What is relevant from a democratic point of view is that the government then makes the decision for younger

women who cannot decide for themselves whether to have the screening test or not. Freedom to take the screening test In contrast to the discussion at the end of the 1980s, in the early Protein Tyrosine Kinase inhibitor 2000s, in Parliament and in the media, some critical questions were raised in response to the government’s position. Especially problematic was the issue that women under 36 years of age had to ask for the test themselves, as the government was under no obligation to inform them of its availability nor was it possible to apply for reimbursement of the cost for the test. For PF-04929113 in vitro women who lacked financial resources, had a lower education or a poor understanding of the Dutch language it would be difficult to have a test (Parliamentary documentation 2003–2004b). Also, a motion was brought forward urging the government to offer prenatal screening to all women (Parliamentary documentation

2003–2004c). In contrast to the reactions in the 1980s, when concerns were raised about whether women would have the option not to be GSK3326595 tested, this time, in parts of society there were concerns about whether women would be able to have a test, if they wanted it. In April 2004, the Health Council produced an updated report on prenatal screening (Health Council of the Netherlands 2004) and again suggested abandoning SDHB the age limit. They now suggested performing a combination test for Down syndrome in the first

trimester—a blood test and a nuchal translucency measurement by ultrasound. For neural tube defects, an ultrasound test in the second trimester would be preferred. The State Secretary of Health responded to this new advice and to the critical questions regarding her letter explaining the government’s stand on the previous Health Council report on prenatal screening. She argued that based on new test developments giving information to all pregnant women on risk assessment tests by now was self-evident. However, women should have the option not to be informed if they did not want to. It should be made clear to women that they could reject screening, what the consequences of having a risk assessment test could be, and what further actions could take place in case of a positive outcome. Then, the woman could reflect on whether she would want to enter that trajectory at all. The restrained policy was continued, as was the age limit. It was argued that for women under 36 years of age, the risk of having a child with Down syndrome was lower, and the test would have more false positive and false negative outcomes than for the group who were 36 years of age or older. It was reiterated that it was not the aim to detect as many abnormalities as possible.