Is it really ableist for a couple to opt for pre-conception counseling? I would say "not necessarily", but admit it's a hard question. First thing to notice--once we have children, we are constantly trying to prevent things. All parents do so, including non-ableist parents of kids who already have differences, diseases, disorders, disabilities--whatever. If your kid has no Ds, you're going to put your baby in a car seat, give her vaccinations, etc. If your kid has some Ds, you're going to do the same so he doesn't wind up with more. Even the most ardent disability activist doesn't want a child to go from being deaf to being both deaf and blind.
So: trying to prevent Ds in a specific child is not necessarily ableist. Not necessarily, but then there could be parents who try to prevent disabilities because they find them repulsive, and would reject, or neglect, or abuse their child if disabilities developed. That could be, but you wouldn't suspect this, just from seeing parents carefully place a baby in a car seat. You'd think they were just protecting their child from disabilities, not displaying a discriminatory attitude.
OK, now let's back up to the time period when a child is still in the making. A woman is in her first trimester of pregnancy and she's a binge drinker, not realizing this puts her child at risk for fetal alcohol syndrome--a combination of physical and mental abnormalities. Her obstetrician asks about patterns of alcohol consumption and counsels her to stop drinking, which she tries to do. This is once again benign prevention--nothing to do with discrimination.
Now back up further. A couple hasn't conceived yet, but is trying to. They're thinking about ingesting Sex Pill, a drug that makes sex just a bit more pleasurable, but at the price of any resulting child having a missing finger. (The example is from 'The Paradox of Future Individuals," by Gregory Kavka, with the missing finger added for specificity.) They think and think, and realize that they're really choosing between two different children here, not deciding whether to endow one child with nine or ten fingers. After all, if they take the pill, that will change the conditions of conception just slightly, but enough so that a different sperm will win the race. Once again, the seemingly responsible decision is made. They don't ingest Sex Pill and wind up with a 10-fingered child.
Did they act irreproachably? Like the parents putting a baby in the car seat, and the pregnant woman stopping her drinking, this couple opts for prevention. The only thing that could make the situation different is that they are choosing between two different children as opposed to protecting one from an undesirable condition. If the parents who use the car seat and the binge drinker both behave out of compassion, can we think the "no sex pill" couple act out of compassion too?
The "no sex pill" couple have a desire they might express in general terms: I want my child, whoever he or she is, not to have to go through life missing a finger. Or even more generally: I wish for a world in which fewer kids are missing fingers. This is a wish about a set of people--the set of my offspring, or the set of human beings--not about any definite person or group of people. Does that stop the state of mind from being compassionate? Is it in fact just the opposite--discriminatory, quality-control-ish, perfectionistic, dehumanizing?
It would be really weird if that were so! People express those kinds of general thoughts all the time, and we think of it as "good will" . You might even say this sort of thing on Santa's knee: I wish for, no, not a new ipad, but a world in which there is no more war, no more disease, no more racism, etc. The fact that this is not a wish on behalf of a specific individual, or specific individuals, doesn't stop it from being compassionate.
Fun little analogy: suppose determinism is false, so there there is not now any particular group of people who will be milling around in Time Square at midnight tonight. If I say I wish the best for the midnight crowd, whoever they are, I'm still (surely!) expressing compassion, even if it's not for anyone (singular or plural) in particular.
OK--so the generality of wishing well for my offspring, whoever they are, is compatible with compassion. So let's press on now, to the parents who take a genetics test, to see what their risk is of conceiving kids with specific disorders. They discover they have a 25% chance of having a child with some syndrome roughly as serious as fetal alcohol syndrome. They think they wouldn't want their children, whoever they are, to go through that, so they decide not to conceive. Is this yet another example of generalized compassion, as in the Sex Pill case, or it discriminatory, quality-control-ish, perfectionistic, and dehumanizing?
My sense is that the state of mind is compassionate, not discriminatory, but the details in the example seem to matter. What if we shift to the supposition that the parents discover their offspring just have a 25% chance of having missing finger syndrome? This time it's not a matter of having a 9-fingered kid rather than a 10-fingered kid, but of having a 9-fingered kid or none at all. They decide not to procreate.
Considering the strength of most people's desire to have children, it's hard to see what they could be thinking, save that missing one finger is a terrible, terrible thing. Now that sort of exaggeration does suggest ableism. They are likely to be freaked out by the sheer fact of abnormality, not concerned for their offspring, whoever they turn out to be, and the real deficits involved in missing finger syndrome.
So yes, I can see how pre-conception counseling could lead to or be motivated by discriminatory, ableist states of mind. If the conditions the kit tests for are myriad and some are trivial, you've got to suspect the demand for the kit comes partly from parents with a sort of consumer approach to procreation. Give me the perfect kid, or no kid at all! But if the conditions they're trying to avoid are serious enough, that suspicion seems to vanish.