Ethics and Costs under Question in Improved Fetal Screening

Fetal screening is commonplace among pregnant women these days. Somewhere around 10 weeks into their pregnancies, most women undergo ultrasounds accompanied by aneuploidy sampling which determine if further diagnostic tests such as amniocentesis or chorionic villus sampling are required.
These diagnostic tests can detect DNA abnormalities such as Downs Syndrome and until now have been done through invasive methods via directly sampling the amniotic fluid or placenta of the pregnant mother. They also come with a ‘low but definite risk of pregnancy loss’ according to the Medical Journal of Australia.
However now that non-invasive prenatal testing has been developed through a high-level screening test using cell-free fetal DNA, the risk is dramatically reduced and detection outcomes are far more accurate, with the ability to screen for not just the Downs Syndrome gene abnormality trisomy 21, but also other trisomies and sex chromosomal anueploidies.
It can also be performed earlier than amniocentesis, at 10 weeks gestation rather than the minimum 16 weeks, as the genetic sample is taken from the mother rather than the fetus.
The test has been available in Australia for over two years but costs up to $900 and is not eligible for public health subsidies.
Maternal-fetal specialists are treating this new technology with caution.
“With the benefit of increased knowledge comes the increased burden of responsibility for decision making”, says Dr Stephen Cole of the Melbourne Obstetric Group in MJA InSight.
The question is whether greater access to this kind of information will lead to gender and ability selection among parents. However, others in the field want all parents to be able to afford the costly tests.
"There are some women where the cost is prohibitive and they can't access the test because of that," Murdoch Children's Research Institute Professor David Amor says.
"Those women need to rely on traditional forms of testing, which is still very good — particularly for low risk women — but they're no longer the best type of test available," he says.
Professor Caroline de Costa of James Cook University wants the process to be subsidised.
"It's an important new development, it should be available," said