遺傳診斷後續處置的倫理與心理社會議題-以產前遺傳診斷為例(I)

The purpose of this study was to explore decision-making process of informed consents of prenatal screening, amniocentesis and selected abortion with or without a complete counseling. We found the problems of inadequate information of prenatal diagnosis, and the anxiety of pregnant women induced by false-positive of maternal serum test. Therefore, we intend to further study the ethical issues of prenatal diagnosis through antenatal serum screen of Down syndrome. Appropriate genetic counseling could provide correct information for women facing prenatal diagnosis. It is important that the health professionals have an in-depth understanding of the psychological impact and the accompanied anxiety, and provide effective intervention to alleviate the anxiety accordingly. The first year study was aimed to understand the effect of genetic counseling in improving the knowledge about Down syndrome and prenatal screening as well as alleviating anxiety of pregnant women undergoing maternal serum screening for Down syndrome. The data were collected by interview at obstetric out-patient department of a teaching hospital. Study subjects were randomly assigned and resulted 95 in experimental group and 96 in control group. Information about women’s demographic data, prenatal diagnosis knowledge, level of anxiety of the women were collected. Genetic counseling was provided to experimental group before first data collection whereas to control group after data collection. The second data collection of women’s anxiety level on both groups was arranged after the result of maternal serum screening for Down syndrome came out. The data were analyzed with the assistance of SPSS computer software. The results of the study showed that the experimental group women had a better knowledge about antenatal serum screening Down syndrome. Another finding of the study was that control group women had higher anxiety than experimental group before receiving genetic counseling. In other words, women after counseling experienced less anxiety than those women without counseling. Most participants had psychological reactions, which included nervousness, worry, sadness, and stress. Their concerns during the decision-marking transition stage were: confirmation of health, normality, and maternal serum screening Down syndrome result, clarification of relations between amniocentesis and maternal serum screening, opinions from obstetrician and family members, and fear of artificial abortion for defect fetus. From the results of the research, the incomplete information about prenatal screening for Down syndrome and the anxiety of women facing antenatal serum screening will arouse the health professionals’ attention, urge them to pay more respect to counseling pregnant women, to validate the informed consent and to alleviate the anxiety accordingly