By Michael Wayland
Every day, patients and doctors are faced with increasing moral and ethical issues related to medical procedures. In the 1970’s it was Roe v. Wade in the United States that led the conversation. Now the issues are more complex than an unwanted pregnancy. Now, almost every desired pregnancy can end up as an abortion. Technological advancements in medicine make it possible to identify an increasingly diverse group of prenatal defects as early as the first trimester.
Alfigen/The Genetics Institute, one of the largest private clinical genetics laboratories in the United States, reports that it replaced second trimester testing with First Trimester Prenatal Screening as a key part of its laboratory services. The new screening tests, for women between 11 and 14 weeks of pregnancy, help detect Down syndrome and Trisomy 18. The test detects approximately 90% of the fetuses affected by Down syndrome and Trisomy 18, higher than the standard second trimester “triple serum” screening's detection rate of 60-65%. Despite this higher detection rate, the testing methodology has not yet been accepted as the standard in the US.
"One of the main advantages of this screening test is that parents can receive genetic information about their fetus earlier in the pregnancy, thereby decreasing waiting time and lessening parental anxiety," says Jin-Chen Wang, M.D., Medical Director and Laboratory Director, Alfigen/The Genetics Institute. "If the result shows an increased risk, it allows for more time for further diagnostic tests and more options for subsequent pregnancy management."
“Pregnancy Management” of downs syndrome clearly implies abortion. Down syndrome, the most commonly recognized form of mental retardation, occurs in approximately 1 of every 700 births. Trisomy 18 is associated with severe birth defects and mental retardation. Mothers age 35 years and older are considered more likely to have a child affected with Down syndrome or Trisomy 18.
“These women who are at risk of having chromosomal abnormalities in the fetus contribute significantly to the genetic burden on society” said Vaidehi Jobanputra in the Indian Journal of Medical Research (Oct 2001). Increasingly, hospitals and medical providers are setting standards expecting doctors to perform such testing not only in high risk cases but in most cases. The American College of Obstetricians and Gynecologists last year began recommending that all women, regardless of age and risk factors, be offered the opportunity for voluntary testing for Down syndrome. Prenatal testing is an increasing financial profit driver on one hand, and on the other hand is thought to selectively remove certain DNA from the gene pool. According to Government reports in New South Wales, Australia, 230 babies were identified as being Downs Syndrome in 2004. Of the 230, 98 Downs babies were born and 132 were aborted. Moral issues abound.
Taking it a step further, parents are able to select and eliminate children they don’t want. In First Things, The Journal of Religion, Culture and Public Life, (April 1993) Elizabeth Kristol writes, “what had long been considered the cutting edge of prenatal screening- the testing of embryos before implantation- is slowly becoming a reality. In this method, a couple undergoes in vitro fertilization, and the resulting embryos are genetically analyzed. The healthiest are implanted in the mother, while those bearing signs of genetic defect are discarded. Future forms of testing may push the screening process still earlier, before conception has taken place; research is already underway into the testing of oocytes before fertilization.”
Sarah Tully, a reporter for The Orange County Register, recounted her moving experience with prenatal testing in a March 2008 article. She recalled how she had been offered Downs testing and had accepted without thinking about it. Weeks later she was informed that she was “positive” for downs. She was crushed. Her doctor did not explain that the particular blood test normally has about 1 true positive out of 50 reported positive results. The other 49 are false positives. When she met with a counselor, she was told the chances of a Downs baby for a 35 year old woman with these test results was 1 in ten. She writes, “My doctor had warned me that I should consider what I would do with the information. Abortion was never an option that I considered. But it is for many women: Experts estimate that between 80 and 90 percent of women who find out their babies have Down syndrome terminate their pregnancies.”
A second test, an amniocentesis, was ordered. After weeks of crying, her test results came back. Her baby was not Downs. She states that she will never have prenatal testing again. Unfortunately, throughout the world, other families will have the testing and will receive false positives. Even more disturbing, some will choose to act on the results. Many people say that is alright because it will clean up the gene pool. I am not so sure. Sometimes God’s gifts come in unusual packages.