Global Ethics – Medical Ethics – Hospital Ethics Committees – Research Ethics – Public Health

Archive for March, 2010

Prenatal test for intelligence

As prenatal tests make it possible to identify fetuses that will have mental retardation, deafness, early-onset Alzheimer’s disease and a range of other conditions, such personal deliberations are adding a new layer to the fraught political debate over abortion.

Abortion rights supporters — who believe that a woman has the right to make decisions about her own body — have had to grapple with the reality that the right to choose may well be used selectively to abort fetuses deemed genetically undesirable. And many are finding that, while they support a woman’s right to have an abortion if she does not want to have a baby, they are less comfortable when abortion is used by women who don’t want to have a particular baby. 

Genomics and Public Health

As prenatal tests make it possible to identify fetuses that will have mental retardation, deafness, early-onset Alzheimer’s disease and a range of other conditions, such personal deliberations are adding a new layer to the fraught political debate over abortion.

Abortion rights supporters — who believe that a woman has the right to make decisions about her own body — have had to grapple with the reality that the right to choose may well be used selectively to abort fetuses deemed genetically undesirable. And many are finding that, while they support a woman’s right to have an abortion if she does not want to have a baby, they are less comfortable when abortion is used by women who don’t want to have a particular baby.

“How much choice do you really want to give?” asked Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania School of Medicine. “That’s the challenge of prenatal testing to pro-choicers.” For many women and their partners, the decision to terminate a pregnancy after a prenatal diagnosis of a serious genetic defect can be harrowing, often coming after a painful assessment of their own emotional and financial resources. And there is widespread support for such an option: 70 percent of Americans said they believe that women should be able to obtain a legal abortion if there is a strong chance of a serious defect in the baby, according to a 2006 poll conducted by the National Opinion Research Center.

“This issue underscores the importance of families making personal, private decisionswithout political interference,” said Nancy Keenan, president of Naral Pro-Choice America, in a statement. “The decision should be with women, their families, and their doctors.” But as more tests become available for conditions that do not involve serious disabilities, childhood diseases or death in early childhood, the emerging ethical questions may inject more nuance into a perennially polarized discussion. “It will capture where the mainstream of Americans are on prenatal testing and abortion. Dr. Caplan added.

Gattaca is not that far away!. For the second time in as many months the Centre for Addiction and Mental Health (CAMH) has signed a licensing agreement with US-based Athena Diagnostics Inc. to market a new genetic test for a certain type of inheritable intelligence.

The test was developed by CAMH scientist Dr. John Vincent as well as independent clinical researcher Dr. Muhammad Ayub. It is based on their research into genetic causes of intellectual disability. The test analyzes a small sample of blood or saliva for the CC2D2A gene mutations that cause about 10% of cases involving a type of intellectual disability, similar to that in Joubert’s syndrome. As an autosomal-recessive disorder, if both the mother and father carry a mutated copy of the gene, Joubert’s syndrome can occur in one out of four of their children. The current research by Drs. Vincent and Ayub is based on findings in families where cousin-cousin marriage is common.

Intellectual disability affects about one in 100 individuals worldwide. There are many types and causes of mental retardation or intellectual disability. It is estimated that up to half of all intellectual disability is caused by genetic mutation. Genetic counsellors will assist physicians to interpret the results for each client and family. “Many affected families are eager for information that will help them understand the cause of the condition, as well as the risk of passing the disorder on to their offspring,” adds Dr. Vincent. “Our test will provide more accuracy to physicians who are trying to identify these hard-to-diagnose cases, and help them offer appropriate genetic counselling to family members who request it.”