So...What's the Ethics Problem?
This is clearly going to be a technique that replaces amniocentesis, so what is the ethical problem? Isn't this a technology that is all to the good? No more needles, no more risk to mom, no more infections, and so on. Unfortunately, there are some potential ethical problems. Amniocentesis is a test performed on perhaps 5% of pregnancies. The ability to draw cells from the mom's blood will quickly become a test that is used on 100% of pregnant women. I would be surprised if it does not become the standard of care.
More testing means that more women may find problems with their fetuses. This test can be performed much earlier than amniocentesis, possibly enabling fetal screening at 7 to 9 weeks. Many people worry that this will lead to more pregnancy terminations. Women who would not have had testing before this will undergo testing, and some may discover things about their fetus that they will not accept, be it a birth defect or some other disease risk factor. Because it is earlier, the burden of abortion may seem morally more acceptable to women than having an abortion much later in pregnancy. Thus, while this technology brings much that is good -- earlier and less risky fetal cell screening -- it certainly will wind up being controversial.
If it leads to more abortions, many critics will say that it is not a good thing. It is something we have to try to restrict. Conversely, if it is easy to do, many doctors will say this must be done routinely for everyone, and it quickly will become the standard of care. But that means much more counseling and much more discussion of the findings. It is one thing to find Down syndrome and decide what to do early in the first trimester of pregnancy. It is another thing to find that your baby has a high risk for breast cancer when they get to be 50 years old. Is that a reason to terminate a pregnancy?
I believe we will have many ethical discussions about this rapidly evolving technique of fetal cell screening using blood tests. The good news is that it is safer, more efficient, and less burdensome to the fetus and mom than amniocentesis. Perhaps the bad news is that it will result in a lot more ethical arguments and discussions about the rationale for ending a pregnancy, what constitutes a disability, and who is going to do the counseling with women who previously have never had fetal testing during their pregnancies.
I am Art Caplan at the NYU Langone Medical Center. Thanks for watching.
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