  Prenatal genetic testing raises serious ethical questions about reproductive rights and eugenics. Reproductive rights are no longer just about the right not to have a child (to use contraception, to have an abortion) or the right to bear a child (to refuse population control measures). Reproductive rights have come to encompass the right to access technological assistance to procreate and to have a certain kind of child (Callahan  1998).[46] The specter of eugenics—and its images of involuntary sterilizations, immigration quotas, “fitter family” contests, and Nazi death camps—reappears once choices are being made about what sort of people are worth bringing into the world. Many authors have appealed to the history of eugenics to provide warnings about the dangers of genetic testing or to urge caution as we move  forward.[47] Historian Diane Paul (1994b) characterizes eugenics as the “‘approved’ project anxiety”: given the lapse of time, we inevitably look good compared to earlier generations (p. 143). Paul notes that attempts to draw lessons from the history of eugenics are confounded by disagreements about how to define “eugenics”—whether to characterize eugenics according to a program's intentions or effects, its use of coercive rather than voluntary means, or its appeals to social and political aims that extend beyond the immediate concerns of individual families. For some commentators, even exhortations to choose the “best child” are not eugenic because they occur in the realm of “private enterprise” and are not directed at improving the population (Savulescu 2001). Others worry that the private reproductive choices of individuals will have the “backdoor” effect of narrowing society's acceptance of diversity (Duster 1990). We are also reminded that valuing reproductive autonomy means supporting a woman's decision not just to abort but to bear a child likely to have a disease or disability: while she may be free of state interference, many other factors make this choice difficult—pressure from clinicians, refusal of health insurers to cover the child when born due to the “pre-existing condition,” disapproval from other health insurance plan members, ableist attitudes in society, lack of financial resources, lack of social support (Hubbard 1990; Hubbard and Wald 1993). Arguably, if intentions matter, prenatal diagnosis means that eugenics is already with us: “prenatal diagnosis necessarily involves systematic and systemic selection of fetuses, mostly frequently on genetic grounds” (Lipmann 1991, p. 24). Indeed, Kitcher (1996) seeks to establish a sound theoretical basis for eugenic practice, envisioning a “laissez-faire” eugenics where people are educated to make “responsible” procreative decisions based on objective evaluative judgments of quality of life, not just for the prospective individual but all others involved—parents, siblings, and since funds for social programs are limited, all members of  society.[48]