Would you abort a Down's Syndrome child?

[Pick]

To be completely fair, I think the point of the hypothetical situation was whether or not you would do it because of a future disability, not "do I trust genetic tests?"

Also, this is not poking holes, this is true and honest questioning for the sake of curiosity, Son of the Suns, you said your sibling was 14? Do you know if the accuracy has increased since then, given the time for procedures to have been improved?

[FSTargetDrone]

Let's look at some of the possible symptoms and health problems associated with Down Syndrome:

What is Down syndrome?

Down syndrome, also known as Trisomy 21, is the single most common genetic pattern of malformation in man.

Most text books quote the incidence of Down syndrome to be between one in 700 to 800 live births.

In 1866, John Langdon Haydon Down described the physical features and associated medical problems that have come to be known as Down syndrome.

In the 1930s, physicians established a relationship between advanced maternal age and Down syndrome. The chromosomal, or genetic, basis of Down syndrome was not established until 1959.

A normal human cell contains 23 pairs of chromosomes which carry all of a person's genetic information. Due to several possible abnormal mechanisms of cell reproduction, patients with Down syndrome have an extra (third) copy of the 21st chromosome. Thus, Down syndrome is also called Trisomy 21.

Advanced maternal age is associated with a high incidence of Trisomy 21, but even women of typical child bearing age can have affected babies.

While the diagnosis may be strongly suggested by characteristic physical findings, the final diagnosis is often made only after chromosome analysis, which includes a complete count and visualization under a microscope of the chromosomes taken from cells in the blood.

A geneticist most often performs this along with a clinical evaluation.

What are the physical characteristics of Down syndrome?

The physical characteristics of Down Syndrome in infancy typically involve low muscle tone, flat appearance of the face, upward slanting eye creases, small ears, single skin crease in the palm, extremely flexible joints, large tongue, and several others.

Physical characteristics may be very obvious, but sometimes are so subtle that the diagnosis can only be made after testing is completed. Physical findings do change as the child ages and certain features may become more or less noticeable with time.

Non-cardiac medical problems associated with Down syndrome

While this chapter focuses on the heart problems associated with Down syndrome, some of the other medical problems seen with Trisomy 21 are:

1. Developmental delay -- All children with Down syndrome are delayed, although this may not be apparent until the child is beyond infancy. IQ scores range from 20 (severe mental retardation) to 85 (low normal). Overall learning abilities are usually equivalent to a 6 to 8 year old child without Down syndrome.

2. Gastrointestinal abnormalities -- 2 percent to 5 percent of children have complete obstruction of the small bowel known as duodenal atresia. Another 2 percent have poor movement abilities of the colon and / or rectum known as Hirschsprung disease.

3. Hearing loss -- Some degree of hearing loss is present in 40 percent to 75 percent of children with Down syndrome. Malformations may affect either the middle or inner ear structures. Ear infections can be a frequent, often difficult problem to treat.

4. Eye disorders -- 60 percent of children have eye disorders that need monitoring and treatment. Congenital cataracts (loss of transparency of the lens of the eye), glaucoma (increased pressure within the eye), strabismus (cross-eyed) and major refractory errors (far sighted or near sighted) are the common problems.

5. Leukemia -- Leukemia occurs in one of every 150 children with Down Syndrome. This is 20 times higher than the general population.

6. Thyroid disorders -- Low thyroid levels are seen in approximately 5 percent of children with Down syndrome.


Congenital heart disease associated with Down syndrome

The overall incidence of congenital heart disease in the general population is 0.8 percent. The incidence of congenital heart disease in children with Down syndrome is up to 50 percent.

The types of heart defects in children with Down syndrome can be broken down into three broad categories:


1. Atrioventricular septal defects
2. Ventricular septal defect (VSD), atrial septal defect, or patent ductus arteriosus
3. Other complex heart disease

Atrioventricular septal defects (AV Canal) is greatly over-represented in these children, making up approximately 60 percent of the congenital heart disease found in Trisomy 21. For comparison, AV canals account for only 2.9 percent of the congenital heart defects in the general population.

Ventricular septal defects, atrial septal defects, and patent ductus arteriosus comprise another 20 percent of the congenital heart disease associated with Down syndrome, although these defects are much more common in the general population compared to AV canals.

Other complex congenital heart diseases including Tetralogy of Fallot and hypoplastic left heart syndrome comprise the rest of the heart disease seen in Trisomy 21.

In addition to the heart defects associated with Down Syndrome, isolated elevated blood pressure in the lungs (pulmonary hypertension) is seen with higher frequency in patients with Down syndrome. This high pressure may be related to malformation of the lung tissue, although the exact cause is not known.

The higher pressures may limit the amount of blood flow to the lungs and therefore decrease the likelihood of symptoms of congestive heart failure seen in babies with complete AV canals or large ventricular septal defects.

However, since the pulmonary hypertension can become irreversible, particularly if these large holes are not surgically corrected by a year of age, children with Down syndrome and AV canals or large ventricular septal defects are often referred for surgery earlier than a non-Down syndrome child with the same heart defect.

If the baby does have evidence of high pressures in the lungs, it may complicate postoperative management and hence prolong the recovery time.

Signs and symptoms of children with Down syndrome and congenital heart disease

Depending on the type of heart defect, children with Down syndrome and heart disease may have a variety of symptoms.

Babies with complete AV canal defects may have signs and symptoms of congestive heart failure such as a fast respiratory rate, labored breathing, difficulty completing feedings, sweating with feedings and poor weight gain.

Children with partial AV canals can be asymptomatic because the extra blood flow to the lungs is not enough to cause symptoms of congestive heart failure.

Even babies with large ventricular septal defects as part of their heart disease who should have large amounts of extra blood flowing to their lungs may have no symptoms due to high pressures in the lungs. These babies must be watched carefully to determine the proper timing for surgery.

Tests to diagnose congenital heart disease in babies with Trisomy 21

Most cardiologists would agree that all babies that have been diagnosed with Down syndrome should have a cardiology evaluation because of the high incidence of associated congenital heart defects.

What degree of cardiac evaluation remains controversial. A good history and physical examination should be performed by an experienced cardiologist to rule out any obvious heart defect.

Most cardiologists would perform an electrocardiogram, which can be very helpful in making the diagnosis of AV canal, even in the absence of physical findings.

Some cardiologists would be satisfied with this level of evaluation. There are those, though, who would argue that at least one echocardiogram should be performed to rule out subtle heart problems.

If the diagnosis of congenital heart disease is made, the cardiologist will follow the child with office visits on a fairly regular basis. Most patients can be watched clinically to determine if the child is having difficulty due to the heart defect.

Occasionally, a repeat electrocardiogram, chest X-ray, or echocardiogram is performed to further evaluate clinical changes. These tests are likely to be repeated before surgical repair is recommended.

Rarely, a cardiac catheterization is required for complete evaluation prior to corrective surgery, especially in patients where elevated pressures in the lungs are a concern.

Treatment options for children with Down syndrome and congenital heart disease

Children with Down syndrome and symptoms of congestive heart failure can be initially managed medically with the use of diuretics, blood pressure medications to allow the heart to eject more blood out to the body rather than out to the lungs, and / or digoxin, a medication used to improve the pumping ability of the heart.

If the baby is having difficulty with feeding and weight gain, nasogastric tube feedings with high calorie formula or fortified breast milk can be used to help with growth.

These are all temporary solutions to allow the baby to grow while deciding if and when surgery is indicated. In general, atrial septal defects, ventricular septal defects, and AV canal defects are closed surgically if the child is demonstrating congestive heart failure that cannot be controlled with medication.

If the baby has no signs of heart failure or is controlled well with medications, the decision for surgical closure can be delayed. AV canals are usually repaired electively between 3 and 6 months of age.

Depending on the size of an atrial septal defect or a ventricular septal defect, surgery can be postponed even longer, keeping in mind the risk of developing irreversible high pressures in the lungs.

The decision must be individualized to each child's physical state as well as the family's concerns.

Long-term prognosis of babies with Down syndrome and congenital heart disease

Overall, survival beyond one year of age is 85 percent in all children with Down syndrome. Over 50 percent of individuals with Down syndrome live to be greater than 50 years old.

Congenital heart disease is the most common cause of death in early childhood. However, as of the late 1980s, 70 percent of children with Down syndrome and congenital heart disease lived beyond their first birthday. With improved medical and surgical care, these numbers continue to improve.

As we can see, there are many potential and debilitating health problems with DS. Granted, there is no guarantee all DS babies will suffer these health issues, but it is something to consider.

A close friend of mine and his wife learned that their new baby had DS. They decided to have the child anyway.

Would I want a child with DS, would I abort? After learning as much as possible about the condition and its potential risk, I would lean to yes.

[Mrs Kendall]

So how would you people feel if you aborted a child who was falsley diagnosed with Downs syndrome? What if after you aborted you found out that the doctor or hospital made a mistake?

Just curious, I'm not trying to start a fight here, I'm not even sure if this can happen.

I would not be seeing that doctor again, but I don't think I could find rational grounds to sue upon. No harm came to me or any human, emotional or physical, as a result of his/her misdiagnosis. Of course, I'm not to familiar with the laws concerning malpractice, but I probably still wouldn't sue. Unless, of course, I wanted a child, and had made the decision to abort purely off of the doctor's word that it was a Down's syndrome child. Then I might have some basis to push a lawsuit. Again, I'm not familiar with legislation concerning this.

I asked you how you would feel not what you would do But I can see that you would be upset enought to consider sueing. I'm just thinking that if I aborted a child and later found out that the diagnosis was wrong I would feel all that much more horribly, I might even kill myself. I just wouldn't do it, for any reason.

[Mrs Kendall]

How can you misdiagnose Down's Syndrome? All you have to do is look at one of the cells and count the number of chromosomes. If it's not right, then there's a serious problem (be it trisomere-21 or another of the chromosomal defects). Seriously, anyone who can count to 50 can tell if there's a problem like Down's Syndrome in a placenta, and it doesn't take much training to be able to diagnose it much more accurately.

Doctors are humans and humans make mistakes especially on such little sleep they get these days! It's entirely possible.

[Mrs Kendall]

All of this talk of potential false results is largely irrelevent in my mind. At that point the fetus is not developed enough to be called human and it's not like conceiving another child would be a terrible burden. Better to err on the side of caution, I would not want to take the chance of giving birth to a child with Down Syndrome; I've been around enough kids with DS to know that I couldn't possible provide any sort of happy existance for him/her, and that it would be the better option for the family to abort it.

It may sound callous, but I don't see why anyone would really think twice about aborting a fetus that has been diagnosed with DS. Who in their right mind would want a child with such a debilitating condition? I would definitely abort the fetus, and I know very well that my wife would agree with me on this.

Huh? Your wife? You are talking about Bohemianfey right? If so holy Congrats!

*sorry for the off topic post*

[Aaron]

How can you misdiagnose Down's Syndrome? All you have to do is look at one of the cells and count the number of chromosomes. If it's not right, then there's a serious problem (be it trisomere-21 or another of the chromosomal defects). Seriously, anyone who can count to 50 can tell if there's a problem like Down's Syndrome in a placenta, and it doesn't take much training to be able to diagnose it much more accurately.

Is Downs something they even test for before birth as SOP?

[astrosanguinus]

OK, I got that wrong, so what. I guess that invalidates the question in the first place, bec you have to have some way to determine a DS case in order to answer it. I personally would abort a DS kid if I were pregnant.

and yes, the blood test has an unusually high % of false positives.

[astrosanguinus]

Amnio is not performed until 15 weeks. The question specifically stated that the child was first trimester, so the only test we have available to us is the blood one that doctors told me when i was pregnant (quote) "This test has both false positives and false negatives".

The question also specifically states that the fetus has down's. Amnio is the test, so how do you want to have it, both ways?

[astrosanguinus]

BTW, all of the guys who answered "I would support whatever my wife" decides, what the fuck kind of answer is that? The question is what you would do. Surely you would have an opinion one way or another.

Relax--maybe they, like I, simply clicked "Yes" (or no whatever) and went on to state an opinion. If all you wanted was a yes or no answer typed out, you should have designed the poll that way.

[astrosanguinus]

And also furthermore, Mrs Kendall, i'ts impossible to misdiagnose Down's. If the parent went in with a positive on the blood test, then yes, bec that's just a screening test to see if you need an amniocentesis. In amnio, they draw the fetus's blood, so it's 100%

Yes it is, it happened to my mother, twice. Also, the original post stated that the infant is in the first trimester, before the test can be performed.

Oh, OK, the entire OB/GYN and counseling staff at Swedish Med. Ctr. need to be informed of this!! They're telling everyone the wrong thing!

[astrosanguinus]

Sorry. I should have held onto it and combined those 4 posts. Darhar

[wolveraptor]

About the abortion itself: I just wouldn't have my own child aborted... if my wife gets pregnant, that was actually our own fault for not using the adequate protection. I do not have a problem with other people getting an abortion, it's just something I personally wouldn't do.

The point with the autism-related Abortions is, personally, that it's hard to tell with a fetus whether or not it's going to have a serious form, or it isn't, science tends to be a bit sketchy when it first starts out.

So you'd "punish" yourself for not having a condom by having the child, even though you didn't want to? Nice environment for the growing baby.

Furthermore, during the 1st trimester, why wouldn't you err on the side of caution and have the abortion anyways?

[Solauren]

Abort.

As much as I think people have a right to live, I personally think conditions like that are a punishment.

I would not punish a child by having to live with Down Syndrome.

I reserve that for criminals.

[Son of the Suns]

Oh, OK, the entire OB/GYN and counseling staff at Swedish Med. Ctr. need to be informed of this!! They're telling everyone the wrong thing!

What are you talking about?

[Master of Ossus]

Doctors are humans and humans make mistakes especially on such little sleep they get these days! It's entirely possible.

I had a teacher in HS who used to do this sort of analysis. She wasn't a doctor--just a lab technician, and at their lab the ones that were flagged by the technician were then given to a senior technician and finally a doctor for a final diagnosis.

[Master of Ossus]

Is Downs something they even test for before birth as SOP?

In high-risk groups, it is. Otherwise you generally have to request such a test, but most people don't since the accurate ones are fairly invasive.

[FSTargetDrone]

Abort.

As much as I think people have a right to live, I personally think conditions like that are a punishment.

I would not punish a child by having to live with Down Syndrome.

I reserve that for criminals.

It's a "punishment" from who, or what?

DS is a result from an error in cell division that has unfortunate side effects. Nothing more.

[FSTargetDrone]

Is Downs something they even test for before birth as SOP?

In high-risk groups, it is. Otherwise you generally have to request such a test, but most people don't since the accurate ones are fairly invasive.

Invasive and potentially fatal to the fetus.

[Darth Wong]

I don't see why I should have to point this out, but as with many hypothetical ethical dilemmas, the point is to discuss what you would do, not whether current technology is up to the task of making the scenario feasible.

[CyberianKnight]

Definately

[Mrs Kendall]

I had a teacher in HS who used to do this sort of analysis. She wasn't a doctor--just a lab technician, and at their lab the ones that were flagged by the technician were then given to a senior technician and finally a doctor for a final diagnosis.

So you're trying to tell me that it wouldn't happen that three people would let it go and misdiagnose because of what happened with your high school teacher, gimme me a break buddy, how many other people in this thread are saying it's entirly possible to misdiagnose DS. I'm not the only one saying this here.

[Aaron]

So you're trying to tell me that it wouldn't happen that three people would let it go and misdiagnose because of what happened with your high school teacher, gimme me a break buddy, how many other people in this thread are saying it's entirly possible to misdiagnose DS. I'm not the only one saying this here.

I think he's trying to say that it's less likely to misdiagnose Downs now because the have a three part system in place to check for it.

[Mrs Kendall]

My question was how you would feel if you aborted because your doctor told you that the child was gonna have downs syndrome, and later found out that the doctor was wrong, how would you feel when you found out that you aborted a perfectly healthy child. I'm also asking how one who wanted children would feel, I'm not directing this question at people who would have had an accident which conceived their child, I'm directing it at people who would have planned to have a child.

I'm also not asking whether it's medically possible or not, I'm asking how you would feel if you later found out that your child would have been perfectly healthy. Some people have answered my question as I intended it to be understood so it's not like I worded the question wrong (at least not as badly as it would be if nobody got the idea)

I said I would probably kill myself because I would be so upset that I killed a perfectly healthy child without going for a second opinion at a different hospital.

[wautd]

yes

(first post in a week)

[Steven Snyder]

Abortion.