ETHICS IN EARLY-CHILDHOOD SPECIAL-EDUCATION

Medicine's growing ability to detect disabling conditions prior to birth raises questions about downward extension of federal and state government support from birth to some prebirth period; prenatal services include testing and increasingly will include genetic engineering to ''fix'' the problem. Part H of the Individuals with Disabilities Education Act (IDEA) assures a family the right to refuse even the most initial services such as testing and referral; this right may have the effect of depressing demand for services, to the child's detriment, as when a mother shuns testing because she fears learning about her human immunodeficiency virus (HIV) status. Meanwhile, as more and more premature infants survive but with disabilities, debate rages about what kinds of services are ''appropriate'' when such infants have very severe, life-threatening conditions. These issues raise ethical questions for which there are as yet few clear-cut answers. One source of guidance multidisciplinary team members may consult is that of adults who themselves have disabilities.