Physicians have an ethical duty to avoid reinforcing the belief of many women
that all children with genetic disease are doomed to marginal lives. Legally, it
is tempting to encourage a woman to abort. Even if she regrets the decision
later, she cannot sue her physician for discussing too many risks. Women
should be given enough information about the impact of the disease on an
affected child to make an informed choice. The nature of the disease is
important to most patients in making decisions about screening, conception,
and abortion. The woman who has uncles, brothers, and sons who are healthy
hemophiliacs may have no interest in prenatal diagnosis. The woman who has
lost a child to Tay- Sachs disease may choose to avoid conception altogether
or use donor sperm to avoid a recurrence.
An informed decision about genetic screening requires that the patient
understand the treatment options available for the disease and whether they
are curative or palliative. The prospect of having a child with a cleft lip that can
be surgically corrected is not nearly so daunting as the prospect of a child with
a biochemical defect that will result in a short life of illness and disability.
Knowing the likelihood of a particular fetus’s having a genetic defect is also
important for the patient’s decision. A woman in her forties may find a 1 in 40
chance of Down syndrome an acceptable risk, particularly if she has
amniocentesis and abortion as an option. A woman who has one child with
Down syndrome and a chromosome attachment that gives her a 1 in 2 chance
of conceiving another affected child may not be willing to accept the risk even
if she has the same options for prenatal diagnosis.