Opportunities for What? Critically Examining Capitalist Constraints on Medicine's Conception of the "Good Life" for Disabled Patients

As medical technologies have grown, our ability to prevent the birth of disabled babies has transformed from the realm of science fiction into a reality demanding our attention. The increasing use of assistive reproductive technologies (ARTs) and the emergence of new, related medical practices, such as genetic counseling, have both legitimized parents' ability to choose against disability and reinforced the standard medical model of disability (i.e., that disability is a medical condition to be fixed/eliminated). Central to the Bioethics literature on "choosing" disability is a discussion of opportunities, with it generally being believed that when we select against disability, we are doing so at least in part because we wish for a broad range of opportunities for the future child. While these discussions of future opportunity range are indeed crucial to the discussion of whether or not to choose disability, I contend that the Bioethics literature and medicine in general (1) dramatically over-emphasize the pertinence of opportunity range to these decisions and (2) do so in a way that is consistent with American medicine's ostensible internalization of the ideologies espoused by capitalism. In particular, I argue that capitalism has constrained our conception of the "good life" for disabled people, and has done so in a way that is not only morally harmful to disabled people but epistemically harmful to all disability-related decisions in American medicine.