Maternal Serum Triple Analyte Screening in Pregnancy

Maternal Serum Triple Analyte Screening in Pregnancy

To the Editor:

I read with interest the article "Maternal Serum Triple Analyte Screening in Pregnancy" in the 3/1/02 issue of American Family Physician. Buried in near-obscurity towards the end of the piece was the curious statement, "Counseling [concerning triple analyte prenatal screening] should be nondirective?" No reason was given for this dubious pronouncement, nor was it expanded upon in any way.

This kind of advice should be looked upon with some skepticism. The authors are directing the physician to be nondirective. Why should I be nondirective? Why not be nondirective in one's article-writing, in which case the authors would presumably not direct me to be nondirective?

Like most physicians, I am very directive in many areas of my practice. If parents bring their child to me with pneumonia, I direct them to give him antibiotics. If a child has asthma and his parents smoke around him, I direct them to cease and desist. Naturally I give appropriate counseling concerning the risks, benefits, etc. But I make no bones as to my recommendation. So why should my practice be any different when counseling a parent whose child is still inside her? Can the author cite any studies that demonstrate a better maternal-child outcome if a ?nondirective? approach is used in counseling concerning prenatal diagnosis? I doubt it.

I have questioned this advice in the past, and the only reason given has been because "directiveness" would "violate the tradition of genetic counselors". This is hardly persuasive reasoning. Traditions exist to be violated, unless they are based on sound rationale.

Obviously the reason why the authors make such a self-contradictory statement is because they want us to think that it is wrong for a physician to tell a woman that it would be wrong of her to discriminate against a child with a disability by hiring someone to kill that child before he's born. Of course, if we acknowledge that such an act is wrong, then it becomes unreasonable to use the "triple analyte screen," since the potential benefits hardly outweigh the potential emotional trauma of a positive result, and the potential risks of amniocentesis for prenatal diagnosis of disabilities far outweigh any putative benefits to the child.

This sort of directive (telling physicians to be nondirective about prenatal testing) is similar to telling medical students and residents, It's OK if you don't want to do an abortion, but you have to be willing to refer a woman who wants one to someone who will do it.? This may be what passes for medical ethics these days. But it's wrong, it's illogical, and it's unethical to teach such nonsense to students or proclaim it to practicing physicians.

Jeremy Klein, M.D., F.A.A.F.P.
Louisa, KY