title: A new ethical landscape of prenatal testing: individualizing choice to serve autonomy and promote public health: a radical proposal.
abstract: A new landscape of prenatal testing (PNT) is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling.
authors.forename: Christian
authors.initials: C
authors.lastname: Munthe
mesh_terms: D000025:Abortion, Eugenic / Q000941:ethics*; D000328:Adult; D002755:Choice Behavior / Q000941:ethics*; D032882:Comprehension; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000235:genetics; D003657:Decision Making / Q000941:ethics; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D034462:Dissent and Disputes; D005260:Female; D005820:Genetic Testing / Q000191:economics / Q000941:ethics* / Q000379:methods / Q000639:trends; D006801:Humans; D057226:Information Seeking Behavior; D007258:Informed Consent / Q000941:ethics; D008403:Mass Screening / Q000191:economics / Q000941:ethics* / Q000379:methods / Q000639:trends; D009313:National Health Programs; D026684:Personal Autonomy; D057285:Precision Medicine; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D011296:Prenatal Diagnosis / Q000191:economics / Q000941:ethics* / Q000379:methods / Q000639:trends; D011634:Public Health / Q000941:ethics / Q000379:methods / Q000639:trends
keywords: NIPT; WGS; arrayCGH; disability; prenatal diagnosis; prenatal screening; reproductive ethics