Carnevale A, Lisker R, Villa A R, Armendares S
Instituto Nacional de Pediatría, Mexico City, Mexico.
Am J Med Genet. 1998 Feb 3;75(4):426-31. doi: 10.1002/(sici)1096-8628(19980203)75:4<426::aid-ajmg16>3.0.co;2-q.
Prenatal diagnosis (PD) provides the physician information on whether the unborn fetus has a genetic or chromosomal disorder, and offers patients a new option: selective abortion. In the present study, we analyzed the answers Mexican geneticists provided to a few selected questions from a multinational survey designed by Wertz and Fletcher [1988: Am J Hum Genet 42:592-600]. The selected questions were related to the use of PD, the acceptance of selective abortion, and the self-reported directiveness of counselling following the diagnosis of a fetal anomaly. Our results show that the great majority of Mexican geneticists participating in the study agree with PD when medically indicated, but not on free demand. Specific cases stimulated the group on thinking more than the general statements provided in the survey. Although the majority agreed that PD should be available to all women, when faced with cases of nonmorbid maternal anxiety, paternity testing, and sex selection, the proportion of geneticists willing to perform the test decreased substantially. When counselling patients on a fetal anomaly, the minority would be as unbiased as possible, and this seems to be the tendency in developing countries where counselling, as stated in the respondents' comments, reflects the belief that the goal of genetics is the prevention of or opposition to abortion. Counselling was influenced by the severity of the disorder. The geneticists' personal attitude toward abortion in the same situations was stronger than when counselling others. Analysis of directiveness in counselling for fetal anomaly showed that older geneticists, with more years of experience in medical genetics, were more likely to be neutral. When counselling directively, the group showed an overall direction toward continuing affected pregnancies. However, older geneticists and those with more than 10 years of practice were more likely than their younger counterparts to counsel towards terminating affected pregnancies. In personal situations of fetal disorder, the general tendency was to abort; however, geneticists seeing more than 5 patients per week, and those who believe that religion is important, were more likely to reject abortion. The sample is representative of Mexican geneticists, and the main limitation of this study is that the geneticists have very little experience in PD, and that their responses were mostly based on theory. However, their opinions may influence the demand and the availability of PD and abortion, as well as the possibility of legalization of abortion on the basis of a fetal defect.
产前诊断（PD）为医生提供有关未出生胎儿是否患有遗传或染色体疾病的信息，并为患者提供了一种新的选择：选择性堕胎。在本研究中，我们分析了墨西哥遗传学家对韦茨和弗莱彻[1988年：《美国人类遗传学杂志》42：592 - 600]设计的一项跨国调查中几个选定问题的回答。选定的问题涉及产前诊断的使用、对选择性堕胎的接受程度，以及在诊断出胎儿异常后自我报告的咨询指导倾向。我们的结果表明，参与研究的绝大多数墨西哥遗传学家在有医学指征时同意进行产前诊断，但不同意随意要求进行。具体案例比调查中提供的一般性陈述更能激发该群体的思考。虽然大多数人同意所有女性都应可获得产前诊断，但面对非病态的母亲焦虑、亲子鉴定和性别选择等情况时，愿意进行检测的遗传学家比例大幅下降。在为胎儿异常的患者提供咨询时，少数人会尽可能保持公正，这似乎是发展中国家的一种趋势，正如受访者评论中所述，咨询反映了一种观念，即遗传学的目标是预防或反对堕胎。咨询受到疾病严重程度的影响。遗传学家在相同情况下对堕胎的个人态度比对他人进行咨询时更为强烈。对胎儿异常咨询中的指导倾向分析表明，在医学遗传学领域经验更丰富的年长遗传学家更有可能保持中立。当进行指导性咨询时，该群体总体上倾向于继续妊娠。然而，年长的遗传学家和有超过10年从业经验的人比年轻同行更有可能建议终止受影响的妊娠。在个人面临胎儿疾病的情况下，总体趋势是选择堕胎；然而，每周看诊超过5名患者的遗传学家以及那些认为宗教很重要的遗传学家更有可能拒绝堕胎。该样本代表了墨西哥遗传学家，本研究的主要局限性在于遗传学家在产前诊断方面经验很少，且他们的回答大多基于理论。然而，他们的意见可能会影响产前诊断和堕胎的需求与可及性，以及基于胎儿缺陷使堕胎合法化的可能性。
