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Background The clinical introduction of non-invasive prenatal testing for fetal aneuploidies is currently transforming the landscape of prenatal screening in many countries. Since it is noninvasive, safe and allows the early detection of abnormalities, NIPT expanded rapidly and the test is currently commercially available in most of the world. As NIPT is being introduced globally, its clinical implementation should consider various challenges, including the role of the surrounding social and cultural contexts. We conducted a qualitative study with healthcare professionals in Lebanon and Quebec as case studies, to highlight the relevance of cultural contexts and to explore the concerns that should be taken into account for an ethical implementation of NIPT. Methods We conducted semi-structured interviews with 20 healthcare professionals (HCPs), 10 from each country, practicing in the field of prenatal screening and follow up diagnostic testing, including obstetricians and gynecologists, nurses, medical geneticists and, genetic counselors. We aimed to 1) explore HCPs’ perceptions and views regarding issues raised by NIPT and 2) to shed light on ways in which the introduction of the same technology (NIPT) in two different contexts (Lebanon and Quebec) raises common and different challenges that are influenced by the cultural norms and legal policies in place. Results We identified challenges to the ethical implementation of NIPT. Some are common to both contexts, including financial/economic, social, and organizational/ educational challenges. Others are specific to each context. For example, challenges for Lebanon include abortion policy and financial profit, and in Quebec challenges include lobbying by Disability rights associations and geographical access to NIPT. Conclusions Our findings highlight the need to consider specific issues related to various cultural contexts when developing frameworks that can guide an ethically sound implementation of NIPT. Further, they show that healthcare professional education and training remain paramount in order to provide NIPT counseling in a way that supports pregnant women and couples’ choice.

... As we have seen, many uses of high-tech home care are viewed by willing individuals and families as unalloyed benefits, as cherished opportunities to be with loved ones at home rather than in a hospital, or to resume a normal life outside the home. In this section, we shall dwell on the darker side, investigating the more problematic implications of high-tech home care for patients and caregivers. Here we examine a set of ethical and social problems that, while not being unique to this form of care, at least display a characteristic \"spin\" in their high-tech environment.

The Following is a very brief, schematic list of some of the more salient points that emerged from our project. A fuller discussion of each issue can be found in the accompanying synoptic article by John D. Arras and Nancy Neveloff Dubler.

We ordinarily think of parents having an almost total obligation for the care of their children, but one can imagine a mother less than eager to care for a semi-comatose teenager who overdosed on drugs... To insist today that individuals have a moral obligation to care for their children, siblings, or parents overlooks the fact that many, perhaps most, people want to care for their loved ones.

...High-tech home care has not proven to be the panacea that it was expected to be, at least partly because oversight has largely been absent. Despite claims to the contrary, the cost-effectiveness of home care is called into question by high prices that often bear little relationship to costs. The absence of research to determine when high-tech home care is clinically appropriate raises doubts about its widespread use. While there may, in fact, be significant advantages over similar, hospital-delivered care, more information is needed before high-tech home care can assume an unquestioned role in the health care continuum.

... But there are, I think, more general troubles with this stark contrast between home and hospital. Most importantly for assessments of hospital-to-home transfers, it ignores transformations that illness often makes in family life and home. For example, illnesses and treatments can make familiar domestic settings alien, or they can confuse family roles and foster mutual deception, detachment, and resentment, even (or especially) in well-ordered families. Contrary to the common assumption, given such transformations hospitals may often allow patients greater autonomy than home and may better preserve family relationships than would home care. If so, then current domestication of care for seriously ill patients may be morally questionable in ways the sterotypes of home and hospital obscure.

... Children connected to ventilators evoke the image of chimeric creatures: they are a combination of two different species. I contend that it is this combination of two historically unrelated conceptual domains -- the human and the mechanical -- that perplexes us and confuses our senses of identity and value of these human-machine hybrids.