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Book Review: Perfecting Pregnancy

Isabel Karpin and Kristin Savall. Perfecting Pregnancy: Laws, Disability, and the Future of Reproduction. Cambridge: Cambridge University Press, 2012. ISBN# 978-0-521-76520-6

Two Australian law professors grapple with the concept of reproduction and pregnancy in a world in which preconception genetic testing (PNT) can identify 448 child diseases, and preimplementation genetic diagnosis (PGD) can identify 150 disorders. Such tests can offer reproductive flexibility, but also may lead down the slippery slope of eugenics. The authors track how legislation does, and does not, provide oversight of abortion, prenatal testing, and PGD in various countries, with an emphasis on Australia and the United Kingdom. The authors ask whether the legal concept of “severe disability,” in contrast to the medical definition, “can, or should, do the work required of it by legal and ethical frameworks” in the context of PGD and PNT. (p. 4) While “drawing heavily” on the empirical work of others, Karpal and Savall also contribute unique empirical research gleaned from interviewing PGD and PNT regulators and clinicians in Australia. (p. 5) The authors recount the various legal and medical attempts to draw a line between serious and trivial disability as a major part of the reproductive decision-making process. They conclude that women and families have an important role in the line-drawing process, and that “the focus should be clearly kept on the parents’ capacity to cope  with what they imagine is ahead of them, rather than the perceived welfare of the future child.” (p. 348)

Another recent book on the same topic, with a focus on similar jurisdictions, is Regulating Pre-implantation Genetic diagnosis: A Comparative and Theoretical Analysis (Routledge, 2013), which focuses on the ethical and legal implications of PDG since 1990 in Australia, New Zealand, and the United Kingdom. A Theory of Unborn Life: From Abortion to Genetic Manipulation compares the legal status of the unborn child in the United States and Germany. Life before Birth: The Moral and Legal Status of Embryos and Fetuses would be another useful, scholarly book for anyone interested in this topic (devoid of in-depth jurisdictional context).