Ethics and trends in applied human genetics.

Unless present trends change, in the next few years the public will see earlier and safer methods of prenatal diagnosis combined with more efficacious methods of fetal therapy. For some time to come, the power to diagnose will far outstrip the power to treat, but with sufficient research and resources, the 2 activities of fetal medicine will assume more balance. The effect of conjoining therapy to diagnosis will bring about a more ethical balance between the immediate risks and benefits of prenatal diagnosis. Abortion will not cease to be a controversial issue in the context of fetal medicine, but the ability to offer treatment to more affected fetuses will create more assurance that progress in diagnosis and treatment will not be halted due to legal and constitutional efforts to protect the life of the fetus. At the same time, special attention should be paid to the mother, father and extended family of the fetus diagnosed for a treatable disorder. Careful discussion and clear communication may prevent misunderstandings and surface family problems that could arise at the last minute to complicate the mother's consent to treatment. When the risks are significant for the mother and the benefits of treatment are unclear, there should be no suggestion or appearance of pressure on her to agree. The same principle should apply even when the risks to the mother are minimal and the benefits to the future child are unclear.