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.