Balancing Equity and Autonomy: The Utilitarian Case for the Public Funding of Non-Invasive Prenatal Testing in Hong Kong

Abstract

Non-invasive prenatal testing (NIPT) demonstrates superior performance compared to conventional screening methods currently available within Hong Kong’s public healthcare system. Nevertheless, the substantial costs associated with NIPT render it inaccessible for much of the population, leading to ethical debates surrounding public funding. A conflict emerges between the imperative to allocate limited resources efficiently and the obligation to uphold ethical principles of equity and reproductive autonomy within the public healthcare system. Adopting a utilitarian-based approach, this chapter initially presents three central arguments suggesting that NIPT can be ethically integrated into the public healthcare system. Subsequently, the discussion examines the challenges associated with incorporating NIPT into Hong Kong’s strained public healthcare system. To address these challenges, we propose two potential solutions: (1) introducing NIPT as a second-tier screening test for high-risk pregnancies, or (2) offering NIPT through public-private partnerships, which would alleviate the demand on public sector resources. Implementing a nominal fee for NIPT adheres to the principle of impartiality in public resource allocation, ensuring equitable decision-making without favoring specific population groups. Ultimately, the future of NIPT in Hong Kong necessitates expanding its availability, enhancing its accuracy, and incorporating it into comprehensive prenatal care. This approach will support the reproductive autonomy of pregnant women and promote accessible healthcare.