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Prenatal diagnosis: serious decision – health

Should health insurance companies pay for blood tests to diagnose trisomies before birth? Those who warn of an increase in abortions should think of more than 100 000 crashes that take place even without a test.

Comment by Kathrin Zinkant

There are debate topics that keep coming up. Pre-natal or prenatal diagnosis is such a classic, which has already turned to different methods – and now flares up again, because pregnant women could possibly make life easier again.

The joint Federal Committee G-BA will initiate a resolution procedure this Friday, which will presumably lead to the approval of a so-called "non-invasive" test in late summer. Specifically, it is about a blood analysis available since 2012 that can diagnose three so-called trisomies seven weeks after conception and, if desired, some other anomalies. This includes trisomy 21, which is known as Down syndrome. So far, pregnant women have to pay the 200 to 450 euro expensive test mostly themselves, in the future he should be free for women from the age of 35 years. Basically, has been summoned for three years, what do such free blood tests because with the family moral in Germany.

The problem is that the debate keeps centering around the same dam failures: why simpler procedures in prenatal diagnostics are not the first step towards child optimization. Even more often, if already born handicapped people would be discriminated against, if they could be sorted out more easily and if parents do not make the decision too easy. Again, representatives of disability associations are again saying that the number of abortions will grow, that there will be practically no disabled people in the future – even though more than 90 percent of all disabilities do not occur before, but during or after birth. It is supposedly about the image of man. Where is the regret, if such a test is free first? Where is the ethics?

It is also about the right of self-determination of women

Forget very quickly. So it has been consensus for many years that parents or mothers who are unwilling to care for a child can cancel a pregnancy – regardless of whether the child is healthy or not. More than 100,000 unborn children are aborted in Germany every year due to this deadline solution. One can argue now whether this right of self-determination of the woman should be abolished, in order to eliminate the blatant break in the argument – or perhaps because the woman's right to self-determination is perhaps not so important after all. In Poland it was almost so long ago. But it's not about the many healthy children who are aborted. It's about those who are known to be unhealthy.

Less than four percent of all crashes are linked to a medical indication or rape. How many abortions of these four percent are due to a trisomy is unknown. It is therefore also unknown how many women actually abort trisomy 21 after diagnosis. There is no empirical basis for the frequently quoted rate of 90 percent; nevertheless, it is consistently quoted because it fits into the picture. It is also a status quo that pregnant women undergo a variety of prenatal examinations that assess the risk of a trisomy 21 without being able to determine the trisomy safely – even though they are aiming for a diagnosis. Certainty could be obtained in this way insecure parents until 2012, only if they had an invasive procedure carried out, which is associated with a risk for miscarriage.

The controversial blood test changes two things: he can diagnose without the risk of a miscarriage, and he shifts the time of diagnosis to the first trimester of pregnancy. An abortion is then possible after the time limit regulation – instead of a late abortion, for which the child has to be euthanized in the womb and dead. Incidentally, such late abortions are a horror that some people may still regard as just punishment for the mother in the current discourse. Who wants to hold on to this horror, but certainly should not speak of ethics.

The decision for the parents remains difficult in the 11th week

Because above all else it is forgotten that the decision for the parents usually remains very difficult. Can we take responsibility? Does our child suffer more after birth than it can live well? Are we guilty? It's a fight that has to be fought the same way in the eleventh week as it is in the sixteenth week, and that is hardly less harsh than the question of whether you want to get a presumed healthy child – or not.

Who wants to help the parents here, they should above all not condemn. And no, tests do not decide. People decide if they can imagine living with a disabled child or not. But this idea depends first and foremost on the society in which the people live. It depends on whether this society is benevolent and tolerant enough to really accept seriously handicapped children. A debate would be more worthwhile.

Medicine right to knowledge

Right to knowledge

Pregnant women are still over-patronized when it comes to abortion or prenatal diagnosis. They need to know what to expect – and then decide for themselves.Comment by Christina Berndt


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