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首页> 外文期刊>Journal of medical ethics >Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access
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Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access

机译：孕妇是否应为非侵入性产前筛查收取？ 对生殖自主权和平等访问的影响

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The introduction of non-invasive prenatal testing (NIPT) in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to (co)pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: (1) to prevent increased uptake of NIPT and (2) to promote informed choice. First, given the aim of prenatal screening (reproductive autonomy), high or low uptake rates are not intrinsically desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women's choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external (ie, financial) influences on women's personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring (substantial) copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair.
机译：在世界各地的医疗保健系统中引入非侵入性产前检测（NIPT）为重新考虑产前筛查的资助政策提供了机会。在一些有普遍接入医疗保健系统的国家，孕妇及其合作伙伴被要求（CO）支付NIPT。在这篇论文中，我们讨论了用于NIPT的妇女的两个重要理由：（1），以防止增加了NIPT和（2）的摄取，促进了明智的选择。首先，鉴于产前筛查（繁殖性自主权）的目的，高或低吸收率不是本质上所需的或不希望的。然而，利用筹资政策对受影响的影响产生负面影响，是筛选的目的。此外，复制不成比例地影响了较低的社会经济地位，这与司法要求相冲突，并阻碍了对产前筛查的同等获取。其次，我们认为，虽然支付模式可能会影响孕妇的选择行为和与NIPT相关性的看法，但是，共同要求并不一定会导致更好的信息。相反，理想情况下，应理想地避免对女性​​对女性的个人选择或针对产前筛查的外部（即财务）。为了提高知情决策，医疗保健系统应相反，应投资足够的非指令，重点的预测咨询。本文得出结论，要求（大量）在普遍接入医疗保健系统中进行NIPT的共存未能促进生殖自治，并且是不公平的。

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