First trimester risk assessment has become a reliable screening tool for trisomy 21, replacing age-based risk assessment. On the basis of the ethical concept of the physician as fiduciary, the professional virtues of integrity and self-sacrifice, and the ethical principles of respect for autonomy, beneficence, and justice, we argue that the obstetrician has an ethical obligation to routinely offer pregnant women first trimester risk assessment in high quality centers. We then argue that both obstetricians and specialists in risk assessment have a strict ethical obligation to identify, responsibly manage, and disclose both economic and non-economic conflicts of interests, especially when they are hidden Ethics is an essential dimension of implementation of first trimester risk assessment for trisomy 21.
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