ She further argues, “the idea that people build families implied that techniques analogous to those used in factory management can and should be applied to sexual and marital relationships.”⁹ The way in which this planning took place is illuminated when placed alongside Nicole Rafter’s account of eugenics against the “feebleminded.”

Nicole Rafter analyzes the first eugenic enterprise against the “feebleminded” organized by Josephine Shaw Lowell. Crucial to Lowell’s efforts was the theory of degeneration. Very generally, according to Rafter, degeneration “was pictured as a tendency to devolve to a lower, simpler, less civilized state…whereas bad living could induce degeneration, clean living might reverse the process.”¹⁰ Degeneration was thoroughly linked with heredity, such that immorality, pauperism, idiocy, insanity, and crime were passed on from parent to child, and interchangeable in causality.¹¹ When this basic postulate interacted with Charles Darwin’s Origin of Species, the result was that social degenerates were mapped onto a lower hierarchy in the evolutionary scale.¹²

Eugenics found its energy in the “conclusion that society was a kind of body, a network in which a diseased member could infect the whole. Eugenics…seemed to be the best way to deal with those who were biologically, morally, and socially diseased.”¹³ There are two important points to mention in relation to degeneration: degeneration is a biologizing of social undesirables, and also puts into motion an evaluative scale. Similar to John Down’s analysis of what came to be known as “Down’s syndrome,” mental disability is linked with a reversion to evolutionary past, and therefore to an inherently inferior state of human existence.¹⁴ Yet in degeneration, disability is also connected with criminality and general social ills. This helps illumine what grounds the broad evaluative scale that is in place: cultured civility.¹⁵ The inward turn towards white social deviants has the same gestures as those in the outward colonialist expansion. The anthropological categorizing of people groups external to white Europeans is further extended in Lowell’s eugenics to map the internal populations of America.

Particularly troubling is how the eugenics movement gained momentum through the backing of Christians. Amy Laura Hall quotes extensively from early 20^th century mainline Protestant clergy and theologians, who provided significant energy and justification for why eugenics was a Christian duty and a responsibility of good parents. By investigating images and sermons of the era, Hall argues that part of the rhetoric indicated that the blood itself of “social undesireables,” their very DNA, was marked as impure and uncultivated. In this way it is an inherently racist discourse, that is dependent on a description of “good and bad blood, fit and unfit children, pure and impure races.”¹⁶ People like Napheys drew livestock analogies, suggesting that cows and pigs are bred for strong, healthy offspring,¹⁷ so why wouldn’t we be even more concerned to do this with our children?¹⁸

According to Hall, the early American eugenics movement argued for eugenics on the basis of the suffering that was incurred both by society and by the “defective” individual.¹⁹ One wonders, then, why some adamantly resist the suggestion that prenatal testing is inherently tied to eugenicist desires when these same arguments are now used in the context of prenatal screening. Hall frames our situation well: “The symbol for true knowledge and domestic progress at the beginning of the twenty-first century is the double helix. Featured at the center of the Genomic Revolution…the double helix signals a stairway to a better future for those who will make the climb.”²⁰

Prenatal Testing: Diagnosing the Undesireable

Prenatal tests have become routine tests performed on a child in utero to determine if various abnormalities are present. These tests screen for neural tube defects,²¹ chromosome abnormalities, physical or structural abnormalities, and other genetic abnormalities. The standard tests include ultrasound, CVS (chorionic villus sampling), amniocentesis, and blood tests. Ultrasounds pass high frequency sound waves through the body, thus constructing an image of the child in the uterus to detect physical abnormalities. CVS is a test in which a needle is inserted into the placenta to withdraw fragments of tissue. The tissue is tested for chromosomal oddities, and some genetic diseases.²² Both amniocentesis and CVS carry a risk of miscarriage, approximately 1 in 200.²³ Pre-implantation genetic diagnosis (PGD) occurs in conjunction with in vitro fertilization (IVF). In PGD embryos found to have “a serious genetic condition” are destroyed. Since 1990, PGD is used primarily to detect three kinds of abnormalities: familial single gene disorders, sex-linked disorders, and familial chromosomal disorders.²⁴

Blood tests measure a combination of substances in the mother’s blood. These tests are usually conducted to screen for Down syndrome.²⁵ In amniocentesis a needle is pressed through the uterine wall into the sac containing amniotic fluid, in order to withdraw some fluid from around the developing child. ²⁶ It was the first test to check for chromosomal abnormalities and is still most common. Abramsky gives an unequivocally clear statement of purpose for these tests: “They are done so that if the baby is affected with a serious disability the parents can choose to have the pregnancy terminated if they wish…The implied value judgment expressed in doing these tests is that if the quality of life will not be good enough…then it is preferable that there be no life.”²⁷

Prenatal testing is technically optional, although it is subtly (if not overtly) coercive in that it has become routinized. Parents also report sensing pressure from medical professionals to have the tests performed, and some women who give birth to children with disabilities have experienced a hostile reception from the medical personnel on hand. But crucial to medical counseling for prenatal screening is “informed consent.” To be fully informed parents must know what conditions can be screened for and which tests do so, the effects of the conditions if found, the risk involved (for child and parent), the accuracy of the tests, what preparations are necessary, and what alternative tests can detect the same condition(s).²⁸ In my reading it became evident that informed consent, while obviously seen as a benefit to the parents, also has the important aspect of preventing litigation. The medical personnel are relieved of any legal responsibility so long as the parents’ are “properly informed.”

Abramsky makes it clear that there is considerable ambiguity attached to the results of any prenatal tests, and parents need to be well aware of this. She cites “ineffective” cases in which women have aborted babies that were probably “normal.”²⁹ Why then are these tests “routine” and so commonly conducted? A recent nursing article gives some insight, as it emphasizes that parents feel a considerable amount of anxiety about their child before she/he is born. Prenatal tests can confirm the child is “normal,” and if anything unusual shows up on the tests the parents can be informed so that they can prepare for the child’s birth, that is, can at least reduce the anxiety over giving birth to a child with disabilities.³⁰

Although I thought it would be less explicit, no one seems to hide the fact that prenatal testing is done principally with the aim to terminate children discovered to have genetic defects. Prenatal screening gives parents “options,” the chief of which is to prevent the birth of a child who may be a burden to him/herself and society. As Abramsky made clear, terminating disabled children assumes that their quality of life is not sufficient. Thus, we see that as the situation stands prenatal testing is filled with intrinsic judgments about what a good life is, how it is to be evaluated, who can live such a life, and what is good for society.

Universal Approaches

Many of the concerns about prenatal testing from a universal perspective can be illuminated by a consideration of reproductive technologies generally. Of chief concern for some writers of the universal persuasion are the rights of embryos, and the status of the institution of marriage. These kinds of concerns have both deontological and consequentialist aspects. Especially for Catholic moral theologians, the discussion tends to assume that the ethics of reproductive technologies are being discussed in the context of marriage. Since the official position of the Catholic Church is that procreation properly takes place in the confines of matrimony, there is little reason to discuss the merits of reproductive technologies for couples who are not married.

Some reproductive technologies (like in vitro fertilization) raise the issue of whether it is ethical to create embryos that may be discarded. Drawing on deontological reasoning, the universal approach argues that the destruction of embryos infringes on their fundamental rights, and that reproductive technologies that depend upon the creation and manipulation of human embryos are inherently immoral.

Artificial insemination and donor insemination raise similar concerns. Catholic theologians have wondered whether it is appropriate to separate conception from sexual intercourse.³¹ According to Humanae Vitae, all marital acts of intercourse must allow for the possibility of procreation. When conception can be achieved without intercourse this presses on the commitment to narrate marital intercourse in a specific way. The consequentialist question raised is how this separation impacts the marital relationships, particularly sexual intercourse.³² Protestants, while much more varied in response, generally accept IVF, locating the bond of marriage more in the “loving relationship” than in the sexual act.

Although there are not specific Scripture passages that refer directly to reproductive technologies and prenatal testing, Catholic moral theologians tend to emphasize passages that affirm God as the Creator. Thus, the account of creation in Genesis becomes an important theological theme for underwriting the sacred nature of created life. Furthermore, God is the one who creates, which casts considerable doubt on our ability to manage procreation. Genesis’ narrative of the creation of Adam and Eve has also been interpreted as God’s creation of the institution of marriage, and therefore this configuration (which involves them becoming “one flesh”) becomes the basis for defending an understanding of marriage that depends on God.³³

The method of surrogacy is usually rejected by Christian theologians, whether Catholic or Protestant. Catholics have worried about the commercialization of embryos and how this extends to the body of a surrogate mother.³⁴ Others suggest that surrogacy infringes on the rights of women. In contrast, Ford suggests that surrogacy may “empower” women and give them the opportunity to improve their socio-economic status. On utilitarian grounds, then, surrogacy could be ethical. But this must also be weighed against the harm of giving up a child.³⁵

Ford, utilizing utilitarian reasoning, suggests that the benefits of artificial reproductive technologies (ART) have to be weighed against any potential harmful effects for the family and society.³⁶ The state may institute certain laws for the common good, of which Ford notes the cessation of research on ART for those of “advanced age.” Yet he also asserts that ultimately the decision to undergo ART treatment lies with the couple, who must weigh the risks and benefits.³⁷

It is important to notice how these approaches address the question of reproductive technologies. The arguments focus on the weighing of “rights,” those of the embryo against those of the mother and society on the whole. Ford makes this clear when he suggests that ultimately the decision must be made by the parents. This also reveals that in the universal approach the matter seems to be more about determining what kinds of reproductive technologies are morally permissible and which are not. This extends into prenatal testing as well. Thus, questions about what these sorts of technologies and tests suggest about our society’s configuration of the family and childbirth are not asked.³⁸

In this light prenatal testing can be addressed more directly. A helpful heuristic question is why women undergo prenatal testing. Like the above, Ford notes that most pregnant women are anxious about having an “abnormal” baby. “Society’s attitudes towards abnormality and disability, along with the desire to avoid burdens and sufferings for their child and themselves, were potent considerations in women’s perception of risk.”³⁹ He points to a study conducted by Searle in which the vast majority of women thought prenatal testing should be a routine part of pregnancy care, in order to relieve maternal anxiety. ⁴⁰

Ford affirms that, “prenatal information may also be of benefit to obstetricians for the better management of the pregnancy, and the prevention of an unnecessary caesarean delivery.”⁴¹ However, “routine prenatal diagnosis does not usually provide information that could lead to fetal therapy. But it can give information that may help provide medication or therapies for the benefit of some fetuses, with the exception of chromosomal and neural tube defects.”⁴²

In these considerations Ford helps name anxiety and future planning as the two primary rationales for prenatal testing. The way Ford names these, though, is important. He remarks that pregnant women have prenatal testing “to be reassured their fetus is normal, to seek any available fetal therapies, or to prepare themselves to care for a child with a disability.”⁴³ It would seem that the anxiety associated with prenatal testing is due to the fear that one will not have a “normal” child. Ford is unable to ask what “normal” is, and who gets to claim it, because he is preoccupied with questions about the benefits of prenatal testing to parents and society, and so Ford’s largely consequentialist considerations lead him away from the most important questions.⁴⁴

Gareth Jones is even more aggressive than Ford. While Ford expressed some reticence to recommend wholesale the selective termination of those who in utero are diagnosed as “disabled,” Jones is much more willing to see this as a part of responsible parenting. Jones echoes what has already been observed, that prenatal diagnosis is utilized to assess the wellbeing of a fetus.⁴⁵ Again, it is quite clear that the purpose of such tests is to detect abnormalities. Since it is the case that the majority of “abnormalities” cannot be treated in utero, or at all, it is difficult to sustain the argument that prenatal tests are separable from the judgments concerning who is abnormal.⁴⁶

Jones discusses dispassionately the introduction of a new form of “cure” in medicine: termination of life, the goal of which “is to overcome abnormality and suffering by means of non-existence.”⁴⁷ Jones largely dismisses objections to prenatal diagnosis, remarking that the tests can be helpful even for parents who continue with the pregnancy, both in care for the fetus and in preparation for the child’s birth. Like Ford, he says that mothers cope better psychologically when they are aware beforehand that they are giving birth to a child with a disorder.⁴⁸ But this argument seems vapid, considering it merely makes evident the social expectations and constructions of what a good birth is, and highlights the anxiety associated with receiving a child with disabilities.⁴⁹

Jones’ only semi-response comes in his assessment of pre-implantation genetic diagnosis, in which he says we should not expect it to provide us with perfect children. Yet with this expectation for attempting to create perfect children “is a noble desire: to do the best for our children.”⁵⁰ His only caveat is that with the increasing ability to sustain and create “health,” the very concept of “health” is changing so as to make even minor conditions (e.g. cleft lip) eligible for termination. This “increasing range of conditions” is worrisome to Jones.⁵¹

Jones’ advice for a theological response to PGD is to emphasize PGD as voluntary, steering clear of coercion. Also, Christians should applaud “therapeutic goals as long as these do not jeopardize the integrity of human personhood.” And he also remarks that “we would not expect the allegedly eugenic nature of PGD to feature in theological arguments.”⁵² Here again, the way in which deontological and utilitarian arguments are deployed obscures the deepest questions surrounding prenatal diagnosis. Whether PGD is coerced by the state is not really the question at hand. There is a far deeper and more profound coercion that has already taken place to make it possible for the tests to even exist, and which continues to energize them and create anxiety that is only quelled when the allegedly “innocuous” tests are conducted.

Subversive Approaches

The Catholic Church’s response to reproductive technology is not based only in what could be considered universal concerns. Rather, it shares in particular one important aspect of feminist accounts of these technologies; that is, the importance of embodiment. Lauritzen points to the two primary reasons why the Catholic Church rejects most reproductive technologies: first, the Church asserts the unified totality of the human being, body and spirit. Thus, the separation and “medicalization” of the body involved in reproductive technologies threatens a fundamental aspect of human nature. Second, the Church sees an “irreconcilable” difference in human procreation and other animal procreation. This difference is based in the “natural law” which circumscribes human reproduction to any form “that includes sexual intercourse between partners in a loving monogamous marriage, helps facilitate the natural process of procreation, and is therefore acceptable.”⁵³

We can see here the overlap in deontological reasoning based in natural law, with a form of “embodiment reasoning” which is concerned for actual bodies. Of course, some feminist critiques would minimize the similarity, arguing that the more important question is whose body is referred to. According to Raymond, the Catholic Church focuses on embodiment in “a context of opposition to violence against fetuses,” whereas feminists locate embodiment in “a context of opposition to violence against women.”⁵⁴ While Raymond may over-emphasize the discontinuity, her point is significant, and I wonder if the subversively resistant potential of the Catholic Church’s position is undercut by its focus on the rights of the “fetus.”

The typical subversive approaches also draw on creation accounts, especially pointing to this importance of embodied existence. God creates real human bodies, so says Genesis, and in order to take seriously the revelation of Jesus Christ we must take seriously his embodied existence. Of course, the Gospel is also a significant impetus for subversive concerns for liberation. What we see, therefore, in a subversive approach to prenatal testing and reproductive technology, is explorations as to whether these technologies contribute to the oppression of marginalized groups. The Scriptural argument buffeting the subversive approach has these two primary prongs: God has created our bodies, and those bodies are liberated by the Gospel of Jesus Christ. Anything that resists that liberation and perpetuates oppression must be exposed.

By focusing on the wider social context of prenatal testing and reproductive technologies, feminists have opened up some of the most important questions to which I point in this paper.⁵⁵ Thus, Cahill is interested in broadening the discussion from protecting women’s rights in decision making to include other questions of social-justice. She suggests some feminist thinkers have neglected this important aspect of the debate, and therefore the debate becomes one generated by the elites and conducted on behalf of the elites.⁵⁶

Cahill’s article discusses the Human Genome Project (HGP), and its aspirations to map exhaustively the human genome in an effort to advance medical diagnosis and treatment of genetic disease.⁵⁷ This effort raises a number of questions that Cahill subsequently addresses. Cahill indirectly discusses the question of what is considered “genetic disease,” and how these criteria are connected with social and political norms of the human body. The efforts of the HGP open up immediately to serious theological questions. How do we think about the body in a context where the body has been so thoroughly medicalized that its goodness has been made inseparable from its genetic makeup? How ought we think about “genetic disease” and what constitutes such “diseases?” How do the very processes of diagnosis and treatment affect the way we think about the body, and about the proper body?

These sorts of questions lead Cahill to probe the economic propensities of the HGP. While the project itself is being conducted by an international group that makes its findings known free of charge, competing groups (like Celera) are attempting to “out-research” the HGP in an effort to patent such genetic technology before it is made available by the HGP. One of Cahill’s most salient concerns is the way that reproductive technology is and is becoming thoroughly commodified. She writes, “perhaps most importantly, [the possibilities of genetic discoveries] are likely to have a negative effect on groups already suffering from social exclusion, within which women are doubly disadvantaged.”⁵⁸ Here Cahill suggests that because the new reproductive technologies are tied to a political economy that makes access to these technologies impossible for those with few material means, they reify a sharp divide between the “haves” and the “have-nots.”⁵⁹

It does seem strange that in our world, in which the majority of the population is bereft of basic medical care, we have chosen to spend our time devising “medical solutions” to the “problem of infertility” (a telling phrase to be sure). Reproductive technologies cannot be implicated wholesale in this dilemma, but it also cannot be overlooked that both the rationale for their development and their actual deployment is carried out in contexts of the socially elite and powerful. In this way, these technologies are inherently bourgeois. The question, often unasked, is whether the context in which they arise has inescapably determined these technologies as promoting bourgeois conceptions of the “proper” human body. My worry is that the very technologies are so tied to bourgeois culture that, as we currently know them, they promote a certain evaluative scale that still lingers from European colonialism and a century of American “progress.” Reproductive technologies are not just about helping infertile parents have children, but about helping them have particular kinds of children.

This is made even more evident by what, or rather who, the technologies are seeking to prevent. This brings us back to our primary consideration of prenatal testing. With respect to the research that makes prenatal testing possible, Neeve and Farrell ask whether anyone should be allowed to profit from genetic research. They express concern about the commodification of the human genome.⁶⁰ Since the case of Diamond v. Chakrabaty there has been an explosion of DNA sequence patents. One concern “about the commercialization of human genetic research is that private industry will develop solutions to exploit previously unknown problems…unnecessary products will be produced for the public to consume.”⁶¹ They put forth the analogy of medically necessary surgery and cosmetic surgery. “Garland Allen has noted that we are becoming increasingly unwilling to accept imperfections in ourselves, and commercialization could foster a climate in which eugenic decisions will be encouraged.”⁶² Here we see again the intersection of the commodification of the body with a particular vision about what they body should be. Genetic “defects” are “imperfections,” which with the right price can be successfully detected and eliminated through prenatal testing and “selective abortion.”

Cahill also raises questions concerning the social pressures that determine women’s role and purpose. Reproductive technologies may perpetuate images of the woman as sacrificial child-bearer, whose existence is subsumed in the iconic mother. Prenatal testing carries explicit descriptions of which children should not be born, and the social pressure on women to eliminate these pregnancies is enormous. Cahill does not press deeply at this point, but she has pointed to an important aspect of prenatal diagnosis: it is the medicalization of an image of the ideal family, which is tied to a vision of the ideal society, citizen, and human being.⁶³ For reasons like this, Cahill contends that feminist concerns will have to go beyond protection of reproductive liberty. “It will require resistance to all conditions that create ‘forced choices,’ for example, the stigmatization of genetic disorders and lack of support for disabled persons and their families…genetic testing leads to employment and insurance discrimination, as well as pressure to terminate pregnancies.”⁶⁴ At this point, feminist concerns, economic concerns on behalf of those living in poverty, and disability concerns coalesce.⁶⁵

Ecclesial Approaches

Like subversive critiques of prenatal testing, ecclesial critiques often require paying attention to actual stories of real people. In light of this, I will begin this section with a brief summary/analysis of an article co-written by Brian Brock and Stephanie Brock, about their experience giving birth to a child diagnosed with Down’s syndrome, Adam. It is quite clear in the Brocks’ article that their assumptions about what Adam needed were at odds with medical personnel before Adam was even born. They sought the pre-natal care of a midwife because of the pressure from Frauenklinik, a German clinic, to establish gestational age.⁶⁶ The rationale for the testing was ambiguous, and the Brocks write, “this places the question in the foreground of whether there are serious medical reasons for establishing gestational age, or whether this is inherently tied to the pressure of legal deadlines for abortion.”⁶⁷ There was little indication that the testing was being pressed on behalf of the medical interests of Stephanie and Adam.

Once Adam was born the Brocks found serious opposition for their reticence to test Adam for Down’s. While Adam was in the hospital a mere few days after he was born, the staff tested Adam’s blood without parental permission, suspecting Adam might have Down’s Syndrome. Although the initial test was inconclusive, the head physician intended to run a new test, apparently never considering that Stephanie and Brian might object. The Brocks refused to allow another test to be conducted, since they received no solid answer as to how the test would aid Adam’s treatment. They write,

the only reasons offered for having the genetic test fell under the category of ‘for future planning.’ …However, we soon found that the real reason to test our son’s chromosomes was to know what kind of Down’s he has…Now the point of the discussion and the push for testing began to emerge from the murk of scattershot argumentation: you wouldn’t want to have any more of ‘these children’.⁶⁸

For Stephanie and Brian, the implication was that the test would help them prepare for the future, which principally meant avoid having another child with Down’s.⁶⁹

From the Brocks’ observations it seems that it may be that Adam terrifies those of us so deeply shaped by the medicinal practices of our society. Viewed from the perspective of diagnostic testing, Adam was a specific statistic, a configuration of genetic material that in its very composition mocks the attempt of medicine to “cure.” Adam cannot be “cured,” but he can be controlled. Genetic testing is only the first means by which Adam can controlled.⁷⁰

In another article, Brock draws on Christian worship to explore prenatal testing by turning to Luther’s concept of sin as anti-doxology. Brock explains

For Luther sin is made up of…aberrant responses to God’s gifts, consisting in filled-out and personified anti-doxology…Luther sees the Psalter as a primer in which Christian faith is taught to praise, in so doing exposing anti-doxologies and the ways they obscure the living presence of grace.⁷¹

By describing sin this way, Brock helps us see the way in which Christian worship exposes those areas in which we are singing praises to human beings. Christian doxology precedes social critique.

In a characteristic ecclesial ethics response, Brock points to the “annunciative character of a genetically anomalous fetus,” suggesting that “the disabled, whether born or unborn, announce an end to our need to draw boundaries between them and us, announcing too that the political is not maintained by violence, but by openness to being surprised by the birth of the unexpected.”⁷² That is to say, that the way in which Christians have been taught to praise God means that children born with disabilities are received in praise and gratitude. He argues that in the church this positive annunciation can be heard, and only in hearing it can the anti-doxologies be exposed.

The basis of the church’s worship is the Scriptural witness to God as the Creator, and to the particular way in which God is revealed as the Creator. Meilaender quotes Josef Pieper to say that “love is a way of saying to another, ‘It’s good that you exist; its’ good that you are in this world!’” It is because we are first loved by God that we are able to love God and others. For this reason Meilaender argues, “Christians ought to set themselves against prenatal screening, at least as it is currently practiced in this country in an increasingly routinized way. For it stands in conflict with the virtue that would say to another: ‘It’s good that you exist.’”⁷³ In this way Meilaender draws deeply from the Scriptural affirmation that God’s creation itself is a gift of love, and God’s redemption is a matter of God seeking out alienated humanity when we did not seek for God.

Brock sees an important distinction between prenatal screening, and prenatal care, which has governed my work in this paper. He analyzes the process of prenatal testing/screening into three major actors:

the geneticists and laboratory technicians whose technical work allows and generates the claim that there is a clear boundary here at this point, the genetic counselors who lead pregnant women to this boundary and explain to them what it entails, and the woman (and perhaps father) who will make the decision about whether to end a particular pregnancy.⁷⁴

Brock argues that the very notion of prenatal testing is inseparably linked with evaluative judgments concerning who properly belongs to the political body.⁷⁵ The prenatal testing processes establish criteria by which to diagnose and name certain genomes as “defective.”

One of Brock’s assumptions is that “before borders are constructed as physical barriers they are collective agreements about boundaries between ‘us’ and ‘them.’”⁷⁶ The boundary Brock is chiefly interested in is the one interpreted by geneticists. He draws on the work of Rayna Rapp to describe how amniotic fluid is medicalized and turned into statistics of “fact.”⁷⁷ He shows how the actual laboratory process is somewhat ambiguous, although the result demanded is one of reassurance and certitude.⁷⁸

Although rarely unambiguous, it tends to be minimized that the process is one of interpretation,⁷⁹ and the geneticists ultimately make the call concerning whether a “karyotype is normal or abnormal.”⁸⁰ Karyotyping is a craft involving interpretation, which is witnessed in the procedural fact that genetic anomalies, if discovered, “can only be identified by comparison with known anomalies.”⁸¹ Brock points out that this essentially means “all genetic diagnoses are judgments resting on consensus opinions inherently open to revision.”⁸² Genetic counselors (95% female) help parents, but primarily the woman, struggle through the process of prenatal screening. The tests are to rule out the anxiety that goes along with childbirth, and to alert the parents to deformities so they can be dealt with (informed consent).

Brock argues that genetic counselors serve the functions of establishing the authority and priority of scientific discourse, as well as communicating risk and constructing a medicalized version of family history.⁸³ The assumption of the counselor is the trustworthiness of the geneticist’s diagnosis, which reveals the bias for professional medical expertise.⁸⁴ Undesirable births are generally seen as “accidents” that can be avoided through prenatal testing. Brock concludes, “it appears then that prenatal diagnosis…expresses a biomedical account in which prenatal screening precedes and is more fundamental than prenatal care.”⁸⁵ He further remarks that completely lost is the reception of children as gifts, and what remains is an “anti-doxology lifting up the promises of perfect control, benevolent expertise, and a life free of ‘accidents.’” ⁸⁶ In a strong indictment of contemporary prenatal screening, Brock concludes “the whole institution of prenatal testing is built on the assertion that we must choose who we will accept into the human polity. Its mechanisms are designed to teach that this is a real choice, and to teach people to sing the praises of the techniques that can save individuals and families from ‘accidents.’”⁸⁷

Hall contributes to the ecclesial discourse by focusing on the normativity of Jesus. She constructively asks the question, “On whose blood is our hope built?” She argues that our salvation wrought in Christ’s blood witnesses against our attempt to achieve salvation through genetic testing and evaluation of human blood. “The field of human genomics proposes to decode the definitive language of human normality itself…the genomic project promises…an account of who we are as human beings.”⁸⁸ This is evident in the very language of “abnormal.” The basis of abnormality is a genetic defect. The implication being that there is a certain normative genome, by which other genetic structures can be measured. What it means to be human is being read into and out of the language of DNA.⁸⁹

Christian eschatology challenges the story told by prenatal testing, in which we anxiously attempt to secure the future of our society through the manipulation of conception, so as to produce “strong,” “productive” children. Hall contends, “The idea that one’s genetic parentage is an indication of one’s place in God’s salvation history is heresy.”⁹⁰ To resist the norms of planned parenthood, Christians must speak of the way forward not as progress by way of the march of children to advance the race, but “through the inscrutable birth of one child – the Word made flesh in an inauspicious manger surrounded by livestock.”⁹¹ Therefore, Hall powerfully suggests, “I…wish to encourage women configured as progressive to recognize that Christian faith is, in an important sense, a call to accept into our lives children who will not ‘get better,’ learn to read, or make a name for themselves in the local or national paper.”⁹² Amen.

A Constructive Proposal

Drawing on the insights of those discussed in this paper I will attempt to offer some suggestions as to how Christians can respond to the circumstances of prenatal testing as we know them. First, as observed the common experience with prenatal testing is one of anxiety, both over whether one’s child will be “disabled” and over actually giving birth to a child with a disability. As Hall points out, this suggests that a particular vision of the family has been internalized, as well as a culture of medicine that is focused on cure and knowing for the sake of knowing. We might say, then, that in our society there is anxiety over the unpredictability and unexpectedness of our origins. Prenatal testing attempts to cope with the fragility fundamental to being human.

Yet this fragility is really only known as fundamentally human when it is embodied as the fragility that belongs to being a creature. That is, fragility can be lived in without anxiety when the knowledge of our weakness is received through the revelation of the God who unveils Godself as the Creator. God does so not abstractly, but as the Creator of Israel. It is Israel that God calls into existence out of nothing, who God elects to covenant with.⁹³

To be creature is to be weak and fragile. It is to be utterly instable. Israel has no stability in and of itself, but only because God elects to covenant with Israel, and in so doing reveals Godself as faithful to unfaithful Israel. This revelation helps us take very seriously the logic of the incarnation, by which God takes to Godself that which is alien to God; that is, humanity. God binds Godself to Israel in the covenant, and this binding is fulfilled in the body of Jesus Christ. What the annunciation and incarnation in the Gospels witness is God’s assumption of weak human flesh. In so doing, God makes that weak flesh sing the praises of God, and God will do so with any flesh. The utter instability of creaturely life is not overcome in the incarnation, but placed in its proper context of dependence on God for life and sustenance.

When we attempt to speak of our origins we are confronted with the reality that we were not there. We cannot speak of our own origin, and Bonhoeffer remarks that there are only two possibilities in doing so:

The speaker may be the one who has been a liar from the beginning, the evil one…[he] will say: I am the beginning and you, O humankind, are the beginning…lie, and you will be in the beginning and will be lord of the truth. Discover your beginning yourself…Or [it is] that other who speaks, the one who has been the truth from the beginning, and the way and the life, the one who was in the beginning, the very God, Christ, the Holy Spirit. No one can speak of the beginning but the one who was in the beginning.⁹⁴

It may be, then, that our attempts to control and shape the origins of human life is but a manifestation of the character of a humanity that has exalted itself to the place of God. We have indeed believed the lie of the evil one: we are our own beginning. We determine who is born and who is not. We believe we can cope with the fragility of our lives by striving after control over our beginnings. The biblical affirmation is that the God of Israel is the Creator, that Christ is the beginning. Only he can speak of our beginnings. This truth cannot but undermine our attempts to master the beginning through medicine.⁹⁵

The truly normative body is the one that belongs to Jesus Christ, God for humanity and humanity for God. His body always destroys every attempt to construct the ideal body. His is a body born in scandal, with no aesthetic appeal, a body covered in dirt, a body that weeps, a body that submits to suffering and mutilation on the part of the religious and political authorities. If his is the normative body, what confidence can we have in describing certain genetic disorders as “disease?”⁹⁶ How can we be certain what is disease, and does it really matter? In a culture of cure, of course, it is absurd to suggest that we not diagnose and treat “disease.” Is it not the case that it is exactly these “diseased” children that God draws to Godself?

I take that to be the case, and find Brock’s description of receiving all children in gratitude extremely helpful. Furthermore, Brock argued that prenatal testing is a kind of boundary. There is, though, a boundary that is theologically important. It is the boundary established by God in God’s election and rejection of humanity. In drawing out evil and sin and exposing it, God draws a boundary around it and rejects it. In drawing the boundary God reveals Godself as Lord even of sin and the evil one. But the eternal election and rejection of humanity has taken place preeminently with reference to one man, Jesus Christ. As such, rejection is overcome in the obedience of the Jewish messiah. Death itself is swallowed up.

The boundary, of course, took concrete shape in the election of Israel over and against the nations.⁹⁷ Which means that if Jesus’ body is where the boundary is ultimately revealed and overcome, we must speak of concrete overcoming in reference to the admittance of Gentiles to the covenant. In this movement we find an important truth that witnesses against screening to create perfect children. Jesus takes the “unnatural,” the Gentiles, and binds the “unnatural” to the “natural.” This is where we learn that the evaluative attempts to construct an ideal humanity must always fall under the judgment of God, and instead give way to the God who tends to take what we think of as unnatural and bind it to Godself, and in so doing to God’s people. To speak of humanity as fundamentally dependent is to know of Israel’s life with and before God, and of Jesus who enters the contingencies of human existence and is not overwhelmed by them. It is he who invites us non-Jews into Israel, and so to live with the God who can say of creation, “it is good.” If we are able to imagine Christian identity inside of Israel then we will be able to resist the determination of our bodies by an alleged genetic purity.

Conclusion

I do not suspect that most medical professionals who offer prenatal screening are consciously pursuing eugenic aims. My wife is a neonatal nurse, and the work she and her colleagues do is remarkable.⁹⁸ But my focus in this paper has been on exposing the demonic inside prenatal testing so as to draw it into the light and under God’s judgment. I argued that prenatal testing as practiced is inseparable from evaluative judgments concerning who should be, and who should not be born. In order to do so I told a brief history of eugenics followed by an analysis of the issue from a universal, subversive, and ecclesial viewpoint. I finished by drawing on the biblical narrative to propose an alternative way of thinking through prenatal testing. Of course, the church has practices that shape us to witness against the assumptions inside prenatal screening. In baptism the truth of our beginning is revealed as we die with Christ and rise with him. And in the Eucharist we partake of the blood of the Jewish messiah, and only his blood saves us. We live our lives, then, between baptism and Eucharist, between our entrance into Israel through Jesus’ body and the perpetual reception of life as gift in being nourished by his body and blood. And to this gift we respond, “Thanks be to God.”