Ethical considerations in first-trimester Down syndrome risk assessment.
OBJECTIVE
First-trimester risk assessment has now become sophisticated and of increasing relevance and applicability to decision-making by pregnant woman about invasive diagnosis. Ethics is an essential dimension of understanding this relevance and applicability. This paper addresses the ethical dimensions of first-trimester risk assessment for trisomy 21.


RESULTS
It is now well established in the ethics and law of the informed consent process that physicians are obligated to offer to patients all medically reasonable alternatives for managing the patient's condition. This disclosure should be guided by the reasonable person standard: the physician should provide clinically important information about the patient's condition or diagnosis, the medically reasonable alternatives for managing it, and the clinical benefits and risks of each such alternative.


CONCLUSIONS
On the basis of the ethics of informed consent, we argue that routinely offering first-trimester risk assessment in centers qualified to provide it is ethically obligatory. We describe how pregnant women can be expected to respond to this offer. We then argue that routinely withholding the results of first-trimester risk assessment is ethically unjustified. The ethics of informed consent is an essential dimension of first-trimester risk assessment for trisomy 21.
Chervenak
Frank A
FA
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York, USA. fac2001@med.cornell.edu
McCullough
Laurence B
LB
D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008423:Maternal Age; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000941:ethics* / Q000379:methods; D018570:Risk Assessment