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publicado em 04/02/2013 às 18h49:00
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Bioethics, abortion and the detection of congenital disorders in pregnancy

Sandra Franco, a lawyer and specialist in Medical Law and Health, effective member of the Law Commission of Health and Medical Liability Hospital of OAB / SP and President of the Brazilian Academy of Medical Law and Health (ABDMS). Deborah Terrin, a lawyer specializing in Medical Law and Health, effective member of the Law Commission of Health and Medical Liability Hospital of OAB / SP and member of the Board of Ethics of the Brazilian Academy of Medical Law and Health (ABDMS).

 
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Foto: Arquivo Pessoal
Sandra Franco, president of the Brazilian Academy of Medical Law and Health
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Sandra Franco, president of the Brazilian Academy of Medical Law and Health

In the month of January, Brazilian laboratories began offering a blood test for pregnant women that detects chromosomal problems in the fetus from the ninth week of pregnancy. The procedure is apparently simple, but not accessible to most Brazilian women, because of the high cost, about $ 3,500.00. The test is harvested in the office as a common blood test and goes to the U.S., where it is analyzed genetic material from the fetus that is circulating in the mother's blood during pregnancy.

A fuller version of this examination is effective to detect Down syndrome, Edwards, Patau, Turner, Klinefelter and triple X. The new test can be done before the traditional indicated generally from the beginning of the fourth month of gestation. Another advantage of this on the current is not present the risk of miscarriage, due to be less invasive. Furthermore, represent a reduction in the number of biopsies taken unnecessarily. Until then, the diagnosis of these congenital syndromes was made only by means of ultrasound and examination of amniotic fluid or chorionic villus sampling, in which a sample is taken from the placenta. However, it should be noted that if the blood test result is positive, the diagnosis should be confirmed by chorionic villus sampling.

Despite the possibility for parents to prepare in case of confirmation that receive a child with chromosomal abnormality, one can not deny the moral and bioethics related to performing an abortion before a positive result. It should be noted that after the approval of such testing in Europe and the U.S., the increase in the number of abortions was a concern of civil society groups in these locations.

There by the International Federation of Organizations of Down syndrome, which brings together 30 associations from 16 countries, a representation in the European Court of Human Rights calling for a ban on such testing the impact that the adoption of the test in some European countries (Spain, Switzerland, Germany, France, Portugal) brought about the possibility of increased abortions, identified as trisomy 21.

In Brazil, abortion is prohibited except in cases of anencephaly, sexual violence or risk of death for pregnant women, but it is estimated that over one million women a year the practice.

In fertility clinics, even before the embryo implants in the uterus, can be diagnosed with Down Syndrome. However, in theory, the couple does not have legal autonomy to decide on the future of the pregnancy of fetuses with this anomaly was occurring or the selection of only potentially perfect babies.

Among the syndromes detected by examination, Edwards and Patau are almost incompatible with life, according to Artur Dzik, scientific director of the Brazilian Society of Human Reproduction. In such cases, you can request a judicial authorization for abortion. For Down syndrome, however, the most common chromosomal abnormality, such consent can not be applied because there is no incompatibility with life.

Faced with such interesting and controversial issues, it is essential to discuss society so organized and academic, moral and legal consequences related to technological advancement. When the Legislature is omitted before the impact on society of such tests, it is up to the judiciary, already overloaded, the difficult task of reviewing the ethical and moral concepts under the law, which sometimes spans decades.

It is always the right to life with dignity and quality that must be observed. Hence the importance of programs created structural and psychological assistance to families, if possible, universal access, the public health system.

There is no doubt that technological advancement is not meant, in any way, a proposal for eugenics, exclusion of the other. Technology should be an agent for creating better quality of life with early treatment of anomalies and identifying the severity of the disability; especially when planning for families who receive a child with special needs.

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   Palavras-chave:   Bioethics    Abortion    Birth defects    Pregnancy   
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