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Ethical considerations to NIPT

A look at the frameworks for decision-making regarding reproductive choice and prenatal testing.

The European journal Medicine, Health Care and Philosophy recently published a discussion of the ethics of noninvasive prenatal testing (NIPT). Specifically, the piece poses the question: In light of the fact that NIPT can now identify a broad range of genetic conditions prenatally, should all couples have access to the full range of testing, and therefore have to wrestle with the difficult choices that the knowledge gleaned from NIPT may force them to make?

The paper notes that the European Society of Human Genetics (ESHG) and the American Society of Human Genetics (ASHG) recommend that, pending further debate, prenatal screening for reproductive choice (that is, pregnancy termination) should be offered only for serious congenital conditions and childhood disorders.

The author, of Maastricht University in the Netherlands, considers “directive” and “nondirective” frameworks for decision-making regarding reproductive choice based on knowledge of a fetus gleaned from NIPT. He discusses objections based on fetal rights, feminist, and disability rights perspectives, also taking into consideration pain and suffering, discrimination, societal burden, privacy, and the issues of “information overload” and the trivialization of abortion.

The author comes to the conclusion that these objections “do not represent coherent moral objections to providing couples with the opportunity for making meaningful reproductive choices …” He argues 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.”