Abstract
The implementation of non-invasive prenatal screening (NIPS) in Canada will be affected
by legal norms. The law can shape physician behaviour, help to crystallize standards
of care, influence utilization patterns, and reflect and reinforce patient expectations.
In Canada, failure to inform a patient about NIPS, or misinterpretation of NIPS results,
could result in a successful "wrongful birth" claim if the patient subsequently gives
birth to a child with a condition that had been detectable. Given that research shows
that physicians’ decisions are influenced by concerns about liability, malpractice
law seems likely to encourage increased recommendation and use of NIPS.
Physicians’ fiduciary and negligence-based disclosure standards require they consider
both objective factors as well as a specific patient's subjective and reasonable beliefs, fears,
desires, and expectations. Thus, physicians likely must address dominant public discourses
and controversies relevant to NIPS. Given the existence of spin, hype, and misinformation
about NIPS, there is an increasing need for a robust consent process and, when appropriate,
genetic counselling.
In sum, the law will define and bound the acceptable behaviour of physicians recommending
or administering NIPS, and nudge the technology's implementation forward. Physicians
and policymakers should be aware of the potential impact of these legal norms on both
utilization and public expectations.
Résumé
La mise en œuvre du dépistage prénatal non invasif (DPNI) au Canada dépendra des normes
juridiques. La loi peut façonner le comportement du médecin, contribuer à fixer les
normes de soins, influencer les habitudes d'utilisation en plus de refléter et de
renforcer les attentes des patientes.
Au Canada, le fait de ne pas informer une patiente au sujet du DPNI et la mauvaise
interprétation des résultats de DPNI peuvent aboutir à un gain de cause pour « naissance
préjudiciable » si la patiente donne naissance à un enfant dont l'affection aurait
été détectable. Comme les recherches montrent que les préoccupations en matière de
responsabilité influencent les décisions des médecins, les lois en matière de faute
professionnelle risquent de faire augmenter la recommandation et l'utilisation du
DPNI.
Les normes relatives à l'obligation fiduciaire et au devoir de diligence des médecins
exigent qu'ils tiennent compte des facteurs objectifs en plus des croyances, peurs,
souhaits et attentes subjectives et raisonnables de la patiente. Ainsi, les médecins
doivent vraisemblablement composer avec les discours et controverses du public en
ce qui concerne les DPNI. Compte tenu des retombées, de la publicité et de la désinformation
à propos des DPNI, il est de plus en plus nécessaire d’établir un protocole solide
sur le consentement et, le cas échéant, sur les consultations génétiques.
En résumé, les lois viendront définir et encadrer le comportement acceptable des médecins
qui recommandent ou réalisent les DPNI, en plus de faire progresser la mise en œuvre
de la technologie. Les médecins et les responsables de l’élaboration des politiques
doivent avoir conscience des conséquences potentielles de ces normes juridiques tant
sur l'utilisation des DPNI que sur les attentes du public en la matière.
Keywords
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Article info
Publication history
Published online: April 28, 2020
Footnotes
Disclosures: This study was funded by the Genome Canada project PEGASUS 2 (PErsonalized Genomics for prenatal Abnormalities Screening USing maternal blood: Towards First Tier Screening and Beyond; RES0038244). Specific funders that supported this research include Genome Canada and Genome Alberta.
Both authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
