Heading Down the Right Path: The Future of Prenatal Testing for Trisomy 21

Abstract

Until recently, the two primary methods by which fetuses were tested for Down Syndrome were amniocentesis and chorionic villus sampling (CVS), both of which are invasive and pose a risk of miscarriage. Thanks to a novel non-invasive prenatal test (NIPT), women can discover with near certainty whether their fetus will be born with Down Syndrome easily, early on in the pregnancy, and entirely safely. When a positive test is received, women make the decision to abort approximately 50% to 60% of the time, with the remainder of mothers keeping the child or placing her up for adoption. This has sparked a tremendous debate regarding the moral permissibility of the test – we are trapped between a desire to provide women with the most information possible regarding their pregnancies and concerns regarding the rights of the fetus, as the only solution that eliminates the diagnosis in the case of a positive test is the termination of the pregnancy. The lack of treatment for Down Syndrome means that while the practice of prenatal testing is considered by many an advancement in healthcare on the one hand, there are many who fear that the practice undercuts the rights of the fetus and perpetuates ableist attitudes that suggest that only rational life is worth living. There also exists a fear of coercion – due to the power dynamic that exists between doctor and patient, there is the risk that women will feel pressured to conduct NIPT against their will, or even be pushed in the direction of aborting the fetus upon receipt of a positive test. 

In this paper, I will show that the arguments in the literature positioned against prenatal testing for Down Syndrome are reducible to two main arguments, one of which is deontological and the other teleological, neither of which are morally persuasive. After examining both of these arguments and the responses to them, I will demonstrate that we are morally obligated to present this test to all pregnant women in the early stages of their pregnancies and encourage them to take it, although any woman who wishes to opt out of the procedure may do so. Not only should NIPT testing be offered to all, but I believe that it should be an aspect of prenatal care that is subsidized by the government and incorporated into our prenatal testing battery. For this process to be ethical, however, true autonomy must be maintained through complete freedom of information. This means that all women who receive positive tests must have access to subsequent nondirective counseling that thoroughly and clearly explains the reality of raising a child who has Down Syndrome. If we desire to uphold the right to liberty that each person is entitled to, we have the moral obligation to provide complete information and counseling that is non-coercive to parents of fetuses who test positive for Down Syndrome. This is conducive to the mental, physical, and emotional well-being of all children, and will ensure their best lives and proper care above all else.