Abstract
In the near future developments in non-invasive prenatal testing (NIPT) may soon provide couples with the opportunity to test for and diagnose a much broader range of heritable and congenital conditions than has previously been possible. Inevitably, this has prompted much ethical debate on the possible implications of NIPT for providing couples with opportunities for reproductive choice by way of routine prenatal screening. In view of the possibility to test for a significantly broader range of genetic conditions with NIPT, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) recommend that, pending further debate, prenatal screening for reproductive choice should only be offered where concerning serious congenital conditions and childhood disorders. In support of this recommendation, the ESHG and ASHG discuss a number of ethical issues on which they prompt further debate: the informational privacy of the future child, the trivialization of abortion, the risk of information overload, and issues of distributive justice. This paper responds to this call with further reflection on each ethical issue and how it relates to the moral justification of providing couples with opportunities for meaningful reproductive choice. The paper concludes that whilst there may be good reasons for qualifying the scope of any unsolicited prenatal screening offer to serious congenital conditions and childhood disorders, if prenatal screening is justified for providing couples with opportunities for meaningful reproductive choice, then health services may have obligations to empower couples with the same opportunity where concerning other conditions.
Highlights
Many health services provide some type of prenatal screening service that is routinely offered to women and their partners during antenatal care
Ethical challenges associated with the informational privacy of the future child, information overload, the trivialization of abortion, and issues of distributive justice may provide good reasons for qualifying the scope of any routine prenatal screening offer to serious congenital conditions and childhood disorders, they do not represent coherent moral objections to providing couples with the opportunity for making meaningful reproductive choices about other conditions
If the use of public health resources is justified for providing couples with opportunities for meaningful reproductive choice through the offer of prenatal screening, public health services may have obligations to empower couples where concerning conditions that fall beyond the scope of serious congenital conditions and childhood disorders
Summary
Many health services provide some type of prenatal screening service that is routinely offered to women and their partners during antenatal care. In line with principles of non-directivity, health services should not convey the message that terminating an affected pregnancy will benefit either the prospective parents or future child in terms of avoiding suffering This would be considered least problematic where concerning conditions that qualify as a life not worth living, the issue remains that couples should have discretion to make such value judgements for themselves. The more prominent role of personal, individually affecting, social determinants of suffering for non-medical traits, means that couples are unlikely to benefit from an unsolicited screening offer (and the provision of associated services for educational support and counseling) over and above making prenatal screening available following personal enquiry In this respect, a more reasonable objection to routinely offering screening for non-medical traits might be that this could ‘trivialize’ the provision of an important antenatal service and undermine public solidarity towards providing couples with opportunities for meaningful reproductive choice. Further ethical debate is necessary on how access to such opportunities may be provided and whether there may be pro tanto reasons for prohibiting it within certain social contexts
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