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Comments and reflections on ethics in screening for biomarkers of prenatal alcohol exposure
Natalie Zizzo1, Nina Di Pietro, Courtney Green
1Neuroethics Research Unit , Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada.
Insights
Early detection of fetal alcohol spectrum disorder (FASD) is crucial. Screening neonates for prenatal alcohol exposure (PAE) biomarkers shows promise but raises significant ethical concerns needing careful consideration before implementation.
Area of Science:
- Medical Ethics
- Neonatal Screening
- Public Health
Background:
- Early identification and intervention optimize outcomes for individuals with fetal alcohol spectrum disorder (FASD).
- Biomarkers for prenatal alcohol exposure (PAE) in neonates could aid in identifying children at risk for FASD, enabling timely interventions.
- Ethical considerations are paramount before implementing PAE screening programs.
Purpose of the Study:
- To identify and discuss ethical, social, and legal concerns related to meconium screening for PAE from a North American perspective.
- To highlight gaps in the current literature regarding PAE screening.
Main Methods:
- Review of ethical, social, and legal literature concerning meconium screening for PAE.
- Analysis of key ethical issues from a North American viewpoint.
Main Results:
- Major ethical concerns include population targeting, consent, stigma, cost-benefit analysis, test result consequences (false positives/negatives), confidentiality, and use in prosecution.
- Significant gaps exist in understanding stakeholder perspectives (parents, healthcare providers) on PAE screening and its ethical challenges.
Conclusions:
- Addressing complex ethical issues is essential before widespread implementation of PAE screening programs.
- Further research is needed to incorporate diverse stakeholder viewpoints into ethical guidelines for PAE screening.
Abstract:
Early identification of and intervention for fetal alcohol spectrum disorder (FASD) has been shown to optimize outcomes for affected individuals. Detecting biomarkers of prenatal alcohol exposure (PAE) in neonates may assist in the identification of children at risk of FASD enabling targeted early interventions. Despite these potential benefits, complicated ethical issues arise in screening for biomarkers of PAE and these must be addressed prior to the implementation of screening programs. Here, we identify and comment, based on a North American perspective, on concerns raised in the current ethical, social, and legal literature related to meconium screening for PAE. Major ethical concerns revolve around the targeting of populations for PAE screening, consent and respect for persons, stigma and participation rates, the cost-benefit analysis of a screening program, consequences of false-positive and false-negative test results, confidentiality and appropriate follow-up to positive screen results, and the use of screen results for criminal prosecution. We identify gaps in the literature on screening for PAE, most notably related to a lack of stakeholder perspectives (e.g., parents, healthcare providers) about screening and the ethical challenges it presents.
