Screening for fetal abnormalities: from a health technology assessment report to a national statute.
OBJECTIVE
Previously in Finland, each municipality selected which methods to use in screening for fetal abnormalities. This resulted in practice variation and inequity. The national health technology assessment (HTA) office Finohta compared the methods and time frames available when screening for chromosomal and structural abnormalities. The assessment identified a need to discuss several value-laden questions before policy decisions could be taken.


METHODS
The National Screening Committee (NSC) at the Ministry of Health and Social Affairs (MOH) formulated a statement based on the HTA report to inform policy makers. This article describes the steps in the policy process.


RESULTS
The national screening committee organized an open forum to discuss the ethically relevant aspects of fetal screening, and a lengthy public discussion highlighted the viewpoints of various stakeholders. Based on the assessment, public discussion, and several committee meetings that heard further experts, the NSC formulated a conclusion based on equity of access. This also offered options for families unwilling to terminate a pregnancy due to fetal abnormality. The MOH sent the conclusion to a comment round, and the proposal was accepted with minor adjustments. The Ministry decided to unify the regulation of all public screening programs by one statute. The policy process lasted three years, and the methods to screen for fetal abnormalities will be unified after a further 3 years.


CONCLUSIONS
The assessment of screening programs for fetal abnormalities reached beyond its original mandate. The process of examining values behind screening resulted in a program that respects the differing objectives and ethical values of pregnant families, and to national legislation on screening programs.
Autti-Rämö
Ilona
I
Finnish Office for Health Care Technology Assessment (Finohta), STAKES, lintulahdenkuja 4, Helsinki, Finland. ilona.autti-ramo@stakes.fi
Mäkelä
Marjukka
M
D002869:Chromosome Aberrations; D000013:Congenital Abnormalities / Q000175:diagnosis*; D005260:Female; D005333:Fetus / Q000002:abnormalities; D005387:Finland; D006291:Health Policy; D006801:Humans; D011050:Policy Making; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000941:ethics* / Q000379:methods; D013673:Technology Assessment, Biomedical