Jason Thacker talks about ethics of prenatal testing and bioethics on World’s “The World and Everything In It” podcast.
Full interview here.
By Marie Delph / Jan 20
I started making dad jokes at the first doctor’s appointment for our baby in the womb. My wife’s doctor asked, “What are we hoping for?” My wife groaned when I responded, “A baby would be great, but we would settle for a velociraptor.” She often responded with something along the lines of, “We just want he or she to be healthy.” And my wife’s response is common to many parents who are faced with the mystery of pregnancy and have an innate desire for their child’s well-being. We know something amazing is happening — but we don’t really know how it’s happening, even if we understand biologically what is developing from week to week. And we are faced with the reality that we have basically no control over the process. As Louie Giglio once pointed out in a sermon, the fact that the body knows to divide skin over your eyes into eyelids at a particular point in pregnancy is an incredible mystery.
Problems of prenatal screening
In the face of this mystery, it makes sense that parents and healthcare providers would desire and perform tests to ensure that the baby is healthy and developing as he or she should. However, recent reporting from The New York Times has cast serious doubts on the accuracy of some genetic tests and reveals concerning trends for Christians. These genetic tests, which screen for genetic diseases ranging from Down syndrome to near universally fatal conditions, were found to be accurate for some conditions (Down syndrome) and wildly incorrect for other, more rare conditions.
In the latter cases, the Times research concluded that they were producing a false positive 85% of the time, requiring more tests to confirm or reject the diagnosis. The diagnosis brought not only a need for more tests, but often mental and emotional anguish. After more tests, many of which are expensive and often not covered by insurance, parents often learned that their unborn child was perfectly healthy. In some cases, parents took the initial test’s diagnosis as a settled issue and chose to terminate the pregnancy when they considered having a child with a disability. One study found that 6% of patients had an abortion after the positive result without further testing. This mirrors the trend in other countries such as Iceland, where parents have almost completely chosen abortion over giving birth to a child with Down syndrome.
Individual concerns for genetic testing
This all raises an important question about the morality of these tests. Should Christians be performing these tests on their unborn children? In this specific situation, the high number of false positives generated by the tests should be reason for healthcare providers to be clearer about the results and certainty parents can actually receive. Initially, the tests were used to detect Down syndrome, a condition where they can reliably provide a correct diagnosis.
However, as the Times report notes, companies began to test for other disorders and rare conditions in an effort to sell more of their products. Often left unmentioned in their pitch to parents is the rate of false positives — which is known to the companies — or the certainty with which parents should receive the results for more obscure diseases. Thus, the mystery and wonder of pregnancy and birth has been commodified by these companies, often to disastrous results for both the child and parents.
However, if the tests were perfectly accurate, Christians may still wonder if they should pursue genetic testing at all. There are two realities at work here, the individual and the societal. At the individual level, a Christian couple who pursues these tests may do so with the desire to prepare for any problems that may arise. And if there are ways to help the preborn baby by preventing disease or correcting issues, then accurate genetic testing could be helpful.
Also, if a couple receives a positive diagnosis, tests such as these give them time to grieve, prepare, and lament what has occurred. A proper Christian response in the face of the brokenness that comes from some of these diseases includes weeping. We are not Stoics unmoved by circumstances and disconnected from the world and the people around us. Like our Savior, lamentation is appropriate in the face of death and sickness (John 11:36). So for the individual couple seeking only knowledge and how best to love their child, accurate genetic tests are a morally valid option.
Genetic testing in an abortion culture
At the same time, Christians must recognize that their decisions are not atomistic or unrelated decisions that affect only the couple. The genetic tests are part of a larger medical landscape in which abortion is an option presented regularly by many doctors and healthcare providers. The history of eliminating vulnerable individuals who are undesirable because of deformity or the idea that they will be “unproductive” members of society has an ugly and bloody history. Earlier generations looked to sterilization of the unfit to improve society. In the present, entire categories of individuals have been almost eliminated because the diagnosis of an extra chromosome leads parents to opt for abortion.
While the tests themselves are morally neutral, the ends to which they are often employed is not. As such, Christians must recognize that we are part of a larger culture where abortion is not only legal but commonplace and encouraged. Thus, we should be wary of communicating, whether intentionally or unintentionally in word or deed, that somehow the value or life of a child is tied to their physical, mental, or genetic makeup. Participation in the larger system can create a demand for these tests, which then helps fuel their use throughout society, including by those who may not use the test solely for diagnostic and preparatory means. This does not mean that Christians err when we use these tests or are somehow morally complicit in the abortion industry by using these tools, but it does mean that we bear the responsibility for knowing this context and considering these realities when we make these type of moral decisions.
Unfortunately, we live in a time when we are able to test for more than we can treat. And in a society that often values individuals solely for what they contribute, rather than on the basis of their humanity rooted in the imago Dei (the image of God), disease and disability prove ample reason to eliminate them. But Christians must not accept this cultural narrative of the worth of any fellow human being, especially children in the womb who represent some of the most vulnerable among us.
We can recognize the tragedy that comes from sin’s effects in the world and the myriad ways that disease can cause harm and pain. However, as theologian Josef Pieper once argued, a good summary of love is our affirmation of the statement: “It’s good that you exist.” Christians looking at sonograms and genetic test results, no matter what they are, can affirm the goodness of their child’s existence. In so doing, they reject narratives of utility and power and affirm the intrinsic worth of every individual solely because they have been created by and bear the very image of God.
By Marie Delph / Jun 8
“At around twelve weeks, we’ll do a blood test to screen for any chromosomal abnormalities, and you’ll be able to find out the sex if you choose to do so.” This is now a routine statement, a version of which can be heard around the world in consultations between pregnant women and their obstetric care providers. When a woman goes to the clinic for an early pregnancy check-up, she will most likely be offered noninvasive prenatal testing (NIPT), sometimes called cell-free DNA (cfDNA) screening.
For many women, the opportunity to find out the sex of their preborn child earlier than the ultrasound anatomy scan is reason enough to have the screening. But what exactly does NIPT screen for? And why are some ethicists concerned about it?
What does NIPT do?
Noninvasive prenatal testing (NIPT) analyzes DNA in a pregnant woman’s blood to screen for chromosomal disorders caused by the presence of an extra or missing copy of a chromosome. NIPT primarily looks for Down syndrome (trisomy 21), trisomy 18, trisomy 13, and extra or missing copies of the X and Y chromosomes. The testing is considered noninvasive because the blood is drawn only from the pregnant woman, unlike diagnostic testing such as amniocentesis, which involves inserting a needle into the womb to collect a sample of amniotic fluid, a procedure which carries a risk of miscarriage.
NIPT can give both false positives and false negatives, and one study revealed a 10% rate of false positivity. Because it is a screening test, any positive result requires invasive diagnostic testing like amniocentesis to confirm the result.
While NIPT is a relatively new testing method, it is being used at rapidly increasing rates. While it was previously covered only for those of advanced maternal age, more insurance companies are now covering it for all women. But there are some concerns.
Ethical concerns
The ethical problems that arise from this kind of screening are extensive. Some ethicists are concerned that the growing prevalence of NIPT will lead to an increase in abortions following a screening that reveals an increased risk for Down syndrome or other chromosomal abnormalities. A study published in 2020 found that the growth of prenatal screening in Europe has reduced the number of babies being born per year with Down syndrome by an average of 54%, and that study was conducted before many European countries offered NIPT. The screening and abortion rates in Iceland have led to only one or two babies with Down syndrome being born each year on average (the population of Iceland is 330,000).
A reduction in the number of people born with these conditions could directly affect the care and research available for those who are living with such conditions, as well as the possibility for increased discrimination. NIPT could also lead to sex-selective abortions, since the sex can be revealed within the first trimester when abortion is more readily available.1Tom Shakespeare et al., “Non-invasive prenatal testing: ethical issues,” Nuffield Council on Bioethics, March 2017, https://www.nuffieldbioethics.org/wp-content/uploads/NIPT-ethical-issues-full-report.pdf.
Some ethicists are also concerned that NIPT will eventually be used to screen for more conditions, including adult onset conditions or carrier status, meaning it could give some indication of issues that might affect the preborn child later in life or be passed on to the child’s future children. And, unfortunately, there is the potential that a mother would be pressured to have an abortion because of a possible condition that could affect the baby decades after he or she is born.
Preparedness or worry
For many parents, NIPT offers the opportunity to be prepared mentally and emotionally for any chromosomal disorder their baby may have. While the screening cannot give them the certainty of a diagnosis, it can give an indication of probability. For some, this probability is helpful in considering the possible needs of their child and even the possibility that he or she will not live long after birth. Knowing a child has an increased likelihood of a chromosomal disorder allows community to come around and support a mother or couple through the pregnancy.
But for some parents, false positives can lead to increased worry, which could have a negative effect on the pregnancy. When a test result comes back with an increased probability of a chromosomal disorder, the couple is normally referred for genetic counseling. Unfortunately, this counseling can increase worry or come with pressure to abort the child.
To test or not to test
While researching NIPT, I heard from many women who chose to have the test, but made it clear to their providers that it would not change anything about their pregnancies. For others, given the concerns and the possibility of false positivity, they chose not to have the screening. For them, the potential for increased worry was not worth the risk.
Dr. Kenneth Singleton, an OB-GYN in Little Rock, Arkansas, shared how he counsels patients who are deciding whether to have NIPT. He advises them that one of the reasons the tests exist is to terminate pregnancies if there is a problem. He goes on:
Counseled correctly, our patients hear the “sanctity of life” bent, and the ones that choose to test are foremost excited about early gender discovery and then are wanting to be mentally prepared if there are other genetic issues that are discovered. I tend to share about my cousin with Down syndrome and also about my granddaughter Sage with trisomy 13. I know patients are getting pushed into testing and then counseled on termination. That is very sad. I have turned that around and use the test as a way to prepare patients mentally, emotionally, and spiritually for the life that God is giving them.
A role we all play
We may not be the ones making decisions about prenatal testing, but as a community of believers, we all have a role to play. As followers of Christ, we recognize the inherent value of every person, even the tiniest preborn baby. At times, prenatal screening will reveal health issues ranging from minor to life-threatening. Whether these issues are revealed early in pregnancy or after birth, we have the opportunity to support families caring for children with a variety of needs. In some cases, our willingness to do so could be the difference for a mother deciding whether to choose life after a difficult diagnosis.
Receiving this hard news can lead to grief and a drastic change in expectations, even for families committed to life. Practical care like meals, a listening ear, and childcare for other children in the family are simple ways to show we are committed to walking with them on what may be a difficult path. Reaching out via text to ask for specific ways we can pray is a simple but powerful way to show someone they are not forgotten.
Deciding whether to have DNA screening may be complicated, but deciding to support and care for expectant mothers and families around us is simple. We follow the example of our Savior when we welcome children into our lives, seeing their value and loving them sacrificially.
- 1Tom Shakespeare et al., “Non-invasive prenatal testing: ethical issues,” Nuffield Council on Bioethics, March 2017, https://www.nuffieldbioethics.org/wp-content/uploads/NIPT-ethical-issues-full-report.pdf.