1
|
Hofmann B. Addressing the paradox: Health expansion threatening sustainable healthcare. Eur J Intern Med 2023; 117:3-7. [PMID: 37735001 DOI: 10.1016/j.ejim.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
We need to address the paradox that health expansion threatens sustainable healthcare as anti-aging drugs are on the trail from trial to the market and come together with health enhancement measures changing demography and the health of populations. This poses global, social, and professional problems, and challenges clinical medicine as well as health policy. To handle the emerging challenges, we need to address four crucial issues: (1) injustice (access), (2) sustainability, (3) basic human rights, and (4) eugenics. To do so we need to differentiate between health improvements and health enhancements and reinforce medicine's strongest moral appeal: to reduce suffering.
Collapse
Affiliation(s)
- Bjørn Hofmann
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, PO Box 1130, Blindern, Oslo N-0318, Norway; Institute for the Health Sciences at the Norwegian, University of Science and Technology in Gjøvik, Norway.
| |
Collapse
|
2
|
Zhao Y, Xue Z, Geng Y, Zhu J, Hu M, Jiang M. Understanding knowledge, perception, and willingness of non-invasive prenatal testing for fetal aneuploidy: a survey among Chinese high-risk pregnant women. Front Med (Lausanne) 2023; 10:1232942. [PMID: 37908853 PMCID: PMC10613663 DOI: 10.3389/fmed.2023.1232942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Non-invasive prenatal testing (NIPT) is utilized for screening the likelihood of fetal aneuploidy, presenting the benefits of non-invasiveness, high sensitivity, and specificity. Its application in prenatal screening has become ubiquitous. The inquiry into how pregnant women comprehend and determine NIPT screening strategies is paramount. Regrettably, there has been a dearth of research on this subject in China. Consequently, this study scrutinizes pregnant women's cognizance and perspectives concerning NIPT, furnishing a foundation for advancing its judicious implementation. Methods From February 2021 to December 2022, a questionnaire survey was conducted among pregnant women receiving prenatal care and screening at the Women's Hospital, School of Medicine, Zhejiang University, who were randomly selected from a pool of individuals exhibiting a high risk of fetal aneuploidy on serological screening. The survey aimed to gather data on participant characteristics, knowledge, perception, and willingness concerning NIPT. The study employed chi-square and Kruskal Wallis tests to analyze subgroup differences. Results A total of 226 valid questionnaires were obtained. 83.2% of women pregnant women identified as high risk by serological screening would opt for NIPT, with 66.4% indicating that they would prefer NIPT for fetal aneuploidy screening in future pregnancies. These findings suggest a notable willingness among pregnant women to undergo NIPT. Additionally, the results suggest that various factors, including place of residence, educational level, family income, causes of abortion, and conception method, influence pregnant women's knowledge about NIPT Accordingly, the level of NIPT knowledge varies among pregnant women. Conclusion The survey generally revealed that pregnant women were strongly inclined to select NIPT; however, expectant Chinese mothers possess limited knowledge and perception regarding this screening method for fetal aneuploidy. Therefore, the government must implement effective measures to augment public awareness of fetal aneuploidy screening and encourage the judicious utilization of NIPT.
Collapse
Affiliation(s)
- Yi Zhao
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhu Xue
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yarui Geng
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Zhu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Maidan Hu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Minmin Jiang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| |
Collapse
|
3
|
Rhodes R, Drago MJ. Prenatal Testing: Responsibility and Reality. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:128-131. [PMID: 37078905 DOI: 10.1080/15265161.2023.2202188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
|
4
|
Wasserman D. Noninvasive Testing for "Non-Medical" Traits: A Misplaced Expressive Concern, Tough Policy Choices. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:59-61. [PMID: 36919550 DOI: 10.1080/15265161.2023.2169403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
5
|
Kamenova K, Haidar H. Bioethicists Are Not so Divided on Reproductive Testing for Non-Medical Traits: Emerging Perspectives on Polygenic Scores. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:48-50. [PMID: 36919552 DOI: 10.1080/15265161.2023.2169399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
6
|
Canter C, Foley K, Callier SL, Meagher KM, Waltz M, Washington A, Cadigan RJ, Prince AER. The Slippery Slope of Prenatal Testing for Social Traits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:36-38. [PMID: 36919542 PMCID: PMC10020886 DOI: 10.1080/15265161.2023.2169395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
7
|
Zhang H, Wang J, Qin Y, Zhang C, Wang B, Wang Y. Anticipatory Governance of Noninvasive Prenatal Testing for "Non-Medical" Traits: Lessons from Regulation of Medically Assisted Reproduction. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:45-47. [PMID: 36919543 DOI: 10.1080/15265161.2023.2169398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Hui Zhang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Jing Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Yan Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Chuanfeng Zhang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Bingwei Wang
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital
| | - Yuming Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| |
Collapse
|
8
|
Quake SR. Prenatal Testing for Non-Medical Traits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:1-2. [PMID: 36919539 DOI: 10.1080/15265161.2023.2179776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
9
|
Johnson T. Considering the Collective in Ethical Decision-Making Concerning Non-Medical Uses of Noninvasive Prenatal Testing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:23-25. [PMID: 36919555 DOI: 10.1080/15265161.2023.2169390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
10
|
Newson AJ, Deans Z, Dive L, Holmes IC. Consistency of What? Appropriately Contextualizing Ethical Analysis of Non-Invasive Prenatal Testing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:56-58. [PMID: 36919553 DOI: 10.1080/15265161.2023.2169402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
11
|
Ormond KE. Expanding Our Thoughts about Autonomy in Relation to Whether We Should Offer Genetic Testing for Nonmedical Traits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:21-23. [PMID: 36919540 DOI: 10.1080/15265161.2023.2169495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
12
|
Yang W, Guo Z, Shi W, Qin L, Xia X, Hao B, Liao S. Security and Sharing of NIPT Data Are the Basis of Ethical Decision-Making Related to Non-Medical Traits. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:29-31. [PMID: 36919545 DOI: 10.1080/15265161.2023.2169392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Wenke Yang
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Zhenglong Guo
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Weili Shi
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Litao Qin
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Xiaoliang Xia
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Bingtao Hao
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| | - Shixiu Liao
- Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University; and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
| |
Collapse
|
13
|
Miner SA, Pereira S. The Need for Diverse Empirical Data to Inform the Use of Polygenic Risk Scores in Prenatal Screening. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:39-41. [PMID: 36919541 DOI: 10.1080/15265161.2023.2169396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
|
14
|
Snoek A, Van Der Hout S. Including Non-Medical Traits in the NIPT: What Can We Learn from an Ethics of Care Approach? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:32-33. [PMID: 36919548 DOI: 10.1080/15265161.2023.2169393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
15
|
Laberge AM, Roy MC, Kleiderman E, Ravitsky V. Going Back to Basics: What is the Target of Prenatal Screening? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:50-52. [PMID: 36919551 DOI: 10.1080/15265161.2023.2169400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
16
|
Mumford K, Roesner N, Berkman BE. The Potential Role of Nudging in Expanded Noninvasive Prenatal Testing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:61-63. [PMID: 36919549 DOI: 10.1080/15265161.2023.2169404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
17
|
Clarke A. Terminology and Consistency. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:53-55. [PMID: 36919554 DOI: 10.1080/15265161.2023.2169401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
18
|
Rueda J, Vallès-Poch M. Genomic Uncertainty as a Burden for Reproductive Choice? The Problem of Probabilistic Causation in Non-Invasive Prenatal Testing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:26-28. [PMID: 36919546 DOI: 10.1080/15265161.2023.2169391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
|
19
|
Johnston M, Warton C, Pertile MD, Taylor-Sands M, Delatycki MB, Hui L, Savulescu J, Mills C. Ethical issues associated with prenatal screening using non-invasive prenatal testing for sex chromosome aneuploidy. Prenat Diagn 2023; 43:226-234. [PMID: 35929376 DOI: 10.1002/pd.6217] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
Prenatal screening for sex chromosome aneuploidies (SCAs) is increasingly available through expanded non-invasive prenatal testing (NIPT). NIPT for SCAs raises complex ethical issues for clinical providers, prospective parents and future children. This paper discusses the ethical issues that arise around NIPT for SCAs and current guidelines and protocols for management. The first section outlines current practice and the limitations of NIPT for SCAs. It then outlines key guidelines before discussing the ethical issues raised by this use of NIPT. We conclude that while screening for SCAs should be made available for people seeking to use NIPT, its implementation requires careful consideration of what, when and how information is provided to users.
Collapse
Affiliation(s)
| | | | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lisa Hui
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | |
Collapse
|