Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Research Institute GROW, Maastricht University, Maastricht, The Netherlands.
Eur J Hum Genet. 2010 Mar;18(3):272-7. doi: 10.1038/ejhg.2009.203. Epub 2009 Dec 2.
This paper explores the ethical implications of introducing non-invasive prenatal diagnostic tests (NIPD tests) in prenatal screening for foetal abnormalities. NIPD tests are easy and safe and can be performed early in pregnancy. Precisely because of these features, it is feared that informed consent may become more difficult, that both testing and selective abortion will become 'normalized', and that there will be a trend towards accepting testing for minor abnormalities and non-medical traits as well. In our view, however, the real moral challenge of NIPD testing consists in the possibility of linking up a technique with these features (easy, safe and early) with new genomic technologies that allow prenatal diagnostic testing for a much broader range of abnormalities than is the case in current procedures. An increase in uptake and more selective abortions need not in itself be taken to signal a thoughtless acceptance of these procedures. However, combining this with considerably enlarging the scope of NIPD testing will indeed make informed consent more difficult and challenge the notion of prenatal screening as serving reproductive autonomy. If broad NIPD testing includes later-onset diseases, the 'right not to know' of the future child will become a new issue in the debate about prenatal screening. With regard to the controversial issue of selective abortion, it may make a morally relevant difference that after NIPD testing, abortion can be done early. A lower moral status may be attributed to the foetus at that moment, given the dominant opinion that the moral status of the foetus progressively increases with its development.
本文探讨了在产前筛查胎儿异常中引入非侵入性产前诊断测试（NIPD 测试）的伦理含义。NIPD 测试简便、安全，可在妊娠早期进行。正是由于这些特点，人们担心知情同意可能变得更加困难，检测和选择性流产将变得“正常化”，并且可能会出现接受对轻微异常和非医学特征进行检测的趋势。然而，在我们看来，NIPD 测试的真正道德挑战在于，将具有这些特点（简便、安全和早期）的技术与新的基因组技术联系起来的可能性，这些技术允许对比目前程序中更广泛的异常进行产前诊断测试。接受率的提高和更多的选择性流产本身并不一定表明对这些程序的轻率接受。然而，将这一点与扩大 NIPD 测试范围相结合，确实会使知情同意更加困难，并对产前筛查作为生殖自主权服务的概念提出挑战。如果广泛的 NIPD 测试包括后期发病的疾病，那么未来孩子的“知情权”将成为产前筛查辩论中的一个新问题。对于选择性流产这一有争议的问题，NIPD 测试后可以早期进行流产，这可能会产生具有重要道德意义的差异。鉴于主流观点认为胎儿的道德地位随着其发育而逐渐提高，因此在那个时刻，可能会将胎儿的道德地位降低。
