Prenatal Testing: Ethics, Benefits, and Social Implications

Introduction

For many people, prenatal testing has opened new opportunities to treat potential illnesses and to save lives. Administering tests that involve visualization, ultrasounds, and amniocentesis allows physicians and parents to identify illnesses and disabilities in children even before birth. More advanced surgical techniques have been used to treat babies before they are born.

Many others, however, have expressed concern over the ethical implications of prenatal testing. While the treatment of diseases is a noble cause, many ethicists worry that prenatal testing will lead to a de facto form of eugenics. In these cases, prenatal testing could be used to screen out mild disabilities and other non-life-threatening conditions.

This paper examines the social implications of prenatal testing, with a particular emphasis on definitions of disability and preferred genetic makeup. The first part looks at the reasons why parents avail themselves of prenatal testing techniques, which range from non-invasive processes such as ultrasounds to fetal tissue analysis. The second part examines the many advantages and arguments in favor of continued prenatal testing. In the third part, the paper considers the various ethical arguments against tampering with natural genetic development, including concerns that prenatal testing would cause a significant increase in abortion rates.

In the conclusion, this paper argues that the fears of ethicists regarding abortion and eugenics remain largely conjectural and represent worst-case scenarios. The advantages of in-utero surgery and early treatment, however, are already a reality. In light of these two factors, prenatal testing should continue to be available for parents who wish to ensure the health of their baby.

In the late 1960s, modern prenatal diagnosis techniques provided parents with new options for prenatal care. At the forefront was amniocentesis, a technique in which cells taken from amniotic fluid are grown in the laboratory. By analyzing these cells, scientists and physicians can identify the presence of genetic markers for diseases like Down syndrome ("Genetic Testing and Screening").

Types of Prenatal Testing

Researchers find that people who opt for prenatal diagnosis do so for common reasons. Many would-be parents request prenatal testing due to the advanced age of the mother; more than 90 percent of prenatal tests are performed for mothers aged 35 and over. Parents with a history of genetic abnormalities such as Tay-Sachs disease also avail themselves of prenatal testing techniques. Related to this, many people who belong to ethnic groups known to be at risk for specific illnesses also turn to prenatal testing ("Genetic Testing and Screening").

The remainder of prenatal diagnoses are conducted for patients who have had difficulty conceiving, experienced difficult pregnancies, suffered miscarriages, or given birth to babies with birth defects. Many couples who have had a child with Down syndrome are also prime candidates for prenatal testing, regardless of maternal age ("Genetic Testing and Screening").

Despite the different reasons for seeking prenatal tests, parents who opt for such testing share the same primary concern: to predict the possibility of birth defects and disease. Even for conditions that are still classified as untreatable, many parents find knowledge regarding their children's health invaluable.

Research has shown that many patients and healthcare practitioners favor prenatal testing. Many pregnant women understand that while prenatal screenings do not constitute a definitive diagnosis, these techniques can identify those at high risk of abnormalities (Suter). In this sense, prenatal testing has become a norm for many pregnancies.

With advancements in science, prenatal testing allows for the diagnosis of many inherited diseases and abnormal chromosomes. Individuals can also avail themselves of carrier testing to assess their risk of bearing a child with genetic anomalies or recessive conditions (Anderson 129). The idea is to give individuals the chance to make informed choices — among them, whether to seek early treatment. In cases where no treatment options exist, parents can also make an informed choice regarding the continuation or termination of a pregnancy.

Advantages of Prenatal Testing

Because of these choices, it could be argued that the current high cost of procedures like amniocentesis and other forms of prenatal testing may place lower-income parents at a disadvantage. Those who cannot afford prenatal screenings do not have access to early, in-utero surgery to treat birth defects such as cardiac anomalies. Surgical techniques are already available to repair the heart of a fetus and return it to the womb for continued gestation.

Additionally, lower-income parents can be carriers of illnesses such as Tay-Sachs disease and Huntington's disease. Limiting the availability of prenatal screening to those who can afford expensive tests is therefore equivalent to making the poor shoulder the greater burden of risk for genetic and chromosomal illnesses. The National Human Genome Research Institute has documented ongoing disparities in access to genetic services that underscore this concern.

Researchers, however, express concern over the "routinization" of prenatal testing procedures. In one study, women in a California HMO reported a reluctance to refuse prenatal testing, and many even described feeling pressured to undergo prenatal tests under the banner of good parenting (Suter).

Others have raised questions about which diseases or conditions should be included in screening. Current prenatal testing procedures, for example, can only test for the possibility of Huntington's disease — a debilitating adult-onset illness — without predicting its occurrence with certainty. Many advocates for people with disabilities also argue against testing for conditions such as Down syndrome. While the chromosomal disorder can cause intellectual disability and physical abnormalities, many of those with Down syndrome live full lives. Advocates for the rights of people with Down syndrome and other disabilities charge that prenatal tests could lead to "therapeutic" abortions for fetuses with these conditions.

Conclusion

Anderson, Gwen. "Nondirectiveness in Prenatal Genetics: Patients Read Between the Lines." Nursing Ethics. 1999: 126–129.

"Genetic Testing and Screening." Bioethics for Students: Issues in Medicine, Animal Rights, and the Environment. 4 vols. Macmillan, 1999. Reproduced in Opposing Viewpoints Resource Center. Farmington Hills, Mich.: Gale Group, 2004.

Suter, Sonia Mateu. "The Routinization of Prenatal Testing." American Journal of Law and Medicine. Boston: 2002. Proquest Database.