Advances in fetal genetic diagnosis and therapy: Ethical issues and appropriate technology in cost-restrained countries

The advent of ultrasound in the 1970s heralded a milestone that could give real-time information about fetal abnormalities, and thereby improve diagnostic accuracy. This knowledge could not be used effectively to benefit the fetus for which it was intended. The 1980s saw science catching up with diagnostic advances, and fetal abnormalities could realistically be treated with an expectation of satisfactory outcomes. As a result, parents could have realistic expectations of having healthy children. Prenatal diagnosis is the first step towards this realisation, as diagnosis can be followed by intrauterine treatment. Scientists have realised that, if an abnormality can be corrected prenatally, prognosis can be improved significantly, as the initial problem does not necessarily threaten the fetus; therefore, if the prenatal condition can be dealt with early, then the downstream repercussions can be eliminated. In this chapter, we address ethical issues in prenatal diagnosis and fetal therapy.