Suchergebnisse

Aktuell wird in Deutschland politisch darüber verhandelt, inwiefern ein einfacher Bluttest zur Diagnose von Trisomien bei Embryonen (Praena- Test) in den Leistungskatalog der gesetzlichen Krankenkassen aufgenommen werden soll. Gegner befürchten, eine solche Regelung würde die Diskriminierung von Menschen mit Down-Syndrom in unserer Gesellschaft befördern. Dieser Beitrag widmet sich anhand der Diskussion des PraenaTests der Frage, was für ein Verständnis von Diskriminierung in diesem Kontext einschlägig ist, und argumentiert, dass der Begriff der strukturellen Diskriminierung die zugrunde liegende moralische Problematik am ehesten einfangen kann. Da sich mithilfe eines Schadensbegriffs moralisch ungerechtfertigter Diskriminierung (Lippert-Rasmussen) die problematischen Aspekte der selektiven Abtreibungspraxis gegenüber Embryonen mit Down-Syndrom nur teilweise erfassen lassen, muss eine angemessene Beschreibung durch einen Missachtungs- und Demütigungsbegriff der Diskriminierung (Hellman) erweitert werden. Allerdings hebt dieser zu stark auf einzelne Akte der Diskriminierung ab und nimmt die strukturelle Dimension von Diskriminierung und ihre diskursprägende Kraft nicht hinreichend in den Blick; er ist deshalb in dieser Hinsicht zu modifizieren. Der Beitrag diskutiert in Hinblick auf Menschen mit Down-Syndrom mögliche diskriminierende Implikationen von pränataler Testung und damit assoziierten Schwangerschaftsabbrüchen. Die Argumentation zeigt auf, dass zwar bezüglich der selektiven Abtreibungspraxis von Embryonen mit Trisomie 21 und ihrer medizinischen Rahmung von einer strukturellen Diskriminierung gegenüber Menschen mit Down-Syndrom gesprochen werden kann; diese Form der Schlechterstellung ist aber nicht durch eine konkrete Ungleichbehandlung dieser Menschen geprägt, sondern bezeichnet die Etablierung und Perpetuierung von sozial wirkmächtigen Stereotypisierungen und Werthaltungen, die ein rein defizitorientiertes Verständnis von Behinderung konsolidieren. Die spezifische Dimension struktureller Diskriminierung im Kontext pränataler Diagnostik soll mit Foucaults Konzept der Biomacht eingefangen werden. Der Beitrag kommt zu dem Ergebnis, dass aus Gründen der Konsistenz der PraenaTest für Risikoschwangerschaften eine Leistung der gesetzlichen Krankenkassen werden sollte (da die riskantere Fruchtwasseruntersuchung bereits eine solche ist), eine flächendeckende Einführung als Reihenuntersuchung jedoch abzulehnen ist. In gesellschaftlicher und kultureller Hinsicht bleibt das Desiderat bestehen, normierende und stereotypisierende Vorstellungen von Behinderung kritisch zu hinterfragen und aufzubrechen. ; Political negotiations are currently underway in Germany to determine to what extent a simple blood test for the diagnosis of trisomies in embryos (PraenaTest) should be included in the catalog of benefits of statutory health insurance. Opponents fear that such a regulation would increase the discrimination against people with Down syndrome in our society. This paper addresses the underlying notion of discrimination and argues that the concept of structural discrimination can best capture the moral problem associated with prenatal testing. Since an understanding of discrimination as harming (Lippert-Rasmussen) fails to fully grasp the social impact of selective abortion practice against embryos with Down syndrome, it has to be complemented by a notion of discrimination stressing its disrespectful and humiliating dimension (Hellman). However, it puts too much emphasis on individual acts of discrimination and does not adequately take into account the structural dimension of discrimination and its discursive power. I therefore propose a structural extension of Hellmans concept. The article discusses possible discriminatory implications of prenatal testing and associated abortions with regards to persons with Down syndrome. The argumentation shows that the selective abortion practice of embryos with trisomy 21 and its medical framing may be considered as structural discrimination. However, this form of discrimination is not characterized by a concrete inequality of treating but denotes the establishment and perpetuation of socially powerful stereotypes and values that consolidate a purely deficit-oriented understanding of disability. The specific dimension of structural discrimination in the context of prenatal diagnosis will be captured by Foucaults concept of bio-power. The article concludes that, for reasons of consistency, the PraenaTest should become a mandatory health insurance scheme for high-risk pregnancies (as the riskier amniocentesis is already one of these), but it should by no means be expanded on a comprehensive scale. From a social and cultural point of view, the desideratum remains to critically question and break down normative and stereotyping ideas of disability. ; (VLID)5236486

In the Netherlands, maternal serum screening for fetal Down's syndrome (OS) and neural tube defects (NTD) is not supported by the Government as a population-wide study. The number of samples sent to the University Hospital Groningen (AZG) nevertheless increased because of the individual requests of pregnant women in the north of the Netherlands. On 1st October 1990, the existing NTD and DS serum screening programme, using maternal serum alpha-fetoprotein (MSAFP) measurement at the AZG, was extended to incorporate routine measurements of maternal serum human chorionic gonadotropin (MShCG). In the period until December 1991 we calculated the OS and NTD risks in 2282 women. Another 298 women, who had already undergone chorionic villus sampling, only wanted to know their NTD risk. Of the 2282 samples, 59.9% came from outside the AZG and had been sent by 133 different applicants, mainly in the north of the Netherlands. (Chapter 2) The most probable cause for abnormal levels of MSAFP and MShCG in pregnancies associated with OS is a dysfunctional placenta, which causes impaired transp01t of AFP and produces an increased amount of hCG. lt is unlikely that a OS fetus produces less AFP. (Chapter 3) In the period described, 5 of the 6 OS cases were detected, as well as 3 of the 4 cases with a closure defect. We were able to achieve a follow-up of 99.8%. Reliable maternal serum screening is feasible in a strongly decentralized obstetrical organization. It is important to keep serum screening centralized at centres for prenatal diagnosis. (Chapter 4) Maternal serum screening had a major effect on the amniocentesis (AC) rate in women of advanced maternal age. Of all the women of 36 years or older, 34.1 % were screen-positive for OS, but only 41.2% of this group chose to undergo AC. This is of imp01tance in a society were the mean maternal age is steadily increasing. (Chapter 5) Serum screening programmes wrongly determine a high risk of fetal NTD or OS if the concentrations of both MSAFP and MShCG are high. The decision to carry out invasive diagnostic procedures should only be made after extensive ultrasound examination, taking into account the increased risk of an adverse pregnancy outcome. (Chapter 6) Elevation of the MSAFP level in the absence of any fetal abnormalities implies a significantly increased risk of preterm birth or fetal growth retardation. If the MSAFP and MShCG are both elevated, the risk of preterm birth is also slightly elevated. MShCG elevation alone does not indicate a significantly increased risk. An elevated MSAFP is an indication to be extra vigilant during the pregnancy. (Chapter 7) Women are in favour of maternal serum screening but do not consider it acceptable to drop the age indication. In their opinion, the risk involved with serum screening is more significant than the age-related risk, although they did not fully appreciate the possible drawbacks of serum screening. (Chapter 8) From an overview of the Dutch situation concerning ethical, psychoso􀎇ial, legal and cost-effective aspects, we concluded that these aspects do not form any real obstacles for performing maternal serum screening. It will problably become increasingly problematic if we do not perform this screening. (Chapter 9) Maternal serum screening will become a regular part of obstetrical care and prenatal diagnosis. Uncontrolled growth is already occuning; therefore it is important to reach consensus about quantity and quality requirements for optimal reliability of serum screening.

Cloning, genetic screening, embryo freezing, in vitro fertilization, Norplant, RU486--these are the technologies revolutionizing our reproductive landscape. Through the lens of procreative liberty--meaning both the freedom to decide whether or not to have children as well as the freedom to control one's reproductive capacity--John Robertson, a leading legal bioethicist, analyzes the ethical, legal, and social controversies surrounding each major technology and opens up a multitude of fascinating questions: Do frozen embryos have the right to be born? Should parents be allowed to select offspring traits? May a government force welfare recipients to take contraceptives? Robertson's arguments examine the broad range of consequences of each reproductive technology and offers a timely, multifaceted analysis of the competing interests at stake for patients, couples, doctors, policymakers, lawyers, and ethicists

Philosophical debates over the fundamental principles that should guide life-and-death medical decisions usually occur at a considerable remove from the tough, real-world choices made in hospital rooms, courthouses, and legislatures. David Orentlicher seeks to change that, drawing on his extensive experience in both medicine and law to address the translation of moral principle into practice--a move that itself generates important moral concerns. Orentlicher uses controversial life-and-death issues as case studies for evaluating three models for translating principle into practice. Physician-assisted suicide illustrates the application of ''generally valid rules,'' a model that provides predictability and simplicity and, more importantly, avoids the personal biases that influence case-by-case judgments. The author then takes up the debate over forcing pregnant women to accept treatments to save their fetuses. He uses this issue to weigh the ''avoidance of perverse incentives,'' an approach to translation that follows principles hesitantly for fear of generating unintended results. And third, Orentlicher considers the denial of life-sustaining treatment on grounds of medical futility in his evaluation of the ''tragic choices'' model, which hides difficult life-and-death choices in order to prevent paralyzing social conflict. Matters of Life and Death is a rich and stimulating contribution to bioethics and law. It is the first book to examine closely the broad problems of translating principle into practice. And by analyzing specific controversies along the way, it develops original insights likely to provoke both moral philosophers and those working on thorny issues of life and death