Melbourne Law School, The University of Melbourne, Carlton, Australia.
Murdoch Children's Research Institute, Parkville, Australia.
Med Law Rev. 2023 Nov 27;31(4):521-537. doi: 10.1093/medlaw/fwad014.
Non-invasive prenatal testing (NIPT) can be used to determine the chromosomal sex of the fetus at an early stage in a pregnancy. The use of NIPT for fetal sex determination raises concerns about potential selective termination of pregnancy by prospective parents who desire a child of a particular sex. Although sex selection for medical reasons is generally accepted, non-medical sex selection (NMSS) has been the subject of considerable controversy. In this article, we explore the current regulatory landscape around reproductive genetic testing techniques that may lead to NMSS, both internationally and within Australia. Specifically, we contrast the approach to regulating preimplantation genetic testing (PGT) with the minimal regulation of NIPT in Australia as a case study for reform. We examine ethical concerns raised in relation to NMSS, which form the basis of the current moratorium on the use of PGT for NMSS. We then highlight some key differences between using PGT for NMSS and NIPT for fetal sex determination to determine whether access to the latter should be regulated and, if so, how. We conclude that there is insufficient evidence to restrict access to NIPT for fetal sex determination and, based on our Australian case study, recommend a facilitative approach to regulating NIPT that would support individuals to make informed reproductive decisions.
非侵入性产前检测 (NIPT) 可用于在妊娠早期确定胎儿的染色体性别。使用 NIPT 进行胎儿性别鉴定引起了人们的担忧，即可能会导致有特定性别偏好的准父母选择性终止妊娠。虽然出于医疗原因选择性别通常是被接受的，但非医疗性别选择 (NMSS) 一直是相当多争议的话题。在本文中，我们探讨了国际上和澳大利亚国内可能导致 NMSS 的生殖遗传检测技术的现行监管格局。具体来说，我们将对比澳大利亚对植入前基因检测 (PGT) 的监管方法与对 NIPT 的最低限度监管，将后者作为改革的案例研究。我们还审查了与 NMSS 相关的伦理问题，这些问题构成了目前对 PGT 用于 NMSS 的使用禁令的基础。然后，我们强调了使用 PGT 进行 NMSS 和使用 NIPT 进行胎儿性别鉴定之间的一些关键区别，以确定是否应监管后者，如果应监管，应如何监管。我们的结论是，没有足够的证据限制 NIPT 用于胎儿性别鉴定，并且根据我们的澳大利亚案例研究，建议采取促进性的方法来监管 NIPT，以支持个人做出知情的生殖决策。
