title: Including ethical considerations in models for first-trimester screening for pre-eclampsia.
abstract: Recent efforts to develop reliable and efficient early pregnancy screening programmes for pre-eclampsia have focused on combining clinical, biochemical and biophysical markers. The same model has been used for first-trimester screening for fetal aneuploidies i.e. prenatal diagnosis (PD), which is routinely offered to all pregnant women in many developed countries. Some studies suggest combining PD and pre-eclampsia screening, so women can be offered testing for a number of conditions at the same clinical visit. A combination of these tests may be practical in terms of saving time and resources; however, the combination raises ethical issues. First-trimester PD and pre-eclampsia screening entail qualitative differences which alter the requirements for disclosure, non-directedness and consent with regard to the informed consent process. This article explores the differences related to the ethical issues raised by PD and pre-eclampsia in order to elucidate which factors are relevant to deciding the type of information and consent required in each context from the perspective of the ethical principles of beneficence and autonomy. Furthermore, it argues that ensuring respect for patient autonomy is context dependent and, consequently, pre-eclampsia screening and PD should be performed independently of one another.
authors.affiliation: Department of Biochemistry, Immunology and Genetics, Statens Serums Institut, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Denmark. Electronic address: jennijo.m.81@gmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Jørgensen
authors.affiliation: Department of Biochemistry, Immunology and Genetics, Statens Serums Institut, Copenhagen, Denmark; Department of Biomedical Sciences, University of Stellenbosch, Cape Town, South Africa. Electronic address: phy@ssi.dk.
authors.forename: P L
authors.initials: PL
authors.lastname: Hedley
authors.affiliation: Danish Centre for Bioethics and Risk Assessment, Institute of Food and Resource Economics, Faculty of Science, University of Copenhagen, Denmark. Electronic address: mickeygjerris@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Gjerris
authors.affiliation: Department of Biochemistry, Immunology and Genetics, Statens Serums Institut, Copenhagen, Denmark. Electronic address: mic@ssi.dk.
authors.forename: M
authors.initials: M
authors.lastname: Christiansen
mesh_terms: D003661:Decision Support Techniques; D004992:Ethics, Medical; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000941:ethics / Q000379:methods; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000941:ethics* / Q000379:methods
keywords: ethics; guidelines; informed consent; pre-eclampsia; pregnancy; screening