Schmitz Dagmar
Institute of History, Theory and Ethics in Medicine, RWTH University Aachen, Wendlingweg 2, 52074 Aachen, Germany.
Med Health Care Philos. 2013 Aug;16(3):357-64. doi: 10.1007/s11019-012-9411-y.
Prenatal care and the practice of prenatal genetic testing are about to be changed fundamentally. Due to several ground-breaking technological developments prenatal screening and diagnosis (PND) will soon be offered earlier in gestation, with less procedure-related risks and for a profoundly enlarged variety of targets. In this paper it is argued that the existing normative framework for prenatal screening and diagnosis cannot answer adequately to these new developments. In concentrating on issues of informed consent and the reproductive autonomy of the pregnant women the ethical debate misses problems related to the clinical pathway as a whole and to implicit normative attributions to clinical actions or the function of health care professionals. If, however, ethical debate would focus on the clinical context and on the ends of PND to a larger extent, it would be able to provide a more comprehensive analysis of the ethical challenges especially of the new technologies in order to be more adequately prepared for their implementation.
产前护理和产前基因检测的实践即将发生根本性变革。由于几项突破性的技术发展，产前筛查和诊断（PND）将很快在孕期更早期提供，与操作相关的风险更低，且针对的目标种类大幅增加。本文认为，现有的产前筛查和诊断规范框架无法充分应对这些新发展。在专注于知情同意问题和孕妇的生殖自主权时，伦理辩论忽略了与整个临床路径相关的问题，以及对临床行为或医护人员职能的隐含规范归因。然而，如果伦理辩论能在更大程度上关注临床背景和PND的目的，它将能够对伦理挑战，尤其是新技术带来的伦理挑战进行更全面的分析，以便为其实施做好更充分的准备。
