Ethical Challenges and Decision-Making in Prenatal Diagnosis of Trisomy 21

Abstract

Objective. To reflect on the clinical, ethical and legal aspects of a case of prenatal diagnosis of Trisomy 21 with detection of fetal DNA in maternal blood. Material and method. An ethical analysis is presented, according to Diego Gracia’s deliberative decision-making model, of a real clinical case of a 16.1-week-pregnant woman who, by means of the fetal DNA test in maternal blood, and after diagnostic confirmation through amniocentesis, is diagnosed with trisomy 21. Results. Extreme courses of action of the case are presented: execution of legal termination of pregnancy versus continuing with gestation. Application of reflections appealing to the ethical aspects and the current legislation in the Spanish context. Conclusions. The implementation of tests such as the determination of fetal DNA in maternal blood can cause fewer children to be born with chromosomopathies, but also increase the number of embryo-fetus abortions that would have resulted in living people and even increase the stress of women and their couple during pregnancy. It is necessary to specify that for women the interruption of their pregnancy entails a situation of both physical (due to the physical risk) and emotional (imbalance at the psychological level of the diagnosis) risk, while their partner suffers on an emotional level. Professionals involved in gestational control must consider the ethical problems posed by prenatal diagnosis and how to give information to their patients, resolve doubts and the extent to which their beliefs can influence their decision-making.