Public Health Law Map - Beta 5 - Medical and Public Health Law Site

who has finally conceived after three years of fertility treatment may feel that she
would rather have a child with Down syndrome than no child at all. On the other
hand, this woman may feel that it is morally reprehensible knowingly to bring a
retarded child into the world. These decisions must be made by the patient. A
physician who is asked for an opinion on what should be done should be sure that
the patient understands what is medical opinion and what is personal belief.
g) Reliability of Testing
The reliability of various tests will also affect a patient’s decision about genetic
testing and abortion. The physician should try to give the patient a realistic
understanding of what test results mean. No test is without false positives and false
negatives. It is never wise to tell a patient that the amniocentesis was normal and
therefore the fetus is normal. If the baby is born with a defect that was not detected
on the amniocentesis, the family may have more trouble dealing with the problem
and may be very angry with the physician who indicated the baby was healthy. On
the other hand, a woman who appears to be carrying a defective fetus must
understand that many tests are uncertain and there is some possibility that there is
no defect. It is difficult to tell a patient this without raising unreasonable hopes. If
the decision to abort is made, patients should not be encouraged to ask for testing
on the abortus unless this will provide useful medical information for future
pregnancies. There is little to be gained from second- guessing an irrevocable
decision.
h) Time Limitations
With prenatal diagnostic testing, there is a duty to schedule tests in a timely manner
so that a patient is not deprived of choice by delays. If the only available abortion
facility will not perform an abortion after 20 weeks, then amniocentesis cannot be
scheduled for 17 weeks if the results may take 6 weeks to come back. The results
must be available in time for the patient to abort a defective fetus if she chooses. A
physician who refers patients out for such testing has the responsibility to ensure
that the test results are available in a timely manner. There should be a system of
flagging the calendar so that results that have not come back in time are
investigated. If the results are lost or the specimen destroyed, the physician must
have left enough time to try again. The physician may have to work to find a
laboratory that can handle a rush job or to arrange a late abortion. It is the
physician’s duty to do everything possible to preserve the patient’s options. If a
screening program routinely schedules such tests toward the end of the window of
opportunity, the physicians should get this corrected or refer to another program. If
the time is cut close on all the patients, eventually there will be a mistake in dates
or a laboratory failure that will push a patient beyond the limit. The fact that the
system endangered other patients in the same way will be a poor defense in a
lawsuit.
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