Ethical challenges with non-invasive prenatal tests (NIPT)

Non-invasive prenatal testing (NIPT) performed with the use of massively parallel sequencing of cell-free DNA (cfDNA testing) in maternal plasma gives extended possibilities in prenatal screening. The tests are claimed to be better than existing alternative tests, they reduce the risk, and it is claimed they are cheaper. They have been used in several countries since 2012, and the University Hospital of North Norway has applied to the Directorate of Health to replace first trimester ultrasound and plasma screening with NIPT. The Directorate of Health is reluctant to reply. Why is this? One of the answers may be that NIPT raises a series of professional and moral questions, and poses profound ethical challenges. This article reviews a series of the challenges with NIPT. The aim is to highlight why NIPT calls for ethical reflection and to contribute to an open debate and a transparent decision-making process. The article identifies five major questions to address in the assessment of NIPT: What are the criteria for screening and removing certain conditions? How certain do we have to be that these conditions do appear in living children? How should we handle information from NIPT for living persons? How can we avoid that persons with the conditions that are selected for screening and removal are insulted, stigmatized, or discriminated? How can we avoid that systematic screening and removal of fetuses with