Case A

Ms. Jane Bradely is a successful commercial real estate agent. She is 41 years old, recently divorced, and is the mother of a 4 year old son who has Down's Syndrome. She has sole custody of her son, Algernon. Like most people with Down's Syndrome, Algernon is typically good-natured, apparently very happy, and is mentally retarded. Ms. Bradely retains the services of a nanny to help take care of Algernon.

Ms. Bradely very much wants to have a healthy child. Towards that end, she opts for artificial insemination. Her physician warns her that the incidence of Trisomy-21 (the chromosomal aberation which results in Down's Syndrome) increases with the age of the mother. Understanding the risk, Ms. Bradely decides to go ahead with the procedure.

After several attempts, Ms. Bradely becomes pregnant. Unfortunately, karyotyping after amniocentesis reveals that the fetus has Trisomy-21. Ms. Bradely is deeply troubled by the news. She is now three months pregnant.

Having carefully evaluated her options, she decides to get an abortion.

After aborting her pregnancy she fully intends to try again in a few months.

Is it morally right for Ms. Bradely to have an abortion?

Theory Applied: IAU (Ideal Act Utilitarianism)

Conclusion: Ms. Bradely's abortion is morally permissible.

According to IAU, an action is morally permissible iff it promotes the best interests of the greatest number, considered equally, as well as any alternative action.

The question put to us here is: Is it morally right for Ms. Bradely to have an abortion? There would seem really to be just two alternative actions here-to have the abortion or not. Of course there are further actions which may be taken--i.e., don't have the abortion and adopt out, etc. But for our purposes it suffices to just consider the two alternatives.

Let us consider just who might be affected by Ms. Bradely's action. There is, of course, Ms. Bradely herself. There are also the nanny and Algernon. There is, somewhat less affected than the others, the physician. Finally we have the fetus with Trisomy-21. Are there any other people or groups who ought to be considered?

Perhaps we should take into account Ms. Bradely's clients, as they might be negatively or positively affected by her decision, however slightly. There are, maybe, other people as well. We should certainly consider all those people who might be involved in the life of the new baby if she hadn't had the abortion. We might also add in "society at large", but that seems hardly relevant to Ms. Bradely's particular situation and her decision.

Taking each person or group in turn, then, we have:

Ms.Bradely: Clearly she prefers not to have another baby with Down's Syndrome. But what she prefers or not is more or less irrelevant to what is in her best interests. Is it in her best interests to have the child or not? Suppose she has the child. Then she has to support a child for life who will himself be unable to procreate. Thus, unless she succeeds with another pregnancy, she will never have the opportunity to have grandchildren. Moreover, chances are increasingly slim that she will succeed with another pregnancy the longer she waits. Having this child will cause her to wait all the longer. Suppose (as is indeed the case) that she doesn't have the child. Then she is able to pursue having a normal child with all due speed--time, of course, is of the essence for her. She may very likely succeed in having a normal child. Is it in her best interests to do so? Presumably, yes. A normal child will bring her much greater fulfillment as a mother and will be able to contribute much more to her life. To put a cap on this argument, let us say that utility in her case (as measured by best interests) is

-7 if she hadn't had the abortion,

+5 for having the abortion.

Algernon: Algernon is a person who requires constant care. He does well with the nanny and should be expected to have a relatively fulfilling life until he dies, as most with Down's Syndrome do, sometime in his thirties. Suppose Ms. Bradely hadn't had the abortion. Then her resources would have been taxed and the nanny's attention would have been distracted. It is likely that Algernon would suffer somewhat, if not in his care then at least in the attention he receives. Attention, of course, is very important to Algernon's well being. But having had the abortion, Algernon receives all the attention he requires. Granted, he does not have a chance at a little sibling who is just like him. But he does have the chance at a normal sibling--who, naturally, does not require nearly the expenditure of care and attention as a Down's Syndrome child--which is clearly better for him. Summarizing, we have for Algernon

-6 if she hadn't had the abortion,

+4 for having the abortion.

The Nanny: She, of course, is pretty much absorbed in taking care of Algernon. Had the abortion not been performed her duties would have demanded a great deal more of her. She is presumably good at her job and will do what is asked of her. But it is much better for her if she is able to care for Algernon and a normal infant than Algernon and a down's syndrome infant.

-3 if she hadn't had the abortion,

+2 for having the abortion.

The Physician: Clearly it is in her interests to make as much money as possible (or so one might assume). Hence it is in her interests that Ms. Bradely have the abortion, since doing so increases the likelihood that Ms. Bradely will engage her services in pursuit of a normal child.

-2 if she hadn't had the abortion,

+2 for having the abortion.

The Clients: We don't know how many clients she has, but surely the distraction of having another child with Down's Syndrome will be bad for them. But presumably the effect will be minimal. Hence, let us just assign

-10 if she hadn't had the abortion,

+0 for having the abortion.

People involved in the new child's life: Had Ms. Bradely not have the abortion, the child would surely have brought much to lives of many. Let us summarize this by assigning,

+15 if she hadn't had the abortion,

+0 for having the abortion.

Totaling, then, we have

-13 if she hadn't had the abortion,

+11 for having the abortion.

Since having the abortion maximizes utility, as measured by best interests, it follows that her having had the abortion was morally permissible.