Future NHS availability of non-invasive pregnancy testing (NIPT) for Down’s syndrome is certain to reduce the number of women who have invasive diagnostic testing. Everyone agrees this is good news because more women will have information about their pregnancy at an earlier stage, and fewer women will be subjected to the small but significant risks associated with amniocentesis and chorionic villus sampling.
The introduction of NIPT will probably reduce the number of children born with Down’s syndrome, since more women are likely to opt for the test and, if the condition is identified, more women may avail themselves of the earlier abortion. Not everyone agrees this is good news. But why not?
Down’s syndrome is a genetic abnormality. It is associated with three (rather than the normal two) copies of a specific chromosome. It is associated with both intellectual and physical impairments, which vary in severity from case to case.
Generally, Down’s syndrome, as with other genetic abnormalities, is a condition that parents would prefer a child not to have, and so historically the ability to avoid it has been seen as a medical advance. Routine antenatal screening has been offered to women for decades and most women opt to terminate an affected pregnancy.
It is probably safe to assert that the ethics of antenatal screening are included in almost any textbook on medical ethics you care to look at. The Abortion Act 1967 includes a specific clause permitting abortion when there is a serious risk of fetal abnormality that (using the words of the time) would be sufficient to result in a ‘serious handicap’, and the ethical debate has tended to focus on who is the right person to make a decision about the circumstances when abortion is ‘right’. In short: should an abortion decision be a matter of personal choice (made by individual women) or public health (made by doctors)?