Just choice: a Danielsian analysis of the aims and scope of prenatal screening for fetal abnormalities

Med Health Care Philos. 2019 Dec;22(4):545-555. doi: 10.1007/s11019-019-09888-5.


Developments in Non-Invasive Prenatal Testing (NIPT) and cell-free fetal DNA analysis raise the possibility that antenatal services may soon be able to support couples in non-invasively testing for, and diagnosing, an unprecedented range of genetic disorders and traits coded within their unborn child's genome. Inevitably, this has prompted debate within the bioethics literature about what screening options should be offered to couples for the purpose of reproductive choice. In relation to this problem, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) tentatively recommend that any expansion of this type of screening, as facilitated by NIPT, should be limited to serious congenital and childhood disorders. In support of this recommendation, the ESHG and ASHG cite considerations of distribution justice. Notably, however, an account of justice in the organization and provision of this type of screening which might substantiate this recommendation has yet to be developed. This paper attempts to redress this oversight through an investigation of Norman Daniels' theory of Just health: meeting health needs fairly. In line with this aim, the paper examines what special moral importance (for Just health) screening for the purpose of reproductive choice might have where concerning serious congenital and childhood disorders in particular. The paper concludes that screening for reproductive choice where concerning serious congenital and childhood disorders may be important for providing women with fair opportunity to protect their health (by either having or not having an affected child).

Keywords: Ethics; Justice; Non-invasive prenatal testing; Prenatal screening; Public health; Reproductive choice.

MeSH terms

  • Delivery of Health Care / ethics
  • Female
  • Fetus / abnormalities*
  • Humans
  • Morals
  • Noninvasive Prenatal Testing / ethics
  • Pregnancy
  • Prenatal Diagnosis / ethics*
  • Public Health / ethics
  • Social Justice