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Is Prenatal Genetic Testing Justifiable for Prolife Couples?

Posted by MDViews on January 7, 2009

I just finished reading and commenting on a post at Mary Meets Dolly which I found at Prolifeblogs.com, one of my favorite sites. Her post is very thoughtful and accurate. She spells out the position of the Catholic church on these issues. She describes genetic testing as a morally neutral activity. Moral culpability rests in the decisions made on the information from the genetic testing. She does take issue with pre-implantation genetic diagnosis (PGD) in which a single cell is removed from a developing embryo to test the embryo’s genetic make up–to see if it passes muster to be implanted. PGD destroys many embryos with the procedure itself, and, if the embryo is not deemed good enough, it gets flushed.

 

I encourage you to view her blog. She makes a good presentation of these procedures. I appreciate someone taking the time to spell out these categories in terms everyone can understand.

I don’t quite agree that genetic testing is morally neutral, however. For three reasons.

The first, in order to get an accurate genetic diagnosis, either amniocentesis or chorionic villus sampling (CVS) must be done. The risk of miscarriage from amniocentesis (which doctors try to do earlier and earlier in the pregnancy which increases the risk of miscarriage from the amniocentesis) is about 1/400 depending on which study you believe. Some studies show the rate of pregnancy loss as being much higher. The risk of miscarriage from CVS is about 2%, much much higher.

Why would someone undertake such a risky, invasive procedure when ultrasound (U/S) rarely misses a baby with a serious abnormality and U/S is safe? No risk of miscarriage with U/S. In general, if a baby has an abnormality serious enough to require immediate care after birth, U/S will pick it up. There are exceptions, of course. But their is no in-utero treatment for a genetic problem to justify the risk of miscarriage from the amniocentesis.

I’ve had a patient get the result of her amniocentesis showing a normal baby on the day she miscarried the baby from a complication of the amniocentsis. I’ve had pro-life women undergo prenatal screening (quad screen it is now called–a blood test on mom–no risk to the baby) which returned abnormal, frightening her into amniocentesis which resulted in miscarriage of her normal pregnancy. The quad screen has a somewhat high false positive rate.

So genetic testing is not a benign walk-in-the-park. It carries real risks and should never be undertaken without good evidence that there would be some problem amenable to in-utero treatment or treatment shortly after birth in my view.

Secondly, prenatal diagnosis would disappear from the face of the earth without abortion-on-demand. I’ve read abortionists comments saying exactly that. The number of women who go through the whole process of genetic diagnosis including amniocentesis or CVS, who then find a baby with a handicap and who then choose to continue the pregnancy is very small. (Sarah Palin being an exception, although I do not know if she had an amniocentesis.) The abortion industry is the fire beneath prenatal diagnosis keeping it going. How do you think the March of Dimes “prevents” birth defects?

The third reason is that there is no such thing as “non-directive counseling” which is what prenatal diagnosis clinics are supposed to provide patients if the amniocentesis returns showing a baby with a handicap. I have had patient after patient describe the pressure placed on them by the “neutral” genetic counselor encouraging the patient and her husband to end the baby’s life. And if the patient did not agree to abortion, the genetic counselor would repeat the whole senario thinking the patient was too stupid to understand the correct decision, which was abortion.

So, her post is correct in theory. But the real life result this activity does little but line the pockets of the abortionists.

7 Responses to “Is Prenatal Genetic Testing Justifiable for Prolife Couples?”

  1. MDViews said

    Dear Monica,

    Thank you for your thoughtful post. I appreciate your willingness to wrestle with a topic such as this. It’s easier sometimes to ignore the dilemmas couples face. I’ve looked at your web site and appreciate your organization.

    If abortion were not available, prenatal diagnosis could be beneficial, but only in limited circumstances, I think.

    You mention spina bifida, and that can be treated by performing a cesarean, operating on the baby, putting it back in and sewing the uterus, praying labor doesn’t start. I praise God for the surgeons willing to undertake such a surgery. It works, apparently, and with almost no scarring.

    Genetic problems have no such fix. The value in that circumstance would be preparation and perinatal hospice. Perinatal hospice is a form of medical care that provides emotional, spiritual and physical support for those women who have a baby without a chance for survival, or limited chance for survival. It allows the couple to grieve and then join with family and friends when the baby passes, whether before birth or after birth. It removes the guilt of killing your own child.

    This type of care was started, I think, by one of my colleagues in the American Association of Pro-Life OB/GYNs.

    It is important, I think, for couples facing such a pregnancy to hear words of support, reassurance that the baby’s problem was not caused by the mother’s behavior, words that emphasize the humanity of the child but grieve with them about the disability and impending outcome.

    I’ve heard some of the most callous comments to patients and couples regarding their baby with a disability. ‘You must have been on drugs’, ‘At least it’s going to die and you won’t have to deal with it’, ‘Why aren’t you aborting it? It would be the kindest thing to do’, ‘You must have done something wrong early in your pregnancy’.

    Regarding the thousands of inborn errors of metabolism, genes for breast cancer, cystic fibrosis testing and pre-implantation diagnosis for any one of a number of gene mutations, there is no justification in my judgment. Tests for all those problems can be done after the baby is born.

    And I do agree that ultrasound is getting so good, many problems can be detected with it. It is especially effective at identifying neural tube defects (spina bifida).

    Thanks again for the discussion.

  2. benotafraid said

    You know, I think it could be morally neutral in a place where there were no abortion, and where there was advanced fetal medicine, despite the risks involved in cvs and amnio. And in such a situation (which I know is at this point imaginary), the “need” for early testing would dissipate . . . testing at 35 weeks for an accurate diagnosis is a different scenario than testing at 16 weeks. And so, because a neutral set of circumstance for prenatal testing is plausible, then I do think we can see it as inherently neutral, though practically it is abused and misused.

    Could it be a great good? Maybe . . . I’m imagining a situation where a baby is a candidate for in utero surgery to treat spina bifida. This is pretty risky for the mom, since it involves 2 c-sections within a short period of time. If the baby has trisomy 18, then they won’t allow the surgery on the baby. Could they tell from ultrasound only . . . possibly, but then they might be excluding a baby who only has a few markers and could survive . . . for the baby w/o t18, the prenatal testing could offer therapeutic benefit. For the baby w t18, it could offer the parents time to cherish the baby w/o worrying about this and that upcoming surgery, etc.

    What do think? That is, if abortion is not a possible outcome . . .

    I tend to agree w/you in that ultrasound is really getting to the point of making the invasive testing less and less justifiable . . .

  3. MDViews said

    I don’t know why this March of Dimes issue isn’t better known. Each year in Burlington, IA, where we used to live and work, there was an annual March of Dimes walk that was very popular. Lots of the nurses would do the walk, especially those from OB. I explained to them my objections and even the pro-life nurses seemed unfazed–like I must be crazy. But, I’m not. And the March of Dimes is not an organization to receive my gift. Thanks for your comments.

  4. Lori said

    Wow. I feel duped. I stopped donating to them because I was frustrated with the amount of money they spent trying to get me to give them money. I must have gotten about 25 mailings from them with custom return labels, note pads, etc. after just sending them one little donation. But your reason is an even better one. Thanks for the heads up!

  5. MDViews said

    Thank you for your question. I guess I threw that in without any explanation, mostly because I posted on the March of Dimes back in 2005. I’ve re-read my post and can’t say it any better now than I could say it then. So I’ve copied the post here so you can read it. I hope it helps.

    In Christ,

    Abigail’s Dad

    Ever wondered how exactly one prevents birth defects?

    I have. Even before I became an OBGYN doctor. You should to.

    That phrase still sticks in my mind from years and years ago, when, on radio and television the March of Dimes (MOD) ad would say, “Give to the March of Dimes. Help prevent birth defects,” if I remember correctly. They raised money by displaying posters, usually at check out counters, asking to give. The entire poster had slots in which to insert dimes. (March of “Dimes”)

    Back then, the MOD was a good organization advocating better prenatal care, better nutrition for pregnant women, avoidance of drugs (prescription and otherwise) when pregnant. That was back in the time of Thalidomide in Europe. I think they were involved in some of the intra-uterine fetal transfusions to save “Rh babies” which were revolutionary at the time.

    And I don’t want to denigrate the good things the March of Dimes does do today. It is still an advocate for prenatal care (albeit a governmental, socialized medicine model) and healthy pregnant women. They’ve pushed hard for awareness of the need for adequate pre-pregnancy and early pregnancy folic acid to prevent spina bifida.

    But somewhere along the line, they lost their way. In 1973 abortion became legal. Suddenly, it was possible to kill an unborn baby before it was born. The intellectual leap to prenatal diagnosis of chromosome abnormalities and termination of those unborn not lucky enough to be perfect was a small one.

    So the MOD made that leap. I can only imagine that they faced a real dilemma at that time and probably still do. They must have realized that advocating termination of the not-so-perfect would be a public relations nightmare. But they wanted to “prevent birth defects” and abortion was the perfect way. So, they just kept empahasizing their slogan. “Give to the March of Dimes. Help prevent birth defects.” Only now their slogan was a false one. If truth-in-advertising applied to them they would have to change it to: “Give to the March of Dimes. Help prevent babies from being born with birth defects.” But that just doesn’t have the good sound to it, does it.

    Currently, the biggest funder of prenatal diagnosis clinics (search-and-destroy clinics may be a better term), according to a pro-life MFM specialist whom I know, is the March of Dimes.

    But, just like the prenatal diagnosis clinics they are officially neutral on abortion. Officially, they are not for it or against it. (Wink, wink, nod, nod) They just fund these clinics so that a diagnosis can be made and then non-directive counseling given.

    That’s just hogwash and everyone in OBGYN knows it. One pro-abort maternal fetal medicine specialist (MFM) let the cat out of the bag writing that prenatal diagnosis clinics would disappear if abortion weren’t available and legal. I’ve had prolife patients tell me of encounters with this “non-dirctive counseling” after discovery by ultasound that their baby had spina bifida. After four, count them, four repeats of this counseling (they kept saying they would not abort), my patients husband stood told the doctor, “Look, doc. We’re not going to flush the kid. Now, what can you do for us?”

    The members of the American Assn of Prolife OBGYNS’s have asked the March of Dimes to disavow abortion. They won’t.

    So, the next time they have a walk to raise money for the March of Dimes, give pause before you donate.

  6. Lori said

    Hi Dr. Anderson, I’m a friend of Abigail’s and have enjoyed reading your blog. Can you expand on your comment about the March of Dimes? Having had premature twins, I’ve supported them in the past and had no idea they were anything but reputable. I should have done my research I guess…

  7. I think it does get down to your position on abortion. People who discriminate against the unborn usually also discriminate against those who have disabilities. Pro life people tend to embrace everyone as worthy of life regardless of your disability or age.

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