Ethical Issues of Prenatal/Perinatal Screening, Diagnosis & Counseling

Instructor: Heather Adewale

Heather has taught reproductive biology and has researched neuro, repro and endocrinology. She has a PhD in Zoology/Biology.

Prenatal testing can help identify potential problems or disorders that may arise during or after birth. But it can be also be a source of controversy. How much information is too much and how do we use the information we obtain? While this controversial topic has many issues, we will stick to the basics in this lesson.

You're Pregnant!

It's early in the morning. You slip into the bathroom and then wait. . . for two whole minutes. A little pink line appears on the test you picked up from Walmart yesterday. You've done it! You're pregnant!

You visit your doctor. He tells you all about everything that will happen over the next nine months. You feel a little overwhelmed, being responsible for a new life, one dependent entirely on you. Fortunately, we now have many technological advances that make tracking and taking care of a baby's development inside the mother far easier than in the past. In fact, we can even screen and sequence the DNA of a baby before he or she is born! Amazing right? However, this technology brings with it a sense of responsibility and a lot of controversy.

Prenatal Screening

These advances in technology fall under what we call prenatal screening (also called prenatal testing). These tests provide information about the health of a baby prior to birth. There are many different tests, but in general they screen for any physical or genetic abnormalities in a child.

How exactly is this done? Some tests simply take pictures of a baby through the mother's uterus; this is called an ultrasound and can be used to ensure that the baby is developing correctly physically. Other tests use a variety of methods to access a baby's DNA so it can be analyzed in a lab. DNA is like the instruction booklet for a human body. It contains all the information that determines who we are, what we look like, how our body works, and what diseases or disorders we may be susceptible to. While this might sound normal, a decade or so ago this was the thing of science fiction and futuristic movies.

So what's next? Well, that right there is the big controversy associated with prenatal screening. The goal of screening is to provide information. But how much is too much? And what do we do with this information? Also, is the obtaining of this information safe for the mother and baby?

Performing Prenatal Tests

Many prenatal tests can be done by simply drawing blood from the mother. However, others require more invasive procedures where samples are obtained from the placenta, or the tissues and fluids surrounding the fetus (such as the amniotic fluid and umbilical cord). These are riskier and can potentially harm the fetus.

You may be wondering why doctors do these types of tests when information can be gathered from a simple blood test. Think of it like this. . . the blood tests are like watching a movie and the more invasive tests are like reading the book. The movie gives you the main story line and the overall picture, but the book provides all the details. But not everybody wants to or has time to read the book. So you start with the movie (or the blood test) and if needed you then go into more depth.

Understanding Prenatal Test Results

So, we now have the ability to take a small sample from a developing baby and predict whether that child will have genetic-based disorders such as downs syndrome, cystic fibrosis, sickle cell, and many others! What could be bad about that?

Receiving the results of prenatal testing can be difficult for some women and oftentimes the mother feels like she is losing control over her pregnancy. Genetic counselors can help by explaining the test results and helping parents understand their options. These options can be a source of controversy. The ability to obtain this type of information from an unborn child is amazing, but with it comes a responsibility to do right by both the mother and the unborn child.

While the results of prenatal tests may, under extreme circumstances, indicate that termination of the pregnancy is the safest course, in most cases this is not required. Many genetic disorders can be lived with. Some may not greatly affect quality of life, while others such as mental or physical disorders may require adaptation, extra medical attention, or extra effort by caretakers and parents. In general, the child's quality of life can still be good.

Ethical Concerns

The goal of prenatal testing is to help the parents prepare for any possible medical difficulties that may accompany a newborn baby. However, one concern is that some parents may use this information to determine whether or not to keep the baby. Many people feel that these tests are allowing us to, in a sense, 'play God' and determine who lives and who doesn't. Some may feel that they either cannot or do not want to raise a special needs child or one who may develop a certain disorder early in life. While this is not the purpose of prenatal testing, it is an unfortunate outcome that may arise.

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