Implementation of first-trimester risk assessment for trisomy 21: ethical considerations

The performance and evaluation of first-trimester risk assessment should meet standards of scientific and ethical excellence. Scientific standards are well understood. Ethical standards are less well understood. On the basis of the ethical concept of the physician as fiduciary, and the ethical principles of respect for autonomy, beneficence, and justice, we show that the obstetrician has an ethical obligation to routinely offer pregnant women first-trimester risk assessment in high quality centers. On the basis of the professional virtues of integrity and self-sacrifice, we then show that both obstetricians and specialists in risk assessment have a strict ethical obligation to identify, responsibly manage, and disclose both economic and noneconomic conflicts of interests, especially when they are hidden. We conclude that ethics is an essential dimension of implementation of first-trimester risk assessment for trisomy 21.