Bioconstitutional visions in the debate on non-invasive prenatal testing in Germany

Since the summer of 2022, statutory health insurance in Germany reimburses the costs of using non-invasive prenatal testing (NIPT), a new technology used in prenatal testing, in ‘justified individual cases’. Analysing moments in the long debate on NIPT in Germany through the framework of bioconstitutionalism and with pragmatic lenses helps us to understand how and why this comparatively unique reimbursement decision became a reasonable and moral one. Conflicts and conversations in these moments reveal two competing definitions and visions of human life relating to measures deemed desirable and legitimate to protect that life. Actors articulating a liberal bioconstitutional vision framed NIPT as a biomedical technology that could protect the lives of foetuses and enable women to exercise their right to know without putting their pregnancy at risk. Actors foregrounding a societal bioconstitutional vision framed NIPT as a selective technology and spoke in the name of all those lives that would be affected by the direct and indirect consequences of NIPT. When public health care authorities endorsed NIPT as a biomedical technology to be reimbursed in individual cases, they sought to reconcile elements of both visions. The case of Germany shows that enduring controversies on reproductive technologies can put constraints on what state authorities are allowed to do. It also suggests that moral controversies on reproductive technologies and the salience of private markets of reproductive care might be the two sides of the same coin.