Guido de Wert1, Wybo Dondorp1, Diana W Bianchi2. 1. Department of Health, Ethics & Society, School for Oncology and Developmental Biology (GROW), School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. 2. Mother Infant Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, US.
Abstract
BACKGROUND: Parallel to recent advances in prenatal screening for Down syndrome (DS), therapies for different aspects of the condition have become available. As intellectual disability is a key aspect, this is an active area for research. Several groups have hypothesized that prenatal interventions will give better chances at improving cognitive functioning in persons with DS than postnatal treatment. Clinical trials are being developed. METHOD: We first discuss the ethical pros and cons of trying to improve cognitive functioning in persons with DS to see if there are categorical objections to the general idea, and then move on to explore ethically relevant aspects of the prospect of developing fetal therapy for DS (FTDS). RESULTS: Only on the basis of a one-dimensional emphasis on the social model of disability would (fetal) therapy aimed at cognitive improvement be inherently problematic. CONCLUSIONS: Inviting pregnant women to participate in FTDS-research should be based on adequate pre-clinical trials, as well as information aimed at avoiding the so-called 'therapeutic misconception'. Should FTDS be proven to be effective and safe, women carrying a fetus with trisomy 21 who have decided to continue the pregnancy may have a moral obligation to make use of this option.
BACKGROUND: Parallel to recent advances in prenatal screening for Down syndrome (DS), therapies for different aspects of the condition have become available. As intellectual disability is a key aspect, this is an active area for research. Several groups have hypothesized that prenatal interventions will give better chances at improving cognitive functioning in persons with DS than postnatal treatment. Clinical trials are being developed. METHOD: We first discuss the ethical pros and cons of trying to improve cognitive functioning in persons with DS to see if there are categorical objections to the general idea, and then move on to explore ethically relevant aspects of the prospect of developing fetal therapy for DS (FTDS). RESULTS: Only on the basis of a one-dimensional emphasis on the social model of disability would (fetal) therapy aimed at cognitive improvement be inherently problematic. CONCLUSIONS: Inviting pregnant women to participate in FTDS-research should be based on adequate pre-clinical trials, as well as information aimed at avoiding the so-called 'therapeutic misconception'. Should FTDS be proven to be effective and safe, women carrying a fetus with trisomy 21 who have decided to continue the pregnancy may have a moral obligation to make use of this option.
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Authors: J C Harper; K Aittomäki; P Borry; M C Cornel; G de Wert; W Dondorp; J Geraedts; L Gianaroli; K Ketterson; I Liebaers; K Lundin; H Mertes; M Morris; G Pennings; K Sermon; C Spits; S Soini; A P A van Montfoort; A Veiga; J R Vermeesch; S Viville; M Macek Journal: Hum Reprod Open Date: 2017-12-04
Authors: J C Harper; K Aittomäki; P Borry; M C Cornel; G de Wert; W Dondorp; J Geraedts; L Gianaroli; K Ketterson; I Liebaers; K Lundin; H Mertes; M Morris; G Pennings; K Sermon; C Spits; S Soini; A P A van Montfoort; A Veiga; J R Vermeesch; S Viville; M Macek Journal: Eur J Hum Genet Date: 2017-12-04 Impact factor: 4.246