Abstract
Definition of the problem
In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree.
Arguments
This development could be interpreted as empowering from the perspective of reproductive autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context?
Conclusion
In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT.
In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree.
Arguments
This development could be interpreted as empowering from the perspective of reproductive autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context?
Conclusion
In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT.
| Translated title of the contribution | Nichtinvasive Pränataltests als Teil der vorgeburtlichen Regelversorgung: Perspektiven und Herausforderungen aus Sicht der reproduktiven Autonomie |
|---|---|
| Original language | English |
| Pages (from-to) | 49-63 |
| Number of pages | 15 |
| Journal | Ethik in der Medizin |
| Volume | 32 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 01 Mar 2020 |
| Externally published | Yes |
Keywords
- Reproductive autonomy
- Prenatal diagnosis
- Shared decision making
- Routinization
- Noninvasive prenatal testing
- Burden of choice
ASJC Scopus subject areas
- Health (social science)
- Philosophy
- Health Policy
- Issues, Ethics and Legal Aspects