Non-invasive prenatal testing: ethical issues explored
Non-invasive prenatal testing: ethical issues explored
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DOI：
10.1038/ejhg.2009.203
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发表时间：
2010-03-01
影响因子：
5.2
通讯作者：
de Wert, Guido M. W. R.
中科院分区：
文献类型：
--
作者：
de Jong, Antina;Dondorp, Wybo J.;de Wert, Guido M. W. R.
本文探讨了引入非侵入性产前诊断测试（NIPD测试）在产前筛查胎儿异常的伦理影响。NIPD测试是简单和安全的，可以在怀孕早期进行。正是由于这些特点，人们担心知情同意可能会变得更加困难，检测和选择性堕胎都将变得“正常化”，并且将出现接受轻微异常和非医学特征检测的趋势。然而，在我们看来，NIPD检测的真实的道德挑战在于将具有这些特征（简单、安全和早期）的技术与新的基因组技术联系起来的可能性，这些技术允许产前诊断检测比当前程序更广泛的异常范围。采用率的提高和选择性堕胎的增多本身并不意味着对这些程序的轻率接受。然而，将这一点与大大扩大NIPD检测范围相结合，确实会使知情同意变得更加困难，并挑战产前筛查服务于生殖自主的概念。如果广泛的NIPD检测包括晚发型疾病，未来孩子的“不知情权”将成为关于产前筛查的辩论中的一个新问题。关于有争议的选择性堕胎问题，在NIPD测试后，堕胎可以及早进行，这可能会在道德上产生相关的差异。由于主流观点认为胎儿的道德地位随着其发育而逐渐提高，因此在那一刻胎儿的道德地位可能较低。European Journal of Human Genetics（2010）18，272-277; doi：10.1038/ejhg.2009.203; 2009年12月2日在线发表
This paper explores the ethical implications of introducing non-invasive prenatal diagnostic tests (NIPD tests) in prenatal screening for foetal abnormalities. NIPD tests are easy and safe and can be performed early in pregnancy. Precisely because of these features, it is feared that informed consent may become more difficult, that both testing and selective abortion will become 'normalized', and that there will be a trend towards accepting testing for minor abnormalities and non-medical traits as well. In our view, however, the real moral challenge of NIPD testing consists in the possibility of linking up a technique with these features (easy, safe and early) with new genomic technologies that allow prenatal diagnostic testing for a much broader range of abnormalities than is the case in current procedures. An increase in uptake and more selective abortions need not in itself be taken to signal a thoughtless acceptance of these procedures. However, combining this with considerably enlarging the scope of NIPD testing will indeed make informed consent more difficult and challenge the notion of prenatal screening as serving reproductive autonomy. If broad NIPD testing includes later-onset diseases, the 'right not to know' of the future child will become a new issue in the debate about prenatal screening. With regard to the controversial issue of selective abortion, it may make a morally relevant difference that after NIPD testing, abortion can be done early. A lower moral status may be attributed to the foetus at that moment, given the dominant opinion that the moral status of the foetus progressively increases with its development. European Journal of Human Genetics (2010) 18, 272-277; doi: 10.1038/ejhg.2009.203; published online 2 December 2009