title: Prenatal diagnosis and abortion for congenital abnormalities: is it ethical to provide one without the other?
abstract: This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms.
authors.affiliation: Donaghue Initiative in Biomedical and Behavioral Research Ethics, Interdisciplinary Center for Bioethics, Yale University/ISPS, 77 Prospect Street, New Haven, CT 06520, USA. a.j.ballantyne@gmail.com
authors.forename: Angela
authors.initials: A
authors.lastname: Ballantyne
authors.forename: Ainsley
authors.initials: A
authors.lastname: Newson
authors.forename: Florencia
authors.initials: F
authors.lastname: Luna
authors.forename: Richard
authors.initials: R
authors.lastname: Ashcroft
mesh_terms: D000025:Abortion, Eugenic / Q000009:adverse effects / Q000941:ethics* / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D000029:Abortion, Legal / Q000941:ethics; D000328:Adult; D001938:Brazil; D000013:Congenital Abnormalities / Q000175:diagnosis*; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence / Q000639:trends; D006801:Humans; D007492:Iran; D007843:Latin America; D008403:Mass Screening / Q000941:ethics; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000941:ethics / Q000523:psychology*; D011296:Prenatal Diagnosis / Q000941:ethics; D012935:Social Justice; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology