The ethical landscape(s) of non-invasive prenatal testing in England, France and Germany: findings from a comparative literature review.

Adeline Perrot,Ruth Horn

doi:10.1038/s41431-021-00970-2

Abstract

Since 2019, England, France and Germany have started offering NIPT as a publicly funded second-tier test for common chromosomal aneuploidies (trisomy 21, 18 and/or 13). Despite these benefits, the introduction of NIPT into routine prenatal care also raises a number of ethical concerns. In this paper, we analyse how these issues are discussed differently across countries, echoing the different socio-political particularities and value-systems that shape the use and regulation of NIPT in a specific country. The international comparison between England, France and Germany shows how each country defines the principle of reproductive autonomy and weighs it against other principles and values, such as, human dignity, disability rights and the duty of care of health professionals. In terms of methodology, our literature review focuses on arguments and regulations of prenatal testing and reproductive choices (specifically on NIPT), through the investigation of regulatory, parliamentary, scientific, medical, association, institutional and media sources. The comparative review helps to better understand ethical questions discussed with regard to NIPT, and, more broadly, to prenatal genomic testing, and the limits associated with reproductive autonomy in the three countries studied. Whereas reproductive autonomy is valued in each country, it is understood and implemented differently depending on the socio-cultural context, and on what other principles are evoked and how they are defined.

Highlights

Non-invasive prenatal testing (NIPT), known as Cell-free fetal DNA screening, is a rapidly developing technology that is constantly widening its scope and offering new approaches to fetal medicine
NIPT has a number of advantages over the conventional combined first‐trimester screening consisting of ultrasound examination and serum markers [3]; it can be performed earlier in pregnancy, is considered more accurate in detecting common chromosomal aneuploidies and with a lower false positive rate [4], and it decreases the number of invasive tests that carry a low risk of miscarriage
Our study provides an insight into the similarities and differences between England, France and Germany through a comprehensive literature review focusing on arguments about, and regulations of, prenatal testing and reproductive choices

Summary

INTRODUCTION

Non-invasive prenatal testing (NIPT), known as Cell-free fetal (cff) DNA screening, is a rapidly developing technology that is constantly widening its scope and offering new approaches to fetal medicine. NIPT has a number of advantages over the conventional combined first‐trimester screening (cFTS) consisting of ultrasound examination and serum markers [3]; it can be performed earlier in pregnancy (from 9 to 10 weeks), is considered more accurate in detecting common chromosomal aneuploidies and with a lower false positive rate [4], and it decreases the number of invasive tests that carry a low risk of miscarriage Despite these benefits, the introduction of NIPT into routine prenatal care raises a number of ethical concerns about, for example, the risk of routinisation undermining reproductive choices or increasing discrimination against children living with a trisomy. Our analysis sheds new light on different meanings of reproductive autonomy within various socio-cultural contexts and how this impacts on the use and regulations around prenatal genetic testing Such an investigation is an important step in advancing the ethical and policy debates regarding NIPT in different countries

METHODS

CONCLUSION

ETHICAL APPROVAL