How are Japan and other countries responding? Artificial abortion in NIPT (New Type Prenatal Diagnosis)

Reasons Why Some Choose Artificial Abortion with NIPT

When NIPT results come back positive, it indicates a possibility that the fetus may have a chromosomal abnormality. Discovering that one's child may have an illness can be bewildering for many.

In Japan especially, the environment for raising children with chromosomal abnormalities may not be fully established, leading some to choose artificial termination of pregnancy based on NIPT results. Artificial termination of pregnancy refers to the deliberate termination of pregnancy within a specified timeframe. Japan is known as a country with high abortion rates, and various reasons contribute to an increasing number of terminations.

Among those opting for NIPT, there's often a heightened concern not just due to advanced maternal age but also because of a strong interest in the baby's health. When a potential disability is detected in a long-awaited child, choosing termination can impose a significant emotional burden.

If considering NIPT, receiving a positive result and deciding whether to proceed with termination can be profoundly shocking. It's crucial for individuals and their partners to reflect on their definitions of life well before undergoing NIPT.

Situation of Artificial Abortion in Japan

In Japan's Penal Code, there is a crime of abortion, and it is prohibited for pregnant women or doctors to perform abortions. However, under a law called the Maternal Protection Law, abortions can be performed legally under certain conditions.

Originally, the predecessor to the Maternal Protection Law was a law called the Eugenic Protection Law, which aimed to prevent the birth of inferior offspring in Japan. Now, the law has been revised to protect the lives and health of pregnant women.

The conditions for artificial abortions under the Maternal Protection Law include the following:

• When pregnancy or childbirth would adversely affect the health of the pregnant woman
• When there is a possibility of economic issues arising from pregnancy or childbirth
• When pregnancy results from rape

(Note: Actual artificial abortions also require the consent of the partner.)

A significant number of abortions are performed based on positive results from NIPT (non-invasive prenatal testing), which is supposed to inform about the health of the fetus, leading some to argue that these tests are effectively becoming a form of "selecting lives."

Currently, there are no specific provisions regarding fetuses in artificial abortions under the Maternal Protection Law. Therefore, related organizations such as the Obstetrics and Gynecology Society take a negative stance on artificial abortions of fetuses with chromosomal abnormalities.

Not All Countries Allow Artificial Abortion

In Japan, if both the father and mother agree, abortion can be chosen as an option. However, in some countries around the world, abortion is illegal, including artificial abortions.

Reasons for Prohibition of Artificial Abortion

In several countries around the world, the prohibition of artificial abortion is heavily influenced by religious backgrounds.

For Japanese people, it might seem curious that abortion cannot be chosen for religious reasons related to gods or their teachings. While Japan has a strong cultural presence of Buddhism in ceremonies and annual events, there is also a significant population of atheists.

For instance, in Christianity, particularly Catholicism, there are strict views against abortion because the fetus is considered a gift from God. Therefore, in some countries, even when pregnancy poses a threat to the mother's life, abortion may not be permitted at all. Below, I will outline the histories and perspectives on artificial abortion from several countries.

History and Current Situation of Artificial Abortion in the United States

It may come as a surprise, but until a few decades ago, artificial abortion was illegal in the United States as well. In the 1970s, the feminist movement advocating for women's rights became increasingly active. In 1973, a landmark decision by the US Supreme Court led to the legalization of abortion.

Pregnancy and childbirth impose significant physical and economic burdens on women. In the United States, as in Japan, abortion is recognized as a "women's rights" issue in cases where there is excessive physical or economic burden, as well as in cases of unwanted pregnancies such as rape.

However, the United States also has a significant population with strong religious beliefs, many of whom hold negative views toward artificial abortion. As a result, abortion often becomes a contentious issue in both state and federal elections.

History and Current Situation of Artificial Abortion in the United Kingdom

In the United Kingdom, artificial abortion became permissible as a part of social welfare policy to prevent families from increasing in size and falling into poverty. Similar to the United States, abortion came to be seen as a women's rights issue during the feminist movement of the 1970s.

Especially in the UK, prenatal testing such as NIPT (non-invasive prenatal testing) and subsequent confirmatory tests are provided free of charge, just like other medical services. Additionally, there are public subsidies available for disabilities. In recent years, various tests, including NIPT, are conducted to avoid the birth of fetuses with chromosomal abnormalities.

While artificial abortion is legal under UK law, unlike Japan, there are provisions regarding fetuses. Specifically, abortion is permitted by law if there are serious abnormalities affecting the physical or mental health of the fetus. Therefore, abortion due to fetal abnormalities is permitted throughout the pregnancy period.

However, there is criticism regarding the termination of pregnancies following the identification of disabilities through NIPT, viewed by some as discrimination against disabled individuals. Ultimately, the decision of whether to undergo NIPT and whether to raise a child with disabilities rests with the parents of the baby.

History and Current Situation of Artificial Abortion in Germany

During World War II, Germany implemented policies based on Nazi eugenics ideology under Hitler's regime, which led to discrimination against people with disabilities. Eugenics aimed to preserve superior genetics while eliminating those deemed inferior.

In wartime Germany, measures such as forced sterilization and isolation were enacted alongside abortion. Consequently, Germany had provisions concerning fetuses in its laws on artificial abortion from that time.

From a bioethical standpoint, Germany has a complex history. However, in 1994, Germany removed provisions regarding fetuses in laws concerning artificial abortion. This removal signaled sensitivity towards discrimination against disabled individuals. In Germany, where eugenic ideology had a strong influence for a long time, this was a significant development.

In Japan, some argue for the necessity of provisions concerning fetuses in the Maternal Protection Law as guidelines for choosing abortion. However, conversely, the inclusion of such provisions in the law could be seen as endorsing exclusion of disabled individuals, potentially fostering discriminatory attitudes.

Ethical Issues in Modern Medical Technology

In medical practices utilizing advanced technologies such as NIPT, ethical issues regarding life often arise. Various countries have different approaches to elective termination of pregnancies. After undergoing NIPT, the decisions on how to proceed are left to the pregnant woman and her partner. Understanding the trends not only in Japan but also in countries worldwide regarding NIPT can be useful in forming opinions and considerations.

References

• Aether Albin et al. - Reform of German Abortion Law: An International Comparative Legal Perspective