Should prenatal genetic diagnosis be offered to all parents?
In 2012, a technique was developed that enabled the foetal genome to be determined in the first trimester of pregnancy, using a small sample of the mother’s blood (Nature 2012, 487,320-4. Erratum Nature 2012; 489,326). This attractive novel technique has opened up new medical possibilities, but also objective ethical questions. A recent article published in the New England Journal of Medicine (370; 195-197) discussed this topic (see HERE).
There is no doubt that this new possibility adds a new level of complexity to medical, family and social decisions resulting from prenatal diagnosis.
As discussed in the article, information can be obtained on some foetal medical issues with the usual methods, such as chorionic villus sampling or amniocentesis. With genomic analysis however, information can not only be obtained on possible diseases, but also on types of autosomal recessive diseases (e.g. Tay-Sachs disease), or the risk that the future child will develop a disease such as diabetes or some type of cancer in adulthood, especially breast and ovarian cancer in women. Knowing the risks of future diseases can be used for the good of the foetus, if prenatal treatments can be applied, but also against their life if abortion is favoured.
This therefore raises several ethical questions, such as, “Should foetal genome studies be routinely offered to everyone?” or “Are parents entitled to know their future child’s genetic information?” One criterion that is probably essential to establish the ethicality of these practices, is that they are always used in the best interests of the child. The NEJM article refers to three criteria proposed by various North American scientific societies to guarantee their ethicality.
In 2005, a report from the American College of Medical Genetics reiterated that the main condition for these techniques to be ethically acceptable is that they are beneficial to the child, although the parents as well as society might also benefit, not only because they may mean advances in scientific research, but also because they may avoid subsequent costs in the treatment of these children.
In 2008, the United States President’s Council on Bioethics recommended that mandatory screening of these types of diseases must have a direct medical benefit to the child, while providing genetic information to the parents that can be used in the best interest of the child and which in turn could facilitate medical research goals.
In 2013, the American Academy of Pediatrics restated that the primary aim of prenatal genetic screening is the good of the child, further adding that family must benefit for these techniques to be ethically justified. To this we would like to add that, independent of the legal judgement that abortion merits in the various countries, any action that can lead to or facilitate abortion is ethically inadmissible. In this regard, we must try to balance the good for the unborn child that results from the development of these techniques, and the unquestionable risk of increasing the number of abortions.
Bioethics Observatory – Institute of Life Sciences
Catholic University of Valencia