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J Med Ethics. 1986 Sep;12(3):143-4, 150.

Prenatal diagnosis and female abortion: a case study in medical law and ethics.


Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus's medical condition.


The use of prenatal diagnosis for sex determination and the subsequent abortion of unwanted female fetuses were discussed at the World Congress on Law and Medicine in February 1985 in New Delhi, India. The author rejects the contention of some participants that prenatal diagnosis should be prohibited outright, examines its benefits, and discusses the cultural and economic factors that promote abortion of female fetuses. He supports a proposal of the Congress that medical licensing authorities in each country should declare unethical the performance of prenatal diagnosis solely or primarily for sex determination, set standards of professional conduct, and, by virtue of their legal authority, discipline physicians who violate these standards.


An issue that arose at the 1985 World Congress on Law and Medicine was whether amniocentesis and other means of prenatal diagnosis were being used simply for sex determination and selective abortion of female fetuses. Many participants considered such use to be improper and that it should be prohibited, but it was unclear as to how sanctions should be applied. Generally, prohibition by law of amniocentesis and other forms of prenatal diagnosis such as ultrasonography, fetoscopy, and chorion villi sampling or biopsy was regarded as an overreaction and inappropriate use of legislative authority. The benefits of prenatal diagnosis were considered with a focus on how women could be helped to bear their children safely and how endangered fetal life could be preserved by timely identification of anomalies and of impending complications. The use of a professional licensing authority was suggested, one which could control abuse of amniocentesis under sanctions now available in law. The test is undertaken to test for a specific condition. The condition sought, such as Down's syndrome, usually is not sex specific. Consequently, fetal sex is not relevant to the test result and need not be disclosed. Fetal sex will be relevant to the outcome if the condition being tested for is a sex-linked disorder. As amniocentesis is conducted only for a medical indication, medically irrelevant information resulting from the test need not be provided in delivery of a medical service. An ethical dilemma arises in environments where the birth of another daughter may bring intolerable social and economic stress. In such circumstances, sex-based abortion may be preferable to the birth of a child destined to be abandoned or to die from neglect or starvation. Many World Congress Law and Medicine participants accepted that abortion on the basis of fetal sex is unethical and that performance of prenatal diagnosis solely or primarily for determination of fetal sex is unethical. The enforcement of medical professional ethics may be preferable to legislation.

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