The implementation of new methods of treating diseases raises possible concerns regarding its moral and ethical character. For example, pre-eclampsia is a condition in pregnant women that can cause their blood pressure to rise, putting themselves and their baby at risk for brain injury and death respectively. Pre-eclampsia is usually diagnosed if the patient has high blood pressure after 20 weeks of pregnancy. Obstetrics procedural interventions such as cesarean section and severe obstetrics morbidities are more common among deliveries with pre-eclampsia than other deliveries. There is no treatment to cure pregnant women of pre-eclampsia while in utero and currently the only cure is delivery of the placenta. As a result, many studies have focused on developing a screening test with the purpose of identifying pregnancies at high risk for developing pre-eclampsia early-on in the pregnancy in the hope that a treatment will eventually be developed. Despite the development of the screening test which is a first step towards treatment development, a screening test “requires an analysis of how the test influences the conditions and choices for those tested” [1]. These conditions and choices refer to how this screening test may further impact the pre-eclamptic condition or emotional/mental well-being of those pregnant women. Without doctors having discovered an effective treatment, it is unethical to start the immediate use of a health screening on women and believe it to be both effective and ethical when the screening test has not yet been tested for safety [1].
With so much not known about pre-eclampsia, it would be difficult to develop an effective screening test. Methods to lower blood pressure, such as medication, can reduce the risk of stroke in the mother, but it cannot cure pre-eclampsia during pregnancy, which is the underlying condition that keeps the blood pressure raised. Additionally, it has been shown that predictive tests that identify pregnancies with a high-risk for pre-eclampsia “do not predict well” due to the lack of knowledge of treating pre-eclampsia, and therefore require more research to be able to see future progress towards both prediction and prevention [2]. Much information is needed through clinical research about a condition like pre-eclampsia to be able to understand exactly what should be looked for in these women when conducting an effective and safe screening especially since there is no single treatment for this condition [2]. Perhaps, researchers could first use clinical research to gain a deeper understanding of that screening before officially using it which may lead to its effective development in overcoming those challenges that make identifying pre-eclampsia difficult. Screenings would be changed to become more accurate in preeclampsia identification and clinical research would give researchers the information needed to improve screenings to become more suitable for pre-eclampsia.
No studies have directly evaluated the test accuracy of blood pressure in identifying pre-eclampsia, which not only implies that more study is needed, but also that current health screenings may inaccurately detect pre-eclampsia in a pregnant woman who may not actually be pre-eclamptic [3]. This may result in a higher blood pressure in women who are not pre-eclamptic due to the stress and could pose as a risk to themselves and their fetus. However, blood tests are effective in identifying severe pre-eclampsia with a 96% accuracy. Some complications with these blood tests though are that it may lead to a false positive or negative result. As a result, there are concerns on whether this health screening may further raise blood pressure or increase the likelihood of death in mothers and infants. Further study is needed to evaluate the ethical efficacy of this screening to determine whether or not it could become a significant addition to prenatal healthcare [1].
Despite its drawbacks, the use of a health screening test for pre-eclampsia has many goals that can be seen as a positive, significant step towards pre-eclampsia treatment. Healthcare workers could potentially identify pre-eclampsia in women early-on through health screenings, enabling them to manage it and attempt to reduce the risk of pre-eclamptic complications later on. By diagnosing pre-eclampsia ahead of time, the risk of “maternal, cerebral, vascular, hepatic, and renal complications” and poor health outcomes may be prevented [4].
While I understand the viewpoint of why a health screening test is needed to identify pre-eclampsia early-on, I believe that the development of it should not be rushed. Further clinical research and testing is needed to ensure both its accuracy and ethicality before its use in mothers at risk for preeclampsia, and before it can become a beneficial addition to prenatal healthcare.