Ethical problems in prenatal diagnosis: pediatric considerations

In Europe, the recent advances in prenatal diagnosis and their practical consequences have elicited political rather than ethical discussions. An attempt will be made to outline and to ethically evaluate criteria pertaining to the termination of pregnancy because of malformation or disease of the fetus. Is it possible to determine the beginning of life, of an individual, of a personality? Are the severity of a malformation or disease, the duration of life to be expected, and the probable time of onset of relevant disease symptoms measurable parameters that can be used to arrive at an ethically correct or at least acceptable decision? In spite of efforts towards ethical objectivity, it appears difficult to set criteria completely independent of professional experience and responsibilities, and of legal liabilities sometimes resulting in dialectical patterns of thinking. The mothers' needs and wishes will play a paramount role in obstetric considerations. The paediatric point of view necessarily emphasizes the best interest of the child. Ethical criteria can not provide unequivocal answers. They can help, however, in a 'no-win' situation, to find an acceptable way between two 'evils': the death of an unborn child or the birth of a child with a severe disease.