And third, phenotype prediction in female foetuses with a full mutation is difficult, if not impossible. Cascade screening may be a more acceptable approach to identify female carriers of FXS (De Jong and De Wert 2002; De Wert 2005). An important advantage being that one starts from (a patient with)

a disease-causing allele, allowing for more straightforward genetic counseling. With regard to PCS for CF, the apparent lack of international buy CH5183284 consensus is reflected in a recent European consensus document that only provides a template for further debate (Castellani et al. 2010). The reasons behind this include the fact that due to the large number of CFTR mutations, CF carrier tests have a less than perfect sensitivity and also that for many mutations the genotype–phenotype correlation is weak. However, in a Dutch study, it was found that PCS for CF would in principle fulfil the requirements of the normative framework (Henneman et al. 2002). Screening in the

context of reproduction is especially sensitive as it may affect decision making with regard to having or avoiding to have children with a disease or disability. It is far from imaginable that as a result of offering such screening, these choices will come under pressure as to what professionals or society would like to see happen. That is indeed the concern behind the charges of eugenics and medicalization

briefly discussed in the beginning of this section. As suggested, the Proteasome inhibitor only way to answer this is through safeguards that protect reproductive freedom. Some of those safeguards will need to be integrated in the set-up of the programme. These include adequate provisions for ensuring voluntary, well-informed decision making regarding participation in PCS, the availability of non-directive counseling (within the limits earlier referred to), and a systematic evaluation aimed at identifying and removing elements of unjustified directivity. Other safeguards will have to crotamiton be of a societal nature, including the continued availability and funding of proper health care services for children born with the diseases targeted in PCS, also when their parents had the option to choose to avoid their birth (Human Genetics Commission 2011). Modes of offering carrier screening Carrier screening may be offered either in pregnancy or preconceptionally, and if preconceptionally, either to couples with possible reproductive plans or to all individuals of (pre-)reproductive age. Which of these learn more approaches is more in line with the proportionality requirement of the normative framework will to a large extent also depend on whether prevention or autonomy is taken as the overarching objective. In terms of enabling reproductive choices, carrier screening in pregnancy is clearly suboptimal.