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避免“选择”?-当前德国关于非侵入性产前检测政策辩论中对历史的引用。

Avoiding 'selection'?-References to history in current German policy debates about non-invasive prenatal testing.

机构信息

Institute for History of Medicine and Science Studies, University of Lübeck, Lübeck, Germany.

出版信息

Bioethics. 2021 Jul;35(6):518-527. doi: 10.1111/bioe.12880. Epub 2021 May 16.

DOI:10.1111/bioe.12880
PMID:33998016
Abstract

This article investigates the role of historical references and arguments in the current policy debate on non-invasive prenatal testing (NIPT) in Germany. It analyses major documents and opinion statements, including the recent parliamentary debate (2019). The implementation of NIPT is accompanied by concerns and strong criticism, particularly in Germany. Many perceive the new test to be a problematic step that facilitates selective practices and is reminiscent of eugenics. Analysis of the German policy discourse shows that 'eugenics', and even more strongly, 'selection', are pivotal terms for rejecting NIPT and its coverage by public health insurance. They touch on a historical dimension in public deliberation, namely the fundamental distancing from the inhuman practices of the National Socialist period and anything that resembles them. However, using these terms to criticize prenatal genetic testing is controversial, and recent discourse demonstrates their avoidance as well, with many supporters of a limited coverage by public health insurance contrasting their approach with more widespread screening. Here, 'screening' has a negative connotation, and functions to demarcate the debate in a way that may reflect distance from certain modes of historical reasoning, but still expresses a special need to reconcile prenatal testing with the principles of dignity, inclusion and diversity. This article aims to elucidate the concerns involved in the national debates on prenatal testing and to increase awareness of the historical dimensions of the language and reasoning with which such methods are negotiated today and in future.

摘要

本文探讨了历史参考资料和论据在德国当前非侵入性产前检测 (NIPT) 政策辩论中的作用。它分析了主要文件和意见声明,包括最近的议会辩论(2019 年)。NIPT 的实施伴随着关注和强烈的批评,特别是在德国。许多人认为这项新测试是一个有问题的步骤,它促进了选择性做法,并让人联想到优生学。对德国政策话语的分析表明,“优生学”,甚至更强烈的是“选择”,是反对 NIPT 及其被公共健康保险覆盖的关键术语。它们触及了公共审议中的一个历史维度,即与纳粹时期不人道的做法以及任何类似的做法彻底保持距离。然而,使用这些术语来批评产前基因检测是有争议的,最近的话语也表明了它们的回避,许多公共健康保险有限覆盖的支持者将他们的方法与更广泛的筛查进行对比。在这里,“筛查”具有负面含义,并起到了划定辩论的作用,这种方式可能反映出与某些历史推理模式的距离,但仍表达了一种特殊的需要,即协调产前检测与尊严、包容和多样性的原则。本文旨在阐明国家产前检测辩论中涉及的问题,并提高对当今和未来此类方法谈判中语言和推理的历史维度的认识。

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Non-invasive prenatal testing (NIPT): is routinization problematic?非侵入性产前检测(NIPT):常规化是否有问题?
BMC Med Ethics. 2023 Oct 26;24(1):87. doi: 10.1186/s12910-023-00970-5.
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Non-Invasive Prenatal Testing (NIPT): Reliability, Challenges, and Future Directions.
无创产前检测(NIPT):可靠性、挑战与未来方向。
Diagnostics (Basel). 2023 Aug 2;13(15):2570. doi: 10.3390/diagnostics13152570.
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Non-invasive prenatal testing in Germany: a unique ethical and policy landscape.德国的无创性产前检测:独特的伦理和政策环境。
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