Prenatal Diagnosis and Abortion for Congenital Abnormalities: Is It Ethical to Provide One Without the Other? Angela Ballantyne, Donaghue Initiative in Biomedical and Behavioral Research Ethics, Interdisciplinary Center for Bioethics, Yale University/ISPS Ainsley J. Newson, Centre for Ethics in Medicine, University of Bristol Florencia Luna, Independent Researcher, and Director of the Area of Bioethics, Buenos Aires, Argentina Richard Ashcroft, Queen Mary, University of London 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. Keywords: abortion, fetal abnormality, Latin America, prenatal diagnosis, reproductive ethics, women
INTRODUCTION Since the mid 1990’s, the provision of medical genetic services in Latin American countries such as Mexico, Argentina and Brazil has increased signiﬁcantly. The provision of these services in public hospitals, university teaching hospitals and private clinics includes widespread access to prenatal diagnosis and antenatal screening (hereinafter PND) for the detection of fetal abnormalities. For example, molecular genetics is used regularly in large hospitals in Mexico for the diagnosis of common genetic conditions such as cystic ﬁbrosis, hemophilia, and muscular dystrophy (Penchaszadeh and Beiguelman 1998). Increasing access to such services in Latin America gives rise to an unusual health policy context in which fetal abnormalities are detected but parents do not have access to safe and legal abortion should they wish to terminate an affected pregnancy. This context has previously been critiqued as giving rise to a ‘therapeutic gap’
(Simpson, 2007). In this paper we argue that the juxtaposition of accessible PND and restrictive abortion law raises serious questions about the moral, social and psychological consequences for women and couples who are informed of a serious congenital abnormality, but who have no legal mechanisms to procure a termination. Genetic technologies are not neutral and the relationship between PND and abortion deserves greater attention. We argue that access to safe and legal abortion must be a component of comprehensive medical genetic services that should sit alongside PND for fetal abnormality. There are four components to our analysis. First, we describe the growing availability of PND in Latin America and the relevant abortion laws, including a case study around abortion for anencephaly in Brazil. Second, we present three ethical problems with the status quo: psychological distress, unjust distribution of burdens between
Acknowledgments: We thank Dr Martin Lupton and Associate Professor Wendy Rogers for their thoughtful comments on an earlier draft of this paper. The idea for this paper grew from discussions surrounding the preparation of the 2006 World Health Organization (WHO)...