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.
Works cited
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?â€,
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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