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A Capabilities Approach to Prenatal Screening for Fetal Abnormalities.

Greg Stapleton1, Wybo Dondorp2, Peter Schröder-Bäck3

  • 1Department of Health, Ethics and Society, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, The Netherlands. greg.stapleton@maastrichtuniversity.nl.

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Prenatal screening guidelines are challenged by new DNA testing. This study uses the capabilities approach to prioritize screening for conditions significantly impacting women's core capabilities, focusing on serious congenital and early-onset conditions.

Keywords:
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Area of Science:

  • Medical Ethics
  • Genetics
  • Reproductive Health

Background:

  • International guidelines advocate non-directive prenatal screening for fetal abnormalities to support informed reproductive choices.
  • Advancements in cell-free fetal DNA (ccfDNA) Non-Invasive Prenatal Testing (NIPT) challenge existing screening policy frameworks.
  • Debates focus on the scope of screening offers and how to best enable meaningful reproductive choices.

Purpose of the Study:

  • To refine the non-directive aim of enabling meaningful reproductive choice using the capabilities approach.
  • To develop a framework for prioritizing prenatal screening offers for different genetic conditions.
  • To assess the relative importance of screening based on potential impact on women's capabilities.

Main Methods:

  • Utilized the capabilities approach to analyze the concept of meaningful reproductive choice.
  • Applied the developed framework to evaluate the prioritization of prenatal screening for various genetic conditions.
  • Assessed conditions based on their potential to diminish a woman's central capabilities.

Main Results:

  • The capabilities approach provides a method to specify the non-directive aim of prenatal screening.
  • A framework was developed to prioritize screening offers based on the impact on women's capabilities.
  • Greater priority should be given to screening for conditions that significantly diminish central capabilities.

Conclusions:

  • Prenatal screening policy requires re-evaluation in light of new NIPT technologies.
  • The capabilities approach offers a robust ethical framework for guiding screening prioritization.
  • Serious congenital and earlier-onset conditions warrant higher priority in prenatal screening offers due to their significant impact on women's capabilities.