Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
J Med Ethics. 2020 Nov;46(11):783-784. doi: 10.1136/medethics-2020-106218. Epub 2020 Apr 10.
Asking pregnant women to (co)pay for non-invasive prenatal testing (NIPT) out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women and children, but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this is an argument for individual women to take part in screening or to terminate an affected pregnancy. However, it a legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women (eg, that they are not at risk), and thus to support informed consent for first-trimester prenatal screening.
要求孕妇自费进行无创产前检测 (NIPT) 会导致社会经济阶层之间获得机会不平等。为避免这些社会公正问题，在荷兰等国家，应将孕早期产前筛查纳入公共资金资助范围，这些国家实行普及全民的医疗保健系统，为所有其他产前护理服务和筛查计划提供免费服务。在本回复中，我们提出了公共资助 NIPT 的另外三个理由。首先，NIPT 对妇女和儿童的主要医疗效用可能不大，而是提供相关信息和生殖选择，因此服务于妇女的重要自主利益。其次，公共资助 NIPT 是合理的，因为它减少了与照顾和支持染色体异常儿童相关的集体承担的费用。需要注意的是，这是为了证明个别妇女参与筛查或终止受影响妊娠的正当性。然而，这是制定筛查计划资金安排政策的一个合理论点。最后，公共资助将有助于纠正孕妇当前的误解（例如，她们没有风险），从而支持对孕早期产前筛查的知情同意。
