It varies from disability to disability.
Your sister’s disability is one that we understand the causes of the best.
Your sister’s muscular dystrophy is definitely genetic in origin.
It is possible (though unlikely) that your sister’s muscular dystrophy came from a mutation.
Your mother’s egg or your father’s sperm could have contained a mutated gene, or your sister’s zygote could have introduced a mutation very early on when your sister was just a couple cells.
But the majority of muscular dystrophy cases aren’t due to mutations.
They’re due to (maybe recessive) genes that your mother’s side and your father’s side just coincidentally happened to be carrying, and just coincidentally happened to be in the egg and sperm that made your sister.
In that sense you could argue your sister’s fate was decided before she was even conceived.
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