Public Health Genetics Ethics
1. screening for treatable deficiencies that warrant mandatory screening
programs on public health grounds?
I believe that a person should be able to object a screening if they have a
true reason as to why they do not want the screening, but only when they
have true rejection about a specific screening and a valid reason. I feel for
newborn screening at least, that it should be mandatory and is a great
preventive tool. The types of screenings done on newborns are to ensure that
the infant is in good general health and that does not need further immediate
attention. If these basic screenings were not done, it is likely that many
parents would miss a potentially dangerous problem and would most likely
be back to the doctor’s at a later time wondering what was going on with
their infants. According to the CDC website these are the basic screenings
done on newborns. A short hearing test is preformed to check for hearing
loss, the CDC explains that this test is easy and painless and that babies
often sleep right though the actual screening process. In some states but not
all, a screening for critical congenital heart defects (CCHD) is preformed.
This test uses a pulse oximentry to look for signs of CCHD. IF CCHD is not
diagnosed soon after birth it can cause significant risk of disability or death.
Other newborn screenings vary are regulated by the individuals state’s
newborn screening programs. Typical newborn screenings include
screenings for diseases such as sickle cell, various hemoglobin disorders,
diseases that cause inability to process certain nutrients such as PKU, as well
as hormonal insufficiencies such as hypothyroidism. Overall, I think
newborn initial screening is ideal and believe that the majority of parents
would want their children screened to ensure they are bringing home the
healthiest baby possible.
1. Can reproductive genetic screening proceed without stigmatizing people
with disabilities and genetic health problems?
I believe this question is more complex than the first one I this weeks
post. I am not sure, I have an absolute defined answer as to if genetic
screening can be properly done without stigmatizing people with disabilities
and genetic problems. One of the worries I have is, that certain populations
of people may fit a profile that would “require” or request a screening that
will automatically stigmatize the parents and family of the unborn child,
such as fetal alcohol syndrome. Others may think screenings for diseases
such as sickle cell disease stigmatize individuals because it is majorly a
disease of African American’s therefore white babies would not need the
screening. This may possibly make one feel stigmatized since they would be
asked or required to have this screening and other families would not. It is
also advised that women over the age of 35, that have family history of birth
defects or have had another child with a birth defects get an amniocentesis
preformed during pregnancy. This could also make people feel stigmatized,
once again because not every mother would be asked to have this screening.
When these types of screenings are preformed privacy must be practiced in
order to not make the individuals involved does not feel singled out or
stigmatized. The last problem I personally have with genetic screening is
that a family may chose to terminate a pregnancy due to a fetus having
markers for a disease or disability. Although, I think it is alright to know in
advance to prepare parents for potential diseases or disabilities, it personally
goes against my beliefs to abort a baby due to a disease or disability. I
believe if God wanted you to have a certain type of child than that is what
you should have and learn from.
What are the relative risks and benefits of increased genetic susceptibility
screening for pharmacogenomics and preventative purposes?
The benefits of genetic susceptibility screening for pharmacogenmics I
found were that by using methods like horizon scanning, epidemiologist in
the public health field can find, monitor and research trends much earlier as
well as begin prospective evidence based evaluations before children are
born, which can give great advancement in understanding and treating many
diseases. These new technologies will allow researchers to examine items
like genetic mutations at the functional genomic level which will better help
them understand biology systems, epigenomics factors such as chemical
agents, nutrition or personal behavior. This work is thought to help
researchers better understand relation to the causation of diseases such as
cardiovascular disease, allergies, cancer, psychiatric disorder and infectious
diseases. With all scientific benefits come initial risks. Risks of genetic
susceptibility screenings are: greater risk of miscarriage, psychological
impact, affects to family relations, insurance issues, privacy as well as
possible increased risk of predisposition to certain diseases due to changed
in chromosomal, DNA or proteins when performing screenings.
References:
Brand, A., Brand, H., Schulte, T. (2008) The impact of genetics and
genomics on public health. European Journal of Human Genetics, 16, 5-13.
CDC, Hoop, Julia,(2004), Genetic Screening and Genetic Testing-Risks and
Benefits of Knowing Your Genetic Makeup, Retrieved by
http://www.bing.com/search?q=risks+of+genetic+susceptibility+screenings
&FORM=AWRE&adlt=strict
CDC, Centers for Disease Control and Prevention, (2014), Pediatric GenticsNewborn Screening, Retrieved by
http://www.cdc.gov/ncbddd/pediatricgenetics/newborn_screening.html