The discussion and consideration of the ethics are of significance in many aspects of health care provision. However, they are critical when it involves genetic testing. Prenatal testing is testing for diseases or conditions for an embryo or fetus before birth. Gates argues that the primary aim of the tests is to detect the defects that the fetus may have such as neural tube defects, chromosome abnormalities, genetic disorders, Down syndrome among other conditions that may occur (12). It could also be used for sex determination. The conventional testing procedures may include ultrasonography, amniocentesis and serum marker testing among others (Gates, 10). The testing is done to ascertain some of the high-risk pregnancies to ensure that delivery is scheduled in a tertiary hospital where the baby can receive special attention and care. Genetic testing is a classical aspects example of a healthcare provision that leads to several issues that may lead to ethical dilemmas. Some of the ethical considerations raised by prenatal diagnostic testing may be related to diagnostic testing itself in general while others may be surrounding the circumstances of the pregnancy. The issues may be better understood in the context of a broader understanding of the primary goals of prenatal testing (Levitt, Chadwick and Shickle, 102). Moreover, the healthcare professionals have a dual obligation to the pregnant woman and to the fetus that have a significant influence on the goals of testing and ultimately the ethical considerations that can result. Below is a discussion of the purpose and the ethical implications of prenatal testing.
Some of the purposes of engaging in prenatal testing are; to ensure that there is timely medical or surgery treatment before or after birth that may be necessary for some identified conditions. It also offers the parents a chance to consider whether they can keep the baby or not following a diagnosed condition depending on whether they are ready to support a child with such a condition or otherwise. Moreover, it gives the parents a chance to prepare themselves psychologically, financially, medically and socially for a baby that may have a defect or disability or even for the possibility of a stillbirth (Levitt, Chadwick and Shickle, 110). For example a fetus diagnosed with Down syndrome, there is a need for immediate intervention after birth due to its association with cardiac defects that may be essential for saving the baby and having early interventions increases the chances of survival and development of such a baby. The parent can also benefit greatly from planning and getting ready for a baby if they can identify the sex of the unborn baby.
Some of the limitations of genetic testing that may lead to ethical dilemmas are that some of the genetic tests do not recognize all the likely gene mutations that could result in certain conditions or may have some limited predictive value. Therefore, the genetic tests may lead to requiring some difficult decisions among the family members, and yet it does not provide sufficient and precise information that would be necessary for the family to make a decision. It may lead to uncertainties among the patients and the clinicians as well. Moreover, the test may identify the presence of particular gene mutation or some conditions but cannot always tell the extent and the severity of such a condition (Purdy, 117).
Some of the tests may lead to ethical dilemma such as whether to terminate or retain a pregnancy based on the non-conclusive information provided by such trials (Purdy, 118). For example, if a CF gene mutation is found among the parents who are carriers, it may lead to such a test being conducted on the fetus. However, the test may result to indicating the presence of such gene mutation but cannot predict the severity of the problem. The test, therefore, presents the ethical dilemma of whether to terminate or keep such a baby without the full knowledge of whether it can survive the mutation or not.
The other major dilemma that exists with genetic testing is on its importance when no interventions or treatment exists if a condition found in the fetus (Gates, 37). It is because, in as much as genetic testing allows for treatment and early interventions for the fetus and the mother, some conditions have no interventions or treatment. It means that testing for such conditions that have no existing interventions may lead to unnecessary psychological and emotional torture on the parents that could even worsen the problem. Therefore, there exists an ethical dilemma as to whether to test such non-treatable conditions or not.
There exist some ethical dilemmas in some of the options provided for by the health caregivers. Such options may include the termination of a pregnancy and yet to some people especially Christians, abortion is not allowed. Therefore, there is a general dilemma on whether to engage in genetic testing at all in the first place due to the possibility of having to make such a decision. However, the parents may also have the fear of giving birth to a baby that has some unexpected defects creating a predicament (Gates, 22). Moreover, some of the tests conducted have uncertain implications and are just common risk assessments. It does not lead to a full effect and hence may result in an irreversible decision that may be wrong or right. Therefore, such a family is faced with making such a decision that could either turn out to be good or bad with the uncertainty causing further predicament.
Some of the interventions and recommendations of that follow the testing may lead to adverse personal and societal consequences (Gates, 20). For example, if a woman has to engage in abortion that may be contrary to the societal expectations and beliefs, she may be subject to potential psychological harm, discrimination, and stigmatization. Therefore, couples are faced with the option of taking the risk or assuming it and let nature take its course.
In conclusion, genetic testing has its equal share of advantages as it may lead to early diagnosis and possible interventions and treatments for identified conditions. It, therefore, may lead to saving of a life and preparation for the parents for the outcome of pregnancy. However, it is faced with dilemmas presented to the family members especially with the possible decisions that they have to make such as abortion. The dilemma is further worsened by the fact that some of the conditions that may be identified may not have a form of intervention or treatment even with early intervention and also that the tests do not offer absolute answers in that the predicted conditions may or may not occur. Therefore, making such a life changing the decision as abortion without a certainty is difficult.
Asch A. Prenatal diagnosis and selective abortion: a challenge to practice and policy. American
Journal of Public Health. 1999;89(11):1649-1657
Gates, Elena. 'Ethical Considerations In Prenatal Diagnosis.'. Western Journal of Medicine 159.3,
1993: 391. Web. 26 Nov. 2015. Pp. 5-100
Levitt Mairi., Chadwick Ruth. and Shickle Daren. The right to know and the right not to know:
genetic privacy and responsibility 2nd edition. Cambridge: Cambridge University Press,
2014. Pp. 100-157
Purdy, Laura. “Genetics and Reproductive Risk: Can Having Children be Immoral?”,
in Kushe, Helga and Singer Peter (ed.), (second ed.) in Bioethics: An Anthology. Oxford:
Blackwell Publishing, 2006. Pp. pp.115-121.
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