Commercial fetal DNA tests, or noninvasive prenatal diagnosis (NIPD) tests, are here. Are we ready for the legal and ethical implications?
There’s a fantastic article by Mara Hvistendahl at Slate about the spate of commercial fetal DNA tests in the pipeline. These tests can determine the sex of the fetus, paternity, and chromosomal conditions like Down Syndrome. She writes:
"The potential benefits of NIPD [noninvasive prenatal diagnosis ] are many: elimination of the risks associated with amniocentesis, the replacement of aggravating probabilities with accurate information, and more time for expectant parents to make difficult decisions. But because insurance providers have an incentive to cover them, fetal DNA tests stand to be introduced before we have time to consider the slew of ethical and political challenges they will introduce."
Among the challenges: sex ratio imbalances in developing countries (prenatal tests to determine gender are already illegal in India, but doctors often disregard the law); ob/gyns who are unable to accurately explain the implications of testing to women or help them deal with the results; potential legal quagmires requiring women to have the testing done at the same time that anti-abortion groups are lobbying to reduce women’s access to abortion.
The National Society of Genetic Counselors issued a statement opposing NIPD in low-risk women, and most medical societies, including ACOG and the International Federation of Gynecology and Obstetrics, oppose sex-selection unless there’s a high risk gender-specific abnormalities. But this is unlikely to stop the companies creating the tests, doctors who want to use them, or women who are hungry for answers.
What do you think? Will you embrace the new tests and do you feel equipped to guide patients through the process? Or are we opening Pandora’s box?