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Erschienen in: Medicine, Health Care and Philosophy 3/2013

01.08.2013 | Scientific Contribution

A new era in prenatal testing: are we prepared?

verfasst von: Dagmar Schmitz

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 3/2013

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Abstract

Prenatal care and the practice of prenatal genetic testing are about to be changed fundamentally. Due to several ground-breaking technological developments prenatal screening and diagnosis (PND) will soon be offered earlier in gestation, with less procedure-related risks and for a profoundly enlarged variety of targets. In this paper it is argued that the existing normative framework for prenatal screening and diagnosis cannot answer adequately to these new developments. In concentrating on issues of informed consent and the reproductive autonomy of the pregnant women the ethical debate misses problems related to the clinical pathway as a whole and to implicit normative attributions to clinical actions or the function of health care professionals. If, however, ethical debate would focus on the clinical context and on the ends of PND to a larger extent, it would be able to provide a more comprehensive analysis of the ethical challenges especially of the new technologies in order to be more adequately prepared for their implementation.
Fußnoten
1
McGraw-Hill Concise Dictionary of Modern Medicine 2002.
 
Literatur
Zurück zum Zitat Buchanan, A., D.W. Brock, N. Daniels, and D. Wikler. 2000. From chance to choice. Genetics & Justice. Cambridge, New York: Cambridge University Press. Buchanan, A., D.W. Brock, N. Daniels, and D. Wikler. 2000. From chance to choice. Genetics & Justice. Cambridge, New York: Cambridge University Press.
Zurück zum Zitat Chervenak, F.A., and L.B. McCullough. 2003. The fetus as a patient: An essential concept for the ethics of perinatal medicine. American Journal of Perinatology 20(8): 399–404.PubMedCrossRef Chervenak, F.A., and L.B. McCullough. 2003. The fetus as a patient: An essential concept for the ethics of perinatal medicine. American Journal of Perinatology 20(8): 399–404.PubMedCrossRef
Zurück zum Zitat Chitty, L.S., C.E. van der Schoot, S. Hahn, and N.D. Avent. 2008. SAFE—the special non-invasive advances in fetal and neonatal evaluation network: aims and achievements. Prenatal Diagnosis 28(2): 83–88.PubMedCrossRef Chitty, L.S., C.E. van der Schoot, S. Hahn, and N.D. Avent. 2008. SAFE—the special non-invasive advances in fetal and neonatal evaluation network: aims and achievements. Prenatal Diagnosis 28(2): 83–88.PubMedCrossRef
Zurück zum Zitat Chiu, R.W., R. Akolekar, Y.W. Zheng, T.Y. Leung, H. Sun, K.C. Chan, et al. 2011. Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: Large scale validity study. BMJ 342: c7401.PubMedCrossRef Chiu, R.W., R. Akolekar, Y.W. Zheng, T.Y. Leung, H. Sun, K.C. Chan, et al. 2011. Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: Large scale validity study. BMJ 342: c7401.PubMedCrossRef
Zurück zum Zitat Davidson, R.G. 1972. Prenatal diagnosis of genetic disorders: Trials and tribulations. Clinical Chemistry 18(3): 179–187.PubMed Davidson, R.G. 1972. Prenatal diagnosis of genetic disorders: Trials and tribulations. Clinical Chemistry 18(3): 179–187.PubMed
Zurück zum Zitat Deans, Z., and A. Newson. 2011. Should non-invasiveness change informed consent procedures for prenatal diagnosis? Health Care Analysis 19(2): 122–132.PubMedCrossRef Deans, Z., and A. Newson. 2011. Should non-invasiveness change informed consent procedures for prenatal diagnosis? Health Care Analysis 19(2): 122–132.PubMedCrossRef
Zurück zum Zitat De Jong, A., W.J. Dondorp, C.E. de Die-Smulders, S.G. Frints, and G.M. de Wert. 2010. Non-invasive prenatal testing: ethical issues explored. European Journal of Human Genetics 18(3): 272–277.PubMedCrossRef De Jong, A., W.J. Dondorp, C.E. de Die-Smulders, S.G. Frints, and G.M. de Wert. 2010. Non-invasive prenatal testing: ethical issues explored. European Journal of Human Genetics 18(3): 272–277.PubMedCrossRef
Zurück zum Zitat De Jong A., W.J. Dondorp, S.G. Frints, C.E. de Die-Smulders, and G.M. de Wert. 2011a. Non-invasive prenatal diagnosis for aneuploidy:toward an integral ethical assessment. Human Reproduction 26(11): 2915–2917. De Jong A., W.J. Dondorp, S.G. Frints, C.E. de Die-Smulders, and G.M. de Wert. 2011a. Non-invasive prenatal diagnosis for aneuploidy:toward an integral ethical assessment. Human Reproduction 26(11): 2915–2917.
Zurück zum Zitat De Jong, A., W.J. Dondorp, S.G. Frints, C.E. de Die-Smulders, and G.M. de Wert. 2011b. Advances in prenatal screening: The ethical dimension. Nature Reviews Genetics 12: 657–663. De Jong, A., W.J. Dondorp, S.G. Frints, C.E. de Die-Smulders, and G.M. de Wert. 2011b. Advances in prenatal screening: The ethical dimension. Nature Reviews Genetics 12: 657–663.
Zurück zum Zitat Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press.CrossRef Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press.CrossRef
Zurück zum Zitat Engelhardt Jr, H.T. 1996. The foundations of bioethics, 2nd ed, 189–238. New York: Oxford University Press. Engelhardt Jr, H.T. 1996. The foundations of bioethics, 2nd ed, 189–238. New York: Oxford University Press.
Zurück zum Zitat Fan, H.C., Y.J. Blumenfeld, U. Chitkara, L. Hudgins, and S.R. Quake. 2008. Noninvasive diagnosis of fetal aneuploidy by shotgun sequencing DNA from maternal blood. Proc Natl Acad Sci U S A 105(24): 16266–16271. Fan, H.C., Y.J. Blumenfeld, U. Chitkara, L. Hudgins, and S.R. Quake. 2008. Noninvasive diagnosis of fetal aneuploidy by shotgun sequencing DNA from maternal blood. Proc Natl Acad Sci U S A 105(24): 16266–16271.
Zurück zum Zitat Ferguson-Smith, M.E., M.A. Ferguson-Smith, N.C. Nevine, and A. Stone. 1971. Chromosome analysis before birth and its value in genetic counselling. BMJ 4(5779): 69–74.PubMedCrossRef Ferguson-Smith, M.E., M.A. Ferguson-Smith, N.C. Nevine, and A. Stone. 1971. Chromosome analysis before birth and its value in genetic counselling. BMJ 4(5779): 69–74.PubMedCrossRef
Zurück zum Zitat Fuchs, M., and D. Lanzerath (Eds). 2004. Prädiktive gentests. “Health Purposes” und Indikationsstellung als Kriterien der Anwendung. Fuchs, M., and D. Lanzerath (Eds). 2004. Prädiktive gentests. “Health Purposes” und Indikationsstellung als Kriterien der Anwendung.
Zurück zum Zitat Greely, H.T. 2011. Get ready for the flood of fetal gene screening. Nature 469(7330): 289–291.PubMedCrossRef Greely, H.T. 2011. Get ready for the flood of fetal gene screening. Nature 469(7330): 289–291.PubMedCrossRef
Zurück zum Zitat Grosse, S.D., and M.J. Khoury. 2006. What is the clinical utility of genetic testing? Genetics in Medicine 8(7): 448–450.PubMedCrossRef Grosse, S.D., and M.J. Khoury. 2006. What is the clinical utility of genetic testing? Genetics in Medicine 8(7): 448–450.PubMedCrossRef
Zurück zum Zitat Haker, H. 2008. Ethische Dimensionen in der Pränatalen Diagnostik. In Der Beratungsprozess in der Pränatalen Diagnostik, ed. D.C. Hürlimann, R. Baumann-Hölzle, and H. Müller, 43–68. Bern: Peter Lang. Haker, H. 2008. Ethische Dimensionen in der Pränatalen Diagnostik. In Der Beratungsprozess in der Pränatalen Diagnostik, ed. D.C. Hürlimann, R. Baumann-Hölzle, and H. Müller, 43–68. Bern: Peter Lang.
Zurück zum Zitat Hofmann, B. 2003. Medicine as techne—A perspective from antiquity. Journal of Medicine and Philosophy 28(4): 403–425.PubMedCrossRef Hofmann, B. 2003. Medicine as techne—A perspective from antiquity. Journal of Medicine and Philosophy 28(4): 403–425.PubMedCrossRef
Zurück zum Zitat Lanzerath, D. 2000. Krankheit und ärztliches Handeln. München: Alber. Lanzerath, D. 2000. Krankheit und ärztliches Handeln. München: Alber.
Zurück zum Zitat Lo, Y.M., K.C. Chan, H. Sun, E.Z. Chen, P. Jiang, F.M. Lun, et al. 2010. Maternal plasma DNA sequencing reveals the genome-wide genetic and mutational profile of the fetus. Science Translational Medicine 2(61): 61ra91.PubMedCrossRef Lo, Y.M., K.C. Chan, H. Sun, E.Z. Chen, P. Jiang, F.M. Lun, et al. 2010. Maternal plasma DNA sequencing reveals the genome-wide genetic and mutational profile of the fetus. Science Translational Medicine 2(61): 61ra91.PubMedCrossRef
Zurück zum Zitat Lo, Y.M., N.B. Tsui, R.W. Chiu, T.K. Lau, T.N. Leung, M.M. Heung, et al. 2007. Plasma placental RNA allelic ratio permits noninvasive prenatal chromosomal aneuploidy detection. Nature Medicine 13(2): 218–223.PubMedCrossRef Lo, Y.M., N.B. Tsui, R.W. Chiu, T.K. Lau, T.N. Leung, M.M. Heung, et al. 2007. Plasma placental RNA allelic ratio permits noninvasive prenatal chromosomal aneuploidy detection. Nature Medicine 13(2): 218–223.PubMedCrossRef
Zurück zum Zitat Manson, N.C., and O. O’Neill. 2007. Rethinking informed consent in bioethics. Cambridge: Cambridge University Press.CrossRef Manson, N.C., and O. O’Neill. 2007. Rethinking informed consent in bioethics. Cambridge: Cambridge University Press.CrossRef
Zurück zum Zitat Newson, A.J. 2008. Ethical aspects arising from non-invasive fetal diagnosis. Seminars in Fetal and Neonatal Medicine 13(2): 103–108.PubMedCrossRef Newson, A.J. 2008. Ethical aspects arising from non-invasive fetal diagnosis. Seminars in Fetal and Neonatal Medicine 13(2): 103–108.PubMedCrossRef
Zurück zum Zitat O’Neill, O. 2002. Autonomy and trust in bioethics. Cambridge, New York: Cambridge University Press.CrossRef O’Neill, O. 2002. Autonomy and trust in bioethics. Cambridge, New York: Cambridge University Press.CrossRef
Zurück zum Zitat Pippin, R.B. 1996. Medical practice and social authority. Journal of Medicine and Philosophy 21(4): 417–437.PubMedCrossRef Pippin, R.B. 1996. Medical practice and social authority. Journal of Medicine and Philosophy 21(4): 417–437.PubMedCrossRef
Zurück zum Zitat Savulescu, J. 2001. Procreative beneficence: Why we should select the best children. Bioethics 15(5–6): 413–426.PubMedCrossRef Savulescu, J. 2001. Procreative beneficence: Why we should select the best children. Bioethics 15(5–6): 413–426.PubMedCrossRef
Zurück zum Zitat Schmitz, D., C. Netzer, and W. Henn. 2009. An offer you can’t refuse? Ethical implications of non-invasive prenatal diagnosis. Nature Reviews Genetics 10: 515.PubMedCrossRef Schmitz, D., C. Netzer, and W. Henn. 2009. An offer you can’t refuse? Ethical implications of non-invasive prenatal diagnosis. Nature Reviews Genetics 10: 515.PubMedCrossRef
Zurück zum Zitat Wiesemann, C. 2006. Von der Verantwortung, ein Kind zu bekommen. Eine Ethik der Elternschaft. München: C.H. Beck. Wiesemann, C. 2006. Von der Verantwortung, ein Kind zu bekommen. Eine Ethik der Elternschaft. München: C.H. Beck.
Zurück zum Zitat Wright, C. 2009. Cell-free fetal nucleic acids for non-invasive prenatal diagnosis. Report of the UK expert working group. PHG Foundation. Wright, C. 2009. Cell-free fetal nucleic acids for non-invasive prenatal diagnosis. Report of the UK expert working group. PHG Foundation.
Metadaten
Titel
A new era in prenatal testing: are we prepared?
verfasst von
Dagmar Schmitz
Publikationsdatum
01.08.2013
Verlag
Springer Netherlands
Erschienen in
Medicine, Health Care and Philosophy / Ausgabe 3/2013
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-012-9411-y

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