50 whys to look for genes: 44. Prenatal diagnosis

Selective abortion following prenatal diagnosis allows parents to decide not to have a child with certain conditions, including chromosomal abnormalities. (This is different from prenatal diagnosis for some cases of physical abnormalities, such as spina bifida, in which corrective surgery may be attempted before the child is born.)

Complications

1. The most obvious complication is that in most cases, prenatal diagnosis is moot if abortion is not possible (legally or otherwise) or acceptable to the parents.  Other complications include the experience of parents when faced with initial positive diagnoses that are not confirmed after subsequent testing, the risk of miscarriage following the common forms of testing, and other ethical issues reviewed well in wikipedia.

2. Genetic counselors and clinicians tend to treat a positive diagnosis as more serious than parents (reference needed).  The guidelines for neutrality in genetic counseling do not speak to the issue of a couple’s preparation to make a decision if they get a positive diagnosis.   For example, by far the most common prenatal diagnosis is Trisomy 21, Down syndrome.  A couple who takes time to visit DS support groups and meet DS families may have a chance to explore whether their family and relationship could accommodate a DS child than one that has not.  The last few decades have seen enormous changes in social acceptance and support for DS children and adults and many improvements in medical treatment and timely physical therapy (http://www.ndss.org/).   How much about actually existing people with DS is known by the 50-85% of parents who abort their fetus in the USA after receiving a diagnosis of DS (http://www.ncbi.nlm.nih.gov/pubmed/22418958)?  (Rapp 1988 provides an early account of multiple voices that might be heard in prenatal screening for DS.)

3. Some might argue that prenatal diagnosis and selective abortion would reduce society’s burden in having to give special care for very disabled people and thus free funds for general health care, education, etc. for the mildly disabled.  Does this freeing of funds happen?  The counter-proposition would be that such “genetic purification” in practice works against tolerance for the usual range of variation and measures to care for the abnormal.  Is that happening?  (To understand the logic of the counter-proposition consider an analogy: The health and fitness boom since the 1980s seems to have reduced tolerance for plump, “overweight” people. Those who have kept themselves trim tend to think that overweight people ought also to be able to do something about their figures.)

Reference
Rapp, R. “Moral Pioneers: Women, Men & Fetuses.” Women & Health 13 (1/2, 1988): 101-116.

——

(Introduction to this series of posts)

Advertisements

One thought on “50 whys to look for genes: 44. Prenatal diagnosis

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s