It is a test that sometimes calls for a grave decision.
Medical institutions that will conduct a new prenatal test must provide pregnant mothers with sufficient information as to whether it is really necessary to take the test.
The Japan Society of Obstetrics and Gynecology (JSOG) has decided to expand the scope of the new prenatal tests, which have been carried out as part of clinical research, by moving forward a step and providing them as regular medical services. During the clinical research, which began in 2013, more than 50,000 couples underwent the prenatal testing. Conditions for providing it as a regular medical service and the overall structure will be prepared based on the results, according to the JSOG.
The clinical study has been performed only at about 90 designated medical institutions. The society established a condition that designated institutions must have a specialist qualified by another genetics-related society.
Should the number of medical institutions that provide the testing be increased, the JSOG has to closely examine past examples, utilizing them to provide careful counseling to pregnant women.
In the testing, small quantities of genetic material from a fetus, contained in a blood sample from the pregnant mother, are screened to determine the presence of any one of three chromosomal abnormalities, including Down syndrome.
As the test is carried out only with a blood sample, it puts a lighter burden on pregnant women than conventional prenatal tests. The accuracy of negative results -- indicating the absence of abnormalities -- is higher than 99 percent. The new test has been conducted widely in the United States and elsewhere. When a positive result is obtained, a test of amniotic fluid is conducted to make a final confirmation, with the fluid extracted from the womb via a needle.
Consider various concerns
Difficulty arises when a fetus is judged to have an abnormality, posing a question to the pregnant mother as to what to do: to give birth or to abort. During the clinical research, more than 95 percent of fetuses that were found to have an ailment were aborted.
Most couples who wish for the testing would opt for an abortion if a fetus is judged to have an ailment. Medical institutions have to approach counseling for couples based on this premise.
It is important for medical institutions to also take into account the possibility of couples having various worries such as household finances, family and age, as for reasons for taking the prenatal test.
The clinical study has limited people eligible for the test to those aged 35 or older. Some people have called for lowering the minimum age to take the test. It would be an appropriate decision for the JSOG to not ease this requirement for the time being. For a start, the society should discern carefully the impact of providing the testing as a regular medical service.
Some medical institutions conduct the testings independently of the JSOG's policy. The society criticizes them, saying, "Without providing any appropriate information or conducting proper counseling, they have created situations that send pregnant women and their families into turmoil."
Some have said that the prenatal screening will "lead to selection of life." The society must avoid promoting the new test without any order, leaving ethical challenges behind.
Some believe that a social environment in which children with congenital disabilities have difficulty living has been a factor behind the use of prenatal testing. Understanding from society as a whole and improvement in welfare programs are called for.
(From The Yomiuri Shimbun, March 26, 2018)
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