Amniocentesis and the apotheosis of human quality control

Justifying prenatal screening and genetic amniocentesis programs by cost-effectiveness analyses: a re-evaluation

A strength of cost-effectiveness analysis is the presentation of all relevant clinical options, variables, and outcomes and the placement of values on the outcomes. Despite success in many fields of health policy, cost-effectiveness analysts have failed to provide a complete evaluation of prenatal screening and genetic amniocentesis programs. Specifically, all published cost-effectiveness analyses of these programs at best only partially acknowledge the potential life of the aborted fetus. These incomplete evaluations not only violate some basic principles of cost-effectiveness analysis, they also produce conclusions that may be misleading. Ultimately, society must answer two basic questions regarding the use of cost-effectiveness to justify prenatal screening programs: Is cost-effectiveness analysis an appropriate tool for the evaluation of these programs? If so, then what are the outcomes of interest? This paper first shows that the current literature does not present a complete evaluation of these programs. The ramifications of this incomplete evaluation are presented from several perspectives. Finally, given the problems associated with the use of cost-effectiveness analysis, the article suggests that cost-effectiveness analysis is not yet an appropriate tool to justify prenatal screening or genetic amniocentesis programs.

Wrongful life - its problems are not just semantic: a reply to Furrow

In an article in the June, 1982 issue of this journal, Barry Furrow suggested that changing the name of the tort of “wrongful life” to “diminished life” would overcome the reluctance that many courts have shown to recognize its existence. Others have made similar suggestions, differing only in the names which they proposed as a replacement for “wrongful life.” It is my belief, however. that the problems that many courts and commentators have had with “wrongful life” are inherent in the nature of the action and will not be resolved by simply changing its name.

In the remainder of this article, 1 will employ the neutral term “X” to refer to any action brought by a child for having been born with some defect or handicap which could only have been prevented, given the current state of medical knowledge, by either aborting the child or preventing its conception. It is hoped that this device will avoid the danger of “semantic overload,” of which Professor Furrow wrote.