Selection against Disability: Abortion,ART,and Access

Asch A. , “Disability Equality and Prenatal Testing: Contradictory or Compatible?” Florida State University Law Review 30, no. 2 (2003): 315–342, at 315.

For example, some states prohibit abortions sought because of the sex of developing fetus. See, e.g., H.B. 2443, 50th Leg., 1st Sess. (Ariz. 2011), codified as Ariz. Rev. Stat. Ann. § 13–3603.02(A) (2014) (prohibiting the performance of an abortion on the basis of the unborn child's sex); 720 Ill. Comp. Stat. 510/6(8) (2014) (“No person shall intentionally perform an abortion with knowledge that the pregnant woman is seeking the abortion solely on account of the sex of the fetus.”); S.B. 141, 85th Leg., Reg. Sess. (Kan. 2013) (“No person shall perform an abortion with knowledge that the pregnant woman is seeking the abortion solely on account of the sex of the unborn child.”); S.B. 353, 2013 Gen. Assemb., 1st Sess. (N.C. 2013), codified as N.C. Gen. Stat. § 90–21.121 (2014) (“[N]o person shall perform or attempt to perform an abortion upon a woman in this State with knowledge, or an objective reason to know, that a significant factor in the woman seeking the abortion is related to the sex of the unborn child.”); H.B. 1305, 63d Legis. Assemb., Reg. Sess. (N.D. 2013), codified as N.D. Cent. Code § 14–02.1–04.1 (2014) (“A physician may not intentionally perform or attempt to perform an abortion with knowledge that the pregnant woman is seeking the abortion solely…[o]n account of the sex of the unborn child.”); S.B. 1890, 52d Leg., 2d Reg. Sess. (Okla. 2010), codified as Okla. Stat. tit. 63, § 1–731.2(B) (2014) (prohibiting the performance of an abortion solely on account of the sex of the unborn child); 18 Pa. Cons. Stat. § 3204(c) (2014) (“No abortion which is sought solely because of the sex of the unborn child shall be deemed a necessary abortion.”); H.B. 1162, 89th Legis. Assemb., Reg. Sess. (S.D. 2014) (prohibiting sex-based abortions). North Dakota prohibits the provision of an abortion because the fetus has been diagnosed with either a genetic abnormality or the potential for a genetic abnormality. N.D. Cent. Code § 14–02.1–04.1 (2014). The constitutionality of these laws is subject to question. See, e.g., MKB Management Corp. v. Burdick, 954 F. Supp. 2d 900, 912 (D.N.D. 2013).

See Woo J. , A Short History of Amniocentesis, Fetoscopy and Chorionic Villus Sampling, available at <http://www.ob-ultrasound.net/amniocentesis.html> (last visited April 21, 2015); Greely H. T. , “Get Ready for the Flood of Fetal Gene Screening,” Nature 469, no. 7330 (2011): 289–291, at 289–290.

See Malek J. , “Disability and the Duties of Potential Parents,” Saint Louis University Journal of Health Law & Policy 2, no. 2 (2008): 119–134, at 121.

Judith Daar gives a clear explanation in lay language of what these various tests entail, and the information they reveal. See Daar J. , “One Small Step for Genetics, One Giant Leap for Genocide?” Rutgers Law Journal 42, no. 3 (2011): 705–724, at 707–711; see also King J. S. , “Not This Child: Constitutional Questions in Regulating Noninvasive Prenatal Genetic Diagnosis and Selective Abortion,” UCLA Law Review 60, no. 1 (2012): 2–75.

See, e.g., King J. S. , “And Genetic Testing for All…The Coming Revolution in Non-Invasive Prenatal Genetic Testing,” Rutgers Law Journal 42, no. 3 (2011): 599–658, at 600; Daar , supra note 5, at 709.

Sulman P. , “Genetic Determinants of Hair, Eye and Skin Pigmentation in Europeans,” Nature Genetics 39 (2007): 1443–1542, at 1443.

Explosion of New Prenatal Genetic Testing on the Horizon, Greely Says , University of Virginia School of Law (March 11, 2010), available at <http://www.law.virginia.edu/html/news/2010_spr/greely.htm> (last visited April 21, 2015); King, supra note 5; King, supra note 6.

James S. D. , Down Syndrome Births are Down in the U.S. , ABC News (November 2, 2009), available at <http://abcnews.go.com/Health/w_ParentingResource/down-syndrome-births-drop-us-women-abort/story?id=8960803#.T9Ki_FKx-pul> (last visited April 21, 2015); Douthat R. , “Eugenics, Past and Future,” New York Times , June 10, 2012, at SR12, available at <http://www.nytimes.com/2012/06/10/opinion/sunday/douthat-eugenics-past-and-future.html?_r=0> (last visited April 21, 2015).

Johnson C. Y. , “DNA Blood Test Can Detect Prenatal Problems,” Boston Globe , February 26, 2014, available at <https://www.bostonglobe.com/lifestyle/health-wellness/2014/02/26/new-study-suggests-prenatal-genetic-tests-could-offered-all-pregnant-women/V1GQuRL4jkr1M6Oe1XcQCK/story.html> (last visited May 20, 2015).

See Fordham B. A. , “Disability and Designer Babies,” Valparaiso University Law Review 45, no. 4 (2011): 1473–1528, at 1480 and note 33 (discussing cases); Spriggs M. , “Lesbian Couple Create a Child Who Is Deaf Like Them,” Journal of Medical Ethics 28, no. 5 (2002): 283–285 (reporting the case of a lesbian deaf couple who used a deaf sperm donor to increase the likelihood that their son would also be deaf); Healy M. , “Fertility's New Frontier,” Los Angeles Times , July 21, 2003, at 1, available at <http://articles.latimes.com/2003/jul/21/health/he-pgd21> (last visited May 4, 2015) (reporting the case of a doctor who refused a couple's request to use PGD to identify and implant an embryo with Down syndrome). In the reported cases, families make these decisions when someone in the existing family has the trait, and a child with similar traits is desired. With deafness, the parents may be member of Deaf Culture, and a deaf child will be particularly treasured. A child with achondroplasia might be desired by parents with achondroplasia for ease of care reasons. In the reported case of parents seeking a child with Down syndrome, the family sought a similarly situated sibling for an existing child with Down syndrome.

Rothschild J. , The Dream of the Perfect Child (Bloomington: Indiana University Press, 2005): At 105.

For individual stories relating such pressure, see National Council on Disability, Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and Their Children (September 27, 2012): At 214–215, available at <http://www.ncd.gov/publications/2012/Sep272012/> (last visited May 4, 2015).

See Linton S. , Claiming Disability: Knowledge and Identity (New York: New York University Press, 1998): At 11.

See Daar , supra note 5, at 718, note 65.

See Darnovsky M. , Countries with Laws or Policies on Sex Selection , Center for Genetics and Society (April 2009), available at <http://geneticsandsociety.org/downloads/200904_sex_selection_memo.pdf> (last visited May 4, 2015); Feikert C. , Sex Selection & Abortion: Australia , Library of Congress (June 2009), available at <http://www.loc.gov/law/help/sex-selection/australia.php#f6> (last visited May 4, 2015); Nehra K. S. , Sex Selection & Abortion , Library of Congress (June 2009), available at <http://www.loc.gov/law/help/sex-selection/index.php> (last visited May 4, 2015).

See Parens E. Asch A. , “The Disability Rights Critique of Prenatal Genetic Testing: Refections and Recommendations,” Hastings Center Report 29, no. 5 (1999): S1–S22, at S16.

See Rothschild , supra note 11, at 71–92.

See Daar , supra note 5, at 709; Smolensky K. R. , “Creating Children with Disabilities: Parental Tort Liability for Preimplantation Genetic Interventions,” Hastings Law Journal 60, no. 2 (2008): 299–346, at 299, note 1.

See, e.g., King , supra note 5; Grant E. W. , “Assessing the Constitutionality of Reproductive Technologies Regulation: A Bioethical Approach,” Hastings Law Journal 61, no. 4 (2010): 997–1034; Schiavone K. E. , “Playing the Odds or Playing God? Limiting Parental Ability to Create Disabled Children through Preimplantation Genetic Diagnosis,” Albany Law Review 73, no. 1 (2009): 283–328, at 294–301; Malek , supra note 4, at 214; Green R. M. , “Parental Autonomy and the Obligation Not to Harm One's Child Genetically,” Journal of Law, Medicine & Ethics 25, no. 1 (1997): 5–15, at 6.

See Parens Asch , supra note 16, at S11, S13 (summarizing the social constructionist argument).

A Mutation Story, PBS, available at <http://www.pbs.org/wgbh/evolution/library/01/2/l_012_02.html> (last visited May 4, 2015).

See Parens Asch , supra note 17, at S2.

See id., at S7; see also Saxton M. , “Why Members of the Disability Community Oppose Prenatal Diagnosis and Selective Abortion,” in Parens E. Asch A. , eds., Prenatal Testing and Disability Rights (Washington, D.C.: Georgetown University Press, 2000): 147–164, at 148.

See Parens Asch , supra note 17, at S2; Malek , supra note 4, at 126.

See Parens Asch , supra note 17, at S2.

Id. (quoting Saxton M. , “Disability Rights and Selective Abortion,” in Solinger R. , ed., Abortion Wars: A Half Century of Struggle, 1950–2000 ([Berkeley: University of California Press, 1997]: At 374–395, at 391).

See Asch , supra note 1, at 316.

See National Council on Disability, supra note 12, at 215 (citation omitted).

See Sandel M. J. , “The Case against Perfection: What's Wrong with Designer Children, Bionic Athletes, and Genetic Engineering,” Atlantic , April 1, 2014, available at <http://www.theatlantic.com/magazine/archive/2004/04/the-case-against-perfection/302927/> (last visited May 4, 2015).

See Parens Asch , supra note 17, at S7; see also Saxton , supra note 24, at 148.

See Asch , supra note 1, at 324.

See id., at 337–41; also Parens Asch , supra note 16, at S19-S20 (proposing reforms).

See Parens Asch , supra note 16, at S2; Malek , supra note 4, at 126. Notably, current technology allows for identification of an embryo's sex. It does not allow identification of sexual orientation, which is a more complicated trait that may never be linked to a single genetic code.

See Parens Asch , supra note 17, at S2.

See Harmon A. , “Prenatal Test Puts Down Syndrome in Hard Focus,” New York Times , May 9, 2007, at A1, available at <http://www.nytimes.com/2007/05/09/us/09down.html?pagewanted=all&_r=0> (last visited May 4, 2015).

See Parens Asch , supra note 17, at S1.

Id., at S3.

See, e.g., Parens Asch , supra note 17, at S2; Kaplan D. Saxton M. , “Disability Community and Identity: Perceptions of Prenatal Screening,” Our Bodies Ourselves, available at <http://www.ourbodiesourselves.org/book/companion.asp?id=31&compID=43&page=2> (last visited May 4, 2015); Saxton , supra note 24.

See King , supra note 5, at 40–41 (arguing against limitations on sex-based selection because such a limitation “prioritizes one form of equality significantly over another by protecting women's equality at the expense of the equality of individuals with genetic diseases, conditions, and characteristics that are deemed ‘undesirable.’ Such an approach would cast a dark shadow of eugenics over the states.”)

See Parens Asch , supra note 17, at S2 (citing Press N. , “Assessing the Expressive Character of Prenatal Testing: The Choices Made or the Choices Made Available?” in Parens E. Asch A. , eds., Prenatal Testing and Disability Rights ([Washington, D.C.: Georgetown University Press, 2000]: At 214–233).

See, e.g., Lombardo P. A. , Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck v. Bell (Baltimore: Johns Hopkins University Press, 2008): At 45; Scotch R. K. , “American Disability Policy in the Twentieth Century,” in Longmore P. K. Umansky L. , eds., The New Disability History: American Perspectives (New York: New York University Press, 2001): At 375–392, at 377–378.

Reilly P. R. , The Surgical Solution: A History of Involuntary Sterilization in the United States (Baltimore: Johns Hopkins University Press, 1991): At 30–40.

“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 are enough.” Buck v. Bell, 274 U.S. 200, 207 (1927). Questions existed about the heritability of conditions and whether the patients actually had the suspect conditions. For example, research indicates that Carrie Buck was not in fact mentally handicapped. See Berry R. M. , “From Involuntary Sterilization to Genetic Enhancement: The Unsettled Legacy of Buck v. Bell,” Notre Dame Journal of Law, Ethics & Public Policy 12, no. 2 (1998): 401–348, at 420–421; Silver M. G. , “Note, Eugenics and Compulsory Sterilization Laws: Providing Redress for the Victims of a Shameful Era in United States History,” George Washington Law Review 72, no. 3 (2004): 862–892, at 867.

See Weber v. Stony Brook Hosp., 467 N.Y.S.2d 685, 686 (2d Dep't 1983). The “Baby Doe” cases were explored by a presidential commission, which issued a report in 1983 that would disallow denial of surgery to “an otherwise healthy Down Syndrome child whose life is threatened by a surgically correctable complication.” Asch A. , “Disability, Bioethics, and Human Rights,” in Albrecht G. L. , eds., Handbook of Disability Studies (Thousand Oaks: Sage Publications, 2001): 297–326, at 303 (quoting President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions [March 1983]: At 6–7); see also Cantrell D. F. , “Bowen v. American Hospital Association: Federal Regulation Is Powerless to Save Baby Doe,” Indiana Law Review 19, no. 4 (1986): 1199–1218 (discussing a case in which a boy, born with Down syndrome and esophageal obstruction, died because his parents refused to consent to life-saving treatment); Antommaria A. M. , “‘Who Should Survive? One of the Choices on Our Conscience’: Mental Retardation and the History of Contemporary Bioethics,” Kennedy Institute of Ethics Journal 16, no. 3 (2006): 205–224 (discussing a film that “contains a dramatization of the death of an infant with Down syndrome as the result of the parents' decision not to have a congenital intestinal obstruction surgically corrected.”).

See Shapiro J. P. , No Pity: People with Disabilities Forging a New Civil Rights Movement (New York: Three Rivers Press, 1994): At 158–175 (discussing institutionalization and education).

See Rehabilitation Act of 1973, 29 U.S.C. § 794(a) (2012); Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101–12213 (2012).

See National Council on Disability, National Disability Policy: A Progress Report (March 31, 2009): At 26–27, available at <http://www.ncd.gov/progress_reports/Mar312009> (last visited May 4, 2015).

See id.; Pendo E. , “Reducing Disparities through Health Care Reform: Disability and Accessible Medical Equipment,” Utah Law Review 4, no. 4 (2010): 1057–1084, at 1059–1060; Hwang K. , “Access and Coordination of Health Care Service for People with Disabilities,” Journal of Disability Policy Studies 20, no. 1 (2009): 28–34, at 29–30 (collecting results of population-based surveys); Office of the Surgeon General, U.S. Department of Health and Human Services, The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities (2005), available at <http://www.ncbi.nlm.nih.gov/books/NBK44667/pdf/TOC.pdf> (last visited May 4, 2015); Center for Research on Women with Disabilities, Health Disparities between Women with Physical Disabilities and Women in the General Population , Baylor College of Medicine (May 2005), available at <https://www.bcm.edu/research/centers/research-on-women-with-disabilities/?PMID=1331> (last visited May 4, 2015) (discussing the first national survey of women with disabilities on their experiences with women's healthcare conducted in the years immediately following passage of the ADA).

See Smedley B. D. , eds., Institute of Medicine of the National Academies, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academies Press, 2003).

These include equipment barriers and communication barriers. See Kailes J. I. , “The patient's perspective on access to Medical Equipment,” in Winters J. M. Story M. F. , eds., Medical Instrumentation: Accessibility and Usability Considerations (Boca Raton: CRC Press, 2006): 3–14, at 6; Pendo E. , “Disability, Equipment Barriers, and Women's Health: Using the ADA to Provide Meaningfulness,” St. Louis University Journal of Health Law & Policy 2 (2008): 15–56, at 17–18 (describing barriers posed by inaccessible buildings and medical equipment); Pendo E. , “Shifting the Conversation: Disability, Disparities and Health Care Reform,” Florida International University Law Review 6, no. 1 (2010): 87–98, at 92 (noting that “twenty years after passage of the [ADA], many people with mobility impairments cannot get on examination tables and chairs, cannot be weighed, and cannot use x-ray and other imaging equipment.”); Schwartz M. A. , “Deaf Patients, Doctors, and the Law: Compelling a Conversation about Communication,” Florida State University Law Review 35, no. 4 (2008): 947–1002 (describing the difficulties experienced by deaf patients who are not provided sign language interpreters by their doctors).

See Pendo (2008), supra note 54, at 17–18.

See id., at 43; Albrecht G. L. Devlieger P. J. , “The Disability Paradox: High Quality of Life against All Odds,” Social Science & Medicine 48, no. 8 (1999): 977–988; Bach J. R. Tilton M. C. , “Life Satisfaction and Well-Being Measures in Ventilator Assisted Individuals with Traumatic Tetraplegia,” Archives of Physical Medicine and Rehabilitation 75, no. 6 (1994): 626–632; Saigal S. , “Self-Perceived Health Status and Health-Related Quality of Life of Extremely Low-Birth-Weight Infants at Adolescence,” JAMA 276, no. 6 (1996): 453–459; National Council on Disability, supra note 51, at 57, 304; Kailes , supra note 54, at 5.

See Carlson D. , National Disability Rights Network, Devaluing People with Disabilities: Medical Procedures That Violate Civil Rights (May 2012), available at <http://disabilitylawva.org/wp-content/uploads/2012/10/Devaluing_People_with_Disabilities.pdf> (last visited May 4, 2015).

Id., at 5.

See, e.g., Lane H. , The Mask of Benevolence: Disabling the Deaf Community (New York: Alfred A. Knopf, 1992): At 212–213 (discussing the mistreatment of deaf patients in France); Longmore P. K. , “Medical Decision Making and People with Disabilities: A Clash of Cultures,” in Longmore P. K. , ed., Why I Burned My Book and Other Essays on Disability (Philadelphia: Temple University Press, 2003): 204–212 (describing conflicts between disabled persons and their healthcare providers); Whitaker R. , Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (New York: Basic Books, 2010): At 71–72; Drake S. , The Doctor Said It Would Be Better If I Didn't Survive, Not Dead Yet (March 30, 2012), available at <http://www.notdeadyet.org/2012/03/stephens_story.html> (last visited May 4, 2015); Coleman D. Drake S. , Disability Discrimination , Hastings Center Bioethics Forum (July 11, 2012), available at <http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5913&blogid=140> (last visited May 4, 2015); Vox F. , “The Cyclops Child': Inhumanity in a 1960 Hospital,” Atlantic , July 14, 2012, available at <http://www.theatlantic.com/health/archive/2012/07/thecyclops-child-inhumanity-in-a-1960-hospital/259810/> (last visited May 4, 2015) (recounting Dr. Fredric Neuman's cruel treatment of a child with severe birth defects).

See id., at 254.

See National Council on Disability, supra note 51, at 59. “[S]urveys of healthcare providers indicate that many providers believe that women with mobility disabilities are not sexually active, and are not or should not be mothers.” See Pendo (2010), supra note 54, at 92.

Nosek M. A. , “Overcoming the Odds: The Health of Women with Physical Disabilities in the United States,” Archives of Physical Medicine and Rehabilitation 81, no. 2 (2000): 135–38, at 136, available at <https://www.bcm.edu/research/centers/research-on-women-with-disabilities/?pmid=5300> (last visited May 4, 2015).

See Gill C. J. , “Becoming Visible: Personal health Experiences of Women with Disabilities,” in Krotoski D. M. , eds., Women with Physical Disabilities: Achieving and Maintaining Health and Well-Being (Baltimore: P.H. Brookes Publishing Company, 1996): At 5–16, at 8–9; Waxman B. F. , “Up against Eugenics: Disabled Women's Challenge to Receive Reproductive Health Services,” Sexuality and Disability 12, no. 2 (1994): 155–171.

See Pendo (2008), supra note 54, at 16; Kailes , supra note 54, at 5.

See Gill , supra note 63, at 6 (“[W]omen with disabilities are stripped of our roles. We are not expected to be workers, romantic partners, caregivers, or mothers. Socially, we are in limbo–not quite children, but not adults; not men, but not real women either. It is difficult to get your bearings and struggle out from under that kind of unremitting yet subtle oppression, because it steals from you the very sense of self you need in order to fight.”)

As Dave Shade notes, “[b]ecause disability has only a neutral or negative impact on fertility, people with disability who wish to have children are equally or more likely than the nondisabled population to experience infertility.” Shade D. , “Empowerment for the Pursuit of Happiness: Parents with Disabilities and the Americans with Disabilities Act,” Law & Inequality 16, no. 1 (1998): 153–218, at 169.

Even non-biological reproduction is difficult for adults with disabilities. Adoption agencies balk at placing children with disabled adults. See National Council on Disability, supra note 12, at 188–193.

Id., at 205.

Id., at 210.

Mutcherson K. M. , “Disabling Dreams of Parenthood: The Fertility Industry, Anti-Discrimination, and Parents with Disabilities,” Law & Inequality 27, no. 2 (2009): 311–364, at 316.

See National Council on Disability, supra note 12, at 216.

See id., at 210.

Daar J. F. , “Accessing Reproductive Technologies: Invisible Barriers, Indelible Harms,” Berkeley Journal of Gender, Law & Justice 23, no. 1 (2008): 18–82, at 73.

Rothstein L. F. , Rights of Physically Handicapped Persons (Colorado Springs: McGraw-Hill, 1984): At 185; see also Stein M. A. , “Mommy Has a Blue Wheelchair: Recognizing the Parental Rights of Individuals with Disabilities,” Brooklyn Law Review 60 (1994): 1069–1100 (documenting cases in which fit parents with physical disabilities have lost custody of children due to their disabilities); Stefan S. , “Accommodating Families: Using the Americans with Disabilities Act to Keep Families Together,” Saint Louis University Journal of Health Law & Policy 2, no. 1 (2008): 135–176 (documenting cases in which people with psychiatric disabilities have lost custody of their children due to their disabilities). For some remarkably moving narratives, see Wates M. Jade R. , eds., Bigger Than the Sky: Disabled Women on Parenting (London: Women's Press, 1999).

See Rothstein , supra note 74, at 185.

See Stein , supra note 74, at 1083 (footnotes omitted) (citing Rothstein, supra note 74, at 185).

See National Council on Disability, supra note 12, at 239. To be sure, some disabilities, including some forms of developmental and mental illness, can affect an individual's ability to parent effectively. The difficulty with a presumption of unfitness is that it excludes capable parents without an individual determination.

See Daar , supra note 73, at 23 (arguing that “stigmatizing would-be parents by depriving them the opportunity to reproduce is dangerously reminiscent of our eugenics past, an era in which misguided judgments about parental fitness culminated in the involuntary sterilization of thousands of Americans.”)

See, e.g., Ariz. Rev. Stat. Ann. § 13–3603.02(A) (2014) (prohibiting the performance of an abortion on the basis of the unborn child's sex); 720 Ill. Comp. Stat. 510/6(8) (2014) (prohibiting sex-based abortions); S.B. 141, 85th Leg., Reg. Sess. (Kan. 2013) (prohibiting sex-based abortions); N.C. Gen. Stat. § 90–21.121 (2014)(prohibiting sex-based abortions).

Position statement, American College of Obstetricians and Gynecologists, available at <http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ethics/Sex_Selection> (last visited May 4, 2015).

See King , supra note 5, at 40.

Position statement, American College of Obstetricians and Gynecologists, available at <http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ethics/Sex_Selection> (last visited May 4, 2015).

E.g., King , supra note 6, at 650–652 (proposing a two-step process for obtaining informed consent to conduct prenatal testing)

See Asch , supra note 1, at 315.

See, e.g., Asch , supra note 1, at 334–335 (emphasizing the need for non-directive counseling of potential parents); King , supra note 6, at 650–52 (proposing a two-step process for obtaining informed consent to conduct prenatal testing); Parens and Asch, supra note 16, at S19-S20 (suggesting improvements to education of professionals and providing disability-related information 0at specific points in the screening process).