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ss nucleus - spring 1994,  Pre-natal Testing - an Ethics Problem?

Pre-natal Testing - an Ethics Problem?

Abortion has been for many years an area of ethical concern, and for many Christians an issue of a clear moral nature. We shake our heads at the horrific numbers of foetuses killed since the 1967 Abortion Act. Some seek to lobby Parliament and get back to the roots of the problem in offering pregnancy testing and counselling with a different perspective, together with support for those mothers who choose to continue their pregnancies.

For Christian doctors, the issue is a difficult one in practice. However, many are willing to take a clear stand in refusing to refer women for termination of pregnancy on social grounds. As a medical student, this issue came into sharp focus for me during my Obstetrics and Gynaecology attachment. It was something I was prepared to face in Gynae clinics. However, I was not so prepared for it to arise in ante-natal clinics.

Progress in research

Over the past few years, research has uncovered the genetic basis for many inherited diseases, for example Cystic Fibrosis and Duchenne Muscular Dystrophy. Tests have been developed for detecting these genes in the foetus, together with other tests for detecting Down's Syndrome and Spina Bifida. In ante-natal clinics all over the UK, and in other 'developed' countries, maternal serum alpha-fetoprotein levels are routinely measured to screen for congenital abnormalities including Down's Syndrome and neural tube defects. If abnormal levels are discovered, amniocentesis or ultrasound scanning respectively can be used to make a more accurate diagnosis, and if the medical staff are convinced of the presence of an abnormality, termination of the pregnancy is often offered to the mother.

Many efforts have been, and are being, made to enable such tests to take place earlier in gestation and studies of various methods of testing (for example chorionic villus sampling versus amniocentesis) are well-known. Pregnant women are being offered tests for an ever-increasing number of conditions and the whole process is widely accepted and praised as being a step forward in clinical practice. But is it?

Implications of testing for doctors and parents

One consideration should be that although pre-natal testing is portrayed as 'prevention' of congenital abnormalities, it is secondary prevention, not primary. The obstetrician has two patients in the case of a pregnancy - the woman and the foetus she is carrying. 'Treating' the woman by termination of pregnancy for foetal abnormality is hardly preventative!

However, the process seems to be regarded by most doctors, and other staff working in obstetrics, as compassionate and beneficial. Any protest against it is quickly discarded as removing the right of parents to choose whether or not to bring a handicapped child, or one with a potentially fatal disease, into the world. But by then is it not too late? What about the right of the child? Does the fact that he or she has a particular disease, gene or syndrome make him or her less worthy to live? Are we as a society in danger of producing an artificially healthier population while failing to direct resources towards the care, education and training of handicapped people?

And what choice are we giving parents? The arrogance of the medical profession all too readily barges into people's lives and fails to consider the consequences of its actions. Surely the reason for doing a 'routine' blood test for alpha-fetoprotein should be explained to parents, as this test is totally unnecessary, as far as I can see, if termination is not being considered. And yet this explanation is often neglected. Progress in medical science often brings people relief and hope, but in this case it brings heart-breaking decisions for parents, with pressure to choose termination of pregnancy 'in compassion' rather than courageously continuing the pregnancy with all that entails.

What is handicap?

The issue of pre-natal testing should bring to mind another consideration: the value of disabled people in society. On a superficial level, we may feel that the elimination of disease, even by selective abortion, is always worthwhile. But surely on deeper consideration we must realise that destroying human beings is too high a price to pay. We are in danger of judging a person's inherent worth by their outward appearance and physical or intellectual ability, and forgetting that in God's sight our greatest handicap is sin which prevents us from relating to him. Indeed, a major contribution to our society by handicapped and chronically ill children and adults is to make us realise that physical or intellectual ability is far less important than spiritual qualities of love, forgiveness, courage and sacrifice. They also turn our eyes to our own weakness and need of God. Some physically disabled people I know are also very active Christians and their disability does not hinder them from serving the Lord.

A Biblical perspective

One of the most moving stories in the Bible concerns a physically disabled man, Mephibosheth, to whom David shows great kindness for the sake of his friend Jonathan (2 Sa 9). Far from regarding him as worthless, David pays Mephibosheth great honour, treating him as a privileged member of his own household. This reminds me of Jesus' words: '...whatever you did for one of the least of these brothers of mine, you did for me' (Mt 25:40).

As Christians, we must present a fresh, godly perspective to society on this issue. God has shown us his regard for the weak and helpless and has commanded us to defend their rights:

'Defend the cause of the weak and fatherless; maintain the rights of the poor and oppressed. Rescue the weak and needy ' (Ps 82:3,4)

'Blessed is he who has regard for the weak; the Lord delivers him in times of trouble.' (Ps 41:1)

Where should we stand as Christians on this issue, particularly as many of us in the medical profession will face it head-on? Will we allow the number of different pre-natal tests and the number of 'socially desirable' abortions to continue unabated?

May God guide us by his grace as salt and light in a dark and decaying world.

'Your hands made me and formed me; give me understanding to learn your commands.' (Ps 119:73)

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