Ethical debate

Ethical debate

Trisomy blood test © dpa

On Thursday, the Bundestag discussed whether prenatal trisomy blood tests should be paid for by health insurers in the future. The positions of the Protestant and Catholic churches diverge in this regard.

Since 2012, pregnant women can use a blood test to determine whether the embryo has a trisomy. On Thursday, the Bundestag debated whether this test will be included in the benefits catalog of the statutory health insurance in the future.

Churches show disagreement on ie of prenatal testing for Down syndrome. While the Catholic Church rejects the tests, the Protestant Church is in favor – provided there is consultation.

Controversial debate in the Bundestag

The parliamentary groups in the German Bundestag were also divided on whether the blood test should be covered by statutory health insurance in the future:

Michael Brand (CDU) said that at the core of the ie was the protection of the right to life, not just cash benefits. If the test becomes routine, the prere on parents to abort disabled embryos will increase. In 90 percent of cases, the diagnosis of Down syndrome already leads to abortion. There is a threat of a trend towards selection and optimization of human beings.

Kirsten Kappert-Gonther (Greens) referred to the experience of Iceland, where the test is widely used. There would hardly come children with Down syndrome to the world.

Corinna Ruffer (Greens) complained that Down syndrome is seen as a disease. "We live in a society that is unfortunately still untrained in dealing with disability, but trained in performance and health".

Peter Weib (CDU) advocated a positive view of people with Down syndrome. They would bring joy and diversity into life.

Beatrix von Storch (AfD) said that the task of the legislator is not to optimize human beings, but to protect and preserve their God-given dignity.

Stephan Pilisinger (CSU), like many other speakers, called for testing to be limited to high-risk pregnancies – for him, from 12 weeks of pregnancy – including comprehensive counseling before and after the test.

Thomas Rachel (CDU) emphasized that only if the health insurance funds cover the costs could such counseling be ensured.

Karl Lauterbach (SPD) said it was not justifiable to deprive women of the lower-risk test. He called for an ethics council of scientists and ethicists to decide on such genetic tests in the future. After all, medicine will soon be able to test more and more diseases or characteristics of the embryo in the mother’s blood.

Like several speakers from the SPD and the Greens, Cornelia Mohring (Die Linke) cited the women’s right to self-determination as an argument in favor of covering the costs.

Number of abortions to be increased

In conversation with our site positions Rainer Maria Cardinal Woelki clearly against prenatal testing."I would much rather argue about whether we are really serious about the dignity of every single human being, regardless of their abilities, their fitness, their economic utility," Woelki said. Meanwhile, he said, practice shows that today about 90 percent of all children who are diagnosed with Down syndrome by the test are aborted. It would be important to offer help and to give courage. "We must show that such news, understandably upsetting as it is, is not the end after all, but the beginning of an unexpected road."

"We appeal to the members of the German Bundestag not to pass any resolutions that in the result are likely to increase the number of abortions," "Stuttgarter Nachrichten" and "Stuttgarter Zeitung" (Thursday) quote the head of the Catholic Office in Berlin, Karl Justen. "All tests to detect trisomy 21 aim to determine a disability."The question is raised as to whether a child with a disability is given a chance in life or not. "But the church never distinguishes between what is worth living for and what is not worth living for. That is why it rejects all tests that have selection as their goal," Justen said.

"The cash allowance of prenatal blood testing would encourage the development of general screening for a variety of genetic disorders and traits," Justen said. "Since it is clearly not a curative treatment, the Catholic Church rejects the amption as a health insurance benefit."

Prevent unregulated genetic testing

Council President Heinrich Bedford-Strohm has underscored the position of the Evangelical Church in Germany (EKD), according to which trisomy examinations should become a health insurance benefit under certain conditions. If the tests already available are used unregulated, there is a danger "that human life will be sorted out according to certain criteria," Bedford-Strohm told the newspapers of the Funke Mediengruppe (Thursday).

The EKD Council therefore combines its approval of prenatal tests as a health insurance benefit for high-risk pregnancies with the offer of psychosocial counseling. This had the protection of life as a goal. "For me, it is crucial that we stick to the unconditional goal of minimizing the number of abortions," said the top representative of German Protestants.

In our site interview speaks prof. Reiner Anselm, who teaches systematic theology and ethics at the Ludwig Maximilian University in Munich, advocates comprehensive ethical counseling. It is unrealistic to believe that the dropout rates will decrease if the insurance companies do not pay for the tests and the church does not try to talk to the women and couples.

"Wealthier families can already afford such a test, poorer families have to resort to amniocentesis, which is already paid for by health insurance, even though it is much riskier for the unborn child. We consider this to be highly problematic," said Anselm.

So far, the tests are self-pay

The Bundestag plans to hold a two-hour orientation debate in the morning in Berlin. It is intended to give members of parliament the opportunity to form an opinion on the ethically controversial ie. Concrete requests are not present.

Blood tests on pregnant women that provide information with a very high probability as to whether the unborn child has a form of trisomy – for example Down syndrome – have been permitted since 2012.

So far, however, they have to be paid for privately by mothers, while procedures such as amniocentesis, which also examine this, are covered. Whether the tests will be covered by health insurance in the future is currently being examined by the responsible Federal Joint Committee in the health sector.

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