OK, before I start, I'll put a health warning on this one before the mods do. Anyone reading this thread might themselves have a disability, or be related to or care for or have a friend who does. So please choose words, and indeed points of view, carefully.

In another thread, Lemur made a remark in passing that the number of children being born with Downs syndrome had fallen dramatically, since approximately 90% of pregnancies diagnosed with Downs syndrome now end in abortion. (In the US, presumably, in the UK it may even be higher). That shocked me.

I was reminded of a debate in the UK some years ago, concerning cochlear implants. These can be implanted in profoundly deaf babies, and essentially recreated an ability to hear and so live a "normal" life. Good news, no? Well, at least some profoundly deaf people thought not. They argued there was a deaf culture and a deaf community and these implants spelt the end of it. In case that sounds daft, (and it did to me at first) put it this way: these people didn't see deafness as a disability, just as part of their identity. Now, isn't that a good thing?

(Here is an update on the story: http://www.newscientist.com/channel/...mg19225795.000 This sums it up:

Geers agrees deaf culture may be under threat, but says "there is no hostility here. People are doing this so that deaf people can live in the hearing world, marry who they like, and work where they like, and so that hearing parents can have their children as part of their culture. But it must seem like genocide to the deaf."
And in a similar vein, returning to Downs syndrome and allowing myself to generalise, people with Downs generally seem happy, don't they?

So, my question is this. I trust we would all agree that, given a person with a disability, we expect society to make reasonable adjustments so that they can function as "normally" as possible within it. No one would say that it was reasonable that, say, wheelchair users are restricted in their choice of jobs because public transport is not accessible. (We might say it was inevitable for a while in the real world given the cost of upgrading the entire transport fleet, but that is a different matter). In that regard we expect to integrate people with disabilties, (even that sounds a bit patronising doesn't it). And we would certainly encourage people not to see a disability as a barrier or a negative thing, or even as the most important thing about a person.

Does this enlightened approach to disability run counter to attempts to prevent or (in particular) "cure" disability? It seems to me there are three cases:

Disability arising because of some external event. Surely no one would say we should ignore, say, health and safety rules, so that people continue to have accidents that put them in wheelchairs.

"Curing" an organically arising disability (ie the cochlear implants). I think this is tough. The more I think of it the more I think there is something in the "deaf culture" argument. And not just for the deaf people themselves but as an enrichment of society as a whole. Can we value deaf people equally, and at the same time support a medical procedure that will remove them (as deaf people) from the future population? That implies surely that we do NOT value them as equal to a hearing person. But equally if I had the choice I know very well I would rather be able to hear than not. Have I gone quite mad?

Terminating pregnancies where the fetus may be disabled (NB anyone who says this is a non issue because all terminations are wrong is not moving the debate forward ) This I think is REALLY tough. I hadn't thought about Downs until Lemur linked to the figures. But whereas you can clearly argue the cochleal implant is in the interests of an otherwise deaf child, I really don't think you can argue a termination is in the interests of a child with Downs. Some disabilities, sure, the quality of life may be so shocking that you can make the case, but as I said above people with Downs seem to live happy and fulfilled lives. And yet 90% of them are not being born.

There is a lot of cobblers spoken about eugenics but actually, what is the intellectual distinction here, other than that we in fact do not value people with disabilities as highly as we like to think we do?

Tricky stuff I think