Ethical Issues In The Prenatal Diagnosis Of Sickle Cell Anaemia In Nigeria

Abstract

Sickle cell anaemia (SCA) is the most common form of haemoglobinopathy in Nigeria affecting 1-3% of the population and it is associated with physical, psychosocial and emotional suffering. Prenatal diagnosis (PND) and genetic counseling are ways of preventing the spread of the disease; however these means of prevention are associated with many ethical dilemmas. Ethical issues discussed in this paper include the safety of the procedures used in obtaining tissue sample for prenatal diagnosis, abortion of affected fetuses and the question of genetic selection. Finally, the ethical implications of genetic counseling and issues relating to the principle of justice in healthcare are highlighted. Sickle cell anaemia (SCA) is the predominant haemoglobinopathy in Nigeria affecting about 1-3% of the Nigerian population. The disease is associated with a lot of physical, psychosocial, emotional and financial burden and could lead to a disruption of family life . Studies from Nigeria have shown different levels of perception of the disease among family members and caregivers and among enlightened members of the public. The disease runs a chronic course but is now curable using gene therapy and bone marrow transplantation . However, these novel means of therapy are not yet widely available in developing countries like Nigeria hence the importance of preventive measures in these settings. The availability of prenatal diagnosis (PND) for the disease has opened a window of opportunity for expectant couples to have information about the haemoglobin (Hb) genotype of their unborn child. This gives them the option of termination of the pregnancy in case of positive result and to prepare them psychologically, financially and medically for the arrival of the new child when abortion is not an option. It is interesting to note that many of the respondents in the studies cited earlier are aware of this possibility even though the test is not widely available in Nigeria (as at the time of the study). Studies from Europe have shown that using prenatal diagnosis PND has led to a reduction in the incidence of some genetic disorders like cystic fibrosis and haemoglobinopathies. Prenatal diagnosis is usually carried out using either chorionic villus sampling (CVS) or amniocentesis and the samples taken have DNA analysis done on them. Both procedures are invasive with CVS being done between the 10th and 12th week of pregnancy while amniocentesis is usually carried out later (between the 14th and 20th week). Prenatal testing for genetic conditions generally is associated with a lot of ethical concerns and sickle cell anaemia is not an exception. The scope of genetic counseling offered by health care workers (clinical geneticist, haematologist, nurse or obstetrician) has a lot of ethical implications. Several studies have clearly shown that genetic counseling is considered as one of the best ways of controlling the disease. As usual with genetic counseling a “nondirective” and “client-centered” form of counseling is preferred. This form of counseling entails disclosure of genetic risk information necessary for the clients to make an informed decision without direct or indirect advice from the counselors. But the question whether it is possible to be absolutely non-directive in counseling is one that is generating a lot of debates among bioethicists and geneticists.