Podvod s prenatálnym testovaním | Medicínske právo
              

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Podvod s prenatálnym testovaním


 | 28.5.2011 | komentárov: 398

Na počesť tohtoročného svetového dňa Downovho syndrómu, Mark Leach pojednáva o nepriznaných účinkoch prenatálneho testovania. Každý rok je 21. marec Svetovým dňom Downovho syndrómu (WDSD). Tento dátum bol vybraný symbolicky ako odkaz na genetickú príčinu tohto stavu, a to trizómiu 21. chromozómu. WDSD sa usiluje zvýšiť povedomie o tomto genetickom ochorení, ktoré môžno čoskoro vymizne. To všetko kvôli podvodu s prenatálnym testovaním.

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Od začiatku roka, titulky novín propagovali pokrok v prenatálnom testovaní. Laboratóriá sľubujú prenatálne diagnostické testy na Downov syndróm len na základe vzorky krvi od nastávajúcej matky, čo by predstavovalo zlepšenie oproti súčasnej diagnostickej metóde, ktorá so sebou nesie vloženie ihly do maternice a riziko potratu. Sľúbené nové testovanie je na pokraji realizácie, a malo by sa s ním začať budúci rok.

Nový typ testovania sa obhajuje tým, že poskytuje možnosť informovať matky o ich tehotenstve bezpečnejším spôsobom a v skorších štádiách než kedykoľvek predtým. Novinové správy informujú ako nové testy eliminovaním rizika potratu spojeného so súčasnou metódou zachránia bábätká a zvýšia počet narodených zdravých detí. Očakáva sa, že testovanie bude mať takmer univerzálne využitie. Vývojári tejto testovacej metódy na to vsádzajú, a to doslova. V prípade Sequenom, verejnej obchodnej spoločnosti, sa cena akcií stihla odraziť od dna po tom, čo prudko klesla pod vplyvom predchádzajúcich nepravdivých správ o ich testovaní. 

To, o čom sa v súvislosti s týmto testovaním hovorí menej, je jeho pravdepodobný dopad. Existujúce  prenatálne vyšetrenia vedú k vysokému počtu  predčasne ukončených tehotenstiev. V Kalifornii ide o viac než 70 percent prípadov, v Anglicku a Európe 90 percent. Pri takýchto vysokých percentách by bolo možno vhodnejšie nazvať to  „počtom eliminovaných tehotenstiev“.  S každým pokrokom v prenatálnej diagnostike sa počet detí ďalšej generácie s Downovým syndrómom znižuje. Počet narodených detí s Downovým syndrómom je o 50 % nižší než by bol,  keby boli tieto deti donosené.

Mnohí sú toho názoru, že ide o modernú eugeniku. Zníženie počtu ďalších generácií o polovicu z dôvodu vykonávania potratov len kvôli genetickej výbave dieťaťa naozaj zodpovedá  eugenike. Vývojári testov a mnohí iní sa bránia tvrdením, že samotné testovanie je informatívnej povahy. Aj mnohé matky detí s Downovým syndrómom sú toho istého názoru. Vyjadrujú vďaku za možnosť dozvedieť sa o chorobe ich dieťaťa ešte pred narodením, a tak si do budúcnosti pripraviť, ako oznámiť túto správu okoliu a vybrať si na pôrod vhodnú nemocnicu s dobrými neonatálnymi službami.

Navyše, odborné lekárske združenia, uznávaní bioetici, a mnoho súdov v tejto krajine potvrdili záväzok ponúknuť matke prenatálne vyšetrenie z dôvodu rešpektovania jej autonómie a jej práva rozhodnúť, či chce pokračovať v tehotenstve. Ide teda o určenie lekárskej, etickej, právnej a  priemyselnej hranice: dostupnosť prenatálneho vyšetrenia na Downov syndróm je žiadúca, pretože rešpektuje právo ženy rozhodnúť sa. Ale aj to je podvod.

Od roku 2007 odborné odporúčanie hovorí, že  prenatálne vyšetrenie na Downov syndróm sa má ponúknuť všetkým nastávajúcim mamičkám. Štúdia v predchádzajúcom roku ale zistila, že takmer polovica všetkých pôrodníkov priznáva, že ich odborná príprava na uskutočňovanie prenatálnych vyšetrení bola "sotva adekvátna" alebo "neexistujúca." Štúdie odvtedy preukázali, že prenatálne vyšetrenia na Downov syndróm v ohromujúcej miere nerešpektujú autonómiu žien. V najlepšom prípade, menej ako polovica všetkých tehotných žien urobí informované rozhodnutie o absolvovaní prenatálneho vyšetrenia. Najpravdepodobnejší výsledok pozitívneho prenatálneho testu je potrat, o ktorom sa  pred stanovením pozitívnej diagnózy zmieňuje zriedka.  Následne je však vykonaný narýchlo a veľakrát v donútení. Ženy ukončujúce tehotenstvo sa už často cítia matkami a svoj plod považujú za dieťa, pričom uznávajú, že svojím rozhodnutím ukončia život ich dieťaťa.

Navyše, napriek všetkým rečiam o informatívnom účele prenatálnych vyšetrení a o nevyžadovaní  potratu, vývojári prenatálnych testov sa  spoliehajú nato, že väčšina žien tehotenstvo ukončí. Musia sa na to spoliehať, aby vykryli vysoké a zbytočné náklady testovania.Viac ako 99 percent tehotných žien totiž nečaká dieťa s Downovým syndrómom.  Negatívny prenatálny test môže poskytnúť vítanú istotu, ale z hľadiska dolárov a centov ide o zbytočné náklady. Vývojári prenatálneho testovania však ospravedlňujú tieto zbytočné výdavky štúdiami dokladujúcimi ich efektivitu. Náklady môžu byť kompenzované súkromnému poistencovi ako aj systému verejnej zdravotnej starostlivosti za predpokladu, že dostatočné množstvo detí s pred narodením diagnostikovaným Downovým syndrómom bude potratených.   Prenatálne vyšetrenie sa takto propaguje ako prostriedok, ktorý šetrí systému zdravotnej starostlivosti náklady, ktoré sú spojené s Downovým syndrómom. Napriek všetkej obhajobe, faktom zostáva, že vývojári sa spoliehajú na vysoké percento potratov, aby vykryli vysoké náklady testovania.

 Režim prenatálnych testovaní  na Downov syndróm sa ukazuje ako podvod, ak ďalej zohľadníme dvojitý štandard v prenatálnom testovaní. V roku 2007, v tom istom roku ako americký Kongres pôrodníkov a gynekológov (American Congress of Obstetricians and Gynecologists- ACOG) odporučil, aby sa všetkým ženám ponúkal test na Downov syndróm, etická komisia Kongresu pôrodníkov a gynekológov vydala stanovisko, podľa ktorého prenatálne testovanie na výber pohlavia je neetické. Rovnaké argumenty však možno použiť pre prenatálne testovanie na výber pohlavia ako aj pre prenatálne testovanie na Downov syndróm. Poskytnutie  informácií o pohlaví dieťaťa je v podstate len rešpektovaním práva ženy na výber, ktorá sa na základe poskytnutých informácii môže rozhodnúť, či v tehotenstve bude pokračovať alebo nie. V rovnakom roku teda ACOG vyzval všetky ženy na testovanie na Downov syndróm, ale zároveň uviedol, že je neetické použiť prenatálne testovanie na určenie pohlavia, pretože sa tým presadzujú sexistické názory, že jedno pohlavie je viac žiadúce  alebo pre spoločnosť a rodinu hodnotnejšie ako to druhé. Výbory Kongresu pôrodníkov a gynekológov pri vypracovaní týchto zjavne kontrastných vyhlásení použili dvojaký meter, keďže prenatálne vyšetrenie na Downov syndróm posilňuje diskriminačné postoje voči zdravotne postihnutým. Pri prvom pohľade na malé dievčatko sa nepýtame,  "prečo jej  rodičia nepodstúpili prenatálne vyšetrenie," ale pri dievčatku s Downovým syndrómom už áno.

Univerzálne ponúkať testovanie sa rýchlo stalo štandardom starostlivosti, a ťažia z neho najmä laboratória. Ak vývojári testu naozaj veria, že iba poskytujú informácie, potom by snáď nebolo na škodu poskytnúť kompletnejšie a podrobnejšie informácie.

V roku 2008 časť zákona Kennedy-Brownback o informovanosti o prenatálne a postnatálne diagnostikovaných ochoreniach výslovne uznala potrebu vyváženosti informácii o Downovom syndróme poskytovaných po pozitívnych prenatálnych testoch. Napriek tomu, táto výzva nebola nikdy plne financovaná a nemá stanovenú žiadnu povinnú formu pre udelenie presných informácií. Laboratóriá by iste posilnili svoju obranu proti obvineniam z podvodu uskutočnenom na spoločnosti, ak by poskytovali vyváženejšie a presnejšie informácie, a tým skutočne rešpektovali autonómiu žien.

Zdroje na vyváženie poskytnutých informácií sú práve teraz k dispozícii: Lettercase distribuuje tlačené zdroje, schválené zástupcami ACOG, Americkej Univerzity lekárskej genetiky, Národnou spoločnosťou genetických poradcov, Národnou spoločnosťou Downovho syndrómu a národným kongresom Downovho syndrómu, pre matky, ktoré ešte stále nevedia či podstúpiť prenatálne vyšetrenie alebo rešpektovať diagnózu: Svetlejšie Zajtrajšky (Brighter Tomorrows) je vzdelávací program pre lekárov o poskytovaní prenatálnej a postnatálnej diagnózy Downovho syndrómu; Asociácia Downovho Syndrómu pre širší Cincinnati (Down Syndrome Association of Greater Cincinnati) spravuje národný register viac ako 250 rodičov, ktorí chcú adoptovať dieťa s Downovým syndrómom; a Downov syndróm tehotenstvo (Down Syndrome Pregnancy) je on-line zdroj pre matky, ktorí sa rozhodli pokračovať v tehotenstve aj po stanovení diagnózy.

Bez zásadnej zmeny v spoločnosti sú tieto náhradné zdroje naozaj jedinou šancou, ktorú máme na zmenu rozhodnutí po prenatálnej diagnostike. V opačnom prípade budeme aj naďalej vidieť čím ďalej tým menej detí s Downovým syndrómom. Tí z nás, ktorí sú obdarení dieťaťom s Downovým syndrómom, alebo aspoň poznajú niekoho s týmto syndrómom, vedia, že naša spoločnosť bude oveľa  ochudobnená. Ochudobnená o každú ušlú príležitosť zažiť jedinečný druh lásky a súcitu, ktorí títo členovia našej spoločnosti dávajú a dostávajú. 


Mark W. Leach je advokát z Louisville, Kentucky, momentálne študujúci za magistra bioetiky. Je členom dozornej rady Lettercase, nedávno bol prezentovaný vo „Svetlejších zajtrajškoch“ na každoročnej konferencii pre profesorov pôrodníctva, a napísal recenziu voľne stiahnuteľnej knihy na downsyndromepregnancy.org. Názory tu prezentované sú iba jeho a nesmú byť pripisované žiadnej organizácii.


Autor: Mark W. Leach

Preklad: Štefan Lazorčák

Zdroj: pôvodne tu

Foto: learn.genetics.utah.edu




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