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Tuesday, July 24, 2007

PREMARITAL TESTING: SHOULD IT BE MANDATORY?



Sree of Sris’ Views poses a problem to us, while handling the divorce case of a couple that are both dentists. 'The wife is asking for divorce on the grounds that the husband did
not reveal the fact that he has 'tuberous sclerosis'. After she gave birth, finding white patches on the baby’s skin, she ran a long list of tests and it was then that the disease was diagnosed”, she says. This is the ground for their divorce case now, she says.
Sree wonders whether premarital screening of the partners for diseases should be mandatory.
So, here is an interesting poser: should we routinely screen for diseases (pre-nup), and if we do, which diseases should be screened, and what are the pros and cons of this?
First see what the world is doing: countries as diverse as China, Taiwan, Italy, Turkey and Brazil are among those states where premarital testing is warranted by law. Most of the rest of the world knows nothing about this, or isn’t too worked up.
You can read an interesting article on this subject here.
Among the tests that can be done are HIV, Hepatitis B, syphilis, other sexually transmitted diseases, German measles (rubella), and a load of others. Physical examination, including vaginal examination of the bride-to-be (and ball-squeezing of the groom to make this non-discriminatory), and urine tests are also done, apart from a detailed history-taking to rule out psychiatric and other problems.
Only if the couple is granted a clean chit of health are the Chinese allowed to marry. In modern days, detailed genetic screening can be done to screen for traits for genetically transmitted diseases (like tuberous sclerosis in Sree’s client), leading to the concern that creation of these designer babies will be a form of eugenics.
Sounds like a good thing, isn’t it? Screen couples for diseases, and thereby prevent new diseases like thalassemia and AIDS from affecting newborn babies. In addition, teach the couple some sex and health education, and parenting, too. Good for the couple, and profitable for the society, right? Wait just a bit there!

There are several glitches in making premarital medical screening mandatory. Like what?
1. The rights of the couple are violated, if the tests are done by fiat, without their consent. In the third world, this means more corruption.
2. The costs: who is going to pay for the tests? In China, the couple pays for the tests. For poor patients, imagine how painfully impossible it would be for them to comply.
3. Test results can sometimes lead to wrong conclusions. There are false positives and false negatives. Chasing more tests to confirm a test for TB, Hepatitis B or HIV, for examples, will cost a lost of money.
4. Privacy violation can stigmatise a person for life: for example, if someone spreads a rumor that a girl tested positive for thalassemia, she would be penalized by her society forever on that count alone, as if thalassemia were a contagious disease!
The solution to this, I think lies with society becoming more smart and enlightened. If people become aware of genetic and transmissible diseases that they want to avoid in a marriage, they must mutually agree to each undergo a battery of tests to that purpose. As genetic testing becomes more sophisticated, and society more aware and affluent, this will surely become more germane an issue in the coming years.

13 comments:

Ankur said...

can you remove the floroscent green at the end of the post... its almost impossible to read in a blue background.

Ankur said...

i totally agree that prenuptial medical screening is important but should not be made mandatory... however there should be a law which mandates sharing of the medical history. (i.e. if a spouse has a medical/mental/genetic condition, then not disclosing it would be a serious/criminal breach of trust)

primarily because the number of tests are just too many and the costs too high.. however since Indian couples do not hesitate asking for the Janam Kundli.. they can as well ask for a few drops of blood.

Sree's Views said...

Thank you for complying with my request,Ram.
A very educative post.

Actually u have brought out the other side of the coin...what problems would arise if screening was made mandatory.

//they must mutually agree to each undergo a battery of tests to that purpose//
when do they mutually agree ? its only after the marriage. What I am saying is , whether the other party finds it palatable or not , its a right of both the parties to ask for certain screenings to be done and if required repeated.
The expenses shd be borne by the party demanding the tests and they shd be prepared to let go of the party if it feels offended by the demand.
So incase both the parties agree to go for the tests , what are the tests to be done ?
Just the major ones that wld pose a serious problem if either transmitted or passed on to the next generation.
Its so saddening to see the mother coping with frequent 'fits' in the child.

Sree's Views said...

Hey Ankur..

however there should be a law which mandates sharing of the medical history. (i.e. if a spouse has a medical/mental/genetic condition, then not disclosing it would be a serious/criminal breach of trust) //
It is expected of both the parties.
One can file divorce if there is any concealing of material facts.

but its not criminal breach of trust..I agree it shd be made one.

.. however since Indian couples do not hesitate asking for the Janam Kundli.. they can as well ask for a few drops of blood. //
of all the stupidity..trying to match the horoscopes !!

Mahendra said...

Both parties have the right to ask for background information as well as seek divorce on grounds of mistrust if any.

But the government and the law do not have any right on the medical history of citizens. Not disclosing one's medical history is not a criminal breach. It may be a breach of the trust and foundation of marriage - a relationship between two individuals.

B. Ramana said...

Ankur,
I wish I could remove that horrible green. It has been haunting me in my dreams ever since I started blogging. Anyone who can tell me the code in private mail (there is a small chicklet or something to the right of the template) gets a dinner from me!
And, BTW, welcome to this blog! :-)

B. Ramana said...

I agree with Mahendra. The State should not come in here.
Sree, there are no limits to what tests could be done. Take the case of your client. No one in their right minds would have screened for tuberous sclerosis normally. So even if they had done all the available screening tests (mind you, you will hardly get a lab or two in India that could do screening for TS) this disease would have been missed. So where do you stand? A fair common-sense screen would include a physical and history by a good doctor (one unlike me), routine blood tests for sugar, kidney and liver function, HIV, Hepatitis B, and tests for thalassemia (common in India). In case of specific family history of cancers, it gets more specific. However, I think there will hardly be a few families that would hang their medical linen in front of a prospective murga/murgi.

Sree's Views said...

Thank you ,Ram.
I think u have given a very accurate summation. It's quite logical that one cannot be too careful.
There is only so much precaution one can take and beyond that is just a play of chance.
But , as far as HIV and other tests are concerned , a prospective bride/groom can demand a screening.
I had done a post about a HIV patient a few months back.
when u find time u can check it
http://srisviews.blogspot.com/2007/03/few-weeks-back-i-was-was-faced-with.html

Krish Ashok said...

Agree with Mahendra. In India, getting the State involved is an invitation to a disaster. Imagine the corruption and the red tape that's possible here. Govt employees will fight to get a posting in this lucrative department.

I just think its difficult to create an environment where people will not lie about something like this.

sree said...

Hello Ram
I have given a link to this post from enagar.
Thank you :)
http://shocking.wordpress.com/2007/07/25/in-sickness-and-in-health/

B. Ramana said...

Sree, your link is not working.

sree said...

I checked all the links. Seems to be OK on my lappie. I am puzzled !

B. Ramana said...

Uh-oh! :-(