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Prenatal Diagnosis

Genetic Counseling And The Ethics Of Prenatal Diagnosis

A genetic counselor helps educate individuals, couples, and families about prenatal tests, and helps them to understand and cope with the results. The couselor also informs the prospective parents of the limitations of the tests, explaining that they can rule out certain conditions but cannot guarantee a healthy baby.

Ethical issues can arise in the decision to undergo prenatal testing. For example, the Nash family received criticism for their decision to intentionally conceive one child to save another. Some people also question the use of prenatal tests or PGD to reject embryos because of a gene that causes an adult-onset disease, such as Alzheimer's disease. In a more general sense, picking and choosing offspring based on genes can be considered eugenic, with the caveat that the intent is not to improve the gene pool, but to prevent suffering. This may mean terminating a pregnancy in which the fetus has a very bleak prognosis, which people opposed to abortion might find unethical. Opponents to this view point out that "letting nature take its course" can be painful for the fetus and may endanger the life of the woman.

The ethics of prenatal diagnosis becomes more complicated when the goal is not to prevent suffering, but to choose a child of a particular sex. Doctors have long reported patients using CVS or amniocentesis to learn the sex of the fetus, then terminating the pregnancy if the outcome is not what is desired. PGD is sometimes used for this purpose, too. Some people have compared this practice to a high-tech version of the ancient practice of leaving girl babies outside city walls to perish. The American Society for Reproductive Medicine endorses the use of PGD for sex selection to avoid passing on an X-linked disease, but discourages use for family planning as "inappropriate use and allocation of medical resources."

The ethical concerns that arose with the ability to foretell the sex of a child are certain to mushroom as data from the Human Genome Project continue to lengthen the list of disorders that can be detected before birth. Physicians and parents-to-be in the future will have to decide just how much they want to know about their offspring and how they will use that information.

Ricki Lewis

Bibliography

Ethics Committee of the American Society for Reproductive Medicine. "Preconception Gender Selection for Nonmedical Reasons." Fertility and Sterility 75, no. 5 (May 2001): 861-864.

Gottlieb, Scott. "Scientists Screen Embryo for Genetic Predisposition to Cancer."British Medical Journal 322 (June 23, 2001): 1505.

Josefson, D. "Couple Selects Healthy Embryo to Provide Stem Cells for Sister."British Medical Journal 321 (October 14, 2000): 917.

Lewis, Ricki. "Preimplantation Genetic Diagnosis: The Next Big Thing?" Scientist14, no. 22 (November 13, 2000): 16.

Additional topics

Medicine EncyclopediaGenetics in Medicine - Part 3Prenatal Diagnosis - Viewing Chromosomes, Less Invasive Methods, Preimplantation Genetic Diagnosis, Genetic Counseling And The Ethics Of Prenatal Diagnosis