The development of ultrasound technology has expanded the ability of ultrasonologists to detect markers of foetal abnormalities, generating new ethical dilemmas concerning patient counseling. However, the ethical imperatives of “nondirective counseling” and “patient autonomy” are aimed primarily at debating prenatal diagnostic issues surrounding medical abortion and the risk of foetal abnormalities. Ethical concepts relating to “social” medicine such as sex selection are secondary.  There is a need to investigate whether women make informed choices with regard to CUB screening in first trimester of pregnancy. Again we need to find out what factors affect women’s preference for type of prenatal screening test for chromosomal abnormalities. What happens if the follow-up test finds an abnormality? In most cases follow-up testing finds a perfectly healthy baby. If Down's syndrome is found this will be discussed fully with  the pregnant woman and her partner and help and advice will be available  in deciding what to do. Some couples may decide to continue with the pregnancy while others may feel that termination of the pregnancy is their preferred choice. There is no pressure from the hospital staff to influence your decision, only help and support.

The CUB-test can make it possible to  identify three times more  pregnancies with an extra chromosome 21.This method has  previously been offered to mothers over 35, because of the increased risk of Down syndrome. In connection with the  emergence of this technology it has brought a public debate about new ethical questions and dilemmas.  Objectively  to clarify different positions in the society by describing different arguments in the debate, pro and contra; You can observe that the pro-side for example is represented by politicians and doctors involved in the process of implementing the CUB-test and the contra-side for example is represented by parents to children with Down syndrome and some academics.

Argumentation from the Principle of Human Dignity

The principle of Human Dignity states that every human is supposed to be treated equally and independent of personal characteristics and functions in society.
A) To use the CUB-test as routine communicates that individuals with certain characteristics and functions, are not fully accepted or wanted in society.
B) To use the CUB-test as routine means that, individuals that have other characteristics and functions in society than average, are exposed to a higher risk to get aborted.Thought: Using the CUB-test as routine for all future parents is not in compliance with the Principle of Human Dignity and the foundations of western medicine ethics.

How to make balance or make priority between different moral principles and interest? Beauchamp and Childress state that when principles come into conflict one has to make a deliberation and judgment of the strength and weight of the norms (Beauchamp and Childress, 2001). Regarding the issue of prenatal diagnosis and abortion there is a risk of conflict between the autonomy of the mother (parents) and the human dignity of the fetus. In public debate, medical praxis and also in some philosophical debate you can see a strong claim for the priority of the mother’s autonomy. To conclude,  applying the Principle of Human Dignity (as interpreted above) then health care of CUB-test and abortion is  morally wrong. But to make a deliberate and well considered moral judgment, for example reflective equilibrium one cannot only rely on a philosophical argumentation or ethical theory without taking into consideration the intuition and medical principles. This means that even if the philosophical argumentation makes the conclusion contra CUB-test and abortion of fetus  one has to take into consideration the medical praxis and the intuition of the parents to make a deliberate and well considered moral decision.

Andrew Akampurira has completed a B.A in Philosophy at Uganda Martyrs University, after graduation he started teaching biomedical ethics at Kyambogo Univesity in Uganda. After two years of teaching he applied for M.A in Applied Ethics at Linköping University, Sweden which he completed recently. In the future he looks forward to starting a PhD. Hi main interest is in biomedical Ethics and bioethics

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	The Ethics Of the Combined Unltrsound and Biochemical (CUB) Test pdf