Abstract

Infectious diseases and genetic conditions are both transmitted “vertically” from a pregnant woman to the child she bears. Most U.S. states require routine screening of women for syphilis during pregnancy, and cases of congenital syphilis now number less than about 400 per year. In contrast, although a blood test can diagnose up to 90% of cystic fibrosis carriers and affected individuals, no states require premarital or prenatal screening for CF. These two vertically transmitted disorders are similar in potential incidence, detectability, and the absence of curative treatments after vertical transmission occurs. Past and present screening policies for syphilis can be characterized as preconception, prenatal, paternalistic, state mandated, universal, with presumed consent for tests and treatment, widely practiced, and effective. Screening policies for cystic fibrosis can, in contrast, be characterized as prenatal, postnatal, selective, and voluntary—except, most recently, for newborn testing. While differences between these policies may rest partly on historical or other factors, the chapter argues that there are moral differences, too. Recent emphasis on individual rights and choice may be more important in explaining different strategies than the fact that one type of vertical transmission is infectious and the other is genetic. Neither is “exceptional”; rather, both the historical and the ethical explanations of difference relate to other factors, particularly ready access to treatment and the availability of methods for preventing transmission.