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Issues Related to New Prenatal Testing and Abortion

Issues Related to New Prenatal Testing and Abortion

What are some of the concerns that may arise from the widespread use of NIPT?
This article will delve into the ethical issues raised by NIPT, while at the same time discussing the environment surrounding abortion in Japan.

Introduction.

Although the new prenatal tests have shown a high level of safety and accuracy and became widespread worldwide in the 2010s, while they have the advantage of determining whether a fetus has a congenital chromosomal disorder such as Down syndrome, they have also brought certain problems to light.

It is a matter of "choice of life" that most of the couples who have undergone prenatal testing choose abortion when their fetus is found to have Down syndrome after the test.

In this article, we will delve into the ethical issues raised by NIPT, and at the same time, we will discuss the environment surrounding abortion in Japan.

In this article, I do not take a position either for or against NIPT or abortion, but I would like to raise the issue of possible concerns about the widespread use of NIPT without consideration of the ethical aspects of the procedure.

So, if you are considering having a child in the future, or are already pregnant and considering prenatal testing, please join us in this discussion!

The Spread of New Prenatal Tests in Japan

The Japanese Society of Obstetrics and Gynecology has set an age limit of 35 years or older at the time of delivery for the new prenatal test in Japan.

In addition, the cost of the test is somewhat high, at approximately 200,000 yen, and since it is mandatory to undergo genetic counseling by a genetic counselor, it is not easy to take the NIPT test.

The number of facilities where NIPT is performed has never been large because NIPT is treated as a clinical experiment. (In recent years, there has been a push by the government to make NIPT a general medical examination, and the number of facilities where the test can be performed is expected to increase in the future.)

However, there is a problem that these regulations are not legally binding, and the number of private clinics that are not under the guidance of academic societies is increasing, and many of these clinics charge relatively low fees for testing and do not provide genetic counseling.

It is not the case that "unapproved = illegal" (the merits or demerits of unapproved/unapproved are not questioned in this article, as the point is not relevant), but since the diagnosis of full-scale test results after a medical examination is only requested to overseas laboratories, highly reliable laboratories can be easily found with a little research.

Problems posed by abortion following test results

What is wrong with these, then, is that most couples who undergo prenatal testing do so with the intention of having an abortion if their child has Down syndrome.

In support of this concern, of the 933 pregnant women who actually took the new prenatal test and tested "positive" from 2013 to 2017, only 26, or 3%, wanted to continue their pregnancies.

Of course, there must be various conflicts and circumstances that led to the abortion, and I don't think it is for others to say anything about them.

However, we should be concerned that the counseling act will be neglected and the use of new prenatal tests will increase without widespread discussion of the risks and ethical aspects of abortion.

The concern is that there is a growing trend among those who feel no guilt about aborting a fetus that has been found to have Down syndrome because "everyone else is doing it.

Such sentiments can be described as "dominant gene supremacist ideology," and if such ideas become widespread, they will lead to increased discrimination against people with disabilities living in the modern world.

In order to stop our feelings and thoughts from moving in a discriminatory direction without our noticing, it seems to me that proper guidance and counseling by academic societies are indispensable for clinics.

In Japan, the ethical issues surrounding abortion seem to be neglected compared to other countries, where the pros and cons of abortion are often debated for religious reasons as well.

The Current State of Abortion in Japan from a Macro Perspective

Let us change our perspective and delve into the situation surrounding abortion in Japan from a global perspective.

In fact, unfortunately, Japan is said to be a "backward country in abortion" and, contrary to its high level of medical technology, it does not have the infrastructure in place regarding the circumstances surrounding abortion.

In Japan, abortion was de facto legalized before the rest of the world under the former Eugenic Protection Act of 1948, but there has been virtually no legal development in the 70 years since then.

The WHO issued "Guidelines for Safe Abortion" in 2012, but the trend abortion pills recommended in this document are not approved, and the safe vacuum aspiration method is not widespread enough due to its high cost.

The main abortion method currently used in Japan is called curettage, and the risks to pregnant women are not negligible, and the WHO has pointed this out.

In addition, in Japan, the act of abortion based on the condition of the fetus as determined by prenatal testing or other means is not exactly legally recognized.

In such cases, the abortion is performed by submitting a report of health problems of the pregnant woman, and since the consent of the husband is also required, there is a problem that the procedure may be delayed if the woman is suffering from domestic violence by her husband.

Considering these facts, it can be said that the act of abortion itself is relatively risky in Japan, and one should be well informed about this when making a decision about childbirth.

Conclusion

As we have seen, there have been cases where prenatal testing has revealed that a fetus is born with Down syndrome, resulting in an abortion in a family that would have otherwise given birth.

As mentioned earlier, the financial and time burden of raising a child is different for each individual, and there are various circumstances that lead to the decision to have an abortion, so abortion itself cannot be ruled out based on the results of a prenatal test.

However, if an abortion is to be performed, it should be done after coming to terms with the desire for a healthy baby and the guilt of abortion.

Nevertheless, it is important to have accurate information about your child, whether you choose to give birth or have an abortion, in order to avoid saying, "This is not how it was supposed to be.

For this reason, I recommend the NIPT test, which is both safe and accurate, but at the same time, I strongly hope that our society will not become one in which "selection for life" is the norm.

A 2011 study also found that 99% of people with Down syndrome were satisfied with their lives, and 79% of parents of children with Down syndrome felt that their outlook on life was more positive because of their child.

This data suggests that there is no need to be pessimistic about the discovery of Down syndrome in a child.

In other words, in addition to seeking counseling from a professional genetic counselor, it may be helpful to listen to the voices of couples and others who have actually given birth to a child with Down syndrome in order to help them make better choices.

References