It wasn’t only that time. The devaluing of human life continues unimpeded, as attendees at a recent conference at the University of Rhode Island learned. At the 10th “Genetic Technology & Public Policy in the New Millennium” symposium, Daniel W. Brock, a bioethicist at the National Institutes of Health, gave a presentation entitled “Genetic Testing and Selection: A Response to the Disability Movement’s Critique.”

In his presentation, Brock argued that prenatal testing to prevent the birth of severely disabled children, such as the blind or those with “severe mental retardation,” was in the public interest. Caring for people with these sorts of disabilities consumes precious and often limited resources: money, time, and emotional energy. Brock told his audience that “it’s a mistake to think that the social and economic costs are not a legitimate concern in this context.”

What’s more, he said, these expenditures don’t necessarily translate into a meaningful improvement in the quality of life of the severely disabled. Even with what Brock calls “environmental” changes, such as handicapped access to buildings, and learning new skills, such as American Sign Language or Braille, the disabled live with “real disadvantages.”

And it doesn’t matter that the disabled don’t seem to mind. “Our notion of how good a person’s life is [isn’t] fully determined by their own subjective self-assessment,” Brock told his audience. Besides, “preventing a severe disability is not for the sake of the child who will have it. Rather, it is for the sake of less suffering and loss of opportunity in the world.”

At the heart of Brock’s plan for preserving opportunity are two commonplace medical procedures: amniocentesis and abortion. Insurance companies already pay for amniocentesis and doctors feel obliged to recommend the procedure to their patients. In addition, there are other forms of genetic screening that can predict certain disabilities even before a woman becomes pregnant.

What’s missing, according to Brock, is a willingness to explicitly take what he believes to be the real costs of giving birth to a severely disabled child into account. If it is true that a severe cognitive disability is a bad thing in someone who has already been born, then would-be parents should ask themselves “why not prevent these conditions in someone who will be born?”

Brock hastened to add that the individual decision should be left to the parents. He also affirmed his commitment to the “full and equal moral status” of the severely disabled. As he put it, “we should distinguish between preventing people from becoming disabled [and] . . . preventing the existence of disabled people.” (Somehow I doubt that advocates for the disabled will draw much comfort from Brock’s distinction.)

Brock probably intended for his remarks to be provocative and he succeeded. But for “pessimists” like me, there’s nothing unprecedented or particularly shocking about what he had to say. On the contrary, Brock’s insistence that a belief in the sanctity of life often gets in the way of what is best for society has a long pedigree in American life.

Compare Brock’s appeal to the prospect of “less suffering and loss of opportunity” to the following:

It would be strange if [the public welfare] could not call upon those who already sap the strength of the State for these lesser sacrifices . . . in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. . . . Three generations of imbeciles is enough.

You’re probably thinking that I’m quoting some Nazi-era document but I’m not. It’s from Supreme Court Justice Oliver Wendell Holmes’ majority decision in Buck v. Bell (1927), which upheld a Virginia law that mandated sterilization of what was then called the “feebleminded.”

For the better part of a century, a segment of American elite opinion has practiced and advocated various forms of what is euphemistically called “birth control” to promote its vision of a better society. (This was the driving force behind the founding of Planned Parenthood. Its founder, Margaret Sanger, wasn’t shy about distinguishing between “desirables” and “undesirables.”) Like Holmes, they made lofty-sounding appeals to the “public welfare” and inveighed against the costs associated with allowing certain births to take place. (One Michigan legislator went so far as to introduce a bill calling for the electrocution of severely retarded infants, claiming that electrocution was a humane way of putting these children out of their suffering.)

While the horrors of the Third Reich made eugenics disreputable, they didn’t eliminate the human temptation to what the ancient Greeks called pleonexia, the “overweening resolve to reach beyond limits.” (In other words, to play God.) There’s no shortage of people who refuse to accept the hand that Nature — or more specifically, Nature’s God — dealt them. This time around, their efforts benefit from two advantages not enjoyed by their predecessors.

The first is technological. Amniocentesis and other genetic screening provide us with a kind of certainty that Sanger and company didn’t dream of, at least with regards to certain kinds of disabilities. It also made the politics of preventing “undesirable” births much easier. Whereas earlier efforts depended on sterilization — a crude instrument that prompted protests — to prevent the birth of certain kinds of people, now we can identify them in utero and single them out.

This singling out required the second advantage: the widespread devaluing of life that Kelly mentioned. For 30 years, we have gone about shrinking the list of those whose right to life we regard as inviolable. In Roe v. Wade, whose 30th anniversary will be marked next month, the Supreme Court felt the need to profess uncertainty about the humanity of the fetus.

When it re-affirmed the right to an abortion two decades later in Planned Parenthood v. Casey, the court didn’t bother with claiming to be uncertain — a claim that advances such ultrasound had rendered untenable. Instead, any moral consequences flowing from the fetus’ humanity were trumped by the woman’s right to self-definition and autonomy and the court’s institutional prerogatives. (In the ruling Justice David Souter essentially said that the court couldn't afford to admit it had been wrong; "to overrule [Roe] would subvert the court's legitimacy beyond any reasonable question.")

As a result, the campaign to minimize suffering and maximize opportunity is free to proceed in an unfettered manner. And proceed it has, long before Brock gave his controversial remarks in Cranston. You see, the dirty little not-so-secret is that Americans are already practicing what Brock preaches. They are working to eliminate an entire class of disabled people: those with Down Syndrome.

These people have been, as Tucker Carlson put it in the Weekly Standard, “targeted for elimination.” According to several studies, 90 percent of the women who learned, through amniocenteses and chromosome analysis, that they were carrying a child with Down Syndrome subsequently had an abortion. Combine this with the way that doctors, for insurance, regulatory and legal reasons, strongly encourage their patients to undergo testing, and a pattern emerges: an unofficial, but nonetheless effective, effort to reduce the number of people with Down Syndrome.

Why? For many of the same reasons Brock cites: raising a child with Down Syndrome is expensive and, as Nachum Sicherman of Columbia University put it, most of the cost is “not going to be paid by parents.” And, of course, there are the non-monetary costs, such as “the number of women who would have to quit their careers to care for these babies,” mentioned by an embryologist in a New York Times article.

Mind you, there are differences between people with Down Syndrome and those described by Brock: people with Down Syndrome are often only mildly retarded. They can tell right from wrong, hold down jobs, and live semi-independent lives. In other words, they’re not what most people would call “severely disabled.”

Yet we are in the process of eliminating them. And that raises a disquieting thought: Brock may be underestimating people’s willingness to use abortion and genetic screening to make sure that their children meet their expectations, or at least don’t create more than an acceptable amount of dislocation in their lifestyles. As more and more disabilities, severe or otherwise, are added to the list of things we can test for in utero, the longer the list of folks targeted for elimination might become. It may turn out that Brock’s presentation wasn’t what economists would call a leading indicator; it was a trailing one.

Brock’s cultural transgression may have been a lack of the requisite sentimentality. He didn’t try to pass off his proposal as a misunderstood act of compassion, or as something that is really in the best interest of the unborn disabled person. Like another controversial ethicist, Peter Singer of Princeton (covered in Boundless here and here), his calculus was a strictly utilitarian one that asked “what course of action is most likely to increase the amount of happiness in the world?”

And whether we care to admit it or not, every discussion of bioethical issues that doesn’t begin with the inviolability of the human person comes down to a similar quid pro quo. We embrace, or at least, overlook, what just a few years ago was considered unthinkable in exchange for benefits such as increased freedom and opportunity. We exclude classes of people from the circle that contains those we deem worthy of protection. In exchange, we make life for those who remain within the circle a little better, at least as we have come to define “better.”

It works, or so we think, until someone comes along and upsets everything by reminding us of what it is we’ve been doing all along. Only this time, it’s our professions of shock that deserve to be called dubious.