Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context

Jessica Mozersky, Vardit Ravitsky, Rayna Rapp, Marsha Michie, Subhashini Chandrasekharan, Megan Allyse

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop.

Original languageEnglish (US)
Pages (from-to)41-49
Number of pages9
JournalHastings Center Report
Volume47
Issue number2
DOIs
StatePublished - Mar 1 2017

Fingerprint

Prenatal Diagnosis
autonomy
DNA
social economics
pregnancy
health care
paradigm
income
Chromosome Disorders
Education
experience
Sex Chromosomes
Genetic Testing
Aneuploidy
North America
Screening
Fetus
Economics
Mothers
Genome

ASJC Scopus subject areas

  • Health(social science)
  • Issues, ethics and legal aspects
  • Philosophy
  • Health Policy

Cite this

Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context. / Mozersky, Jessica; Ravitsky, Vardit; Rapp, Rayna; Michie, Marsha; Chandrasekharan, Subhashini; Allyse, Megan.

In: Hastings Center Report, Vol. 47, No. 2, 01.03.2017, p. 41-49.

Research output: Contribution to journalArticle

Mozersky, Jessica ; Ravitsky, Vardit ; Rapp, Rayna ; Michie, Marsha ; Chandrasekharan, Subhashini ; Allyse, Megan. / Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context. In: Hastings Center Report. 2017 ; Vol. 47, No. 2. pp. 41-49.
@article{95c72328158f4205bcc6788df3e77602,
title = "Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context",
abstract = "Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop.",
author = "Jessica Mozersky and Vardit Ravitsky and Rayna Rapp and Marsha Michie and Subhashini Chandrasekharan and Megan Allyse",
year = "2017",
month = "3",
day = "1",
doi = "10.1002/hast.690",
language = "English (US)",
volume = "47",
pages = "41--49",
journal = "Hastings Center Report",
issn = "0093-0334",
publisher = "Hastings Center",
number = "2",

}

TY - JOUR

T1 - Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context

AU - Mozersky, Jessica

AU - Ravitsky, Vardit

AU - Rapp, Rayna

AU - Michie, Marsha

AU - Chandrasekharan, Subhashini

AU - Allyse, Megan

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop.

AB - Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop.

UR - http://www.scopus.com/inward/record.url?scp=85015664393&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015664393&partnerID=8YFLogxK

U2 - 10.1002/hast.690

DO - 10.1002/hast.690

M3 - Article

C2 - 28301696

AN - SCOPUS:85015664393

VL - 47

SP - 41

EP - 49

JO - Hastings Center Report

JF - Hastings Center Report

SN - 0093-0334

IS - 2

ER -