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Non-invasive prenatal testing as a routine procedure of prenatal care

Perspectives and challenges regarding reproductive autonomy

Nichtinvasive Pränataltests als Teil der vorgeburtlichen Regelversorgung

Perspektiven und Herausforderungen aus Sicht der reproduktiven Autonomie

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Abstract

Definition of the problem

In March 2019, the German Gemeinsamer Bundesausschuss (G‑BA; Federal Joint Committee) presented the result of the method assessment process on non-invasive prenatal testing (NIPT). The aim of this method assessment process was to decide whether NIPT should become a publicly funded procedure of routine prenatal care. The G‑BA decided in favor of NIPT, making the implementation of NIPT very likely, provided that other healthcare and political institutions also agree.

Arguments

This development could be interpreted as empowering from the perspective of reproductive autonomy, since NIPT allows pregnant women to obtain valuable information on the health of the fetus in a fast and easy manner and without the risks of invasive methods. However, the routinization of NIPT also implies ethical challenges. Will the routinization lead to a normalization of prenatal quality control? Will it lead to an expansion to women outside the high-risk group? What would be the ethical implications of such a development? How should physicians, geneticists, and patients deal with the increased amount of obtainable information? What are the implications for choice and decision-making in the prenatal care context?

Conclusion

In this paper, we analyze the ethical aspects of the routinization of NIPT, focusing on information and the counseling process, the burden of choice, and the threats to reproductive autonomy by societal interests linked to NIPT.

Zusammenfassung

Fragestellung

Im März 2019 veröffentlichte der Gemeinsame Bundesausschuss (G‑BA) das Ergebnis des Methodenbewertungsverfahrens hinsichtlich nichtinvasiver Pränataltests (NIPT). Ziel des Methodenbewertungsverfahrens war zu beurteilen, ob NIPT als solidargemeinschaftliche Leistung in die vorgeburtliche Regelversorgung aufgenommen werden sollen. Der G‑BA votierte zugunsten von NIPT, was deren Implementierung in der Regelversorgung wahrscheinlich macht, sofern andere Körperschaften des Gesundheitswesens und politische Institutionen zustimmen.

Argumente

Diese Entwicklung kann als Empowerment der reproduktiven Autonomie verstanden werden, da NIPT es den Schwangeren ermöglichen, wertvolle Gesundheitsinformationen bezüglich des Fetus zu erhalten. Zudem erfolgt die Anwendung von NIPT relativ schnell und einfach und ist nicht mit den Risiken invasiver Verfahren verbunden. Die Routinisierung von NIPT bringt allerdings auch ethische Herausforderungen mit sich. Wird der routinemäßige Einsatz von NIPT zur Normalisierung der pränatalen Qualitätskontrolle führen? Kann die Routinisierung eine Ausweitung der Anwendung jenseits der Hochrisikogruppe zur Folge haben? Was wären die ethischen Aspekte einer solchen Entwicklung? Wie sollen Ärzte, Genetiker und Patienten mit der gesteigerten Menge verfügbarer Daten umgehen? Welche Konsequenzen ergeben sich für den Prozess der Entscheidungsfindung im Kontext pränataler Versorgung?

Schlussfolgerung

In diesem Beitrag analysieren wir die ethischen Aspekte der Routinisierung von NIPT. Dabei fokussieren wir auf die Rolle der Aufklärung und des Beratungsprozesses, den Aspekt der „burden of choice“ und die möglichen Bedrohungen für die reproduktive Autonomie durch gesellschaftliche Interessen, die mit dem Einsatz von NIPT verbunden sind.

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Authors and Affiliations

  1. Institute of Medical History and Ethics, Heidelberg University, Im Neuenheimer Feld 327, 69120, Heidelberg, Germany

    Giovanni Rubeis

  2. Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany

    Marcin Orzechowski &  Florian Steger

Authors
  1. Giovanni Rubeis
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  2. Marcin Orzechowski
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  3. Florian Steger
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Correspondence to Giovanni Rubeis.

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Conflict of interest

G. Rubeis, M. Orzechowski and F. Steger declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by the author. All studies performed were in accordance with the ethical standards indicated in each case.

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Rubeis, G., Orzechowski, M. & Steger, F. Non-invasive prenatal testing as a routine procedure of prenatal care. Ethik Med 32, 49–63 (2020). https://doi.org/10.1007/s00481-019-00555-0

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