SCREENING IN FETAL MEDICINE

Screening in Fetal Medicine

Screening in Fetal Medicine

Abstract

In recent decades antenatal screening has become one of the most routine procedure of pregnancy-follow up and the subject of hot debate in bioethics circles. In this paper the rationale behind doing antenatal screening and the actual and potential problems that it may cause will be discussed. The paper will examine the issue from the point of view of parents, health care professionals and, most importantly, the child-to-be. It will show how unthoughtfully antenatal screening is performed and how pregnancy is treated almost as a disease just since the emergence of antenatal screening. Genetic screening and ethical problems caused by the procedure will also be addressed and I will suggest that screening is more to do with the interests of others rather than those of the child-to be.

Introduction

Antenatal testing (ANT) is widely used in modern obstetrics and gynaecology. I shall discuss the procedures involved in ANT from different perspectives, beginning with definitions of 'antenatal screening' and 'antenatal diagnosis', the main objectives and indications for their use. Secondly, I will discuss the risks and complications of ANT, the concerns, doubts and moral controversies it raises. Thirdly, since counselling is an integral part of ANT, I shall try to determine what the ideal of counselling before and after ANT is meant to be. Finally, with particular reference to some relevant concepts like 'responsibility', 'suffering' and 'interest', I attempt to describe the whole issue more comprehensively.

Recent studies have indicated that the major paediatric health problems are handicaps due to genetic disorder or congenital malformation. When it was noticed that more than a quarter of all deaths in the first year of life were due to fetal abnormalities [1], scientists were alarmed and parents sought a 'remedy' for the 'problem'. Although antenatal diagnostic techniques were initially described in the nineteenth century, it was not until the middle of 20th century that the techniques were applied to AND management of various genetic disorders and congenital malformations. And, at the present time, antenatal screening and diagnostic techniques are almost the norm. It has been said that, probably around 90% of women in the UK have undergone one of these at some time during pregnancy [2]. Although there is only a slight difference between the two procedures, the authorities do distinguish between antenatal screening (ANS) and antenatal diagnosis (AND).

Aims of Antenatal Testing

ANS services are based on population screening to identify people with a genetic risk, or a risk of having a child with a congenital or genetic disorder [3]. In the Dutch Health Council report on genetic screening, the major aim is defined as: "To enable people to decide upon a course of action that is acceptable for them" [3]. ANS includes:

1. Screening for sporadic conditions affecting the fetus (infections, chromosomal disorders, malformations, maternal diabetes);

2. Family history for genetic risks;

3. Population screening for carriers of common recessively inherited diseases.

Different health authorities in different countries have pointed out various aspects of ANS. While the Danish Health Council considers screening as ...