نگاهی به غربالگری و سقط جنین از منظر اخلاق پزشکی

در سال‌های اخیر چالش‌هایی دربارۀ سقط جنین در کشور به وجود آمده است (1-3). به نظر می‌رسد از دلایل به وجود آمدن این تنش‌ها در نظر نگرفتن مشکلات اجرایی فرایند موجود سقط جنین است. غربالگری و سقط درمانی نه به‌دلیل قوانین غلط، بلکه به‌سبب اجرای نادرست و جدی‌نگرفتن اخلاق پزشکی از مرحلۀ اجرای غربالگری تا مرحلۀ صدور دستور سقط دچار اختلالاتی بوده و همچنان هست.

screening and abortion from the perspective of medical ethics

during the recent years, there have been challenges surrounding the issue of abortion in the country (1-3). it seems that these tensions stem from the failure to consider the executive problems associated with the existing procedure to be followed for abortion. screening and abortion therapy suffer certain shortcomings and problems that have not been dealt with yet, not due to wrong rules but because of inappropriate implementation and ignoring the medical ethics from the stage of screening to issuing the permit for abortion.screening tests are a part of the prenatal and perinatal care. pregnant women are normally selected to take screening tests when they have certain risk factors such as age, previous experience of fetal defect in pregnancy, or genetic disorders in their families (4, 5). this selection is usually based on their medical history, physical examination, and some primary laboratory tests. these cases are selected as the cases with indication for doing screening tests. as implied by the term screening, the mentioned tests examine and monitor the fetus for early birth defects. the first ethical problem in the screening process is when all women rather than those with indication are directed to take screening tests. another problem concerns the errors in tests. any experiment or test is likely to have two types of errors. type 1 error or alpha error or false positive is when the experiment or test says this fetus has, for example, the evidences of down’s syndrome, but they are not really related to this syndrome. type 2 error or beta error or false negative happens when the test says there is no disease but there is in fact a disease. screening tests are highly sensitive so that they become positive if there is the smallest possibility of a disease. however, false positive cases are likely to occur due to the high sensitivity of the screening tests. from the perspective of medical ethics, it should be explained to the couples that the result being positive is not an absolute indicator of a disorder in the fetus. accordingly, besides the screening tests, there are some confirmatory tests that have high specificity. in these types of tests, false positive cases are less likely to occur (6, 7).ethical considerations in screening tests1) data clarification and disclosure (inform to the patient): the patient needs to have enough information about two issues; about the disease and conflict of interests. the physician must provide the parents with enough information about the disease likely to be developed by the fetus on which the screening test is going to be performed. furthermore, s/he should make clarifications on his/her own conflict of interests and those of the patient.what is told to the parents about the likely defect of the fetus must include the doubts existing on the accuracy of the test results and their being non-absolute. in addition, they must also be told about the false positive or negative results depending on the type of test (screening or confirmatory). those who take a more careful look at the issue hold that the amount of concern expressed by the physician about the death, defect or disease must be consistent with the amount of concern the public might usually have in this regard and not the physicians and experts (8).